Q
I have a 2 year old daughter. I have been brushing her teeth with childrens’ toothpaste for 1 year. On the back of the childrens’ toothpaste it says it contains 500ppm fluoride. She has been eating this stuff for a year because she can’t spit. I feel horrible. Now she has what looks to be mild fluorosis. We switched to non-fluoride toothpaste but I am concerned that her permanent teeth have already been affected. Will she have fluorosis on those too?
A
First, confirm that the changes you see are truly fluorosis. Other problems — nutritional deficiencies (calcium, phosphorus, vitamin D), developmental enamel defects like amelogenesis imperfecta, or decay from bottle use — can produce white or brown spots that resemble fluorosis. Your dentist can examine your daughter’s teeth and determine the correct cause.
While you wait for a dental appointment, continuing with non-fluoride toothpaste is reasonable for young children who cannot reliably spit. Many dentists recommend avoiding fluoride toothpaste until a child can spit consistently; some advise non-fluoride toothpaste up to about age 10 when ingestion risk is a concern.
Dental fluorosis that affects enamel formation is irreversible once the teeth have developed, but its appearance can often be improved later with cosmetic dental treatments in adolescence or adulthood. Those treatments vary in cost and longevity, and in moderate to severe cases there can be an increased risk of cavities and structural problems that require more restorative care. Early and gentle dental care is important to avoid creating fear of the dentist during formative years.
Fluorosis: What It Is and How to Prevent It
Dental fluorosis results from excess fluoride exposure while teeth are developing in the jaw. It affects the appearance and structure of enamel, ranging from faint white streaks to more noticeable mottling or brown staining in more severe cases. Causes include swallowing fluoride toothpaste, high-fluoride drinking water, and excessive use of fluoride supplements.
When you first notice baby teeth erupting, contact your dentist to discuss appropriate fluoride exposure for your child. Your dentist can advise based on local water fluoride levels and other sources of fluoride, such as formula prepared with fluoridated tap water, beverages, and diet. If fluoride is recommended, it is important for parents and providers to track the total fluoride intake up to about age 10.
Some regions have naturally high fluoride in groundwater or well water, and I have seen higher rates of mottled enamel in children from those areas even without intentional fluoride use.
Fluoride Isn’t Only In Water
Fluoride enters the body from many sources. Formula-fed infants may receive substantially more fluoride than exclusively breastfed infants if they consume formula made with fluoridated water. Fluoride can cross the placenta, be inhaled from contaminated air, and accumulate in blood and bone. Because fluoride metabolism is complex and varies by prior exposure and body size, estimating a child’s total fluoride burden can be challenging.
Given those complexities, it’s understandable to be cautious about fluoride exposure for young children. Work with your dentist or pediatrician to balance the benefits of fluoride for cavity prevention against the risk of fluorosis.
Sources of Fluoride: It’s (Almost) Everywhere
- Toothpaste
- Tap water
- Infant formula (when mixed with fluoridated water)
- Processed cereals
- Juice
- Soda
- Tea
- Wine
- Beer
- Mechanically de-boned chicken
- Fish and seafood
- Teflon pans
- Fluoridated salt
- Inhalation anesthetics
- Cigarettes
- Second-hand smoke
- Pesticides
Keep track of where your child may be getting fluoride and how much relative to their body weight. Because young children have lower body mass, the same fluoride intake represents a higher mg/kg dose than for adults and can increase their susceptibility to fluorosis.
Fluorosis in Children Is Increasing
Reported rates of fluorosis have risen over recent decades, and parents and clinicians are often unsure how much fluoride a child is ingesting from all sources. Knowing the fluoride concentration of your local water supply and supervising young children during toothbrushing are important preventive steps.
For children under six, use only a pea-sized amount of toothpaste and keep tubes out of reach. If your primary water source contains more than 2 ppm fluoride — a level seen in some regions — consider an alternative water source for children eight years and younger to reduce fluorosis risk.
References
Surveillance and research have documented increases in dental fluorosis prevalence over time. Health authorities and peer-reviewed studies report higher rates of very mild to severe fluorosis in recent decades compared with earlier surveys.
For specific data and study details, consult publications from public health organizations and dental research journals or discuss them with your dentist.