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Fluoride is an element, which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by children who are unable to spit can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.


Some of these sources are:


  • Too much fluoridated toothpaste at an early age.

  • The overuse of fluoride supplements.

  • Sources of fluoride in the child’s diet.


Young children may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.


Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all the child’s cavity risk level and has been determined and upon the recommendation of your pediatrician or pediatric dentist.


Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities.


Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:


  • Use training toothpaste on the toothbrush for children under the age of 2, unless directed by your pediatric dentist.

  • Ages 2-5 should only use a smear (grain of rice-sized) of fluoride toothpaste.

  • Ages 5+ place only a small pea sized drop of children’s toothpaste on the brush when brushing.

  • Avoid giving any fluoride-containing supplements unless the need is determined by your pediatric dentist and pediatrician.

  • Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).


The pediatric dentist is the best person to decide whether a child needs fluoride supplements.  First, the dentist will ask questions in order to determine how much fluoride the child is currently receiving, gain a general health history, and evaluate the sugar content in the child’s diet.  If a child is not receiving enough fluoride and is determined to be at high-risk for tooth decay, an at-home fluoride supplement may

be recommended.


Topical fluoride varnish can also be applied to the tooth enamel quickly and painlessly during a regular

office visit.