Fluoridation of tap water has been a common practice in many countries since the 1940s. It has been an effective way to assist in preventing cavities and tooth decay at a very low cost to the government. But what you might not know is that excessive fluoride levels early in life can negatively affect tooth development.
Dental Fluorosis is damage done to the enamel caused by high levels of fluoride. It can range from minor fluorosis with only a few white spots or streaks on teeth, to severe dental fluorosis with brown markings and discoloration. Teeth with dental fluorosis tend to be pitted and rougher making them harder to clean. The spots and discoloration will normally get worse over time.
While fluoride can help prevent tooth decay and cavities once teeth are fully developed and erupted from the gums, overexposure to fluoride prior to tooth eruption can cause dental fluorosis.
The prevalence of dental fluorosis (of varying degrees of severity), is actually above 40% in children now, up from 22% in 1987. This clearly shows that for children the fluoride levels they are exposed to is too high. Between fluoridation of water, toothpaste, and natural fluoride exposure in foods, children under 8 are consuming far more than the recommended amounts. The vast majority of dental fluorosis cases are caused by exposure in tap water.
For babies under the age of 1 adequate exposure levels of fluoride are considered to be 0.01-0.5mg/day with an upper tolerable limit of 0.7mg-0.9/day. With normal recommended municipal tap water fluoridation levels at about 1ppm*, more than 700ml a day of tap water will put your child above the tolerable limit. While this might seem like quite a bit, that is only 23 oz, which is far less than most children that age drink even if they’re being fed with formula. While this is less of an issue for breastfed babies, it becomes one once they move onto tap water.
Under the age of 3, the upper tolerable limit for fluoride is under 1.3 mg/day, which means less than 1.3 liters of tap water. At this limit it becomes much easier to control but what about in combination with other exposures to fluoride?
Bottled water can be problematic too since the fluoride levels are actually unregulated. Most toothpaste brands have added fluoride since the 1950s and the levels are around 1100 ppm* which is quite high. Swallowing fluoride after brushing is a major cause for concern, especially with children. While large amounts would needs to be swallowed to actually be toxic, the amount consumed in regular brushing combined with tap water fluoridation puts many kids above the tolerable limit. This is why non-fluoride toothpaste is recommended for children until they can consistently brush without swallowing toothpaste. Once they do start with a fluoride based toothpaste, remember that a dab is all you need, despite toothpaste ads showing a massive dollop on a toothbrush.
Though helpful in lowering rates of tooth decay, fluoride does have side effects. And while dental fluorosis is mainly an aesthetic issue, it can also cause more damaging issues over time. Limit your child’s exposure to fluoride until their teeth are fully developed and permanent teeth are in by using fluoride free toothpaste and drinking filtered water.
*PPM = Parts per million