Fluoride helps to strengthen enamel and prevent tooth decay, making it especially important for kids who are still developing teeth. But how much do they need? Can too much be harmful?
What is fluoride?
Fluoride is a natural mineral commonly found in water, soil and some packaged foods. It can help prevent cavities because it makes enamel more resistant to acid, which causes the breakdown of teeth.
“Studies have shown that in children we can reduce the risk of decay by 35 percent in the primary teeth and 26 percent in the permanent teeth,” said Lauren DiBenedetto, DDS, MPH, Associate Program Director, Pediatric Dental Center of Yale New Haven Children’s Hospital.
Tooth decay is a progressive disease caused by bacteria that produce acid from sugars in the diet. If left untreated, it can damage the enamel, reach the inner pulp of the tooth, and lead to nerve damage, pain, or serious infection. Decay can also spread to adjacent teeth and affect overall oral health. Using fluoride helps strengthen tooth enamel and prevent the onset of cavities, reducing the risk of more invasive, costly, and painful dental treatments later in life.
How much fluoride do you need?
Fluoride is important for all ages, but it is especially critical during early childhood because that’s when permanent teeth are forming under the gums. This typically lasts from infancy to around age 16.
Dr. DiBenedetto says during this time, kids should get fluoride in two ways. The first is topically, by brushing teeth. Kids under 3 who typically can’t spit out their toothpaste should use a smear about the size of a grain of rice. A pea size amount is recommended for kids 3 and older who can spit out toothpaste when brushing.
The other way to get fluoride is through water. The optimal amount is 0.7ppm or .7 milligrams of fluoride for every liter of water, with optimal amounts differing by age. Families with well water should consider getting their water tested, so they know how much fluoride is present. If there’s not enough, the American Academy of Pediatric Dentistry recommends a fluoride supplement until around 16, when the development of wisdom teeth is complete. Topical fluoride treatment is also recommended at twice yearly dental checkups.
Is fluoride toxic?
Dr. DiBenedetto says just like with any other supplement or medication, an excess of fluoride can result in side effects, however they are usually mild. Prolonged high doses of fluoride can lead to fluorosis, which is when white streaks or spots become present on the teeth, but does not pose any significant health risks.
However, it is very rare for kids to be exposed to toxic levels of fluoride. For example, a 5-year-old child would have to consume an entire tube of toothpaste to reach a dose associated with toxicity.
“One of the biggest misconceptions is that it’s unsafe and potentially neurotoxic. Fluoride has been extensively studied for the past 70 years, and the recommendations we give on fluoride are highly evidence based," said Dr. DiBenedetto. “We know that fluoride is very safe at recommended levels.”
Healthy teeth for kids
Fluoride is just one piece to the puzzle when it comes to developing healthy dental hygiene. Risk factors for tooth decay can include things like low salivary flow, medications and braces. However, fluoride, hygiene and diet are the risk factors that we can control.
“Dental decay is a complex process. Most children at risk for dental decay may have suboptimal fluoride exposure, inconsistent dental hygiene and frequent consumption of fermentable carbohydrates, which is anything that can break down and turn into sugars,” said Dr. DiBenedetto.
That can include candy as well as crackers, breads, cereals, juice and even milk. Brushing twice daily with a fluoride toothpaste, eating a variety of health foods and staying on top of visits to the dentist can help set kids up for success.
