Fluoridation vs Fluorosis

The ADA recommends the fluoridation of public water, along with taking measures to prevent fluorosis in children.


What is fluoride?

Fluoride—often called nature’s cavity fighter—is a naturally occurring mineral that helps prevent cavities in children and adults. Fluoride makes the outer surface of the teeth (or the enamel) stronger, making it more resistant to the acid that causes tooth decay.1

For the past 70 years, fluoride has been added to public water supplies to bring fluoride levels up to the amount necessary to help prevent tooth decay. In fact, the Centers for Disease Control and Prevention proclaimed community water fluoridation one of ten great public health achievements of the 20th century. Studies prove water fluoridation prevents tooth decay by at least 25% in children and adults.1

25% reduction in tooth decay with water fluoridation

The American Dental Association (ADA) continues to support fluoridation of community water, claiming it is one of the most effective and least costly ways to prevent disease. The Association strongly urges communities to continue fluoridating water at the levels the government recommends.2 The ADA asserts that fluorosis—a change in the appearance of the tooth’s enamel, which can vary from barely noticeable white spots to staining and pitting in more severe cases—is not a disease and doesn’t affect the health of the teeth. Fluorosis only occurs when children aged 8 years and younger consume too much fluoride over long periods when teeth are developing under the gums. Once teeth break through the gums, one cannot develop fluorosis.3

Preventing fluorosis at home

Getting the right amount of fluoride—not too much and not too little—is key to preventing fluorosis in children. The ADA offers the following measures parents can take at home to help prevent fluorosis4:

Infant to 3 years old:

  • Breast feed—breast milk is very low in fluoride
  • If using infant formula, mix with water that either is fluoride-free or has low concentrations of fluoride (e.g., de-ionized, purified, demineralized, or distilled)
  • Use ready-to-feed formula, which contains little fluoride
  • When teeth start coming in, brush them thoroughly twice a day with no more than a smear of toothpaste the size of a grain of rice

3 to 8 years old:

  • Continue brushing teeth thoroughly twice a day
  • Keep an eye on the child’s brushing to help minimize the amount of toothpaste that gets swallowed
  • Avoid fluoride mouthrinses for children under age 6, as children this age haven’t fully developed their swallowing reflex and may swallow more than they spit out
  • If the home’s naturally occurring water source has fluoride levels in excess of 2 parts per million, use an alternative water source or home water treatments
  • Use dietary fluoride supplements only as prescribed by a physician or a dentist

Fluoride benefits both children and adults and has played an important role in the reduction of tooth decay. The risk of fluorosis can be avoided by following these practical steps4.

Fluoridation vs Fluorosis Footnotes

References: 1. American Dental Association. Mouth Healthy. Fluoride. https://www.mouthhealthy.org/en/az-topics/f/fluoride. Accessed October 28, 2015. 2. American Dental Association. ADA applauds USPHS final recommendation on optimal fluoride level in drinking water. https://www.ada.org/en/public-programs/advocating-for-the-public/fluorid.... Accessed December 2, 2015. 3. Centers for Disease Control and Prevention (CDC). FAQs for dental fluoridation. Accessed October 28, 2015. 4. American Dental Association. Mouth Healthy. Fluorosis. https://www.mouthhealthy.org/en/az-topics/f/fluorosis. Accessed October 28, 2015.