Fluoridation of community drinking water has been practiced in the U.S. for more than 60 years. It is accepted as a safe and effective public health practice for people of all ages. The past five Surgeon General's have recommended communities fluoridate their water to prevent tooth decay. Recently a report was released by the National Academy of Science reporting a high level of naturally occurring fluoride in several states. These findings resulted in the release of interim guidance statements by the American Dental Association (ADA), concerning the reconstitution of powdered or liquid infant formula with tap water if the infant is below the age of one year. Some infants whose primary source of feeding is powdered or liquid formula reconstituted with tap water may be consuming fluoride at a level that might increase the potential for very mild or mild enamel fluorosis. Enamel fluorosis is a cosmetic condition and is not considered an adverse health effect. This occurs on baby and permanent teeth while they are forming under the gums. Once the teeth come into the mouth, they are no longer able to develop this condition. Typically, very mild or mild fluorosis is barely noticeable, if noticed at all, usually noticed only by a trained dental professional. The ADA interim guidance recommends that parents of infants whose main source of nutrition is formula mixed from powder or liquid concentrate use water that is low in fluoride for mixing formula. The full ADA statement is available at:
The Centers for Disease Control and Prevention (CDC) has information on enamel fluorosis and the issue concerning infant formula on their webpage at: http://www.cdc.gov/fluoridation/safety/infant_formula.htm. The ADA, California Department of Health Services (CDHS) and the CDC encourage mothers to breastfeed their babies. Breast milk is widely acknowledged as the most complete form of nutrition for infants.
Parents and caregivers are encouraged to consult with their pediatrician, family physician or dentist on the most appropriate water to use in their area to reconstitute the infant formula. Parents and health care providers should weigh the balance between a child’s risk for very mild or mild enamel fluorosis and the benefit of fluoride for preventing tooth decay. Historically, some occurrence of the milder forms of fluorosis has been accepted as a reasonable and minor consequence balanced against the substantial protection from tooth decay afforded by drinking water containing an optimal concentration of fluoride. However, steps can be taken to reduce the potential for enamel fluorosis associated with drinking water and other fluoride products. CDC has issued recommendations and will continue to assess the science regarding the use of fluoride in preventing tooth decay while limiting enamel fluorosis and will modify its recommendations if new information shows that a change is appropriate. CDC continues to believe that water fluoridation is safe and effective and promotes its use for people of all ages.
The CDHS advises parents to follow the recommendations that CDC has developed to reduce the risk for enamel fluorosis. This information is public information and should be utilized by parents or caregivers concerned about the occurrence of fluorosis following the reconstitution of liquid or powdered infant formula with tap water. We suggest that you avail yourselves of that information by utilizing the web address listed above for the CDC.
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