For the past 65 years, fluoride, which is naturally found in water and soil, has been added to the public water supply in most U.S. municipalities to help prevent cavities. While the fluoridation of water has been lauded as one of the greatest public health initiatives in recent history, it is not without controversy. To add fuel to the fire, the Department of Health and Human Services (HHS) and the Environmental Protection Agency (EPA) announced last week that they plan to reduce the recommended amount of fluoride in public drinking water.
The announcement comes after a new analysis by the EPA revealed an increase in the incidence in fluorosis, which appears in children under 8 years old. Fluorosis occurs when permanent teeth developing in the gums are exposed to too much fluoride and results in white spots in tooth enamel. In the U.S., cases of fluorosis are usually mild and only noticeable by a dentist. However, severe dental fluorosis can result in pitted teeth with yellow stains. Although rare, skeletal fluorosis can result from chronic high exposures to fluoride and may result in alterations in bone structure and calcification of ligaments, ultimately leading to arthritis-like muscle and joint pain.
Fluorosis has been on the rise since the 1980s and is likely related to increased accessibility of fluoridated toothpaste, mouthwash and fluoride preparations applied directly to the teeth by dentists. Even some bottled water and other drinks contain fluoride. In the U.S., most fluoride intake derives from fluoridated water and beverages made from fluoridated water. However, if toothpaste or mouthwash is accidentally swallowed, it can lead to greater fluoride intake than intended. The new EPA/HHS recommendation suggests that fluoride levels in public water supplies be reduced to 0.7 mg per liter of water, down from the current level of 0.7 to 1.2 mg per liter.
To reduce the risk of fluorosis in children, parents can take the following precautions:
- Check with your local municipality to see if your water is fluoridated
- If using powdered or liquid concentrate infant formula, consider using non-fluoridated water to prepare it
- Do not use fluoridated toothpaste before age 2 unless recommended by a dentist
- Children ages 2 to 6 should use no more than a pea-sized amount of fluoridated toothpaste
- Supervise children while brushing until age 6, or until they can reliably spit out toothpaste
- Bring your child to a dentist within 6 months of their first tooth erupting and every 6 months thereafter