Safety l Fluoridation Facts 45 10 mg/day regardless of weight. Using the established ULs for fluoride, the amount of fluoride that can be consumed each day to reduce the risk of moderate enamel fluorosis for children through age eight, has been calculated by sex and age group (expressed as average weight).40 (See Table 2.) As a practical example, daily intake of 2 mg of fluoride is adequate for a 9- to 13-year-old child weighing 88 pounds (40 kg). This was calculated by multiplying 0.05 mg/kg/day (AI) times 40 kg (weight) to equal 2 mg. At the same time, that 88 pound (40kg) child could consume 10 mg of fluoride a day as a tolerable upper intake level. Children living in a community with water fluoridation get a portion of their daily fluoride intake from fluoridated water and a portion from dietary sources which would include foods and other beverages. When considering water fluoridation, an individual must consume one liter of water fluoridated at 0.7 mg/L to receive 0.7 milligrams (0.7 mg) of fluoride. Children under six years of age, on average, consume less than one-half liter of drinking water a day.35 Therefore, children under six years of age would consume, on average, less than 0.35 mg of fluoride a day from drinking optimally fluoridated water (at 0.7 mg/L). If a child lives in a nonfluoridated area and is determined to be at high risk for tooth decay, the dentist or physician may prescribe dietary fluoride supplements.41 As shown in Table 1 “Dietary Fluoride Supplement Schedule” (See Benefits Section, Question 12.), the current dosage schedule recommends supplemental fluoride amounts that are below the AI for each age group.41 The dosage schedule was designed to offer the benefit of decay reduction with a margin of safety to prevent mild to moderate enamel fluorosis. For example, the AI for a child 3 years of age is 0.7 mg/ day. The recommended dietary fluoride supplement dosage for a child 3 years of age in a nonfluoridated community is 0.5 mg/day. This provides leeway for some fluoride intake from processed foods and beverages, and other sources. Tooth decay rates are declining in many population groups because children today are being exposed to fluoride from a wider variety of sources than decades ago.16 Many of these sources are intended for topical use only however, some fluoride is ingested inadvertently by children.42,43 By reducing the inappropriate ingestion of fluoride from toothpaste, the risk of dental fluorosis can be reduced without jeopardizing the benefits to oral health. Table 2. Reference Intakes for Fluoride Food and Nutrition Board of the Institute of Medicine 199740 Age Group Reference Weights kg (lbs)* Adequate Intake (mg/day) Tolerable Upper Intake (mg/day) Infants 0-6 months 7 (16) 0.01 0.7 Infants 7-12 months 9 (20) 0.5 0.9 Children 1-3 years 13 (29) 0.7 1.3 Children 4-8 years 22 (48) 1.0 2.2 Children 9-13 years 40 (88) 2.0 10.0 Boys 14-18 years 64 (142) 3.0 10.0 Girls 14-18 years 57 (125) 3.0 10.0 Males 19 years and over 76 (166) 4.0 10.0 Females 19 years and over 61 (133) 3.0 10.0 * Value based on data collected during 1988-94 as part of the Third National Health and Nutrition Examination Survey (NHANES III) in the United States.40
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