© 2025 American Dental Association l 47
Fluoridation Facts
The Tolerable Upper Intake Level (UL) establishes a maximum guideline, but it is not the recommended
level of intake. The UL is the estimated maximum intake level that should not produce unwanted effects
on health. The UL for fluoride intake from all sources (fluoridated water, food, beverages, fluoride dental
products, and dietary fluoride supplements) is 0.10 mg/kg/day (milligram per kilogram of body weight
per day) for infants, toddlers, and children through 8 years of age. For older children and adults, who are
no longer at risk for dental fluorosis, the UL for fluoride is 10 mg/day regardless of weight. Using the
established ULs for fluoride, the amount of fluoride that can be consumed each day to protect against
the risk of moderate enamel fluorosis for children through age 8 has been calculated by sex and age
group (based on average weight).146
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 (40 kg) 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, including various types of 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 mg of fluoride. Children under 6 years of age, on average, consume less than one-half liter
of drinking water a day.207 Therefore, children under 6 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 non-fluoridated area and is determined to be at high risk for tooth decay, the
dentist or physician may prescribe dietary fluoride supplements.75 As shown earlier in Table 1 for
the 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.75
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 non-
fluoridated community is 0.5 mg/day. This provides leeway for some fluoride intake from processed
foods and beverages, as well as toothpaste and other sources.
Tooth decay rates have declined substantially in many population groups because children today
are being exposed to fluoride from a wider variety of sources than many decades ago.39 Many of
these sources are intended for topical use only however, some fluoride is ingested inadvertently by
children.210,211 By reducing the inappropriate ingestion of fluoride from toothpaste, the risk of dental
fluorosis can be reduced without jeopardizing the benefits to oral health through caries prevention.
For example, it has been reported in a number of studies that young children inadvertently swallow about
30–60% of the fluoride toothpaste applied, or an average of about 0.30 mg of fluoride from fluoride
toothpaste at each brushing.212-217 If a child brushes twice a day, 0.60 mg of fluoride could be ingested
inappropriately. This could slightly exceed the AI values from Table 2. The 0.60 mg consumption is 0.10
mg higher than the AI value for children 6–12 months and is 0.10 mg lower than the AI for children
from 1 to 3 years of age.146 Although toothpaste is not meant to be swallowed, children could consume
the daily recommended AI amount of fluoride from toothpaste alone. In order to decrease the risk of
dental fluorosis, the ADA recommends:218
• “For children younger than 3 years, caregivers should begin brushing children’s teeth as soon as
they begin to come into the mouth using fluoride toothpaste in an amount no more than a smear
or the size of a grain of rice (Figure 4). Brush teeth thoroughly twice per day (morning and night)
or as directed by a dentist or physician. Supervise children’s brushing to ensure they use the
appropriate amount of toothpaste.
Fluoridation Facts
The Tolerable Upper Intake Level (UL) establishes a maximum guideline, but it is not the recommended
level of intake. The UL is the estimated maximum intake level that should not produce unwanted effects
on health. The UL for fluoride intake from all sources (fluoridated water, food, beverages, fluoride dental
products, and dietary fluoride supplements) is 0.10 mg/kg/day (milligram per kilogram of body weight
per day) for infants, toddlers, and children through 8 years of age. For older children and adults, who are
no longer at risk for dental fluorosis, the UL for fluoride is 10 mg/day regardless of weight. Using the
established ULs for fluoride, the amount of fluoride that can be consumed each day to protect against
the risk of moderate enamel fluorosis for children through age 8 has been calculated by sex and age
group (based on average weight).146
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 (40 kg) 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, including various types of 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 mg of fluoride. Children under 6 years of age, on average, consume less than one-half liter
of drinking water a day.207 Therefore, children under 6 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 non-fluoridated area and is determined to be at high risk for tooth decay, the
dentist or physician may prescribe dietary fluoride supplements.75 As shown earlier in Table 1 for
the 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.75
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 non-
fluoridated community is 0.5 mg/day. This provides leeway for some fluoride intake from processed
foods and beverages, as well as toothpaste and other sources.
Tooth decay rates have declined substantially in many population groups because children today
are being exposed to fluoride from a wider variety of sources than many decades ago.39 Many of
these sources are intended for topical use only however, some fluoride is ingested inadvertently by
children.210,211 By reducing the inappropriate ingestion of fluoride from toothpaste, the risk of dental
fluorosis can be reduced without jeopardizing the benefits to oral health through caries prevention.
For example, it has been reported in a number of studies that young children inadvertently swallow about
30–60% of the fluoride toothpaste applied, or an average of about 0.30 mg of fluoride from fluoride
toothpaste at each brushing.212-217 If a child brushes twice a day, 0.60 mg of fluoride could be ingested
inappropriately. This could slightly exceed the AI values from Table 2. The 0.60 mg consumption is 0.10
mg higher than the AI value for children 6–12 months and is 0.10 mg lower than the AI for children
from 1 to 3 years of age.146 Although toothpaste is not meant to be swallowed, children could consume
the daily recommended AI amount of fluoride from toothpaste alone. In order to decrease the risk of
dental fluorosis, the ADA recommends:218
• “For children younger than 3 years, caregivers should begin brushing children’s teeth as soon as
they begin to come into the mouth using fluoride toothpaste in an amount no more than a smear
or the size of a grain of rice (Figure 4). Brush teeth thoroughly twice per day (morning and night)
or as directed by a dentist or physician. Supervise children’s brushing to ensure they use the
appropriate amount of toothpaste.
