© 2025 American Dental Association l 55
Fluoridation Facts
28. Is it safe to use fluoridated water to reconstitute infant formula?
Answer
Yes, it is safe to use fluoridated water to reconstitute infant formula.
Fact
Fluoridated water can be used to prepare infant formula. However, if the child is exclusively consuming
infant formula reconstituted with fluoridated water, there could be an increased chance of mild dental
fluorosis.196 To lessen this chance, parents can use low-fluoride bottled water some of the time to
mix infant formula. These bottled waters are labeled as deionized, purified, demineralized, or distilled.
However, parents should be aware that using these types of waters exclusively means an infant does
not receive the amount of fluoride the NAM indicated is required to prevent tooth decay.146
On the other hand, the exclusive use of non-fluoridated water to reconstitute infant formula will not
guarantee that an infant will not develop dental fluorosis. The chance of development of dental fluorosis
exists through approximately 8–10 years of age when the later-erupting permanent teeth are still
forming under the gums. Fluoride intake during this time from other sources, such as from toothpaste,
mouthrinse, dietary fluoride supplements, and from other beverages and foods also contributes to the
chance of dental fluorosis for children living in both non-fluoridated and fluoridated communities.258
The ADA’s 2011 report, Evidence-Based Clinical Recommendations Regarding Fluoride Intake From
Reconstituted Infant Formula and Enamel Fluorosis: A Report of the American Dental Association
Council on Scientific Affairs,258 encourages clinicians to follow the AAP guidelines for infant nutrition,
which now recommend exclusive breastfeeding until the child is about 6 months, with the introduction
of complementary solids at about 6 months.259
Additionally, the ADA report,258 designed for use by clinical practitioners, offers the following
suggestions in advising parents and caregivers of infants who consume powdered or liquid
concentrate infant formula as the main source of nutrition:
Suggest the continued use of powdered or liquid concentrate infant formulas reconstituted
with optimally fluoridated drinking water while being cognizant of the potential risk of
enamel fluorosis development.260
When the potential risk of enamel fluorosis development is a concern, suggest ready-to-
feed formula or powdered or liquid concentrate formula reconstituted with water that either
is fluoride-free or has low concentrations of fluoride.258
It should be noted that the CDC,261 as well as other agencies and organizations such as HHS,196
the American Public Health Association (APHA),262 and health departments such as the New York
State Health Department,263 provide similar information regarding the use of fluoridated water to
reconstitute infant formula.
Fluoridation Facts
28. Is it safe to use fluoridated water to reconstitute infant formula?
Answer
Yes, it is safe to use fluoridated water to reconstitute infant formula.
Fact
Fluoridated water can be used to prepare infant formula. However, if the child is exclusively consuming
infant formula reconstituted with fluoridated water, there could be an increased chance of mild dental
fluorosis.196 To lessen this chance, parents can use low-fluoride bottled water some of the time to
mix infant formula. These bottled waters are labeled as deionized, purified, demineralized, or distilled.
However, parents should be aware that using these types of waters exclusively means an infant does
not receive the amount of fluoride the NAM indicated is required to prevent tooth decay.146
On the other hand, the exclusive use of non-fluoridated water to reconstitute infant formula will not
guarantee that an infant will not develop dental fluorosis. The chance of development of dental fluorosis
exists through approximately 8–10 years of age when the later-erupting permanent teeth are still
forming under the gums. Fluoride intake during this time from other sources, such as from toothpaste,
mouthrinse, dietary fluoride supplements, and from other beverages and foods also contributes to the
chance of dental fluorosis for children living in both non-fluoridated and fluoridated communities.258
The ADA’s 2011 report, Evidence-Based Clinical Recommendations Regarding Fluoride Intake From
Reconstituted Infant Formula and Enamel Fluorosis: A Report of the American Dental Association
Council on Scientific Affairs,258 encourages clinicians to follow the AAP guidelines for infant nutrition,
which now recommend exclusive breastfeeding until the child is about 6 months, with the introduction
of complementary solids at about 6 months.259
Additionally, the ADA report,258 designed for use by clinical practitioners, offers the following
suggestions in advising parents and caregivers of infants who consume powdered or liquid
concentrate infant formula as the main source of nutrition:
Suggest the continued use of powdered or liquid concentrate infant formulas reconstituted
with optimally fluoridated drinking water while being cognizant of the potential risk of
enamel fluorosis development.260
When the potential risk of enamel fluorosis development is a concern, suggest ready-to-
feed formula or powdered or liquid concentrate formula reconstituted with water that either
is fluoride-free or has low concentrations of fluoride.258
It should be noted that the CDC,261 as well as other agencies and organizations such as HHS,196
the American Public Health Association (APHA),262 and health departments such as the New York
State Health Department,263 provide similar information regarding the use of fluoridated water to
reconstitute infant formula.
