© 2025 American Dental Association l 57
Fluoridation Facts
non-fluoridated community were attributed to children having brushed with fluoride toothpaste more
than once per day during the first 2 years of life.265 Fluoride toothpaste use had an even greater impact
on fluorosis in the optimally fluoridated community, with 68% of fluorosis due to children using more
than a pea-sized amount of toothpaste during the first year of life. However, recognizing that the risk for
tooth decay can start before a child’s first birthday with initial tooth eruption, it is considered important
to begin using a fluoride toothpaste when the child’s first tooth appears in the mouth.218
Dietary Fluoride Supplements
Dietary fluoride supplements should only be prescribed for children at high risk for tooth decay
who live in non-fluoridated areas.75 Furthermore, dietary fluoride supplements should be prescribed
according to the dosage schedule found in the Evidence-Based Clinical Recommendations on the
Prescription of Dietary Fluoride Supplements for Caries Prevention: A Report of the American Dental
Association Council on Scientific Affairs published in 2010.75 There is strong evidence that the use of
dietary fluoride supplements during the first 3 years of life is associated with significantly increased
risk for dental fluorosis,266 so they should only be used for children at high risk for caries where the
risk of tooth decay is of great concern.
It is important to determine the risk for tooth decay through a professional caries risk assessment, which
assists the healthcare provider to identify and modify factors that could contribute to the development
of cavities.145 A child’s risk for dental caries should be routinely evaluated because risk status can be
affected by changes in the child’s development, home conditions, dietary regimen, and oral hygiene
practices. Additional information on caries risk assessments can be found on the ADA’s website.145
Because of the many sources of fluoride in the diet, proper prescribing of dietary fluoride supplements
can be complex. It is suggested that all sources of fluoride be evaluated with a thorough fluoride history
before dietary fluoride supplements are prescribed for a child.75 This evaluation should include testing
of the home water supply and other important water sources (e.g., childcare/preschool/school) if the
fluoride concentrations are unknown. Families on community water systems should contact their water
supplier to ask about its fluoride level. Consumers with private wells should have the water tested
annually to accurately determine the fluoride content.
Over-the-Counter Fluoride-Containing Dental Products
Parents, caregivers, and health care professionals should judiciously monitor the use of all
fluoride-containing dental products by children younger than age 6. As is the case with any
therapeutic product, more is not always better. The same is true for most products found in the medicine
cabinet care should be taken to adhere to label directions on fluoride prescriptions and over-the-
counter (OTC) products (e.g., fluoride toothpastes and mouthrinses).
The ADA recommends the use of fluoride mouthrinses, but not for children less than 6 years
of age because they often swallow the rinse, thus increasing the risk for fluorosis. This
is particularly true if used by the youngest children. For this reason, such products should be
stored out of the reach of children. Additional information regarding the use of mouthrinses can be
found on the ADA’s website.267
While professionally applied fluoride products, such as fluoride varnish, gels, foams, and silver diamine
fluoride (SDF), have high fluoride concentrations,241 they are used so infrequently (compared to fluoride
toothpaste, mouthrinses, or water containing higher amounts of fluoride), that their use has not been
shown to affect dental fluorosis prevalence.268
Fluoridation Facts
non-fluoridated community were attributed to children having brushed with fluoride toothpaste more
than once per day during the first 2 years of life.265 Fluoride toothpaste use had an even greater impact
on fluorosis in the optimally fluoridated community, with 68% of fluorosis due to children using more
than a pea-sized amount of toothpaste during the first year of life. However, recognizing that the risk for
tooth decay can start before a child’s first birthday with initial tooth eruption, it is considered important
to begin using a fluoride toothpaste when the child’s first tooth appears in the mouth.218
Dietary Fluoride Supplements
Dietary fluoride supplements should only be prescribed for children at high risk for tooth decay
who live in non-fluoridated areas.75 Furthermore, dietary fluoride supplements should be prescribed
according to the dosage schedule found in the Evidence-Based Clinical Recommendations on the
Prescription of Dietary Fluoride Supplements for Caries Prevention: A Report of the American Dental
Association Council on Scientific Affairs published in 2010.75 There is strong evidence that the use of
dietary fluoride supplements during the first 3 years of life is associated with significantly increased
risk for dental fluorosis,266 so they should only be used for children at high risk for caries where the
risk of tooth decay is of great concern.
It is important to determine the risk for tooth decay through a professional caries risk assessment, which
assists the healthcare provider to identify and modify factors that could contribute to the development
of cavities.145 A child’s risk for dental caries should be routinely evaluated because risk status can be
affected by changes in the child’s development, home conditions, dietary regimen, and oral hygiene
practices. Additional information on caries risk assessments can be found on the ADA’s website.145
Because of the many sources of fluoride in the diet, proper prescribing of dietary fluoride supplements
can be complex. It is suggested that all sources of fluoride be evaluated with a thorough fluoride history
before dietary fluoride supplements are prescribed for a child.75 This evaluation should include testing
of the home water supply and other important water sources (e.g., childcare/preschool/school) if the
fluoride concentrations are unknown. Families on community water systems should contact their water
supplier to ask about its fluoride level. Consumers with private wells should have the water tested
annually to accurately determine the fluoride content.
Over-the-Counter Fluoride-Containing Dental Products
Parents, caregivers, and health care professionals should judiciously monitor the use of all
fluoride-containing dental products by children younger than age 6. As is the case with any
therapeutic product, more is not always better. The same is true for most products found in the medicine
cabinet care should be taken to adhere to label directions on fluoride prescriptions and over-the-
counter (OTC) products (e.g., fluoride toothpastes and mouthrinses).
The ADA recommends the use of fluoride mouthrinses, but not for children less than 6 years
of age because they often swallow the rinse, thus increasing the risk for fluorosis. This
is particularly true if used by the youngest children. For this reason, such products should be
stored out of the reach of children. Additional information regarding the use of mouthrinses can be
found on the ADA’s website.267
While professionally applied fluoride products, such as fluoride varnish, gels, foams, and silver diamine
fluoride (SDF), have high fluoride concentrations,241 they are used so infrequently (compared to fluoride
toothpaste, mouthrinses, or water containing higher amounts of fluoride), that their use has not been
shown to affect dental fluorosis prevalence.268
