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Dental health & fluoride – what you need to know

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There is a lot of misinformation on fluoride when it comes to your child. Does your child need it? Should you only use fluoride free toothpaste? What are the benefits? Let’s break it down into what you need to know, including when you should start brushing your baby’s teeth!

What is fluoride?

Fluoride is a mineral found in water, soil, and air. Many public water supplies in America have fluoride. Bacteria in the mouth combine with sugars and make acid that can harm the outer layer of the tooth (enamel). Fluoride helps protect teeth from damage and helps prevent cavity formation.

Per the ADA, Before teeth break through the gums (erupt), the fluoride taken in from foods, beverages and dietary supplements makes tooth enamel (the hard surface of the tooth) stronger, making it easier to resist tooth decay. This provides what is called a “systemic” benefit.

If fluoride in water safe?

Many communities have fluoride added to the water supply in safe levels to help reduce the risk of cavities. This is safe. Fluoride at the much lower recommended concentrations (0.7 mg/L) used in community water fluoridation is not harmful or toxic.

You can search if your county’s water supply has fluoride in it by checking out this resource from the CDC. Communities fluoridate their water supply because it is a cost-effective public health method that helps prevent cavities. Per the ADA, studies have shown that water fluoridation continues to be effective in reducing dental decay by at least 25% in children and adults, even in the era widespread availability of fluoride from other sources, such as fluoride toothpaste.

Fluoride supplements are usually only prescribed to children who live in communities without fluoridated water. You do not need fluoride supplements if you have fluoride in your water supply, unless directed by your dentist or Pediatrician.

What is fluoride varnish?

Fluoride varnish is used to help prevent or slow down tooth decay. Your pediatrician will apply the varnish starting when your baby is 6 months old at routine check-ups or the dentist may do this. It is painted on the top and sides of each tooth and hardens quickly. It is recommended that children have varnish applied 2 to 4 times per year until they are 5 years old.

Do babies under 6 months need fluoride?

Breastfed and formula fed babies under 6 months do not need fluoridated water or fluoride supplements. There is a small risk of developing fluorosis (which is streaks on the teeth from fluoride), so speak to your clinician if you are unsure.

If you prefer not to use fluoridated water with formula before your baby’s first tooth emerges, you can use:

  • ​Bottled or purified water that has no fluoride with the formula.
  • Ready-to-feed formula that does not need water to be added.

Who is high risk for cavities? How does fluoride toothpaste help?

The amount of fluoride in a smear of toothpaste is not harmful to a baby or child, so consider using this toothpaste. This is especially important if your child is at high risk for cavities and if your water supply does not have fluoride in it. All toothpaste helps remove plaque, a film of bacteria that forms on teeth and gums every day. Plaque can cause gum disease and tooth decay. In addition, fluoride toothpaste provides an extra benefit in preventing tooth decay by making tooth enamel stronger.

Children who are high-risk for cavities or tooth decay and should absolutely consider using fluoride toothpaste include:

  • Having a primary caregiver who is high-risk for cavities (you can transmit the bacteria that causes cavities by kissing and sharing beverages)
  • More than three sugar-containing snacks or beverages a day
  • Going to bed with a bottle
  • History of cavities
  • A diet high in sugars and starches
  • Water supply that has limited or no fluoride in it

When should we start brushing?

  • For children younger than 3 years and who can’t spit yet, caregivers should begin brushing children’s teeth as soon as they begin to come into the mouth by using fluoride toothpaste in an amount no more than a smear or the size of a grain of rice.
  • For children 3 to 6 years of age, parents and caregivers should dispense no more than a pea-sized amount of fluoride toothpaste.

If you opt to use fluoride-free toothpastes, remember that they will help clean teeth, but they won’t protect teeth from tooth decay. You can opt to use this toothpaste if you feel your child is not at high-risk for cavities. But know that fluoride toothpaste in the amounts we recommend (a smear) is safe for children who can’t spit including in areas with fluoride in the water supply.

Practice, practice, practice. Your goal should be twice-a-day brushing by one year (sooner if possible!).

Does my child still need fluoride toothpaste if there is fluoride in water supply?

Yes. The recommendation is to use fluoride toothpaste as mentioned above. I have some families opt to not because their child is low risk for cavities. The best idea is to make a decision with your child’s dentist.

For our family, my husband has a genetic history of cavities so we opted to use fluoride toothpaste (along with drinking fluoridated water). We began fluoride toothpaste consistently at one year. Before that, we used water on a toothbrush.

When should we see a dentist?

Six months after the first tooth erupts or at one year—whichever comes first. Many parents wait until their child is older as they feel they have proper dental hygiene and no risk of cavities. Creating a dental home after one is great for dental education and incase of injuries to the mouth. Having a dentist after one can also allow your child to get more comfortable with going to a dentist. Brush up!

For more, check out episode 36 of The PedsDocTalk Podcast – The Deets on Baby Teeth.

P.S. Get my teeth guide and I’ll walk you through the symptoms and signs of teething and which unhelpful teething myths have been officially debunked!

Dr. Mona Admin

Hi there!

I’m a Board Certified Pediatrician, IBCLC, and a mom of two.

I know the ups and downs of becoming a mom and raising kids.

I help moms ditch the worry and second-guessing so you can find more joy in motherhood.


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All information presented on this blog, my Instagram, and my podcast is for educational purposes and should not be taken as personal medical advice. These platforms are to educate and should not replace the medical judgment of a licensed healthcare provider who is evaluating a patient.

It is the responsibility of the guardian to seek appropriate medical attention when they are concerned about their child.

All opinions are my own and do not reflect the opinions of my employer or hospitals I may be affiliated with.