We have teeth!

Well, yes, technically “we” all have teeth. What I mean to say is Baby O finally has teeth! To be precise, she has her two front bottom teeth (they came in at the same time). It seems like we waited so long for them to come that I take great pride in her new little buds!

The new arrivals coincidentally sprung up around the same time as my bi-annual teeth cleaning. After my visit, the hygienist was putting together my goody bag and I asked if she could throw in a children’s toothbrush so I could start use it with Baby O to get her used to this ritual. She very excitedly said yes and then told me I needed to start giving her a fluoride supplement because the county we live in no longer puts fluoride the water. This never even occurred to me.

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Then I did the thing I always do whenever any “mainstream” healthcare professional gives me advice. I question it. I don’t know when/how I’ve become so skeptical and cynical about these things, but admittedly I am. So I asked the hygienist why the county stopped putting fluoride in the water. She didn’t know. I asked her why fluoride is important. She said because it makes teeth stronger. I asked her what the risks were. She didn’t know. Then I asked the Village. The girls both said they were skeptical about fluoride but didn’t have a lot of concrete data.

So I decided to do some research.

Per the AskDrSears.com website, fluoride has been added to drinking water for almost fifty years. According to public health officials, fluoride supplementation ranks along with water purification and vaccines as one of the top public health measures of the 20th century. The American Academy of Pediatrics, the U.S. Public Health Department, and the American Dental Association have all recommended that from 6 months to 16 years children with growing teeth should receive fluoride supplements either through their diet or in the water they drink. It’s even recommended that for children living in areas that do not have fluoridated water, fluoride supplements (tablets, drops, or lozenges) should be taken.

The basic assertion is fluoride makes teeth stronger and therefore less susceptible to decay by entering the bloodstream and becoming incorporated in the tooth enamel before the teeth erupt. Fluoride applied topically (via toothpaste or by a dentist) also make teeth more resistant to decay and strengthens enamel.

Sounds good so far. What’s the downside?

As far as I can tell, the biggest issue is a condition called fluorosis. This is the over-exposure of fluoride, causing white spots or patches on the teeth, with more severe cases causing a brownish mottling and weakened enamel. Dental fluorosis is permanent, unsightly, and it means your child is ingesting more fluoride than is needed. The scariest part is there is mounting evidence that has linked high fluoride exposure during the first year of life with the development of dental fluorosis. But because the condition won’t be visible in the first year, it’s likely you won’t know whether your infant is being exposed to more fluoride than is recommended until later in life.

picture of fluorosis

On top of the unsightliness of fluorosis, there is the claim that fluoride is a highly toxic substance. According to fluoridealert.com, fluoride is more toxic than lead, but slightly less toxic than arsenic and has long been used in rodenticides and pesticides. Accidents involving over-ingestion of fluoridated dental products can cause serious poisoning incidents including death. The FDA now requires a poison warning be printed on all fluoride toothpaste sold in the US. Over-exposure to fluoride has also been linked to arthritis, brain effects, cancer, diabetes, kidney disease, liver disease, bone deformities, male infertility, and thyroid disease amongst others. A recent review in The Lancet describes fluoride as “an emerging neurotoxic substance.”

Now I am sufficiently freaked out. Is there a middle ground?

In an article from AskDrSears.com, the author explains that just the right amount of fluoride helps the teeth and too much harms the teeth. The trick really is to give your children just the right amount of fluoride. It is universally agreed that infants under the age of 6 months should not be given any fluoride (drops, tablets, toothpaste, fluorinated tap water). In a guideline published by the American Academy of Pediatric Dentistry, they outline the daily fluoride supplementation schedule to be less less than 0.25mg of fluoride for infants from 6 months – 3 years. You can see the schedule here.

Here are some practical tips you can follow to be sure your child gets the right amount of fluoride:

  • Call your local water department to determine if your water is fluoridated. If your child drinks several glasses of tap water per day and if the local water supply has a fluoride concentration of at least .3 parts per million, your child does not need fluoride supplements in the form of tablets or drops.
  • If your child does not drink any or enough tap water to receive sufficient fluoride or if your local water is not fluoridated, you may want to consult with your doctor or dentist about giving your child fluoride supplements in accordance with AADP guidelines.
  • Don’t use fluoride-containing dental products (toothpaste, mouthwash) with children under the age of two because they tend to swallow.
  • If your child uses fluoride-containing toothpaste, use a pea-sized amount of toothpaste for children aged 2 through 5 years.
  • If you feed your child formula, do not mix with fluoride-supplemented water.
  • Breastfed babies do not need additional fluoride supplements.

this is Baby A, part of the Village, showing off her beautiful teeth! Baby O has yet to flash a smile showing off her chompers

After all is said and done, it’s still confusing. I think I’ve ended up somewhere in the middle ground, concluding I most likely will not supplement Baby O with flouride drops or tablets. The clincher here for me was that she is currently a breastfed baby and  therefore is probably getting adequate amounts from me. I am not sure if I will supplement during the time after she stops breastfeeding but before she’s old enough to understand not to swallow fluoridated toothpaste. There will likely be a gap of 6 months – 1 year. Right now, I consider this a small risk, but I am not entirely certain.

Have you done any research on fluoride and do you give your little ones fluoride supplements?