Fluoride is an essential mineral for bones and teeth. The water supply has contained fluoride for more than 70 years and has positively impacted dental health in the United States. The American Dental Association recommends water fluoridation as a safe and effective strategy for preventing cavities and reducing tooth decay by 20 to 40%. The evidence-base for fluoride is strong, yet controversy about this mineral still exists. Fluoride concentrations in water vary by region, but there is an optimal level of fluoride (0.7 ppm) known to ensure an effective level of fluoride to reduce the incidence of tooth decay, while minimizing the risk of cosmetic fluorosis in the general population.

Fluoride protects teeth by making enamel resistant to acid and demineralization, thus preventing cavities. The CDC estimates that fluoridated water reduces tooth decay by 25% among children and adults. Approximately 3.0 to 4.0 mg of fluoride is needed per day for adults, and the upper limit is set at 10.0 mg per day. The adequate intake levels for children are provided below in mg/d:

  • Age 1-3 years AI: 0.7, UL: 1.3
  • 4 – 8 years AI: 1.0, UL: 2.2
  • 9-13 years AI: 2.0, UL: 10.0
  • 14-18 years AI: 3.0, UL: 10.0

An excess of fluoride while teeth are still forming, called fluorosis results in white lines or specks on children’s teeth can be caused by over-ingestion of fluoride, so it is important to maintain intakes below the UL. Children have the tendency to swallow toothpaste, so it is recommended that children under age 6 avoid mouthwash rinses and use toothpaste under supervision.