Fluoride in Richmond’s Water Supply

An update to our recent post on the risks and benefits of fluoride in city drinking water.

My mom has always said, “Everything is better in moderation.” This statement holds true for just about everything, including the amount of fluoride your child needs to make their teeth healthy and strong. There have been a lot of news stories published in health journals and the local media (watch Dr. Liz on Channel 8) about how the Department of Health and Human Services has recommended decreasing the amount of fluoride in the drinking water to 0.7 ppm (parts per million).

“This is a superb example of a government agency fulfilling its mission to protect and enhance the health of the American people. We applaud the Department of Health and Human Services for reaffirming the safety and efficacy of optimal community water fluoridation, with science on their side.” ADA President Dr. Raymond F. Gist

The City of Richmond Department of Public Utilities made this adjustment to provide an effective level of fluoride to reduce the incidence of tooth decay while minimizing the rate of tooth fluorosis (white spots) in the general population.

Both the ADA (American Dental Association) and the CDC (Centers for Disease Control and Prevention) have approved and applauded the change.

Should parents be concerned about the change in the amount of fluoride in Richmond’s drinking water?

NO! The amount of fluoride in our public water systems has been lowered but is still within the normal range (0.7-1.2ppm). Many scientific studies have been published proving the effectiveness of fluoride in the prevention of tooth decay. The decrease to 0.7ppm will also help to prevent fluorosis or “white spots” on your child’s teeth.

If my child has white spots on their teeth, was it from ingesting too much fluoride?

White spots on teeth can develop on teeth for many reasons. When a tooth develops, the enamel (the white outer surface) may not form correctly causing a white spot. These white spots may or may not be due to the ingestion of too much fluoride during the development of the tooth. There are many causes for malformed enamel including (but certainly not limited to) childhood illnesses, intrauterine infections, infection or trauma to a baby tooth, the use of certain antibiotics, and ingestion of too much fluoride. A white spot may also indicate a weakened area of your child’s tooth that if not detected early and treated with fluoride, can cause a cavity. A dentist can often help you narrow down the cause by reviewing you and your child’s health history, dental history, and observing the pattern of the white lesions on your child’s teeth during an oral exam.

How much fluoride is too much fluoride?

Parents should consider the following when evaluating how much fluoride their child is ingesting:

1. What kind of toothpaste is your child using?

Unless advised to do so by a dentist or other health professional, parents should not use fluoride toothpaste for children less than 2 years old. Many children under age 6 have not fully developed their swallowing reflex and may be more likely to inadvertently swallow fluoride toothpaste. Please ask your dentist when it is best to switch to fluoridated toothpaste.

Related: What’s the best toothpaste for children?

2. How much toothpaste is your child putting on their toothbrush?

Children need LESS than a pea sized amount of toothpaste. You can brush the bristles of the brush over the top of the toothpaste and get plenty for brushing. Young children should always be supervised while brushing to prevent them from swallowing too much toothpaste.

Related: What’s the best toothbrush for children?

3. Is your child swallowing or spitting out their toothpaste?

Our biggest concern is children who LOVE their toothpaste so much that they sneak into the bathroom and squirt the toothpaste into their mouths and swallow it. This amount of fluoride can become dangerous. Again, supervise your child so that he/she applies the right amount to the toothbrush, and spits the majority of the toothpaste out. The same applies with mouth rinses – rinse and SPIT!

4. Is your child taking fluoride supplements?

Children should only receive dietary supplemental fluoride tablets or drops as prescribed by their physician or dentist based on the dietary fluoride supplement schedule approved by the ADA (American Dental Association), AAP (American Academy of Pediatrics), and AAPD (American Academy of Pediatric Dentistry). Fluoride supplements are not recommended for children under 6 months of age.

5. What kind of water does your child drink?

Tap water has already been adjusted to contain the optimal level of fluoride which is safe for your child. In fact, the American Dental Association has endorsed fluoridation of community water supplies as safe and effective for preventing tooth decay for over 40 years.

Most bottled water does NOT contain fluoride which means your child is missing out on this great vitamin for their teeth. If you live in an area with well water, we recommend having your well water tested to determine how much fluoride your child needs. You can ask us for the water testing kits when you come in for your next check up appointment.

Related: Reasons why water is a better choice than juice for kids.

What do enamel fluorosis “white spots” look like?

Fluorosis

Fluorosis

Most cases of fluorosis result in faint white lines or streaks on tooth enamel that are not readily apparent to the affected individual or the casual observer. Enamel fluorosis is not a disease but rather affects the way that teeth look.

Do you have questions? Leave a comment and we’ll answer them!

(CC Photo Credit: ShannonAshley on Flickr)

Elizabeth Cook Miller, D.D.S., M.S. is a pediatric dentist at Atkins, Maestrello, Miller & Associates Pediatric Dentistry in Richmond, VA. She is a new mother, active runner and her favorite movie is "Finding Nemo".

4 Comments

  • Erin Michels

    January 30, 2012, 9:27 pm

    How do you cure mild enamel fluorosis without bleaching? How much would it cost?

    • Dr. Liz

      Dr. Liz

      January 30, 2012, 9:34 pm

      Hi Erin, we’ll follow up with an email to answer your questions. Thanks for the question!

  • wedy

    December 6, 2012, 3:51 am

    My son has mild fluorosis he is 8 years old and i would like to know how i can help him

    • Dr. Liz

      Dr. Liz

      December 6, 2012, 2:34 pm

      Hi wedy, your child’s dentist can help you measure the amount of fluoride in your local water supplies and recommend a course of action. The goal is to make sure your son gets enough fluoride but not too much. Every situation is different. Good luck!

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