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Follow guidelines for fluoride intakeDr Reitz: My 4-month-old daughter is lactose intolerant and requires soy-based infant formula. We live in an area of community fluoridated water. Should I consider fluoride supplements in the formula? - Mary Dear Mary: Protecting your daughter's teeth against tooth decay starts with introducing fluoride as the teeth are forming. Since tooth development is occurring under the gums during the first year of life, it's important to get fluoride to the forming teeth. Fluoride in the diet that is delivered to the tooth building cells via the blood supply is called systemic fluoride. The right amount of systemic fluoride available to the tooth can be beneficial; unfortunately too much fluoride introduces the risk of dental fluorosis. Very mild fluorosis causes white spots or chalky appearance on the surface of the enamel. In cases of severe fluorosis the teeth appear brown and become pitted. Given the correct amount, fluoride does not affect the appearance of the teeth and is responsible for a 47 percent reduction in tooth decay. With fluoride in the enamel, the tooth is less susceptible to acids that are given off by oral bacteria. If you were breast-feeding your daughter, she would be getting on average 0.01 milligrams per day of fluoride from the breast milk. The Institute of Medicine decided to use that same amount as the recommended daily fluoride dose for infants. Most formula manufacturers try to eliminate fluoride in their products, nevertheless, studies have found all infant formula contains fluoride in trace amounts. A comparison of milk-based formula to soy-based formula found higher concentrations of fluoride in the soy-based. The ideal amount of fluoride is achieved using concentrated formula and adding community fluoridated water. As semisolid baby food is added to her diet, daily fluoride intake will increase, especially with foods containing high fluoride levels, such as chicken. Fortunately, the fluoride increase will still be within the daily ideal range. If you are using ready-to-feed formula or adding de-ionized water to the concentrated or powdered formula, your child is likely not getting the recommended amount of fluoride for her developing teeth. Based on the American Dental Association's recommendations, she would then be a candidate for fluoride supplements at age 6 months. Doing what is best for your daughter's teeth includes making sure she never falls asleep with the bottle in her mouth. The Dentist's Chair appears Saturdays. The column is written by John Reitz, DDS, and does not represent the opinion of the Pennsylvania State Dental Board. Dr Reitz answers questions from readers. E-mail them via his Web site at reitzdds.com or mail to John Reitz, DDS, 30 Commerce Drive, Wyomissing PA 19610. John
V. Reitz, D.D.S., F.A.G.D. Copyright
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