Limit Flouride with Babies - Use bottled water for formula mixing

CDC, dental group warn of too much fluoride for babies

By ALISON YOUNG
The Atlanta Journal-Constitution
Published on: 02/07/07
http://www.ajc.com/metro/content/metro/stories/2007/02/07/0207meshdental.html

Health officials are recommending that parents who feed formula to their
babies consider using bottled water — rather than tap — when mixing it to
prevent a dental condition that causes subtle white marks on developing
teeth.

While emphasizing the significant benefits of fluoridated tap water in
preventing cavities, new recommendations from the Centers for Disease
Control and Prevention and the American Dental Association say parents
need to be aware of how much fluoride babies and young children are
exposed to.

"Since the beginning we knew there was a trade off between preventing
tooth decay and enamel fluorosis," said William Maas, director of CDC's
Division of Oral Health.

Enamel fluorosis is a condition involving changes to the enamel surface of
teeth — ranging from barely noticeable chalk-like white flecks and lines
to more severe pitting and staining. The condition occurs when children
are exposed to too much fluoride while their teeth are forming — and mild
forms have been on the rise since the late 1980s.

Currently about one-third of U.S. children will develop very mild or mild
fluorosis — which causes subtle white specks or lines on their adult teeth
that in most cases is not considered a cosmetic problem. About 4 percent
will develop moderate and severe forms of the condition, usually from
prolonged exposure to naturally high fluoride levels in some well water.

CDC has for years cautioned parents to limit the amount of fluoridated
toothpaste children use to no more than a pea-sized dollop because
ingesting the toothpaste during the first six years of their life — while
adult teeth are forming — had been linked to an increased risk of
fluorosis.

Then last year, for the first time, a study indicated an association
between the use of infant formula and very mild and mild fluorosis,
prompting the CDC and the American Dental Association to put out new
guidance. Infant formula has not been associated with more severe forms of
fluorosis.

"One of the more effective ways to reduce the already low fluoride levels
the youngest children are getting is looking at the reconstitution of
powdered or concentrated liquid formulas," said John Stamm, a spokesman
for the American Dental Association and professor of dental ecology at the
University of North Carolina-Chapel Hill.

The issue isn't the infant formula itself, but the water it's
reconstituted with, Stamm and Maas said. For their size, babies consume a
large percentage of their body weight in fluoridated water when
reconstituted formula is their primary source of nutrition.

Ready-to-use infant formula has low levels of fluoride because companies
generally make it with demineralized water, and it is recommended by the
ADA. But most consumers prefer the lower price and convenience of powdered
formula or a concentrated liquid formula, which are mixed with tap water
before use.

Most municipal water supplies in Georgia and across the country have added
low levels of fluoride for decades as a means of preventing tooth decay.
Fluoride, when it washes over teeth, stops the removal of minerals from
teeth by oral bacteria. The CDC considers fluoridating community water
supplies a highly safe and effective health measure.

Both the CDC and the ADA note that breastfeeding is best.

In a recommendation issued in November, the American Dental Association
said that for infants who get most of their nutrition from formula,
parents should use fluoride-free or low-fluoride bottled water to mix
batches of formula.

The CDC, which published its background paper on the formula issue in
December, said parents should check the fluoride level of their water
supply, then weigh the risk of minor white flecking against the potential
protective benefits of early fluoride exposure against tooth decay.

"They need to consider the trade off and decide accordingly," Maas said.

Steven Adair, chairman of the department of pediatric dentistry at the
Medical College of Georgia, said most wells in Georgia have low levels of
fluoride, except some in coastal areas. Local water officials or dentists
can assist in getting water tested.

"If your household has fluoridated water and your child is taking
concentrated formula that's reconstituted, if it's economically feasible
to use bottled water to reconstitute it, that would be a good idea," Adair
said.

Children are at greater risk, Maas noted, from improper use of toothpaste
than from tap water. For years the CDC has urged parents to be careful
with toothpaste to avoid children swallowing it and putting them at higher
risk of fluorosis.

Since 1996 toothpaste tubes have carried a warning that parents should
consult with a dentist or doctor before introducing a child younger than 2
to fluoridated toothpaste.

"People still don't realize how important it is to control toothpaste
use," Maas said.

[Trust the ADA and CDC at your own risk]

To read the American Dental Association's and the CDC's recommendations,
go to:
www.ada.org/prof/resources/positions/statements/fluoride_infants.asp and
http://www.cdc.gov/fluoridation/safety/infant_formula.htm

For more information about children's dental health, go to:
http://www.cdc.gov/OralHealth/factsheets/brushup.htm