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Making up infant formula feeds  with fluoridated water – recommendations from the American Dental Association (2011)

Recommendation from expert panel to continue using fluoridated water to make up infant formula feed products

In 2011 the American Dental Association’s Council on Scientific Affairs published recommendations suggesting that dentists advise parents to continue to use optimally fluoridated water to reconstitute powdered and liquid concentrate formula feeds products for their infants, including those for whom this is a main source of nutrition during the first year of life. (1)

The recommendations were based on the findings of an expert panel convened by the ADA to review evidence on possible associations between infant formula products made up with fluoridated water and the risk of developing dental fluorosis in permanent teeth.

Where parents are especially keen to minimise the risk dental fluorosis, however mild that fluorosis might be, the ADA suggests they consider purchasing a ready-to-use feed with a low fluoride content or, alternatively, to make up the feed with fluoride-free or low fluoride water.

Guidance on use of fluoride toothpaste

The ADA also recommends parents to follow professional guidance when their children use a fluoride toothpaste to brush with.  This includes limiting the paste to a pea-sized amount and ensuring that, when the toothbrushing is completed, their child spits it all out and refrains from swallowing any.

Breastfeeding recommended wherever possible

As in the UK, health agencies in the United States recommend breastfeeding of infants.  For example, guidelines on infant nutrition from the American Academy of Pediatrics advocate exclusive breastfeeding until the child is six months old, followed by continued breastfeeding as complementary foods are introduced. (2)  The AAP says that, unless there are specific medical reasons why not, breastfeeding should continue for one year or longer as mutually desired by mother and infant.

1.  American Dental Association (2011). Evidence-based clinical recommendations regarding fluoride intake from reconstituted infant formula and enamel fluorosis – a report of the American Dental Association Council on Scientific Affairs.

2.  American Academy of Pediatrics (2012). Breastfeeding and the use of human milk.  Pediatrics, March 2012, volume 129, issue 3.


Recommendation to dentists and parents on infant formula feeds and fluoridated water

“When dentists advise parents and caregivers of infants who consume powdered or liquid concentrate infant formula as the main source of nutrition, they can suggest the continued use of powdered or liquid concentrate infant formulas reconstituted with optimally fluoridated drinking water while being cognisant of the potential risks of enamel fluorosis development.”