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Fluoride in infant formulas

In October of 2006 the Food and Drug Administration started allowing bottlers of drinking water to claim that fluoride in their products may reduce tooth decay. According to the FDA notification, bottled water containing greater than 0.6 and up to 1.0 mg/L (0.6 to 1.0 parts-per-million) total fluoride can use the claim language: "Drinking fluoridated water may reduce the risk of [dental caries or tooth decay]." The FDA pointed out, however, that this health claim was not intended for use on bottled water products specifically marketed for use by infants. At the time there was a concern that too much fluoride could result in tooth discoloration called fluorosis, a harmless condition where tooth enamel becomes discolored with white or brown mottled spots or blotches. A 2011 recommendation by the American Dental Association, “Evidence-Based Clinical Recommendations Regarding Fluoride Intake From Reconstituted Infant Formula and Enamel Fluorosis” provides the following guidance1.

Breast milk and most ready-to-feed baby formulas contain an appropriate amount of natural fluoride, or fluoride that has been incorporated into the formula during its manufacture. The American Dental Association expert panel concluded that for infants from birth to age 12 months who consume reconstituted infant formula as the main source of nutrition, the continued use of powdered or liquid concentrate formulas reconstituted with optimally fluoridated drinking water is appropriate, as long as the parent or caregiver is cognizant of the potential risk for enamel fluorosis. If parents and caregivers are concerned about the potential for increasing a child’s risk of developing enamel fluorosis, breast feeding, ready-to-feed formula or powdered or liquid concentrate formula reconstituted with water that either is fluoride free or contains low concentrations of fluoride are an alternative. This type of water is often labeled “purified,” “demineralized,” “deionized,” “distilled” or “produced through reverse-osmosis.”

Check with your pediatrician regarding sterilizing or the use of sterile water. Giving your baby the proper amount of fluoride is essential for the development of strong, decay-resistant teeth.



1. “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: The Journal of the American Dental Association January 2011 vol. 142 no. 1 79-87.

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