For water agencies, maintaining the proper dosage is challenging when the mandate demands 1 drop of artificial fluoridating substance to a million drops of water, yet two drops causes damage the tooth-forming cells and 4 drops, crippling skeletal fluorosis.
ADA Issues Warning
ADA
article
November 9, 2006
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Interim Guidance on Reconstituted Infant Formula
Have any of your patients ever asked what type of water should be used when mixing powdered or liquid concentrate infant formula? Information about fluoride intake for infants and young children, which includes interim guidance on reconstituted infant formula, is posted on ADA.org.
The appropriate amount of fluoride is essential to prevent tooth decay, but fluoride intake above the recommended level for a child’s age creates a risk for enamel fluorosis in teeth during their development before eruption through the gums. According to fluoride intake guidelines set by the Institute of Medicine, the amount of fluoride recommended for babies under a year old is less than that for older children and adults. Infants less than one year old may be getting more than the optimal amount of fluoride (which may increase their risk of enamel fluorosis) if their primary source of nutrition is powdered or liquid concentrate infant formula mixed with water containing fluoride.
Recent developments led the ADA to develop the interim guidance. Last spring, the National Research Council released a report on naturally occurring fluoride in drinking water. While not the major focus of the report, research was cited that raised the possibility that infants could receive a greater than optimal amount of fluoride from reconstituted baby formula. Then, on Oct. 14, the FDA said bottlers could claim that fluoridated water can reduce the risk of dental cavities or tooth decay, but that this claim could not be used on water marketed to infants.
More research is needed before definitive recommendations can be made, but, in the meantime, if parents and caregivers are concerned, the ADA’s interim guidance provides steps to simply and effectively reduce fluoride intake during a baby’s first year of life. Essentially, the ADA supports the pediatricians’ recommendations on the benefits of breast feeding and notes that using ready-to-feed formula for bottle-fed babies will keep their fluoride intake under IOM limits. If using a product that needs to be reconstituted, parents and caregivers should consider using water that has no or low levels of fluoride.
Infants, Formula and Fluoride
The ADA offers these recommendations so parents, caregivers and health care professionals have some simple and effective ways to reduce fluoride intake from reconstituted infant formula:
For infants who get most of their nutrition from formula during their first 12 months, ready-to-feed formula is preferred to help ensure that they do not exceed the optimal amount of fluoride intake.
If liquid concentrate or powdered infant formula is the primary source of nutrition,
it can be mixed with water that is fluoride free or contains low levels of fluoride
to reduce the risk of fluorosis. Examples are water that is labeled purified,
demineralized, deionized, distilled or reverse osmosis filtered water. Many
grocery stores sell these types of drinking water for less than $1 per gallon.
Breast milk is widely acknowledged as the most complete form of nutrition for
infants. The American Academy of Pediatrics recommends human milk for all infants
(except for the few for whom breastfeeding is determined to be harmful).
Parents and caregivers should consult with their pediatrician, family physician
or dentist on the most appropriate water to use in their area to reconstitute
infant formula. Ask your pediatrician or physician whether or not water used
in infant formula should first be sterilized.
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