Fluoride in Infant Formulas

In October of 2006 the Food and Drug Administration (FDA) started allowing bottlers of drinking water to claim that fluoride in their products may reduce tooth decay¹. 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. The reason for this restriction was a concern that using fluoridated water to reconstitute liquid-concentrate or powdered baby formulas would result in an overall fluoride level higher than what is established as optimal for teeth. Too much fluoride can result in tooth discoloration called fluorosis, a harmless condition where tooth enamel becomes discolored with white or brown mottled spots or blotches.

Giving your baby the proper amount of fluoride is essential for decay-resistant teeth. 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. Formulas that have been concentrated or powdered also already contain an optimal amount of fluoride, and reconstituting these with fluoridated water may result in more fluoride than needed. If you use concentrated or powdered formulas the current recommendation from the American Dental Association is that you reconstitute these with non-fluoridated, bottled distilled water¹¹. This water may be labeled as distilled baby water, purified, demineralized, deionized, distilled, or reverse osmosis filtered water. Tap water should not be used unless it is first filtered through a reverse osmosis filtration system that removes most of the existing fluoride. Check with your pediatrician regarding sterilizing or the use of sterile water. Breast feeding, using ready-to-feed formulas, or reconstituting formulas with low fluoride or fluoride-free water will ensure your baby receives the right amount of fluoride to develop strong and healthy teeth.

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1. Health Claim Notification for Fluoridated Water and Reduced Risk of Dental Caries. U.S. Food and Drug Administration, CFSAN/Office of Nutritional Products, Labeling, and Dietary Supplements, October 14, 2006.
2. ADA.org: Oral Health Topics: Fluoride & Fluoridation: Infants, Formula and Fluoridehttp://www.ada.org/public/topics/fluoride/infantsformula.asp
3. Center for Disease Control and Infection, Department of Health and Human Services: Infant Formula and the Risk for Enamel Fluorosis