How Much Fluoride Is Enough?
Your child may be getting more fluoride than you think!
Children ingest fluoride from a variety of sources, some of which are not
well-known. Excessive fluoride ingestion by preschool-aged children can lead to
dental fluorosis, which is an unsightly discoloration of the adult teeth.
Parents can take specific steps to decrease the risk of fluorosis in their
children's adult teeth.
Dental fluorosis is the result of excessive fluoride ingestion by young children
during tooth development early in life. The increased prevalence of fluorosis is
due to the cumulative effects of:
1. Use of fluoridated toothpaste before the age of two.
2. Inappropriate use of fluoride supplements.
3. Hidden sources of fluoride in a child's diet.
Two- and three-year-olds may not be able to expectorate fluoride-containing
toothpaste when brushing. As a result, these youngsters may ingest an excessive
amount of fluoride during toothbrushing. Toothpaste ingestion during this
critical period of adult tooth development is the greatest risk factor in the
development of fluorosis.
Excessive intake of fluoride supplements may also contribute to fluorosis.
Fluoride drops and tablets, as well as fluoride fortified vitamins should not be
given to infants younger than six months of age. After that time, fluoride
supplements should only be given to children after all of the sources of
ingested fluoride have been accounted for.
Certain foods contain high levels of fluoride, especially: powdered concentrate
infant formula, soy-based infant formula, infant dry cereals, creamed spinach,
and infant chicken products. Some beverages also contain high levels of
fluoride, especially: decaffeinated teas, white grape juice, and juice drinks
manufactured in fluoridated cities.
Parents can take the following steps to decrease the risk of fluorosis in their
1. Use baby tooth cleanser on the toothbrush until your child is 2 1/2 years
2. Place only a pea-sized drop of children's toothpaste on the brush from age 2
1/2 to 8.
3. Account for all of the sources of ingested fluoride before requesting
fluoride supplements from your child's physician or dentist.
4. Avoid giving any fluoride-containing supplements to infants until they are 6
5. Obtain fluoride level test results for your drinking water before giving
fluoride supplements to your child.
Can Deep Stains Of Children's Teeth Be
Many children have persistent stains of their teeth which
cannot be removed by brushing or professional dental cleaning. These
discolorations may represent: enamel stains, enamel dysmineralization, or
Deep stains may be caused by: compromised enamel development; high fever or
intake of certain medications during early childhood; previous trauma caused by
a displaced or intruded baby incisor; previous dental infection or abscess of a
baby tooth; or direct trauma to the erupted adult incisor.
The actual method of treating dental staining must take into account: the color
and darkness of the stain, the extent and location of the stain, the number of
teeth affected, the age and cooperation level of the child, and the putative
cause of the dental discoloration. Treatment of stains will involve one or more
of the following procedures: bleaching of the stained tooth, removal of the
stained enamel, or covering up the stained area.
Dental bleaching is useful in many situations. Bleaching can also be used in
combination with microabrasion of the affected tooth. Tetracycline-stained teeth
are difficult to bleach, however, because this drug-induced stain resides in the
dentin layer, which lies under the enamel.
The active ingredient in dentist-prescribed home bleaching is a 10% carbamide
peroxide gel. The parent places this high-viscosity bleaching gel in a
custom-fitted bleaching tray. The child then wears this bleaching tray for two
hours per day for two months, or until the stain is gone. Only five
dentist-prescribed, home-use bleaching products currently have the ADA Seal of
Approval. No OTC bleaching gels have this seal.
If bleaching is ineffective in removing the stain, and the defect is limited to
the enamel layer, then microabrasion is performed next. Enamel microabrasion is
the removal of dental stains using a combination of acid and abrasive. According
to Croll et al, "Enamel microabrasion is useful for the removal of
superficial enamel dysmineralization defects and decalcification lesions."
"Both dental bleaching and enamel microabrasion can be used for children as
young as six or seven years."
The last option for treating stained teeth is to cover up the discolored areas
with cosmetic bonded materials. In this technique, the surface of the tooth is
covered by either a composite resin material or a porcelain veneer. Due to cost
issues, however, most of the bonded cosmetic veneers for children utilize a
microfilled bonded composite resin.
A journal article describes techniques for treating dental stains in children:
Croll T, Segura A. Tooth color improvement for children and teens: Enamel
microabrasion and dental bleaching.
J Dent Child, 63:17-22, Jan-Feb 1996.
Can Teeth Be Pushed Up Into The Gums?
Baby teeth can be pushed up "into the gums" and
supporting bone during a fall or traumatic event. This kind of dental trauma is
called an intrusion injury, and can affect the developing adult tooth buds. Most
intruded primary teeth re-erupt on their own.
Intrusion injuries are most common in 2 and 3-year-old children. Young toddlers
are still learning how to walk and run, and their coordination is limited. When
toddlers fall, their teeth are usually subjected to a vertical, intrusive force.
Dental trauma in older children, however, is often associated with horizontal
forces to the teeth, resulting in a greater number of tooth fractures and
Intruded primary incisors may pose a threat to the developing permanent tooth
buds. Only a thin layer of bone separates the root of a primary tooth from the
follicle of the permanent tooth. If the root tip of the baby tooth impales the
developing adult tooth, problems will occur with normal adult tooth development.
An extra-oral, lateral-anterior radiograph will show the position of both
primary and permanent teeth.
Most intruded baby incisors will re-erupt within 1 to 6 months. Intruded teeth
which threaten development of the permanent tooth bud, however, will need to be
extracted. According to Holan et al, "The majority of intruded
primary incisors may re-erupt and survive with no complication after more than
36 months post trauma..."
Parents should take the following steps when a baby tooth has been displaced or
1. First, take your child to a physician to rule out other injuries, neurologic
damage, or airway obstruction. The physician will provide a tetanus toxoid
booster or antitoxin injection, if necessary.
2. Next, take your child to a pediatric dentist for an evaluation. He/she may
need to use gentle restraint to examine your child's teeth and oral structures.
Your child may need to sit on your lap when dental radiographs are taken. You
may also be called upon to provide gentle restraint during the examination and
x-ray procedures. The dentist may need to take both an "occlusal" and
a "lateral-anterior" radiograph of the teeth.
3. Request periodic dental re-evaluations for your child.
4. Brush and clean our child's teeth every day, especially around the intruded
A recent journal article discusses this topic:
Holan G, Ram D: Sequelae and prognosis of intruded primary incisors: a
Pediatric Dentistry 21:242-47, 1999.