Associations Between Fluorosis of Permanent Incisors and Fluoride Intake From Infant Formula, Other Dietary Sources and Dentifrice During Early Childhood

ABSTRACTObjectivesThe authors describe associations between dental fluorosis and fluoride intakes, with an emphasis on intake from fluoride in infant formula.MethodsThe authors administered periodic questionnaires to parents to assess children's early fluoride intake sources from beverages, selected foods, dentifrice and supplements. They later assessed relationships between fluorosis of the permanent maxillary incisors and fluoride intake from beverages and other sources, both for individual time points and cumulatively using area-under-the-curve (AUC) estimates. The authors determined effects associated with fluoride in reconstituted powdered infant formulas, along with risks associated with intake of fluoride from dentifrice and other sources.ResultsConsidering only fluoride intake from ages 3 to 9 months, the authors found that participants with fluorosis (97 percent of which was mild) had significantly greater cumulative fluoride intake (AUC) from reconstituted powdered infant formula and other beverages with added water than did those without fluorosis. Considering only intake from ages 16 to 36 months, participants with fluorosis had significantly higher fluoride intake from water by itself and dentifrice than did those without fluorosis. In a model combining both the 3- to 9-months and 16- to 36-months age groups, the significant variables were fluoride intake from reconstituted powder concentrate formula (by participants at ages 3–9 months), other beverages with added water (also by participants at ages 3–9 months) and dentifrice (by participants at ages 16–36 months).ConclusionsGreater fluoride intakes from reconstituted powdered formulas (when participants were aged 3–9 months) and other water-added beverages (when participants were aged 3–9 months) increased fluorosis risk, as did higher dentifrice intake by participants when aged 16 to 36 months.Clinical ImplicationsResults suggest that prevalence of mild dental fluorosis could be reduced by avoiding ingestion of large quantities of fluoride from reconstituted powdered concentrate infant formula and fluoridated dentifrice.