Sources of Fluoride Exposure for Children



Sources of Fluoride Exposure: Data from Published Literature

"Dental and Public health administrators should be aware of the total fluoride exposure in the population before introducing any additional fluoride programme for caries prevention."
SOURCE: World Health Organization. (1994). Fluorides and Oral Health. WHO Technical Report Series 846.

"Estimation of the amount of fluoride ingested from all environmental and dietary sources is important so that rational and scientifically sound decisions can be made when guidelines for the use of fluorides are reviewed periodically and modified."
SOURCE: Pang D, et al. (1992). Fluoride intake from beverage consumption in a sample of North Carolina children. Journal of Dental Research 71: 1382-1388.

TOOTHPASTE

"Virtually all authors have noted that some children could ingest more fluoride from dentrifice (toothpaste) alone than is recommended as a total daily fluoride ingestion."
SOURCE: Levy SM, Guha-Chowdhury N. (1999). Total fluoride intake and implications for dietary fluoride supplementation. Journal of Public Health Dentistry 59: 211-23.

TABLE 1: Comparison of Daily Fluoride Ingestion from Toothpaste with Recommended Total Daily Intake (0.05 mg/kg/day)*
	Average F Intake from Toothpaste Alone		Maximum F Intake from Toothpaste Alone
Age (Avg wt**)	Intake from 2 Brushings (1000 ppm F)	% of Recommended Intake	Intake from 2 Brushings (1000 ppm F)	% of Recommended Intake	Reference
2 (12.05 kg)	0.66 mg 0.055 mg/kg/day	110%	n/a	n/a	Naccahe ‘87 +
2 1/2 (14.2 kg)	0.54 mg 0.038 mg/kg/d	76%	1.66 mg 0.12 mg/kg/d	240%	Bentley ‘99
2-3 (13.2 kg)	0.56 mg 0.042 mg/kg/d	84%	n/a	n/a	Simard ‘84 +
2-4 (12.6 kg)	0.6 mg 0.048 mg/kg/d	96%	>1.46 mg >0.12 mg/kg/d	240%	Barnhart ‘76 +
3-6 (17.25 kg)	0.76 mg 0.44 mg/kg/d	88%	2.32 mg 0.13 mg/kg/d	260%	Hargreaves ‘75 +
3 (14.35 kg)	0.36 mg 0.025 mg/kg/d	50%	n/a	n/a	Naccahe ‘85 +
4 (16.35 kg)	0.78 mg 0.05 mg/kg/d	100%	n/a	n/a	Simard ‘84 +
4 (16.35 kg)	0.26 mg 0.016 mg/kg/d	32%	0.6 mg 0.04 mg/kg.d	80%	Ericsson ‘74 +
5 (18.2 kg)	0.44 mg 0.24 mg/kg/d	48%	n/a	n/a	Simard ‘84 +
* Recommended Daily Intake (0.05 mg/kg/day) from Institute of Medicine’s 1997 report: “Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride.”
** Average weight data from: http://www.webhealthcentre.com/general/yc_hwchart.asp
+ Data cited in: Levy SM, Guha-Chowdhury N. (1999). Total fluoride intake and implications for dietary fluoride supplementation. Journal of Public Health Dentistry 59: 211-23.

PROCESSED FOODS & BEVERAGES:

"The increase in percentage of communities with fluoridated water has resulted in an increase in the mean content of fluoride not only in soft drinks and fruit juices, but in canned goods (notably soups), leading to increased intake of fluoride by individuals in communities with nonfluoridated water."
SOURCE: Fomon SJ, Ekstrand J, Ziegler EE. (2000). Fluoride intake and prevalence of dental fluorosis: trends in fluoride intake with special attention to infants. Journal of Public Health Dentistry 60(3):131-9.

"Our data suggest that young children who regularly or frequently drink substantial quantities of [juice] possibly should not receive dietary fluoride supplements, since they might be at increased risk of developing dental fluorosis."
SOURCE: Kiritsy MC, et al. (1996). Assessing fluoride concentrations of juices and juice-flavored drinks. Journal of the American Dental Association 127(7):895-902.

"Seventy-one percent of the [sodas] had fluoride levels exceeding 0.60 ppm, which is considered to contain sufficient fluoride so that dietary fluoride supplements are contraindicated.
SOURCE: Heilman JR, et al. (1999). Assessing fluoride levels of carbonated soft drinks. Journal of the American Dental Association 130(11):1593-9.

"[W]e found that infant foods containing chicken were high in fluoride. Thus, any infants who regularly eat more than a couple of ounces of infant foods containing high-fluoride-content chicken would be at elevated fluorosis risk."
SOURCE: Heilman JR, et al. (1997). Fluoride concentrations of infant foods. Journal of the American Dental Association 128(7):857-63.

"Instant tea, one of the most popular drinks in the United States, may be a source of harmful levels of fluoride... The researchers found that some regular strength preparations contain as much as 6.5 parts per million (ppm) of fluoride, well over the 4 ppm maximum allowed in drinking water by the Environmental Protection Agency."
SOURCE: 'Potentially harmful fluoride levels found in some instant tea'', Washington University School of Medicine, January 25, 2005.

Table 2. Fluoride Concentrations of Foods & Beverages
Product	# of samples	Mean Concentration	Range of Concentrations	Reference
Artificially Fluoridated Water	--	1.0 ppm	0.6-1.2 ppm
Juice	43	1.03 ppm	0.15-6.8 ppm	Stannard 1991
Grape juice	9	2.4 ppm	1.16-6.8 ppm	Stannard 1991
Juice	532	0.56 ppm	0.02-2.80 ppm	Kiritsy 1996
White grape juice	10	1.45 ppm	0.15-2.80 ppm	Kiritsy 1996
Juice	24	0.69 ppm	0.16-1.08	Turner 1998
Soda	12	0.78 ppm	0.68 - 0.91 ppm	Turner 1998
Soda	105	0.74 ppm	0.07-1.37 ppm	Pang 1992
Soda	332	0.72 ppm	0.02-1.28 ppm	Heilman 1999
Coca-Cola	79	0.70 ppm	0.02-1.10 ppm	Heilman 1999
Dr. Pepper	47	1.02 ppm	0.70-1.28 ppm	Heilman 1999
Pepsi Cola	104	0.60 ppm	0.02-1.22 ppm	Heilman 1999
Gatorade	13	0.85 ppm	0.02-1.04 ppm	Pang 1992
Gatorade	1	1.08 ppm	--	Turner 1998
Wine	19	1.02 ppm	0.23-2.8 ppm	Burgstahler 1997
Wine	--	--	0.1 - >12 ppm	California State University, 1990-1994
Tea (brewed w/ NF water)	26	2.56 ppm	0.61-6.68 ppm	Pang 1992
Tea (brewed w/ NF water)	--	3 ppm	0.1-4.2 ppm	Levy 1999
Fluoridated Salt*		200-250 ppm	--	Marthaler 2000
Cereals (processed w/fluoridated water)	--	--	3.8 - 6.3 ppm	Warren 2003
Fish	--	2.1 ppm	--	Dabeka 1995 (cited in ATSDR 2001)
Canned Fish	--	4.57 ppm	--	Dabeka 1995 (cited in ATSDR 2001)
Chicken infant foods	6	4.4 ppm	1.05-8.38 ppm	Heilman 1997
Pureed Chicken baby food (w/ mechancially deboned chicken)	--	4.2 ppm	1.89-8.63 ppm	Fein 2001
Chicken sticks (w/ mechancially deboned chicken)	--	3.61 ppm	1.61-6.0 ppm	Fein 2001
Luncheon meat (w/ mechancially deboned chicken)	--	1.98 ppm	1.01-3.65 ppm	Fein 2001
Dry cereals produced w/ fluoridated water	--	--	4-6 ppm	Fomon 2000
Powdered Infant Formula (made w/ fluoridated water)	--	0.97 ppm	--	Fomon 2000
Breast milk	--	0.005-0.01 ppm		Fomon 2000
* The use of fluoridated salt is becoming increasingly widespread across the globe. While the US & Canada do not yet have salt fluoridation programs, it is currently estimated that more people in the world are exposed to fluoridated salt than fluoridated water. Thus, this source of fluoride exposure is becoming increasingly important and insidious. Fluoridated salt usually contains about 250 ppm fluoride, which would result in a daily intake of 2.5 mg of fluoride per day for people consuming 10 grams of salt. Countries with extensive salt fluoridation programs include: Austria, Bolivia, Columbia, Costa Rica, Dominican Republic, France, Germany, Honduras, Nicaragua, Panama, Switzerland, and Venezuela.

References:

Agency for Toxic Substances and Disease Registry (ATSDR) (2001). Toxicological Profile for Fluorides: Draft Profile for Public Comment. U.S. Department of Health & Human Services, Public Health Service.

Bentley EM, et al. (1999). Fluoride ingestion from toothpaste by young children. British Dental Journal 186(9):460-2.

Burgstahler AW, et al. (1997). Fluoride in California wines and raisins. Fluoride 30: 142-146.

Fein NJ, Cerklewski FL. (2001). Fluoride content of foods made with mechanically separated chicken. Journal of Agricultural Food Chemistry 49(9):4284-6.

Fomon SJ, Ekstrand J, Ziegler EE. (2000). Fluoride intake and prevalence of dental fluorosis: trends in fluoride intake with special attention to infants. Journal of Public Health Dentistry 60(3):131-9.

Heilman JR, et al. (1999). Assessing fluoride levels of carbonated soft drinks. Journal of the American Dental Association 130: 1593-9.

Heilman JR, et al. (1997). Fluoride concentrations of infant foods. Journal of the American Dental Association 128(7):857-63.

Kiritsy MC, et al. (1996). Assessing fluoride concentrations of juices and juice-flavored drinks. Journal of the American Dental Association 127(7):895-902.

Levy SM, Guha-Chowdhury N. (1999). Total fluoride intake and implications for dietary fluoride supplementation. Journal of Public Health Dentistry 59: 211-23.

Lung SC, et al. (2003). Fluoride concentrations in three types of commercially packed tea drinks in Taiwan. Journal of Exposure Analysis and Environmental Epidemiology 13(1):66-73.

Marthaler TM. (2000). Salt fluoridation in Europe, comparisons with Latin America. Paper available online at: http://www.sph.emory.edu/PAMM/SALT2000/marthaler.pdf

Pang D, et al. (1992). Fluoride intake from beverage consumption in a sample of North Carolina children. Journal of Dental Research 71: 1382-1388.

Stannard JG, et al. (1991). Fluoride Levels and Fluoride Contamination of Fruit Juices. Journal of Clinical Pediatric Dentistry 16(1):38-40.

T urner SD, et al. (1998). Impact of imported beverages on fluoridated and nonfluoridated communities. General Dentistry 46(2):190-3.

Warren JJ, Levy SM. (2003). Current and future role of fluoride in nutrition. Dental Clinics of North America 47: 225-43.

Fluoride Action Network | 802-338-5577 | info@fluoridealert.org