Fluoride in the U.S. water supply should be limited because the additive is damaging children’s teeth, federal officials said in announcing the first restrictions in almost 50 years.

Drinking water should contain the lowest amount of the mineral recommended as the Environmental Protection Agency reviews the maximum level allowable, the Department of Health and Human Services said today. The change stems from rising rates of fluorosis, discoloration and damage of tooth enamel now found in more than one in three American children.

Fluoride has become more widely used than anticipated and tooth decay levels have fallen in the past half century, HHS said. Dental companies now include the additive in toothpaste, mouth rinses and other products, prompting municipal officials across the U.S. to consider limiting the compound in tap water.

The review “will help us make sure that people benefit from tooth decay prevention while at the same time avoiding the unwanted health effects from too much fluoride,” said Peter Silva, EPA’s assistant administrator for the Office of Water, in a statement.

More than 72 percent of Americans on public systems drink water with fluoride, part of the nation’s defense against tooth decay for 65 years, according to the Centers for Disease Control and Prevention in Atlanta. The additive should be limited to 0.7 milligrams in each liter of drinking water, the low end of the government recommended fluoride levels of 0.7 to 1.2 milligrams a liter since 1962, HHS said.

Children Most Vulnerable

Fluorosis results from children getting too much of the mineral as their teeth form, generally from ages one to eight, according to the CDC. The condition causes permanent damage to enamel coating, with most cases showing up as small streaks or specks of white. The condition may include brown discoloration and rough, pitted surfaces, the agency said.

American children aged 12 to 15 with some level of fluorosis climbed to 41 percent in 2004 from 23 percent in 1987, according to the most recent data available in the National Health and Nutrition Examination Survey.

The condition showed up in 36 percent of other teenagers and 33 percent of younger children, the survey found. Only 8.7 percent of adults in their 40s studied had fluorosis.

Fluoride in the tooth’s enamel can’t be taken out once fluorosis sets in, though damage can be hidden or reduced by thinning the outer layer of enamel or use of composite bonding or veneers that cover the surface, the CDC said.

Kids ‘Overexposed’

At the start of the 20th century, most Americans lost a majority of their teeth by the time they were 40 years old, according to the National Institutes of Health. Today, the CDC calls fluoridated water one of the 10 greatest public health advances of the 20th century, along with vaccination, birth control and the recognition of tobacco as a health hazard.

About 100 million Americans don’t have access to fluoridated water, the CDC says.

“Our kids are being overexposed,” said Paul Connett, executive director of the Fluoride Action Network, an advocacy group based in Canton, New York. “They are getting four times more fluoride than the original promoters of fluoridation intended.”

Only nine countries in the world, including Australia, Ireland, Singapore and Colombia, provide fluoridated water to the majority of their people, Connett said. Most European countries don’t provide any supplementation, and their cavity and tooth decay rates are as good as those in the U.S., he said in a telephone interview. More studies are needed, he said.

Limiting Toothpaste Amounts

Officials from New York City to Juneau, Alaska, have discussed limits on fluoride in the water supply to avoid potential health risks of overexposure in the past decade.

Parents shouldn’t avoid fluoridated water, which helps form strong teeth, or toothpaste with fluoride to protect teeth that have erupted, said John Liu, president of the American Academy of Pediatric Dentistry.

Toothpaste is a bigger culprit than fluoridated water for discoloration of teeth, Liu said in a telephone interview from his practice in Issaquah, Washington. Most advertisements show a toothbrush with a full ribbon of toothpaste, too much for a child likely to swallow some of it, he said.

“Parents need to monitor the amount of toothpaste their children use,” he said. “A pea-sized amount is the best way to prevent the white spots.”

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