For a patient whose water source does not contain fluoride, how important is supplementation? If supplementing, how much, how often, and at what age do you start and stop?
—Amy Waggner, FNP-C, Washington, Ind.

The American Dental Association and the CDC have very clear guideline statements regarding this topic. For urban areas with fluoridated water supplies, no additional supplementation is needed. Fluoridated water supplies are titrated to a 0.6-0.7 ppm concentration.

It is estimated that more than 100 million Americans live in areas where there is no added fluoride in the water supply. In these areas, the following guidelines apply: age 0-6 months, no supplement; aged 6 months-3 years, 0.25 g/day; aged 3-6 years, 0.50 mg/day; and aged 6-16 years, 1.0 mg/day.

One source suggested that a “pea-sized” amount of fluoride toothpaste twice daily is adequate for children younger than 6 years of age. Other sources include multivitamins (liquid and chewable). For more information, see Am Fam Physician. 2004;70:2113-2120.

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