Studies: All Infant Formula Contains Fluoride at Tooth-Discoloring Levels

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Oct 21, 2009, 9:24:10 AM10/21/09
to Fluoridation News Releases,,,
New York – October 2009 – All infant formulas, whether ready-to-feed,
concentrated or organic, contain fluoride at levels which can discolor
developing teeth, reports the October 2009 Journal of the American
Dental Association (JADA) (1).

Fluoride, added to some bottled and public water supplies ostensibly
to prevent cavities, is also in many foods and beverages, including
infant formula. Excessive fluoride discolors and/or weakens permanent
teeth (moderate fluorosis).

Researchers measured fluoride content of 49 infant formulas. See:

The research team concludes, "Most infants from birth to age 12
months who consume predominantly powdered and liquid concentrate
formula are likely to exceed the upper tolerable limit [of fluoride]
if the formula is reconstituted with optimally fluoridated water (0.7
- 1.2 ppm).”

Surprisingly, the study reveals that all 6-month-olds and younger will
also exceed the lower “adequate intake” (0.01 mg/day) from all
formulas (concentrated or not) risking moderate dental fluorosis from
formula, alone. (2)

Breast milk contains about 250 times less fluoride than "optimally"
fluoridated water and isn't linked to fluorosis.

"Babies don't need fluoride and fluoride ingestion doesn’t reduce
tooth decay,” says attorney Paul Beeber, President, New York State
Coalition Opposed to Fluoridation, Inc. “So why are US babies still
exposed to unnecessary fluoride chemicals via the water and food
supplies and why aren’t parents informed of the consequences?” asks

Up to 48% of school children have fluorosed teeth – 4% severe, reports
the Centers for Disease Control (CDC) (3).

Both the CDC and the American Dental Association’s web sites advise
parents to avoid mixing fluoridated water into concentrated infant
formula, but they have never effectively broadcast this information to
parents or the media (4,5).

A review of human studies by different researchers published in JADA
(July 2009) concluded, “Our systematic review indicated that the
consumption of infant formula [concentrated and ready-to-feed] is, on
average, associated with an increased risk of developing at least some
detectable level of enamel fluorosis.” (6)

“Parents, protect your children since dental and government agencies
won’t. Petition local and state legislators to stop adding unnecessary
and harmful fluoride chemicals into public water supplies and,
thereby, into our food supply,” says Beeber. “Further, demand that the
fluoride content of all food products be required on labels."

Researchers agree with Beeber. " One interpretation of the available
evidence would be that public health officials should create
guidelines for infant formula consumption ensuring that the upper
intake level established by the Institute of Medicine... is not
exceeded. Another approach would be to strive for 'biological
normality' and to strive for fluoride levels observed in breast milk,"
write Hujoel et al. in "Infant Formula and Enamel Fluorosis: A
Systematic Review. (6)

A recent investigation by the Environmental Working Group (EWG) found
that over-exposure to fluoride among infants is a widespread problem
in most major American cities. EWG's study found that, on any given
day, up to 60% of formula-fed babies in US cities were exceeding the
Institute of Medicine's "upper tolerable" limit for fluoride. (6a)

In 2004, fluoride researcher Dr. Teresa A. Marshall told Reuters
Health, "Very young infants are unlikely to benefit from the caries-
prevention effects of fluoride…They may be at increased risk of dental
fluorosis." (7) Marshall co-authored “Associations between Intakes of
Fluoride from Beverages during Infancy and Dental Fluorosis of Primary
Teeth,” in the Journal of American Clinical Nutrition. (b)

In 2000, researcher A K Mascarenhas evaluating only well-conducted
studies from the 1980s through the 1990s concluded in Pediatric
Dentistry that infant formula was a major risk factor for dental
fluorosis. (8)

As part of the on-going Iowa Fluoride Study, Levy and his team
measured the fluoride content of infant formula and found from 0.15 to
0.30 ppm in ready-to-feed infant formula. (9)

Common household water filters (e.g. carbon filters) do not remove
fluoride; and unlike chlorine, which dissipates upon boiling, fluoride
becomes more concentrated. Only distillation, reverse osmosis and
political activism removes fluoride from tap water.

USDA: Fluoride-content of common foods:

Pictures of fluorosis


SOURCE: New York State Coalition Opposed to Fluoridation, Inc.


1) “Assessing a potential risk factor for enamel fluorosis: a
preliminary evaluation of fluoride content in infant formulas,”
Journal of the American Dental Association October 2009





6) “Infant Formula and Enamel Fluorosis: A Systematic Review,”
Journal of the American Dental Association by Hujoel, et al, July 2009

6a) "National Academy Calls for Lowering Fluoride Limits in Tap
Water," EWG News Release, March 2006

7) "Too Much Fluoride May Harm Babies' Teeth," Reuters Health, May 5,

8) Pediatric Dentistry. July-August 2000. "Risk factors for dental
fluorosis: a review of the recent literature," by Mascarenhas AK

9) Dental Clinics of North America 47(2003), "Current and future role
of fluoride in nutrition," by Warren & Levy, 225-243
More evidence that infant formula is linked to dental fluorosis:

(The following is compiled by the Fluoride Action Network

a) "[F]luoride intakes during each of the first 4 years were
individually significantly related to fluorosis on maxillary central
incisors, with the first year most important, followed by the second,
third, and fourth year .”
SOURCE: Hong L, Levy SM, et al. (2006). Timing of fluoride intake in
relation to development of fluorosis on maxillary central incisors.
Community Dentistry and Oral Epidemiology 34(4):299-309.

b) "Our data suggest that the fluoride contribution of water used to
reconstitute infant feedings is a major determinant of primary tooth
SOURCE: Marshall TA, et al. (2004). Associations between Intakes of
Fluoride from Beverages during Infancy and Dental Fluorosis of Primary
Teeth. Journal of the American College of Nutrition 23:108-16.

c) "Our results suggest that breastfeeding infants may help to protect
against fluorosis. This is consistent with other studies that suggest
that consuming infant formula reconstituted with tap water increases
the risk for dental fluorosis. Importantly, this study shows that the
protective effect of breastfeeding is important not only in
fluoridated communities but also in nonfluoridated areas. Parents
should therefore be advised that they may be able to protect their
children from dental fluorosis by breastfeeding their infant and by
extending the duration for which they breastfeed."
SOURCE: Brothwell D, Limeback H. (2003). Breastfeeding is protective
against dental fluorosis in a nonfluoridated rural area of Ontario,
Canada. Journal of Human Lactation 19: 386-90.

d) “The findings of this investigation suggest that nearly 10 percent
of the enamel fluorosis cases in optimally fluoridated areas could be
explained by having used infant formula in the form of a powdered
concentrate during the first year."
SOURCE: Pendrys DG. (2000). Risk of enamel fluorosis in nonfluoridated
and optimally fluoridated populations: considerations for the dental
professional. Journal of the American Dental Association 131(6):

e) "The findings indicate that early mineralizing teeth (central
incisors and first molars) are highly susceptible to dental fluorosis
if exposed to fluoride from the first and – to a lesser extent – also
from the 2nd year of life."
SOURCE: Bardsen A, Bjorvatn K. (1998). Risk periods in the development
of dental fluorosis. Clinical Oral Investigations 2:155-160.

f) "There was a strong association between mild-to-moderate fluorosis
on later forming enamel surfaces and infant formula use in the form of
powdered concentrate (OR=10.77, 95% CI 1.89-61.25)."
SOURCE: Pendrys DG, Katz RV. (1998). Risk factors for enamel fluorosis
in optimally fluoridated children born after the US manufacturers'
decision to reduce the fluoride concentration of infant formula.
American Journal of Epidemiology 148:967-74.

g) "[T]he odds ratio of fluorosis on enamel zones that began forming
during the first year of life was 8.31 for children exposed since
birth or during the first year of life relative to those exposed after
1 year of age. The odds that a child had a maxillary central incisor
with fluorosis were 5.69 times higher if exposure occurred during the
first year of life compared with exposure after 1 year of age. Only
those exposed to the high-fluoride water during the first year of life
developed fluorosis on the mandibular central incisors... The first
year of life was a significant period for developing fluorosis on the
mandibular and maxillary central incisors."
SOURCE: Ismail AI, Messer JG. (1996). The risk of fluorosis in
students exposed to a higher than optimal concentration of fluoride in
well water. Journal of Public Health Dentistry 56:22-7.

h) "It appears that, at least under some circumstances, high intakes
of fluoride during the early months of life may make the difference
between developing or failing to develop dental fluorosis. A study
conducted in Sweden of 12- and 13-year-old children who had lived
since birth in a community with 1.2 ppm of fluoride in the drinking
water demonstrated that dental fluorosis was less common in those who
had been breast-fed during the first 4 months of life than in those
who had been fed powdered formulas reconstituted with tap water
(Forsman, 1977). A somewhat similar study in the United States
demonstrated that among 7- to 13-year-old children (most of them
living in a community with fluoride concentration of the drinking
water 1 mg/L), the prevalence of mild enamel fluorosis was
significantly greater in those who had been fed concentrated liquid
formula diluted with tap water during the first 3 months of life than
in those who had been breast-fed during this time (Walton and Messer,
1981). It seems reasonable to conclude that the lower prevalence of
fluorosis of the permanent teeth of individuals who were breast-fed
during the early months of life is related to the low fluoride
concentrations of human milk - concentrations less than 7 ug/L
regardless of the concentration of fluoride in the women's drinking
SOURCE: Ekstrand J, et al. (1994). Absorption and retention of dietary
and supplemental fluoride by infants. Advances in Dental Research


Fluoride content of and estimated fluoride intake from milk formula P.

Conclusions: Some infant formulae, when reconstituted with water
containing 1.0 mg/l fluoride, may result in a fluoride intake that
exceeds the optimum level (0.05-0.07 mg/kg body weight/day), which may
put infants at risk of developing dental fluorosis.

Fluoride intake and prevalence of dental fluorosis: trends in fluoride
intake with special attention to infants.

Fomon SJ, Ekstrand J, Ziegler EE.

RESULTS AND CONCLUSIONS: Based on this review, we conclude that
fluoride intakes of infants and children have shown a rather steady
increase since 1930, are likely to continue to increase, and will be
associated with further increase in the prevalence of enamel fluorosis
unless intervention measures are instituted.


ASDC J Dent Child. 2001 Jan-Feb;68(1):37-41, 10.

Fluoride content of infant formulas prepared with deionized, bottled
mineral and fluoridated drinking water.

Buzalaf MA, Granjeiro JM, Damante CA, de Ornelas F.
it is necessary to avoid use fo fluoridated water (around 1 ppm) to
dilute powdered infant formulas.


Caries Res. 2003 Sep-Oct;37(5):327-34.

Socio-demographic features and fluoride technologies contributing to
higher fluorosis scores in permanent teeth of Canadian children.

Maupomé G, Shulman JD, Clark DC, Levy SM.
Consuming bottled water between birth and 6 months of age was
protective [in preventing fluorosis].


J Dent Res. 1988 Dec;67(12):1488-92.

Risk factors for dental fluorosis in a fluoridated community.

Osuji OO, Leake JL, Chipman ML, Nikiforuk G, Locker D, Levine N.

prolonged use of infant formula (greater than or equal to 13 months)
was associated with 3.5 times the risk of fluorosis, compared with no,
or shorter duration of, formula use.


Am J Epidemiol. 1989 Dec;130(6):1199-208.

Risk of enamel fluorosis associated with fluoride supplementation,
infant formula, and fluoride dentifrice use.

Pendrys DG, Katz RV.

An odds ratio of 1.7 associated with infant formula use was
suggestive of an increased risk of enamel fluorosis as was an odds
ratio of 2.9 associated with fluoride dentifrice use.


J Public Health Dent. 1995 Winter;55(1):57-62.

Commentary on and recommendations for the proper uses of fluoride.

Horowitz HS.

Fluorosis has been associated with... prolonged use of infant


Aust Dent J. 1996 Feb;41(1):37-42.

Fluoride content of infant formulae in Australia.

Silva M, Reynolds EC.
When reconstituted, according to the manufacturer's directions, with
water not containing fluoride, the formulae ranged in fluoride content
from 0.031 to 0.532 ppm, with the average fluoride content 0.240 ppm.
Using average infant body masses and suggested volumes of formula
consumption for infants 1-12 months of age, possible fluoride
ingestion per kg body mass was estimated. None of the formulae, if
reconstituted using water containing up to 0.1 ppm F, should provide a
daily fluoride intake above the suggested threshold for fluorosis of
0.1 mg F/kg body mass. However, if reconstituted with water containing
1.0 ppm F they should all provide a daily fluoride intake of above the
suggested threshold for fluorosis with intakes up to 2-3 times the
recommended upper 'optimal' limit of 0.07 mg/kg body mass.


Am J Epidemiol. 1998 Nov 15;148(10):967-74.

Risk factors for enamel fluorosis in optimally fluoridated children
born after the US manufacturers' decision to reduce the fluoride
concentration of infant formula.

Pendrys DG, Katz RV.
There was a strong association between mild-to-moderate fluorosis on
later forming (FRI classification II) enamel surfaces and infant
formula use in the form of powdered concentrate (OR=10.77, 95% CI
1.89-61.25), ...


Caries Res. 1999 Jul-Aug;33(4):267-74.

Altitude as a risk indicator of dental fluorosis in children residing
in areas with 0.5 and 2.5 mg fluoride per litre in drinking water.

Rwenyonyi C, Bjorvatn K, Birkeland J, Haugejorden O.

In bivariate correlation analyses, F exposure from liquid (FEL), ...
infant formula, ... were significantly associated with the tooth
prevalence of fluorosis (TPF), i.e. at a severity of TF score >/=1
(p<0.05); age and gender were not.


J Am Dent Assoc. 2000 Jun;131(6):746-55.

Risk of enamel fluorosis in nonfluoridated and optimally fluoridated
populations: considerations for the dental professional.

Pendrys DG.
Enamel fluorosis in the optimally fluoridated study sample was
attributed to early toothbrushing behaviors, inappropriate fluoride
supplementation and the use of infant formula in the form of a
powdered concentrate.

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