Fluoride supplements also are effective in reducing prevalence of dental caries and should be considered for children
at high caries risk who drink fluoride-deficient (less than 0.6 ppm F) water (see Table 1). Determination of dietary
fluoride before prescribing supplements can help reduce intake of excess fluoride. Sources of dietary fluoride may include
drinking water from home, day care, and school; beverages such as soda, juice, and infant formula; prepared food; and toothpaste. Infant formulas, especially powdered formulas that have been reconstituted with fluoridated water, have been associated with an increased risk of fluorosis. Infants may be particularly susceptible because of the large consumption of such liquid in the first year of life, while the body weight is relatively low. However, a recent evidence-based review suggests that reducing fluoride intake from reconstituted infant formula alone will not eliminate the risk of fluorosis development. Fluorosis is associated with cumulative fluoride intake during enamel development, with the severity dependant on the dose, duration, and timing of intake. Findings from a national survey report that eight percent of 12-15 year-olds have mild fluorosis and five percent have moderate fluorosis.