Dietary Fluoride Supplements
Dietary fluoride supplements should be considered for children living in communities in which the community water is not fluoridated or who drink well water that does not contain fluoride.26 Because there are many sources of fluoride in the water supply and in processed food, it is essential that all potential sources of fluoride be assessed before prescribing a dietary supplement, including consideration of differing environmental exposures (eg, dual homes, child care). As a general guideline, if the primary source of water is fluoridated tap or well water, the child will not require fluoride supplementation, even if he or she primarily drinks bottled water, because the teeth are exposed to fluoride through cooking and brushing. The risk of fluorosis is high if fluoride supplements are given to a child consuming fluoridated water.30 Information about the fluoridation levels in many community water systems can be found on the CDC Web site entitled My Water’s Fluoride (http://apps.nccd.cdc.gov/MWF/Index.asp). Not all communities report this information to the CDC; therefore, it may be necessary to contact the local water department to determine the level of fluoride in the community water. Well water must be tested for fluoride content before prescribing supplements; such testing is available in most states through the state or county public health laboratory.