It is also important that dental hygienists and dentists know the amount of fluoride to which the child is exposed, so they can discuss fluoride use and over-use with parents or guardians. Source of fluoride may include water (which may be from multiple locations and may include bottled water), prescription multiple vitamins from the child’s pediatrician, and toothpaste. With combined ingestion from multiple sources, total
levels of fluoride could lead to fluorosis. Pendrys reports that one third of fluorosis cases in nonfluoridated areas and two thirds of fluorosis cases in fluoridated areas are attributable to early fluoridated toothpaste use, and two thirds of mild-to-moderate
fluorosis cases in nonfluoridated areas are attributable to fluoride supplements with the pre-1994 protocol.Anticipatory guidance about keeping fluoride toothpaste, fluoride
rinses, and fluoride tablets out of the reach of children is recommended.