To fluoridate or not to fluoridate, that is the question
Since I have spent an inordinate amount of time researching this subject, and it appears to be a somewhat controversial one, I figured I would blog about it. Nope, not talking about vaccines or circumcision…I’m talking about fluoride. What? You heard me right, I have spent an inordinate amount of time researching fluoride. I bet you wish you had my life don’t you? 😉
Anyways, fluoride is a topic that is of interest to me because 1) our house is hooked up to a well, not municipal fluoride-supplemented water and 2) our little guy now has two teeth popping through. Anyways, in residency, I had been taught that if you had a little guy or gal who had well water as their main source of water, that they should be started on a fluoride supplement after the age of 6 months, to strengthen those itty bitty teeth. Yet, as Baby D was getting closer to that 6 month mark, I started to do a bit more research because I am very cautious about putting into my little guy that may be unnecessary. (Because kids never get unneeded medication, right? Antibiotics, I am talking to you…)
And that research was the thing that made me go “hmmm”.
To start off, I would say pretty much everyone agrees that little ones under the age of 6 months should not be getting fluoride. So mothers giving their babies formula that is mixed with tap water…you may want to put that in your pipe and smoke it for a bit. But, after 6 months, things get a bit more complicated.
If you look closely into most of the statements given by the AAP and the ADA, they state that infants should be given fluoride supplementation if they are not exposed to appropriately fluoridated water AND are at high risk for dental carries. Yes, that second part of the statement is what gives me pause. Because Baby D is not at a high risk for dental caries. We have been brushing his gums regularly before he had teeth, he does not get much juice (at all) and we do not bottle prop or let him go to bed with a bottle. Hence, not high risk. Hence, should I be putting something into his body that he potentially does not need.
Initially, when he turned 6 months old, my answer was “no”. He is not at high risk and I am planning on taking him to the dentist when he turns one year old. If they decide to do a fluoride varnish at that time, more power to them. But then, I went to our “new” paediatrician and she seemed pretty surprised that I was not supplementing him with fluoride. She didn’t force the issue, but it did give me some pause.
So, I did more research. And the deeper I dug into this issue, the more I realized that this is not an easy cut and dry issue. And, in my research, I found out that the ADA now recommends that babies under the age of 2 can start using fluoridated toothpaste as long as it is just a “smear” twice per day. This goes against everything I was taught. I was taught to give “baby” toothpaste (un-fluoridated) to kids until they could spit on their own (so as not to swallow it). Apparently, this is no longer the case. Now, the little ones get a “smear” and the older ones (over 2) get a “pea-sized” amount. Color me confused.
So, if I now do this “smear”, do the oral supplements go out the window (the oral supplements that I am..ahem..not currently giving)? I would assume so. But, it is not clearly stated anywhere. Every source reiterates that each child has different circumstances and should be evaluated on an individual basis. Riiiight.
And don’t even get me started on Nursery water. That opens a whole new can of worms. Although, I was considering this can of worms for a while, as a way to avoid having to give the actual fluoride supplement (as I could titrate this a bit easier). But then, I realized that Baby D does not drink much water, or much diluted juice at this point. He will sometimes wash down a bit of solids with something other than breast milk, but he is still pretty much a breast milk guy. So, I don’t think he would be getting much fluoride from this Nursery water.
So, are you confused yet? So am I. So, I think I have come around to my original decision. I am going to hold off on supplementation until his first dentist visit at 12 months. Then, they may or may not tell me that I am an idiot and I need to start supplementing him, or they may or may not do a fluoride varnish to his chompers. And, if I am around some wayward tap water, I will let him slurp away.
If he ends up with cavities, I will fully take the blame…well, within reason 😉