Fluoride is a very safe and effective agent. However, care needs to be taken to minimize the risk of fluorosis. Chronic excessive fluoride exposure to developing teeth can cause white mottling of the tooth surfaces.

  • Mainly a cosmetic effect

Prevalence & Risk Factors

  • Prevalence of fluorosis (mostly mild or very mild) in the United States is 23% and rising.
  • The risk of developing fluorosis is greatest at an intake of more than 0.06 milligram per kilogram of body weight per day.
  • Varnish is not a major risk factor for fluorosis as it is an irregular source of fluoride when applied appropriately and as recommended two to four times per year.

Risk Reduction

  • Determine the fluoride content of the child's drinking water before prescribing supplements.
  • Avoid duplicating fluoride prescriptions.
  • Follow current dosage schedules for systemic fluoride supplementation.
  • Advise appropriate amount of fluoride toothpaste use by age.
  • Keep fluoride-containing products out of the reach of small children.

Moderate Fluorosis

Joanna Douglass, BDS, DDS
Joanna Douglass, BDS, DDS

Severe Fluorosis

John McDowell, DDS
John McDowell, DDS


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Wright JT, Hanson N, Ristic H et al. Fluoride toothpaste efficacy and safety in children younger than 6 years: A systematic review. JADA. 2014. 145(2): 182-189.