Systemic Fluoride
Guidelines
- All children at high caries risk should receive fluoride through systemic water fluoridation or dietary supplements.
- Children who drink optimally fluoridated water should NOT receive supplements.
- Optimal water fluoridation level is 0.7 ppm.
Steps to Take Before Considering Prescribing Supplements
Determine the source of your patient's water, which may be:
- Fluoridated city water
- Nonfluoridated city water
- Bottled water (variable fluoride levels)
- Well water (variable fluoride levels)
Determine the fluoride content:
- Public water supply: Contact local health departments or water company for fluoride levels.
- Well water: Test the well water for fluoride level. Local health departments can perform test or provide resources
for water testing.
Additional factors affecting fluoride content:
- Water filters:
- Most filters are charcoal based and do not remove fluoride.
- Only reverse osmosis water filters (costly to install) remove fluoride.
- Bottled water:
- If companies add fluoride, this must be listed on the bottle.
- The fluoride content of most bottled water is unknown as that water source may or may not contain naturally occurring fluoride.
References
Community Water fluoridation Recommendations. Community Water Fluroridation,
Centers for Disease Control, Bethesda, MD. May 15, 2024.
www.cdc.gov/fluoridation/about/community-water-fluoridation-
recommendations.html
Rozier RG, Steven Adair S, Graham S, Lafolla T. et al. Evidence-Based Clinical Recommendations on the Prescription of Dietary Fluoride Supplements for Caries Prevention. Journal of the American Dental Association. 2010; 141 (12): 1480-1489.
Fluoride Fact Sheet for Health Professionals. National Institutes of Health, Office of Dietary Supplements, Bethesda, MD. April 11, 2025.
https://ods.od.nih.gov/factsheets/Fluoride-HealthProfessional