Systemic Fluoride


  • 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 (very 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.


Federal Registrar: View site here (accessed March 18, 2014).

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.