What risks are associated with delaying fluoride treatment until one year of age (or longer)?

Dental decay is extremely common in children and very preventable. We see much less of it today than we used to, mostly thanks to the discovery in the 1940s that people who lived in areas where fluoride naturally occurred in water had few to no cavities, compared to the rest of us.  Fluoridated water, in our area, is only present in Amherst, Athol, Holyoke and Longmeadow.   For infants and children living in all our other towns, or with well water (without naturally occurring fluoride), prescription oral fluoride supplements are recommended at safe, low levels, and have been prescribed at least since the 1970s. The amount of fluoride prescribed was lowered by half in 1994 to avoid fluorosis, which is a harmless, cosmetic white staining of teeth.  Fluoride works to prevent decay and rebuild dental enamel by a process called remineralization, which hardens and strengthens the enamel to resist decay.  This has been a great public health advancement, and it is often remarked that one of the risks of fluoride is that dentists would put themselves out of business. 

The doses now recommended, since 1994 (for children who do not have access to fluoridated tap water), are 0.25 mg daily from 6 months to 3 years, 0.5 mg from 3 to 6 years, and 1 mg from 6 years on up until all the permanent teeth are erupted.  This dosage schedule is agreed upon by the American Dentistry Association, the American Association of Pediatric Dentistry, and the American Academy of Pediatrics.   Fluoride toothpastes should not be used by children under 3 years (or when a child has learned to "swish and spit"), and after that, only a pea-sized amount.  Fluoride solutions for daily rinsing are only for children over the age of 6.

Babies start to get their first teeth at 6 months, and most have 8 teeth by a year of age, so even at this young age, they are susceptible to decay.  Infants spend a lot of time with milk in their mouths, and their mouths are already pretty well colonized by decay-causing bacteria.  Liquid (or chewable) fluoride acts topically, right on your child's teeth, for up to an hour or two after it is given, but the protection is extended because fluoride is thereafter present in small amounts in saliva, which continually bathes the teeth. Parents should also clean and rinse the teeth with water after every feeding.  Giving juice or other sugary liquids significantly increases the risk of decay.

We have seen far too many children in our practice who suffer from severe rotting of their teeth, requiring dental surgery and often extraction, under anesthesia, a totally avoidable situation that peaks between age 2 and 5, having started much earlier.  This usually occurs with a combination of inadequate dental care, lack of fluoride, and dietary problems, especially delayed nighttime weaning of the bottle.  The primary teeth need to be protected, not just as space holders for their permanent counterparts, but for speech development, good nutrition, risk of spreading infection to the developing secondary teeth beneath, and for the child's appearance and related self-esteem.  

While we wish our towns all had fluoridated water, they do not, and we as a practice confidently support our patients' use of recommended safe and effective doses of fluoride supplements, starting at 6 months.  If you have questions about this, please don't hesitate to bring them up with your child's doctor or nurse practitioner.