Fluoride is a natural mineral that prevents tooth decay and strengthens bones. The American Academy of Pediatrics, American Dental Association and many other health organizations recommend fluoride to help children develop strong teeth and set a foundation for oral health throughout their lifetimes. 

Many parents have questions about fluoride and its role in their children’s health: 

What is fluoride? 

Fluoride is a natural mineral present in foods, water, soil, plants and rocks. People generally consume fluoride in food, water and supplements such as toothpaste or mouthwash.

What causes cavities? 

When people eat sugar and refined carbohydrates, bacteria in the mouth create acid, which breaks down enamel, the protective outer layer of teeth. This can lead to cavities. 

How does fluoride help? 

Fluoride strengthens the enamel by attracting calcium and phosphate when acid starts to break down the enamel. This “remineralization” stops the acid and rebuilds the enamel. 

When do kids need fluoride? 

Babies don’t need fluoride until they get their first tooth. When the first tooth comes in, parents should help brush with a rice grain-size smear of fluoride toothpaste and make an appointment with a dentist. Once teeth come in, fluoride is recommended. 

Is fluoride bad for kids? 

Excessive amounts of fluoride may create risks, though evidence-based research shows that the amount of fluoride in drinking water and commonly consumed from other sources is safe. Excessive fluoride may cause a condition called fluorosis, indicated by faint white streaks on teeth. Fluorosis generally is mild and not painful. Some studies have suggested a link between fluoride in drinking water and children’s IQ scores, but the American Academy of Pediatrics notes the fluoride levels in those studies were more than twice what is commonly in drinking water. 

Does bottled water have fluoride? 

Many brands of bottled water filter out minerals, including fluoride, so generally there is only a negligible amount of fluoride in bottled water. If a company adds fluoride to the bottled water, it is required to report that information on the label, but if it only includes the fluoride naturally in the water, there is no labeling requirement. 

What if I’m concerned my child isn’t getting enough fluoride? 

Discuss your concerns with your child’s pediatrician or dentist. They can assess whether your child is vulnerable to tooth decay and give you appropriate next steps, possibly including fluoride supplements or varnishes. 

In most cases, they likely will recommend that children: 

• Brush twice a day with an appropriate amount of fluoride toothpaste. (A rice-grain size smear up to age 3; a pea-size amount from ages 3–6; and a slim ribbon after age 6.) 

• Avoid rinsing after brushing, which washes away the fluoride from the toothpaste. If the child must rinse, use a fluoride rinse. (Spitting during brushing is OK.) 

• Floss each day, generally before bed. 

• Eat a healthy diet by reducing sugar intake, including soft drinks, fruit juices, cereals and sports drinks. 

• Drink more water. 

What if I’m concerned my child is getting too much fluoride? 

Discuss your concerns with your child’s pediatrician or dentist. They can assess whether your child may be allergic to fluoride, which is rare, or at risk of developing fluorosis. They may suggest changing or using less toothpaste, supervising brushing to make sure the child spits out toothpaste or reducing use of fluoridated mouthwash or other supplements.

Does all toothpaste have fluoride? 

Most commercial toothpastes have fluoride, but there are some non-fluoride toothpastes. Unless your child is allergic, a fluoride toothpaste is recommended. 

What are fluoride supplements? 

Your pediatrician or dentist may recommend prescription-level mouth rinses, lozenges or tablets. They will explain their recommendation and the appropriate uses. 

What is a fluoride varnish? 

Your pediatrician or dentist may recommend a fluoride-rich varnish, which is painted on the top and sides of the child’s teeth. It hardens quickly and the parent brushes it off several hours later. Your pediatrician or dentist may recommend this two- to four-times a year when your child is under 5.