Fluoride for the prevention and control of caries is safe and effective. Infant formula and the water used to reconstitute the formula may contain fluoride (less than 0.1ppm F). The formula can be mixed with fluoridated water.

The AAPD and FDA do not recommend pre‑natal fluoride.


  • Does not cross the placenta
  • No significant difference in caries with mothers who were and who were not given fluoride

It is recommended the dentist’s decisions concerning the administration of additional fluoride are based on the needs of each patient depending on their caries risk assessment and their existing fluoride exposure.

Chronic excessive fluoride intake can result in fluorosis, and unaesthetic mottling of the teeth. For an average five‑year‑old, a dose of 5mg per kg of fluoride from toothpaste represents 95ml, or about one half of typical 8‑oz tube. Larger doses of fluoride can cause life‑threatening hypocalcemia with convulsions, tetanus, decreased myocardial contractility, ventricular arrhythmia’s and cardiac arrest.

The risk of fluorosis should be evaluated. Fluorosis has been associated with cumulative fluoride intake during enamel development, with the severity dependent on the dose, duration, and timing of intake.

Some states are providing funding for physicians to provide oral health screenings and fluoride varnish at their medical offices with a potential to get reimbursed as seen in the map below.

Figure 10. States with Medicaid Funding for Physician Oral Health Screening and Fluoride.
US states with Medicaid Funding for Oral Health Screening and Fluoride Varnish