Using Fluoride to Prevent and Control Tooth
Decay in the United States
Although there have been notable declines in tooth decay among children
and adults over the past three decades, tooth decay remains the most common
chronic disease of children aged 6 to 11 years (25%), and of adolescents
aged 12 to 19 years (59%). Tooth decay is four times more common than asthma
among adolescents aged 14 to 17 years (15%).
This summary guidance explains how to achieve protection from tooth decay
throughout life, while reducing the chances of developing
Dental fluorosis is a change in the appearance of the tooth surface and most
commonly appears as barely noticeable white spots. Dental fluorosis can only
develop during the time that the teeth are forming under the gums—generally
from birth through age 8.
- Drink tap water with optimal amounts of fluoride. Water fluoridation
has been accepted as a safe, effective, and inexpensive method of
preventing tooth decay. Adding fluoride to municipal drinking water is
an efficient strategy to reduce dental disease among Americans of all
social strata. It is the most cost-effective way to prevent tooth decay
among populations living in areas with adequate community water supply
To find out more about the fluoride level in your drinking
- If you are on a community water system, call your water utility
company and request a copy of the utility’s most recent Consumer
- If you live in a state that participates in CDC’s
Fluoride, you can go online and find information on your water system’s
- Brush at least twice daily with fluoride toothpaste. Daily and
frequent exposure to small amounts of fluoride best reduces tooth decay
for all age groups. Drink water with optimal levels of fluoride and
brush at least twice a day with fluoride toothpaste—preferably after
- If you have children younger than 2 years, do not use fluoride
toothpaste unless advised to do so by your doctor or dentist. You should
clean your child’s teeth every day as soon as the first tooth appears by
brushing without toothpaste with a small, soft-bristled toothbrush and
If you have children younger than 6 years, supervise their
tooth brushing. For children aged 2 to 6 years, apply no more than a
pea-sized amount of fluoride toothpaste to the brush and supervise their
tooth brushing, encouraging the child spit out the toothpaste rather than
swallow it. Up to about age 6, children have poor control of their
swallowing reflex and frequently swallow most of the toothpaste placed on
- Use prescription fluoride supplements and high concentration
fluoride products wisely. Fluoride supplements may be prescribed by your
dentist or physician if your child is at high risk for decay, and lives
in a community with a low fluoride concentration in their drinking
water. If the child is younger than 6 years, however, then the dentist
or physician should weigh the risks for developing decay without
supplements with the possibility of developing dental fluorosis. Other
sources of fluoride, especially drinking water, should be considered
when determining this balance. High concentration fluoride products,
such as professionally applied gels, foams, and varnishes, also may
benefit children who are at high risk of decay.
- Know some of the factors that can increase your child’s risk for
tooth decay. These include the following:
- Older brothers, sisters, or parents who have had
- Taking in a lot of sugary foods and drinks, like
soda, especially between meals.
- Not brushing teeth daily.
- Not using a fluoride toothpaste if older than age 2.
- Your usual source of drinking water has a very low
- Presence of special health care needs.
- No family dentist or regular source of dental care.
- Wearing braces or orthodontic or oral appliances.
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Date last reviewed: January 7, 2011
Date last modified: January 7, 2011
Division of Oral Health,
National Center for Chronic Disease Prevention and