The average daily dose of fluoride: a model based on fluid consumption

The quantity of fluoride needed to prevent caries but avoid dental fluorosis is unknown. To estimate the desired daily dose of fluoride, we analyzed fluid consumption data from a stratified random sample of 7,345 children studied during the 1977-78 US Department of Agriculture Nationwide Food Consumption Survey and applied it to Dean's observations of optimally fluoridated communities in the 1940s. The average daily fluoride intake per kilogram body weight from optimally fluoridated tap water was highest (0.080 mg/kg/d) from 7 to 9 months of age, and declined linearly to 0.034 mg/kg/d at 12.5 to 13 years of age. The mean was 0.068 +/- 0.008 mg/kg/d from birth to age 7 years, and 0.042 +/- 0.006 mg/kg/d from age 7 to 13 years. The American Academy of Pediatrics supplementation schedule delivers fluoride dosage rates that are below our findings of the average daily dose of fluoride after the third month of life, although the two curves are within 0.006-0.013 mg/kg/d from 3 months to 16 years of age. While supplementation alone does not exceed the average daily dose of fluoride, the cumulative effects of fluoride from tap water, processed foods, ingested toothpaste, and dental treatments after the third birthday should be evaluated for their role in the increased prevalence of fluorosis.