Evidence-based clinical recommendations regarding fluoride intake from reconstituted infant formula and enamel fluorosis: a report of the American Dental Association Council on Scientific Affairs

J Am Dent Assoc. 2011 Jan;142(1):79-87. doi: 10.14219/jada.archive.2011.0032.


Background: This article presents evidence-based clinical recommendations regarding the intake of fluoride from reconstituted infant formula and its potential association with enamel fluorosis. The recommendations were developed by an expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs (CSA). The panel addressed the following question: Is consumption of infant formula reconstituted with water that contains various concentrations of fluoride by infants from birth to age 12 months associated with an increased risk of developing enamel fluorosis in the permanent dentition?

Types of studies reviewed: A panel of experts convened by the ADA CSA, in collaboration with staff of the ADA Center for Evidence-based Dentistry (CEBD), conducted a MEDLINE search to identify systematic reviews and clinical studies published since the systematic reviews were conducted that addressed the review question.

Results: CEBD staff identified one systematic review and two clinical studies. The panel reviewed this evidence to develop recommendations.

Clinical implications: The panel suggested that when dentists advise parents and caregivers of infants who consume powdered or liquid concentrate infant formula as the main source of nutrition, they can suggest the continued use of powdered or liquid concentrate infant formulas reconstituted with optimally fluoridated drinking water while being cognizant of the potential risks of enamel fluorosis development. These recommendations are presented as a resource to be considered in the clinical decision-making process. As part of the evidence-based approach to care, these clinical recommendations should be integrated with the practitioner's professional judgment and the patient's needs and preferences.

Publication types

  • Practice Guideline

MeSH terms

  • Cariostatic Agents / administration & dosage*
  • Cariostatic Agents / adverse effects
  • Cariostatic Agents / analysis
  • Evidence-Based Dentistry*
  • Fluorides / administration & dosage*
  • Fluorides / adverse effects
  • Fluorides / analysis
  • Fluorosis, Dental / etiology*
  • Fluorosis, Dental / prevention & control
  • Humans
  • Infant
  • Infant Formula / administration & dosage*
  • Infant Formula / chemistry
  • Infant, Newborn
  • Risk Factors
  • Water Supply / analysis


  • Cariostatic Agents
  • Fluorides