Fluoride for the prevention and control of caries is safe and effective. Ready to feed milk based infant formulas in the US contain an average of 0.15ppm and soy based 0.21ppm of fluoride. The powder based infant formula combined with fluoridated water is less of an issue than in the past since community water supplies of 0.7ppm have been instituted.10
The AAPD and FDA do not recommend pre-natal fluoride.
It is recommended that 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. Fluorosis can occur if more than 1.8ppm/day is ingested.
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 potential to get reimbursed as seen in the map below.
Figure 6. Percentage of Nondental Providers who Performed Oral Preventive Services in 2014.11
(The map was assembled by M. E. by using publicly available Medicaid Early and Periodic Screening, Diagnostic, and Treatment Survey data for 2014.) AK, Alaska; AL, Alabama; AR, Arkansas; AZ, Arizona; CA, California; CO, Colorado; CT, Connecticut; DC, District of Columbia; DE, Delaware; FL, Florida; GA, Georgia; HI, Hawaii; IA, Iowa; ID, Idaho; IL, Illinois; IN, Indiana; KS, Kansas; KY, Kentucky; LA, Louisiana; MA, Massachusetts; MD, Maryland; ME, Maine; MI, Michigan; MN, Minnesota; MO, Missouri; MS, Mississippi; MT, Montana; NC, North Carolina; ND, North Dakota; NE, Nebraska; NH, New Hampshire; NJ, New Jersey; NM, New Mexico; NV, Nevada; NY, New York; OH, Ohio; OK, Oklahoma; OR, Oregon; PA, Pennsylvania; RI, Rhode Island; SC, South Carolina; SD, South Dakota; TN, Tennessee; TX, Texas; UT, Utah; VA, Virginia; VT, Vermont; WA, Washington; WI, Wisconsin; WV, West Virginia; WY, Wyoming.