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Clinical Resources

Fluoride Supplements and Drinking Water

At early ages, fluoride becomes incorporated into tooth enamel as teeth are forming in the mouth. The inclusion of fluoride in tooth enamel creates a stronger mineral structure that is more resistant to decay.

While fluoride supplements are intended to have systemic affect during development, it has been shown to also have a topical effect on erupted teeth.

Knowing the fluoride concentration in drinking water is the first step to determining the appropriate dose of dietary fluoride supplementation. U.S. Department of Health and Human Services recommends a 0.7 ppm level of fluoride in drinking water for optimal dental health.

Well Water

Fluoride is a mineral that is naturally found in rock, soil and water. The level of fluoride in private well water varies on the location and environment.

Private well water is not regulated by federal or local governments. As a result, the owners are responsible for testing water and ensuring that it is safe to drink. Private wells should be tested regularly because water quality may change over time. Without testing, it is impossible to determine the level of fluoride in well water.

Public Water Supplies

While the U.S. Public Health Service recommends public water fluoridation, local governments ultimately decide if they comply with the recommendation.

My Water’s Fluoride, a voluntary public disclosure website, allows consumers to look up information on their local water systems. Additional information can be requested from local governments or water utilities.

Fluoride Supplements

Primary care providers should consider a patient’s age and the amount of fluoride found in local drinking water to determine if fluoride supplementation is necessary, and if so, the appropriate dose.

Fluoride supplements should be considered for children who live in communities where the public water is not fluoridated or if children drink from well water that does not contain the optimal amount of fluoride. The American Dental Association recommends a dosage schedule that is dependent on the age of the child and the amount of fluoride in their drinking water.

Table: 2010 American Dental Association Fluoride supplement dosage schedule



Fluoride Ion Level in Drinking water (ppm)*


0.3 – 0.6


Birth – 6 months




6 months – 3 years

0.25 mg/day**



3 – 6 years

0.50 mg/day

0.25 mg/day


6 years – 16 years

1.0 mg/day

0.50 mg/day


*1.0 part per million (ppm) = 1 milligram per liter (mg/L)

**2.2 mg soidum fluoride ions contains 1mg fluoride ion