We often get asked about fluoride, and whether it’s a safe and effective way to help reduce the chance of cavities in children. Below you’ll find information that we hope you’ll find useful.

Fluoride is a compound that contains fluorine, a natural element. Using small amounts of fluoride on a routine basis helps to prevent tooth decay. Fluoride encourages  “remineralization,” a strengthening of weakened areas of tooth enamel. It also affects bacteria that cause cavities, discouraging acid attacks that break down the tooth.

Fluoride can occur naturally in water but is often added to community water supplies, such as Anacortes, and in-town Oak Harbor. It is found in many different foods and in dental products such as toothpaste, mouth rinses, gels and varnish. Fluoride is most effective when combined with a healthy diet and good oral hygiene.


  •  Systemic fluoride has been shown to reduce caries between 55 to 60 percent.
  • Water fluoridation is still the No. 1 cost effective way to prevent tooth decay. However, 30 percent of communities in the United States do not have fluoride in their public sources of water.
  • Children aged 6 months to 16 years may need fluoride supplements if they drink water that is not optimally fluoridated. The pediatric dentist considers many different factors before recommending a fluoride supplement.  Your child’s age, risk of developing dental decay and the different liquids your child drinks are important considerations. Bottled, filtered and well waters vary in their fluoride amount, so a water analysis may be necessary to ensure your child is receiving the proper amount.
  • Fluoride for infants is available in fluoride drops or in combination with prescription vitamins. Fluoride sources for children include fluoride toothpastes, fluoride mouth rinses and fluoride applications in the pediatric dental office.
  • Your child should use toothpaste with fluoride and should not swallow any toothpaste. Careful supervision is encouraged. For children under 2-years-old, use a smear of fluoridated toothpaste. For those 2 to 5-years-old, a small pea-sized amount of fluoridated toothpaste on the brush is recommended.
  • When a child develops a cavity, we occasionally use certain types of tooth-colored filling materials (such as resin ionomer or compomer) that contain time-release fluorides. This extra fluoride targeted to the child’s problem area can prevent decay and the need for future fillings.
  • Children who benefit the most from fluoride are those at highest risk for dental decay. Risk factors include a history of previous cavities, a diet high in sugar or carbohydrates, orthodontic appliances and certain medical conditions such as dry mouth.
  • Topical fluoride is a preventive agent applied to tooth enamel. It comes in a number of different forms. We often place fluoride gels and foams in trays that are held against the teeth for up to 4 minutes. Topical fluoride also can be applied as a varnish.


Fluoride varnishes used at Playhouse Dental are painted on the teeth instead of being applied like traditional fluoride treatments in trays. Completed in minutes, the varnish remains on the tooth surface for several hours, longer than other topical fluoride products. The treatment could be particularly valuable to children at high risk for tooth decay.

Fluoride varnish has been documented to be safe and effective to fight dental decay. This method is especially useful in young patients and those with special needs that may not tolerate fluoride trays comfortably.


  • Ingesting too much fluoride can cause fluorosis of the developing teeth. However, fluorosis usually is mild, with tiny white specks or streaks that often are barely noticeable, while it makes the tooth harder and more resistant to acid attack. Images of mild fluorosis
  • Three common ways a child can get too much fluoride are:

1. Taking more of a fluoride supplement than the amount prescribed.
2. Taking a fluoride supplement when there is already an optimal amount of fluoride in the drinking water.
3. Using too much toothpaste, then swallowing it instead of spitting it out.

Parents should supervise their preschoolers’ tooth brushing. Use a small smear of fluoridated toothpaste for children under two-years-old. For those aged 2 to 5 years, use a pea-sized amount of fluoridated toothpaste when helping your children brush. (see Figure 1)

Figure 1. Comparison of a smear (left) with a pea-sized (right) amount of toothpaste.


To avoid having too much fluoride, you need to establish the fluoride content of your child’s primary drinking water source, as well as other sources of fluoride.

1. Your Kitchen Faucet
• Just knowing whether your water is fluoridated is not enough. The age of municipal water treatment plants and use of home water filters can vary the fluoride levels for families who live in the same community. You can have your water tested. Just ask your pediatric dentist.

2. The School Drinking Fountain
• School-age children spend a significant portion of their day at school. According to the U.S. Census Bureau, three in 10 preschoolers attend a childcare facility. That means your child’s primary water source may not come from home, but from day care, school or grandma’s house.

3. Bottled Water
• Americans drink almost three billion gallons of bottled water a year, but only 4 percent of bottled waters sold in the U.S. have added fluoride. Parents can check with bottled water manufacturers or the International Bottled Water Association (www.ibwa.org) to find out if fluoride has been added to their bottled water.

4. Water Filters• Do home water filters remove fluoride? Devices that operate by reverse osmosis can remove up to 95 percent of the fluoride from water. Charcoal or carbon-based systems are better in that they only remove insignificant amounts of fluoride.