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AAPD Journal Article Abstract

Author:	Samina Van Winkle, Steven M. Levy, Mary C. Kiritsy, Judy R. Heilman, James S. Wefel, Teresa Marshall
Title:	Water and Formula Fluoride Concentrations: Significance for Infants Fed Formula
Abstract:	The independent contributions of formula and water to the total fluoride (F) intake from the diet of formula-fed infants is not fully documented. Although the precise timing and mechanism by which dental fluorosis occurs has not been fully defined, water F levels can be an important consideration in the risk of dental fluorosis for formula-fed infants. An assessment of 1,308 participants younger than 2 years old revealed that: 81% of homes received public water; 19% received well water; 26% of participants used bottled water; and 11% used some kind of filtration system. In this study, virtually all formulas consumed by the birth cohort and water sources used in the reconstitution of these formulas were assayed for F using a F ion specific electrode and direct read method, except for soy-based formulas, which were analyzed by microdiffusion (modified Taves). Among 78 commercially available bottled waters in Iowa, F levels ranged from 0.02 to 1.36 ppm (mean 0.18 ppm), 83% from 0.02 to 0.16 ppm, 7% from 0.34 to 0.56 ppm, 1% had a F level of 0.88, and 9% had F levels>1.0 ppm. Among 47 casein (milk)-based formulas, 16 ready-to-feed (RTF) formulas had levels of 0.04 to 0.55 ppm F (mean 0.17 ppm), 14 liquid concentrates (LC) reconstituted with distilled water had levels of 0.04 to 0.19 ppm F (mean 0.12 ppm), and 17 powdered concentrates (PC) reconstituted with distilled water had levels of 0.05 to 0.28 ppm F (mean 0.14 ppm). The 17 soy-based formulas had a range of 0.04 to 0.47 ppm F (mean 0.26 ppm). These 1992-93 findings generally are consistent with results of studies conducted in the 1980s. Type of formula and the water used could be an important consideration in fluorosis risk assessment and dietary fluoride supplementation recommendations. (Pediatr Dent. 17:305-310)