ADA Publishes Clinical Recommendations on Infant Formula and Enamel Fluorosis


The American Dental Association Council of Scientific Affairs (CSA) published a report1 in the Journal of the American Dental Association (JADA) concerning potential associations between infant formula and enamel fluorosis.

The CSA convened an expert panel to address the 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?”

Based on its findings, the expert panel made the following recommendations:

  • Dentists should advocate exclusive breastfeeding until the child is 6 months of age and continued breastfeeding until at least 12 months of age, unless specifically contraindicated.
  • Dentists should suggest continued use of powdered or liquid concentrate infant formulas reconsitituted with optimally fluoridated drinking water while being cognizant of the potential risks of enamel fluorosis.
  • When the potential risk of enamel fluorosis development is a concern, dentists should suggest ready-to-feed formula or powdered or liquid concentrate formula reconstituted with water that is either fluoride free or has a low concentration of fluoride.

The recent report and recommendations replace the Interim Guidance on Fluoride Intake for Infants and Young Children published by the ADA in 2006.

“I believe these ADA recommendations are a useful guidance for Canadian dentists and their patients,” notes Dr. Euan Swan, CDA’s manager of dental programs.

The full report is available in the January 2011 edition of JADA.


  1. Berg J, Gerweck C, Hujoel PP, King R, Krol DM, Kumar J, et al. 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;142(1):79-87.