Tap water and infant formula

IN response to the report on the use of tap water in reconstituting infant formula (October 5), I’d like to clarify a few facts.

The impact of water fluoridation and use of fluoride toothpastes worldwide has seen a reduction in the need for treatment of dental decay, a decrease in extractions and a resulting improvement in quality of life. Research has demonstrated the benefits of water fluoridation in reducing decay.

Although the occurrence of enamel fluorosis (recorded and reported by our researchers) increased among Irish children between 1984-2002, the level of fluoride in the water stayed the same. Babies have been safely fed infant formula reconstituted with fluoridated water for the past 35 years.

Since the level of fluoride in the water stayed the same and the level of fluorosis increased, we must look further for the cause. What is likely to have changed over the past 20 years is the use of fluoride toothpaste, which is highly effective in preventing dental decay and its effects are additional to those of water fluoridation.

However, international research has shown that early or inappropriate use of fluoride toothpaste (which can contain up to 1,500 parts per million fluoride as opposed to water, which up to recently contained one part per million fluoride) can be associated with dental fluorosis (fine white lines or white patches on teeth). This is because children under the age of two are not good at spitting out toothpaste after brushing.

As the level of fluoride in the water has remained unchanged since the mid-1960s, the most plausible explanation for the increase in fluorosis is that young children are swallowing too much fluoride toothpaste.

This is easy to rectify. Keep toothpaste out of children’s reach and always supervise its use, and do not use fluoride toothpaste to brush children’s teeth before age two. From age two to seven, use a pea-sized amount twice a day and get children to spit it out.

These are the recommendations made by an expert group convened to review the safety and effectiveness of water fluoridation in Ireland. The group also recommended the reduction of fluoride in water from 0.8-1.0ppm to 0.6-0.8ppm. This was introduced in July 2007.

Although there is little evidence to suggest that reconstituting babies’ bottles with mineral water would have any effect on the levels of dental fluorosis, I would be concerned about using them such waters to reconstitute infant formula as they sometimes have high levels of sodium and other minerals which could be detrimental to the health of infants.

Much of our population up to age 35 were fed formula reconstituted with fluoridated water. Look around, do you see a problem?

Helen Whelton

Director

Oral Health Services

Research Centre;

Senior Lecturer

University Dental School

and Hospital

Wilton

Cork