Allowance (RDA) defines the average daily amount of
the nutrient needed to meet the health needs of 97–
98% of the population. The Adequate Intake (AI) is
an estimate set when there is not enough information
to determine an RDA. The Tolerable Upper Intake
Level (UL) is the average maximum amount that can
be taken daily without risking negative side effects.
The DRIs are calculated for children, adult men,
adult women, pregnant women, andbreastfeeding
women. Similar recommendations have been defined
elsewhere, e.g., Canada, the United Kingdom, and
other European countries.
Fluoride is not considered an essential nutrient so
the IOM has not set RDAs for it. Instead, it has set AI
and UL levels for all age groups. The daily AIs and
ULs for fluoride for healthy individuals as established
by the IOM are:
Children birth–6 months: AI 0.01 mg; UL 0.7 mg
Children 7–12 months: AI 0.5 mg; UL 0.9 mg
Children 1–3 years: RDA 0.7 mg; UL 1.2 mg
Children 4–8 years: RDA 1.0 mg; UL 2.2 mg
Children 9–13 years: RDA 2.0 mg; UL 10 mg
Adolescents 14–18 years: RDA 3.0 mg; UL 10 mg
Men age 19 and older: RDA 4.0 mg; UL 10 mg
Women age 19 and older: RDA 3.0 mg; UL 10 mg
Pregnant women of all ages: 3.0 RDA mg; 10 UL mg
Breastfeeding women of all ages: 3.0 RDA mg; 10 mgSources of fluoride in diet
The overwhelming source of fluoride for most
people is water. In 1945, Grand Rapids, Michigan,
was the first city to add fluoride to its public water
supply. About two-thirds of Americans now drink
fluoridated water. From the 1950s to the 1970s, the
issue of fluoridating public water supplies caused
heated debate. Some scientists claimed that fluorida-
tion caused birth defects,cancer, and liver disease.
Multiple independent, well-designed studies have con-
clusively demonstrated that this is false. Fluoridation
of water at a level that prevents tooth decay does not
increase health risks.Critics of fluoridation still persist. Some reject
existing scientific research and claim that fluoridation
is ineffective and/or harmful. For others, fluoridation
of public water raises moral issues about personal
rights versus the government’s rights. The decision to
fluoridate drinking water has generally rested with
local governments and communities. The recom-
mended rate of fluoride in water is between 0.7 and
1.2 parts per million (ppm). The fluoridation rate is
usually at the low end of the range in warm places and
at the high end of the range in cold places because
people drink more water and thus get more fluoride
where it is warm.
A few foods contain significant amounts of fluo-
ride. Since it is found in seawater, ocean fish contain
fluoride. It is also concentrated in tea leaves. The
approximate fluoride content for some common foods:
Tea, 3.5 ounces (100 mL): 0.1–0.6 mg
Canned sardines with bones, 3.5 oz (100 g): 0.2–0.4 mg
Fish without bones, 3.5 oz (100 g): 0.01–0.17 mg
Chicken, 3.5 oz (100 g): 0.06–0.10 mg
Toothpaste and mouthwashes containing fluoride
provide significant protection against tooth decay.
For children who do not drink fluoridated water, the
American Dental Association (ADA) and the Ameri-
can Academy of Pediatrics recommend prescription
fluoride supplements from age six months onward.
Supplements come as liquids and chewable tablets of
varying strengths and are prescribed by a pediatrician,
family physician, or dentist. In addition, dentists may
apply fluoride pastes or varnishes directly to children’s
teeth for additional protection. This is usually done at
six-month intervals at regular dental check-ups.Precautions
The amount of fluoride occurring naturally in
drinking water varies widely depending on location.
People who use wells should have them tested for
fluoride. People on public water supplies should call
their local public health office to determine if their
water is fluoridated. People who primarily use bottled
water should consult their supplier about whether or
not it contains fluoride. Some built-in home water
softening systems may remove fluoride from water.
Consult the manufacturer or installer for specific
information.Interactions
Antacids containing aluminum hydroxide and
calcium supplements can decrease the absorption of
fluoride from the small intestine.KEY TERMS
Osteoporosis—A condition found in older individ-
uals in which bones decrease in density and
become fragile and more likely to break. It can be
exacerbated by lack of vitamin D and/or calcium in
the diet.Fluoride