Doctor Betti
Dr. Betti Hertzberg Ressler is a Board Certified Pediatrician on staff at Miami Children's Hospital. Dr. Hertzberg developed the toilet training video "Let's Go Potty." She is the co-author of "The Doctor's Book of Home Remedies for Children."

Weaning of the bottle

Question: We do not have fluoride in our water. Our pediatrician recommended a daily vitamin with .25 mg of fluoride per day. Our pediatric dentist did not recommend giving the vitamin each day, stating that the fluoride could stain her permanent teeth. But, he had not heard of the vitamin (Enfamil with fluoride) and he then recommended giving her daily vitamins on some days, and daily vitamins with fluoride on other days. What is your opinion. Lynne

Answer: Both the American Academy of Pediatrics and the American Academy of Pediatric Dentistry recommend supplementation of fluoride in infants and children in communities that do not have a source of natural fluoride in food or in their community's water supply. Infants who are breastfed receive only very small amounts of fluoride, even if mother drinks fluorinated water.

Fluoride toothpaste also has been shown to reduce the amount of cavities only on teeth that are present. It has no effect on teeth that have not erupted. Fluoride ingested has it's effect on the developing permanent teeth. The problem of over fluoridation occurs when an excess amount is ingested. Swallowing fluorinated toothpaste or a fluoride rinse can pose problems in young children who inadvertently swallow even small amounts on a daily basis. Adding supplemental fluoride in this case is not recommended. The result can be discoloration of the permanent teeth.

You stated that the drinking water where you live does not have fluoride. Be aware that some bottled water, whether mineral or spring, may also contain natural fluoride. Also available is "fluorinated water for babies."

Enfamil is a major brand formula which is available with and without iron. It does not come as Enfamil with fluoride. Presently, there are no formulas on the market that contain fluoride. This is probably why your dentist is not familiar with it. There are some vitamins that contain fluoride, however, it's only available by prescription. It is not found in any infant formula in the United States.

Your dentist and pediatrician both feel that it is important to supplement, at the same time being careful so that your child receive not too much, or too little of fluoride. There is no substitute for good oral hygiene. Good habits that start early in life tend to last a lifetime.

Dr. Betti

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    This information is not intended to be a substitute for visiting your pediatrician. If you or your child has specific concerns, you should see your doctor for a diagnosis and treatment.