My Teen Daughter’s Struggle With Dental Fluorosis

When I took my 13-year-old to the orthodontist this week to have her braces removed I sensed her anxiety.  On a day when she should have been thrilled to finally reveal her beautiful new smile to herself and her friends, she dreaded the fact that she would no longer be able to hide behind her braces.  She didn’t want to have her braces taken off because they helped to conceal the discolorations on her teeth that she’s always been so embarrassed about—mottled discolorations caused by dental fluorosis.

She’ll be turning 14 this month and starting her freshman year in high school.  The last thing she needs is to feel self-conscious right before going back to school, in a new school, with a bunch of new kids.

In the past, sometimes kids at school have ignorantly assumed that her teeth were stained because she just doesn’t brush her teeth enough.  They couldn’t have been more wrong.  She has always taken great care of her teeth, and her dental records confirm this fact.  Unfortunately, most people have never heard of dental fluorosis, what causes it, and how difficult it is to deal with—especially for kids and teens.

What Causes Dental Fluorosis?

Dental fluorosis is not caused by poor oral hygiene.  None of my three daughters has ever even had a single cavity.

My daughter’s baby teeth were perfectly aligned and brilliantly white.  But after losing her baby teeth, as her adult teeth began to erupt one by one, we were shocked to see that they were already discolored.  As each adult tooth advanced slowly through her gums and into place, it was clear that her adult teeth showed characteristics consistent with mild-to-moderate dental fluorosis.

Enamel fluorosis is caused by the long-term ingestion of fluoride during tooth development. Even low fluoride intake (about 0.03 μg/kg bw) will result in a certain, although low, level of fluorosis in a population.

—Critical Reviews in Oral Biology & Medicine, Dental Fluorosis: Chemistry and Biology

Fluorosis is caused by ingesting too much fluoride during the first 8 years of life.  Fluoride can be found in water, tea, juice, soft drinks, canned foods, commercially grown (non-organic) fruits and veggies, Teflon and T-Fal-coated pots and pans, pesticides, fumigants, polishes and lubricants, some medications, and of course toothpaste and mouthwash.

In the last two decades, increasing fluoride exposure in various forms and vehicles is most likely the explanation for an increase in the prevalence of mild-to-moderate forms of dental fluorosis in many communities, not the least in those in which controlled water fluoridation has been established. The effects of fluoride on enamel formation causing dental fluorosis in man are cumulative, rather than requiring a specific threshold dose, depending on the total fluoride intake from all sources and the duration of fluoride exposure. Enamel mineralization is highly sensitive to free fluoride ions, which uniquely promote the hydrolysis of acidic precursors such as octacalcium phosphate and precipitation of fluoridated apatite crystals. Once fluoride is incorporated into enamel crystals, the ion likely affects the subsequent mineralization process by reducing the solubility of the mineral and thereby modulating the ionic composition in the fluid surrounding the mineral. In the light of evidence obtained in human and animal studies, it is now most likely that enamel hypomineralization in fluorotic teeth is due predominantly to the aberrant effects of excess fluoride on the rates at which matrix proteins break down and/or the rates at which the by-products from this degradation are withdrawn from the maturing enamel. Any interference with enamel matrix removal could yield retarding effects on the accompanying crystal growth through the maturation stages, resulting in different magnitudes of enamel porosity at the time of tooth eruption.

—Critical Reviews in Oral Biology & Medicine, Dental Fluorosis: Chemistry and Biology

Her pediatric dentist confirmed my daughter’s dental fluorosis, and tried to reassure me saying, “It’s only cosmetic, and when she gets older, if it bothers her, she can get her teeth whitened or consider getting veneers.”

Only cosmetic?  Tell that to my daughter.

Is Dental Fluorosis Just a Cosmetic Problem?

fluorosis-comp

Dental fluorosis can cause significant emotional and psychological distress and embarrassment, especially in children and teens.  Kids with moderate or severe fluorosis are often perceived as lacking proper dental hygiene or having rotten teeth, which can significantly damage their self-esteem.  But brushing three times a day with whitening toothpaste, flossing, rinsing with mouth wash, and regular trips to the dentist won’t make the mottled and/or stained appearance go away.

In today’s selfie-obsessed culture, kids with dental fluorosis are dealing with more than just a cosmetic problem—their emotional well-being suffers as well.

How Did This Happen?

I’ve always wondered what specifically caused my daughter’s dental fluorosis, and over the years I’ve considered all the usual suspects.

Was it the Toothpaste and/or Mouthwash?  

When my girls were little, I always helped them brush their teeth to make sure they used the right amount of toothpaste, and make sure they didn’t swallow any because I knew that it can be toxic if ingested, especially in children’s bodies.

After learning more about fluorosis and the dangers of fluoride ingestion, I made the switch to non-fluoridated toothpaste and mouthwash.

I am confident that my due diligence prevented any accidental ingestion of fluoride from toothpaste or mouthwash.  But even still, if I had it all to do over again, I would have never purchased fluoridated toothpaste and mouthwash for my young girls, knowing what I know now about the potential health risks.

Was it the Fluoride in our Drinking Water?

Naturally occurring fluoride is found in drinking water at varying concentration levels.  In my my county in Arizona, it varies widely between 1.6 and 6.4 ppm.

According to the CDC, there are 193 water systems in Pima County, where I live.  Of those, 20 are fluoridated, and 8 are what they call ‘mixed’ because they receive water from multiple wells with varying fluoride levels.

Through coercion and undue influence, many areas in the U.S. add additional fluoride to city water supplies and most people aren’t even aware of it.  This completely violates individual autonomy, and the right to voluntarily consent or decline treatments, as well as the right to be informed of all potential risks, benefits, and alternatives.

In 2012, a woman in Phoenix, Arizona named Jody Clute began fighting the city of Phoenix about their water fluoridation after she was diagnosed with hypothyroidism and learned that people with hypothyroidism should avoid fluoride—a difficult undertaking when it’s added to the water supply with or without your consent.  Sure, people can take steps to avoid ingesting fluoride by avoiding foods and other products that are known to contain fluoride, but without a pricey reverse osmosis system or water filter specifically designed to filter out fluoride, you will be ingesting fluoride in your drinking water, whether you like it or not.  Not everyone agrees that adding fluoride to the water supply benefits public health.

“How can one set of people vote to get another set of people to ingest something?” Jody Clute asked.  “They are politicians and not medical doctors.”

Tucson Sentinel, Woman’s Curiosity Reopens Fluoridation Debate in Phoenix

That’s a very good question.

Was it the Soy-Based Infant Formula?

When my daughter was an infant, she had some gastric distress and vomiting.  Her pediatrician suspected a milk intolerance may have been causing it and suggested switching to a soy-based infant formula.  I was reluctant to do so, mainly because soy-based formula costs more than milk-based formula, but I agreed to switch based on the doctor’s expert recommendation.

A study published back in 1988 by The American Academy of Pediatric Dentistry found that soy-based infant formulas contained significantly higher levels of fluoride than milk-based formulas.

Soy-based ready-to-feed and diluted liquid concentrate formulas were found to contain significantly higher levels of F than milk-based formulas. These findings, coupled with the potential bioavailability of the F in soy-based formulas, suggest that infants consuming soy-based (and some milk-based) formulas, along with supplemental dietary F, are receiving larger than optimum daily dosages of F, given currently defined norms for F dosage.

Fluoride Content of Infant Formulas: Soy-Based Formulas as a Potential Factor in Dental Fluorosis

Was it the Most Trusted Name in Baby and Toddler Foods?  

Over the years, I’ve researched dental fluorosis at length, but it wasn’t until this week, while researching ways to cosmetically address fluorosis stains, that something else jumped out at me—grape juice has some of the highest concentrations of fluoride.  Guess what my daughter’s favorite juice is?

When she was little, I used to buy these cute little Gerber White Grape Juice bottles.  They came in a 4-pack, and were the perfect size to pack in the diaper bag and take along on outings.  She loved them!  They were healthy (or so I thought at the time), convenient, and, of course, made by Gerber—the most trusted name in baby and toddler food in America.

And guess which juice of all the juices tested for fluoride concentrations had the highest concentration?  There it is, right at the top of the list—Gerber White Grape Juice.  The fluoride concentration in Gerber White Grape Juice is more than twice as high as the next highest juice in the list.

Fluoride ion concentration in commercial fruit juices and drinks
Product Name Company/Location Fluoride concentration (ppm F)
White Grape Gerber, Fremont, MI 6.80
White Grape Minute Maid, Houston, TX 3.00
Grape 100% Welch’s, Concord, MA 2.60
Tropical Blend Bcechnut, Canajoharie, NY 2.60
Grape Purity Supreme, Boston, MA 2.00
White Grape Welch’s, Concord, MA 1.95
Grape Stop & Shop, Boston, MA 1.94
Pineapple Minute Maid, Houston, TX 1.35
Apple I 00% Minute Maid, Houston, TX 1.30
Grape Welch’s, Concord, MA 1.28
Grape Minute Maid, Houston, TX 1.25
Apple-plum Hi-C, Houston, TX 1.25
Apple-grape Hi-C, Houston, TX 1.16
Cherryberry Rainbow, Hazelwood, MO 1.15
Peach Dole, San Francisco, CA 1.15
Grape Drink Rainbow, Hazelwood, MO 1.13
Fruit Apple 50% Welch’s, Concord, MA 1.09
Cranapple Ocean Spray, Middleboro, MA 1.08
Apple Cranberry Beechnut, Canajoharie, NY 0.96
Lemon-sparkler Sundance, Van Nuys, CA 0.78
Apple Ocean Spray, Middleboro, MA 0.78
Mixed Fruit Gerber, Fremont, MI 0.78
Natural Sour Cherry Sundance, Van Nuys, CA 0.70
Pear Stage I Beechnut, Canajoharie, NY 0.65
Cran Blueberry Ocean Spray, Middleboro, MA 0.62
Apple-Cherry Beechnut, Canajoharie, NY 0.52
Grape Beverage Tropicana, Brandenton, FL 0.47
Apple 100% Stop & Shop, Boston, MA 0.39
Grape 10% Hi-C, Houston, TX 0.35
Cran-raspberry Ocean Spray, Middleboro, MA 0.27
Cranberry Veryfine, Westford, MA 0.30
Apple 100% Mott’s, Stamford, CT 0.26
Prune Stop & Shop, Boston, MA 0.26
Apple 100% Mott’s, Stamford, CT 0.22
Mixed Fruit Beechnut, Canajoharie, NY 0.22
Orange Drink Tropicana, Brandenton, FL 0.20
Apple Stagel Beechnut, Canajoharie, NY 0.18
Prune Sunsweet, Pleasantown, CA 0.175
Apple 100% Veryfine, Westord, MA 0.16
Grape (artificial) Veryfine, Westford, MA 0.16
Cranberry Ocean Spray, Middleboro, MA 0.15
Fruit Punch Veryfine, Westford, MA 0.15

 

If I had known that the fluoride concentration in Gerber White Grape Juice was so high in fluoride I would have never given that juice to my precious little girl!  Hind sight is 20/20.  But at least now you know, and can avoid making the same mistakes I made.

giphy

“The only cause of dental fluorosis is fluoride consumption during childhood.

— Public Justice, NEMPHOS V. NESTLE WATERS NORTH AMERICA, INC., ET AL.

Companies like Gerber and Carnation Good Start that manufacture infant formula and juice should be transparent about potential hazards of the ingredients in their products (including the extremely high levels of fluoride in their products that have been shown to cause fluorosis, especially when mixed with fluoridated water).  These companies should at the very least label their products accordingly so that consumers can make truly informed choices.

David and Goliath

My daughter isn’t the only one to develop dental fluorosis from trusted infant formula and baby foods that contain high levels of fluoride.  In 2011, Michelle Nemphos sued Nestle, Gerber, and Dannon alleging they failed to warn consumers that their products contain exceedingly high concentrations of fluoride, and that this caused her daughter to develop dental fluorosis.  She was just a mom facing off against powerful corporations that had misled her and others.  Her case was thrown out.

Advertising like Nestle’s and Dannon’s, which induce consumers to purchase a product by touting an ingredient’s benefits without warning of that same ingredient’s known hazards, is generally prohibited by state tort and consumer protection laws.  Those laws allow wronged consumers to sue for injuries the product caused.

But lawsuits over damage caused by fluoride consumption might be thrown out due to federal preemption of laws governing food standards—meaning that any dental fluorosis lawsuits brought under state laws are wiped out by federal laws, leaving injured children without redress.  This is an unsupported expansion of the scope of federal preemption under the relevant federal laws and improperly removes health and safety regulations from the state’s authority, despite being traditionally reserved to the states.

That’s what the federal district court allowed to happen to Nemphos.

Nemphos attempted to recoup the high cost of her daughter’s dental care and sued on the child’s behalf in Maryland under state claims, as well as the Maryland Consumer Protection Act.  The MCPA prohibits manufacturers from making false and misleading statements.

The case is Nemphos v. Nestle Waters North America, Inc., et al.

But the federal trial court in Maryland dismissed the case, improperly holding that Nemphos’ claims are preempted by the federal Nutritional Labeling and Education Act.

The NLEA requires manufacturers to disclose the ingredients in food, but does not require safety warnings about those ingredients. The court held that the case was preempted because, by suing under Maryland’s MCPA, Nemphos was asking the court to enforce a state labeling standard different from the federal standard.

Public Justice, NEMPHOS V. NESTLE WATERS NORTH AMERICA, INC., ET AL.

10 Steps Can You Take To Prevent Fluorosis in Your Children

  1.  Choose breastfeeding over bottle feeding whenever possible.  A mother’s body filters fluoride out of her breast milk (mother’s milk is 0.004 ppm).  If you’re struggling with breastfeeding, consult a lactation consultant for help.  However, if you choose to use infant formula, keep in mind that soy-based formulas have the highest concentrations of fluoride; choose the best infant formula you can afford.
  2. Consider getting a reverse osmosis system or a water filter that filters out fluoride, particularly if you live in an area that adds fluoride to the city water, or if the levels of fluoride in your area are naturally high.  Keep in mind that reverse osmosis systems use a considerable amount of water (most RO systems use three gallons of water to make one gallon for drinking).  If you’re concerned about wasting water, this may not be the best option.  As a desert dweller, I try to be water wise, so I use a Berkey water filter instead of an RO system.
  3. Switch to fluoride-free toothpaste, or consider brushing with baking soda.  You may want to check out The Secret by Dr. Behm of Behm Natural Dentistry.
  4. Avoid purchasing juices on this list.  Consider buying only organic grape juice.
  5. Throw out your non-stick pots and pans and replace them with stainless steel, cast iron, or ceramic cookware.  Non-stick pots and pans can leech fluoride and other harmful chemicals into your foods when heated.
  6. Eat more fresh, whole foods.  As much as possible, purchase organic fruits and veggies.
  7. Don’t take Cipro or other fluorinated medications.
  8. If you drink tea, drink teas made from younger tea leaves.  Teas made from older tea leaves contain higher levels of fluoride.
  9. Avoid buying soft drinks, canned foods, and other highly processed foods.
  10. Avoid buying or feeding your children anything containing mechanically de-boned chicken.

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