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Dose recs
Infant fluoride and the OptiDose® dropper - by Ray Grogan


* Powdered formula plus fluoridated water supplies about 2 times the infants need. Even with no supplement there is a slight risk of mild fluorosis if under 3 mos. To get the fluoride intake perfect when using powdered formula, use a commercial baby water. (Examples: Beech-Nut® Spring Water with Fluoride, Hinkley Springs Nursery® Water. Dependable sources are big stores like K-Mart (with other baby stuff) and Wal-Mart (with other waters). All of these have about .5 mg F, which is about half the strength of fluoridated water. Overall this is one of the easiest and best methods of getting perfect fluoride.) Or mix fluoridated water 50-50 with bottled water, or alternate, etc.)  (An easy mistake to make when using powdered formula is to assume the child spends all day at home. Check water fluoride levels at day care, etc.)


** Over age 3 years fluoride does not affect the appearance of any teeth that really show. For caries control keep the total fluoride intake from water and supplements at roughly .033 mgF/kg. An 8 oz glass of 1 ppm F water is about .25 mg F. Most children drink about 1-2 glasses per day. At about age 3 years (33 pounds) use .25 mg F in fluoridated areas, and .5 mg F in moderate and low fluoride areas.


*** We do not make a .0165 dropper yet (and this may end up a .011 dropper for other reasons, call for the current situation). For now there are 2 ways you can fake it. The first way is to dilute the fluoride to the right concentration. (I suggest you do the mixing for the parents.) The main brands have both a plain and a fluoridated vitamin. For example, Mead Johnson makes Tri-Vi-Sol® (plain vits, no fluoride) and Tri-Vi-Flor® (vits and fluoride) (the fluoride comes in several strengths, get the .25 mg F/ML). Buy one of each (one plain and one with fluoride) and mix them 50-50 in a paper cup, then pour back into the bottles and use normally. Mark the bottles .125 mg F/1 ML. This way is harder up front, then easy. The second way is easy up front but far easier to make a mistake later. You could use the .033 dropper at 1/2 weight. For example, when the child weighs 10 pounds fill dropper to 5 pounds. I suspect most parents would do this wrong even if you put a prominent sticker on the bottle, and I don't really recommend it.


**** Breast fed infants in fluoridated areas are tricky because you can set them up assuming no consumption of the water, and then the parent shifts to powdered formula. However, it takes about 2 months to make a mild spot big enough to see, and even then only in about 20% of the children. I think it is worth it to supplement as long as the parents come in often and you review the feeding methods each time.