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Main Page Site Index Getting Pregnant Pregnancy Parenting Pregnancy and Parenting Journals Fertility Nutrition Pregnant Moms Morning Sickness Women's Health Child Health	Considering Fluoride Concentrations in Commercial Juice Drinks By Kimberly A. Loos, D.D.S. and Brad J. Loos Key Points from the Article that Follows: Too little fluoride does not provide adequate cavity-fighting protection. Too much fluoride may cause harmful dental fluorosis. The severity of dental fluorosis depends on the total amount of fluoride consumed. The fluoride concentration in fruit juices are highly variable. Orange juice, pineapple juice, fruit nectars, and lemonade have relatively low fluoride concentrations. Prune, grapefruit, cranberry, pear, cherry, and mixed fruit drinks generally have more variable fluoride concentrations. The volume of juice consumed is also an important consideration in determining fluoride intake. The type and amount of juice consumed is important for parents and dentists to consider to protect children's teeth from cavities and dental fluorosis. Introduction: Today American children have fewer cavities primarily due to sealants, fluoride toothpastes, fluoride supplements and fluoridated water. It is projected that about one-half of the children entering kindergarten in the United States in 1997 will be cavity-free. However, this good news is tempered by the fact that cases of dental fluorosis in North America increase up to 65 percent in some areas where water is fluoridated. Dental fluorosis occurs when excessive amounts of fluoride are ingested during the early period of tooth development. Mild cases are exemplified by small opaque areas on the tooth surface. Severe cases include confluent pitting and brown stains on all tooth surfaces. It is the cumulative amount of fluoride swallowed from water, toothpaste, supplements, and other sources that determine if fluorosis will occur. Recent Studies: Some studies suggest that children are now drinking less water and consuming more sodas and juices. On average, children less than a year old drink 3 ounces of juices and beverages per day. Children ages 1 to 2 years drink about 9 oz. while children ages 3 to 5 years old drink about 11 oz. Where does your child fit in this trend? If a child drinks more juice, are they more likely to get cavities? Are they less likely to suffer from dental fluorosis? One exceptional study by Kiritsy et al., (1996) examined the fluoride concentrations in 532 juices and juice-flavored drinks. Fluoride ion concentrations varied from 0.02 to 2.80 parts per million (ppm). This is a very large range! This difference is due to several factors including the fluoride concentration in the water at the location where the juices are made. Parents and dentists should consider the type and amount of fruit juice consumed by children to insure that correct levels of cavity-fighting fluoride protection are achieved while the risk of developing dental fluorosis is minimized. Study Results: Fluoride concentrations of 0.60 to 1.00 ppm are generally considered safe and effective at reducing cavities without causing dental fluorosis. One alarming find of the Kiritsy et al., (1996) study was that almost 20 percent of the juices examined had fluoride concentrations above 1.00 ppm! White grape juices had the highest average value of 1.45 ppm. This may be due to the insecticides sprayed on the grapes because many grape juices do not have fluoridated water added. Grape juices prepared after the skin had been removed from the grapes had no detectable fluoride! Prune, cranberry, tea, red grape, cherry and apple-grape juices all had average fluoride concentrations above 0.60 ppm. The fluoride concentration in some juices may be an important factor in developing dental fluorosis. Apple juice is usually processed locally and then shipped around the United States. Other juices are purchased at one location and have water added at various other sites. The amount of fluoride in the water may vary from location to location. This causes variation in the amount of fluoride in the same type of juice made by the same manufacturer. We found no studies that showed a large difference in fluoride concentrations when frozen concentrate and ready-to-drink juices were compared. Kiritsy et al., (1996) found that the fluoride content of powdered drinks like Tang® and Kool-Aid® were very small when they were reconstituted with deionized water. If you live in an area where your water is optimally fluoridated, these powered drinks probably contain the correct amount of fluoride after they are mixed with tap water. For answers to common questions regarding fluoride use see Fluorides: Questions and answers and Ask the Dentist - Fluoride Issues. References: Levy et al., "FLUORIDE LEVELS OF READY-TO-FEED JUICES AND JUICE DRINKS" Journal of Dental Research (1993) 72(ABSTR. SPEC. ISSUE):234. Kiritsy et al., "ASSESSING FLUORIDE CONCENTRATIONS OF JUICES AND JUICE-FLAVORED DRINKS" Journal of the American Dental Association (1996) 127(7):895. Nathanson et al., "EFFECT OF FLUORIDE PRE-TREATMENT OR RE-HARDENING WITH CALCIFYING SOLUTIONS ON ENAMEL SOFTENED BY ORANGE JUICE" Journal of Dental Research (1973) 52(3):625. Gedalia et al., "FLUORIDE EFFECTS ON DE-MINERALIZATION AND RE-MINERALIZATION OF ENAMEL SOFTENED BY ORANGE JUICE" Journal of Dental Research (1973) 52(3):588. Graubart et al., "EFFECTS OF FLUORIDE PRE-TREATMENT IN-VITRO ON HUMAN TEETH EXPOSED TO CITRUS JUICE" Journal of Dental Research (1972) 51(6):1677. You can find out more information about your and your child's dental health by visiting the website below! Visit the Boyden/Loos Dental Practice Homepage