In this newsletter, explore how to help Head Start programs support the use of fluoride for children and pregnant women. Learn why using fluoride is one of the safest and best ways to prevent tooth decay. Discover how people receive fluoride, tips for working with families, and program policies and procedures. There is also a list of resources, along with text that can be tailored for a family newsletter.

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Using fluoride is one of the safest and best ways to maintain oral health and prevent tooth decay. And the U.S. Surgeon General supports community water fluoridation and credits it with contributing to declines in the prevalence and severity of tooth decay. It is important for Head Start health managers, family service coordinators, and home visitors to help parents and pregnant women understand the benefits of fluoride. 

How People Receive Fluoride

Fluoride is an element found in nature, including soil, rocks, and plants. All water naturally has fluoride, but amounts vary. Since most water doesn’t have enough natural fluoride to prevent tooth decay, many towns and cities add fluoride to their water supplies. This is called “community water fluoridation.” Fluoride added to water supplies is regularly monitored by water operators and meets strict safety standards. Community water fluoridation is one of the nation’s greatest public health achievements. Thousands of studies have documented the safety and effectiveness of community water fluoridation.

Most people receive fluoride by drinking fluoridated tap water and consuming foods and beverages prepared with fluoridated water. This is the easiest way to benefit from fluoride because it is inexpensive and requires little or no effort. Drinking fluoridated tap water strengthens children’s permanent teeth that are still forming underneath the gum tissue. Fluoride supplements (tablets or drops) can be prescribed if the public water supply or well water has low levels of fluoride. These two types of fluoride (community water fluoridation and fluoride supplements) are called systemic fluoride because they are ingested.

Topical fluoride is applied to tooth surfaces to make them strong and resistant to tooth decay. Topical fluoride includes fluoride toothpaste, gels, and varnish. Oral health professionals can apply fluoride gels and varnish to tooth surfaces. InsureKidsNow.gov offers a Find a Dentist web page to help parents locate a dentist for their child. Users can enter their state, benefits plan, and location and then the site displays a list of nearby dentists.

In most but not all states, physicians, nurse practitioners, and other health professionals can also apply topical fluoride. The American Academy of Pediatrics maintains
a Caries Prevention Services Reimbursement Table on its Oral Health web page that identifies types of non-oral health professionals that can apply topical fluoride.

Fluoride in tap water has a topical as well as a systemic effect. When individuals drink fluoridated tap water, some of the fluoride goes into the body (systemic effect) and some goes into the saliva. Fluoridated saliva washes the teeth and makes them strong and more resistant to tooth decay (topical effect).

Fluoride Facts

Fluoride is the 13th most common element in the earth’s crust. It occurs naturally in groundwater, rocks, and soil.

Demonstration on the right way to brush teeth with propsProgram Policies and Procedures

Your program can do the following things to support the use of fluoride for children and pregnant women enrolled in Head Start:

  • Establish a policy stating that fluoride toothpaste will be used to promote oral hygiene in conjunction with meals by ensuring that Head Start staff and/or volunteers assist
    • Children under age 3 in brushing their teeth using a smear of fluoride toothpaste.
    • Children ages 3 and over in brushing their teeth using a pea-size amount of fluoride toothpaste.
  • Find out whether each child and pregnant woman on a fluoridated community water supply is drinking tap water; if they are not, determine why not.
  • Document that each child receives a topical fluoride application from an oral health professional or other health professional at least once every year.
  • Determine which children need and receive a prescription for fluoride supplements from an oral health professional or other health professional because their community water supply is not fluoridated at the optimal level.
  • Encourage Head Start programs to use bottled water with fluoride if the program’s water supply is not safe to drink or does not contain fluoride.

Children's toothbrushes lined up in a rackTips for Working with Families

Head Start health managers, family service coordinators, and home visitors can help parents understand the importance of fluoride in preventing tooth decay and how to use fluoride appropriately.

  • Help parents check the safety of water from private wells. Almost 15 percent of Americans get their drinking water from private wells, which are not subject to EPA standards for drinking water. Drinking well water should be tested once every year. If parents are concerned about the safety of their well water, they can find information on what to do on EPA’s Private Drinking Water Wells web page. Parents can also talk with local experts such as county or local health department officials, water well contractors, and public water supply officials about the best way to keep well water safe for drinking.
  • Explain to parents that fluoridated tap water is safe to drink. Some parents may be concerned that adding fluoride to the community water supply is not safe. Thousands of studies have found fluoridated tap water is safe to drink and effective at preventing tooth decay. Leading organizations, including the National Academy of Medicine (formerly the Institute of Medicine), the National Research Council, the American Academy of Pediatrics, the American Academy of Pediatric Dentistry, and the American Dental Association support the use of fluoride to protect children’s teeth. Ask parents about any concerns and talk about them. 
  • Using motivational interviewing is a good approach to address parents’ concerns. The Early Childhood Learning and Knowledge Center’s website offers many  useful resources, such as Using Motivational Interviewing Techniques to More Effectively Partner with Parents, that Head Start staff can use to engage parents of young children.
  • Teach parents about fluoride and fluoridated tap water. Many parents have heard about fluoride and fluoridated tap water but do not know fluoride prevents tooth decay. Putting up posters about fluoridated tap water can help motivate parents to talk about it and learn about it.

Fluoride Facts

Fluoride helps prevent tooth decay by making teeth stronger and more resistant to decay.

  • Explain to parents the benefits of drinking fluoridated tap water over bottled water. Most bottled water comes from springs or is treated tap water. This means bottled water may not have the benefits of fluoridated tap water. Manufacturers of bottled water are not required to indicate whether their product contains fluoride. Bottled water costs much more than tap water. However, bottled water is valuable to have for emergency situations, such as floods and earthquakes.
  • Help parents find out if their drinking water is fluoridated. Determine if their water comes from a community water system or a private well. To find out if a community’s water supply is fluoridated, check the Centers for Disease Control and Prevention’s My Water’s Fluoride web page. Another option is to call their state oral health program and ask if the community’s water supply is fluoridated. State oral health programs can also help parents with well water find out if their water is fluoridated at the optimal level. If the well water doesn’t have enough fluoride, encourage parents to talk to their child’s oral health professional or other health professional about fluoride supplements (tablets or drops) for their child.
  • Show parents how much fluoride toothpaste to put on their child’s toothbrush. For children under age 3, show parents how to put a smear of fluoride toothpaste on their child’s toothbrush. For children ages 3 and older, show parents how to put a pea-sized amount of fluoride toothpaste on their child’s toothbrush.
Smear sized amount of toothpaste on a toothbrush
Smear sized amount of toothpaste on a toothbrush
Pea sized amount of toothpaste on a child's toothbrush
Pea sized amount of toothpaste on a child's toothbrush


Resources on ECKLC

Other Resources

Common Questions About Fluoride: A Resource for Parents and Caregivers (English and Spanish)

Community Water Fluoridation (website)

Fluoride: Cavity Fighter (poster available in English and Spanish)

Fluoride Prevents Cavities: Get It from the Tap (poster available in English and Spanish)

Give a Kid a Healthy Smile: Use Fluoride! (poster available in English and Spanish)

Increasing Access to Drinking Water and Other Healthier Beverages in Early Care and Education Settings

Say This, Not That: Tips for Talking About Community Water Fluoridation (tip sheet available in English and Spanish)

Why Do Children Need Fluoride? (poster available in English and Spanish)

B is for Brushing PosterFor Your Family Newsletter

You can tailor the following to include in your family newsletter.

Did you know fluoride is a safe and proven way to strengthen teeth for people of all ages? Fluoride occurs naturally and is found in rocks, soil, and water. It can also be found in foods and drinks prepared with fluoridated tap (faucet) water and in toothpaste. Young children can benefit the most from fluoride because it strengthens their permanent teeth forming underneath their gum tissue. 

Brushing your child’s teeth with fluoride toothpaste twice a day is one of the most important ways to prevent tooth decay. Because your child may not have the skills to brush his or her teeth thoroughly, you should supervise brushing or help your child brush. Children do not have the manual dexterity they need to brush their own teeth well until they are able to tie their own shoelaces, usually around age 7 or 8.

If your child is under age 3, put a smear of fluoride toothpaste on the toothbrush. If your child is over age 3, put a pea-size amount of toothpaste on the toothbrush. Make sure your child spits out the remaining toothpaste once brushing is done. Keep your child from rinsing after brushing so the fluoride has time to soak into the outer layer of the tooth.

This will make teeth stronger. Fluoride varnish can be applied to children’s teeth by an oral health professional or other health professional, such as a pediatrician or nurse practitioner.

Giving your child fluoridated tap water and foods and drinks made with fluoridated tap water is also a great way to prevent tooth decay. There are no added oral health benefits to drinking bottled water. In fact, most bottled water does not contain enough fluoride to prevent tooth decay. Drinking tap water with the right amount of fluoride is better and cheaper than drinking bottled water.

Topic:Oral Health

Resource Type: Publication

Last Updated: October 23, 2018