Fluoride Exposure for Fetal and Infants 0-6 Months. Fluoride Action Network Pesticide Project.

FLUORIDE ACTION NETWORK PESTICIDE PROJECT

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2. FOOD Exposure
2.1. Food Exposure via Pesticide: CRYOLITE
2.2. Food Exposure via Pesticidal Fumigant: SULFURYL FLUORIDE
2.3. Food Exposure via ANTIMICROBIAL FORMULATIONS - FOOD CONTACT SURFACE SANITIZING SOLUTIONS
2.4. Food Exposure via Pesticides: EPA "INERTS"
2.5. Food Exposure via Pesticides: NEW PROPOSAL FOR TOLERANCE EXEMPTIONS
3. Exposure via Dental and Pharmaceuticals
4. Exposure from INDUSTRIAL ACTIVITY
4.1. U.S. Manufacturers of Hydrogen Fluoride, Fluorine, Sodium Fluoride, Fluosilicic Acid, and Sodium Silicofluoride
5. Fluoride Exposure: Various Other Sources

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TABLE 1.
Fluoride Exposure for FETAL AND INFANTS: 0–6 MONTHS

Only applicable for infants that are exclusively breast fed

Route Estimated F Level Reference

Human Milk - exclusively breast fed and consuming 170 mL/kg-day 2 µg/kg-day REF. 1

Human Milk - in women living in an area with high levels of naturally occurring fluoride (1–7 ppm) 5–10 µg/L REF. 2

Formula reconstituted with Fluorindated Drinking Water 102 to 167 µg/kg-day REF. 3

Bottled Water for baby formula that is specifically fluorinated. One examle: In the US, Beech-Nut Bottled Water with added Fluoride "can be mixed with formula, cereal and juice, or as drinking water." ? REF. 4

Placenta transfer ? REF. 5

Ref. 1.
-- Page 231. Fluoride intake in infants depends on whether the child is nursed or not. Human breast milk contains very little fluoride (about 0.5 µmol/L or 0.01 mg/L) and provides <0.01 mg fluoride/day (NRC 1993). Fluoride intake by an infant who is exclusively breast fed and consuming 170 mL/kg-day is generally <2 µg/kg-day (Fomon and Ekstrand 1999). Levy et al. (2001) found that for most children, water fluoride intake was the predominant source of fluoride, especially through age 12 months. This was due in large part to children receiving fluoridated water mixed with infant formula concentrate (Levy et al. 1995b, 2001).
Ref: TOXICOLOGICAL PROFILE FOR FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service. Agency for Toxic Substances and Disease Registry. September 2003 (published March 2004).
http://www.atsdr.cdc.gov/toxprofiles/tp11.pdf

Ref. 2.
-- Page 143-144. In humans, fluoride is poorly transferred from plasma to milk (Ekstrand et al. 1981c, 1984b; Esala et al. 1982; Spak et al. 1983). A single dose of 1.5 mg sodium fluoride did not result in a significant rise in fluoride breast milk concentrations within 3 hours of the exposure (Ekstrand et al. 1981c). Although no linear correlation between fluoride levels in tap water and fluoride levels in breast milk has been found, significantly higher breast milk fluoride concentrations were found in women living in an area with high levels of naturally occurring fluoride (1–7 ppm) as compared to women in areas with low fluoride levels in tap water (0.2 ppm) (Esala et al. 1982). Fluoride levels in human milk of 5–10 µg/L have been measured (Fomon and Ekstrand 1999).
Ref: TOXICOLOGICAL PROFILE FOR FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service. Agency for Toxic Substances and Disease Registry. September 2003 (published March 2004).
http://www.atsdr.cdc.gov/toxprofiles/tp11.pdf

Ref. 3.
-- Page 206. Fluoride intake in infants depends on whether or not the child is nursed. Fluoride intake by an infant who is exclusively breast fed is generally <2 µg/kg-day(Fomon and Ekstrand 1999). Levy et al. (2001) found that for most children, water fluoride intake was the predominant source of fluoride, especially through age 12 months. This was due in large part to children receiving fluoridated water mixed with infant formula concentrate (Levy et al. 1995b, 2001). Fluoride exposure was calculated to be 102, 105, and 167 µg/kg-day for infants consuming concentrated liquid milk-based formula, concentrated liquid isolated soy protein-based formula, and powdered milk-based formula, respectively, which were diluted with water that is 1 ppm in fluoride. Infants may be exposed to higher fluoride concentrations now than in the past. In the 1960s, nearly 80% of infants were fed cow's milk by 6 months of age. In 1991, 80% of 6-month-old infants were fed formula (Fomon and Ekstrand 1999).
Ref: TOXICOLOGICAL PROFILE FOR FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service. Agency for Toxic Substances and Disease Registry. September 2003 (published March 2004).
http://www.atsdr.cdc.gov/toxprofiles/tp11.pdf

Ref. 4. for Beech Nut. Online July 25, 2004:
http://www.beechnut.com/Caring%20For%20Baby/nutrition%20tips/Articles/NT_articles_BigDealLittleTeeth.asp

Ref. 5.
-- Page 143. Human and animal studies have shown that fluoride is readily transferred across the placenta. There appears to be a direct relationship between maternal blood fluoride levels and cord blood fluoride levels (Armstrong et al. 1970; Gupta et al. 1993; Malhotra et al. 1993; Shen and Taves 1974). At relatively low maternal blood levels, the cord blood levels were at least 60% of that of maternal blood (Brambilla et al. 1994; Gupta et al. 1993). Although cord fluoride levels were typically lower than maternal levels, one study found no statistical difference between maternal and newborn (1 day old) serum fluoride levels (Shimonovitz et al. 1995). However, a partial placental barrier may exist at high maternal fluoride levels. At higher maternal blood levels, the cord to maternal fluoride ratio is lower than at lower maternal fluoride levels (Gupta et al. 1993). Another study found that the use of fluoride supplements markedly increased placental fluoride levels, while fluoride levels in fetal blood remained relatively constant, suggesting that the placenta can regulate the transfer of fluoride from maternal blood to fetal blood (Gedalia 1970). Animal studies also demonstrate that maternal fluoride exposure also results in increased levels of fluoride in fetal teeth and bones (Bawden et al. 1992b; Nedeljkovi c´ and Matovi c´ 1991; Theuer et al. 1971).
Ref: TOXICOLOGICAL PROFILE FOR FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service. Agency for Toxic Substances and Disease Registry. September 2003 (published March 2004).
http://www.atsdr.cdc.gov/toxprofiles/tp11.pdf

The Food and Nutrition Board of the Institute of Medicine has developed adequate intakes (AIs) for fluoride. The AI is the “estimated fluoride intake that has been shown to reduce the occurrence of dental caries maximally in a population without causing unwanted side effects including moderate dental fluorosis.” The AIs for each age group are presented in Table 2-1. (pages 15-16, Ref 1)

Table 2-1. Adequate Intake Levels for Fluoride a

Age range Adequate intake level (mg/day) Adequate intake level (mg/kg/day)b

0–6 months 0.01 0.0014

6–12 months 0.5 0.056

1–3 years 0.7 0.054

4–8 years 1 0.045

9–13 years
(males and females) 2 0.05

14–18 years (males) 3 0.046

14–18 years (females) 3 0.053

>18 years (males) 4 0.052

>18 years (females) 3 0.049

a Source: IOM 1997 b mg/kg/day doses were calculated by using reference body weights reported by IOM (1997)
b mg/kg/day doses were calculated by using reference body weights reported by IOM (1997)

Reference:
September 2003 (published March 2004). TOXICOLOGICAL PROFILE FOR
FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service. Agency for Toxic Substances and Disease Registry. http://www.atsdr.cdc.gov/toxprofiles/tp11.pdf

TABLE 1. Fluoride Exposure for FETAL AND INFANTS: 0–6 MONTHS Only applicable for infants that are exclusively breast fed
Route	Estimated F Level	Reference
Human Milk - exclusively breast fed and consuming 170 mL/kg-day	2 µg/kg-day	REF. 1
Human Milk - in women living in an area with high levels of naturally occurring fluoride (1–7 ppm)	5–10 µg/L	REF. 2
Formula reconstituted with Fluorindated Drinking Water	102 to 167 µg/kg-day	REF. 3
Bottled Water for baby formula that is specifically fluorinated. One examle: In the US, Beech-Nut Bottled Water with added Fluoride "can be mixed with formula, cereal and juice, or as drinking water."	?	REF. 4
Placenta transfer	?	REF. 5

Ref. 1. -- Page 231. Fluoride intake in infants depends on whether the child is nursed or not. Human breast milk contains very little fluoride (about 0.5 µmol/L or 0.01 mg/L) and provides <0.01 mg fluoride/day (NRC 1993). Fluoride intake by an infant who is exclusively breast fed and consuming 170 mL/kg-day is generally <2 µg/kg-day (Fomon and Ekstrand 1999). Levy et al. (2001) found that for most children, water fluoride intake was the predominant source of fluoride, especially through age 12 months. This was due in large part to children receiving fluoridated water mixed with infant formula concentrate (Levy et al. 1995b, 2001). Ref: TOXICOLOGICAL PROFILE FOR FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service. Agency for Toxic Substances and Disease Registry. September 2003 (published March 2004). http://www.atsdr.cdc.gov/toxprofiles/tp11.pdf
Ref. 2. -- Page 143-144. In humans, fluoride is poorly transferred from plasma to milk (Ekstrand et al. 1981c, 1984b; Esala et al. 1982; Spak et al. 1983). A single dose of 1.5 mg sodium fluoride did not result in a significant rise in fluoride breast milk concentrations within 3 hours of the exposure (Ekstrand et al. 1981c). Although no linear correlation between fluoride levels in tap water and fluoride levels in breast milk has been found, significantly higher breast milk fluoride concentrations were found in women living in an area with high levels of naturally occurring fluoride (1–7 ppm) as compared to women in areas with low fluoride levels in tap water (0.2 ppm) (Esala et al. 1982). Fluoride levels in human milk of 5–10 µg/L have been measured (Fomon and Ekstrand 1999). Ref: TOXICOLOGICAL PROFILE FOR FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service. Agency for Toxic Substances and Disease Registry. September 2003 (published March 2004). http://www.atsdr.cdc.gov/toxprofiles/tp11.pdf
Ref. 3. -- Page 206. Fluoride intake in infants depends on whether or not the child is nursed. Fluoride intake by an infant who is exclusively breast fed is generally <2 µg/kg-day(Fomon and Ekstrand 1999). Levy et al. (2001) found that for most children, water fluoride intake was the predominant source of fluoride, especially through age 12 months. This was due in large part to children receiving fluoridated water mixed with infant formula concentrate (Levy et al. 1995b, 2001). Fluoride exposure was calculated to be 102, 105, and 167 µg/kg-day for infants consuming concentrated liquid milk-based formula, concentrated liquid isolated soy protein-based formula, and powdered milk-based formula, respectively, which were diluted with water that is 1 ppm in fluoride. Infants may be exposed to higher fluoride concentrations now than in the past. In the 1960s, nearly 80% of infants were fed cow's milk by 6 months of age. In 1991, 80% of 6-month-old infants were fed formula (Fomon and Ekstrand 1999). Ref: TOXICOLOGICAL PROFILE FOR FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service. Agency for Toxic Substances and Disease Registry. September 2003 (published March 2004). http://www.atsdr.cdc.gov/toxprofiles/tp11.pdf
Ref. 4. for Beech Nut. Online July 25, 2004: http://www.beechnut.com/Caring%20For%20Baby/nutrition%20tips/Articles/NT_articles_BigDealLittleTeeth.asp
Ref. 5. -- Page 143. Human and animal studies have shown that fluoride is readily transferred across the placenta. There appears to be a direct relationship between maternal blood fluoride levels and cord blood fluoride levels (Armstrong et al. 1970; Gupta et al. 1993; Malhotra et al. 1993; Shen and Taves 1974). At relatively low maternal blood levels, the cord blood levels were at least 60% of that of maternal blood (Brambilla et al. 1994; Gupta et al. 1993). Although cord fluoride levels were typically lower than maternal levels, one study found no statistical difference between maternal and newborn (1 day old) serum fluoride levels (Shimonovitz et al. 1995). However, a partial placental barrier may exist at high maternal fluoride levels. At higher maternal blood levels, the cord to maternal fluoride ratio is lower than at lower maternal fluoride levels (Gupta et al. 1993). Another study found that the use of fluoride supplements markedly increased placental fluoride levels, while fluoride levels in fetal blood remained relatively constant, suggesting that the placenta can regulate the transfer of fluoride from maternal blood to fetal blood (Gedalia 1970). Animal studies also demonstrate that maternal fluoride exposure also results in increased levels of fluoride in fetal teeth and bones (Bawden et al. 1992b; Nedeljkovi c´ and Matovi c´ 1991; Theuer et al. 1971). Ref: TOXICOLOGICAL PROFILE FOR FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service. Agency for Toxic Substances and Disease Registry. September 2003 (published March 2004). http://www.atsdr.cdc.gov/toxprofiles/tp11.pdf

The Food and Nutrition Board of the Institute of Medicine has developed adequate intakes (AIs) for fluoride. The AI is the “estimated fluoride intake that has been shown to reduce the occurrence of dental caries maximally in a population without causing unwanted side effects including moderate dental fluorosis.” The AIs for each age group are presented in Table 2-1. (pages 15-16, Ref 1)
Table 2-1. Adequate Intake Levels for Fluoride a
Age range	Adequate intake level (mg/day)	Adequate intake level (mg/kg/day)b
0–6 months	0.01	0.0014
6–12 months	0.5	0.056
1–3 years	0.7	0.054
4–8 years	1	0.045
9–13 years (males and females)	2	0.05
14–18 years (males)	3	0.046
14–18 years (females)	3	0.053
>18 years (males)	4	0.052
>18 years (females)	3	0.049
a Source: IOM 1997 b mg/kg/day doses were calculated by using reference body weights reported by IOM (1997) b mg/kg/day doses were calculated by using reference body weights reported by IOM (1997)
Reference: September 2003 (published March 2004). TOXICOLOGICAL PROFILE FOR FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service. Agency for Toxic Substances and Disease Registry. http://www.atsdr.cdc.gov/toxprofiles/tp11.pdf