Sources of Dietary Fluoride Intake in 6–7‐Year‐Old English Children Receiving Optimally, Sub‐optimally, and Non‐fluoridated water

Objectives: Due to increased consumption of pre‐packaged drinks, tap water may no longer be the principal source of water intake and consequently fluoride intake. Little is known about the importance of solid foods as fluoride sources and how the relative contribution of foods/drinks to fluoride intake is affected by residing in fluoridated or non‐fluoridated areas. This study investigated the relative contributions of different dietary sources to dietary fluoride intake and compared this in children residing in optimally artificially fluoridated, sub‐optimally artificially fluoridated, and non‐fluoridated areas. Methods: Thirty‐three healthy children aged 6 years were recruited from fluoridated and non‐fluoridated communities and categorised into three groups based on fluoride content of home tap water: optimally fluoridated (<0.7 mgF/L), sub‐optimally fluoridated (>0.3 to <0.7 mgF/L) and non‐fluoridated (<0.3 mgF/L) drinking water. A 3‐day dietary diary collected dietary information. Samples of foods/drinks consumed were collected and analyzed for fluoride content. Results: Drinks provided 59%, 55% and 32% of dietary fluoride intake in optimally, sub‐optimally and non‐fluoridated areas respectively. Tap water, fruit squashes and cordials (extremely sweet non‐alcoholic fruit flavoured drink concentrates) prepared with tap water, as well as cooked rice, pasta and vegetables were important sources of fluoride in optimally and sub‐optimally fluoridated areas. Carbonated soft drinks and bread were the most important contributors to dietary fluoride intake in the non‐fluoridated area. Conclusion: The main contributory sources to dietary fluoride differ between fluoridated and non‐fluoridated areas. Estimating total fluoride intake from levels of fluoride in tap water alone is unlikely to provide a reliable quantitative measure of intake. Studies monitoring dietary fluoride exposure should consider intake from all foods and drinks.