In addition to fluoridated water and fluoride treatments received in dental offices, patients may receive fluoride from other sources. These are not typically major sources of fluoride for most people, but they do contribute to total daily fluoride consumption levels. Use of fluoridated water in addition to fluoride from other sources (such as topical fluoride products) is recommended by the Centers for Disease Control and Prevention (CDC) as part of a good dental hygiene program for all age groups. 

Additional forms of fluoride are either topically applied or ingested. It is important not to eat or drink for at least 30 minutes after topical application of fluoride to maximize its contact with teeth. When purchasing over-the-counter fluoride products, it is important to look for the American Dental Association Seal of Acceptance.   

Additional sources of fluoride include:

• Toothpaste with fluoride. Available over-the-counter and recommended for use by adults and children over 2 years old. Typically advised for use twice a day while brushing teeth.
  
  
• Mouth rinse with fluoride. Available over-the-counter and by prescription in higher strengths. Recommended for anyone over the age of 6 years (due to the risk of swallowing). Teeth should be cleaned by brushing and flossing prior to use. These mouth rinses may be especially helpful for patients with braces or other dental appliances that can trap bacteria, making removal by brushing alone difficult. Mouth rinses with fluoride may be used daily or weekly.
  
  
• Fluoride gels. Available by prescription and recommended for people at high risk of tooth decay (e.g., people with a history of cavities, inadequate dental hygiene or dental visits, poor diet). Fluoride gels are usually applied with a toothbrush.
  
  
• Fluoride supplements. Available by prescription in tablet, liquid or lozenge form. Supplements are recommended for children between the ages of 6 months and 16 years who do not receive adequate levels of fluoride in the water they drink. These are typically based on a child’s age and the amount of fluoride ingested through other sources. Supplements should be taken every day. Liquid forms may be dropped directly in the mouth, or mixed with food or beverages. Tablets and lozenges are designed to be chewed or sucked for a minute or two before being swallowed.

Fluoride is also found in many different types of food and beverages. Anything cooked in or processed with fluoridated water will contain some fluoride. Levels of fluoride in these products may occur at levels similar to that found in fluoridated water (0.7 to 1.2 parts per million). Meat, fish (including bones), seafood, eggs, green/leafy vegetables and fruit may contain fluoride. Beverages such as fruit juice, tea (including iced tea) and bottled water may also contain fluoride. In addition, cooking with Teflon-coated or aluminum pans may add fluoride to foods.

Some bottled water may have fluoride added to it. Companies that add fluoride to the water are required to list the amount on the label. However, companies are not required to put this information on their label if it comes from natural sources and is not added to the water. Patients, caregivers or parents concerned about fluoride levels should check with the manufacturer about possible fluoride levels in bottled water. The Food and Drug Administration (FDA) is responsible for regulating fluoride in beverages (e.g., bottled water). Some fluoridated bottle water products may be labeled with a health claim that fluoride may reduce the risk of tooth decay.