Written in collaboration Dr. Rebecca Pikos, Board-Certified Pediatric Dentist, and Dr. Rosana Lastra, Board-Certified Pediatrician.
Starting July 1st, the state of Florida will begin removing fluoride from public water systems—a move that has raised a lot of questions for families across the state (CNN, May 2025). If you're a parent, you might be wondering: what now? How do I protect my child’s teeth without that daily dose of fluoride in their drinking water?
As a pediatrician here in Florida, I’ve been hearing this question a lot lately—and I’m not alone. Pediatric dentist Dr. Rebecca Pikos and I have both been hearing it from parents, so we teamed up to break it down and share what it means for your family, along with tips to keep your child’s teeth healthy and strong.
Fluoride is a naturally occurring mineral that strengthens enamel and helps prevent cavities. For over 70 years, it's been added to many U.S. municipal water systems to safely reduce dental decay—especially in children.
In fact, according to the American Academy of Pediatric Dentist (AAPD), community water fluoridation reduces tooth decay by 26% in permanent teeth and 35% in primary (baby) teeth. 👉 Source AAPD Fluoride Policy
If your local water supply no longer contains fluoride, your child can still benefit from it in other ways:
Here are five key steps that Dr. Pikos and I recommend:
✅ 1. Use Fluoridated Toothpaste (Even for Babies! Even if your child cannot spit!)
Help your child brush until they are around 6-7 years old and can do it thoroughly on their own. Children younger than 6 years old should not brush their teeth alone because they typically lack the manual dexterity, judgment, and awareness needed to brush effectively and safely. Even at the age of 6-7, supervision is still suggested.
✅ 2. Get Fluoride Varnish Starting Early
Fluoride varnish can be applied as soon as your baby’s first tooth erupts, often before their first birthday.
Many pediatricians provide this service at well visits. If not, your pediatric dentist can apply it. It's quick, painless, and highly effective. This can be done 4 times a year. If you’re getting fluoride varnish at both your pediatrician and pediatric dentist, keep track of when it is applied, as to not exceed 4x/year.
✅ 3. Use Fluoride Supplements (When Appropriate)
Fluoride supplements may be considered for high-risk children, especially now that water is no longer a source.
⚠️ These are not for everyone and should be discussed with your pediatrician and/or pediatric dentist before starting. Before considering prescription fluoride drops or tablets, it is essential to first identify the child’s age, the primary drinking water source, review naturally occurring fluoride levels using Consumer Confidence Reports, and, if necessary, conduct direct testing of the water.
⚠️ Additionally, the FDA began the process in May 2025, with a scheduled safety review and public comment period to conclude by October 31, 2025, after which manufacturers may be asked to voluntarily withdraw the products at that time, and fluoride supplementation will no longer be available. 👉 Source ADA News
✅ 4. Visit the Dentist Early—and Regularly
The AAP and AAPD recommend a first dental visit by age 1, but many families benefit from going even earlier—around 9 months or as soon as the first tooth erupts. After that, aim for visits every 6 months, or every 3 months for higher-risk children.
✅ 5. Ask About Prescription-Strength Fluoride Toothpaste
If your child has early signs of decay, visible plaque, or a history of cavities, your dentist may recommend a prescription higher-concentration fluoride toothpaste for added protection if your child is 6 years of age or older.
Without fluoride in your water, cutting out high-risk foods and drinks is even more important. Here’s what to watch for:
🥛 Milk in a Bottle Overnight
Offer only water at bedtime! If your child drinks milk before sleep—or wakes up for milk during the night—make sure to brush afterward. Milk sugars sitting on teeth overnight feed cavity-causing bacteria.
🧃Juice
The AAP recommends no juice before age 1, and no more than 4 oz/day after that—but zero juice is best, especially without fluoride protection. Juice is acidic, sugary, and offers no nutritional advantage over whole fruit.
🥤Sugar-Sweetened Beverages (SSBs)
Say no to:
SSBs feed oral bacteria that produce acid, attacking tooth enamel and causing cavities. Frequent sipping—especially from bottles or sippy cups—extends acid exposure and harms developing teeth more.
🍪 Snack Smart with Tooth-Friendly Foods
Swap out sticky snacks like gummies, crackers, and raisins for tooth-friendly options like cheese, apples, cucumber slices, or nuts. These snacks don’t cling to teeth and help reduce the risk of cavities
💧 Pro Tip:
In sippy cups and easy-to-use containers such as straw cups, give kids WATER only.
Some families were fluoride-free long before this change—whether by choice or because they use reverse osmosis (RO) or distillation filtration systems, which remove fluoride from drinking water, or drink primarily bottled water. Additionally, some families elect for non-fluoridated toothpaste by choice.
If that’s you, here’s what to know: If your child has already been fluoride-free and has no history of cavities, optimal oral hygiene routines, consumes a low-caries risk diet, and visits the dentist regularly ...then continuing fluoride-free may be reasonable—but should always be discussed with your dentist.
Hydroxyapatite is a mineral form of calcium that makes up 97% of natural tooth enamel. It’s used in some toothpastes to remineralize enamel and protect teeth in a way that mimics the body’s natural processes. Nano-hydroxyapatite (Nano-HP) is the recommended form, as the ultra-small particle size can easily penetrate and fill initial cavities.
One of the biggest advantages is that hydroxyapatite is safe to swallow, and doesn’t carry the same concerns some parents have about fluoride ingestion in very young children.
Several studies support hydroxyapatite as an effective alternative:
While fluoride remains the AAP’s gold standard for caries prevention (AAP Clinical Report), hydroxyapatite is emerging as a credible and safe alternative for low-risk children and fluoride-conscious families—when paired with excellent brushing habits and regular dental care.
The AAPD currently has no official policy on hydroxyapatite in pediatric dental care. While hydroxyapatite-containing products are increasingly recognized as promising adjuncts or alternatives, fluoride continues to be suggested.
Want to give your child’s teeth the best defense? Here are our recommendations:
🦷✨ Toothpaste Power Combo – Use a toothpaste that contains both fluoride and nano-hydroxyapatite for the best of both worlds when it comes to remineralizing and protecting enamel.
→ Check out SuperMouth – use code shinyhappysmiles for 10% off!
💦 Mouthspray or Baking Soda Rinse – A pH-balancing spray (or a simple baking soda + water swish) can help neutralize acids in the mouth—especially helpful after snacks.
🚫 Skip the Mouthwash After Brushing – Mouthwash has a lower fluoride concentration than toothpaste and can actually rinse away those protective benefits if used right after brushing.
→If you do choose to use it, do it BEFORE brushing. Mouthwash is most beneficial when used at times when brushing isn’t possible—like after a snack or after school.
🧵 FLOSS, FLOSS, FLOSS! – No substitute here! Water flossers and picks aren’t as effective.
→ Use traditional floss or dental picks on any teeth that touch. Research indicates that up to 60-70% of caries in school-aged children occur where teeth touch- floss any teeth that touch as soon as they touch! 👉 Source Pubmed
My kids are obsessed with these fun animal-shaped ones [HERE].
While not every state is removing fluoride from water, Florida's change is significant—and it's worth knowing how to adapt.
🪥 Consistent brushing and flossing
🦷 Early dental care
🍎 A low-risk diet
🤝 And a great partnership with your pediatrician and pediatric dentist
If you’re unsure what Florida’s fluoride changes mean for your child—or whether fluoride is necessary—I’ve created a free guide just for you.“Navigating Fluoride: A Pediatrician’s Guide” breaks down what fluoride actually does, how to assess your child’s needs, what to ask your doctor or dentist, and how to stay in control of your child’s oral health—no matter what’s happening with public water.
About Dr. Rebecca Pikos
Dr. Rebecca Pikos, DMD, is a board-certified pediatric dentist with specialized training in caring for children and teens. She’s passionate about creating positive dental experiences and empowering families with the knowledge they need to support lifelong oral health.
→ Special thanks to Dr. Rebecca Pikos for her collaboration on this important topic.
About Dr. Rosana Lastra
Dr. Rosana Lastra, MD, MS, FAAP, is a bilingual, board-certified pediatrician with over a decade of experience in a variety of clinical settings. She founded Head2Toe Pediatrics, a concierge-style pediatric practice, to give families something that’s often missing in traditional care: the time, space, and support to feel truly heard and informed. Through home visits, telemedicine, and 24/7 access, she helps parents feel confident and connected at every stage of childhood.
This content is for educational purposes only and should not be considered medical advice. Always consult your pediatrician or pediatric dentist for personalized medical guidance.
