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Original Research

Open Access

Potential risk of dental fluorosis associated with different baby formulas and water brands marketed in Spain

  • Sandra M Gallego-Reyes1
  • Jaime A Cury2
  • Amparo Pérez-Silva3
  • Clara Serna-Muñoz3,*,
  • Icíar Fernández-Pizarro1
  • Yolanda Martínez-Beneyto4
  • Antonio J Ortiz-Ruiz3

1Faculty of Medicine-Dentistry, University of Murcia, Hospital Morales Meseguer, 30008 Murcia, Spain

2Piracicaba Dental School, University of Campinas, 13414-000 Campinas, SP, Brazil

3Department of Integrated Pediatric Dentistry, Faculty of Medicine-Dentistry, University of Murcia, Hospital Morales Meseguer, 30008 Murcia, Spain

4Department of Dermatology, Stomatology and Radiology, Faculty of Medicine-Dentistry, University of Murcia, Hospital Morales Meseguer, 30008 Murcia, Spain

DOI: 10.22514/jocpd.2024.013 Vol.48,Issue 1,January 2024 pp.111-119

Submitted: 15 May 2023 Accepted: 14 July 2023

Published: 03 January 2024

*Corresponding Author(s): Clara Serna-Muñoz E-mail:


Despite efforts to promote breastfeeding, many babies aged <6 months receive only baby formula reconstituted with bottled water. The intake of high levels of fluoride during amelogenesis has been associated with hypomineralization of the tooth enamel, with aesthetic and mechanical repercussions. The objective of this study was to determine the potential risk of dental fluorosis associated with baby formulas marketed in Spain. We measured 26 baby formulas frequently consumed in Spain; 17 brands for babies aged <6 months, 5 for those aged >6 months, and 4 ready-to-use brands. They were prepared with 4 types of water: distilled water and three brands of bottled water with different levels of fluoride. The fluoride concentration (mg/L or ppm F) was measured with an ion-specific electrode coupled to an ion analyzer. Each sample was prepared according to the manufacturer’s instructions and analyzed in triplicate. A descriptive analysis was carried out. The minimum fluoride level found was 0.04 mg/L and the maximum was 1.02 mg/L. Considering the daily intake of these formulas, none exceeded the clinically-acceptable daily dose limit risk for fluorosis (0.07 mg F/day/kg body weight) when mixed with bottled water with a low level of fluoride (0.1 mg/L). However, when the same brands of formula were reconstituted with bottled water with a higher fluoride content (0.99 mg/L), they all exceeded the daily dose limit for the risk of fluorosis. As the potential risk of dental fluorosis associated with the formulas tested depends exclusively on the fluoride concentration of the waters used for reconstitution, formula packaging should contain a warning.


Dental fluorosis; Bottle feeding; Fluoride intake; Bottled water; Baby formula

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Sandra M Gallego-Reyes,Jaime A Cury,Amparo Pérez-Silva,Clara Serna-Muñoz,Icíar Fernández-Pizarro,Yolanda Martínez-Beneyto,Antonio J Ortiz-Ruiz. Potential risk of dental fluorosis associated with different baby formulas and water brands marketed in Spain. Journal of Clinical Pediatric Dentistry. 2024. 48(1);111-119.


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