J R Heilman, M C Kiritsy, S M Levy, J S Wefel

Dental fluorosis occurs as a result of excessive total fluoride intake during tooth development. Some children may receive substantial intake from soft drinks, but few studies have reported fluoride levels in soft drinks. The authors examined the fluoride concentrations of 332 soft drinks. Soft drinks were purchased from Iowa grocery stores. To identify production sites, the authors recorded product details and batch numbers. After decarbonating the drinks, the authors assayed samples for fluoride content using a fluoride ion-specific electrode, and reported the results in parts per million, or ppm, using appropriate standards and duplicate assessments. Descriptive statistics were used to summarize the findings. The fluoride levels of the products ranged from 0.02 to 1.28 ppm, with a mean level of 0.72 ppm. Fluoride levels exceeded 0.60 ppm for 71 percent of the products. Results varied substantially by production site, even within the same company and for the same product. There were no substantial differences between flavors or between diet and regular soft drinks. The majority of soft drinks had fluoride levels exceeding 0.60 ppm. Variation in fluoride levels probably is due largely to the different water sources used in production. With no fluoride levels marked on the soft drink products or easily available from the manufacturers, it is not possible for clinicians or consumers to directly estimate fluoride ingestion from carbonated beverages. Therefore, to reduce the risk of dental fluorosis, dental and medical practitioners should be cautious about prescribing dietary fluoride supplements to preschool-aged children in nonfluoridated areas who consume large quantities of carbonated soft drinks.