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Expert Group Recommends Kids' Earlier Use of Fluoride Toothpaste
February 19, 2014

By Nancy Volkers
InteliHealth News Service

INTELIHEALTH - Experts at the American Dental Association have changed fluoride guidelines for young children. They now recommend fluoride toothpaste for children under the age of 2.

Previously, the ADA recommended brushing only with water until age 2. From ages 2 to 6, the group suggested using a "pea-sized" amount of toothpaste on the brush.

Now, the ADA recommends a "smear" of toothpaste be used from the time a child's first tooth comes in. Once a child turns 3, parents can use a pea-sized amount in brushing the child's teeth.

The ADA also changed its advice for fluoride supplements. These are given to children who have a high risk of developing cavities and drink water that is not fluoridated contains very little or no fluoride. The supplements generally start at age 6 months. In the past, the recommended supplement dose increased when a child turned 2. Now, the ADA recommends waiting to increase the dose until age 3.

The recommendations are meant to reduce the risk of tooth decay while limiting fluorosis, which causes white streaks and spots on the teeth. Fluorosis is caused by swallowing too much fluoride.

The ADA group, called the Council on Scientific Affairs, reviewed all information about the effects of fluoride on young children's teeth. The Council stressed that dentists should assess each child's risk for tooth decay before making decisions or giving advice about fluoride. Dentists also should consider all of the sources of fluoride in a child's life: not just toothpaste and supplements, but also drinking water, other drinks and foods.

A "smear" of toothpaste is flat, with toothpaste covering most of the bristles on a child-sized toothbrush. It contains about 0.1 milligram of fluoride. The council says that a smear of toothpaste is about the size of a grain of rice. A pea-sized amount contains 0.25 milligram of fluoride more than twice as much.

Tooth decay is the most common chronic disease in children. The council says that by the time that U.S. children enter kindergarten, 25% of them have tooth decay.

The council's recommendations:

  • When a child's first tooth comes in, caregivers should brush the child's teeth twice a day using a smear of fluoride toothpaste.
  • From ages 3 to 6, brush twice a day using a pea-sized amount of fluoride toothpaste. Encourage children to spit out the toothpaste, rather than swallow it.
  • Dentists should describe and show the proper amount of toothpaste so that parents and caregivers do not use too much.

The new advice appears in the February issue of the Journal of the American Dental Association.

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