On February 1, 2019 the Centers for Disease Control released a study regarding the overuse of Fluoride Toothpaste by young children. What is the bottom line that parents need to know regarding this subject?

Here is the summary from the CDC:


What is already known about this topic?

Fluoride prevents dental caries; however, excessive ingestion by young children can discolor and pit the permanent teeth. Toothbrushing should commence when the first tooth erupts, and children aged <3 years and 3–6 years should use a smear the size of a rice grain and a pea-sized amount of toothpaste, respectively.

What is added by this report?

In a survey of toothbrushing practices, nearly 80% of children aged 3–15 years began toothbrushing at age ≥1 year, approximately one third brushed once daily, and nearly 40% of children aged 3–6 years used too much toothpaste.

What are the implications for public health practice?

Health care professionals can educate parents about using the recommended amount of fluoride toothpaste under parental supervision to realize maximum benefit."

Children aged 3 and up:

The American Dental Association recommends squeezing a “pea-sized” amount of toothpaste onto the brush for kids aged 3-6. Unfortunately, a child’s perception of the size of a pea may differ from a parent’s perception. If the child loads their toothbrush themselves, they are likely to use too much paste. Combined with some children’s inability to spit and rinse well, they are  also at risk for fluorosis (mottling and streaking) of their permanent teeth.

We recommend supervising your children’s daily brushing until they are at least 7 years old. Demonstrate to your child how much toothpaste they should be using or place the toothpaste onto the brush yourself.

Infant children to age 3

For younger children, especially under the age of three, we recommend using a “tiny smear” of toothpaste. Some healthcare sources suggest a “grain of rice”.  Again, the size of a grain of rice can be perceived differently. For toddlers, all that is needed is the tiniest smear of a fluoride toothpaste. This should definitely be done by the parent or caregiver for this age group. Children this age, if left to their own devices, will tend to overload their toothbrush resulting in ingesting too much toothpaste and too much fluoride. Most children under the age of 3 are unable to spit out and will swallow much of the excess paste.

“Can’t I just skip the fluoride toothpaste and use unfluoridated toddler toothpaste?”, you may ask. We strongly recommend the use of fluoridated toothpaste from the time the first tooth erupts in the child’s mouth. Tooth decay is still a very prevalent disease in children and can be prevented or at least significantly reduced by using fluoride daily.

In a nutshell-

We recommend brushing infant and toddler’s teeth for them from the time of eruption (approximately 6 months of age) with a “tiny smear” of fluoridated kid’s toothpaste twice daily. We recommend brushing children’s teeth, aged 2-6 for them with a “pea” sized amount of fluoridated kids’ toothpaste twice daily.

Remain present with the child until the brushing is completed and assist them to rinse out their mouth.

Using these suggestions should minimize the risk of using too much paste yet simultaneously reduce the chances your child will have early childhood tooth decay.

Duvall Family Dental

Dr. Jessica H.Y. Chen


You can find the full CDC report here: https://www.cdc.gov/mmwr/volumes/68/wr/mm6804a3.htm

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