Current Pediatric Fluoride Usage and Guidelines

Current pediatric fluoride guidelines from the American Dental Association


New guidelines were released February 2014 by the American Dental Association (ADA) regarding use of fluoride toothpaste with young children. A systematic review of 17 different studies was published in the February 2014 issue of the Journal of the American Dental Association.  The article concluded that scientific evidence demonstrated that fluoride toothpaste is effective in controlling tooth decay, and at “the appropriate amount” should be used “by all children regardless of age.”  The new guidelines are as follows:

Parents shoul now  use a thin, TINY (rice-grain sized) smear of fluoride toothpaste (i.e. Crest Kids or similar) to brush baby teeth twice daily AS SOON AS THEY ERUPT (~6 months old).

This advice revises the decades old recommendations.  Young children have traditionally been susceptible to cavities for a variety of reasons including limited (or no) dexterity to brush/floss properly and frequent snacking.  Despite continued advancements in both dental technology and public dental awareness, pediatric cavities are actually increasing rather than decreasing. This very disturbing trend likely heavily influenced the formation of new guidelines. 

toothpaste amount

Rice vs Pea toothpaste 2

It is very important to emphasize that only the tiniest amount of fluoride toothpaste should be used to minimize a condition called flurorosis.  This condition is typically characterized by mild discoloration, white spots, or streaking of the teeth and is caused by a young child ingesting too much fluoride (usually in the form of toothpaste) over a long period.[iii]  The new guidelines stress that children should spit out toothpaste as soon as they are physically able, but not being able to spit does not preclude the use of a rice-grain sized bit of fluoride toothpaste.[iv]  Since most children under the age of two cannot rinse and spit after brushing, some of the toothpaste is inevitably swallowed and the fluoride is absorbed internally.  With the exception of the severe fluorosis, the vast majority of fluorosis cases are primarily cosmetic in nature with minimal long-term impact on the health of the teeth.  Except for wisdom teeth, the crowns (the part you see in the mouth) of all of the permanent teeth fully form by the time you are about 8 years old.[v]  At that time, the risk of fluorosis decreases dramatically.  Extra fluoride does not affect other parts of the tooth.  Ultimately, once your teeth have erupted into your mouth, they are no longer susceptible to fluorosis.  The aim of the new ADA guidelines is that a balance is found between cavity prevention and the risk of fluorosis and the key to that balance is the tiny rice-grain size smear of toothpaste.

For additional information, please visit the American Dental Association website  I am extremely passionate about modern dentistry and sincerely love discussing it with patients.  If you would like to speak about fluoride, or any other dental topic, please feel free to call the office and schedule a complimentary appointment with me.  Email and Twitter are also available options.  I am extremely passionate about modern dentistry and love discussing it with patients, so don’t hesitate to contact me. 



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