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Toothpaste

Ingestion of toothpaste increases the risk of enamel fluorosis. If fluoridated toothpaste is used, strategies to limit the amount swallowed include limiting the amount placed on the brush and observing the child as they brush.

The American Academy of Pediatric Dentistry (AAPD) suggests that the best way to minimize the child's risk for fluorosis is to limit the amount of toothpaste placed on the toothbrush. The AAPD suggests a "smear" of fluoride toothpaste for children younger than 2 years of age who are at a moderate or high risk for dental caries and a "pea-sized" amount for all children ages 2 to 5.

The Maternal and Child Health Bureau expert panel recommends a "smear" of fluoride toothpaste for children younger than 2 years of age who are at high risk for dental caries and a "pea-sized" amount for all children ages 2 to 6. The AAP agrees with this recommendation.

The Centers for Disease Control and Prevention suggests that for children aged <2 years, the pediatrician should "consider the fluoride level in the community drinking water, other sources of fluoride, and factors likely to affect susceptibility to dental caries when weighing the risk and benefits of using fluoride toothpaste," but they do not give specific advice on how much to use in children aged <2 years.


For children aged <6 years parents should:
 
1.
Limit toothbrushing to 2 times a day.
 
2.
Apply less than a pea-sized amount to the toothbrush.
 
3.
Supervise tooth-brushing and encourage the child to spit out excess toothpaste.

Finally, toothpaste should be kept out of the reach of young children to avoid accidental ingestion.

Pediatricians and families should consider the child's risk of dental caries, risk of dental fluorosis, and the benefit of the topical application of fluoride in the form fluoridated toothpaste when deciding to use it in children younger than 2 years of age.
 
 
Children at high risk for dental caries should use fluoridated toothpaste, regardless of age.
 
Children under 2 years of age at high risk for caries should use a "smear" of toothpaste and all children aged 2 - 6 years should use a "pea-sized" amount of toothpaste.
 
Toothbrushing should always be supervised.
 
Toothpaste should be kept out of reach of young children.
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