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Oral Hygiene, continued
Ingestion of toothpaste increases the risk of enamel
Fluorosis: An abnormal condition (as mottled enamel of human teeth) caused by fluorine or its compounds.

fluorosis. (Refer to Chapter 6: Fluoride for more information). 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) advises limiting the amount of toothpaste on the toothbrush. The AAPD recommends a "smear" of toothpaste for children younger than 2 years of age and a "pea-sized" amount for children ages 2 to 5.

A 2007 Maternal and Child Health Bureau expert panel recommended that all children at high risk for dental caries should use fluoride toothpaste.

The panel suggests children younger than 2 use a "smear" of toothpaste. Children aged 2-6 years use a slightly larger, "pea-sized" amount. The AAP endorses this recommendation.

For children younger than 2, the Centers for Disease Control and Prevention (CDC) suggests physicians consider all fluoride exposure when weighing the risks and benefits of using fluoride toothpaste.

The CDC does not give specific advice on how much fluoridated toothpaste to use in children younger than 2, but recomments that families dusciss with a heathcare provider.. For children younger than 6, it suggests parents apply a pea-sized amount to the toothbrush. (See Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States.)

When deciding wheather to use fluoridated toothpaste on children younger than 2 years of age, consider these factors:

  • The child's risk of dental caries
  • The child's risk of dental fluorosis
  • The benefit of the topical fluoride exposure via use of fluoridated toothpaste
Children at high risk for dental caries should use fluoride toothpaste.
Children under 2 years of age at high risk for caries should use a "smear" of fluoride toothpaste and all children aged 2-6 years should use a "pea-sized" amount of toothpaste.
To prevent fluorosis, parents should make efforts to minimize the swallowing of toothpaste, or consider using only water or a non-fluoridated toothpaste.
Parents should begin flossing the child’s teeth as soon as the tooth surfaces touch each other.
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