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Oral Hygiene, continued
Fluoridated Toothpaste
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 suggests that the best way to minimize the child's risk for fluorosis is to limit the amount of toothpaste placed on the toothbrush. They suggest a "smear" of fluoride toothpaste for moderate and high-risk children younger than 2 years of age and a "pea-sized" amount for children ages 2 to 5.

Likewise, a 2007 Maternal and Child Health Bureau expert panel recommended that all children at high risk for dental caries should use fluoride toothpaste and those children under 2 years of age use a "smear" of toothpaste while those children aged 2-6 years use a slightly larger "pea-sized" amount of toothpaste. The AAP endorses 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 apply a pea-sized amount to the toothbrush. (See Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States.)

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 of fluoridated toothpaste when deciding to use it in children younger than 2 years of age.
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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