PACT Spry Menu Pages

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.

According to the American Academy of Pediatric Dentistry (AAPD), 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.

For children younger than 2, the Centers for Disease Control and Prevention suggests the pediatrician consider fluoride levels 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 fluoride toothpaste. For children younger than 6, the CDC recommends that parents:

  1. Limit tooth brushing to 2 times a day. 
  2. Apply less than a pea-sized amount of toothpaste to the brush. 
  3. Supervise tooth brushing and encourage children to spit out excess toothpaste.
  4. Keep toothpaste out of the reach of young children to avoid accidental ingestion.

A 2007 Maternal and Child Health Bureau expert panel recommended:

  • All children at high risk for dental caries use fluoride toothpaste
  • Children younger than age 2 use a “smearâ€� of fluoride toothpaste
  • Children aged 2-6 years use a slightly larger, “pea-sizedâ€� amount
  • The AAP endorses this recommendation.

When deciding whether to use fluoridated toothpaste in children younger than 2, the panel recommends considering:

  • The child's risk of dental caries
  • The risk of dental fluorosis
  • The benefit of the topical application in the form of fluoridated
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.
View the Chapter 6 Photo Gallery.