When should your child start using fluoride toothpaste? The Tooth Ferry recognizes that the answer to this question is not one-size-fits-all!
The reason the back of the toothpaste tube advises caregivers to consult a dental professional before usage of the product in children younger than 2 years of age, is because the risk of dental fluorosis developing in the permanent front teeth is highest in this age group. Dental fluorosis is a discoloration (which can range from brown to tan to bright white spots) of the teeth that can cause a significant cosmetic defect. In severe cases, fluorosis actually causes the teeth to look chipped and pitted, rather than smooth and white.
The decision to begin to use fluoride toothpaste is a balancing act between the risk of developing fluorosis, and the benefit gained by the prevention of tooth decay in this young age group (which, when severe, can require general anesthesia in order to fix the cavities- an outcome every parent would like to avoid, if possible). If a child is determined to be moderate- or high-caries risk, then use of fluoride toothpaste under the age of 2 is recommended. Because caries-risk (one’s risk for developing a cavity) is complex and multi-factorial, it is recommended that a pediatric dentist (or other specially trained professional) carry out a comprehensive caries risk assessment for you child. However, if your child has certain habits, such as drinking juice many times throughout the day (especially from a bottle or sippy-cup), breast-feeding or bottle-feeding many times during the night, or if a sibling or parent has many cavities, they may be very likely to be at high risk for developing tooth decay.
If a child begins to use fluoride toothpaste at younger than 3 years of age, it is recommended that they only use a smear of fluoride toothpaste (less than a grain of rice) in order to minimize the amount of fluoride that is being swallowed. This toothpaste should always be applied to the brush by an adult, as children will likely swallow most (if not all) of the toothpaste that’s being put on the brush. Even if they are able to spit, most children are not able to reliably spit-out the toothpaste that they are using to brush their teeth at this young age. For this reason, the amount of toothpaste being used is considered to be a systemic “dose” of fluoride, equal to 0.1mg of fluoride. This is well within the safe recommendation for systemic fluoride intake for children under the age of 6 (0.05mg/kg/day), even if the smear of fluoride toothpaste is being used morning and night.
Dr. Posthuma’s Philosophy on Fluoride Toothpaste
My philosophy, as a pediatric dentist, is to attempt to limit the exposure to fluoridated toothpaste under the age of 3 years old, when the situation will allow for it. After all, ingestion of fluoride is like ingestion of any other medication, and we don’t want to prescribe it in cases where it’s not necessary. For this reason, I like to examine a baby or child’s teeth and gums (the gums tell us A LOT about the bacterial activity going on in the mouth). If I see areas of heavy plaque accumulation, red and bleeding gums, or areas of de-calcification starting, I like to alert parents to the elevated caries risk that is present, and start recommending an appropriate fluoride regimen that is individualized for their child.