European Archives of Paediatric Dentistry

, Volume 10, Issue 3, pp 168–174 | Cite as

How much toothpaste should a child under the age of 6 years use?

Article
First Online:

Abstract

AIM: To discuss current concepts in the use of fluoride and to determine how much fluoride is sufficient for caries prevention but also how much is too much. Use of fluoride by young children is a balance between maximising caries efficacy and minimising the risk of fluorosis. METHODS: Review of the current literature. This review considers the importance of amount, concentration and dose of fluoride applied from toothpaste and the implications for risk and benefit. RESULTS: Dental fluorosis is dependent on local fluoride levels in the extra cellular fluid surrounding the tooth during its development. These fluoride levels are determined by the plasma concentration that in turn is a function of the daily intake of fluoride. Fluoride released from bone during remodelling may also contribute to fluoride levels in the tissue. There is evidence to suggest that the effects of fluoride resulting in fluorosis prior to eruption of the tooth are cumulative and dependent on the amount and duration of exposure rather than a specific window of vulnerability. In contrast to dilution of ingested fluoride in the large volume of plasma, dilution of toothpaste in oral fluids is relatively small. Hence, for a given dose of fluoride, higher fluoride levels can be achieved in the oral environment using small amounts of toothpaste with higher fluoride concentrations rather than larger amounts with lower fluoride concentrations. CONCLUSION: It is concluded that for young children fluoride ingestion needs to be carefully controlled during the first six years of life and the best balance between risk and efficacy might be achieved by using small amounts of high fluoride toothpaste under close supervision from parents.

Keywords

fluoride toothpaste fluorosis caries 
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References

  1. Australian Research Centre for Population Oral Health. The use of fluorides in Australia: guidelines. Aust Dent J. 2006 Jun;51(2):195–9.CrossRefGoogle Scholar
  2. Andersen L, Richards A, Care AD, et al. Parathyroid glands, calcium, and vitamin D in experimental fluorosis in pigs. Calcif Tissue Int 1986; 38:222–6.PubMedCrossRefGoogle Scholar
  3. Aoba T, Fejerskov O. Dental fluorosis: chemistry and biology. Crit Rev Oral Biol Med.2002;13(2):155–70.PubMedCrossRefGoogle Scholar
  4. Ashley PF, Attrill DC, Ellwood RP, Worthington HV, Davies RM. Toothbrushing habits and caries experience. Caries Res. 1999 Sep–Oct;33(5):401–2.PubMedCrossRefGoogle Scholar
  5. Bårdsen A. “ Risk periods” associated with the development of dental fluorosis in maxillary permanent central incisors: a meta-analysis. Acta Odontol Scand. 1999 Oct;57(5):247–56.PubMedCrossRefGoogle Scholar
  6. Bentley EM, Ellwood RP, Davies M. Factors influencing the amount of fluoride toothpaste applied by the mothers of young children. Br Dent J. 1997 Dec 13–27;183(11–12):412–4.PubMedCrossRefGoogle Scholar
  7. Bhuridej P, Levy SM, Warren JJ, Islam M, McGrady JA. Effects of toothbrush size and dentifrice type/brand on pea-sized and larger amounts of dentifrice. Int Dent J. 2007 Apr;57(2):71–6.PubMedCrossRefGoogle Scholar
  8. Burt BA. The changing patterns of systemic fluoride intake. J Dent Res. 1992 May;71(5):1228–37.PubMedCrossRefGoogle Scholar
  9. Catani DB, Hugo FN, Cypriano S, Sousa Mda L, Cury JA. Relationship between fluoride levels in the public water supply and dental fluorosis Rev Saude Publica. 2007 Oct;41(5):732–9.PubMedCrossRefGoogle Scholar
  10. mission Directive 2007/53/EC amending Council Directive 76/768/EEC concerning cosmetic products for the purposes of adopting Annex III thereto to technical progressGoogle Scholar
  11. Dean HT. The Investigation of physiological effects by the epidemiological method. In: Moulton FR, Fluorine and dental health. Publication No.19. American Association for the Advancement of Science, 1942:23-31.Google Scholar
  12. Den Besten P, Ko HS. Fluoride levels in whole saliva of preschool children after brushing with 0.25 g (pea-sized) as compared to 1.0 g (full-brush) of a fluoride dentifrice. Pediatr Dent. 1996 Jul–Aug;18(4):277–80.Google Scholar
  13. Department of Health and The British Association for the Study of Community Dentistry. Delivering better oral health: An evidence-based toolkit for prevention, Lonon: Department of Health, 2007Google Scholar
  14. Department of Health and Children, Forum on Fluoridation, Dublin: Stationary Office, 2002Google Scholar
  15. Duckworth RM, Morgan SN, Burchell CK. Fluoride in plaque following use of dentifrices containing sodium monofluorophosphate. J Dent Res. 1989 Feb;68(2):130–3.PubMedCrossRefGoogle Scholar
  16. Duckworth RM, Stewart D. Effect of mouthwashes of variable NaF concentration but constant NaF content on oral fluoride retention. Caries Res. 1994;28(1):43–7.PubMedCrossRefGoogle Scholar
  17. Duke SA, Forward GC. The conditions occurring in vivo when brushing with toothpastes. BrDentJ. 1982 Jan 19;152(2):52–4.PubMedCrossRefGoogle Scholar
  18. Ellwood, R., Fejerskov, O, Cury JA, Clarkson B. 2008, Clinical use of Fluoride, in Fejerskov, O., Kidd, E.A.M. (eds), Dental Caries: The disease and its clinical management, Blackwell Munksgaard, Oxford, pp. 287–327.Google Scholar
  19. Evans RW, Darvell BW.. Refining the estimate of the critical period for susceptibility to enamel fluorosis in human maxillary central incisors. J Public Health Dent. 1995 Fall;55(4):238–49PubMedCrossRefGoogle Scholar
  20. Fejerskov O, Baelum V, Richards A. Dose response and dental fluorosis In: Fejerskov O, Ekstrand J Burt BA. Eds. Fluoride in Dentistry. Copenhagen: Munksgaard, 1996: 153–66.Google Scholar
  21. Franzman MR, Levy SM, Warren JJ, Broffitt B. Fluoride dentifrice ingestion and fluorosis of the permanent incisors. J Am Dent Assoc. 2006 May;137(5):645–52.PubMedGoogle Scholar
  22. Hong L, Levy SM, Broffitt B, et al. Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors. Community Dent Oral Epidemiol. 2006a Aug;34(4):299–309.PubMedCrossRefGoogle Scholar
  23. Hong L, Levy SM, Warren JJ, Broffitt B, Cavanaugh J. Fluoride intake levels in relation to fluorosis development in permanent maxillary central incisors and first molars. Caries Res. 2006b;40(6):494–500.PubMedCrossRefGoogle Scholar
  24. Lagerlöf F, Dawes C. The volume of saliva in the mouth before and after swallowing. J Dent Res. 1984 May; 63(5):618–21.PubMedCrossRefGoogle Scholar
  25. Levy SM, Guha-Chowdhury N. Total fluoride intake and implications for dietary fluoride supplementation. J Public Health Dent. 1999 Fall;59(4):211–23.PubMedCrossRefGoogle Scholar
  26. Levy SM, McGrady JA, Bhuridej P, et al.. Factors affecting dentifrice use and ingestion among a sample of U.S. preschoolers. Pediatr Dent. 2000 Sep–Oct;22(5):389–94.PubMedGoogle Scholar
  27. Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;(1):CD002278.Google Scholar
  28. Parkins FM, Tinanoff N, Moutinho M, Anstey MB, Waziri MH. Relationships of human plasma fluoride and bone fluoride to age. Calcif Tissue Res. 1974;16(4):335–8.PubMedCrossRefGoogle Scholar
  29. Pendrys DG. Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. J Am Dent Assoc. 2000 Jun;131(6):746–55.PubMedGoogle Scholar
  30. Richards A, Kragstrup J, Josephsen K, Fejerskov O. Dental fluorosis developed in post-secretory enamel. J Dent Res 1986; 65:1406–9.PubMedCrossRefGoogle Scholar
  31. Robinson C. Kirham J. Weatherell JA Fluoride in Teeth and Bone. In: Fluoride in Dentistry. Copenhagen: Munksgaard, 1996: 69–87.Google Scholar
  32. Twetman, S Caries prevention with flouride toothpaste in children; an update Europ Archs Paediatr Dent 2009;10: 3:162–167Google Scholar
  33. Villena RS. An investigation of the transverse technique of dentifrice application to reduce the amount of fluoride dentifrice for young children. Pediatr Dent. 2000 Jul–Aug;22(4):312–7.PubMedGoogle Scholar
  34. Warren JJ, Levy SM, Broffitt B, et al. Considerations on Optimal Fluoride Intake Using Dental Fluorosis and Dental Caries Outcomes — A Longitudinal Study. J Public Health Dent. vol. 69, No. 2, Spring 2009; p111–115.PubMedCrossRefGoogle Scholar

Copyright information

© Adis International 2009

Authors and Affiliations

  1. 1.Dental Health UnitUniversity of ManchesterEngland
  2. 2.Piracicaba Dental SchoolUniversity of Campinas, SPBrazil

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