New Fluoride Recommendations for Young Children


For children younger than 6 years of age, fluoride toothpaste use is effective in reducing caries. The evidence also shows that ingesting pea-sized amounts or more can lead to mild fluorosis. The new regimen is intended to maximize the caries-preventive benefits of fluoride while further reducing the risk of developing fluorosis when compared with previous protocols.

The best predictor of a person’s developing dental caries in the future is the presence of dental caries. Because most 1-year-old children do not have dental caries, and considering the rate of caries progression, it is difficult to predict which children will become the approximate 40 percent of children who experience dental caries in their primary teeth.  Therefore, this new recommendation is based on the best available evidence in an attempt to prevent the caries process beginning with initial tooth eruption.

The new recommendation from The American Dental Association‘s Council of Scientific Affairs is as follows:

For Children Younger Than 3 Years of Age:

  • Caregivers should begin brushing children’s teeth as soon as they begin to come into the mouth by using fluoride toothpaste in an amount no more than a smear (.1mg of fluoride). Brush teeth thoroughly twice per day (morning and night).  Supervise children’s brushing to ensure they use the right amount of toothpaste.

For Children 3-6 Years of Age:

  • Caregivers should dispense no more than a pea-size (.25mg of fluoride) of fluoride toothpaste. Brush teeth thoroughly twice per day (morning and night). Supervise children’s brushing to ensure they use the right amount of toothpaste.

What is Fluoride?

Fluoride is the fluorine ion added to toothpastes and dental rinses to help protect your teeth from cavities. While increasing the concentration of systemic fluoride (e.g., through fluoridating drinking water) has not been proven to reduce the incidence of tooth decay, direct contact between fluoride and teeth strengthens and helps re-mineralize damaged enamel.

Here’s how Fluorideworks

  • The calcium and phosphate compound that makes up tooth enamel is a modified form of hydroxyapatite, which is susceptible to attack by acids. Bacteria that thrive on the sugars found in the mouth multiply on dental surfaces and produce acids.
  • Mechanical brushing of teeth dislodges these bacteria and rinses them away, but doesn’t do anything to address the ongoing damage to enamel from acid exposure. Fortunately saliva neutralizes these acids, and teeth use compounds found in saliva to re-mineralize the enamel. So, as long as the rate of demineralization and the rate of re-mineralization remain in balance, teeth remain strong and healthy.
  • When more minerals are lost from teeth than are replaced, dental caries or cavities form. Fluoride helps by interacting with hydroxyapatite to form a stronger compound that is less susceptible to acid attack. Also, fluoride re-mineralizes damaged enamel (though it can’t fix a cavity once one has formed). There is some evidence fluoride may inhibit the growth of bacteria on teeth or limit their capacity for producing acid.
  • Even though you spit out toothpaste and probably rinse your mouth, enough fluoride remains on your teeth and in your saliva to confer protection for a while after brushing your teeth or using a fluoridated rinse.

In conclusion, your child’s first visit with the dentist should be at 12 months of age or after the initial eruption of their primary teeth.

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Frank Orlando, DDS, FAGD, FICOI maintains a private dental office in Midtown Manhattan focused on Comprehensive Cosmetic and Implant Dentistry with a specific focus on Oral Systemic Health. He strives to educate patients on oral health as an integral part to systemic health. As a founding member of the American Academy of Oral Systemic Health and a Fellow in the Academy of General Dentistry and The International Congress of Oral Implantologists, Dr. Orlando is well versed in all aspects of general and advanced dentistry with a continual focus on improving your oral health to optimize your overall systemic health.

For a free list of oral and dental health DO’s and DON’Ts for new mothers and mothers-to-be, or to receive an oral health consultation, women who are pregnant or in the planning stages may contact him:

[email protected]

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