Start using fluoride-containing toothpaste as soon as baby teeth come in

The Pediatric Insider

© 2014 Roy Benaroch, MD

A new guideline from the American Dental Association suggests that parents start using fluoride toothpaste early to best protect teeth. (The guideline itself is behind a paywall, but you can read a summary here.)

The old advice was to wait until age two to use fluoride. The concern had been that babies can’t spit well (ironic—they seem to spit up just fine when they want to), and that early fluoride could lead to fluorosis, or a staining of teeth. But it turns out that the vast majority of children with fluorosis have minimal cosmetic changes that are only noticeable by a dental professional, and that mild fluorosis actually strengthens teeth. An appropriate amount of fluoride toothpaste, when used very young, will lead to fewer cavities and better dental health.

How much is the right amount? The ADA is suggesting just a smear, or a bit of toothpaste about the size of a single grain of rice. That’s not a lot. Even for older kids, past three, a pea-sized amount is plenty. (That’s what’s recommended for adults, too. The big blobby stripe of toothpaste shown in commercials is there just to trick you into using too much.)

Once teeth come in, brush them twice a day with a rice-sized bit of fluoride-containing toothpaste twice a day. Now, if we could also get them to floss….

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9 Comments on “Start using fluoride-containing toothpaste as soon as baby teeth come in”

  1. Thank you for this post. When my son was little, the DENTIST kept telling us not to use fluoride. By the time my son was 4-years-old he had 5 cavities in his baby teeth and had to get them filled. Poor kid did not need to go through that.

    When my daughter was little, I brushed with a tiny bit of fluoride toothpaste as soon as her teeth came in and she has had no cavities.

    BTW, we also switched dentists.


  2. INTP mom Says:

    What about fluoride supplements? My daughter gets a daily multivitamin with 0.25 mg of fluoride. Should we use fluoride toothpaste instead of or in addition to the supplement?


  3. Dr. Roy Says:

    INTP, fluoride supplements are routinely recommended for children growing up in households without fluoridated water, in addition to using a small amount of fluoride-containing toothpaste. The dose is by age. .25 mg per day is typical correct age for child from 6 mos to 3 years of life. A good summary of oral fluoride supplementation is here:


  4. INTP mom Says:

    Okay, so the fluoride supplement is just to take the place of fluoridated water, and I’ll need to start using fluoride toothpaste on top of that. Thanks!


  5. Dani Says:

    I just read an article about a research linking the usage of fluoride and mental disorder among our kids. Including ADHD? How can it go together with this dental advice?


  6. Dr. Roy Says:

    Dani, there’s a small but noisy cadre of fluoride-haters out there, recycling their nonsense, desperate for attention. There are also some who think the Holocaust didn’t happen, that the world is flat, that (insert whichever president’s name here) is actually a space alien, or that a Nigerian prince is going to wire 23 million dollars into your bank account. The world is a colorful place. Don’t believe everything you read.


  7. Carrie Says:

    I was twelve before I learned that you were supposed to spit toothpaste out. I’m fine and my dentist has always been impressed with the health of my teeth.
    Of course it’s possible to have too much fluoride (as it is anything up to and including oxygen) but I have a hard time believing it’s the menace it’s cracked up to be.


  8. Baby Teeth Says:

    Thanks for sharing this informative post. My little one is about 3 years old and I help him brush his teeth without toothpaste. It is good to know about using toothpaste containing flouride to protect his teeth, but I’m just wondering what if he swallows the toothpaste, is it harmful?


  9. Dr. Roy Says:

    Swallowing a small amount of fluoride-containing toothpaste is not harmful.


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