How much toothpaste should a child under
the age of 6 years use?
R P Ellwood*, JA Cury**
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.
Key words: fluoride, toothpaste, fluorosis, caries
Eur Archs Paediatr Dent 2009;10(3):168-174
* Dental Health Unit, University of Manchester, England.
** Piracicaba Dental School, University of Campinas, SP, Brazil.
Postal address: Prof. R. Ellwood. Dental Health Unit, Skelton House,
Manchester Science Park, Lloyd St North, Manchester, M15 6SH, United Kingdom.
Email: roger.ellwood@manchester.ac.uk
