Since 2014, the American Dental Association (ADA), the American Academy of Pediatrics (AAP), and the American Academy of Pediatric Dentistry (AAPD) have all recommended that parents and caregivers use a rice-sized smear of fluoride toothpaste for children under the age of 3, to begin brushing with the very first tooth, and to do so twice a day. Likewise, these organizations have recommended using a pea-size amount of fluoride toothpaste beginning when kids are age 3 rather than age 2, as stated in the directions that accompany many brands of toothpaste.
Where do these recommendations come from? What is their scientific basis?
In 2012, the ADA Council of Scientific Affairs recommended that a systematic review on the effectiveness and safety of fluoride toothpaste for young children (under age 6) be conducted and used to create evidence-based, consistent guidance for parents and caregivers. Professor of Pediatric Dentistry J. Timothy Wright conducted a review with five colleagues and published the findings in 2014 in the peer-reviewed Journal of the American Dental Association. In a meta-analysis and review of 17 studies, Dr. Wright and colleagues found that young kids who brushed with fluoride toothpaste in clinical trials had an average of 25% fewer cavities in baby teeth. They also determined that a lower amount of fluoride from toothpaste at age 2 is warranted to maximize the caries-preventive benefits of fluoride while reducing the risk of developing fluorosis, especially while kids learn to spit out toothpaste rather than swallow it.
This review is one that pediatricians, dentist, hygienists, interested parents, and oral health advocates can use to clarify guidance for patients and families.
