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FAQ: fluoride--what parents should know

Posted by Dr. Claire McCarthy  February 15, 2013 07:37 AM

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Recently I've been doing a lot of talking about fluoride. We give toothbrushes and toothpaste out in our practice, and it seems like all the parents of babies and toddlers are really surprised when I hand them toothpaste with fluoride in it.

"But we're not supposed to use fluoride toothpaste now," they say. Some of them hand it back to me, nicely pointing out that I goofed up.

Actually, you can use it--and you probably should. 

As soon as babies get teeth, you should start brushing them, using a toothbrush designed for their age (brushes come labeled with age recommendations). As for what to put on that brush...

Kids older than 2 definitely should use fluoride toothpaste (although from ages 2-5, a pea-sized amount is fine). Any child under the age of two who might be at higher risk for cavities (because they carry a juice cup around, for example, or because cavities run in the family) should use it too--but just a smear across the bristles.

But honestly, there really isn't a significant downside to using fluoride toothpaste, as long as you are careful to just use that smear across the bristles. That's why the dentists at Boston Children's, where I work, recommend that all parents use it as soon as their kids get teeth.

The worry with fluoride is something called fluorosis--if you get too much fluoride (like by eating the yummy kids' toothpaste, which little kids are likely to do) you might end up with defects in the enamel of the teeth. But the vast majority of cases of fluorosis are really mild--just little white specks that are really hard to see--and can be avoided if, like I said, parents are careful to only use that smear.

That smear, which kids usually do end up swallowing, is probably all the fluoride kids need, according to the chief of the dental department at Boston Children's, Dr. Man Wei Ng. So while supplementation with fluoride is still recommended if your local water supply doesn't have fluoride (or if you are giving your child only bottled water, which a lot of parents do even though it's not necessary), you may be just fine with fluoride toothpaste. Check with your doctor to be sure. To get the most out of the toothpaste, Dr. Ng recommends not rinsing after brushing.

Here are some other tips to keep your child's teeth healthy:
  • Have a dental home! Your children should see a dentist every 6 months starting at a year of age (or sooner, if teeth come early).
  • Brush twice a day (with fluoride toothpaste). Even if your child likes to do it alone, do it with him (or after him) until he's really able to do it well himself, which is probably somewhere around first grade.
  • Floss between teeth that are in contact. Start when kids are young, to get in the habit.
  • Candy isn't great for teeth--but what's really bad for teeth is frequent candy, or any frequent snack--especially gummies and fruit roll-ups that get stuck in and around teeth. Because that's what causes cavities: when the sugars and starches hang out in the mouth and are broken down by bacteria into acid. Limit snacks and sugary things, and brush afterward.
  • For the same reason, juice (especially sugar-sweetened, but any kind, really) is bad news for teeth, especially when carried around in a sippy cup all day (diluting it may cut the calories, but it doesn't help with preventing cavities). Drink water and plain milk instead.
  • Don't let your baby or toddler sleep with a bottle.
  • Consider xylitol-containing candies and chewing gum--they may help.


Do you have a question you'd like me to answer? Leave me a message on my Facebook page.


This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About MD Mama

Claire McCarthy, M.D., is a pediatrician and Medical Communications Editor at Boston Children's Hospital . An assistant professor of pediatrics at Harvard Medical School and a senior editor for Harvard More »

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