In 2009, the American Academy of Pediatric Dentistry changed their guidelines on infant oral care. Instead of using training toothpaste on infants and young children under 2 years of age, they now recommend using a regular toothpaste with fluoride. This amendment also emphasized that only a smear-size amount of toothpaste should be used in children 0-2 instead of the pea-size amount that’s recommended for children 2-5.
Smear Size vs. Pea Size
Most toothpastes on the market are manufactured to contain fluoride. Fluoride is a natural mineral that interacts with ions on the enamel surfaces to make teeth stronger and less prone to cavities. Since the introduction of adding fluoride into community water in 1945, the prevalence and severity of dental decay in our country has dramatically decreased.
While a little bit of fluoride everyday is a good thing, too much fluoride can also lead to problems. Due to its chemical properties, when a larger than regular amount of fluoride is ingested (0.3 mg/kg, about a teaspoon of toothpaste for a 1 year old), it could cause minor gastro-intestinal discomfort. If it’s an extremely large dose, it could even lead to toxicity and possibly death (5mg/kg, about 5 tablespoons of toothpaste for a 1 year old). Chronic exposure of too much fluoride during childhood can also lead to discoloration of permanent teeth at a later age.
Training toothpastes are made without fluoride and they’re targeted towards young toddlers who haven’t learned how to spit. While these products are well-intended, children who use them do not receive the benefits of fluoride exposure.
The current recommendations are made with the intention of balancing the pros and cons of fluoride. With a tiny smear of toothpaste, little kids will receive all the benefits of daily fluoride exposure. Even if they swallow it, since it’s only a smear-size no harm will be done to their tummies nor to the development of their future permanent teeth.
Of course, there are still a lot of moms that worry about swallowing too much fluoride on a daily-basis. For parents who are concerned, my recommendation is to use training toothpaste in the morning and fluoride toothpaste at night. That way fluoride ingestion is cut down by 50%. Night time fluoride toothpaste use is also great because the small amount of toothpaste that’s left on teeth will continue to strengthen enamel while the child is asleep.