Pediatricians Echo CDC Caution on Using Too Much Toothpaste

Marcia Frellick

February 07, 2019

Children are brushing with too much toothpaste and, as a result, are ingesting too much fluoride, the Centers for Disease and Prevention (CDC) warns after analyzing results from a survey on brushing habits.

When children with developing teeth are exposed to too much fluoride, the result can be fluorosis, which can change the enamel structure of teeth and cause discoloration, pitting, or striping.

The advertising of oral-health products doesn't help with toothpaste restraint, said Michelle Terry, MD, a pediatrician at Seattle Children's Hospital.

"Every toothpaste commercial I have seen shows the application of about an inch or two of toothpaste on the toothbrush with a little 'curly q' at the top. The toothpaste is advertised such that people use about 10 times the amount they need," she told Medscape Medical News.

Also, with flavors like bubble gum and berry, kids can be tempted to swallow the paste rather than spit it out, she pointed out.

The CDC and the American Dental Association recommend that children begin to use fluoride toothpaste at age 2, but only a drop the size of a grain of rice until age 3. From the ages of 3 to 6, children should use no more than a pea-sized dab. At 6 years, the swallowing reflex has developed enough to prevent accidental ingestion, the study authors report.

Questions about the toothpaste and brushing habits of kids and teens were included in the National Health and Nutrition Examination Survey (NHANES) for the first time in the 2013/14 cycle.

An analysis of 2013 to 2016 NHANES data, which involved responses from 5157 parents of children 3 to 15 years of age, was published in the February 1 issue of the Morbidity and Mortality Weekly Report.

The findings show that 38% of children 3 to 6 years of age use more than the dentist-recommended amount of toothpaste.

This study highlights "the importance of recommendations that parents supervise young children during brushing and monitor fluoride ingestion," the study authors write.

Parents Aren't Getting Enough Details on Brushing

Although oral health is discussed during well-child visits, the amount of toothpaste to use might get lost because pediatricians have so many other things to talk with parents about during those early visits, including development milestones, vaccinations, car seats, and crossing the street safely, Terry said.

The recommended amounts for each age are listed on toothpaste tubes, but people might not think to look there, she added.

The CDC also recommends that brushing start as soon as the first tooth erupts, which can be as early as 6 months. But the NHANES data show that brushing started later than the recommended time for 80% of the children.

However, the overall message is that parents aren't getting enough details on brushing, possibly because the pediatrician is racing through the instructions during a well visit or is providing more information than the parents can absorb during the visit, Christina Suh, MD, from Children's Hospital Colorado in Aurora, told Medscape Medical News.

The study also shows that parents who are just glad that their child is brushing should spend more time watching how the child brushes, she added.

The CDC also recommends that 2-year-old children brush twice a day with a fluoride toothpaste to reduce the risk for dental caries.

In this survey, however, 34.2% of the children and teens brushed just once a day.

The study authors acknowledge the limitations of the study, which include the fact that the data were parent-reported and the type of toothpaste — fluoride or nonfluoride — used was not specified.

The study authors, Terry, and Suh have disclosed no relevant financial relationships.

MMWR Morb Mortal Wkly Rep. 2019;68(4):87-90. Full text

Follow Medscape Pediatrics on Twitter @MedscapePeds and Marcia Frellick @mfrellick

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