Study says parents may overshoot fluoride toothpaste dose for toddlers, risking dental fluorosis


In a latest examine printed within the journal BDJ Open, researchers in Canada and Germany examined the doses of fluoride toothpaste that folks gave to youngsters as much as two years outdated. Their outcomes point out that many mother and father could give their youngsters considerably extra toothpaste than optimum and may undertake fluoride-free options to keep away from fluoride consumption.

Picture Credit score: Inna Reznik / Shutterstock


Whereas good oral hygiene throughout childhood is crucial to forestall dental caries and different oral illnesses, the fluoride current in toothpaste has raised toxicological considerations about its security for infants and toddlers.

Research have additionally noticed that regardless of fluorides getting used incessantly all over the world, dental caries proceed to be prevalent, with world estimates suggesting that they have an effect on almost half of all youngsters.

Fluoride could trigger continual toxicity and different adversarial long-term results. Because of this, pointers in numerous elements of the world counsel limiting the dose of fluoride for younger youngsters to a small smear or the dimensions of a single grain of rice (as much as 24 months of age) or a pea (for kids below six).

Nevertheless, younger youngsters could swallow 64-100% of their toothpaste, placing them susceptible to dental fluorosis since they’re being systematically uncovered to fluoride. Due to this fact, it’s essential to gather extra data on how a lot toothpaste their mother and father are giving them.

In regards to the examine

On this examine, researchers hypothesized that folks would discover it difficult to observe pointers recommending giving youngsters aged as much as two years one grain’s rice value of toothpaste. They examined this speculation by testing the real-life doses of toothpaste given by mother and father to their youngsters.

The examine was undertaken throughout 5 daycare facilities in Germany, the place mother and father got two commercially out there manufacturers of toothpaste containing 1,000 ppm of fluoride and appropriate for kids and requested to dose them as they normally did at dwelling.

Photograph of the reference doses (i.e., a grain of rice-size amount of toothpaste as recommended for toothpastes for children aged up to 24 months with 1000 ppm fluoride) of toothpaste A (left) and toothpaste B (right) on children’s toothbrushes. A natural grain of rice was used as model. Both amounts were dosed by an experienced dentist.

{Photograph} of the reference doses (i.e., a grain of rice-size quantity of toothpaste as advisable for toothpastes for kids aged as much as 24 months with 1000 ppm fluoride) of toothpaste A (left) and toothpaste B (proper) on youngsters’s toothbrushes. A pure grain of rice was used as mannequin. Each quantities had been dosed by an skilled dentist.

To be included within the examine, they wanted to make use of fluoride toothpaste for kids at dwelling frequently. Dad and mom of youngsters older than two years had been requested to offer a dose primarily based on what they did earlier than the kid’s second birthday. This was thought of to be consultant of how a lot they’d give their youngsters at dwelling.

The burden of every dose was decided and in contrast with the ‘optimum’ advice of 1 grain. Dad and mom had been additionally requested to state how incessantly their youngster’s tooth had been brushed every single day to calculate fluoride publicity, in addition to their information of the optimum doses.


The kids had been, on common, 24 months outdated on the time of the examine, and 61 mother and father met the inclusion standards. Greater than 60% of oldsters mentioned that their youngsters brushed twice day by day, whereas about 23% mentioned they brushed thrice day by day.

The typical worth of a reference dose of fluoride was 0.039-0.045g; nevertheless, mother and father dosed their youngsters with 0.263-0.281g of fluoride on common. The overdose issue was between 5.6 and eight.2.

Greater than 60% of oldsters didn’t find out about fluoride well being warnings or circumstances for its use. Almost 15% used fluoride tablets along with fluoride toothpaste for his or her youngster.


These findings present that youngsters could also be receiving overdoses of fluoride from their mother and father. The authors famous that they might be underestimating youngsters’s publicity to the substance, as fluoride can also be current in meals equivalent to rice, cow milk, and bananas, in addition to consuming water and typically salt.

Nevertheless, even fluoride consumption by means of toothpaste exceeded what is taken into account to be an higher restrict to keep away from dental fluorosis. Additional analysis ought to undertake a complete threat evaluation, together with different sources of fluorides, and likewise contemplate the potential for neurotoxicity as an consequence. It also needs to take socioeconomic elements under consideration.

One of many causes for giant dose sizes may very well be that tv commercials usually showcase extra quantities of toothpaste on brushes. For instance, earlier research had proven that the majority commercials depicted a big swirl of paste that coated your complete head of the comb, far exceeding the advisable dose. The flavour of toothpaste may additionally be palatable to youngsters, main them to ingest extra.

Since shelling out a rice grain’s value of fluoride could also be difficult for fogeys, the researchers counsel utilizing fluoride-free toothpaste varieties, together with another anti-caries substances.

These may embody calcium sodium phosphosilicate or hydroxyapatite, of which the latter has been clinically proven to be protecting towards caries. It’s secure for infants and toddlers if swallowed and might cut back bacterial colonization on the floor of tooth. Encouraging mother and father to interchange fluoride toothpaste with environment friendly and secure options can promote oral care in younger youngsters – and maintain them secure from fluorosis.

Journal reference:

  • Doses of fluoride toothpaste for kids as much as 24 months. Sudradjat, H., Meyer, F., Fandrich, P., Schulze sur Wiesche, E., Limeback, H., Enax, J. BDJ Open (2024). DOI: 10.1038/s41405-024-00187-7,
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