The use of fluoride-containing toothpastes in young children: the scientific evidence for recommending a small quantity.

The prevalence of dental fluorosis has increased since the 1930s in both fluoridated and nonfluoridated United States communities because of increased exposure to systemic fluorides. 1-4 Although the increase in dental fluorosis is of the mild and very mild categories and poses no immediate health problem, more severe levels are of esthetic concern and may threaten the continued use of systemic fluorides to prevent dental decay. Indeed, the severity of dental fluorosis in a few isolated populations already has become a public concern (see footnote). 5-7 Considering these factors, it is imperative that all possible efforts are undertaken to control the prevalence and severity of dental fluorosis within the range of public acceptance. In March, 1991, the National Institute of Dental Research sponsored an international workshop, Changing Patterns of Systemic Fluoride Intake. In this meeting, fluoride and clinical science researchers discussed issues relating to the safe and effective use of systemic and topical fluorides. Workshop participants agreed that in addition to drinking water, fluoride supplements, and dietary sources, the inadvertent ingestion of toothpaste by young children could be a source of systemic fluoride. It is a common practice in the dental profession to recommend the use of a small quantity or a pea-size amount of toothpaste for young children. The rationale for this recommendation is to minimize the inadvertent ingestion of fluoride-containing dentifrices, which theoretically could lead to increased systemic fluoride intake. The purpose of this article is to discuss the relationship between fluoride-containing dentifrices and dental fluorosis; in particular, we will examine the scientific evidence for recommending the use of a small amount of fluoridated toothpaste for children.