"Brush your teeth with fluoride toothpaste twice daily," is no longer just applicable to older children and adults; it is now recommended for kids ages 2 and under. The American Dental Association (ADA) has overturned its decades-old recommendation and now suggests parents use a tiny smear of fluoride toothpaste to brush their children’s baby teeth as soon as they grow. This advice was prompted by the alarming high rates of U.S. children who develop tooth decay or cavities before kindergarten.

"Approximately 25 percent of children have or had cavities before entering kindergarten, so it’s important to provide guidance to caregivers on the appropriate use of fluoride toothpaste to help prevent their children from developing cavities,” said Dr. Edmond L. Truelove, chair of the Council on Scientific Affairs, in a press release. Prior to the ADA’s new guidelines, the Council on Scientific Affairs recommended the use of water to brush the teeth of children younger than 2 years old and to brush the teeth of children 2 to 6 years old with a pea-size dollop of fluoride toothpaste. However, researchers have contested the efficacy and safety of fluoride toothpaste for children under age 6, acknowledging its early protection from tooth decay, while also limiting the risk of developing fluorosis — a mild discoloration of the teeth.

In a study published in The Journal of the American Dental Association, a team of researchers conducted a systematic review of 17 studies to assess the potential benefits of using fluoride toothpaste at a young age. While the data was limited for those under 6, and robust for older children, the findings revealed using this toothpaste is effective in preventing tooth decay, and the appropriate amount should be used by children of all ages. To minimize the risk of fluorosis, children should be taught to discard the excess toothpaste as soon as possible.

Parents are told to encourage the use of fluoride toothpaste, even if their kids can’t spit it out yet, because an early start to preventing tooth decay is vital. Dentists like Dr. Jonathan Shenkin, a pediatric dentist in Augusta, Maine, and a spokesman for the ADA, believe cavity prevention and minimal fluoride consumption is feasible for kids ages 2 and under. The pediatric dentist told The New York Times, he has 5-year-old patients who are “still not using a fluoride toothpaste because parents don’t think they can spit it out yet.” If parents become actively involved in this process, they can control the amount of toothpaste on the toothbrush and help their youngsters to brush effectively.

While this may come as “new” advice to many parents, it echoes the American Academy of Pediatric Dentistry’s long recommended use of fluoride toothpaste for youngsters. The smaller trade group suggests parents use a pea-size amount of toothpaste for kids at risk for cavities, those who sleep with a bottle at night, or have a family history of tooth decay. Now the ADA's new guidelines support this belief and emphasize the importance of preventing and reducing tooth decay at a young age.

Tooth decay commonly occurs when bacteria and food come together. Plaque that contains bacteria forms on the teeth and gums, as the bacteria feeds off the sugar in the food consumed, changing them into acids. The Centers for Disease Control and Prevention says over 19 percent of children between the ages of 2 and 19 have untreated cavities. This condition remains the most common chronic childhood illness in the U.S., and if left untreated, it can lead to malnourishment, bacterial infections, emergency surgery, and even death. Oral disease, like tooth decay, causes children to miss 51 million school hours and results in their parents losing 25 million work hours, per year.

The ADA recommends parents to take their child to the dentist either when their first tooth appears, or no later than their first birthday.

Source: Wright JT, Hanson N, Ristic H, Whall CW, Estrich CG, Zentz RR. Fluoride toothpaste efficacy and safety in children younger than 6 years: A systematic review. JADA. 2014.