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How much toothpaste is just right? CDC says most kids use too much or too little

A new study reinforces what dentists know about toothbrushing for young children: they aren't doing it right.
/ Source: TODAY

Getting children to brush their teeth feels like so much work. Having them actually put their toothbrush onto their teeth is a struggle and then they use great globs of toothpaste or no toothpaste at all. A new report from the Centers of Disease Control and Prevention (CDC) reinforces what dentists know about childhood brushing: Parents need to supervise it to make sure it is done correctly. But many parents remain unsure of what to do.

“Supervision for children less than 6 years old (is needed). Not only do parents need to watch them brush, but they also need to encourage them to brush twice daily,” Dr. Gina Thornton-Evans, an author of the study featured in the CDC's Morbidity and Mortality Weekly Report, told TODAY.

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Thornton-Evans and her colleagues asked participants of the National Health and Nutrition Examination Survey (NHANES), a large national health survey beginning in 2013-2014, about their children’s brushing habits. Data from 2013 to 2016 revealed that 38 percent of children age 6 to 8 use too much toothpaste — much more than the CDC endorses. The CDC and other organizations recommend that children begin brushing when teeth first erupt — around six months old — with toothpaste with fluoride. But using too much toothpaste with fluoride can cause problems.

“About 40 percent of children are using too much (toothpaste),” said Trew Stransky from Rockford Pediatrics in Rockford Michigan. “We treat fluoride like any vitamin, where too much is not a good thing and too little is not a good thing,” said Stransky, a doctor of osteopathic medicine who wasn’t involved in the study

Too much fluoride can cause fluorosis, little white spot and streaks, which can carry over to permanent teeth.

“It is a Goldilocks problem,” Janice Townsend, chair of division of pediatric dentistry at the Ohio State University and chief of dentistry at Nationwide Children's Hospital, told TODAY. “If you use too little fluoride you are at increased risk for decay. (Too much) can cause problems with developing permanent teeth, some little speckles.”

Children under 3 should brush with a rice-sized dollop of toothpaste with fluoride. Children 3 to 6 should use a pea-sized drop of toothpaste with fluoride. And, children need to spit to avoid ingesting too much fluoride, which can contribute to fluorosis or just an upset stomach.

“We recommend with kids that parents supervise their teeth brushing and watch them swish and spit. Studies show have shown that kids can’t do that until they are 5,” Stransky said.

The study also found that a whopping 80 percent of parents were not starting brushing early enough.

“I was a little surprised,” said Thornton-Evans. “Only 20 percent of parents reported that under the age of 1 they brushed their child’s teeth.”

The experts agree that parents simply aren’t aware of what they should do when it comes to their children’s oral hygiene. Parents should wipe off their babies mouths prior to tooth development as part of good hygiene. At six months, they should use a small soft bristled tooth brush with rice-size dots of toothpaste with fluoride. Some people might believe using a toothpaste without fluoride is safer, but such a toothpaste will not prevent cavities from developing.

Fluoride-free toothpastes are not going to prevent cavities and kids need to use fluoride,” Townsend said. “There is a sweet spot in the middle that is beneficial.”