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J Am Dent Assoc. 2014 Feb;145(2):182-9. doi: 10.14219/jada.2013.37.

Fluoride toothpaste efficacy and safety in children younger than 6 years: a systematic review.

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Dr. Wright is a professor and the chair, Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill.



The authors conducted a systematic review to assess the efficacy and safety of fluoride toothpaste use in children younger than 6 years.


The authors defined research questions to formulate a search strategy. They screened studies, extracted data and assessed risk of bias systematically. They conducted meta-analyses to determine the effects of brushing with fluoride toothpaste.


Use of fluoride toothpaste brushing had a statistically significant effect on mean decayed, missing and filled primary tooth surfaces and decayed, missing and filled primary teeth for populations at high risk of developing caries (standard mean difference [95 percent confidence interval {CI}], -0.25 [-0.36 to -0.14] and -0.19 [-0.32 to -0.06], respectively). The effects of using different fluoride concentration toothpastes on caries varied. Study findings showed either a decrease in the odds of having fluorosis (odds ratio [OR] [95 percent CI] = 0.66 [0.48-0.90]) when the use of fluoride toothpaste was initiated after 24 months or no statistically significant difference (OR [95 percent CI] = 0.92 [0.71-1.18]). Beginning use after 12 or 14 months of age decreased the risk of fluorosis (OR = 0.70 [0.57-0.88]).


Limited scientific evidence demonstrates that for children younger than 6 years, fluoride toothpaste use is effective in caries control. Ingesting pea-sized amounts or more can lead to mild fluorosis. Practical Implications. To minimize the risk of fluorosis in children while maximizing the caries-prevention benefit for all age groups, the appropriate amount of fluoride toothpaste should be used by all children regardless of age. Dentists should counsel caregivers by using oral description, visual aids and actual demonstration to help ensure that the appropriate amount of toothpaste is used.


Caries; fluoride; fluorosis; infant care; toothbrushing; toothpaste

[Indexed for MEDLINE]

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