Modules

Module 4: Anticipatory Guidance, Fluoride Varnish, and Referral

4.1 Anticipatory Guidance

Toothbrushing

Toothbrushing with fluoridated toothpaste helps maintain the health of teeth and gums. Toothbrushing with fluoridated toothpaste serves as a vehicle for applying small doses of topical fluoride to tooth surfaces. Frequent exposure to small amounts of topical fluoride each day is the best way to reduce the risk for dental caries.1

Because many brands of toothpaste are flavored, young children tend to swallow toothpaste more readily than do older children and adults. Concern over fluorosis occurring in the permanent teeth has resulted in a number of confusing and contradictory recommendations regarding the use of fluoridated toothpaste. Recognizing fluoride’s cariostatic properties, the American Academy of Pediatric Dentistry recommends that all children’s teeth be brushed twice daily with fluoridated toothpaste.2 Specific guidelines as to the amount of toothpaste dispensed according to the age of the child were developed to reduce the risk of fluorosis. These guidelines are as follows:

For Infants and Children Under Age 2

  • Use a soft toothbrush that is an appropriate size for the infant’s or child’s age
  • Dispense a smear of fluoridated toothpaste on the bristles of the toothbrush
  • Parents should brush the infant’s or child’s teeth twice daily

For Children Ages 2 Through 5

  • Use a soft toothbrush that is an appropriate size for the child’s age
  • Dispense a pea-sized amount of fluoridated toothpaste on the bristles of the toothbrush
  • Parents should brush the child’s teeth or supervise brushing twice daily
smear of toothpaste pea-sized amount of toothpaste
Smear   Pea-size
Used with permission from Norman Tinanoff, D.D.S., M.S., University of Maryland Dental School.