Excerpt from Fluoride Use in Caries Prevention in the Primary Care Setting:

Use of fluoride toothpaste should begin with the eruption of the first tooth. When fluoride toothpaste is used for children younger than 3 years, it is recommended that the amount be limited to a smear or grain of rice size (about one-half of a pea). Once the child has turned 3 years of age, a pea-sized amount of toothpaste should be used (20,21). Young children should not be given water to rinse after brushing because their instinct is to swallow. Expectorating without rinsing will both reduce the amount of fluoride swallowed and leave some fluoride in the saliva, where it is available for uptake by the dental plaque. Parents should be strongly advised to supervise their child’s use of fluoride toothpaste to avoid overuse or ingestion.

High-concentration toothpaste (5000 ppm) is available by prescription only. The active ingredient in this toothpaste is sodium fluoride. This agent can be recommended for children 6 years and older and adolescents who are at high risk of caries and who are able to expectorate after brushing. Dentists may also prescribe this agent for adolescents who are undergoing orthodontic treatment, as they are at increased risk of caries during this time (22).

*Original article online at http://fluoridealert.org/wp-content/uploads/clark-2014.pdf