Fluoride Action Network

Toothpaste and Toothbrushing: a new report by the CDC.

Fluoride Action Network | Online February 4, 2019 | Updated March 13, 2019

The report was released on February 1, 2019: Use of Toothpaste and Toothbrushing Patterns Among Children and Adolescents — United States, 2013–2016Morbidity and Mortality Weekly Report, by Thornton-Evans G1, Junger ML1, Lin M1, Wei L2, Espinoza L1, Beltran-Aguilar E2.

It’s called a “CDC report” because four1 of the authors are with the Division of Oral Health at the Center for Disease Control and Prevention (two2 work for DB Consulting Group, Inc., Atlanta, GA).

There were 1,686 children in the age group 3-6 years, for which 38% used more than the recommended amount of toothpaste “exceeding current recommendation for no more than a pea-sized amount (0.25 g) and potentially exceeding recommended daily fluoride ingestion (1,6).”

The CDC noted that “ingestion of too much fluoride while teeth are developing can result in visibly detectable changes in enamel structure such as discoloration and pitting (dental fluorosis) (1). Therefore, CDC recommends that children begin using fluoride toothpaste at age 2 years. Children aged <3 years should use a smear the size of a rice grain, and children aged >3 years should use no more than a pea-sized amount (0.25 g) until age 6 years, by which time the swallowing reflex has developed sufficiently to prevent inadvertent ingestion.”

The CDC recommended “that all persons drink optimally fluoridated water (0.7 mg/L)” without any warning for pregnant women, formula-fed infants, people with kidney disease, or those with allegies to fluoride.

The CDC noted these limitations to the report:

  • “First, the measures used are based on parents’ self-report, so reporting bias is possible.
  • “Second, the question about the amount of toothpaste used focuses on the amount currently used and therefore might overestimate the amount that was used at younger ages.
  • “Finally, the type of toothpaste (fluoride versus nonfluoride) was not specified.”

The CDC used 5 references for dental fluorosis dated 1988, 1992, 1994, 2014, and 2015. Surprisingly none included direct references to NHANES (National Health and Nutrition Examination Surveys) data on dental fluorosis which has documented significant increases in dental fluorosis in U.S. children between 1986 to 2012. For example:

Neurath et al. (2019) reported NHANES data on dental fluorosis for 12-15 year olds: 22% (1986-1987), 41% (1999-2004) and 65% (2011-2012). Wiener et al. (2018) looked at the NHANES data for a different age group, and reported: “There was a difference of 31.6% in dental fluorosis prevalence between 2012-2011 when compared to data from 2002-2001 in adolescents aged 16 and 17 years.”

The Fluoride Action Network issued a press release on February 4th titled Dental fluorosis out of control – Media is missing the elephant in the room, which noted:  “A spate of news stories – triggered by a CDC report  – focused on kids swallowing too much toothpaste. But according to Paul Connett, PhD, director of FAN, “The defenders of water fluoridation are missing the real story. Dental fluorosis is a biomarker of over-exposure to fluoride and the ‘elephant in the room’ is what damage fluoride is doing to other tissues.

The CDC report generated a rash of articles. Here are some of them:

Jan 1, 2019, The Washington Post. Study: Many small kids in US are using too much toothpaste, by Mike Stobbe, AP.

Feb 1, 2019. ABC-TV Eyewitness News. Study: Kids in US are using too much toothpaste, by Mike Stobbe, AP.

Feb 1, 2019, CBS-TV (New York). CDC Warning: Children Are Using Too Much Toothpaste.

Feb 1, 2019, Fatherly. CDC Says Your Kid is Probably Using Way Too Much Toothpaste, by Amanda Tarlton.

Feb 2, 2019, Fox News. Too much toothpaste? Young kids are overusing, CDC says, by Madeline Farber.

Feb 2, 2019,  Kids, You May Be Using Too Much Toothpaste, CDC Suggests,

Feb 2, 2019, Fortune. Kids Are Using Too Much Toothpaste CDC Warns, by Veronica Neto.

Feb 2, 2019, People. Kids Are Starting to Brush Their Teeth Later Than Recommended, Using Too Much Toothpaste: Study, by Jen Juneau.

Feb 2, 2019, The Times of India. Why parents must not let children brush alone, by AP.

Feb 2, 2019, India Today. Brushing with toothpaste too often can cause tooth decay: New study.

Feb 2, 2019. The Atlanta Journal-Constitution. Your child may be using too much toothpaste, and it’s unhealthy, CDC says, by Najja Parker.

Feb 3, 2019, The New York Times. Many Children Are Overdoing It on the Toothpaste, C.D.C. Study Says, by Julia Jacobs.

Feb 3, 2019, The HANS India. US kids use excess toothpaste: Report.

Feb 3, 2019. Scary Mommy. CDC Says Kids Are Brushing Their Teeth Wrong, Moms Everywhere Say ‘No Sh*t’, by Cassandra Stone.

Feb 4, 2019. Fluoride Action Network. Dental fluorosis out of control – Media is missing the elephant in the room. Press Release.

Feb 4, 2019. USA Today. Children are using an unhealthy amount of toothpaste, CDC warns, by Ashley May.

Feb 4, 2019. ScienceAlert. Almost 40% of American Kids Are Making This Simple Toothpaste Mistake, CDC Says, by Peter Dockrill.

Feb 4, 2019. WMTW News 8 Portland. CDC: Parents need to monitor how much toothpaste younger kids are using, by

Feb 4, Gulf News – Dubai. Tooth diary: How much toothpaste is enough? By New York Times News Service.

Feb 4, 2018. Chicago Sun-Times. Kids are using an unhealthy amount of toothpaste, CDC warns, b

Feb 4, 2019. ABC News. Too much toothpaste may hurt your child’s smile, by Alexandra H. Antonioli.

Feb 4, 2019. News Medical Life Sciences. Kids using too much toothpaste says CDC, b

Feb 4, 2019. Newser. CDC: Kids Are Using Too Much Toothpaste, by Jenn Gidman.

Feb 4, 2019. -TV Eyewitness News (Calif). CDC: Children Are Using Too Much Toothpaste, by Jessica Shotorbani

Feb 4, 2019, The Boston Globe. A reprint of the NYT article of Feb

Feb 5, 2019. South China Morning Post. Many parents are brushing children’s teeth with an unhealthy amount of toothpaste, CDC warns, by Associated Press.

Feb 6, 2019. Kidspot (Australia). New report warns about kids and toothpaste, by Claire Haiek.

Feb 6, 2019. New York State Coalition Opposed to Fluoridation. Not Just Toothpaste, is Overused. Press Release.

Feb 6, 2019. KETK-TV, East Texas Matters. Study finds nearly half of children are using harmful amounts of toothpaste, by Olivia Sandusky.

Feb 6, 2019. Good Housekeeping. Your Kids Are Probably Using Too Much Toothpaste, And It’s Hurting Their Teeth, by Caroline Picard (health editor).

Feb 7, 2019. Medscape. Pediatricians Echo CDC Caution on Using Too Much Toothpaste, by Marcia Frellick.

FEB 7, 2017. Today Show. How much toothpaste is just right? CDC most kids use too much or too little, by Meghan Holohan.

Feb 8, 2017. ABC News (Australian Broadcasting Corporation). You could be using too much toothpaste. Here’s how much Australian dentists recommend, by Alle McMahon.

Feb 19, 2019. Mercola.com. Public Health Warning Issued for Fluoride Toothpaste, by Dr Mercola.

May 13, 2019. ABC27 News (Pennsylvania). Mommy Minute: Is your child using too much toothpaste? By Ali Lanyon.