NEW YORK (Reuters Health) – Parents know that fluoridated toothpaste is good for their children’s teeth and can help prevent cavities. What they may not realize, however, is that overusing toothpaste or other sources of fluoride in very young children can be a case of too much of a good thing.
According to a report in the Journal of the American Dental Association, intake of excess fluoride–whether through toothpaste, fluoridated water, fluoride supplements, or a combination of these–can cause a condition in children known as dental fluorosis.
This condition is not known to cause any actual health problems, but does cause an unsightly discoloration of the teeth, reports Dr. David G. Pendrys, associate professor of dentistry at the University of Connecticut in Farmington. While fluorosis can be treated by bleaching the teeth, the best method is to avoid the condition in the first place, he told Reuters Health.
The condition is particularly a problem in children under age 6, whose permanent teeth are developing even though they have not yet erupted through the gums.
In his study, Pendrys looked at 429 children aged 10 to 14 who grew up in areas of Massachusetts or Connecticut where the water was not fluoridated, and 234 children the same age who grew up in Connecticut areas with optimal fluoridation.
The researcher found that 39% of the youngsters from areas with unflouridated water had some signs of fluorosis as did 34% of those from areas with optimal fluoridation of water. In its mild form, fluorosis appears as white lines or streaks on the teeth that can be detected only by a trained examiner, though more severe cases can lead to mottled teeth and even brown staining or pitting of enamel.
For the children from non-fluoridated areas, most fluorosis was attributable to excess fluoride supplement use from ages 2 to 8, brushing more than once a day during the first 2 years of life, and using more than a pea-sized amount of toothpaste.
In the fluoridated-water group, the majority of cases were linked to use of too much toothpaste and tooth brushing more than once per day. Overuse of supplements in children between ages 1 and 2 was implicated to a lesser degree. These children were born prior to 1994, when guidelines for fluoride supplementation were higher.
Currently, fluoride supplement recommendations vary according to the age of a child, and anyone concerned about supplementation should see their dentist or doctor, Pendrys said. Too little fluoride is implicated in tooth decay, he noted.
However, parents can avoid fluorosis in children by making sure their preschool-aged children use no more than a pea-size portion of toothpaste, regardless of whether or not their water is fluoridated.
And parents need to “encourage the child to spit out the toothpaste,” he said.
“Parents should encourage their children to expectorate the toothpaste at the earliest possible age rather than swallow it, avoid toothpaste with flavors that would encourage young children to wish to eat the toothpaste, and keep toothpaste and all other fluoride-containing products out of the reach of preschool-aged children,” he notes in the report.
SOURCE: Journal of the American Dental Association 2000;131:746-754.
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