Fluoride Use in Children: Fluoridated Water, Toothpaste and Preventing Tooth Decay

“Should my child use fluoride toothpaste?”“Do I need to prepare my baby's formula with fluoridated water?”“Is fluoride harmful for children?”“At what age should toothpaste be started?”

Fluoride use is one of the topics that causes families the most confusion when it comes to children's oral and dental health.

Fluoride is a natural mineral that, when used in the right amount, helps make tooth enamel more resistant to decay. However, when it comes to fluoride use in children, age, the amount of the product used and the child's total fluoride exposure all matter.

For this reason the aim is not “the more fluoride, the better.”

Using fluoride at the right age, in the right amount and in the right way is important in preventing tooth decay.

What Is Fluoride?

Fluoride is a mineral found in nature.

It can occur naturally in water and in some foods and drinks; it is also used to prevent tooth decay in;

• Toothpastes
• Some oral care products
• Professional fluoride varnishes
• Drinking water in some regions

as a protective measure.

Fluoride works particularly on the tooth surface, helping to make enamel more resistant to acid attacks and helping early mineral loss to be regained.

How Does Fluoride Prevent Tooth Decay?

Bacteria in the mouth produce acid, especially after foods and drinks containing sugar.

Over time these acids can cause mineral loss from tooth enamel and lead to decay.

Fluoride;

• Increases the resistance of tooth enamel
• Supports the regaining of lost minerals

It helps reduce the risk of tooth decay developing.

For this reason, using fluoride toothpaste is one of the basic ways of preventing tooth decay in childhood.

At What Age Should Children Use Fluoride Toothpaste?

There is no need to wait until age 2 or 3 to use fluoride toothpaste.

Brushing should begin as soon as the first tooth comes through.

However, the amount of toothpaste used should be adjusted according to the child's age.

Between 0 and 3 Years

From the time the first tooth appears until age 3, fluoride toothpaste should be used as a very thin layer the size of a grain of rice.

At this age it is not right to put a large amount of toothpaste on the brush.

Between 3 and 6 Years

Between the ages of 3 and 6, fluoride toothpaste can be used in an amount the size of a pea.

Even if the child is allowed to brush on their own, it is important for the parent to control the amount and supervise the brushing.

How Many Times a Day Should Children's Teeth Be Brushed?

In general, brushing twice a day with fluoride toothpaste is recommended.

Brushing before bed at night is particularly important.

In young children, the parent needs to brush the teeth themselves or help with the brushing.

As children's manual skills develop, responsibility can gradually be handed over to the child; however, they may need parental supervision for a long time.

Should Babies Be Given Fluoridated Water?

In the first 6 months there is no need to give a baby extra fluoridated water solely to provide fluoride.

Routine fluoride supplementation is not recommended for babies younger than 6 months.

A breastfed baby also does not need to drink extra water only for fluoride.

Once a baby is older than 6 months, the need for fluoride is assessed together with the amount of fluoride in the drinking water, the risk of tooth decay and other sources of fluoride.

Can Formula Be Prepared With Fluoridated Water?

Safe drinking water should be used to prepare formula.

Preparing formula with water containing fluoride is possible. However, it is not necessary to prepare a baby's formula specifically with fluoridated water just to provide fluoride.

Especially in the first months of life, continuous exposure to very high amounts of fluoride can increase the risk of mild dental fluorosis in developing teeth.

For this reason the content of the water used matters.

If the family uses well water, or if the fluoride content of the water is unknown, the content of the water may need to be assessed.

Does Every Child Need a Fluoride Supplement?

No.

Systemic supplements in the form of fluoride drops or tablets are not given routinely to every child.

When making this decision;

• The child's age
• The risk of tooth decay
• The fluoride level of the drinking water
• Toothpaste use
• Other sources of fluoride

should be assessed.

Whether a fluoride supplement is needed should be decided by the pediatrician or the dentist.

Is There Fluoride in Tap Water?

The answer to this question varies by region.

The amount of natural or added fluoride in drinking water is not the same in every city and every water source.

In particular, in families who;

• Use well water
• Use drinking water from a changing source
• Consistently prefer bottled water

the child's fluoride intake may need to be assessed separately.

For this reason a general statement such as “tap water definitely contains enough fluoride” is not correct.

Is There Fluoride in Bottled Water?

The fluoride amounts in bottled waters can differ from one another.

Some may contain fluoride at a very low level, while others may naturally contain higher amounts.

If a family consistently uses the same bottled water and the child is at high risk of tooth decay, it can be useful to assess the mineral content of the water.

Is Fluoride Harmful?

The effect of fluoride depends on the dose.

Fluoride toothpaste used in the recommended amounts helps prevent tooth decay in children.

However, regularly swallowing more fluoride than needed, especially at the young ages when teeth are developing, can increase the risk of dental fluorosis.

For this reason the basic approach in children is not to avoid fluoride completely but to use it in a suitable amount.

What Is Dental Fluorosis?

Dental fluorosis is a change that can occur in the appearance of tooth enamel as a result of taking in more fluoride than needed over a long period while the teeth are developing.

In mild fluorosis, teeth may show;

• Fine white lines
• White spots

as changes.

Most cases of mild fluorosis are cosmetic in nature.

More severe fluorosis is associated with much higher and longer-lasting fluoride exposure.

For this reason it is important to use toothpaste in an age-appropriate amount in young children.

What Happens if a Child Swallows Toothpaste?

It is common for young children to swallow some of the toothpaste while brushing.

For this reason the amount of toothpaste used needs to be kept particularly small.

This is one of the reasons for using a rice-grain-sized amount in children under 3 and a pea-sized amount between the ages of 3 and 6.

Over time the child should be helped to develop the habit of spitting out the toothpaste rather than swallowing it.

If a large amount of toothpaste is swallowed by accident, medical assessment may be needed depending on the amount of the product used and the child's condition.

Is Fluoride-Free Toothpaste Safer?

Using fluoride-free toothpaste is not automatically a healthier option.

There is strong scientific evidence for the benefit of fluoride in preventing tooth decay in children.

What matters is;

• Choosing a fluoride toothpaste suitable for the child's age
• Using the correct amount
• The parent supervising the brushing

That the child does not swallow an unnecessary amount of toothpaste.

What Is Fluoride Varnish in Children?

Fluoride varnish is a protective application containing a high concentration of fluoride that is applied to the tooth surface by a health professional.

It can be useful especially in children at risk of tooth decay.

After the first teeth come through, the pediatrician or the dentist can assess the risk of decay and plan fluoride varnish application.

Fluoride varnish is not an alternative to daily fluoride toothpaste use; it is one of the additional protective applications used when needed.

When Should a Child's First Dental Check-Up Be?

Oral and dental health follow-up should not start after the first cavity appears.

Beginning oral care when the first teeth come through and having an early dental assessment can be useful for;

• The family learning the correct brushing method
• Identifying the risk of decay
• Assessing the need for fluoride
• Reviewing eating habits

as part of preventive care.

Baby Teeth Will Fall Out Anyway, Does Their Care Matter?

Yes, it matters.

Baby teeth contribute to;

• The child's chewing
• Speech development
• Holding space for the permanent teeth

as they grow.

Decay in baby teeth can lead to pain, infection, and eating and sleeping problems.

For this reason oral health care should start from the very first baby tooth.

Does Putting a Child to Bed With a Bottle Cause Tooth Decay?

After the teeth have come through, prolonged contact between the teeth and milk, formula or drinks containing sugar, especially through the night, can increase the risk of decay.

If a child constantly uses a bottle while falling asleep, this habit needs to be reviewed in terms of oral and dental health.

Adding;

• Sugar
• Honey
• Molasses

to the bottle should be avoided.

How Does Sugar Consumption Affect Tooth Decay in Children?

In tooth decay, it is not only the amount of sugar consumed that matters but also how often sugar is encountered.

Frequently consuming;

• Candy
• Cookies
• Sugary drinks
• Fruit juice
• Sticky desserts

throughout the day can increase how often acid attacks occur in the mouth.

For this reason, daily eating habits are just as important as fluoride use in children's oral health.

What Can Be Done to Prevent Tooth Decay in Children?

To protect a child's oral and dental health;

Start brushing when the first tooth comes through.

Use an age-appropriate amount of fluoride toothpaste.

Brush the teeth twice a day.

As a parent, supervise brushing in young children.

Reduce how often sugary foods and drinks are consumed.

Avoid sugary or calorie-containing drinks in a bottle at night.

Have your child's dental check-ups done regularly.

Consider protective applications such as fluoride varnish when needed.