Fluoride Toothpaste Linked To Teeth Discoloration In Children

November 30, 1998

COLUMBUS, Ohio -- Children who use too much fluoride toothpaste before age 6 may run an increased risk of developing a condition that discolors teeth, new research shows.

A study of 1,189 seventh-grade children in India found that nearly 13 percent had fluorosis, a primarily aesthetic condition that affects adult teeth during their development. Children in this study who had used a fluoride toothpaste (8.2 percent) before age 6 had almost twice the rate of fluorosis as children not exposed to fluoride at that age. In the United States, about 95 percent of children 6 years or younger use fluoride toothpaste.

The results don't mean children shouldn't brush with fluoride toothpaste, said Ana Karina Mascarenhas, assistant professor of dentistry at Ohio State University. However, parents should make sure their child uses no more than a pea-sized amount each time they brush.

Also, the researchers found that the children who began brushing under the age of two with a fluoride toothpaste seemed to have a more severe form of fluorosis.

In mild cases, fluorosis tends to leave teeth with white stains. In severe forms, which are not very common, teeth can turn brown and enamel may break off, which can lead to cavities.

She conducted the study with Brian Burt of the University of Michigan. The results appear in a recent issue of the journal Community Dentistry and Oral Epidemiology.

According to Mascarenhas, no one had studied whether toothpaste might be a primary cause of fluorosis. She and Burt examined junior high school-aged children in Goa, India.

They cleaned the subjects' teeth with gauze and let the teeth air dry one minute before checking for fluorosis stains. Mascarenhas said she chose Goa because the state does not add fluoride to its water supply and other sources of fluoride are scarce. This means the children received most of their fluoride from toothpaste.

The researchers had the children's parents fill out questionnaires which included a history of fluoride toothpaste use and children's brushing habits. Parents were asked to circle a picture of the amount of toothpaste that most closely resembled what their child normally brushed with.

Ninety-three percent of the parents reported using toothpaste when they first began brushing their child's teeth. About equal numbers of children, 44 percent and 41 percent respectively, reportedly used toothpaste amounting to half or three-quarter lengths of the toothbrush head. The rest of the children were equally divided between using either a pea-sized or full-brush amount.

The American Dental Association recommends children under 6 use a pea-sized amount of toothpaste. The ADA also recommends fluoride supplements -- in the form of tablets or drops -- be given to children 6 months or older who do not have access to fluoridated water. The U.S. government began fluoridating community water sources in 1945 with fluoride levels of 1 part per million. Without adding fluoride, water naturally contains fluoride levels of about 0.05 to 0.1 parts per million.

Mascarenhas said a tube of fluoridated toothpaste contains fluoride levels of about 1,000 to 1,500 parts per million. She added that many European countries offer toothpastes with lower fluoride doses, around 250-600 parts per million, for use by children.

"I do recommend that children under 6 years old use a fluoride toothpaste," Mascarenhas said. "But parents should put less toothpaste on their child's brush and supervise the child when she brushes."

Ohio State University

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