To help prevent children’s tooth decay, the CSA recommends that caregivers use a smear of fluoride toothpaste (or an amount about the size of a grain of rice) for children younger than 3 years old and a pea-size amount of fluoride toothpaste for children 3 to 6 years old.

"For half a century, the ADA has recommended that patients use fluoride toothpaste to prevent cavities, and a review of scientific research shows that this holds true for all ages," said Edmond L. Truelove, D.D.S.,  chair of the Council on Scientific Affairs. "Approximately 25 percent of children have or had cavities before entering kindergarten, so it’s important to provide guidance to caregivers on the appropriate use of fluoride toothpaste to help prevent their children from developing cavities."

Dental decay is the most common chronic childhood disease with more than 16 million children suffering from untreated tooth decay in the U.S, according to the U.S. Centers for Disease Control. Oral disease causes children to miss 51 million school hours and their parents to lose 25 million work hours annually. Additionally, oral disease disproportionately affects children from low-income families and these children have almost twice the number of decayed teeth that have not been treated by a dentist as compared to others in the general population.

CSA previously recommended using water to brush the teeth of children younger than 2 years old and to brush the teeth of children 2 to 6 years old with a pea-size amount of fluoride toothpaste. CSA updated the ADA’s guidance based on a review of scientific evidence.

The report, "Fluoride toothpaste use for young children," and the results of the systematic review, "Fluoride toothpaste efficacy and safety in children younger than 6 years," are published in the February 2014 issue of The Journal of the American Dental Association.

The new guidance is intended to provide children with the full benefit of cavity protection while limiting their risk of developing fluorosis, which is a mild discoloration of teeth usually appearing as faint lines. Based on a systematic review of the evidence, CSA concluded that using just a "smear" of toothpaste for children younger than 3 years old and a pea-size amount for children 3 to 6 years helps prevent cavities and is less likely to cause fluorosis. Children should spit out toothpaste as soon as they are old enough to do so.

The ADA encourages caregivers to take their child to the dentist when the first tooth appears or no later than the child’s first birthday.