Modules
Module 2: Caries PreventionCaries Risk Classification Table

2.3 Mineral and Antimicrobial Agents

Girl brushing teeth

Fluoride

Fluoridated Toothpaste

Fluoride in toothpaste is thought to have played a major role in the decline of dental caries since 1975, especially in industrialized countries.8 Oral health professionals should encourage all patients to brush their teeth twice a day with fluoridated toothpaste.9,10 Because of its direct uptake from toothpaste into enamel, plaque, and saliva, fluoride in toothpaste confers benefits in addition to those that other fluorides provide. Patients should be advised not to rinse after brushing to allow fluoride to remain in contact with the teeth for longer, thereby increasing topical absorption into the enamel surface of the teeth.

As previously mentioned, education for children under age 10 should be provided to parents or other caregivers, as well as to the child. It is important that parents or caregivers be present when oral health professionals provide instruction on the use of fluoridated toothpaste for children under age 10.

No more than a smear of toothpaste should be used for children ages 2 and younger, and a pea-sized amount for all other ages. To help ensure that the right amount of toothpaste is being used, oral health professionals can tell patients and parents to put toothpaste on the toothbrush bristles sideways (not lengthwise).

High-Fluoride Prescription Toothpaste

High-fluoride prescription toothpaste may be indicated for adults and children ages 6 and older who are at high or very high risk.11,12 Oral health professionals should instruct patients to use high-fluoride toothpaste according to the manufacturer’s instructions. Patients over age 16 should spit after brushing but should not rinse with water or a mouthwash and then should not eat or drink anything for one half hour. Patients ages 6 through 16 should spit after brushing and then rinse.

Children who have difficulty spitting or rinsing should not use this type of toothpaste because excessive ingestion of fluoride can cause nausea, fluorosis, or both. High-fluoride toothpaste contains enough fluoride to be harmful to children under age 6, if ingested. It should be kept in a locked cabinet out of children’s reach.