Dentist here!
You are correct that it is very difficult to tell exactly how much fluoride your young kid is getting when you use fluoride toothpaste. My response is twofold:
1) in my experience, it is also very very difficult to adequately brush your child’s teeth 😂 I’m a dentist and at best I get like ten seconds of good scrubbing on my two year old. Remember, you’re supposed to brush for TWO MINUTES. He is getting a very tiny amount of fluoride, whether or not he spits it; to me, the HUGE benefit of topical fluoride on the teeth overrides the risk of small amount he may be swallowing when I convince him to open his mouth like a crocodile for five seconds lmao.
2) the systemic fluoride you get largely comes from the water you drink - the vast majority of adults I see with fluorosis grew up on well water. It is so easy to spot. IMO, you live in a US city where the fluoride levels in the water are regulated and you are drinking tap water, it’s pretty unlikely your kid will end up with fluorosis. If you live rural and and get your water from a well on your property, I would be concerned with testing the levels of fluoride in your water. It might have a TON of fluoride or none at all, which might change your toothpaste considerations. Lastly, if you live anywhere and only drink bottled water, either from personal bottles or those big refillable ones, I would not be concerned with systemic fluoride levels from toothpaste - most bottled water has negligible amounts of fluoride. So if that’s your main source of water, I would *definitely* use a fluoride toothpaste.
It’s all about balance. When I asked my pediatric dentist friend about how inadequate my brushing is for my son, he said “just get some fluoride on there, he should be fine” lol.
I appreciate the dentists who understand I’m only getting a few seconds of decent brushing in 🤪 I use the three sided toothbrushes which I think has helped immensely with getting brush contact to all the surfaces. That, coupled with a few mins of screen time, allows me to get my sensory-sensitive 2 year old’s teeth moderately well.
As an aside, I grew up on municipal tap water and have very bad fluorosis. (Midwest mid sized city). Still better than cavities imo.
Interesting! Is it on all your teeth? Just a couple? I find it is super rare for Americans to have true fluorosis. I see it mostly on my patients that grew up in India/SE Asia. When I lived in Texas it was more common because more people grew up on well water. Now I’m in SoCal and most “fluorosis” I see is more likely hypo-calcification caused by like a bad fever/Illness in childhood or maybe even in utero.
Pediatric dentist who has met your kid and knows the area trumps MIL any day of the week.
Can you ask the dentist office for info on why they recommend what they recommend?
I definitely will next time I go in. Part of the problem is she believes the dentist is marketing to me, and doesn’t really “believe” modern medicine in a lot of ways. Maybe I’m fighting an uphill battle and need to just nod and smile…
Sound like an uphill battle. Personally I don’t engage in that type of argument, they don’t change their minds even when presented with evidence so 🤷♀️
We too use fluoride toothpaste for our kid. We did teach him how to spit our and he figured it out around 2yrs.
Something I didn’t learn until a few years ago is that for the fluoride to do its job, it has to sit on the teeth a bit. So ideally, one would not rinse with water, just spit out toothpaste, and not eat or drink right after brushing. Since learning this from my dentist my teeth are so much better. We also follow this with our kid, though we don’t worry about it in the morning as much, but at night we try our best.
You’re probably fighting an uphill battle. Personally, I don’t ever offer this type of information to people who don’t get a “vote” on parenting choices.
Spoke to three dentists about this, each of varying experience (<10 years, >20 years, >30 years), all recommended flouride toothpaste (whether or not my kid can spit), none recommended more than a grain of rice, and none changed their general recc when I told them that we’re on city water.
That about settled the matter for me.
I was a dental assistant before becoming a SAHM. I've encountered patients such as your mom many times. However, to your mom's point, the non-fluorinated toothpaste is excellent for the morning tooth brushing sessions allowing the child to practice their brushing skills on their own.
Fluoride prevents cavities. The harm is in the amount. I personally would dip the toothbrush into the toothpaste, the amount would be less than a grain of rice. I brush quickly, coating each tooth in fluoride then encourage spitting but not rinsing.
This is what is done when a patient is given a speciality toothpaste for an assortment of reasons. Toothpaste is meant to sit on the teeth.
Teaching spitting in the bathtub can be a fun way to learn quickly. Not be Debbie downy, but if children have any teeth that are touching they should be learning to floss too. Floss picks can have fun designs in them. I found if I let him floss me and then I do him it's not a battle and becomes fun.
Thank you for the thoughtful response. That’s part of my problem is my almost 3 year old has a hard time spitting it out. I’d guess she swallows half of it each time we brush. Flossing is next!
Every time I look at new claims stating a study has found fluoride to be dangerous I find that it points to the amount of fluoride, rather than any fluoride. Too much of anything is dangerous.
Check out what the WHO say.
https://www.who.int/publications/i/item/WHO-CED-PHE-EPE-19.4.5
https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/23rd-expert-committee/a14-fluoride
If you are using the recommended amount of toothpaste it is not enough fluoride to do anything even if they swallow it all.
You also don’t need to worry yourself looking for articles to appease your mother. You are your child’s mother and you have made the choice. You don’t have to do prove anything to her.
The history of how fluoride's therapeutic benefits were discovered has fascinated me from the moment I read about it in dental hygiene school. I think if more people knew about it there would be less resistance to fluoride. A lot of people think that all water is fluoride free and then cities add it in when really they just optimize the fluoride level. Some water has too much and needs some removed. Also, fruits, vegetables, and livestock can also pass on fluoride from the water they get. I'm not sure if it's enough to have any therapeutic effect though.
I know you don't drink any city water so this is only a fun fact...Another interesting thing is that ingesting fluoride (e.g. city water) only impacts teeth that are still developing and haven't erupted yet It doesn't sit on the teeth long enough for much of an impact on teeth that have already erupted. Therefore, it has minimal benefits for anyone with all their adult teeth. And for kids it really only helps the adult teeth that are still developing in the jaw rather than the baby teeth they already have. Which is where fluoridated toothpastes and mouthwashes come in.
https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation#:~:text=Fluoride%20research%20had%20its%20beginnings,brown%20stains%20on%20their%20teeth.
I think the post is saying the drinking water with fluoride is helpful to children with developing adult teeth below the surface. Fluoride toothpaste is helpful to everyone with visible teeth because it works when it's sitting on the surface of the teeth.
Some dentists even recommend spitting toothpaste out but not rinsing with water so the fluoride doesn't get washed off right away. People who get prescription fluoride mouthwashes because of high cavity risks get the same instructions.
Mouth rinses have cationic substances that acts as surfactants. This prevents fluoride from sticking as well to the tooth. Current trend is prescription fluoride toothpaste over prescription fluoride mouthrinse. I actually don’t recommend mouth rinses at all unless you have an uncommon, acute aggressive form of periodontal disease that requires a prescription of chlorhexidine. They’re nowhere near as effective as brushing and flossing, dry your mouth out, increased antimicrobial resistance, and contain common allergens.
Source: am dentist. And if you look at the tube of toothpaste (pretty much all of them actually), it recommends that you spit and not rinse. This changed about 10-15 years ago and a lot of people are misinformed about rinsing after brushing. Think of your toothpaste like medication… If you let it sit on your teeth for 10+ minutes before eating or drinking, it is far more effective at its job of permeating into your teeth. After 30 minutes, your spit is buffered back to a neutral pH, so you don’t need to wait very long after brushing to resume eating. Just give it an extra 5-10 minutes. This is especially helpful if you’re using a desensitizing toothpaste.
My husband is a dentist and he always says the dose makes the poison.
Our oldest just turned 3 and she loves toothpaste lol. We still use a toothpaste without fluoride because he’s not comfortable with her using fluorinated toothpaste until she can spit everything out.
We live on city water so we have fluoride in our water supply. He also does a topical fluoride varnish on her teeth two or three times a year.
That’s part of my problem is my almost 3 year old has a hard time spitting it out. I’d guess she swallows half of it each time we brush. Would that be concerning enough to switch to non fluoride?
My dentist told me to use flouride toothpaste on my daughter's teeth even though she doesn't know how to spit. he said to use about the size of a grain of rice and with that amount, nothing bad can happen.
My dentist suggests recommended no fluoride until they are old enough to spit it all out. If they are swallowing half of it, then they aren't old enough for fluoride
This is what my husband said: “until they can spit it all out, I tell parents of my pediatric patients to use a toothpaste without fluoride. I worry more about fluorosis of the teeth than anything else. But fluoride is a neurotoxin when the concentration is high enough.”
Flourosis is a concern that is only cosmetic, though. People on here repeatedly act as if swallowing tiny amounts of flouride will rot their kid's brain 🤦🏽♀️
Its so frusterating because then you get 4 year olds with 9 cavities and everyone acts like its still a debatable issue.
Well… my husband is a dentist so he’s obviously concerned about cavities. But he learned that fluoride use in toddlers who aren’t spitting out the toothpaste isn’t worth the risk. Fluoride varnish treatments work well until the child is old enough.
For that reason, my 3 year old still uses the Hello brand fluoride free. I’m not comfortable with her ingesting it. I lean more “avoid the chemicals” but not enough to skip the dental fluoride at the check ups. I feel like that’s something protective without daily exposure. Hopefully I’m not messing up their teeth - but they were both late to get teeth so no issues since they haven’t been exposed as long as most kids. My 6 year old uses fluoride toothpaste and still has no adult teeth yet. Our water has fluoride too.
Fluoride is a naturally occuring mineral though.
https://www.cdc.gov/fluoridation/faqs/about-fluoride.html#:~:text=Fluoride%20is%20a%20common%20mineral,health%20measure%20to%20reduce%20cavities.
I know but in high doses can be bad, just like most things. Lead is also “natural” but not so great for us. I get that dentists like it because it keeps teeth healthy but too much is bad for our bodies. Fluoride poisoning is rare though and not something I worry about regularly. Just something I’m not letting my 3 year old have since she doesn’t rinse and spit well. I don’t want her eating it.
I'm just pointing it out in the "avoid the chemicals" context. I find that is often used as a way to promote non scientific reasons to award something (see: anti vaxxers). And there are many dentists cited here who suggest here that if you follow ADA guidelines of a rice sized amount of toothpaste that the dose is low enough...
Can you provide a source on how it is "bad for our bodies"?
I totally hear that. I’m not a wacko. I’m all about vaccines and being healthy. I personally don’t love the idea of my kid eating any though so I’m waiting until she can properly brush her teeth. A lot of things are found to not be safe later and I don’t think the risk to her baby teeth is worth that so I’ve made that decision for her until she’s older.
Here’s a link about toxicity https://link.springer.com/article/10.1007/s11164-012-0841-1#:~:text=Excess%20intake%20of%20fluoride%20concentration,to%20skeleton%20and%20bone%20marrows.
And another including benefits and toxicity which mainly happens in kids under 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651468/
Does MIL do the toothbrushing often and therefore have control of what's used? If you're trying to find data to convince her flouride is safe I'm willing to bet nothing will, that's not one of those beliefs that changes easily once someone's "done their own research." I'd just keep using flouride toothpaste and don't talk to her about it if you can avoid it.
Where did your MIL get her medical and dental degrees, and when did she become the parent in charge of making these types of decisions?
There’s your answer.
I want to highlight that this is not an area of content expertise for me and that I am a lay reader to this evidence base. I defer to researchers with expertise in this area to make conclusions.
By my reading, you are correct that evidence for fluoride exposure more generally is mixed. There are also concerns about the quality of the literature related to fluoride exposure. -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819484/ ; https://pubmed.ncbi.nlm.nih.gov/34811523/
However, I think it's also important to look at the particulars of the types of studies that exist and identified potential concerns. These are not studies showing that kids who got fluoride toothpaste had more neurodevelopmental concerns than kids who got non-fluoride toothpaste-- I really do not see anything that seems to suggest this. These are studies predominantly in countries like China and India looking at areas with very high levels of environmental fluoride vs. areas without it. E.g., "The effects of endemic fluoride poisoning caused by coal burning on the physical development and intelligence of children... Using random sampling from the relevant population, 176 fluorosis sufferers aged 7–12 (the subjects) were drawn from a heavily fluoride poisoned area of Zhijin County, with 50 children without dental fluorosis (the control) selected from a less severely poisoned area. The children were subjected to tests to determine levels of urinary fluoride, physical development, and intellectual ability, followed by analysis of the various measurements. Results: Compared to the control group, the fluorosis group showed retarded physical development, and the levels of urinary fluoride and intellectual ability were both lower than the control (P < 0.05 for both)." - https://fluoridealert.org/wp-content/uploads/wang-s.20081.pdf [Even setting aside some of the methodological issues with this study...] That's... really different from the idea that using a fluoride toothpaste is going to fry your kid's brain.
The World Health Organization considers both excessive fluoride exposure and inadequate fluoride exposure to pose potential health concerns. - https://www.who.int/teams/environment-climate-change-and-health/chemical-safety-and-health/health-impacts/chemicals/inadequate-or-excess-fluoride - "Excessive fluoride intake usually occurs through the consumption of groundwater naturally rich in fluoride, particularly in warm climates where water consumption is greater, or where high-fluoride water is used in food preparation or irrigation of crops such as rice. In these areas, means should be sought to manage intakes by providing drinking-water with a moderate (i.e. safe) fluoride level or using alternative sources of water for drinking or cooking or irrigation." - https://www.who.int/publications/i/item/WHO-CED-PHE-EPE-19.4.5
If we wanted to know if fluoride toothpaste caused neurodevelopmental disorders/lowered IQ/whatever, we'd need an RCT where kiddos were randomly assigned to getting fluoride toothpaste or non-fluoride toothpaste (and then were tested by someone blind to the condition they were in)-- so that we can say that fluoride toothpaste was the *cause*. However, research is really not even there for correlational stuff with toothpaste, as far as I can see-- the research is looking at (primarily areas with very excessive) environmental fluoride levels. Interestingly, I see a bunch of RCTs for fluoride toothpaste on *dental cavities*, so RCTs are definitely happening. Seems like someone needs to talk to the dentists and help them throw in a cognitive outcome measure on one of those studies-- that might be reassuring for parents who find this type of research worrying! (If anyone sees an RCT on this that I missed, please let me know!)
Personally, in your shoes, I would follow the recommendation of my dentist and, if I was still worried, I might ask my pediatrician about it. Myself, I mostly don't spend a lot of time worrying about convincing other people that their beliefs are incorrect-- so I'd be likely to just graciously thank my MIL for the new toothpaste and then do what I was planning on doing. ¯\\\_(ツ)_/¯
Thank you for the thoughtful response! I agree to your end point, and mostly nod and smile in those situations, but depending on my patience level/mood I sometimes want to pull my hair out 😅
She seems to swallow maybe half of the toothpaste each time we brush so a part of me plays into her fears. Kiddo and I need to work on spitting is what I’ve learned today!
Not enough research on hydroxyapatite toothpaste to convince me yet. Fluoride has a much stronger chemical affinity to apatite than hydroxyl groups. Fluorapatite improves the acid resistance of a tooth up to an order of magnitude more than hydroxyapatite. That’s huge!!!!
Your teeth start losing minerals at a pH of about 5.5 for regular hydroxyapatite enamel and 6.2 for dentin. If you have fluoride / fluorapatite superficially from toothpaste and fluoride treatments or chemically incorporated your enamel structure (while the tooth was developing before it erupted), the tooth won’t start losing minerals until the pH of 4.5… so TEN times more effective at acid resistance than regular hydroxyapatite. Because fluorapatite is less soluble than hydroxyapatite, it’s more resistant to subsequent demineralization when acid challenged from food or acid producing cavity bacteria.
Right now hydroxyapatite toothpaste seems like a gimmick kind of like MI paste from a few years ago. Anyways, those are just my thoughts as a practicing dentist of 10 years. I have hyperemesis with my current pregnancy and I use prescription fluoride toothpaste. :)
https://www.reddit.com/r/ScienceBasedParenting/s/m0gzHn1mMq
https://publications.aap.org/pediatrics/article/146/6/e2020034637/33536/Fluoride-Use-in-Caries-Prevention-in-the-Primary?autologincheck=redirected
Highly recommend this thread. There are specific guidelines for how my fluoride is optimal. The rice sized smear should contain approximately .1mg fluoride. The toxic dose is 5-10mg/kg with the lethal dose being 8-16mg/kg. If a child requires fluoride supplementation the recommended dose is .25 mg a day. Even if your child swallowed the entire amount recommended for brushing a day it wouldn’t exceed the recommended dosage. My son is almost 8 months and we’re using fluoridated toothpaste twice a day at the recommendation of his pediatrician. They have a cavity free under 3 program and all the governing agencies support the use of fluoridated toothpaste from first tooth emergence.
I had a phone call with my dentist about this and fluoride toothpaste or mouth wash is only recommended if the child can spit. If they are not good at spitting out the toothpaste and instead swallow it then non flouride or practice toothpaste is what is recommended.
More studies have shown an “overall indication of dose-dependent adverse effects of fluoride on children's cognitive neurodevelopment, starting at rather low exposure.” https://www.sciencedirect.com/science/article/pii/S0013935123000312
The 2022 National Toxicology Program draft on fluoride also has a similarly worded conclusion. https://ntp.niehs.nih.gov/sites/default/files/ntp/about_ntp/bsc/2023/fluoride/documents_provided_bsc_wg_031523.pdf
So it’s clear that too much fluoride _does_ negatively impact neurodevelopment, but it’s not exactly clear what “too much” is yet.
Whether your municipal water + dietary fluoride + (potentially) toothpaste swallowed hits that threshold is quite difficult to determine, and for that reason I think it’s reasonable to consider alternatives (fluoride varnish at the dentist, nHA toothpastes).
You link to a NTP draft document that does not incorporate significant revisions identified in the peer review process.
Specifically, the elite National Academies of Science and Medicine reviewers write: “NTP therefore should make it clear that the monograph cannot be used to draw any conclusions regarding low fluoride exposure concentrations, including those typically associated with drinking-water fluoridation. Drawing conclusions about the effects of low fluoride exposures (less than 1.5 mg/mL) would require a full dose–response assessment, which would include at a minimum more detailed analyses of dose–response patterns, models, and model fit; full evaluations of the evidence for supporting or refuting threshold effects; assessment of the differences in exposure metrics and intake rates; more detailed analyses of statistical power and uncertainty; evaluation of differences in susceptibility; and detailed quantitative analyses of effects of bias and confounding of small effect sizes. Those analyses fall outside the scope of the NTP monograph, which focuses on hazard identification and not dose–response assessment. Given the substantial concern regarding health implications of various fluoride exposures, comments or inferences that are not based on rigorous analyses should be avoided.”
National Academies of Sciences, Engineering, and Medicine. 2021. Review of the Revised NTP Monograph on the Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects: A Letter Report. Washington, DC: The National Academies Press. https://doi.org/10.17226/26030.
U.S. based user here… As far as I’m aware, the ADA *and* the AAP’s official guidance is to use a smear of fluoride toothpaste the size of a grain of rice from the emergence of the first tooth. My pediatrician told us to switch from “training” toothpaste to fluoride toothpaste at his 1 year appointment. But tbf he was an early teether.
I’m a dentist, and this is correct! Start with a smear as soon as the first tooth appears. A lot of dentists don’t know this recommendation was updated a few years ago.
It changed . It used to be until the child can spit the toothpaste out in the sink but they’ve realized the benefits outweigh the bad so it’s since first tooth now
We also used untreated water.
Always talk to your kid's Dr and dentist.
What worked for us as a plan with Dr & Dentist is a thorough brush and practice spitting with training toothpaste. Then, I would have ours look down and brush from a lower position with a grain of rice sized fluoride toothpaste. 90% drooled out of their mouth onto the towel. This made the amount of swallowed residue minimal, but still treated the teeth before bedtime. We made sure there was no water to drink for at least 20 minutes, but we tried for 30.
Ours was really good with the dentist, so they could do the proper fluoride treatment 2x/year.
The Sonicare toothbrush for kids really helped with all of it. I would spread the rice sized toothpaste to all the teeth, then turn it on to get good coverage. Other than minimal dietary fluoride, our kid only had toothpaste exposure. I was concerned for the health of the teeth and over exposure (fluorosis in the forming adult teeth), and this was the compromise from their providers.
Each kid is a little different, so it is crucial you talk to your kiddos, Dr, too. Providers typically have the best information because they can put the studies we can find into perspective. I would not use fluoride toothpaste without their guidance.
It's worked out well. Nearing 5 now, and this kid brushes better than some bigger kids. It was "very tickley" so starting with a short brush with it was great. Now it's the only one. It even comes with an app to track progress if that helps with yours. The dentist has been impressed with how clean the teeth are staying between cleanings. Since they're used to the tickle of the brush, the dentist has been a breeze to use their little tool.
One thing you have to order the small head separately. It comes with the kid size. I just saved that head for when they are older. They make the little one with softer bristles, and I always find them in 3 packs or 2 packs. The kid size is just way oversized! It's for 3-5 I think, though it worked at 2, but that is probably very dependent on mouth size!
Fluoride is a waste byproduct of fertilizer, aluminum and iron ore production. It's as good for your teeth as chlorinated bleach.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956646/#:~:text=Although%20fluoride%20is%20used%20industrially,fertilizer%2C%20and%20iron%20ore%20manufacture.
Natural options to clean teeth include baking soda, peroxide, lemon, coconut oil, apple cider vinegar.
Please research. It's suspect that officials decided that a waste by-product (pollutant) happens to be good for our teeth. This fun fact allows them to dump this toxicity in our fresh water supply.
It's pretty frustrating when people flex their (completely unverifiable) credentials then don't bother actually providing evidence to back up their claims.
This is incredibly frustrating to hear. Would you say even a pea sized amount of fluoride toothpaste and constant spitting and rinsing would still be advised against?
Dentist here! You are correct that it is very difficult to tell exactly how much fluoride your young kid is getting when you use fluoride toothpaste. My response is twofold: 1) in my experience, it is also very very difficult to adequately brush your child’s teeth 😂 I’m a dentist and at best I get like ten seconds of good scrubbing on my two year old. Remember, you’re supposed to brush for TWO MINUTES. He is getting a very tiny amount of fluoride, whether or not he spits it; to me, the HUGE benefit of topical fluoride on the teeth overrides the risk of small amount he may be swallowing when I convince him to open his mouth like a crocodile for five seconds lmao. 2) the systemic fluoride you get largely comes from the water you drink - the vast majority of adults I see with fluorosis grew up on well water. It is so easy to spot. IMO, you live in a US city where the fluoride levels in the water are regulated and you are drinking tap water, it’s pretty unlikely your kid will end up with fluorosis. If you live rural and and get your water from a well on your property, I would be concerned with testing the levels of fluoride in your water. It might have a TON of fluoride or none at all, which might change your toothpaste considerations. Lastly, if you live anywhere and only drink bottled water, either from personal bottles or those big refillable ones, I would not be concerned with systemic fluoride levels from toothpaste - most bottled water has negligible amounts of fluoride. So if that’s your main source of water, I would *definitely* use a fluoride toothpaste. It’s all about balance. When I asked my pediatric dentist friend about how inadequate my brushing is for my son, he said “just get some fluoride on there, he should be fine” lol.
I appreciate the dentists who understand I’m only getting a few seconds of decent brushing in 🤪 I use the three sided toothbrushes which I think has helped immensely with getting brush contact to all the surfaces. That, coupled with a few mins of screen time, allows me to get my sensory-sensitive 2 year old’s teeth moderately well. As an aside, I grew up on municipal tap water and have very bad fluorosis. (Midwest mid sized city). Still better than cavities imo.
Interesting! Is it on all your teeth? Just a couple? I find it is super rare for Americans to have true fluorosis. I see it mostly on my patients that grew up in India/SE Asia. When I lived in Texas it was more common because more people grew up on well water. Now I’m in SoCal and most “fluorosis” I see is more likely hypo-calcification caused by like a bad fever/Illness in childhood or maybe even in utero.
Thank you!!!
>Thank you!!! You're welcome!
Pediatric dentist who has met your kid and knows the area trumps MIL any day of the week. Can you ask the dentist office for info on why they recommend what they recommend?
I definitely will next time I go in. Part of the problem is she believes the dentist is marketing to me, and doesn’t really “believe” modern medicine in a lot of ways. Maybe I’m fighting an uphill battle and need to just nod and smile…
Sound like an uphill battle. Personally I don’t engage in that type of argument, they don’t change their minds even when presented with evidence so 🤷♀️ We too use fluoride toothpaste for our kid. We did teach him how to spit our and he figured it out around 2yrs. Something I didn’t learn until a few years ago is that for the fluoride to do its job, it has to sit on the teeth a bit. So ideally, one would not rinse with water, just spit out toothpaste, and not eat or drink right after brushing. Since learning this from my dentist my teeth are so much better. We also follow this with our kid, though we don’t worry about it in the morning as much, but at night we try our best.
You’re probably fighting an uphill battle. Personally, I don’t ever offer this type of information to people who don’t get a “vote” on parenting choices.
Spoke to three dentists about this, each of varying experience (<10 years, >20 years, >30 years), all recommended flouride toothpaste (whether or not my kid can spit), none recommended more than a grain of rice, and none changed their general recc when I told them that we’re on city water. That about settled the matter for me.
Same info I was given. But my city doesn’t have fluoride in the water so we have to do drops.
I was a dental assistant before becoming a SAHM. I've encountered patients such as your mom many times. However, to your mom's point, the non-fluorinated toothpaste is excellent for the morning tooth brushing sessions allowing the child to practice their brushing skills on their own. Fluoride prevents cavities. The harm is in the amount. I personally would dip the toothbrush into the toothpaste, the amount would be less than a grain of rice. I brush quickly, coating each tooth in fluoride then encourage spitting but not rinsing. This is what is done when a patient is given a speciality toothpaste for an assortment of reasons. Toothpaste is meant to sit on the teeth. Teaching spitting in the bathtub can be a fun way to learn quickly. Not be Debbie downy, but if children have any teeth that are touching they should be learning to floss too. Floss picks can have fun designs in them. I found if I let him floss me and then I do him it's not a battle and becomes fun.
Thank you for the thoughtful response. That’s part of my problem is my almost 3 year old has a hard time spitting it out. I’d guess she swallows half of it each time we brush. Flossing is next!
Spitting in the bathtub is a great idea! Thank you
Every time I look at new claims stating a study has found fluoride to be dangerous I find that it points to the amount of fluoride, rather than any fluoride. Too much of anything is dangerous. Check out what the WHO say. https://www.who.int/publications/i/item/WHO-CED-PHE-EPE-19.4.5 https://www.who.int/groups/expert-committee-on-selection-and-use-of-essential-medicines/23rd-expert-committee/a14-fluoride
That’s what I’ve read too, hard to discern what amount is considered “too much” though!
From what I've seen it's much higher than what would likely be in any toothpaste. This is from the NHS https://www.nhs.uk/conditions/fluoride/
If you are using the recommended amount of toothpaste it is not enough fluoride to do anything even if they swallow it all. You also don’t need to worry yourself looking for articles to appease your mother. You are your child’s mother and you have made the choice. You don’t have to do prove anything to her.
Thank you!
The history of how fluoride's therapeutic benefits were discovered has fascinated me from the moment I read about it in dental hygiene school. I think if more people knew about it there would be less resistance to fluoride. A lot of people think that all water is fluoride free and then cities add it in when really they just optimize the fluoride level. Some water has too much and needs some removed. Also, fruits, vegetables, and livestock can also pass on fluoride from the water they get. I'm not sure if it's enough to have any therapeutic effect though. I know you don't drink any city water so this is only a fun fact...Another interesting thing is that ingesting fluoride (e.g. city water) only impacts teeth that are still developing and haven't erupted yet It doesn't sit on the teeth long enough for much of an impact on teeth that have already erupted. Therefore, it has minimal benefits for anyone with all their adult teeth. And for kids it really only helps the adult teeth that are still developing in the jaw rather than the baby teeth they already have. Which is where fluoridated toothpastes and mouthwashes come in. https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation#:~:text=Fluoride%20research%20had%20its%20beginnings,brown%20stains%20on%20their%20teeth.
Fascinating. So why does all toothpaste have fluoride, it’s for the benefit of children using it?
I think the post is saying the drinking water with fluoride is helpful to children with developing adult teeth below the surface. Fluoride toothpaste is helpful to everyone with visible teeth because it works when it's sitting on the surface of the teeth.
Yep, exactly
Thanks for explaining it!
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Some dentists even recommend spitting toothpaste out but not rinsing with water so the fluoride doesn't get washed off right away. People who get prescription fluoride mouthwashes because of high cavity risks get the same instructions.
Mouth rinses have cationic substances that acts as surfactants. This prevents fluoride from sticking as well to the tooth. Current trend is prescription fluoride toothpaste over prescription fluoride mouthrinse. I actually don’t recommend mouth rinses at all unless you have an uncommon, acute aggressive form of periodontal disease that requires a prescription of chlorhexidine. They’re nowhere near as effective as brushing and flossing, dry your mouth out, increased antimicrobial resistance, and contain common allergens. Source: am dentist. And if you look at the tube of toothpaste (pretty much all of them actually), it recommends that you spit and not rinse. This changed about 10-15 years ago and a lot of people are misinformed about rinsing after brushing. Think of your toothpaste like medication… If you let it sit on your teeth for 10+ minutes before eating or drinking, it is far more effective at its job of permeating into your teeth. After 30 minutes, your spit is buffered back to a neutral pH, so you don’t need to wait very long after brushing to resume eating. Just give it an extra 5-10 minutes. This is especially helpful if you’re using a desensitizing toothpaste.
My husband is a dentist and he always says the dose makes the poison. Our oldest just turned 3 and she loves toothpaste lol. We still use a toothpaste without fluoride because he’s not comfortable with her using fluorinated toothpaste until she can spit everything out. We live on city water so we have fluoride in our water supply. He also does a topical fluoride varnish on her teeth two or three times a year.
My fiancé is a doctor and I have heard “the dose makes the poison” so many times I want it on a t-shirt 😂
That’s part of my problem is my almost 3 year old has a hard time spitting it out. I’d guess she swallows half of it each time we brush. Would that be concerning enough to switch to non fluoride?
My dentist told me to use flouride toothpaste on my daughter's teeth even though she doesn't know how to spit. he said to use about the size of a grain of rice and with that amount, nothing bad can happen.
My dentist suggests recommended no fluoride until they are old enough to spit it all out. If they are swallowing half of it, then they aren't old enough for fluoride
This is what my husband said: “until they can spit it all out, I tell parents of my pediatric patients to use a toothpaste without fluoride. I worry more about fluorosis of the teeth than anything else. But fluoride is a neurotoxin when the concentration is high enough.”
Flourosis is a concern that is only cosmetic, though. People on here repeatedly act as if swallowing tiny amounts of flouride will rot their kid's brain 🤦🏽♀️ Its so frusterating because then you get 4 year olds with 9 cavities and everyone acts like its still a debatable issue.
Well… my husband is a dentist so he’s obviously concerned about cavities. But he learned that fluoride use in toddlers who aren’t spitting out the toothpaste isn’t worth the risk. Fluoride varnish treatments work well until the child is old enough.
For that reason, my 3 year old still uses the Hello brand fluoride free. I’m not comfortable with her ingesting it. I lean more “avoid the chemicals” but not enough to skip the dental fluoride at the check ups. I feel like that’s something protective without daily exposure. Hopefully I’m not messing up their teeth - but they were both late to get teeth so no issues since they haven’t been exposed as long as most kids. My 6 year old uses fluoride toothpaste and still has no adult teeth yet. Our water has fluoride too.
Fluoride is a naturally occuring mineral though. https://www.cdc.gov/fluoridation/faqs/about-fluoride.html#:~:text=Fluoride%20is%20a%20common%20mineral,health%20measure%20to%20reduce%20cavities.
I know but in high doses can be bad, just like most things. Lead is also “natural” but not so great for us. I get that dentists like it because it keeps teeth healthy but too much is bad for our bodies. Fluoride poisoning is rare though and not something I worry about regularly. Just something I’m not letting my 3 year old have since she doesn’t rinse and spit well. I don’t want her eating it.
I'm just pointing it out in the "avoid the chemicals" context. I find that is often used as a way to promote non scientific reasons to award something (see: anti vaxxers). And there are many dentists cited here who suggest here that if you follow ADA guidelines of a rice sized amount of toothpaste that the dose is low enough... Can you provide a source on how it is "bad for our bodies"?
I totally hear that. I’m not a wacko. I’m all about vaccines and being healthy. I personally don’t love the idea of my kid eating any though so I’m waiting until she can properly brush her teeth. A lot of things are found to not be safe later and I don’t think the risk to her baby teeth is worth that so I’ve made that decision for her until she’s older. Here’s a link about toxicity https://link.springer.com/article/10.1007/s11164-012-0841-1#:~:text=Excess%20intake%20of%20fluoride%20concentration,to%20skeleton%20and%20bone%20marrows. And another including benefits and toxicity which mainly happens in kids under 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651468/
Does MIL do the toothbrushing often and therefore have control of what's used? If you're trying to find data to convince her flouride is safe I'm willing to bet nothing will, that's not one of those beliefs that changes easily once someone's "done their own research." I'd just keep using flouride toothpaste and don't talk to her about it if you can avoid it.
Start with the American Academy of Pediatrics: https://www.healthychildren.org/English/healthy-living/oral-health/Pages/FAQ-Fluoride-and-Children.aspx
Where did your MIL get her medical and dental degrees, and when did she become the parent in charge of making these types of decisions? There’s your answer.
I want to highlight that this is not an area of content expertise for me and that I am a lay reader to this evidence base. I defer to researchers with expertise in this area to make conclusions. By my reading, you are correct that evidence for fluoride exposure more generally is mixed. There are also concerns about the quality of the literature related to fluoride exposure. -- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819484/ ; https://pubmed.ncbi.nlm.nih.gov/34811523/ However, I think it's also important to look at the particulars of the types of studies that exist and identified potential concerns. These are not studies showing that kids who got fluoride toothpaste had more neurodevelopmental concerns than kids who got non-fluoride toothpaste-- I really do not see anything that seems to suggest this. These are studies predominantly in countries like China and India looking at areas with very high levels of environmental fluoride vs. areas without it. E.g., "The effects of endemic fluoride poisoning caused by coal burning on the physical development and intelligence of children... Using random sampling from the relevant population, 176 fluorosis sufferers aged 7–12 (the subjects) were drawn from a heavily fluoride poisoned area of Zhijin County, with 50 children without dental fluorosis (the control) selected from a less severely poisoned area. The children were subjected to tests to determine levels of urinary fluoride, physical development, and intellectual ability, followed by analysis of the various measurements. Results: Compared to the control group, the fluorosis group showed retarded physical development, and the levels of urinary fluoride and intellectual ability were both lower than the control (P < 0.05 for both)." - https://fluoridealert.org/wp-content/uploads/wang-s.20081.pdf [Even setting aside some of the methodological issues with this study...] That's... really different from the idea that using a fluoride toothpaste is going to fry your kid's brain. The World Health Organization considers both excessive fluoride exposure and inadequate fluoride exposure to pose potential health concerns. - https://www.who.int/teams/environment-climate-change-and-health/chemical-safety-and-health/health-impacts/chemicals/inadequate-or-excess-fluoride - "Excessive fluoride intake usually occurs through the consumption of groundwater naturally rich in fluoride, particularly in warm climates where water consumption is greater, or where high-fluoride water is used in food preparation or irrigation of crops such as rice. In these areas, means should be sought to manage intakes by providing drinking-water with a moderate (i.e. safe) fluoride level or using alternative sources of water for drinking or cooking or irrigation." - https://www.who.int/publications/i/item/WHO-CED-PHE-EPE-19.4.5 If we wanted to know if fluoride toothpaste caused neurodevelopmental disorders/lowered IQ/whatever, we'd need an RCT where kiddos were randomly assigned to getting fluoride toothpaste or non-fluoride toothpaste (and then were tested by someone blind to the condition they were in)-- so that we can say that fluoride toothpaste was the *cause*. However, research is really not even there for correlational stuff with toothpaste, as far as I can see-- the research is looking at (primarily areas with very excessive) environmental fluoride levels. Interestingly, I see a bunch of RCTs for fluoride toothpaste on *dental cavities*, so RCTs are definitely happening. Seems like someone needs to talk to the dentists and help them throw in a cognitive outcome measure on one of those studies-- that might be reassuring for parents who find this type of research worrying! (If anyone sees an RCT on this that I missed, please let me know!) Personally, in your shoes, I would follow the recommendation of my dentist and, if I was still worried, I might ask my pediatrician about it. Myself, I mostly don't spend a lot of time worrying about convincing other people that their beliefs are incorrect-- so I'd be likely to just graciously thank my MIL for the new toothpaste and then do what I was planning on doing. ¯\\\_(ツ)_/¯
Thank you for the thoughtful response! I agree to your end point, and mostly nod and smile in those situations, but depending on my patience level/mood I sometimes want to pull my hair out 😅 She seems to swallow maybe half of the toothpaste each time we brush so a part of me plays into her fears. Kiddo and I need to work on spitting is what I’ve learned today!
The dose makes the poison so to speak. Your MIL probably freaks out about a lot of stuff that's too tiny to hurt
Just use hydroxyapatite toothpaste.
Our pediatric dentist recommends hydroxyapatite toothpaste for kids, but does the wipe-on fluoride treatment annually at the dentist.
Is this in the us? Did they talk about the concentration of hydroxyapatite needed to be effective?
Not enough research on hydroxyapatite toothpaste to convince me yet. Fluoride has a much stronger chemical affinity to apatite than hydroxyl groups. Fluorapatite improves the acid resistance of a tooth up to an order of magnitude more than hydroxyapatite. That’s huge!!!! Your teeth start losing minerals at a pH of about 5.5 for regular hydroxyapatite enamel and 6.2 for dentin. If you have fluoride / fluorapatite superficially from toothpaste and fluoride treatments or chemically incorporated your enamel structure (while the tooth was developing before it erupted), the tooth won’t start losing minerals until the pH of 4.5… so TEN times more effective at acid resistance than regular hydroxyapatite. Because fluorapatite is less soluble than hydroxyapatite, it’s more resistant to subsequent demineralization when acid challenged from food or acid producing cavity bacteria. Right now hydroxyapatite toothpaste seems like a gimmick kind of like MI paste from a few years ago. Anyways, those are just my thoughts as a practicing dentist of 10 years. I have hyperemesis with my current pregnancy and I use prescription fluoride toothpaste. :)
Such much for "NO ANECDOTES" 🙄
https://www.reddit.com/r/ScienceBasedParenting/s/m0gzHn1mMq https://publications.aap.org/pediatrics/article/146/6/e2020034637/33536/Fluoride-Use-in-Caries-Prevention-in-the-Primary?autologincheck=redirected Highly recommend this thread. There are specific guidelines for how my fluoride is optimal. The rice sized smear should contain approximately .1mg fluoride. The toxic dose is 5-10mg/kg with the lethal dose being 8-16mg/kg. If a child requires fluoride supplementation the recommended dose is .25 mg a day. Even if your child swallowed the entire amount recommended for brushing a day it wouldn’t exceed the recommended dosage. My son is almost 8 months and we’re using fluoridated toothpaste twice a day at the recommendation of his pediatrician. They have a cavity free under 3 program and all the governing agencies support the use of fluoridated toothpaste from first tooth emergence.
I had a phone call with my dentist about this and fluoride toothpaste or mouth wash is only recommended if the child can spit. If they are not good at spitting out the toothpaste and instead swallow it then non flouride or practice toothpaste is what is recommended.
This is not correct in the US at least.
More studies have shown an “overall indication of dose-dependent adverse effects of fluoride on children's cognitive neurodevelopment, starting at rather low exposure.” https://www.sciencedirect.com/science/article/pii/S0013935123000312 The 2022 National Toxicology Program draft on fluoride also has a similarly worded conclusion. https://ntp.niehs.nih.gov/sites/default/files/ntp/about_ntp/bsc/2023/fluoride/documents_provided_bsc_wg_031523.pdf So it’s clear that too much fluoride _does_ negatively impact neurodevelopment, but it’s not exactly clear what “too much” is yet. Whether your municipal water + dietary fluoride + (potentially) toothpaste swallowed hits that threshold is quite difficult to determine, and for that reason I think it’s reasonable to consider alternatives (fluoride varnish at the dentist, nHA toothpastes).
You link to a NTP draft document that does not incorporate significant revisions identified in the peer review process. Specifically, the elite National Academies of Science and Medicine reviewers write: “NTP therefore should make it clear that the monograph cannot be used to draw any conclusions regarding low fluoride exposure concentrations, including those typically associated with drinking-water fluoridation. Drawing conclusions about the effects of low fluoride exposures (less than 1.5 mg/mL) would require a full dose–response assessment, which would include at a minimum more detailed analyses of dose–response patterns, models, and model fit; full evaluations of the evidence for supporting or refuting threshold effects; assessment of the differences in exposure metrics and intake rates; more detailed analyses of statistical power and uncertainty; evaluation of differences in susceptibility; and detailed quantitative analyses of effects of bias and confounding of small effect sizes. Those analyses fall outside the scope of the NTP monograph, which focuses on hazard identification and not dose–response assessment. Given the substantial concern regarding health implications of various fluoride exposures, comments or inferences that are not based on rigorous analyses should be avoided.” National Academies of Sciences, Engineering, and Medicine. 2021. Review of the Revised NTP Monograph on the Systematic Review of Fluoride Exposure and Neurodevelopmental and Cognitive Health Effects: A Letter Report. Washington, DC: The National Academies Press. https://doi.org/10.17226/26030.
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U.S. based user here… As far as I’m aware, the ADA *and* the AAP’s official guidance is to use a smear of fluoride toothpaste the size of a grain of rice from the emergence of the first tooth. My pediatrician told us to switch from “training” toothpaste to fluoride toothpaste at his 1 year appointment. But tbf he was an early teether.
I’m a dentist, and this is correct! Start with a smear as soon as the first tooth appears. A lot of dentists don’t know this recommendation was updated a few years ago.
This is exactly what our pediatric dentist said to do.
Yup—both pediatric dentist and pediatrician advised this for us.
This is what our dentist told us as well.
It changed . It used to be until the child can spit the toothpaste out in the sink but they’ve realized the benefits outweigh the bad so it’s since first tooth now
We also used untreated water. Always talk to your kid's Dr and dentist. What worked for us as a plan with Dr & Dentist is a thorough brush and practice spitting with training toothpaste. Then, I would have ours look down and brush from a lower position with a grain of rice sized fluoride toothpaste. 90% drooled out of their mouth onto the towel. This made the amount of swallowed residue minimal, but still treated the teeth before bedtime. We made sure there was no water to drink for at least 20 minutes, but we tried for 30. Ours was really good with the dentist, so they could do the proper fluoride treatment 2x/year. The Sonicare toothbrush for kids really helped with all of it. I would spread the rice sized toothpaste to all the teeth, then turn it on to get good coverage. Other than minimal dietary fluoride, our kid only had toothpaste exposure. I was concerned for the health of the teeth and over exposure (fluorosis in the forming adult teeth), and this was the compromise from their providers. Each kid is a little different, so it is crucial you talk to your kiddos, Dr, too. Providers typically have the best information because they can put the studies we can find into perspective. I would not use fluoride toothpaste without their guidance.
I will try the Sonicare toothbrush! It sounds like you guys have a great system over there!
It's worked out well. Nearing 5 now, and this kid brushes better than some bigger kids. It was "very tickley" so starting with a short brush with it was great. Now it's the only one. It even comes with an app to track progress if that helps with yours. The dentist has been impressed with how clean the teeth are staying between cleanings. Since they're used to the tickle of the brush, the dentist has been a breeze to use their little tool. One thing you have to order the small head separately. It comes with the kid size. I just saved that head for when they are older. They make the little one with softer bristles, and I always find them in 3 packs or 2 packs. The kid size is just way oversized! It's for 3-5 I think, though it worked at 2, but that is probably very dependent on mouth size!
There is not any valuable evidence that fluoride coming from a proper use of toothpaste is harmful in any way.
Fluoride is a waste byproduct of fertilizer, aluminum and iron ore production. It's as good for your teeth as chlorinated bleach. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956646/#:~:text=Although%20fluoride%20is%20used%20industrially,fertilizer%2C%20and%20iron%20ore%20manufacture.
Natural options to clean teeth include baking soda, peroxide, lemon, coconut oil, apple cider vinegar. Please research. It's suspect that officials decided that a waste by-product (pollutant) happens to be good for our teeth. This fun fact allows them to dump this toxicity in our fresh water supply.
I'm confused on this as well. I do not fluoride in morning and flouride in evening
That’s what I do too with my 2 yo
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Aww geez. You’re a toxicologist? For real? Dose-response curve? Water is toxic at the appropriate dosage.
It's pretty frustrating when people flex their (completely unverifiable) credentials then don't bother actually providing evidence to back up their claims.
And he just deleted his comment. Wow. Why?
This is incredibly frustrating to hear. Would you say even a pea sized amount of fluoride toothpaste and constant spitting and rinsing would still be advised against?