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Maternal and Child Health Bureau logoA Health Professionals Guide to Pediatric Oral Health Management
HomeModuleModule 1: An Introduction to Infants' and Young Children's Oral HealthModule 2: Managing Infants' and Young Children's Oral HealthModule 3: Oral Conditions and AbnormalitiesModule 4: Prevention of Oral DiseaseModule 5: Non-Nutritive Sucking HabitsModule 6: Oral InjuryModule 7: Infants and Young Children with Special Health Care NeedsContentsGlossaryEvaluationHelp
Module 4: Prevention of Oral Disease
Module Contents
4.1 Oral Hygiene
4.2 Fluoride
Systemic Fluoride
Topical Fluoride (current page)
4.3 Nutrition
The Role of Food in
Oral Health
Anticipatory Guidance
Key Points
Additional Resources

4.2 Fluoride, continued

Topical Fluoride

notepad graphicParents should begin brushing their infant's teeth using a small smear of fluoridated toothpaste as soon as the first tooth erupts.


Topical fluoride is probably the most important source of prevention of tooth decay. Topical fluoride reaches the teeth directly. It inhibits the metabolism of the decay-producing bacteria in plaque and stabilizes minerals in the teeth, thus preventing or slowing down the caries process. Topical fluoride is most effective when delivered at very low doses many times a day through water, foods containing fluoride, and fluoridated toothpaste.


photo of children's toothbrushes

Almost all toothpaste manufactured in the United States provides topical fluoride. Toothpaste often becomes an unintended source of systemic fluoride (rather than an intended source of topical fluoride) when it is swallowed. Excess ingested fluorides may cause fluorosis. (See Module 3, section 3.5, Fluorosis.) Parents should begin brushing their infant's teeth using a smear of fluoridated toothpaste as soon as the first tooth erupts. [6] After age 2, parents should use a pea-size amount of fluoridated toothpaste. Children should spit out the toothpaste after brushing but should not rinse with water. The small amount of fluoridated toothpaste that remains in the mouth helps prevent tooth decay.[1]

Another form of topical fluoride is professionally applied fluoride (via varnishes, gels, foams), which renews the high levels of fluoride in superficial enamel (the outer layer). Topical fluoride may be especially effective for those children at high risk for dental caries because they lack fluoridated water, have a history of caries, snack frequently on foods containing sugar (see Nutrition section, this module), or have a medical problem that decreases caries resistance. (See Module 7.) These treatments also enhance remineralization of early carious lesions. Topical fluoride treatments should be applied only by a dentist or other qualified health professional.

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