should begin brushing their infant's
teeth using a "smear" of fluoridated
toothpaste as soon as the first tooth
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.
Almost all toothpaste manufactured
in the United States provides topical fluoride.
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
section 3.5, Fluorosis.)
For infants and children under age 3, beginning as soon as the first tooth erupts, parents should brush the infant's or child's teeth twice daily using a soft toothbrush that is an appropriate size for the infant's or child's age. Parents should dispense a "smear" of fluoridated toothpaste on the bristles of the toothbrush.  For children ages 3 through 6, parents should brush the child's teeth or supervise brushing twice daily using a soft toothbrush that is an appropriate size for the child's age. Parents should dispense a "pea-size amount" of fluoridated toothpaste on the bristles of the toothbrush.
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
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