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Can my 2 year old child use toothpaste with fluoride content, and what happens if he were to accidentally swallow it?

Paediatric Dentistry Children’s Health Dental

My boy is 2.5 yo. He still doesn’t know how to gargle, and the dentist did advise that there are signs of tooth decay. Not sure if it is ok for my child to use children toothpaste with fluoride content? What is the consequence if a child swallows toothpaste with fluoride?

DOCTOR’S ANSWER (2)

It is wonderful that you have brought your son to the dentist for a check up at a young age. When decay is detected, using a fluoride containing toothpaste is certainly helpful in limiting the progression of further tooth decay. Here are some tips I have to share with you. 

Pick the right toothpaste

In my experience, many parents reach out for fluoride toothpastes (good!) but did not use one of an appropriate strength. Please do make sure that the toothpaste you have chosen has at least 1000ppm fluoride content. This is often labelled on the toothpaste box. While many kids' toothpastes do contain fluoride, only those at 1000ppm concentration and above are effective in decay prevention. Some options are Elgydium's 7-12 year old Bubblegum flavour and Pearlie White's 2 year old and above Strawberry flavour. Both are 1000ppm content. ( Yes, I know the age labelling is confusing but that's a discussion for another time!) 

A non-foaming toothpaste would be better for your son

What I like about the Pearlie White version for your son is that it does not foam. Although using a dry toothbrush to brush may help, the root cause is the foaming agent placed in toothpastes : sodium lauryl sulfate (commonly known as SLS)

Pearlie White's toothpastes come without SLS which makes it less bubbly. When there is less foam, there is less volume to accidentally swallow. Do not worry as having more foam and bubbles does not mean the toothpaste cleans better!

Practise spitting together

I teach many of my parents to start practising spitting and gargling with their children early. Most children get the hang of it between 2-3 years old. This will only happen if you practise often. There are many opportunities to practise besides during toothbrushing: shower time (think more water play! See who can spit farther!) and after snack time are great times to practise the spit without worrying of them swallowing any toothpaste. After all, it's just water in their mouths! Once he can spit better, you will have a lesser worry about ingestion. 

Wipe before the spit 

When I ask children to use fluoride toothpaste before they have mastered the gargle, I ask parents to wipe off the toothpaste film from the teeth as part of the toothbrushing routine. A simple swipe with a clean washcloth will do. This is just to remove the excess spit and toothpaste that is lingering that may be swallowed. Don't worry, you won't be able to wipe off every single bit of fluoride goodness that is protecting the teeth! 

What if he swallows

Living in Singapore, we do consume fluoride daily - from the water we drink to the food that is prepared here. The amount that may be accidentally swallowed while using a pea size amount of 1000ppm fluoride toothpaste twice daily, AND with the above safety tips I have given you, I have to say that the risks of using the toothpaste are generally low. As compared to the risk of spreading tooth decay, your boy stands to gain a lot of protection from the fluoride toothpaste instead. 

The biggest risk of long term ingestion in Singapore is fluorosis. This refers to white snowflake like spots on the adult teeth which are usually only noticeable by dentists. This does not weaken the teeth. In fact, some people like it as it makes their teeth look more-white! 

Still not comfortable with the use of fluoride? 

While fluoride is indeed a very helpful tool in managing tooth decay, in my years as a paediatric dentist, I have learnt that dental advice needs to be customised according to each child's dental needs and parents' comfort levels. Plus, fluoride is only one of the many tools we have! We have many others! 

If you are indeed uncomfortable with the idea of using fluoride toothpaste, do tell your dentist. You should never force yourself to do something you are uncomfortable with. 

Hope you have found this useful and do see your child's dentist regularly to make sure we get the tooth decay under control! 


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912 views 1 Nov 2018

I agree with your dentist that your son should be using a fluoridated toothpaste to help with your decay prevention efforts.

There are specially formulated children's toothpastes with different levels of fluoride depending on age group. A good example is Elgydium.

To minimize the risk of swallowing, these tips may help:

1) Brush teeth using a DRY toothbrush

This helps to cut down on the foaming that may make it difficult for your child to cope with. Less foam means less accidental swallowing!

2) Use less toothpaste

A small smear of toothpaste that is enough to wet the toothbrush bristles is sufficient. Avoid using large quantities of toothpaste to minimize foaming and inadvertent swallowing.

3) DO NOT rinse out after brushing

Teach your son to spit out the residual foam as many times as he likes. Children below 8 years old should not use mouthrinses because their swallowing reflex is not yet fully developed. Rinsing the mouth with water after brushing dilutes the toothpaste (remember, toothpaste is a topical medicine for the teeth!) and increases the risk of ingestion.

If your son swallows a small amount of toothpaste accidentally, there is minimal risk of toxicity. Higher concentrations of fluoride may cause tummy upsets. 

If large amounts of fluoride are ingested over a long period of time, this may affect the development of his adult tooth enamel which have already started to form within the jawbones from birth. Fluoride may also come from other sources like tap water and tea grown in certain regions of the world with high fluoride in the soil. Ingestion of small amounts of fluoride during tooth development may be beneficial in growing strong enamel that is more decay-resistant. As you can see, fluoride in small amounts is beneficial and it is the dose that makes the poison. 

Apart from relying on fluoridated toothpaste, drinking tap water, thorough brushing and flossing of the teeth, and reducing frequent consumption of sweetened food, beverages (cordial, fizzy drinks, fruit juices, yoghurt drinks) or infant formula will go a long way in preventing further tooth decay. Fluoride is just a small part of the picture.


Dr Jaclyn Toh
BDS

ELITE DENTAL GROUP
1 GRANGE ROAD
ORCHARD BUILDING
#12 - 03 Singapore 239693

932 views 31 Oct 2018
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