To fight the rising number of cavities in the very young, the dental group now advises getting a jump-start on prevention. However, they emphasize only the tiniest amount of fluoride toothpaste should be used to minimize the risk of mild discoloration, white spots or streaking of the teeth, a condition called fluorosis that is caused by ingesting fluoride toothpaste at a young age.
"We want to minimize the amount of fluoride consumption to reduce the risk of fluorosis while simultaneously adding a preventive tool for kids 2 and under that we haven't recommended previously," said Dr. Jonathan Shenkin, a spokesman for the A.D.A. and a pediatric dentist in Augusta, Me. Only a tiny amount of toothpaste should be smeared on the brush since some youngsters are likely to ingest some of the fluoride, he said.
The change comes after a systematic review of 17 studies published in The Journal of the American Dental Association this month. It concluded that scientific evidence, though limited in children under age 6 and more robust in older children, demonstrated that fluoride toothpaste is effective in controlling tooth decay, and that "the appropriate amount" should be used "by all children regardless of age."
An early start is crucial, Dr. Shenkin said, because children with dental decay are at greater risk of developing cavities as adults. "By starting earlier, we can effectively reduce a lifetime of disease for a lot of kids."
Dr. Man Wai Ng, the dentist in chief at Boston Children's Hospital, applauded the new recommendation and said, "It's a great thing for parents to know: 'Use a tiny amount of fluoride, and brush two times a day to counter the effects of frequent snacking.'"
Most of the children she sees with tooth decay are using "a training toothpaste without fluoride," she said.
The new A.D.A. guidelines stress that children should spit out toothpaste as soon as they are able, but not being able to spit does not preclude the use of a rice-grain-size bit of fluoride toothpaste.
Fluoride is controversial in some circles, amid allegations--based, medical officials say, on questionable science--that fluoride is a carcinogen and can lower children's IQs. In 2012, New Jersey was embroiled in the controversy when it considered legislation that would require each town in the state to fluoridate its water.
Image: Child's toothbrush, via Shutterstock