Too much toothpaste? It’s a thing with children.

At home in the Heights neighborhood of Houston, Shannon Alfonso helps her 2-year-old daughter, Lizzie, brush her teeth twice a day.

“Lizzie really likes to brush her teeth when she sees that I’m brushing my teeth,” Alfonso said. “She’s very independent and she likes to brush her own teeth, but I keep an eye on her and help her sometimes to make sure she is getting a good cleaning.”

Contrary to what many parents assume, a good cleaning does not mean an abundance of toothpaste.

A new report from the Centers for Disease Control and Prevention (CDC) examined the use of toothpaste and toothbrushing patterns among 5,157 children and adolescents from 2013 to 2016. The report found that nearly 40 percent of children ages 3 to 6 used too much toothpaste.

Several issues can arise when children 6 and under use excessive amounts of toothpaste.

When children use too much toothpaste with fluoride, they run the risk of fluorosis, a cosmetic condition that can change the coloring of teeth, said Gregory Olson, D.D.S., professor and chair of pediatric dentistry at The University of Texas Health Science Center at Houston (UTHealth) School of Dentistry. In severe cases, fluorosis can cause pitting in the teeth.

“This is all age- and amount-dependent,” Olson said. “For the general population, it is better to use a toothpaste with fluoride, but for children, it is better to use a toothpaste with a lower amount of fluoride. Not only do kids have trouble as they are developing their dexterity, but a lot of kids don’t spit out toothpaste and you don’t want them swallowing it all.”

There are benefits to brushing with and without toothpaste, he added.

“Brushing well without toothpaste, you can remove the plaque. Brushing with toothpaste that has some fluoride, you can strengthen and harden your teeth,” Olson said.

The CDC, the American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) recommend that children ages 3 to 6 use a pea-size amount of toothpaste and that children under 3 use a smear of
toothpaste the size of a grain of rice.

Although these recommendations are directed at children under the age of 6, who do not typically have permanent teeth, the health of baby teeth is vital to a person’s oral health over a lifetime, Olson said.

“People think they are just baby teeth and you get a second chance,” he said. “These baby teeth hold space for normal growth and development and if you lose space too early, you’re more likely to have crowded teeth that do not look nice or function well. If you get a lot of decay early on, it’s almost like setting up the environment. You lose your baby teeth, but you still have that bacterial environment that is actually at a higher risk for infecting or causing problems for grown-up teeth.”

The best way for children to achieve optimal oral health is to have a dental home.

“Kids need a pediatric dentist to supervise them the same way their pediatrician does,” Olson said.“If you are a parent, you have a lot on your plate and this is just another issue.”

The CDC, AAPD and the ADA recommend children be seen by a dentist after their first baby tooth comes in and no later than age 1.

“We took Lizzie to the dentist for the first time at 1,” Alfonso said. “Our pediatrician recommended a list of pediatric dentists for us to see and our dentist has helped us with brushing guidelines and getting Lizzie off of her pacifier.”

Because some Houstonians do not have a regular dental home or even access to a toothbrush and toothpaste, Olson is proud that UTHealth dental students help to fill some of the gaps in providing dental homes for children in the greater Houston area.

“We have two mobile dental clinics … and our dental students rotate through several clinics in the community to do cleanings, screenings and educational events,” Olson said. “Through these clinics patients can get basic oral hygiene implements like toothbrushes, toothpaste and, if they are in pain, they can be seen and have care provided. A lot of it is just getting out there where people are and trying to identify their need.”