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Dental Fluorosis

Advancement in the speciality of Paediatric Dentistry

Like all natural products, getting the balance between too much and too little fluoride is important. In the same way that too much natural salt can be a problem to your health, it is important to ensure that your child gets the right amount of fluoride but not too much. This is especially true for preschool aged children. Eating excessive quantities of toothpaste in the first few years of life can result in dental fluorosis.

There is a risk of dental fluorosis in the developing adult teeth:

  1. If toothpaste is deliberately eaten by toddlers or preschool aged children.
  2. If excess toothpaste is used by toddlers or preschool aged children
  3. If extra fluoride tablets are accidentally or deliberately swallowed.


Fluorosis occurs while the teeth are growing in the gum, and may vary from small white flecks in the enamel of the adult front teeth, through to large areas of brown and missing enamel in severe cases. The peak risk occurs at 20-30months. Unfortunately, the damage to the adult teeth is not visible until long after the damage actually occurred. This condition is called dental fluorosis.

Although dental fluorosis can be successfully treated with a combination of enamel micro-abrasion and composite bonding, prevention is always far better than cure. See article on "Treating surface discolourations on teeth"

Mild fluorosis

Dental fluorosis is not a disease, it is a condition. It is most commonly seen as a white mottling on the tooth enamel of the front teeth and it is particularly noticeable when the surface of the tooth becomes dry. In mild cases, the only noticeable sign of dental fluorosis is white flecks at the tip of the teeth.

More severe forms of dental fluorosis may require some treatment and should be discussed with your dentist or oral health professional.

Moderate fluorosis

Severe fluorosis

Prevention of fluorosis

Fluoride toothpaste is proven to help prevent tooth decay. You should start brushing with a fluoride toothpaste as soon as the first teeth come through.

Toothpaste is not a food group and should not be deliberately eaten. Although children will inevitably swallow a small quantity of toothpaste while brushing, this will not be a problem if you follow these recommendations.

  1. Keep toothpaste and fluoride tablets out of the reach of young children.
  2. Use the recommended type of toothpaste for your child’s age and caries risk. Discuss your child's caries risk with your dentist.
  3. Measure out the correct amount of toothpaste when required. A rice grain until age two, and a pea size after age two.
  4. Push the toothpaste down into the bristles before brushing.
  5. Supervise your child while they are brushing.
  6. Children should be encouraged to spit after brushing.


How much toothpaste?

Use a rice grain size smear until age 2, and a pea size blob until age six