Home Medizin Studie besagt, dass Eltern die Fluorid-Zahnpasta-Dosis für Kleinkinder möglicherweise überschreiten und so eine Zahnfluorose riskieren

Studie besagt, dass Eltern die Fluorid-Zahnpasta-Dosis für Kleinkinder möglicherweise überschreiten und so eine Zahnfluorose riskieren

von NFI Redaktion

In a recent study published in the journal BDJ Open, researchers in Canada and Germany tested the doses of fluoride-containing toothpaste parents give to children up to the age of two. Their findings suggest that many parents may be giving their children significantly more toothpaste than is optimal and should consider switching to fluoride-free alternatives to avoid excessive fluoride consumption. Image source: Inna Reznik / Shutterstock

Background
While good oral hygiene in childhood is crucial for preventing tooth decay and other oral diseases, the fluoride contained in toothpaste has raised toxicological concerns about its safety for infants and toddlers. Studies have also shown that, despite the widespread use of fluoride worldwide, tooth decay continues to be prevalent, affecting nearly half of children globally. Fluoride can cause chronic toxicity and other adverse long-term effects. Consequently, guidelines in various parts of the world recommend limiting fluoride doses for toddlers to a small smear or the size of a single grain of rice (up to 24 months of age) or a pea (for children under six years).

However, young children can swallow 64-100% of their toothpaste, exposing them to the risk of dental fluorosis due to systematic fluoride exposure. Therefore, it is important to gather more information on how much toothpaste parents are giving their children.

About the Study
In this study, researchers hypothesized that it would be challenging for parents to comply with guidelines recommending toothpaste doses equivalent to a grain of rice for children up to the age of two. They tested this hypothesis by examining the actual toothpaste doses parents gave to their children. The study was conducted in five daycare centers in Germany, where parents were provided with two commercially available toothpaste brands suitable for children with 1,000 ppm fluoride and were asked to dose them as they would at home.

To be included in the study, parents had to use fluoride-containing toothpaste regularly at home for their children. Parents of children older than two were asked to administer a dose based on what they had done before their child’s second birthday, representing the amount they would typically give their children at home. The weight of each dose was determined and compared to the „optimal“ recommendation of a grain of rice. Additionally, to calculate fluoride exposure, parents were asked to report how often their child’s teeth were brushed each day and indicate how they knew the optimal dose.

Results
At the time of the study, the children had an average age of 24 months, and 61 parents met the inclusion criteria. More than 60% of parents reported that their children brushed their teeth twice a day, while approximately 23% reported brushing three times a day. The average weight of a reference dose of fluoride was 0.039–0.045 g; however, parents administered an average of 0.263–0.281 g of fluoride to their children. The overdosage factor ranged from 5.6 to 8.2. More than 60% of parents were unaware of health warnings and conditions for fluoride use. Nearly 15% used fluoride tablets in addition to fluoride-containing toothpaste for their child.

Conclusions
These findings indicate that children may be receiving an overdose of fluoride from their parents. The authors noted that parents may underestimate children’s exposure to the substance, as fluoride is also present in foods such as rice, cow’s milk, and bananas, as well as in drinking water and sometimes in salt. Nonetheless, even fluoride exposure through toothpaste alone exceeded the upper limit considered to prevent dental fluorosis. Further research should conduct a comprehensive risk assessment, considering other sources of fluoride and the potential for neurotoxicity, while also accounting for socioeconomic factors.

One of the reasons for large doses could be the frequent depiction of excessive amounts of toothpaste on brushes in television commercials. Previous studies, for example, had shown that most advertisements depicted a large swirl of paste covering the entire brush head, far exceeding the recommended dose. The taste of toothpaste can also be appealing to children, prompting them to consume more. Since administering fluoride in the amount of a grain of rice can be challenging for parents, the researchers recommend using fluoride-free toothpaste varieties containing other anti-decay substances such as calcium sodium phosphosilicate or hydroxyapatite, the latter of which has been clinically shown to protect against cavities. It is safe for infants and toddlers to swallow and can reduce bacterial colonization on the tooth surface. Encouraging parents to replace fluoride-containing toothpaste with efficient and safe alternatives may promote oral care in young children – and protect them from fluorosis.
Journal reference: Fluoride toothpaste dosing for children up to 24 months. Sudradjat, H., Meyer, F., Fandrich, P., Schulze sur Wiesche, E., Limeback, H., Enax, J. BDJ Open (2024). DOI: 10.1038/s41405-024-00187-7, https://www.nature.com/articles/s41405-024-00187-7

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