48 l © 2025 American Dental Association
Section 2: Safety
• For children 3 to 6 years of age, caregivers should dispense no more than a pea-sized amount (Figure
4) of fluoride toothpaste. Brush teeth thoroughly twice per day (morning and night) or as directed
by a dentist or physician. Supervise children’s brushing to minimize swallowing of toothpaste.”
Additional information on this topic can be found in this Section, Question 29.
Figure 4. Examples of Toothpaste Amounts for Children49
For children under three
years old, use no more
than a smear or grain-
of-rice-sized amount of
fluoride toothpaste.
For children three to six
years old, use only a pea-
sized amount of fluoride
toothpaste.
It should be noted that the amounts of fluoride discussed here are intake, or ingested, amounts. When
fluoride is ingested, a portion is retained in the body and a portion is excreted.
Additional information on this topic can be found in this Section, Question 25.
24. Is there a need for prenatal dietary fluoride supplementation?
Answer
No. There is no scientific basis to suggest the need to increase a person’s daily fluoride intake during
pregnancy or breastfeeding to protect their health. Scientific evidence is insufficient to support the
recommendation for prenatal fluoride supplementation for decay prevention for infants.
Fact
The National Academy of Medicine (NAM) determined that, “No data from human studies document
the metabolism of fluoride during lactation. Because fluoride concentrations in human milk are very
low (0.007–0.011 ppm) and relatively insensitive to differences in the fluoride concentrations of
the mother’s drinking water, fluoride supplementation during lactation would not be expected to
significantly affect fluoride intake by the nursing infant or the fluoride requirement of the mother.”146
A 2005 randomized, double-blind study219 compared the amount of fluoride incorporated into primary
teeth exposed to prenatal and postnatal fluoride supplements to the incorporation of fluoride in
primary teeth that were exposed to only postnatal fluoride. The study concluded that teeth exposed
to prenatal and postnatal fluoride supplements had no additional measurable fluoride other than that
attributable to postnatal fluoride alone.219 This study confirmed the findings of a 1997 randomized,
double-blind study that evaluated the effectiveness of prenatal dietary supplementation, which
concluded that the data did not support the hypothesis that prenatal fluoride had a strong decay
preventive effect on primary teeth.220
Section 2: Safety
• For children 3 to 6 years of age, caregivers should dispense no more than a pea-sized amount (Figure
4) of fluoride toothpaste. Brush teeth thoroughly twice per day (morning and night) or as directed
by a dentist or physician. Supervise children’s brushing to minimize swallowing of toothpaste.”
Additional information on this topic can be found in this Section, Question 29.
Figure 4. Examples of Toothpaste Amounts for Children49
For children under three
years old, use no more
than a smear or grain-
of-rice-sized amount of
fluoride toothpaste.
For children three to six
years old, use only a pea-
sized amount of fluoride
toothpaste.
It should be noted that the amounts of fluoride discussed here are intake, or ingested, amounts. When
fluoride is ingested, a portion is retained in the body and a portion is excreted.
Additional information on this topic can be found in this Section, Question 25.
24. Is there a need for prenatal dietary fluoride supplementation?
Answer
No. There is no scientific basis to suggest the need to increase a person’s daily fluoride intake during
pregnancy or breastfeeding to protect their health. Scientific evidence is insufficient to support the
recommendation for prenatal fluoride supplementation for decay prevention for infants.
Fact
The National Academy of Medicine (NAM) determined that, “No data from human studies document
the metabolism of fluoride during lactation. Because fluoride concentrations in human milk are very
low (0.007–0.011 ppm) and relatively insensitive to differences in the fluoride concentrations of
the mother’s drinking water, fluoride supplementation during lactation would not be expected to
significantly affect fluoride intake by the nursing infant or the fluoride requirement of the mother.”146
A 2005 randomized, double-blind study219 compared the amount of fluoride incorporated into primary
teeth exposed to prenatal and postnatal fluoride supplements to the incorporation of fluoride in
primary teeth that were exposed to only postnatal fluoride. The study concluded that teeth exposed
to prenatal and postnatal fluoride supplements had no additional measurable fluoride other than that
attributable to postnatal fluoride alone.219 This study confirmed the findings of a 1997 randomized,
double-blind study that evaluated the effectiveness of prenatal dietary supplementation, which
concluded that the data did not support the hypothesis that prenatal fluoride had a strong decay
preventive effect on primary teeth.220
