Fluoride options
As a pediatric dentist, I stand with the American Academy of Pediatric Dentistry (AAPD) in recommending fluoridated toothpaste be used for children of all ages, in age-appropriate amounts. This means a grain of rice or smear sized amount of paste for a child under age three, and a pea sized amount of paste for children three years and older.
Some of my kids’ favorite fluoride toothpastes are: Crest sparkle fun, ACT bubblegum burst, Tom’s of Maine Silly Strawberry, and Colgate watermelon burst, in that order. They’ve also tried some of the SLS-free options, and Tanner’s Tasty Paste in Vanilla Bling is their favorite. If your child complains that a toothpaste is “spicy” it may be due to the SLS, so try an SLS-free paste (more information on this below).
In the US, all fluoridated toothpaste contains the same amount of fluoride, 1000ppm, whether marketed as adult or child toothpaste. This is not the case in other countries, so be sure to verify your local product’s amount of fluoride and also the recommendations of your local dental authority as to whether or not your child should use fluoride toothpaste.
Fluoride-free options
I have several patient families that prefer not to use a fluoride paste, so for them I recommend finding a paste that contains xylitol as a cavity-preventative. I haven’t been wowed by the science so far behind nanohydroxyapatite or hydroxyapatite pastes (both ingredients are marketed as substitutes for fluoride, but fluoride works by forming fluoro-hydroxyapatite crystals that are remineralized into the enamel, which makes the teeth more resistant to future acid breakdown. Nanohydroxyapatite is a smaller version of hydroxyapatite that’s already in your enamel, so in theory, maybe it remineralizes more deeply, but it’s still just as susceptible to acid breakdown as before. Clinical studies are ongoing and we’ll see what results show). That said, nanohydroxyapatite is an option if you’re looking for something besides fluoride, but I am not yet convinced that the claims are true that it is a substitute for fluoride.
My kids’ favorite fluoride-free flavors were Tanner’s Tasty Paste Baby Vanilla Bling (xylitol, SLS free) and Hello Watermelon (xylitol, SLS free). My kids didn’t like any of the other natural toothpastes we tried due to the textures. I tried them, too, and I found them quite gritty.
SLS-free options
Some children (and adults) are sensitive to the foaming agent found in many kinds of toothpaste, called sodium lauryl sulfate (SLS). If your child is prone to frequent mouth ulcers, try a paste without SLS and see if it helps. If switching pastes doesn’t resolve the frequent mouth ulcers, mention the frequent ulcers to your child’s pediatrician. Frequent mouth ulcers can be an early indicator of Crohn’s disease or IBS, so it is worth looking into further, especially if a family history exists for either condition.
Some of my kids’ favorite SLS-free options are Tanner’s Tasty Paste (Vanilla Bling or Chocolate) and Hello Strawberry.
Training Pastes
In my opinion, there’s no real need for training toothpaste (often sold with silicone finger brushes). Before teeth arrive, use a water-wet washcloth or silicone finger brush to get baby used to you cleaning her mouth. Once teeth arrive, it’s time for “real” toothpaste and a toothbrush with actual nylon bristles! The silicone brushes are for gums, not teeth.
Flavorless pastes
Some children are very sensitive to flavors and for that reason dislike most toothpaste. For those children in my practice, I recommend Dr. Bob (sweet but unflavored) or Oranurse toothpaste (neither sweet or flavored). Oranurse is fluoridated (at 50% higher concentration vs Dr. Bob, 1450ppm) and both are SLS free. For Oranurse I would use 2/3 the amount recommended with regular toothpaste. The texture of Oranurse is grittier than Dr. Bob, so if texture is also an issues, Dr. Bob may be best.
If your child is still sensitive to pastes, another option is to brush with water and then dip a Q-tip or tooth sponge into fluoridated mouth rinse like ACT and wipe it over the teeth after brushing.
