Fluoride has long been recognised as a cornerstone of paediatric dental care, and its importance lies in the way it supports the development and maintenance of strong teeth during childhood. Deciduous teeth are particularly vulnerable to caries because they are softer and more porous,[i] making additional care vital in many cases.
Despite the many benefits of fluoride use in oral hygiene, the excessive ingestion of this chemical can lead to fluorosis. For this reason, the use of fluoride in paediatric dental care should be carefully monitored and balanced between mitigating caries and avoiding fluorosis.
Historic discoveries
The successful use of fluoride in the prevention of caries has been well documented for over 100 years. In 1901, dentist Dr Frederick McKay observed that many children living in a specific area of Colorado Springs presented with a unique brown staining on their teeth, but suffered with very few caries. [ii]
Upon further research, Dr McKay discovered a very high concentration of fluoride in the local water supply, prompting further research into the relationship between fluoride and its ability to mitigate of caries. By the 1940s, states in America began adding fluoride to the public water supply, and its use in dental products became widespread across the world by the 1950s.[ii]
Bountiful benefits
Fluoride helps to reinforce enamel, making it more resistant to the acids that cause caries. It does this by promoting remineralisation, and mitigating early damage.[iii]
The recommendations for fluoride use vary depending on age, and careful supervision is essential to ensure children benefit without risk of overexposure. For infants and toddlers up to three years old, only a small amount of fluoride toothpaste (the NHS references it as a smear) is advised.[iv] Parents should supervise brushing closely at this stage to prevent children from swallowing toothpaste.
From the age of three to six, the amount can be increased to a pea-sized portion, with children encouraged to spit out the toothpaste after brushing without rinsing.[iv] Twice daily brushing at this age helps to build good habits for later life whilst protecting deciduous teeth. Professionals may find it appropriate to recommend fluoride varnish applications during routine check-ups. These varnishes provide an extra layer of protection, particularly for children at higher risk of caries or hypersensitivity. Patients of all ages can continue to benefit from these if they need extra support alongside a standard oral hygiene routine.
The need for moderation
Dental fluorosis appears as faint white streaks or spots on the teeth.[v] As this develops, white lines in the enamel can become more pronounced, alongside cloudy aspects of the enamel, or even the entire tooth taking on a chalky white appearance, ultimately losing transparency.[v] With prolonged exposure, the enamel can become less mineralised and more susceptible to damage.[v]
If children ingest an excessive amount of fluoride, usually from swallowing too much toothpaste or from unnecessary doses of fluoride tablets, fluoride toxicity can occur. Nausea, vomiting, abdominal pain, and diarrhoea are some of the symptoms, and whilst rare, very high doses may even be fatal.[vi] Such issues are rare, but clinicians can support paediatric patients if they begin to notice adverse symptoms or have been exposed to high levels of fluoride.
Supervision is key
Parents play a crucial role in managing fluoride use. Supervision during brushing is vital, especially for younger children, to avoid swallowing excess toothpaste.
Following age-specific guidelines and professional advice ensures that children receive the right amount of fluoride safely.[iv] Clinicians should provide the necessary support for all parents, to ensure that young patients are best supported. They can also provide assurance for concerned parents who may be aware of fluorosis, but unknowing of quite how much fluoride will trigger adverse effects.
Finding the right balance
In addition to daily routines, professional fluoride treatments can provide valuable support. 3M™ Clinpro™ Clear Fluoride Treatment from Solventum (formerly known as 3M Health Care) is one option that focuses on making the experience more pleasant for children. Unlike traditional varnishes that may feel sticky or taste unpleasant, Clinpro™ Clear Fluoride is designed to be comfortable, with a smoother application and improved taste. It is formulated to provide an effective fluoride uptake with a lower dosage, thanks to soluble fluoride ions that immediately deposit on the tooth, supporting patients experiencing hypersensitivity.
A lifetime of protection
Fluoride remains an essential ally in paediatric dentistry, offering powerful protection against caries when used responsibly. The challenge lies in striking the right balance, providing children with enough fluoride to strengthen and safeguard their teeth, while avoiding the risks of overexposure. With careful supervision, adherence to age-specific guidelines, and professional oversight, fluoride can continue to play a pivotal role in nurturing healthy, confident smiles that last a lifetime.
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[i] Lynch, R. J. (2013). The primary and mixed dentition, post-eruptive enamel maturation and dental caries: a review. International dental journal, 63, 3-13.
[ii] National Institute of Dental and Craniofacial Research, (2024). The story of fluoridation. Available at: https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation [Accessed November 2025]
[iii] Nassar Y, Brizuela M. (2023). The role of fluoride on caries prevention. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/books/NBK587342/ [Accessed November 2025]
[iv] NHS England, (2025). Children’s teeth. (Online) Available at: https://www.nhs.uk/live-well/healthy-teeth-and-gums/taking-care-of-childrens-teeth/ [Accessed November 2025]
[v] DenBesten, P., & Li, W. (2011). Chronic fluoride toxicity: dental fluorosis. Monographs in oral science, 22, 81.
[vi] Fluoride: Fact Sheet for Health Professionals. Office of Dietary Supplements. Available at: https://ods.od.nih.gov/factsheets/Fluoride-HealthProfessional/#ref
