How Much Toothpaste?

Excessive ingestion of toothpaste can cause fluorosis which is a minor cosmetic problem, relative to losing teeth to caries. In rare situations, such as consuming a large portion of a family sized tube, systemic toxicity including electrolyte abnormalities can result in a medical emergency.


  • Use a small smear for children less than 3 years old (size of a grain of rice or a dab).
  • Apply a pea-sized amount of toothpaste for children three years and older regardless of caries risk status.
  • Most preschool children swallow much of the toothpaste placed on the brush. These guidelines take this into account and these amounts are safe to swallow, but spitting out should always be encouraged.
  • Parents should keep toothpaste tubes out of reach of small children.

Less than 3 years
Small smear or "grain of rice"


3 years or older
"Pea-sized" amount of toothpaste

Rocio Quiñonez DMD, MPH
Rocio Quiñonez DMD, MPH


Shulman JD, Wells LM. Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age. J Public Health Dent 1997;57:150-8.

Douglass JM, Douglass AB, Silk H . A Practical Guide to Infant Oral Health at the Well Child Visit. American Family Physician 2004;70:2113-2120,2121-2122.

American Dental Association Council on Scientific Affairs. Fluoride toothpaste use for young children. JADA. 2014; 145(2): 190-191.

Krol D. Maintaining and Improving the Oral Health of Young Children. Section on Oral Health Policy Statement. Pediatrics. 2014; 134: 1224–1229.