Toothbrushing and Toothpaste

Regular tooth brushing is important to remove plaque and food debris, and most importantly for distributing the fluoridated toothpaste.

Brushing Guidelines

  • Brush twice daily beginning as soon as teeth emerge.
    • Bedtime is most critical due to decreased salivary flow.
  • Caregiver should brush child's teeth until age 8 or 9, at least until they have developed the manual dexterity to write in cursive and tie their own shoes.
    • Young children can not reliably spit and will swallow toothpaste. Children learn to expectorate well between age 3 and 5 years.
    • Young children have difficulty adequately brushing all areas.
    • Parents should continue to intermittently supervise brushing after children assume independence.
  • Caregivers should place only a smear (under two years) or pea size dab (children over age 3) of fluoridated toothpaste on the child's toothbrush.
  • Caregiver should stand or sit behind child.
  • Lift lip and brush along the gumline.
  • Child should spit out, not rinse, after brushing to increase topical fluoride exposure.
Joanna Douglass, BDS, DDS
Joanna Douglass, BDS, DDS

Small Smear (grain of rice size):

Less than 3 years of age


Pea Sized:
3 years & over, regardless of caries risk

Rocio Quiñonez DMD, MPH
Rocio Quiñonez DMD, MPH


Chestnutt IG, Schafer F, Jacobson AP, Stephen KW. The influence of tooth brushing frequency and post-brushing rinsing on caries experience in a caries clinical trial. Community Dentistry & Oral Epidemiology. 1998;26(6):406-11.

Wright JT, Hanson N, Ristic H et al. Fluoride toothpaste efficacy and safety in children younger than 6 years: A systematic review. JADA. 2014. 145(2): 182-189.

Sotthipoka K, Thanomsuk P, Prasopsuk R, et al. The effects of toothpaste amounts and post-brushing rinsing methods on salivary fluoride retention. Journal of Health Research, 2018; 32(6): 421-431.

Duckworth R, M, Maguire A, Omid N, Steen I, N, McCracken G, I, Zohoori F, V: Effect of Rinsing with Mouthwashes after Brushing with a Fluoridated Toothpaste on Salivary Fluoride Concentration. Caries Res. 2009; 43:391-396.