The objective of this study was to estimate the intake of toothpaste fluoride used by
children aged 2 to 6 years (n=87) treated at a hospital of a medium-sized city (Campina
Grande, PB) in the Northeastern region of Brazil. Data regarding sociodemographic
characteristics of families and children’s toothbrushing were collected from questionnaire-
based interviews with parents/guardians, and the amount of fluoride used during
toothbrushing was estimated using a precision scale for assessment of the risk of dental
fluorosis, considering a cutoff value of 0.07 mgF/kg body weight/day. Fluoride content
in the toothpastes was analyzed using a specific fluoride electrode. Data were analyzed
using descriptive and inferential statistics using the chi-square and Fisher’s exact tests
(a=0.05). Considering the use of the dentifrice, the risk of fluorosis in the children was
19.5%. There was significant association (p<0.05) between the risk of fluorosis, brushing
frequency, type of dentifrice and who performed the child’s oral hygiene. It was concluded
that a high percentage of children in the studied sample used toothpaste inappropriately
and were at risk of developing dental fluorosis.
Estimation of Toothpaste Fluoride
Intake in Preschool Children
Helena Aguiar Ribeiro do Nascimento
1
, Jainara Maria Soares Ferreira
2
, Ana
Flávia Granville-Garcia
1
, Edja Maria Melo de Brito Costa
1
, Ana Lúcia Almeida
Cavalcante
3
, Fábio Correia Sampaio
3
1
Department of Dentistry, UFPB
- State University of Paraíba,
Campina Grande, PB, Brazil
2
Department of Dentistry, UNIPE
- University Center of João
Pessoa, João Pessoa, PB, Brazil
3
Department of Clinic and Community
Dentistry, UFPB - Federal University
of Paraíba, João Pessoa, PB, Brazil
Correspondence: Profa. Dra.
Jainara Maria Soares Ferreira,
Avenida Mar da Noruega, 66/303,
Intermares, 58310-000 Cabedelo,
PB, Brasil. Tel: +55-83-8833-0315.
e-mail: jainara.s@ig.com.br
Key Words: toothpaste, fluoride,
child, dental fluorosis.
ISSN 0103-6440
Brazilian Dental Journal (2013) 24(2): 142-146
http://dx.doi.org/10.1590/0103-6440201302087
Introduction
In recent decades, there has been a worldwide decline
in the prevalence and severity of dental caries, even in
countries with unstable market economy (1). However,
simultaneous to such reduction, there has been increase in
dental fluorosis in locations where the public water supply
is not fluoridated (2,3).
One of the most widely accepted measures for control
of dental caries is brushing with fluoridated toothpaste,
as it combines the mechanical biofilm removal to the
therapeutic properties of fluoride (4). In order to a
dentifrice have anticaries potential, it must have fluoride
(F) at the minimum concentration of 1000 ppm, which
must be soluble in the formulation (5). Therefore, if used
at optimal levels, fluoride has highly beneficial effects in
preventing and controlling dental caries (6). However, if
fluoride is ingested in excessive doses and high frequency
at the time of tooth formation, this halogen may lead to
the emergence of developmental structural changes known
as dental fluorosis, characterized by patches of enamel (7).
The association between early use of fluoride dentifrice
and the prevalence of dental fluorosis is widely reported in
the literature in fluoridated and non-fluoridated regions
(8-11). The ingestion of fluoride toothpaste before the age
of 6 is identified as one of the main risk factors for dental
fluorosis (8,12).
The aim of this study was to estimate the fluoride
intake from toothpaste in preschoolers, considering the
risk of dental fluorosis in face of an inadequate chronic
ingestion of this product during toothbrushing.
Material and Methods
A cross-sectional study was conducted including
children aged 2 to 6 years who were waiting for medical
consultation at a hospital in the city of Campina Grande,
PB, a medium-sized city in the northeastern region of
Brazil. The sample was calculated by the statistical program
Epi Info 6.04 from a population of 825 children, summing
up 87 children with 95% confidence level, 10% error and
50% power.
Interviews based on a questionnaire containing
questions about sociodemographic characteristics and the
use of children’s fluoride toothpaste were conducted with
parents/guardians by a previously trained researcher in a
pilot study with 10% of the sample not included. After this
stage, children’s toothbrushes (Tek
®
Jr.; Johnson & Johnson,
São Paulo, SP, Brazil) were distributed to the children and
the parents/guardians reported to use one of the following
fluoride toothpastes: Tandy
®
, Smile
®
, Colgate
®
and Colgate
®
kids (Colgate, São Paulo, SP, Brazil), and Even
®
and Even
kids
®
(Grupo Raymundo da Fonte, Paulista, PE, Brazil).
Then, the parents/guardians were asked to simulate the
amount of toothpaste placed on the child’s brush at home
to perform the oral hygiene. The amount of dentifrice on
the brush used by each child was measured by the brush
weight difference before and after dentifrice insertion,
both measured on a precision scale 500G JL-6 (Western,
China). The child’s weight was obtained by scale (Welmy,
Santa Barbara d’Oeste, SP, Brazil).
The concentrations of fluoride in the different brands
of toothpastes were measured after acidic digestion in 2 M
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