Appropriate Fluoride Toothpaste Application: Improving Caregiver Compliance

Purpose: Fluoridated toothpaste ingestion is associated with increased dental fluorosis prevalence. Current guidelines recommend a smear of fluoridated toothpaste for children younger than three years old and a pea-sized amount for children age three years or older. The purpose of this study was to evaluate two educational approaches to improve caregiver toothpaste dosing. Methods: Eighty-five caregivers of one- to six-year-olds were surveyed and applied toothpaste to a toothbrush as they normally would for their child. All caregivers then received visual aid (VA) counseling on toothpaste dosing (smear equals 0.09 g, with 0.10 mg fluoride and pea equals 0.22 g with 0.25 mg fluoride). Forty-three caregivers were randomly assigned for teach-back (TB) counseling. Each toothpaste application was weighed. Results: Caregivers (N) equals 56) not familiar with toothpaste guidelines applied more toothpaste at baseline than caregivers familiar with the guidelines (P=0.02). The TB group dispensed toothpaste amounts closer to the ideal compared with the VA group. For all caregivers, VA improved dispensing ability (P=0.008). While TB improved dispensing ability, the difference in average deviation from ideal was not statistically significant (P=0.40) between the TB and VA groups. Conclusions: Teach-back and visual aid counseling methods help caregivers dispense more appropriate toothpaste quantities. Dentists should counsel caregivers of children six years old or younger on fluoride toothpaste dosing and use VA and TB to verify dispensing skills.