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Oral Health Research Supporting Your Practice

Research Results: CDC Study Uncovering Toothpaste and Toothbrushing Patterns Among Kids

Earlier this month, the CDC released results of a research study looking at toothpaste and toothbrushing patterns among children and adolescents in the United States from 2013 to 2016.


To determine if children were beginning to brush at the recommended age and if they were being given the appropriate amount of fluoridated toothpaste for their age group. Questions on toothbrushing practices and toothpaste use among children and adolescents were included in the questionnaire component of the National Health and Nutrition Examination Survey (NHANES)*. 

Overall Findings

  1. Responses suggest that overall children and adolescents are doing appropriate daily preventive dental health practices but that getting people started in adopting and following implementation of recommendations is lacking.
  2. This presents a chance for dentists to educate parents and caregivers about recommended toothbrushing practices and using the recommended amount of fluoridated toothpaste under parental supervision.

The Study

According to the CDC, “This study estimates patterns of toothbrushing and toothpaste use among children and adolescents by analyzing parents’ or caregivers’ responses to questions about when the child started to brush teeth, age the child started to use toothpaste, frequency of toothbrushing each day, and amount of toothpaste currently used or used at time of survey.” 

Datasets included only children and adolescents aged 3–15 years whose parent or caregiver completed the following open-ended questions:

  1. At what age did study participant start brushing their teeth?
  2. At what age did study participant start using toothpaste?

Responses were coded into four categories: <1 year, 1 year, 2 years, and ≥3 years

A total of 5,157 children and adolescents were included in this analysis. 


Analysis of 2013–2016 data found that:

  • Overall, 60.5% of children aged 3–15 years were reported to brush their teeth twice a day.
  • >38% of children aged 3–6 years used more toothpaste than that recommended by CDC and other professional organizations potentially exceeding recommended daily fluoride ingestion.
  • Nearly 80% of children aged 3–15 years started brushing later than recommended. 
  • Among children living with a head of household with less than a high school education, 44.5% were reported to start tooth-brushing at age ≤1 year.
  • Initiation of toothpaste use at age <1 year, 1 year, 2 years, and ≥3 years was reported for 9.0%, 35.2%, 32.7%, and 23.1% of children, respectively. 

View full study results and figures.


Authors of this study indicated that findings were subject to three limitations:

  1. The measures used are based on parents’ self-report, so reporting bias is possible.
  2. The question about the amount of toothpaste used focuses on the amount currently used and therefore might overestimate the amount that was used at younger ages.
  3. The type of toothpaste used (fluoride versus non-fluoride) was not specified. 

Promoting Toothbrushing for Kids in Your Practice

The Canadian Dental Association (CDA) recommends a child’s first visit take place within 6 months of the first tooth erupting and no later than 12 months of age as a dental best practice to help prevent early childhood caries (ECC). A child’s first visit by 12 months of age is critical for the early diagnosis and prevention of tooth decay, to educate parents and caregivers about dietary habits, daily oral hygiene, and the importance of regular professional dental care.  

Talk to new and expectant parents and caregivers about fluoride and toothbrushing using your social media, newsletter, or during their visits. Posting and sharing easy-to-read, plain language resources like the ones below in your office also helps educate patients and keep them informed.

CDA guide for cleaning children’s teeth

First tooth first visit resource for dentists and patients (French and Engish available)

Infographic Poster: Oral health tips for children aged 3-6

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Until next time!

CDA Oasis Team

*NHANES is a multistage probability sample of the noninstitutionalized U.S. population; data are obtained from assessments made using interview questionnaires and clinical examinations


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