Studies have shown a higher prevalence of enamel mottling in children
who live in fluoridated areas than in those from low fluoride areas. I
t is possible that the additive effect of fluoride ingestion from wate
r and toothpaste may be responsible since it is known that young child
ren may swallow up to half of the toothpaste on the brush. Parents mus
t supervise toothbrushing for young children, low fluoride paste shoul
d be used, and the brush merely smeared with paste. The commonly recom
mended pea-sized quantity may be too much.