Awareness of Fluoride Toothpaste among Parents of Children and Adolescents

Article information

J Korean Acad Pediatr Dent. 2024;51(4):392-406

Publication date (electronic) : 2024 November 25

doi : https://doi.org/10.5933/JKAPD.2024.51.4.392

Seungyong Hwang¹, Jaeho Lee¹, Jong-Hoon Choi², Koeun Lee¹, Chung-Min Kang^,1

¹Department of Pediatric Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea

²Department of Orofacial Pain and Oral Medicine, College of Dentistry, Yonsei University, Seoul, Republic of Korea

Corresponding author: Chung-Min Kang Department of Pediatric Dentistry, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea Tel: +82-2-2228-3174 / Fax: +82-2-365-7420 / E-mail: KANGCM@yuhs.ac

Received 2024 August 6; Revised 2024 September 21; Accepted 2024 September 24.

Trans Abstract

Introduction

Dental caries is characterized as a hard tissue disease caused by the demineralization of tooth minerals and the destruction of organic matter owing to organic acids produced by bacteria breaking down carbohydrates, leading to damage and defects in teeth. Treatment of dental caries involves invasive procedures, making primary prevention before the onset of caries crucial[1].

Several methods have been suggested to prevent dental caries, including fluoride administration, fissure sealants, plaque control, and dietary adjustments. Fluoride inhibits the demineralization of the tooth surface and promotes remineralization of the demineralized areas[2]. The relationship between fluoride and teeth has been well established since 1916. Fluoride has shown significant effects for preventing damage to hard dental tissues (both systemically and topically) and in the repair of damaged tissues[3]. The Federation of Dentists International has stated that fluoride use is beneficial, safe, and effective for preventing dental caries[4]. Methods for fluoride use include water fluoridation programs, fluoride-containing toothpastes, fluoride rinses, and professional fluoride applications[5].

The use of fluoride toothpaste with 1000 ppm fluoride has been shown to prevent caries in both primary and permanent teeth[6]. Consequently, in Korea, the fluoride content in toothpastes had been regulated to 1000 ppm, and most commercially available toothpastes contain this amount[7]. The “Regulation on Approval, Notification, and Review of Quasi-drugs” was revised in September 2014, and the permissible fluoride content in toothpastes was increased from 1000 ppm to 1500 ppm, allowing for imports of toothpaste with higher fluoride content. Since 2020, domestically manufactured toothpastes have been permitted to contain 1450 ppm fluoride, and such products are now available for consumer purchase[8].

Public concerns about fluoride toxicity have persisted because excessive fluoride intake is known to cause diarrhea, vomiting, fluoride poisoning, and dental or skeletal fluorosis[9]. Children aged < 6 years are particularly at risk owing to their underdeveloped swallowing reflexes. Those aged < 3 years are especially vulnerable because this is a critical period for the formation of permanent tooth hard tissues[10], increasing the probability of dental fluorosis from excessive intake[11]. However, adverse effects of fluoride absorption typically occur only with excessive intake. To minimize the potential risks, various guidelines, including those from the American Dental Association, the European Academy of Paediatric Dentistry (EAPD), and the Korea Disease Control and Prevention Agency, recommend age-appropriate fluoride and toothpaste intake for infants and young children. These guidelines suggest using a smear or rice-grain sized amount of toothpaste for children less than 3 years of age, and a pea-sized amount for children aged 3 - 6 years. This approach aims to ensure proper fluoride exposure while minimizing the risk of excessive intake[12-14]. Despite numerous studies on the effects and characteristics of fluoride and guidelines on fluoride toothpaste use, there is a lack of research on fluoride toothpaste use in Korea.

Therefore, this study aimed to investigate the status and practices of fluoride toothpaste use. We also administered a survey to parents and children who visited the Yonsei University Dental Hospital to evaluate parental awareness of its benefits and risks. The survey focused on the actual use of fluoride toothpaste and the extent of knowledge of its benefits and risks.

Materials and Methods

2. Methods

Parents who visited the Department of Pediatric Dentistry were informed of the survey by staff members and completed the questionnaire upon consent. The survey investigated the general characteristics of the respondents and their children, oral health status, and current oral hygiene practices. Additionally, it examined parents’ awareness and usage patterns of fluoride toothpaste, including their understanding of the necessity, effects, and potential side effects of fluoride. The survey also enquired about the fluoride content of children’s toothpaste and parents’ knowledge of the appropriate amount of toothpaste per brushing session (Fig. 1 - 3).

Fig 1.

Survey questionnaire on characteristics of parents and children.

Fig 2.

Survey questionnaire on adult toothpaste use and awareness of fluoride toothpaste.

Fig 3.

Survey questionnaire on children’s toothpaste use and awareness of fluoride toothpaste.

Results

1. Characteristics of the Study Participants

Among the parents who responded, 139 (82.7%) were female. About 98 parents (58.3%) were aged ≥ 40 years. The majority of the parents, about 131 (78.0%), had a university education (either current students or graduates). About 130 parents (77.4%) had not received dental treatment for dental caries or periodontal diseases. In the past year, 93 parents (55.4%) underwent dental checkups despite experiencing no discomfort. When surveyed about their oral health status, 21 parents (12.5%) reported it to be “very good” or “good,” 94 (56.0%) as “fair,” and 53 (31.6%) as “poor” or “very poor.”

Of the children, 88 (52.4%) were male. The age distribution of children was as follows: 29 (17.3%) were 0 - 35 months old, 35 (20.8%) were 36 - 71 months old, and 104 (61.9%) were ≥ 72 months old. Firstborn children were the most common birth order, accounting for a total of 110 children (65.5%). Parents’ assessment of their children’s oral health status showed that 41 (24.4%) considered it “very good” or “good,” 69 (41.1%) considered it “fair,” and 58 (34.5%) considered it “poor” or “very poor.” For survey questions regarding children’s cooperation with tooth brushing, 31 (18.5%) reported it to be “very good” or “good,” 53 (31.5%) as “fair,” and 84 (50.0%) as “poor” or “very poor.” About 60 children (35.9%) received regular fluoride application during their dental visits and 107 children (64.1%) did not receive such treatment (Table 1).

Table 1.

General characteristics of study participants

2. Parental Awareness of Fluoride Toothpaste

1) Selection Criteria for Adult’s Fluoride Toothpaste by Parents

When surveyed about the most important criteria for selecting adult toothpaste, functionality (caries prevention, tooth whitening, gum improvement, and breath freshening) was chosen by 97 parents (57.7%), making it the most common response. This was followed by safe ingredients 15 (8.9%), brand 9 (5.4%), taste 7 (4.2%), price 6 (3.6%), and other reasons 1 (0.6%). Notably, 33 parents (19.6%) reported having no specific criteria, making this the second most common response after functionality.

2) Awareness and Perceived Necessity of Fluoride in Toothpaste

Among the surveyed parents, 128 (76.2%) reported awareness about the fluoride content in their toothpaste, whereas 39 (23.2%) reported a lack of knowledge. One respondent (0.6%) acknowledged an awareness of fluoride; however, he opted not to use fluoride toothpaste. The sole reason cited for abstaining from fluoride toothpaste was its perceived lack of efficacy. Regarding the perceived necessity of fluoride toothpaste, 159 parents (94.6%) affirmed its necessity, whereas 9 parents (5.4%) deemed it unnecessary.

3) Awareness of the Effects and Side effects of Fluoride Toothpaste

About 139 parents (82.7%) reported being aware of the effects of fluoride toothpaste. Among these 139 parents, the most significant effect of fluoride toothpaste was predominantly thought to be for dental caries prevention (135 parents, 97.1%), followed by tooth remineralization (3 parents, 2.2%), and reduction of tooth sensitivity (1 parent, 0.7%). Information sources included dentists (35 parents, 25.2%), television broadcasts (27 parents, 19.4%), blogs, online forums (21 parents, 15.1%), newspaper articles (12 parents, 8.6%), doctors (5 parents, 3.6%), and YouTube videos (4 parents, 2.9%). About 35 parents (25.2%) reported alternative sources of information, including educational institutions and personal contacts.

Awareness of the side effects of fluoride toothpaste was acknowledged by 30 parents (17.9%). Of these, fluorosis (dental discoloration) was known by 17 parents (56.7%), gastrointestinal discomfort by 11 parents (36.7%), and emetic symptoms by 2 parents (6.6%). Information about side effects was primarily obtained from online platforms (8 parents, 26.7%), television broadcasts (5 parents, 16.7%), newspaper articles (4 parents, 13.3%), dental professionals (2 parents, 6.7%), and medical and pharmaceutical sources (1 parent, 3.3%). About 9 parents (30.0%) cited alternative information sources, including personal acquaintances.

4) Associations between Parental Characteristics and Awareness of Fluoride Toothpaste

Males demonstrated lesser awareness across several aspects of fluoride toothpaste use. Specifically, 41.0% of males reported being unaware of the presence of fluoride in their toothpaste, 34.5% were unaware of the effects of fluoride toothpaste, and 20.9% were unaware of the potential side effects. In contrast, females showed significantly higher awareness, with 89.8% aware of fluoride presence (p < 0.0001), 86.3% aware of its effects (p= 0.007), and 100.0% aware of its potential side effects (p= 0.007).

These differences between males and females were statistically significant, indicating a substantial gap in fluoride toothpaste awareness based on parental sex.

Parents who reported their oral health to be “very good” or “good” were more likely to be unaware of the effects of fluoride toothpaste, with 27.6% indicating a lack of awareness. Conversely, parents who reported their oral health to be “fair” or “poor/very poor” demonstrated higher awareness levels, with 57.6% and 33.1%, respectively, reporting knowledge of the effects of fluoride toothpaste. This association was statistically significant (p= 0.025).

A notable correlation was observed between ongoing dental treatment and awareness of fluoride content in toothpaste. Among parents who were on dental treatment, 41.0% reported being unaware of the fluoride content in their toothpaste. In contrast, 82.8% of parents who did not undergo dental treatment reported an awareness of fluoride content. This difference was statistically significant (p= 0.002). Notably, other factors such as parental age, educational background, place of residence, and regular dental checkups did not show statistically significant associations with the awareness of adult use of fluoride toothpaste (Table 2).

Table 2.

Awareness of fluoride toothpaste for adults according to parental characteristics

3. Parental Awareness of Fluoride Toothpaste for Children

1) Current Toothpaste Usage and Selection Criteria for Children by Parents

The toothpaste currently used by children was reported as follows: fluoride-free toothpaste 10 (5.9%), low-fluoride toothpaste 68 (40.5%), high-fluoride toothpaste 65 (38.7%), a combination of fluoride-free and high-fluoride toothpaste 9 (5.4%), and uncertain 16 (9.5%). When surveyed about the most important criteria for selecting children’s toothpaste, 82 (50.0%) chose safe ingredients, followed by fluoride concentration 43 (26.2%), brand 11 (6.7%), and taste 8 (4.9%). Seventeen parents (10.4%) reported having no specific criteria.

2) Parental Awareness of Fluoride Presence and Concentration in Children’s Toothpaste

Among the surveyed parents, 142 (93.4%) reported that their children used fluoride toothpaste and 10 (6.6%) reported no use of fluoride toothpaste. In households using either fluoride-free or fluoride-containing toothpaste, 71 parents (42.3%) were aware of the fluoride content of their children’s toothpaste. The most common age for initiating fluoride toothpaste use was 3 - 6 years, as reported by 67 parents (45.0%), followed by 0 - 3 years (43 parents, 28.9%), and 6 - 9 years (32 parents, 21.5%).

The primary reason for starting fluoride toothpaste use was stated to be as dentists’ recommendation by 66 parents (44.0%), followed by online platforms such as blogs and forums by 26 parents (17.3%), and television broadcasts by 11 parents (7.3%). Additionally, 35 parents (23.3%) selected “other” reasons, including school, spouse, and daycare centers. Regarding the necessity of fluoride for children’s oral health, 162 parents (96.4%) responded that it was necessary, and 6 parents (3.6%) deemed it unnecessary.

3) Parental Awareness of Toothpaste Amount Used by Children

Among the surveyed parents, 70 (41.7%) reported that their children applied toothpaste themselves and 98 parents (58.3%) reported that they applied the toothpaste for their children. Of the 70 children who applied toothpaste themselves, 68 (97.1%) were aged ≥ 6 years, and 2 (2.9%) were aged < 6 years. The age distribution for children whose parents applied toothpaste was 29 children (29.6%) < 3 years, 32 children (32.6%) between 3 - 6 years, and 37 children (37.8%) ≥ 6 years. Regarding the toothpaste amount, 32 (19.1%) used a small rice grain size, 98 (58.3%) used a pea-sized amount, 33 (19.6%) filled half of the toothbrush, and 5 (3.0%) used a full toothbrush amount. Only 65 parents (38.7%) reported awareness of age-appropriate toothpaste quantities, whereas 103 parents (61.3%) were unaware. Among parents of children aged < 6 years, 39 out of 64 parents (60.9%) were aware of the appropriate amounts. The parents obtained information from dentists (12), blogs (10), YouTube videos (5), newspaper articles (3), TV broadcasts (2), and doctors (1). For children aged < 3 years, 22 of 29 parents (75.9%) used a small rice grain-sized amount of toothpaste, and for children between 3 - 6 years, 22 of 35 parents (62.9%) used a pea-sized amount of toothpaste.

4) Associations Between Parental Characteristics and Awareness of Toothpaste Used by Their Children

This study revealed significant sex-based differences in parental awareness of children’s toothpaste use. Among males, 24.7% reported being unaware of the fluoride content of their children’s toothpaste, whereas 93.0% of females reported awareness. This difference was statistically significant (p= 0.003). Further, regarding awareness of the recommended toothpaste amounts for children, 26.2% of males reported being unaware, whereas 96.9% of females reported being aware of the toothpaste amount. This difference was statistically significant (p < 0.0001).

Parental age was also associated with the level of awareness. Parents aged 30 - 39 years were more likely to report awareness of their child’s toothpaste fluoride content, whereas those aged ≥ 40 years were more likely to report being unaware. This association was statistically significant (p < 0.0001). Similar results were found for awareness of the recommended toothpaste amounts (p < 0.0001).

Notably, other factors such as parental education level, place of residence, oral health status, and regular dental checkups were not statistically significantly associated with awareness of fluoride toothpaste use in children (Table 3).

Table 3.

Awareness of fluoride toothpaste for children according to parental characteristics

5) Associations Between Children’s Characteristics and Parental Awareness of Toothpaste Used by Children

This study revealed significant associations between the children’s characteristics and parental awareness of toothpaste use. About 62.0% of parents reported awareness of the fluoride content in their child’s toothpaste for male children, whereas 54.6% of parents reported being unaware of the fluoride content in their child’s toothpaste for female children. This difference was statistically significant (p= 0.033). Similarly, regarding the recommended toothpaste amount, 63.1% of parents of male children reported awareness, whereas 54.4% of parents of female children reported being unaware. This difference was statistically significant (p= 0.027).

Children’s age was significantly associated with parental awareness. Parents of children aged 0 - 35 months and 36 - 72 months were more likely to report awareness of fluoride concentration in their child’s toothpaste (29.6% and 25.4%, respectively), whereas 74.2% of parents of children aged ≥ 72 months reported being unaware (p < 0.0001). A similar pattern was observed for awareness of the recommended toothpaste amount, with statistical significance (p < 0.0001).

The children’s oral health status was not statistically significantly associated with parents’ awareness of the fluoride content in their children’s toothpaste. Parents who reported their children’s oral health to be “fair” or “very good/Good” were more likely to be unaware of the recommended toothpaste amount, with 43.7% and 31.1%, respectively. Conversely, parents who reported their children’s oral health to be “poor” or “very poor” demonstrated higher awareness levels, with 49.2%, reporting knowledge of the recommended toothpaste amount. This association was statistically significant (p= 0.003).

Notably, the presence or absence of siblings, children’s toothbrushing cooperation, and regular fluoride application were not statistically significantly associated with parental awareness of fluoride toothpaste use in children (Table 4).

Table 4.

Awareness of fluoride toothpaste for children according to children characteristics

Discussion

Fluoride is recognized as an efficient and economical method of oral care that prevents dental caries and strengthens hard tooth tissues. Fluoride adheres to the crystal surface of teeth in the oral cavity, thereby protecting the tooth surface and preventing crystal dissolution. Furthermore, as the oral pH changes from acidic to neutral, fluoride has been shown to be absorbed into the enamel forming fluorapatite, which facilitates tooth remineralization and enhances tooth resistance to acidic environments[15].

In South Korea, the fluoride concentration in toothpaste had been regulated to an upper limit of 1000 ppm, with manufacturers producing and selling toothpaste at or below this concentration. However, several countries, including Germany, the United Kingdom, and the United States, have set their fluoride upper limit at 1500 ppm[16].

Recently, South Korea granted approval for manufacturing toothpaste containing 1450 ppm fluoride. Consequently, toothpastes with fluoride concentrations exceeding 1000 ppm have been introduced and marketed domestically in alignment with international standards. In 2022, South Korea revised its ‘2022 Oral Examination Dentist Counseling Manual’, recommending the use of toothpaste containing 1,000 to 1500 ppm fluoride. The manual advises using a smear or rice-grain sized amount of toothpaste for children aged 0 - 2 years, and a peasized amount for those aged 3 - 6 years[14]. However, this increase in fluoride content raises concerns regarding the potential side effects.

This survey examined parental criteria for selecting toothpaste for themselves and their children. Functionality (caries prevention, tooth whitening, gum improvement, and breath freshening) emerged as the primary consideration for adults, followed by those without specific criteria. This finding indicates that parents prioritize toothpaste efficacy, which is consistent with previous research[17] that identified functionality as the most influential factor in toothpaste selection. However, a significant proportion (19.6%) of parents without specific criteria indicated a lack of engagement in adult toothpaste selection, potentially leading to the purchase of familiar and readily available brands.

In contrast, most of parents reported selecting toothpaste for their children, prioritizing safe ingredients over fluoride concentrations. This disparity likely stems from the lower risk of toothpaste ingestion in adults than in children, allowing parents to focus more on functionality for themselves while emphasizing safety for their children. The selection of a fluoride concentration for children’s toothpaste has been attributed to a higher incidence of dental caries in pediatric and adolescent populations.

The majority of parents acknowledged the necessity of fluoride in both adults’ and children’s toothpaste; thus, demonstrating a high awareness of the presence and benefits of fluoride. However, awareness of the potential side effects was notably lower. A significant gender difference was observed in fluoride toothpaste awareness, with mothers showing greater interest than fathers. This suggests the need for increased promotion and information dissemination to fathers. Additionally, the level of awareness regarding fluoride toothpaste differed based on the child’s gender. However, this difference may be attributed to the sample characteristics in our study, where there were more female parents for male children compared to female children. Further research is needed to confirm and explore this relationship.

Most parents identified caries prevention as the primary benefit of fluoride. Information sources for obtaining fluoride-related information were diverse and included dentists, television broadcasts, and online platforms. Those aware of side effects primarily obtained information from digital media and personal contacts, with only 3 survey respondents citing medical professionals as their source of information. This highlights the potential gap in side-effects communication during dental and medical consultations.

These findings underscore the need for dental and medical professionals to provide comprehensive information on fluoride toothpaste usage, along with the potential side effects and precautions. Such guidance would enable parents to make informed decisions when selecting and using fluoride toothpaste for themselves and their children.

About 81.0% of parents reported that for their children they predominantly used children’s toothpaste, with low-fluoride toothpaste accounting for 40.5% of usage. According to Walsh et al.[18], toothpaste containing an average of 1000 ppm fluoride demonstrated a caries prevention rate of approximately 23%, whereas toothpaste with 2400 ppm fluoride showed a 36% prevention rate. However, toothpaste with an average fluoride concentration of 500 ppm did not exhibit significant caries prevention effects. This finding indicated that children using 500 ppm fluoride toothpaste may not receive adequate caries prevention benefits. Additionally, when comparing 1000 ppm and 1500 ppm fluoride toothpaste, the 1500 ppm fluoride toothpaste showed a tendency for higher remineralization effects, demonstrating a greater caries prevention effect[19]. Consequently, it is evident that parents should be informed and encouraged to select toothpaste with fluoride concentrations of 1000 ppm or higher for their children. Furthermore, for children with high caries risk, it is advisable to recommend 1500 ppm fluoride toothpaste.

Among households using either fluoride-free or fluoride-containing toothpaste, 42.3% of parents reported being aware of the fluoride content of their children’s toothpaste. Notably, the levels of awareness significantly differed based on the age of the parents and children. Parents of younger children, particularly those in infancy and early childhood, demonstrated greater concern and knowledge regarding the fluoride content of their children’s toothpaste than parents of school-age children.

These findings highlight the need for targeted education and guidance, especially for parents of older children, to ensure the appropriate selection and usage of fluoride toothpaste across all age groups. The data also highlights the importance of maintaining parental awareness and engagement in oral health practices throughout children’s developmental stages.

The practice of parents applying toothpaste to their children’s toothbrushes was predominantly observed in households with children aged < 6 years. Parents of children aged between 0 - 6 years generally reported the use of age-appropriate amounts of toothpaste. However, the majority of parents demonstrated a lack of awareness regarding the recommended toothpaste quantities for different age groups.

Notably, this study revealed that parents of children with “poor” or “very poor” oral health reported greater knowledge of the recommended toothpaste amounts. This finding suggests that parents become more attentive to preventive measures, such as fluoride use, when their children’s oral health is compromised.

The most common age for initiating fluoride toothpaste use has been reported as 3 - 6 years. Parents cited dentists, blogs, and television broadcasts as primary sources of influence in selecting to use fluoride-based toothpaste, indicating that dental professionals have been actively recommending fluoride toothpaste.

Parents of children aged 0 - 3 years preferred fluoride-free toothpaste, likely because of concerns about ingestion and potential side effects during the critical period of permanent tooth formation[10]. However, research has shown that the recommended daily fluoride intake for children is 0.05 - 0.07 mg/kg of body weight. The toxic dose of fluoride is reported to be 5 mg/kg, while the lethal dose is estimated at 16 mg/kg for young children and 32 mg/kg for adults. This indicates that fluoride toxicity occurs only when a considerably large amount of fluoride is ingested[20-23]. By using the American Academy of Pediatric Dentistry guidelines for toothpaste amounts, the actual fluoride intake from 1000 ppm toothpaste has been calculated as 0.2 mg/day in a rice-grain size (0.1 mg F) toothpaste application for children < 3 years and as 0.5 mg/day in a pea-sized (0.25 mg F) toothpaste application for children between 3 - 6 years[12]. These calculations indicate that the risk associated with the use of fluoride toothpaste in children aged 0 - 3 years is likely very low. Furthermore, the 2019 EAPD guidelines, the World Dental Federation, and the World Health Organization recommend the use of toothpaste containing at least 1000 ppm fluoride for children aged < 3 years[4,13,24]. Based on these findings, it has been suggested that fluoride toothpaste use should be recommended for children aged < 3 years and not just for children aged between 3 - 6 years, as previously reported. However, parental supervision and management are deemed necessary for children aged < 3 years to prevent potential side effects of excessive fluoride ingestion.

South Korea has implemented an oral health screening program for infants and young children alongside general health checkups. The participation rate in oral health screening has significantly increased over time[25]. Another study reported that 58.4% of parents cited oral health screening as the primary reason for their child’s first dental visit[26]. These findings are similar to those reported by the present study (61.0%). Prior to the screening, parents completed a questionnaire that enquired about fluoride use using questions such as the presence of fluoride in their child’s toothpaste, amount of toothpaste used, regular fluoride application, and whether they had received advice about fluoride.

This study found that dentists played a crucial role in providing information about the importance and necessity of fluoride to parents. Many parents reported receiving information from dental professionals about starting the use of fluoride toothpaste, and information on its effects and appropriate usage amounts shared during screening.

This study was limited by its focus on fluoride toothpaste, lacking consideration of other fluoride sources such as topical fluoride applications, fluoride rinses, fluoride supplements, and fluoride-containing foods. Additionally, it was limited by its focus on parents of children and adolescents who visited a specific department of a single university hospital in Seoul. This could have influenced the survey results owing to the participants’ potentially higher understanding of dental care. The impact of not only fluoride toothpaste but also other forms of fluoride intake should be considered in future studies. Parents visiting various institutions should be included to ensure a diverse and larger population is represented. Fluoride awareness among parents of children with disabilities, particularly in children who are unable to spit out toothpaste, should also be investigated. This could provide insights into the patterns and perceptions of fluoride toothpaste use in this population. Regional differences in fluoride toothpaste use and awareness among parents of children and adolescents could be further explored in follow-up studies. How parents of children who cannot spit out toothpaste perceive and use fluoride toothpaste should also be examined, which could inform the designing of guidelines for the proper use of fluoride toothpaste in these children.

Conclusion

This study investigated and evaluated the usage patterns and awareness of fluoride toothpaste use among parents of children and adolescents using a survey. Parents were knowledgeable in the necessity and importance of fluoride toothpaste; however, they had limited knowledge about its side effects. Female parents exhibited higher awareness of the presence of fluoride, its benefits, and its side effects in adult toothpastes. A trend was observed where younger parents and those with younger children showed higher awareness of fluoride content and appropriate toothpaste use for their children. While most parents reported using fluoride-containing toothpaste for their children, this study showed that more children started using fluoride toothpaste at ages 3 - 6 years (44.7%) than at ages 0 - 3 years (28.7%). Additionally, parents showed low awareness of the appropriate amount of toothpaste for their children. These findings highlight the need for efforts to educate parents about fluoride concentration in toothpaste and appropriate usage amounts, and to promote the timely initiation of fluoride toothpaste use. Such initiatives are necessary to improve the oral health of children and adolescents.

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