Scientific Article Review: Use of Toothpaste and Toothbrushing Patterns Among Children and Adolescents — United States, 2013–2016

Scientific Article Review:

Use of Toothpaste and Toothbrushing Patterns Among Children and Adolescents — United States, 2013–2016

Published In: Morbidity and Mortality Weekly Report
Publication Year: 2019

Study Design

This study was an observational cross-sectional study based on data from the National Health and Nutrition Examination Survey (NHANES) from 2013–2016.

Funding Sources

The study was conducted by the Centers for Disease Control and Prevention (CDC) and does not list specific external funding sources or conflicts of interest.

PICO Framework - what was studied and how?

Population:
Children and adolescents aged 3–15 years in the United States.

Intervention:
Recommended toothbrushing practices, including frequency and proper toothpaste amounts.

Comparison:
Actual toothbrushing frequency and toothpaste quantities as reported by parents or caregivers.

Outcomes:

• Age of initiation of toothbrushing and toothpaste use.
• Frequency of daily toothbrushing.
• Amount of toothpaste used per brushing.

In Paragraph Form:
This study analyzed toothbrushing behaviors among U.S. children aged 3–15 years to compare actual practices with CDC recommendations. It examined the age at which toothbrushing and toothpaste use began, the frequency of brushing, and the amount of toothpaste used, highlighting discrepancies between recommended and actual practices.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Children and adolescents aged 3–15 years.
• Completed questionnaire responses by parents or caregivers on brushing practices.

Exclusion Criteria:

• Missing values for demographic data or responses regarding toothbrushing practices.

Demographics and Study Design

• Sample Size: 5,157 children and adolescents.
• Age Groups:
  • 3–6 years: 1,686 participants (29.7%).
  • 7–11 years: 2,116 participants (37.7%).
  • 12–15 years: 1,355 participants (32.5%).
• Sex:
  • Male: 51.5%.
  • Female: 48.5%.
• Race/Ethnicity:
  • Non-Hispanic White: 51%.
  • Non-Hispanic Black: 14.4%.
  • Mexican-American: 15.9%.
• Socioeconomic Status:
  • ≥200% of the federal poverty level: 52.8%.
  • Heads of households with education > high school: 69.1%.

Primary Outcome Variables and Results

• Toothbrushing Initiation:

  • 20.1% started brushing before age 1.
  • 38.8% started at age 1.
  • 26.6% started at age 2.
  • 14.5% started at age 3 or older.

• Toothpaste Use:

  • 9.0% began toothpaste use before age 1.
  • 35.2% at age 1, 32.7% at age 2, and 23.1% at age 3 or older.

• Toothpaste Amount (3–6 years old):

  • 12.4% used a smear-sized amount.
  • 49.2% used a pea-sized amount (recommended).
  • 20.6% used a half-load.
  • 17.8% used a full-load (exceeding recommendations).

Key Statistical Findings:

• 38% of children aged 3–6 years used more toothpaste than recommended.
• Disparities by socioeconomic status and education level were statistically significant (p < 0.05).

Conclusions

The study highlighted significant discrepancies between recommended and actual toothbrushing practices. Many children used excessive amounts of toothpaste, potentially risking fluoride overexposure. Furthermore, some children began brushing their teeth later than recommended. These findings underscore the need for better parental education on proper brushing techniques and fluoride use.

Discussion

Strengths:

• Large, nationally representative sample.
• Use of validated NHANES data collection methods.

Limitations:

• Self-reported data from parents may introduce reporting bias.
• Focus on current practices could overestimate or underestimate historical behaviors.
• Lack of data on the type of toothpaste (fluoride or non-fluoride).

Citation

Thornton-Evans G, et al. Use of Toothpaste and Toothbrushing Patterns Among Children and Adolescents — United States, 2013–2016. Morbidity and Mortality Weekly Report. 2019;68(4):87-90. PubMed Link

Visual Aids

Simple Chart: Toothpaste Usage Among Children Aged 3–6 Years