Brush from the first tooth with a smear of fluoride toothpaste the size of a grain of rice: the ADA, the AAP and the pediatric dentists’ academy agree, and the “2 and up” on every children’s fluoride tube is an FDA labeling line that sends you to a doctor or dentist, not a safety warning. The aisle pulls the other way, because almost everything sold as “baby toothpaste” is a fluoride-free training paste. Parents describe the gap in the same words again and again: “Our dentist said to use fluoride toothpaste and when I went and bought some it was all “2 years and up”,” one r/BabyBumps parent wrote. The picks come first; the section after them puts the guidance, the label rule and the CDC’s pages side by side, so you can walk into that first dental visit knowing what to ask. Two tubes the strip above does not show: Colgate’s My First kit, a first brush with a training paste in the box, and Boka Kids, if you have chosen fluoride-free with your dentist and want an active ingredient. From the second birthday, our toddler toothpaste guide takes over.
Evidence Receipt
How we researched this page: we read the ADA, AAP and AAPD guidance on fluoride for children, the FDA rule that writes the “under 2” line onto every fluoride label, the Cochrane reviews of fluoride toothpaste and fluorosis in young children, and the Drug Facts label on DailyMed for each fluoride pick. For the training pastes, which have no drug label, we read each brand’s own page. We read 93 Reddit threads in full, most from r/moderatelygranolamoms, r/ScienceBasedParenting, r/NewParents, r/askdentists, r/beyondthebump, r/Mommit, r/toddlers and r/DentalHygiene, and read the 2025 independent heavy-metal testing that the newest Amazon reviews keep mentioning. What that reading found:
- Fluoride toothpaste works in baby teeth, and the amount is what the guidance manages. Cochrane’s 2019 review found 1,500 ppm fluoride paste cut new decay in the primary teeth against a paste with no fluoride (moderate-certainty evidence, 998 children in one study), that 1,055 ppm and 550 ppm pastes did about the same as each other in two studies, and that 1,450 ppm slightly beat 440 ppm (Walsh et al.). The review’s conclusion: “The choice of fluoride toothpaste concentration for young children should be balanced against the risk of fluorosis.”
- The smear is the safety mechanism. The ADA’s 2014 review of fluoride toothpaste in children under 6 found it “effective in caries control” and that “ingesting pea-sized amounts or more can lead to mild fluorosis” (Wright et al.). Cochrane’s 2024 update found moderate-certainty evidence that children who brushed with 1,000 ppm or more from age one or two until five or six “probably had an increased chance of developing dental fluorosis in permanent teeth”, and only very uncertain evidence either way on whether starting before 12 months makes a difference (Wong et al.). Fluorosis at these levels means faint white marks; the ADA says most are visible only to a dentist.
- Toddlers swallow most of it, and parents put on too much. Children aged 24 to 36 months swallowed about 60% of the paste on the brush in one measured study (Moraes et al.); nobody has measured the share under 18 months, and it is unlikely to be lower. When 61 German parents of children up to 24 months were asked to dose a brush, they put on about six to seven times a rice-grain amount (Sudradjat et al.; the study was funded by a maker of fluoride-free toothpaste, which recommends its own category in the conclusion).
- Training paste has no cavity evidence. We found no trial testing a fluoride-free training paste against anything for cavities in children under 3. In the fluoride trials, a paste with no fluoride is the comparison that fluoride beat.
- Hydroxyapatite has one children’s trial, in ages 3 to 7. A fluoride-free 10% hydroxyapatite paste was “not inferior” to a 500 ppm fluoride paste over 336 days in 177 children aged 3 to 7, in a trial funded by the hydroxyapatite paste’s maker (Paszynska et al.). Nothing in children under 3.
- The 2025 lead testing found metals in most toothpastes and none over the FDA limits. An advocacy tester reported lead in about 90% of 51 toothpastes it had checked; the FDA’s limits, as the Guardian reports them, are 10,000 ppb of lead for fluoride-free and 20,000 ppb for fluoride pastes, and “none exceeded the FDA limits” (The Guardian). Two of the training pastes on this page were on the tester’s non-detect list, meaning none of the four metals was found in the sample tested.
hello Kids Wild Strawberry Fluoride Toothpaste: Editor’s Pick
hello Kids Fluoride Toothpaste, Wild Strawberry, 3-pack
Best for: The fluoride smear from the first tooth, in a paste with no SLS and no dyes
- Sodium fluoride 0.24% (Drug Facts label)
- ADA Seal of Acceptance
- Xylitol, stevia; no sodium lauryl sulfate, no dyes
- Three 4.2 oz tubes, about $5 each
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Why We Recommend It
For a smear that gets swallowed twice a day, the ingredient list matters more than it does for an adult who spits. hello’s label lists sodium fluoride 0.24% as the one active ingredient, with sorbitol, silica, water, glycerin, xylitol and natural flavor behind it, and no sodium lauryl sulfate and no dyes (DailyMed). It holds the ADA Seal of Acceptance, which means the ADA’s council found it “safe and has shown efficacy in helping prevent tooth decay when used as directed” (ADA). It is also one of the two fluoride pastes parents name most often when they describe the rice-grain smear for a baby, Tom’s being the other: “We use Hello w fluoride. Started about when she got her first teeth at 9 months,” one r/moderatelygranolamoms parent wrote, and another in the same subreddit, “My husband is a pediatric dentist - we use Hello toothpaste with Fluoride. My kids love the “Dragon Dazzle” one,” which is the flavor the lead section below is about.
The 3-pack costs about $15, so about $5 a tube, and a tube lasts a long time at a grain of rice twice a day. It holds 4.6 stars across 433 ratings on this 3-pack listing, a small pool, and its newest 50 reviews average 4.3.
Key Features
- Sodium fluoride 0.24%, the same strength as adult pastes
- ADA Seal of Acceptance
- No SLS, no dyes, no artificial sweeteners; xylitol and stevia
- Label: “children under 2 years ask a dentist or physician”; 2 to 6 “use only a pea sized amount and supervise”
Who It’s Best For
A parent who has been told to start fluoride, or who has read the ADA and AAP smear guidance and wants the plainest fluoride paste to bring to the dentist and say “this one?”.
Potential Downsides
The label’s age line is the one every children’s fluoride paste carries in some wording: 2 and up, under 2 ask a dentist or physician. The pool is small for an Editor’s Pick, and several reviewers found the tube hard to squeeze. Taste is not universal: one r/beyondthebump parent called hello’s watermelon tube “yuk.” Two more things to know. hello also sells fluoride-free tubes, and the 2025 Reddit threads titled “Hello kids toothpaste lawsuit” are about those, not this paste; check the front of the box for “fluoride”. And in 2025 the independent tester Lead Safe Mama reported lead and mercury in hello’s Dragon Dazzle fluoride paste, a different flavor of this line, at a lead level its own page calls “not illegal in any way”; the Wild Strawberry tube itself was not among the products we saw tested, and the testing is the tester’s own, not a published study (Lead Safe Mama). See the lead section below.
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Crest Kids Cavity Protection Sparkle Fun: Best Value
Crest Kids Cavity Protection Toothpaste, Sparkle Fun, 3-pack
Best for: An ADA-Seal fluoride paste for about $1.66 a tube
- Sodium fluoride 0.243% (Drug Facts label)
- ADA Seal of Acceptance
- Three 4.6 oz tubes for about $5, sold by Amazon
- Contains SLS, Blue 1 and saccharin
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Why We Recommend It
The same fluoride as hello, the same ADA Seal, a third of the price, and the tube parents in the threads we read say their dentist handed them: “Most dentists just give out kids crest but you can use any,” an r/Mommit commenter wrote, and on r/beyondthebump, “We use crest kids “sparkle” tooth. My MIL is a retired pediatric dental surgeon […] this is what she told us to do.” Crest’s label lists sodium fluoride 0.243% and the same two-and-up directions (DailyMed), and the ADA’s council accepted it as “safe and has shown efficacy in helping prevent tooth decay when used as directed” (ADA). Three 4.6 oz tubes sell for about $5, shipped and sold by Amazon, and the listing holds 4.8 stars across 33,815 ratings shared with the travel-size packs of the same paste; its newest 50 reviews average 4.9. At a rice grain twice a day, one tube could outlast the whole first year.
Key Features
- Sodium fluoride 0.243%
- ADA Seal of Acceptance
- Label: “children under 2 yrs.: ask a dentist”; under 6, a pea and supervision
- Three 4.6 oz tubes, sold by Amazon
Who It’s Best For
Anyone who wants the ADA Seal and the fluoride at the lowest price, and does not mind the sparkle.
Potential Downsides
The sparkle is mica and titanium dioxide, the color is Blue 1, the sweetener is saccharin, and the foam is sodium lauryl sulfate, all on the label. None of that is a safety line, but it is the list a parent who chose hello for its ingredients was avoiding (hello’s label does list titanium dioxide). Crest makes it for ages 2 and up; under 2, the label sends you to a dentist, as every children’s fluoride paste does.
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Dr. Brown’s Fluoride-Free Baby Toothpaste: Best Training Paste
Dr. Brown's Fluoride-Free Baby Toothpaste, Strawberry
Best for: Brushing practice before your dentist starts fluoride, with a non-detect metals test on record
- Fluoride-free; eleven listed ingredients, xylitol-sweetened
- 2025 test found no lead, cadmium, mercury or arsenic in the strawberry sample
- Brand says 0 to 3 years; 1.4 oz tube, about $4.50
- Contains xylitol: keep away from dogs
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Why We Recommend It
If your dentist has said to wait on fluoride, or you want something on the brush while you get a baby used to it, this is one of two training pastes here with a clean metals test on record. Its strawberry tube came back “non-detect” for lead, cadmium, mercury and arsenic in the 2025 independent lab round (Lead Safe Mama; non-detect means none was found in the sample tested). The Amazon listing’s ingredient list runs to eleven items: glycerin, water, xylitol, propanediol, sorbitol, pectin, xanthan gum, silica, sorbic acid, calcium lactate and flavor; the brand’s page adds “no artificial flavors or colors” and no SLS, parabens or phthalates (Dr. Brown’s). It costs about $4.50 for a 1.4 oz tube, sold by Amazon, and holds 4.8 stars across 10,772 ratings, a count the 3-pack shows too; its newest 50 reviews average 4.9 with none below 3 stars. Parents in the threads we read describe it for the reasons on the label: “It is clear, so no dyes, and is safely edible,” one r/beyondthebump parent wrote; another on r/moderatelygranolamoms uses it in the morning and a fluoride paste at night, having “prioritized a flouride free toothpaste with xylitol until kiddo could reliably spit just after 2.”
Key Features
- No fluoride, no SLS, no dyes; xylitol-sweetened
- Brand label: 0 to 3 years; “safe to swallow” is the brand’s claim
- 2025 test found none of the four metals in the strawberry sample
- 1.4 oz flip-cap tube
Who It’s Best For
Practice brushing, a baby who gags on the fluoride smear, or a family that has settled on fluoride-free with their dentist and wants the simplest tube.
Potential Downsides
It has no cavity evidence, and parents answering the fluoride-or-not question say so bluntly: “Every dentist I’ve seen talk about it has stated non fluoride toothpaste basically does nothing,” reads the top comment in an r/beyondthebump thread asking fluoride or not. Dr. Brown’s calls it a “perfect first step for growing mouths to help baby learn good dental hygiene”, which is the right description, and the ADA’s rule is that no fluoride-free paste can carry a Seal cavity claim. Its directions say a pea, which is a fluoride-paste amount; without fluoride there is no fluoride dose to manage, but the habit you are building is a rice grain. It contains xylitol, which the FDA warns is toxic to dogs (FDA); the brand prints “keep away from dogs” on the listing for that reason. Cochrane’s review of xylitol products lists cramps, bloating, constipation and loose stools among the side effects reported in its trials (Riley et al.); a smear of paste is a very small amount.
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Orajel Kids Sesame Street Training Toothpaste: Best Xylitol-Free Training Paste
Orajel Kids Sesame Street Fluoride-Free Training Toothpaste, Berry
Best for: A training paste with no xylitol, for houses with a dog, on a listing dating from 2008
- Fluoride-free; seven ingredients, stevia-sweetened, no xylitol
- 2025 test found none of the four metals in its sample (Elmo berry)
- Listed since 2008; sold by Amazon today, 1.5 oz, about $5
- Amazon title: ages 0 to 3; brand page prints no age
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Why We Recommend It
The Elmo tube is the training paste one r/moderatelygranolamoms parent describes as the first-pass tube: “We used the Elmo orajel toothpaste. We actually still uses it- he brushes first. Then we use a small amount of flouride toothpaste when we brush for him,” one r/moderatelygranolamoms parent of a three-year-old wrote. Its ingredient list is the shortest here: water, vegetable glycerin, cellulose gum, banana extract, natural flavor, stevia leaf extract and a coconut-derived cleanser, as printed on both the brand’s page and the listing (Orajel Kids). No xylitol, which matters if there is a dog in the house, and no SLS, parabens or dyes. It was on the same 2025 non-detect list as Dr. Brown’s. The listing dates from July 2008 and holds 4.8 stars across 14,421 ratings shared with the watermelon flavor and the two-pack; the newest 50 average 4.7. About $5.30, shipped and sold by Amazon.
Key Features
- No fluoride; seven ingredients; stevia, no xylitol
- “Safe if swallowed, when used as directed” is the brand’s claim
- 1.5 oz tube with a foil seal
- 2025 test found none of the four metals in its sample
Who It’s Best For
The same jobs as Dr. Brown’s, at a dollar more for a slightly bigger tube, and the better choice where xylitol is a worry.
Potential Downsides
No fluoride, no cavity evidence. Orajel’s page calls it “#1 pediatrician recommended fluoride-free toothpaste” with the footnote “among those who recommend a brand”, a survey claim rather than a clinical one. The brand’s own page prints no age range; the “ages 0-3” is in the Amazon title. At about $5.30 for 1.5 oz it costs a dollar more than Dr. Brown’s.
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Colgate My First Baby Toothbrush and Training Toothpaste: Best Starter Kit
Colgate My First Baby Toothbrush and Training Toothpaste, 3 to 24 months
Best for: A first brush and a fluoride-free paste in one box for about $5
- Fluoride-free bubblefruit paste; sugar-free, SLS-free (brand)
- Colgate's own range: 3 to 24 months
- Extra-soft infant toothbrush included
- About $5; 4.8 stars across 11,962 ratings shared with a brush-only pack
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Why We Recommend It
The one product here whose maker draws an age line close to this page’s. Colgate’s page says the kit is “designed for babies and toddlers ages 3-24 months” and that “the toddler toothpaste formula is made for kids under 2 years old and safe if swallowed” (Colgate). You get the brush as well, which you need from the first tooth whatever paste goes on it. The listing holds 4.8 stars across 11,962 ratings for about $5, sold by Amazon; that rating is shared with a brush-only Colgate Kids 4-pack for ages 6 and up, so it is not a verdict on this kit alone. No parent in the threads we read named this kit; Colgate’s kids fluoride paste comes up instead, so the case for it rests on the label and the listing, not on owners.
Key Features
- Fluoride-free paste: propylene glycol, glycerin, water, sorbitol, silica, poloxamer, cellulose gum, saccharin, flavor, citric acid
- Infant brush with extra-soft bristles (Colgate’s description)
- Colgate: 3 to 24 months
- About $5 for the set
Who It’s Best For
A parent buying the first brush anyway, or a gift. Our toddler toothbrush guide compares the brushes on their own.
Potential Downsides
The paste is sweetened with saccharin and carried in propylene glycol, which the plainer-ingredient parents will not love, and it has no fluoride. The newest 50 reviews on the shared listing average 4.2, and every low one is about a brush: “not extra soft”, bristles that “hurt my kids teeth”, a brush that did not last a month; because the ages-6+ brush pack shares the listing, we cannot tell which brush each is about. Read the kit as a cheap paste plus a brush to try. We did not see this paste in the 2025 metals testing.
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Boka Kids Nano-Hydroxyapatite Toothpaste: Best Fluoride-Free Alternative
Boka Kids Nano-Hydroxyapatite Toothpaste, Strawberry Mango
Best for: Families who have chosen fluoride-free with their dentist and want an active ingredient rather than plain practice
- Nano-hydroxyapatite (percentage not printed)
- Boka: ages 1 and up; "safe to swallow for kids 1 year+" is the brand's claim
- No SLS, no dyes, no parabens; xylitol
- 4 oz tube, about $12
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Why We Recommend It
Some dentists suggest hydroxyapatite for parents who will not use fluoride, and parents in the threads we read report it: “I’ve seen a lot of dentists recommending Boka or Risewell,” one r/moderatelygranolamoms commenter wrote, and on r/beyondthebump, “Our dentist recommended Boka toothpaste.” The ingredient is the mineral enamel is made of, and it has evidence a training paste does not: in children aged 3 to 7, a fluoride-free 10% hydroxyapatite paste was “not inferior” to a 500 ppm fluoride paste over 336 days (Paszynska et al.). Boka labels this tube “for toddlers and kids ages 1 and up”, with no SLS, parabens or dyes, and sells it for about $12, sold by Boka itself and shipped by Amazon; the listing holds 4.6 stars across 12,566 ratings shared across the brand’s kids flavors and packs, with the newest 50 averaging 4.2. Our hydroxyapatite toothpaste for kids page compares six of these, and our fluoride vs hydroxyapatite page weighs the evidence.
Key Features
- Nano-hydroxyapatite; percentage not printed
- Boka: ages 1 and up
- No SLS, no dyes, no parabens; xylitol and stevia
- 4 oz tube; also sold as a 3-pack
Who It’s Best For
A family that has decided against fluoride with its dentist and wants more than practice from the paste, from the first birthday.
Potential Downsides
The biggest Boka thread we read is titled “Boka toothpaste - a word of caution”: an adult with no cavities for years found several after a year on it, and the most upvoted reply, by a wide margin, was “Under all reasonable interpretations of normal use, there are ZERO reasons not to be using fluoride toothpaste.” One r/beyondthebump parent who had bought a fluoride-free tube by mistake, assuming it had fluoride, replied to a Boka recommendation with “I think this is the reason our daughter got cavities.” Those are stories, not trials; what the trial shows is that hydroxyapatite was not inferior to a low-strength fluoride paste, not that it beat one. The evidence stops at age 3: we found no trial of hydroxyapatite paste in younger children, and the one children’s trial used a non-nano hydroxyapatite paste, not Boka’s nano form, against a 500 ppm fluoride paste, about half the strength of the US children’s pastes above, in a study the hydroxyapatite maker funded. Boka does not print the percentage, so you cannot compare it with the 10% used in that trial; Mouthology Kids (Affiliate link) lists 5% in its product text at about $10, if a printed figure matters to you, though its Amazon rating count reset this year and it has few ratings yet. Boka’s listing says both “safe to swallow for kids 1 year+” and “not intended for ingestion”, and its own help pages say to consult a dentist before starting a routine under 2. The tube contains xylitol: keep it from dogs.
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Fluoride Under 2: What the Guidance and the Labels Say
Three statements, side by side, because they are what every parent is trying to reconcile.
The guidance. The ADA: “The ADA recommends that children use a smear of toothpaste (the size of a grain of rice) from the time the first tooth erupts until age 3 years” (ADA). The AAP: “For children under 3 years old, use a smear of fluoride toothpaste (about the size of a grain of rice)”, and brushing “with toothpaste that contains fluoride is one of the most effective things parents can do to prevent cavities” (HealthyChildren.org). The American Academy of Pediatric Dentistry puts the same smear at 0.1 mg of fluoride and recommends it as “first line for caries prevention” (AAPD).
The label. US law writes the directions on every 850 to 1,150 ppm fluoride toothpaste, and the last line reads: “Children under 2 years of age: Consult a dentist or doctor” (21 CFR 355.50). That is why the hello and Crest tubes above say “ages 2 and up” on the box: the rule gives directions from age 2 and sends the under-2 question to a clinician. It is not a statement that fluoride is unsafe under 2. The ADA’s own council said in 2014 that it had, until then, advised brushing with water and consulting a dentist before fluoride for under-2s, and replaced that with the smear-from-the-first-tooth advice after reviewing the evidence (ADA Council on Scientific Affairs).
The CDC. Its fluoride page says smear before age 3, and “for children younger than 2, consult first with your doctor or dentist about the use of fluoride toothpaste or other fluoride products” (CDC); the page’s own reference for that line is a 2015 AAP parent page, which the AAP has since replaced with the smear-from-the-first-tooth advice above. The CDC’s separate tips page for babies says to start brushing “with a soft, small-bristled toothbrush and plain water” and to talk to a dentist or doctor about varnish from the first tooth. If you have read one of those pages, that is why it reads differently from the ADA.
What to do with that: the ADA says the first dental visit “take place within six months after the first tooth appears, but no later than a child’s first birthday” (MouthHealthy). But the label says dentist or doctor, and the doctor your baby already sees counts. The AAP says “Your pediatrician or dentist can apply the varnish starting after your baby gets their first tooth” (HealthyChildren.org), and the US Preventive Services Task Force gives a grade B recommendation that primary care clinicians apply fluoride varnish from the first tooth and prescribe fluoride supplements from 6 months where the water lacks fluoride (USPSTF). So the under-2 question has an answer at the next well-baby visit, not in six months. This page does not hand out a dose; it tells you what the smear is, and who can confirm it for your child.
Why you are hearing two answers. Parents in the threads we read had been told fluoride-free by a dentist and “the smallest tiniest bit” by a pediatrician, or the reverse. The written guidance is one thing; some clinicians still teach the older line. On r/askdentists, a hygienist posted that “The textbook answer is to use baby toothpaste (fluoride free) until 2-3 years old,” and two dentists with verified flair answered in turn: “The textbook answer is not fluoride free. The American academy of pediatric dentists suggest fluoride toothpaste,” and “The AAP and ADA recommend fluoride for all ages.” The most upvoted professional comment we found anywhere, from a commenter who says they are a board-certified pediatric dentist, puts it the way the guidance does: “AAPD + AAP recommend introducing rice size amount of fluoride toothpaste under age 3 and pea size amount over age 3.” The other side is real too, and mostly about swallowing: “In practice we always recommend non fluoridated until they can learn to spit, so they’re not ingesting it,” wrote a parent who says they are a hygienist. If your own dentist is in that camp, the training pastes above are what they mean; the next section is what the guidance means.
How Much, and How
- The amount. A smear the size of a grain of rice. The ADA’s arithmetic, for a 15 kg child (about 33 lb, heavier than most under-2s): swallowing a rice-sized smear twice a day gives about 0.2 mg of fluoride a day, or 0.013 mg per kg, against the 0.05 mg per kg daily level its page uses as the fluorosis reference; a pea gives 0.033 mg per kg (ADA). A lighter baby gets a bigger dose per kg from the same smear, which is the argument for keeping it to a grain of rice and not a pea. Parents in the dosing study in the Evidence Receipt put on six times the smear without meaning to, so look at the brush, not the tube.
- Who holds the tube. The AAP’s line: “An adult should always place toothpaste on the toothbrush and then keep it out of reach” (HealthyChildren.org). The warning on every fluoride label, “keep out of reach of children under 6 years of age”, is about the tube, not the smear.
- Swallowing. A baby cannot spit. The AAP says to tilt the head down so the paste dribbles out, and not to rinse afterwards. A swallowed smear is the expected case and is what the smear size is for; a swallowed mouthful from the tube is the Poison Control case on the label. Two tips from the threads: a pediatric dentist told one r/NewParents parent they “could use gauze after brushing to make sure she isn’t swallowing excess toothpaste unnecessarily,” and a flaired hygienist on r/DentalHygiene suggested keeping the foil seal on the tube and using “a toothpick to put a tiny hole in the foil. that way you can dispense a small amount at a time with easier control.”
- Before teeth. Wipe the gums with a damp cloth after feeds (MouthHealthy). No paste is needed; the brush and paste start with the first tooth.
- Twice a day, every day. The AAPD’s recommendation is brushing “at least twice daily with an age-appropriate amount of over-the-counter fluoride-containing toothpaste”. By age 3, 28% of US children already have a cavity, per the AAP’s page.
Other Tubes Parents Name
Tom’s of Maine Kids fluoride is the fluoride paste parents name in more of the threads we read than any other for the baby smear (“We use Tom’s strawberry flavor!” is the top comment in one r/beyondthebump thread, and an r/moderatelygranolamoms parent of a 12-month-old chose it “because the ADA recommends using fluoride”). It is not on this page because its rating is shared with the fluoride-free tube a lawsuit names, and its newest 50 Amazon reviews average 3.3 against a 4.6 lifetime rating, with most of the 19 one-star reviews about the lead allegations in the section below. One parent’s texture verdict, for balance: “Feels like mud.” RiseWell Kids (hydroxyapatite) is the other tube a parent says a dentist handed them samples of; it is on our hydroxyapatite kids page. ATTITUDE gets praise for its EWG listing, most of it for the brand’s kids fluoride tube rather than the fluoride-free baby one (“it’s natural and microplastic free, but still contains flouride” is a 17-vote comment in a 2026 r/moderatelygranolamoms thread), and its taste draws two complaints, “so horrible and soapy” and “tasted and smelled terrible”. Tubby Todd is the fluoride-free baby tube parents name most often of these three, a dozen owners across eleven threads, nearly all of them on taste (“tastes delicious”, “so yummy”), one on a weeks-long stock gap in spring 2025. BOTAO has two detailed recommendations, and the earlier one was later edited by its author to read “Apparently Botao has moderate levels of lead, which is concerning.” We left those three off the cards for different reasons: ATTITUDE’s only outside support is an ingredient-hazard rating, not evidence; Tubby Todd’s listing is under a year old and prints “Do not swallow” beside “Safe for Baby”; BOTAO’s prints “Do not swallow” beside “completely safe to swallow” and has that lead edit against it. Boka’s listing carries the same swallow contradiction, and we say so on its card; it stays because it is the one fluoride-free paste here with a children’s trial. These counts come from the threads we opened plus a search of comment text across nine parenting subreddits, so passing mentions are counted too.
Our Methodology
We built this page around the fluoride question, because that is the question parents actually ask, and then chose products for two jobs: a fluoride paste for the smear the guidance recommends, and a fluoride-free paste for practice or for families who have chosen that route with a dentist. Fluoride picks had to hold the ADA Seal and have a readable Drug Facts label; training picks had to publish a full ingredient list. Every Amazon listing was checked for its seller, rating total, whether the rating is shared with other products, and the average of its newest 50 reviews against its lifetime figure. We dropped Tom’s of Maine Kids fluoride paste on that last test and on its shared rating pool, dropped Colgate Kids Cavity Protection because its listing is sold by third parties at a labelled discount, and left out ATTITUDE (ingredient-hazard rating as its only outside support), Tubby Todd (listing under a year old; “Do not swallow” beside “Safe for Baby”) and BOTAO (“Do not swallow” beside “completely safe to swallow”, and a lead report in the threads we read). Every Reddit quote on this page was checked against the live thread on the day we wrote it; comments since deleted were not used, and we set aside several accounts that praised one brand across unrelated subreddits. Where a commenter’s profession is a claim rather than a verified flair, we say so. We did not test these products. Prices are the Amazon listing price on the day we read it and will change.
Community vs. Evidence
| Topic | What parents and clinicians say on Reddit | What the sources say |
|---|---|---|
| The tube says 2 and up | The most repeated confusion in the threads we read; “just ignore the label” is the top answer in one | The line is required by 21 CFR 355.50 and sends under-2s to a dentist or doctor; the ADA, AAP and AAPD say a rice-grain smear from the first tooth |
| My baby swallows all of it | The main reason parents give for choosing fluoride-free; one parent’s pediatric dentist said to wipe with gauze | A rice-grain smear swallowed twice a day is about 0.2 mg of fluoride, a quarter of the reference level for a 15 kg child (ADA); 24-to-36-month-olds swallow about 60% of what is on the brush |
| Training paste | Used as the child’s own first pass before the parent’s fluoride pass in five threads; “basically does nothing” and “pointless” in two | We found no cavity trial of any fluoride-free training paste; non-fluoride paste is the comparison fluoride beat in Cochrane’s review |
| Hydroxyapatite | Dentist-suggested in three threads; a 260-upvote caution thread about cavities after a year on it | One children’s trial, ages 3 to 7, maker-funded, non-nano paste against 500 ppm fluoride; none found under 3 |
| Lead | Five threads since 2025; in the four with a clear top reply, it doubts the tester or the lawsuit | Metals found in most pastes, none over the FDA limits as the Guardian reports them; the Tom’s case is an allegation with no ruling we found |
| Buying on Amazon | “I personally would never buy my baby’s toothpaste from Amazon,” one parent wrote, citing counterfeits | Five of the six carded tubes are sold by Amazon.com; Boka is sold by Boka itself and shipped by Amazon. “Sold by” is the line to check on any listing |
Lead in Kids’ Toothpaste: What the 2025 Testing Found
The newest Amazon reviews of several kids’ toothpastes, Tom’s most of all, carry the word “lead”. Here is what is behind it. In early 2025 the independent tester Lead Safe Mama published laboratory results for dozens of toothpastes. The Guardian’s summary: about 90% contained some lead, 65% arsenic, just under half mercury, one-third cadmium; the FDA’s limits, as the Guardian reports them, are 10,000 ppb of lead for fluoride-free toothpaste and 20,000 for fluoride toothpaste, and “none exceeded the FDA limits” (The Guardian). The tester argues for a far lower limit than the FDA’s; her page on hello’s fluoride paste says the lead level found “is not illegal in any way”.
Two things followed. A class action filed in February 2025 alleges that Tom’s of Maine Kid’s Natural Fluoride-Free Silly Strawberry contains “unsafe levels of lead and arsenic”, resting on that testing (Top Class Actions); it is an allegation, and we found no ruling. And Tom’s Kids ratings filled with one-star reviews about the news, which is one reason Tom’s of Maine Kids fluoride paste, a product parents name often for the baby smear, is not on this page: its newest 50 reviews average 3.3 against its 4.6 lifetime, most of the one-star ones on this topic, and the listing’s rating is shared with the fluoride-free tube the lawsuit names.
Reddit’s own reading, in the threads where the news landed, was calmer than the headlines. In the r/toddlers lawsuit thread, the most upvoted reply was “A lawsuit being filed is not proof of its claims. Anyone can file a lawsuit,” and in the r/moderatelygranolamoms thread on Tom’s toddler paste it was a parent whose son “has been using this for a year. He just had a lead test at his 2 year checkup and his levels were normal.” What a parent can take from it: the testing is one tester’s laboratory results, not a published study; the levels were legal; and we found no regulatory action on it. It is not a reason to drop fluoride: the two fluoride pastes on this page were not among the products we saw flagged, and the risk the guidance is built around, cavities, is the documented one. If the question still keeps you up at night, the two training pastes the tester found none of the four metals in, Dr. Brown’s strawberry and the Orajel Elmo berry, are at least pastes with a test on record; they are practice pastes, and the fluoride question stands. The tester has also said, in a comment on her own site, that she expects hydroxyapatite itself to carry lead; that is her expectation, not a result we saw.
What to Use, by Age
- Before the first tooth. A damp cloth on the gums after feeds. No paste.
- The first tooth. A soft baby brush and the rice-grain smear of fluoride paste, per the ADA and AAP; ask your pediatrician at the next visit and book the first dental visit within six months. If you are waiting for that answer, Dr. Brown’s or the Orajel Elmo paste are practice.
- Around 12 months. The dental visit should have happened by now; it is where the fluoride question is answered for your child, your water and your family history. Boka’s label starts here if you are going fluoride-free with an active ingredient.
- 12 to 24 months. Still a smear, still twice a day, an adult still holding the tube. The AAPD notes 15 to 30 months as the window when the permanent front teeth are most susceptible to fluorosis, which is the reason for the smear, not a reason to stop.
- The second birthday. Every fluoride paste’s label now gives directions. Our toddler toothpaste guide picks up from here, and the fluoride-free kids guide covers families staying off fluoride.
What each label says
Fluoride lines are from each product’s Drug Facts label on DailyMed; training-paste lines are the brand’s own, read in November 2026.
| Product | Fluoride | Age on the label | Sweetener | SLS | 2025 metals test |
|---|---|---|---|---|---|
| hello Kids Wild Strawberry | Sodium fluoride 0.24% | 2 and up; under 2 ask a dentist or physician | Xylitol, stevia | No | Sibling flavor positive for lead and mercury (lead under the FDA limit); this flavor not seen tested |
| Crest Kids Sparkle Fun | Sodium fluoride 0.243% | 2 and up; under 2 ask a dentist | Saccharin | Yes | A different Crest kids paste was tested; this one not seen |
| Dr. Brown’s Baby, Strawberry | None | 0 to 3 years (brand) | Xylitol | No | Non-detect for all four metals in the sample tested |
| Orajel Elmo, Berry | None | 0 to 3 (Amazon title); brand page prints none | Stevia | No | Non-detect for all four metals in the sample tested |
| Colgate My First kit | None | 3 to 24 months (brand) | Saccharin | No (brand) | Not seen tested |
| Boka Kids | None (nano-hydroxyapatite) | 1 and up (brand) | Xylitol, stevia | No | Not seen tested |
Frequently Asked Questions
Should a 6-month-old or a 9-month-old use toothpaste?
As soon as there is a tooth, the ADA, the AAP and the AAPD say yes: a rice-grain smear of fluoride paste, twice a day, brushed by you. The fluoride label says to ask a dentist or doctor first for a child under 2, and the ADA says that first visit should happen within six months of the first tooth. If the tooth is here and the dental visit is not, your pediatrician can answer the fluoride question at the next check-up; until then a training paste or a soft brush with water keeps the habit going.
My dentist said fluoride, but every tube says 2 and up. Which do I follow?
Your dentist. The age line comes from the FDA rule that writes the directions on every fluoride toothpaste, and it does not say the paste is unsafe under 2; it says to ask a dentist or doctor, which you have done. The ADA replaced its own advice of water and a consultation before fluoride for under-2s with the smear-from-the-first-tooth line in 2014. Parents who have been through this say the same thing in plainer words: “all fluoride toothpaste will say not for children under 2 because that’s the standard recommendation. I think if your doc is saying otherwise you’ll have to just ignore the label.”
Is it safe if my baby swallows the toothpaste?
A swallowed smear is expected; that is why the amount is a grain of rice. The ADA’s arithmetic puts a twice-daily swallowed smear at about 0.2 mg of fluoride, a quarter of its reference level for a 15 kg child and a larger share for a lighter baby, which is why the smear stays a grain of rice. Swallowing from the tube is different: the label says to get medical help or call Poison Control if more than a brushing’s worth is swallowed, so the tube stays with you.
What is fluorosis, and should I worry?
Faint white lines or flecks on the adult teeth, which form under the gums until about age 8. The ADA says it “isn’t a disease and doesn’t affect the health of your teeth” and that in most cases only a dentist would notice (MouthHealthy). Cochrane’s 2024 review found moderate-certainty evidence that children brushing with 1,000 ppm or more from age one or two “probably had an increased chance” of fluorosis in their permanent teeth, which is the trade the guidance makes with the smear.
Fluoride-free training paste or fluoride: which is actually better for a baby?
For cavities, fluoride; we found no trial showing a training paste preventing anything. For practice, either. What the “safe to swallow” label means is that a training paste has no fluoride to dose, and also no ingredient with cavity evidence behind it. Treat it as a stage unless your dentist has told you otherwise.
Is hydroxyapatite toothpaste safe for babies?
Boka labels it from age 1 and RiseWell says from the first tooth, but we found no trial of it in children under 3. In children aged 3 to 7 a 10% hydroxyapatite paste was not inferior to a 500 ppm fluoride paste, in a trial the maker funded. It is a reasonable fluoride-free alternative for a family that has made that choice with a dentist; it is not the ADA’s recommendation.
Does my baby need a special baby toothbrush?
A soft, small-headed brush, yes; a special brand, no. Our toddler toothbrush guide compares the first brushes for 0 to 3.
Our water is not fluoridated. Does that change the answer?
It strengthens it. The AAP says babies under 6 months, breastfed or formula-fed, need no fluoride supplement, and that fluoridated water used for formula “might increase the risk of dental fluorosis”, most cases mild (HealthyChildren.org). Where the water supply lacks fluoride, the US Preventive Services Task Force recommends that primary care clinicians prescribe fluoride supplements from 6 months, a grade B recommendation, alongside varnish from the first tooth. Your pediatrician knows your water; this is the question to bring to the next visit.