In most instances the regular use of a fluoride-containing toothpaste is the only topical application that children need up to 3 years of age. Because children under 4 years of age cannot effectively expectorate, care must be taken to minimize the amount of toothpaste that is used and swallowed. Generally children under 2 years of age should not use toothpaste or use only a scant smear on the brush. Children over 2 years of age should have a pea-size amount placed on the brush, and parents should supervise the brushing session so that the dentifrice and saliva are expectorated. Preschoolers should not use fluoride rinses. Topical applications of fluoride in a concentrated solution or gel may be applied to the permanent teeth by the dentist or hygienist at regular 6-month intervals. There is a cumulative, enhanced effect on the teeth by the use of both topical and systemic fluoride. Look for the ADA seal of approval on dentifrice and topical products to ensure quality.