When children under the age of four eat excess toothpaste, a condition called dental fluorosis can occur in the enamel of permanent teeth. This fluorosis in the appearance of a slight whiteness in the teeth to a dark coloration and desquamation of the teeth in rare cases. What I found was curious, many children had stained or poor quality enamel of their permanent teeth or only their front teeth. This staining pattern did not match the normal pattern of fluorosis, but I could not explain why it happened. Maybe we have an answer now.