Dangers of fluoride treatments
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Dangers of Fluoride Treatments
Dental Fluorosis in Children
Risk of Dental Fluorosis from Topical Fluoride
Topical fluoride treatments, such as fluoride toothpaste, mouthrinses, gels, foams, and varnishes, are widely used to prevent dental caries. However, these treatments pose a risk of dental fluorosis, particularly in young children. Dental fluorosis occurs when excessive fluoride is ingested during the development of teeth, leading to changes in the appearance of the enamel. Studies indicate that starting the use of fluoride toothpaste before the age of 12 months is associated with an increased risk of fluorosis, while the evidence for its use between 12 and 24 months is inconclusive.
Recommendations to Mitigate Fluorosis Risk
To mitigate the risk of fluorosis, it is recommended that the fluoride level in toothpaste for children under six years of age be lower than 1000 parts per million (ppm). Additionally, parents should supervise their children's tooth brushing to ensure they use an appropriate amount of toothpaste and avoid swallowing it.
Acute Fluoride Toxicity
Potential for Acute Toxicity
While fluoride is beneficial for dental health, there is a potential for acute toxicity if ingested in large amounts. The American Dental Association (ADA) recommends that no more than 120 mg of fluoride be dispensed at one time to minimize the risk of toxic ingestion, especially with the increasing use of pleasant-tasting fluoride products. Acute fluoride toxicity can occur from the ingestion of concentrated fluoride preparations used in professional treatments, necessitating careful application and monitoring.
Emergency Treatment for Overdose
In cases of suspected fluoride overdose, immediate measures include inducing vomiting, administering fluoride-binding agents like milk or antacids, and seeking emergency medical care. Proper training for dental professionals on the calculation of ingested fluoride and emergency protocols is crucial to prevent and manage potential toxic effects .
Long-Term Safety and Efficacy
Evaluation of Fluoride Products
Fluoride has been used in various forms, including water fluoridation, fluoride-containing tablets, and topical applications like toothpaste and mouthrinses, for over a century. Despite its widespread use, the safety and efficacy of fluoride treatments continue to be evaluated. Recent studies emphasize the need for a balanced approach, considering both the caries-preventive benefits and the potential risks of fluoride toxicity.
Monitoring and Guidelines
The European Academy of Paediatric Dentistry (EAPD) recommends the appropriate use of fluoride toothpaste in conjunction with good oral hygiene as a fundamental part of caries prevention programs. These programs should be regularly re-evaluated and adapted to individual needs and risks to ensure safety and effectiveness.
Conclusion
While fluoride treatments are effective in preventing dental caries, they carry risks such as dental fluorosis and acute toxicity, particularly in young children. Careful supervision, appropriate dosage, and adherence to guidelines are essential to maximize the benefits of fluoride while minimizing its dangers. Ongoing research and updated guidelines will continue to play a critical role in ensuring the safe use of fluoride in dental care.
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