health of your child or the health of your child’s teeth. For concerned parents who want to decrease their child’s chance of developing fluorosis, three options exist: breast feeding; using a ready-to-feed formula (these types of formula contain little fluoride and do not contribute significantly to the development of mild dental fluorosis) or; use powdered or liquid concentrate formula mixed with water that either is fluoride-free or has low concentrations of fluoride. These bottled waters are labeled as de-ionized, purified, demineralized, or distilled. (ADA, n.d.). Bleaching, microabrasion, veneering, and fixed prosthodontics are the main recourses for aesthetic problems posed by teeth with enamel fluorosis (Bertassoni et al., 2008, Di Giovanni, T., Eliades, T., & Papageorgiou, S. N., 2018; da Cunha Coelho, A. S. E., 2019). Generally, bleaching and microabrasion are appropriate for superficial staining, whereas conservative restorations may be more appropriate for more severe fluorosis.
fluoridated drinking water. Comparison of National Health and Nutrition Examination Survey data from the years 1986-1987 and 1999-2004 showed, for example, that the prevalence of fluorosis (very mild or greater) had increased from 23% to 41% among adolescents age 12 to 15 years; moderate to severe fluorosis in this age group had risen from 1.3% to 3.6% (U.S. Department of Health and Human Services Panel on Community Water Fluoridation, 2015). Prevention of enamel fluorosis typically involves defluoridation of drinking water in areas with high fluoride content, judicious use of fluoride supplements, and supervision of the use of fluoride toothpaste in children younger than age 5 years (Bertassoni et al., 2008). While the American Dental Association (ADA) agrees that it is safe to use fluoridated water to mix infant formula, if a baby is primarily fed infant formula, using fluoridated water there might be an increased chance for mild enamel fluorosis; although enamel fluorosis does not affect the
Table 1: Dean Fluorosis Index Score Criteria Normal (0)
The enamel is almost glassy, with a smooth, glossy surface. The color is slightly off-white. Questionable (0.5) This classification falls short of a diagnosis of fluorosis, even though there are some signs of the condition. There may be white flecks or white spots. Very mild (1) Less than one quarter of the surface of the teeth is scattered with small white spots. The tips of the summits of the cusps of bicuspids or second molars may show 1 to 2 mm (but no more) of opaque whiteness.
Mild (2)
More than one quarter, but less than one half, of the teeth surfaces show white opaque areas.
Moderate (3)
The condition affects all of the enamel surfaces, and there may be brown staining. Tooth surfaces may show wear. Moderately severe fluorosis has progressed to the severe stage. The severity of the hypoplasia may affect the forms of the teeth. All enamel is affected, showing brown staining, pitting, and the appearance of corrosion.
Severe (4)
Note . Adapted from “The Investigation of Physiological Effects by the Epidemiological Method,” by H. T. Dean, 1942, in F. R. Moulton (Ed.), Fluorine and Dental Health , Washington, DC: American Association for the Advancement of Science, Publication No. 19, pp. 23-31; “Health Effects of Ingested Fluoride,” by the Subcommittee on Health Effects of Ingested Fluoride (National Research Council), 1993, Washington, DC, National Academy of Sciences; and “National Center for Health Statistics Data Brief No. 53: Chronic Fluoride Toxicity: Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004,” by E. D. Beltrán-Aguilar, L. Barker, and B. A. Dye, 2010, U.S. Department of Health and Human Services, retrieved from https://www.cdc.gov/nchs/data/databriefs/db53.pdf. Effects of anticonvulsants Prenatal and postnatal administration of anticonvulsants
exposure to valproate may be a possible cause for dental agenesis (failure of teeth to form). These medications may have a teratogenic component that, when administered in a prenatal setting, may have other effects resulting in a syndromic condition (Jacobsen et al., 2014). Postnatally, the age of the child, dosage, and duration of treatment will factor into the severity of tooth-related abnormalities. development and other dental anomalies of permanent teeth have also been reported after pediatric stem cell transplantation (Proc et al., 2016). Additionally, reports indicate that childhood cancer survivors are at an increased risk of caries as well as developmental dental disturbances (Gawade et al., 2014). It is important to recognize that the lifetime dental needs of this patient population may be complicated by their early exposure to chemotherapeutic medications.
has been implicated in adverse effects on dental development of the newborn (Jacobsen, Henriksen, Haubek, & Østergaard, 2014). Prenatal exposure may significantly increase mesiodistal crown dimensions of the posterior maxillary teeth – affecting both the primary and permanent molars. One report indicated that prenatal Effects of chemotherapeutic drugs Children undergoing chemotherapy before completion of tooth development and eruption have been reported to show abnormal dental development (Lezot et al., 2014). The age of the child, dosage, and duration of treatment are the main factors in the severity of dentofacial- developmental and tooth-related abnormalities. Examples of the latter include tooth agenesis, arrested tooth development, microdontia, and disturbances affecting all the hard tooth structures (enamel, dentin, and cementum). Disturbed root Antiresorptive medication and osteonecrosis of the jaw Medication-related osteonecrosis of the jaw (MRONJ) is a severe adverse drug reaction that may result in progressive bone destruction in the maxillofacial region
(Kuroshima, Sasaki & Sawase, 2019). One cause of MRONJ is antiresorptive agents, including bisphosphonates.
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