average fluoride intake in the first 3 years of life (Buzalaf & Levy, 2011), especially intake that is elevated for all of the first 3 years of life. In 2015, the U.S. Public Health Service updated its fluoride recommendation for drinking water, reducing it to 0.7 mg/L for all communities (U.S. Department of Health and Human Services Panel on Community Water Fluoridation, 2015). The earlier Public Health Service recommendation ranged from 0.7 to 1.2 mg/L, based on local outdoor air temperatures. The thinking in 1962, when the earlier recommendation was published, was that children living in cooler locations were likely to drink less water and should therefore be exposed to more fluoride in their drinking water than children who lived in warmer climates. Newer evidence has contradicted this assumption. Furthermore, in recent decades, surveys have shown an increase in dental fluorosis, probably because children are now exposed to fluoride from various sources (mouth rinses; supplements; dental applications; and toothpaste, often inadvertently swallowed) in addition to 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). Effects of anticonvulsants Prenatal and postnatal administration of anticonvulsants 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 exposure to valproate may be a possible cause 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 development and other 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. In 2011, an advisory committee of the ADA Council on Scientific Affairs published evidence-based guidelines to optimize the oral health of bisphosphonate-treated patients. This committee expanded previous guidelines to include information concerning other medications with antiresorptive properties because these medications can have the same effect on the oral cavity as bisphosphonates (Hellstein et al., 2011). According to the ADA Council on Scientific Affairs, there is generally no need to modify routine dental treatment solely because of the patient’s use of antiresorptive therapy (Hellstein et al., 2011). However, comprehensive dental examination should be considered before initiating antiresorptive therapy, especially in patients not receiving regular dental care. Patients should be informed of the very low risk of developing medically related osteonecrosis of the jaw (MRONJ), and precautions such as good oral hygiene and regular dental care should be taken to further reduce the potential risk. Practitioners should be aware that no validated technique currently exists
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 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. 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. 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. to identify patients who are at an increased risk for MRONJ and discontinuation of antiresorptive agents may not eliminate the risk of MRONJ development. More recently at the World Workshop on Oral Medicine VI, controversies regarding dental management of medically complex patients were reviewed and updated recommendations included the following: MRONJ- expert recommendations trend toward proceeding with dental treatment with little to no modification in osteoporotic patients on bisphosphonates (Napeñas, 2015). Nonsurgical periodontal therapy can be performed on patients taking oral bisphosphonates, along with the generally recommended reevaluation at 4 to 6 weeks (Hellstein et al., 2011). When necessary, modest bone-recontouring techniques can be used; however, specific guidelines for periodontal surgery are not provided and, because of the risk for MRONJ, such techniques should be used judiciously based on patient need. Dental professionals should explain the risk of developing MRONJ to patients undergoing invasive surgical procedures (Hellstein et al., 2011; Aminoshariae, Donaldson, Horan, Mackey, Kulild, & Baur, 2022). They should discuss alternative treatment plans with these patients, including allowing roots to exfoliate (instead of performing extraction) in endodontically treated and decoronated teeth. Provision of bridges, partials, and dentures
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