The risk of dental fluorosis originated from the use of
105
Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14 (2):E103-7. Dental fluorosis
fluoride supplements is well established. Therefore, clinicians
must be aware of the optimum concentration of
fluoride needed in water, before prescribing them. Fluorosis
can be prevented if pediatricians, as well as dentists,
follow the new guidelines for fluoride supplements, and
be aware that these supplements are not recommended
for children who are exposed to water supplies with an
adequate amount of fluoride.
- Topical fluoride
The excessive fluoride intake, in consequence to the
inadequate use or swallowing of fluoride-containing toothpastes,
is also responsible for the development of dental
fluorosis. Children up to 5 years old swallow around 30%
of the amount of toothpaste used every time they brush
their teeth. If fluoridated water is consumed at the same
time, a potential risk of dental fluorosis occurs (16).
Two alternatives have been suggested to reduce the consumption
of fluoride:
Firstly, a reduction in the amount of toothpaste used
should be achieved by educating parents to offer small,
and therefore safe, amounts of toothpaste. For children
between 4 and 6 years old, parents can be taught to use an
amount equivalent to “a pea size”, dispending toothpaste
over the toothbrush with the “transverse technique”. For
children in a more tender age, parents should simply
touch the toothbrush inside the toothpaste cover or tube,
instead of squeezing it on the toothbrush (16). It has to
be always reminded that children under six years old
should be monitored during tooth brushing, encouraged
not to swallow toothpaste, and not to use fluoridated
mouth rinses.
The second alternative is the development of dentifrices
with low fluoride concentration, which are already
available in many countries. Some studies did not found
significant differences in the anticaries effectiveness
between the fluoride toothpastes with low (500-550 ppm)
and standard concentration of fluoride (1.000-1.1000
ppm) (17,18). Nevertheless, some other researches are still
controversial when considering the effectiveness of low
fluoride toothpastes (19, 20). However, several studies
assessed children older than 6 years old, which are not
in risk of dental fluorosis anymore. We cannot assume
that similar results would be seen in primary teeth as in
permanent teeth since the literature indicates that there
may be differences between primary and permanent
enamel in reactivity to cariogenic challenges (21). In
addition, the oral cavity of young children (2–6 years
old) is much smaller than that of children aged 12 or
more, so the amount of F necessary for caries preventive
effects may not be the same in these age groups. Without
the confirmation of studies that show their anticaries
effectiveness, it seems that the best balance between
the prevention of caries and dental fluorosis is obtained
with low concentrations, approximately 400-550 ppm
of fluoride, in preschool children (17, 22). The choice of
using a fluoride-containing toothpaste or not, depends on
caries activity and risk, on children’s age and the ability
to spit the dentifrice during oral hygiene.
Studies considering the relative toxicity of the professional
topical fluoride application in children are scarce
in the literature; however, it is important to prevent the
toxicity risks that can occur, mainly in little children.
Whenever topical fluoride is applied, such as acidulated
phosphate fluoride (APF) at 1, 23% and sodium fluoride
at 2.0% in gel, some recommendations and suggestions
should be followed in order to prevent or reduce the
potential ingestion of fluoride. These are: to reduce the
concentration of fluoride in the product and decrease
the application time; to confection individuals trays
recovered with foam and trimmed; to maintain the seat
in a vertical position so that the patient remain seated;
to always use a saliva ejector; to remove the excess of
fluoride with a gauze; and to request the patient to spit
as much as possible after the fluoride application. This
method is, however, appropriate for children above 3
years old.
Based on the risks of the overexposure to fluoride and
the prevention of dental fluorosis, another presentation of
acidulated phosphate fluoride was developed, the fluoride
dental foam. According to manufacturers’ instructions,
the product is safer because of its lower ability to flow
and the smaller amounts requires for application, when
compared to the gel. Indeed, the use of fluoride dental
foam is considered a safe method with respect to toxicity,
due to its quick adhesion to the dental surface and
slow dissolution, making it feasible to be used specially
in the young children. It is important to clarify that the
properties offered by the fluoride dental foam goes beyond
prevention of fluorosis and includes effectiveness
in the prevention of caries (23, 24). Four-minute fluoride
foam applications, every six months, would be effective
reducing the increment of dental caries in the primary
dentition and newly erupted permanent first molars
(23,24). However, there are few clinical studies in the
literature considering the effectiveness of this foam,
and it needs to be more investigated to support the foam
advantages
The risk of dental fluorosis originated from the use of 105Med Oral Patol Oral Cir Bucal. 2009 Feb 1;14 (2):E103-7. Dental fluorosisfluoride supplements is well established. Therefore, cliniciansmust be aware of the optimum concentration offluoride needed in water, before prescribing them. Fluorosiscan be prevented if pediatricians, as well as dentists,follow the new guidelines for fluoride supplements, andbe aware that these supplements are not recommendedfor children who are exposed to water supplies with anadequate amount of fluoride.- Topical fluorideThe excessive fluoride intake, in consequence to theinadequate use or swallowing of fluoride-containing toothpastes,is also responsible for the development of dentalfluorosis. Children up to 5 years old swallow around 30%of the amount of toothpaste used every time they brushtheir teeth. If fluoridated water is consumed at the sametime, a potential risk of dental fluorosis occurs (16).Two alternatives have been suggested to reduce the consumptionof fluoride:Firstly, a reduction in the amount of toothpaste usedshould be achieved by educating parents to offer small,and therefore safe, amounts of toothpaste. For childrenbetween 4 and 6 years old, parents can be taught to use anamount equivalent to “a pea size”, dispending toothpasteover the toothbrush with the “transverse technique”. Forchildren in a more tender age, parents should simplytouch the toothbrush inside the toothpaste cover or tube,instead of squeezing it on the toothbrush (16). It has tobe always reminded that children under six years oldshould be monitored during tooth brushing, encouragednot to swallow toothpaste, and not to use fluoridatedmouth rinses.The second alternative is the development of dentifriceswith low fluoride concentration, which are alreadyavailable in many countries. Some studies did not foundsignificant differences in the anticaries effectivenessbetween the fluoride toothpastes with low (500-550 ppm)and standard concentration of fluoride (1.000-1.1000ppm) (17,18). Nevertheless, some other researches are stillcontroversial when considering the effectiveness of lowfluoride toothpastes (19, 20). However, several studiesassessed children older than 6 years old, which are notin risk of dental fluorosis anymore. We cannot assumethat similar results would be seen in primary teeth as inpermanent teeth since the literature indicates that theremay be differences between primary and permanentenamel in reactivity to cariogenic challenges (21). Inaddition, the oral cavity of young children (2–6 yearsold) is much smaller than that of children aged 12 ormore, so the amount of F necessary for caries preventiveeffects may not be the same in these age groups. Withoutthe confirmation of studies that show their anticarieseffectiveness, it seems that the best balance betweenได้รับการป้องกันการผุและฟันฟันตกมีประมาณ 400-550 ppm ความเข้มข้นต่ำของฟลูออไรด์ ในเด็ก preschool (17, 22) ทางเลือกของใช้ยาสีฟันที่ประกอบด้วยฟลูออไรด์ หรือไม่ ขึ้นอยู่กับกิจกรรมผุและความเสี่ยง อายุของเด็กและความสามารถในคาย dentifrice ระหว่างอนามัยช่องปากศึกษาพิจารณาความเป็นพิษที่สัมพันธ์กันของมืออาชีพเฉพาะการเคลือบฟลูออไรด์ในเด็กขาดแคลนในวรรณคดี อย่างไรก็ตาม มันเป็นสิ่งสำคัญเพื่อป้องกันการความเสี่ยงความเป็นพิษที่เกิดขึ้น ส่วนใหญ่ในเด็กเล็กเมื่อมีใช้ฟลูออไรด์เฉพาะ เช่น acidulatedฟอสเฟตฟลูออไรด์ (APF) ที่ 1, 23% และโซเดียมฟลูออไรด์2.0% ในเจ คำแนะนำ และข้อเสนอแนะควรมีการป้องกัน หรือลดการการกินฟลูออไรด์เป็น ได้แก่: การลดการความเข้มข้นของฟลูออไรด์ในผลิตภัณฑ์ลดลงเวลาแอพลิเคชัน ให้คนแต่ละถาดกู้กับโฟม และ ตัด การรักษานั่งในแนวตั้งตำแหน่งนั้นยังผู้ป่วยนั่งใช้ ejector น้ำลาย เสมอ การลบส่วนที่เกินของฟลูออไรด์กับตาข่าย และขอให้ผู้ป่วยบ้วนมากที่สุดหลังจากการเคลือบฟลูออไรด์ได้ นี้วิธี คือ อย่างไรก็ตาม เหมาะสำหรับเด็กข้างบน 3ปีเก่าตามความเสี่ยงของ overexposure ให้ฟลูออไรด์ และการป้องกันทันตกรรมฟันตก นำเสนออื่นacidulated ฟอสเฟตฟลูออไรด์ได้รับการพัฒนา ฟลูออไรด์dental foam. According to manufacturers’ instructions,the product is safer because of its lower ability to flowand the smaller amounts requires for application, whencompared to the gel. Indeed, the use of fluoride dentalfoam is considered a safe method with respect to toxicity,due to its quick adhesion to the dental surface andslow dissolution, making it feasible to be used speciallyin the young children. It is important to clarify that theproperties offered by the fluoride dental foam goes beyondprevention of fluorosis and includes effectivenessin the prevention of caries (23, 24). Four-minute fluoridefoam applications, every six months, would be effectivereducing the increment of dental caries in the primarydentition and newly erupted permanent first molars(23,24). However, there are few clinical studies in theliterature considering the effectiveness of this foam,and it needs to be more investigated to support the foamadvantages
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