THE POWER POINTPRESENTATION IS ABOUT FLOUIDE TOXICITY N DENTISTRY AND IT INCLUDE THE CLASSIFICATION OF FLOURIDE TOXICITY, ACUTE FLUORIDE TOXICITY AND ITS CLINICAL SYMPTOMS AND ITS MANAGEMENT, FACTORS AFFECTING ACUTE FLOURIDE TOXICITY , CHRONIC FLOURIDE TOXICITY, SKELETAL FLOUROSIS , DENTAL FLOUROSIS AND THEIR SYMPTOMS AND MANAGEMENT
2. PROBABLE TOXIC DOSE
•Threshold dose that could cause serious systemic
signs and symptoms(5mg/kg of body weight)
Safely tolerated
dose:8-16mg/kg
body weight
Toxic Dose:16-32
mg/kg body weight
Certainly Lethal
dose:32-64mg/kg
body weight
4. Factors affecting acute fluoride toxicity
• Bioavailability
• Route of administration
• Age
• Rate of absorption
• Acid base status
5. Signs and symptoms
• Nausea, vomiting, abdominal pain and diarrhoea
• Excessive salivation and mucosal discharge
• Generalized weakness and carpopedal spasms
• Weak ,thready pulse and fall in B.P
• Depression of respiratory centre
• Ventricular tachycardia and fibrillation
• Decreased plasma calcium level, increased potassium level
• Cardiac arrhythmia ,Coma and Death
6. Management of acute fluoride overdose
• Induce vomiting,fluid
replacement,monitor calcium and
potassium
Immediate
• Give calcium (milk)orally
• Induced vomiting not necessary
Less than 5mg/kg body
weight
• Induce vomiting
• Give orally soluble
calcium(milk,5%calcium gluconate
or calcium lactate soln)
• Epsom salts or aluminium
5-15mg/kg body
weight
7. Immediate admission to hospital,
Induce vomiting
Cardiac and electrolyte monitoring
Administer i.v 10 ml calcium gluconate sol
Ensure adequate urine output using diuretics
9. COMMONLY RECOGNIZED EFFECT OF FLOURIDE
INGESTION THROUGH FLOURIDATED WATER AT
VARIOUS LEVELS
FLOURIDE
LEVEL
FLOURIDE IN DRINKING
WATER
EFFECTS
0.7-1.2ppm Depending upon the
temperature of the area
Prevents dental caries.
No skeletal/dental flourosis
1.5-3.0 ppm Consumption of water for a
period of 5-10 yrs or more
Milder forms of dental flourosis
3.0-8.0 ppm Consumption of water for
a period over 15-20 years
Severe form of dental fluorosis
and a milder form of skeletal
flourosis
8.0ppm or more Consumption of water for a Severe form of dental and
10. Skeletal/osteoflourosis
• Water fluoride levels over 4ppm causes a mild variant
• Levels over 8ppm cause severe fluorosis
• If fluoride is ingested at the rate of 10-25mg/day for a period of 10-20
years
• Workers in aluminium factories
• Crippling fluorosis- most advanced form
11. TEOTIAetal.
MILD
• Generalized
bone and
joint pains
• Radiological-
osteosclerosi
s only
MODERATE
• Stiffness, rigidity,
restricted movt. of spine
and joints
• Radiological-
osteosclerosis,
periosteal bone
formation,calcifications
of interosseous
membrane,ligaments,m
uscular attachments
SEVERE
• Signs of moderate plus
flexion deformities of spine,
hips and knees,
• Genu valgum, Genu varum,
Bowing and rotational
deformities of legs
• Neurocomplications,Crippling
• Radio-osteoporosis,exostosis
osteophytosis
12. Dental flourosis
Developmental disturbance of dental
enamel ,caused by successive exposures
to high conc .of fluoride during tooth
development leading to enamel with lower
mineral content and increased porosity
Hypoplasia
or
hypomatura
tion of
tooth
enamel or
dentin
13. ETIOLOGY
Excessive fluoride in
water
Non-prescribed use of
fluoride supplements
Ingestion of topical
flouride
Direct inhibitory effect
on enzymatic action of
ameloblasts leading to
defective matrix
formation and
subsequent
hypomineralization
14. Clinical features
Thin white striae
across enamel
surface
“snow cap
phenomenon”
White lines more
broader and
pronounced
“cloudy white
areas”
Brown stains
and chalky
white areas
Opaque surface
with focal loss of
outermost enamel
“pits”
15. DEAN’s Flourosis Index-Modified criteria (1942)
CLASSIFICATION CRITERIA
NORMAL(0) Enamel translucent semivitriform type of structure ,smooth ,glossy ,pale
creamy white colour
QUESTIONABLE(0.5) Slight aberrations from translucency ,few white flecks to occasional
white spots
VERY MILD(1) Small, opaque, paper white areas scattered irregularly,not as much as
25%of tooth surface
MILD(2) White opaque areas more extensive, but not as much as 50%of tooth
MODERATE(3) All surfaces affected, surfaces subject to attrition show wear, Brown
stain
SEVERE(4) Marked hypoplasia, general form of tooth affected,discrete or confluent
pitting, wide spread brown stains-corroded appearance
16. Dean’s Community Flourosis Index
F Ci = n*w/N
Fci= community index of fluorosis
N=total population
n =number of children in each category
w =weight for each category
17. PUBLIC HEALTH SIGNIFICANCE OF COMMUNITY
FLOUROSIS INDEX SCORES(DEAN 1946)
Range of scores for community
fluorosis index
Public health significance
0.0-0.4 Negative
0.4-0.6 Borderline
0.6-1 Slight
1.0-2.0 Medium
2.0-3.0 Marked
3.0-4.0 Very marked
19. Skeletal muscles
Destruction of
actin and myosin
filaments
Weakness, loss of
muscle energy
Inability to stand
in erect position
Erythrocyte
membrane
becomes pliable
Thrown into folds Echinocytes
RBC s
22. Recommended schedule for the use of fluoride
dentrifice in young children
• Below 4 yrs: fluoride toothpaste is not recommended
• 4-6 years: brushing once daily with fluoride paste and twice
without paste
• 6-10 yrs: brushing twice daily with fluoride paste and once
without paste
• Above 10yrs: brushing thrice daily with fluoride paste
