FLUORIDE TOXICITY

harshulsinghLeave a comment


• Fluoride can be toxic, if administered in excess quantity.
• The toxic effects of fluoride can be either acute or chronic.
• Acute toxicity occurs due to a single ingestion of large amount of fluoride.
• Chronic toxicity occurs dụe to long-term ingestion of small amounts of fluoride excessive than the required optimal level.

Acute Fluoride Toxicity:
• Acute fluoride poisoning can occur either as a result of accidental ingestion or from deliberate attempts like suicide
• This can be from the use of fluoride containing products such as toothpaste, mouth rinse, tablets or household insecticides.
• Acute fluoride poisoning can also occur from overfeeds in community and school water fluoridation systems.
• Most of the time overfeeds occur in small water supplies.

Terms used in relation to fluoride toxicity:
Safely Tolerated Dose (STD): Dose below which symptoms of toxicity are unlikely to occur
(1 mg/kg of body weight).

Potentially Lethal Dose (PLD): Lowest dose associated with a fatality.

(5 mg/kg of body weight).

Certainly Lethal Dose (CLD): Survival after consuming this amount of fluoride is unlikely (32-64 mg/kg of body weight).

Features of acute toxicity of fluorides are:

  1. Nausea
  2. Vomiting
  3. Diarrhoea
  4. Abdominal pain
  5. Hypocalcaemia
  6. Acidosis
  7. Progressive hypotension
  8. Ventricular tachycardia and fibrillation.

The ingested fluoride combines with hydrochloric acid in the stomach to form hydrofluoric acid which exhibits a corrosive effect on the gastric mucosa causing nausea, vomiting, diarrhoea and abdominal pain.


*Hypocalcemia is caused by the affinity of fluoride to cations in the serum.
**Hypocalcemia is associated with paresthesia, paresis, muscle fibrillation, tetany, convulsions, decreased myocardial contractility and cardiovascular collapse.

Death usually occurs due to:

  1. Convulsions
  2. Cardiac arrhythmias
  3. Coma.

Chronic Fluoride Toxicity:
• Long-term ingestion of small amounts of excessive fluoride will lead to chronic fluoride toxicity which is often referred to as fluorosis.
• Fluorosis usually affects the bones and the teeth.
• Fluorosis of the bone is called as osteofluorosis and the fluorosis of the teeth is called as dental fluorosis.

MANAGEMENT:

REFERENCES:

  • Pediatric Dentistry: Principles & Practice, MS Muthu(2nd Edition)
  • downtoearth.org.in

Gingival (Gum) hyperplasia/hypertrophy

Dr. Shazmeen MemonLeave a comment

▪Can only be confirmed by determined by biopsy which is not always done.

▪Not always clear whether it is hyperplasia or hypertrophy.

▪Gingival enlargement is preferred terminology.

Causes

▪Vincent’s angina, Scurvy

▪Sodium Valproate, Nifedipine, Ciclosporin

▪Pregnancy, Oral contraceptive pill

▪Acute Myeloid leukaemia (M5) – may regress after treatment.

Clinical

▪May be bleeding enlarged gums

▪Anaemia – ? AML

▪Known epilepsy

Management

▪Specialist review of medications as appropriate

▪Good dental care

Reference:Textbook of periodontology shantipriya Reddy

INHALATIONAL SEDATION:

harshulsinghLeave a comment


NITROUS OXIDE & OXYGEN SEDATION
Properties:
• Nitrous oxide is a non-irritating, sweet smelling, colourless inorganic gas.
• Specific gravity: 1.53 (heavier than air).
• This allows nitrous oxide to occupy the region nearest to the alveolar basement membrane by displacing air.
• Enables better absorption in the blood stream.
• It has low gas partition coefficient i.e, remains insoluble in the blood stream.
• Minimally (absorbed) metabolized by the body.
• Rapid onset and recovery.
• Is a weak anaesthetic with a Minimum Alveolar Concentration (MAC) of 105.
• As MAC is 100, it is theoretically impossible to anaesthetize a patient with nitrous oxide alone.

OBJECTIVES:
• To reduce or eliminate anxiety.
• To reduce untoward movement and reaction to dental treatment.
• To enhance communication and patient co-operation.
• To raise the pain reaction threshold.
• To increase tolerance for longer appointments.
• To aid in treatment of the mentally/physically
• To reduce gagging.

EQUIPMENT:

INDICATIONS:
• Fearful/conscious patients for whom basic behaviour guidance technique have not been successful.
• Patient unable to cooperate due to lack of physiological/emotional maturity.
• To protect to developing patient’s psyche.(young children)
• To reduce patient’s medical risk.


CONTRAINDICATIONS:
• May be contraindicated in some chronic obstructive pulmonary diseases.
• Patients with severe emotional disturbance or drug related dependencies.
• Patients with sickle cell disease.
• Patients treated with Bleomycin sulfate


PROCEDURE:

POTENTIAL COMPLICATIONS:
• Nausea.
• Vomitting
• Diffusion Hypoxia.
• Claustrophobia
Effects Associated with Gas Accumulation:
• Tooth pain due to accumulation of gas in sinus cavity.
• Vertigo.
• Middle Ear Pain.


REFERENCES:
• Pediatric Dentistry: Principles and Practice, MS Muthu (2nd Edition).
• Pedodontics: Practice and Management, Badrinatheshwar GV.