Inappropriate Prescribing

Fluoride and dental health

Anthony Blinkhorn, Kareen Mekertichian, in Handbook of Pediatric Dentistry (Fourth Edition), 2013

Probable toxic dose (Table 5.2)

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32–60 mg F−/kg of body weight.

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Fatalities in children have been reported at doses of 16 mg F−/kg of body weight. A number of concentrated topical preparations could provide such levels for young children if used in a single dose.

The inappropriate prescription of home-fluoride treatments with high concentration fluoridated gels for very young children (e.g. in the management of early childhood caries) and inappropriate use of high fluoride products in the dental office, are of concern (Evans & Stamm, 1991). It must be emphasized that fluoride cannot control ECC in very young children without a change in diet, especially modification of the use of a night-time bottle or the use of bottle during the day as a comforter.

The management of acute fluoride toxicity consists of:

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Estimating the amount of fluoride ingested.

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Minimizing further absorption.

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Removing fluoride from the body fluids.

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Supporting the vital signs.

If vomiting has not occurred spontaneously:

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Give as much milk as can be ingested or.

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Administer orally 5% calcium gluconate or calcium lactate or milk of magnesia.

While this immediate action is being taken, the hospital should be advised that a case of acute fluoride poisoning is in progress so that preparation for the appropriate therapeutic intervention can be made.

Note that while previous protocols advocated the use of an emetic, there has been a move away from encouraging vomiting because of the risk of aspiration of vomitus and burning the oesophagus by the hydrofluoric acid formed in the stomach, by the interaction of fluoride with hydrochloric acid. Modern emergency department protocols advocate the use of activated charcoal or gastric lavage in most poisonings.

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