Diagnosis and treatment of acute fluoride toxicity

The literature has shown overwhelmingly that fluoride used for dental prophylaxis presents minimal risks if used appropriately. However, there is an increasing potential for ingestion of toxic doses of fluoride because of the increasing use of pleasant-tasting fluoride products. The ADA has recommended that no more than 120 mg fluoride (264 mg NaF) be dispensed at any one time. As with any medication, fluoride preparations should be prescribed in child-resistant containers, and patients or parents (or both) should be instructed as to the proper daily treatment regimens and the potential for toxic overdoses. Possibly the greatest risk of fluoride intoxication relates to the concentrated fluoride preparations used for professionally applied fluoride treatment (Table 3). Therefore, patients receiving professional topical fluoride treatments should have well-fitting trays with the minimal amount of fluoride necessary to contact the teeth. These patients should be provided with a saliva ejection system, and they should never be left unobserved during the topical application. Health professionals should be aware of the potential toxic effects of fluoride in addition to the well-known caries preventive effects. It is necessary to know how to calculate the amount of fluoride ingested and the emergency treatment recommended to prevent toxic effects in suspected overdose cases.