Dental enamel, fluorosis and amoxicillin

Introduction: Amoxicillin is one of the most used antibiotics among pediatric patients for the treatment of upper respiratory tract infections and specially for acute otitis media (AOM), a common diseases of infants and childhood. It has been speculated that the use of amoxicillin during early childhood could be associated with dental enamel fluorosis, also described in literature with the term Molar Incisor Hypomineralization (MIH), because they are generally situated in one or more 1st permanent molars and less frequently in the incisors. The effect of Amoxicillin seems to be independent of other risk factors such as fluoride intake, prematurity, hypoxia, hypocalcaemia, exposure to dioxins, chikenpox, otitis media, high fever and could have a significant impact on oral health for the wide use of this drug in that period of life. Objective: The aim of this work was to review the current literature about the association between amoxicillin and fluorosis. Methods and Results: A literature survey was done by applying the Medline database (Entrez PubMed); the Cochrane Library database of the Cochrane Collaboration (CENTRAL). The databases were searched using the following strategy and keywords: amoxicillin* AND (dental fluorosis* OR dental enamel*) AND MIH*. After selecting the studies, only three relevant articles published between 1966 and 2011 were included in the review. Conclusion: The presence of several methodological issues does not allow to draw any evidence-based conclusions. No evidence of association was detected, therefore, there is a need of further well-designed studies to assess the scientific evidence of the relationship between amoxicillin and fluorosis and to restrict the prescription of this drug for recurrent upper respiratory tract infections especially acute otitis media (AOM) during the first two years of life. When it is possible can be opportune to use an alternative antibiotic treatment.