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Liang Hong, DDS, MS, PhD; Steven M. Levy, DDS, MPH; John J. Warren, DDS, MS; Deborah V. Dawson, PhD; George R. Bergus, MD, MA; James S. Wefel, PhD

Arch Pediatr Adolesc Med. 2005;159:943-948.

Background  It has been speculated that amoxicillin use could be associated with dental enamel defects.

Objective  To assess the association between dental fluorosis, one of the most common developmental tooth enamel defects, and amoxicillin use during early childhood.

Design, Setting, and Participants  As participants in the Iowa Fluoride Study, subjects were followed up from birth to 32 months using questionnaires every 3 to 4 months to gather information on fluoride intake and amoxicillin use.

Methods  Early-erupting permanent teeth of 579 subjects were assessed for fluorosis using the Fluorosis Risk Index at approximately the age of 9 years. Relationships between fluorosis and amoxicillin use were assessed using relative risk (RR), Mantel-Haenszel stratified analyses, and multivariable logistic regression.

Results  Amoxicillin use was reported by 75% of subjects by 12 months and 91% by 32 months. Overall, 24% had fluorosis on both maxillary central incisors. Amoxicillin use from 3 to 6 months significantly increased the risk of fluorosis on the maxillary central incisors (RR = 2.04; 95% confidence interval [CI], 1.49-2.78). After adjusting for fluoride intake and otitis media, the risk of fluorosis on the maxillary central incisors from amoxicillin use during 3 to 6 months (Mantel-Haenszel RR = 1.85; 95% CI, 1.20-2.78) was still statistically significant. Multivariable logistic regression analyses confirmed the increased risk of fluorosis from amoxicillin use during 3 to 6 months (odds ratio = 2.50; 95% CI, 1.21-5.15); fluoride intake was also statistically significant.

Conclusion  The findings from this study suggest a link between amoxicillin use during infancy and developmental enamel defects of permanent teeth; however, further research is needed.

Author Affiliations: Departments of Preventive and Community Dentistry (Drs Hong, Levy, Warren, and Dawson), Epidemiology (Dr Levy), and Family Medicine (Dr Bergus), Dows Institute for Dental Research, and the Department of Pediatric Dentistry (Dr Wefel), University of Iowa, Iowa City. Dr Hong is now with the Department of Dental Public Health and Behavioral Science, University of Missouri–Kansas City.

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