No visible dental staining in children treated with doxycycline for suspected Rocky Mountain Spotted Fever.

OBJECTIVE: To evaluate whether cosmetically relevant dental effects occurred among children who had received doxycycline for treatment of suspected Rocky Mountain spotted fever (RMSF). STUDY DESIGN: Children who lived on an American Indian reservation with high incidence of RMSF were classified as exposed or unexposed to doxycycline, based on medical and pharmacy record abstraction. Licensed, trained dentists examined each child's teeth and evaluated visible staining patterns and enamel hypoplasia. Objective tooth color was evaluated with a spectrophotometer. RESULTS: Fifty-eight children who received an average of 1.8 courses of doxycycline before 8 years of age and who now had exposed permanent teeth erupted were compared with 213 children who had never received doxycycline. No tetracycline-like staining was observed in any of the exposed children's teeth (0/58, 95% CI 0%-5%), and no significant difference in tooth shade (P=.20) or hypoplasia (P=1.0) was found between the 2 groups. CONCLUSIONS: This study failed to demonstrate dental staining, enamel hypoplasia, or tooth color differences among children who received short-term courses of doxycycline at <8 years of age. Healthcare provider confidence in use of doxycycline for suspected RMSF in children may be improved by modifying the drug's label.

State oral health infrastructure and capacity: lessons learned from other states.

This paper discusses some preliminary findings from the Infrastructure Enhancement Project conducted by the Association of State and Territorial Dental Directors (ASTDD), which focuses on state oral health programs and their roles in addressing core public health functions and essential public health services. Findings from analysis of state data since 2000, surveys, reports, and key informant interviews substantiate the value of the following: a) state oral health surveillance; b) oral health improvement plans; c) collaborations and coalitions; d) evidence-based practices and evaluation; e) diversified funding; f) placement and authority of the programs and directors; and g) competencies versus staffing formulas. No single program model fits all the unique populations and political and economic variations among states. Each state is encouraged to use the many tools, resources, and best practices/lessons learned available through ASTDD, federal agencies, and national organizations to design effective and sustainable programs.