What is dental fluorosis?

What is dental fluorosis?

The right amount of an element called fluoride helps in the formation of strong teeth. This fluoride when ingested during your teeth formation makes your teeth stronger. Excessive fluoride during the tooth formation can cause a variety of changes in your teeth. These changes range from mild colour changes in the enamel to severe pitting of  your tooth called mottling. Amounts of fluoride above 2 ppm in drinking water will cause Dental Fluorosis.

However, you’ll need this fluoride on a everyday basis as topical application after your tooth formation is complete. But did you know that people with fluorosis are relatively resistant to dental caries (tooth decay caused by bacteria), although the colour of your teeth is a cosmetic concern.

What does fluorosis look like?

In the “very mild” (and most common) form of fluorosis, you can have small, opaque, “paper white” areas scattered irregularly over the tooth, covering less than 25% of the tooth surface. In the “mild” form, these mottled patches can involve up to half of the surface area of the teeth.

When fluorosis is moderate, all of the surfaces of your teeth are mottled and teeth may be ground down and brown stains frequently “disfigure” the teeth.

Severe fluorosis is characterized by brown discoloration and discrete or confluent pitting. Brown stains are widespread and your teeth often present a corroded-looking appearance.


Why does fluorosis of teeth happen?

Dental fluorosis is caused by a higher than normal amount of fluoride ingestion whilst teeth are forming. Primary dentin fluorosis and enamel fluorosis can only happen during tooth formation. Structurally, hydroxyapatite ( these are the mineral crystals that forms the enamel )is converted to fluorohydroxyapatite.

The most superficial concern in dental fluorosis is aesthetic changes in the permanent dentition (the adult teeth). The period when these teeth are at highest risk of developing fluorosis is between when the child is born up to 6 years old, though there has been some research which proposes that the most crucial course is during the first 2 years of the child’s life. From roughly 7 years old thereafter, most children’s permanent teeth would have undergone complete development (except their wisdom teeth), and therefore their susceptibility to fluorosis is greatly reduced, or even insignificant, despite the amount of intake of fluoride.

What are the sources of fluoride?

Many well-known sources of fluoride may contribute to overexposure including dentifrice/fluoridated mouthrinse (which young children may swallow), excessive ingestion of fluoride toothpaste, bottled waters which are not tested for their fluoride content,  ingestion of foods rich in fluoride and fluoride in drinking water. Severe cases can be caused by exposure to water that is naturally fluoridated to levels above the recommended levels, or by exposure to other fluoride sources such as brick tea or pollution from high fluoride coal.

How can we prevent fluorosis?

Dental fluorosis is preventable at a population level through ‘Defluoridation’. Defluoridation is the downward adjustment of the level of fluoride in drinking water. In India several RO water plants are set up by the government for water defluoridation. There are other sources of fluoride such as fluoride containing toothpastes and mouth rinses. You can prevent the risk of fluoride toxicity in children by giving them a child formula toothpaste.

Also, once your tooth formation is completed there is no effect of the fluoride levels on the teeth. So exposure to excessive levels later in life will not change the existing condition.

What are the treatment options in fluorosis?

Your tooth discolouration ca be a cosmetic concern. In some cases, when the discolouration can cause  a varying degree of negative psychosocial effect, your dentist will help you with these treatment options

  • Mild cases: Tooth bleaching or teeth whitening
  • Moderate cases: Micro-abrasion (the outer affected layer of enamel is abraded in an acidic environment)
  • Severe cases: Composite fillings, Micro-abrasion, Veneers, Crowns


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