2. What is fluoroses
Fluorosis is a cosmetic condition that affects the teeth. It’s caused by overexposure to fluoride during the
first eight years of life. This is the time when most permanent teeth are being formed.
After the teeth come in, the teeth of those affected by fluorosis may appear mildly discolored. For
instance, there may be lacy white markings that only dentists can detect. In more severe cases, however,
the teeth may have:
● Stains ranging from yellow to dark brown
● Surface irregularities
● Pits that are highly noticeable
3.
4. Causes
A major cause of fluorosis is the inappropriate use of fluoride-containing dental products such as
toothpaste and mouth rinses. Sometimes, children enjoy the taste of fluoridated toothpaste so much that
they swallow it instead of spitting it out.
But there are other causes of fluorosis. For example, taking a higher-than-prescribed amount of a fluoride
supplement during early childhood can cause it. So can taking a fluoride supplement when fluoridated
drinking water or fluoride-fortified fruit juices and soft drinks already provide the right amount.
5. Clinical manifestation of dental fluorosis
Clinically, mild cases of dental fluorosis are characterized by a white opaque appearance of the enamel,
caused by increased subsurface porosity.
The earliest sign is a change in color, showing many thin white horizontal lines running across the
surfaces of the teeth, with white opacities at the newly erupted incisal end.
The white lines run along the ‘perikymata’, a term referring to transverse ridges on the surface of the
tooth, which correspond to the incremental lines in the enamel known as Striae of Retzius.
7. Levels of drinking water
Fluoride occurs naturally in water. Natural fluoride levels above the currently recommended range for
drinking water may increase the risk for severe fluorosis. In communities where natural levels exceed 2
parts per million, the CDC recommends that parents give children water from other sources.
Prompted by concerns that children may be getting too much fluoride, the Health and Human Services
Department in January 2011 lowered its recommended level of fluoride in drinking water. And the
Environmental Protection Agency is reviewing its rules on the upper limit of fluoride levels in drinking
water.
8. Symptoms
Symptoms of fluorosis range from tiny white specks or streaks that may be unnoticeable to dark brown
stains and rough, pitted enamel that is difficult to clean. Teeth that are unaffected by fluorosis are smooth
and glossy. They should also be a pale creamy white.
Contact your dentist if you notice that your child’s teeth have white streaks or spots or if you observe one
or more discolored teeth.
9. ● Questionable. The enamel shows slight changes ranging from a few white flecks to occasional
white spots.
● Very mild. Small opaque paper-white areas are scattered over less than 25% of the tooth surface.
● Mild. White opaque areas on the surface are more extensive but still affect less than 50% of the
surface.
● Moderate. White opaque areas affect more than 50% of the enamel surface.
● Severe. All enamel surfaces are affected. The teeth also have pitting that may be discrete or may
run together.
10. Treatment
In many cases, fluorosis is so mild that no treatment is needed. Or, it may only affect the back teeth where
it can’t be seen.
The appearance of teeth affected by moderate-to-severe fluorosis can be significantly improved by a
variety of techniques. Most of them are aimed at masking the stains.
Such techniques may include:
● Tooth whitening and other procedures to remove surface stains; note that bleaching teeth may
temporarily worsen the appearance of fluorosis.
● Bonding, which coats the tooth with a hard resin that bonds to the enamel
● Crowns
● Veneers, which are custom-made shells that cover the front of the teeth to improve their
appearance; these are used in cases of severe fluorosis.
● MI Paste, a calcium phosphate product that is sometimes combined with methods like
microabrasion to minimize tooth discoloration
11. Prevention
Parental vigilance is the key to preventing fluorosis.
If your water comes from a public system, your doctor or dentist -- as well as your local water authority or
public health department -- can tell you how much fluoride is in it. If you rely on well water or bottled water,
your public health department or a local laboratory can analyze its fluoride content.
Once you know how much fluoride your child is getting from drinking water and other sources such as fruit
juices and soft drinks, you can work with your dentist to decide whether or not your child should have a
fluoride supplement.
12. At home, keep all fluoride-containing products such as toothpaste, mouth rinses, and supplements out of
the reach of young children. If a child ingests a large amount of fluoride in a short period of time, it may
cause symptoms such as:
● Nausea
● Diarrhea
● Vomiting
● Abdominal pain
Although fluoride toxicity usually doesn’t have serious consequences, it sends several hundred children to
emergency rooms each year.
13. It’s also important to monitor your child’s use of fluoridated toothpaste. Only place a pea-sized amount of
toothpaste on your child’s toothbrush.
That is sufficient for fluoride protection. Also teach your child to spit out the toothpaste after brushing
instead of swallowing it. To encourage spitting, avoid toothpastes containing flavors that children may be
likely to swallow.
