What is Dental fluorosis ?

Dental fluorosis is a condition that causes changes in the appearance of tooth enamel. It may result when children regularly consume fluoride during the teeth-forming years, age 8 and younger. Most dental fluorosis in the U.S. is very mild to mild, appearing as white spots on the tooth surface that may be barely noticeable and do not affect dental function. Moderate and severe forms of dental fluorosis, which are far less common, cause more extensive enamel changes.

In the rare, severe form, pits may form in the teeth. The severe form hardly ever occurs in communities where the level of fluoride in water is less than 2 milligrams per liter.

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.

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.

Since the 1930s, dentists have rated the severity of fluorosis using the following categories:

  • 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.

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