Dental Fluorosis | What is it, its Causes, Symptoms and Treatment
AUTHOR : Dr Saumya Lal
Dental Fluorosis is a common cosmetic condition in which your teeth are discolored with tiny chalky white or, in severe cases, brown stains. Dental Fluorosis is a common defect of tooth enamel caused by ingestion of too much fluoride during the first 8 years of life when enamel is formed. Characterized by hypo mineralization, the lack of calcium in teeth leads to visual changes in enamel, causing varying levels of discoloration and in some cases, damage to teeth. Even though dental fluorosis can be cosmetically treated, enamel damage is permanent. Additionally, the extent to which dental fluorosis develops depends on the amount and duration of fluoride exposure while teeth are forming.
Dental fluorosis will be one of the first indicators of fluorosis. In clinical work one of the most widely used methods of classifying and recording dental fluorosis is the dental fluorosis index (DFI) formulated by Dean (1942). This system allows the amount of enamel alteration on each tooth to be classified. The first evidence of dental fluorosis is a loss of sheen, followed by the development of white patches that later discolour and may be accompanied by pitting . The pitting that occurs with fluorosis is a hypoplastic defect.
Dental fluorosis is a hypo-mineralization of enamel associated with elevated fluoride intake during the process of enamel formation. In its mildest form, dental fluorosis appears as barely discernable fine flecks or lines of opaque white enamel. Slightly more involved mild fluorosis often presents as lacy markings that follow the perikymata of the enamel. More involved dental fluorosis is characterized by thicker lines or bands of opaque enamel that can coalesce to form larger areas of affected enamel. In severe cases, these coalesced areas sometimes break down to form discrete pits, which can be accompanied by areas that are stained orange to dark brown.
At the structural level, dental fluorosis is characterized by subsurface porosity of the enamel surface, which is actually similar to what is seen in early dental caries lesions. Excess fluoride during enamel formation is believed to disrupt mineralization and promote the retention of enamel protein, yielding weaker enamel structures and thus subsurface porosity. All developmental stages of enamel are thought to be susceptible to excess fluoride, but it appears the early maturation stage is when the enamel is most sensitive to fluoride.
Dental fluorosis is dose dependent—the greater the fluoride intake during tooth development, the more severe the fluorosis. Dental fluorosis can occur in the primary dentition, but it is less common and less commonly studied than in the permanent dentition. In areas of very high-water fluoride concentrations, all primary teeth can be affected, but in most instances, only the later-erupting primary teeth are affected—mainly the primary second molars.
Sources of Fluoride :
One fluoride source or a combination of, can cause dental fluorosis. Whether natural or artificial, multiple sources of fluoride have the potential to cause dental fluorosis. However, the development typically occurs due to the following scenarios:
• Fluoridated drinking water (especially during infancy)
• Ingestion of fluoride toothpaste
• Use of fluoride tablets
• Consumption of food made with fluoridated water
Even something that seems so harmless like tea, can single handedly cause dental fluorosis in a child. As fluoride in tea can reach up to six times the amount of fluoride than tap water. In addition, most dental products for children are now flavored, and the likelihood of younger children swallowing toothpaste is extremely likely. Individuals should also keep in mind toothpastes are extremely potent in fluoride(1000 to 1500 ppm) and what seems like a small amount of toothpaste is in reality, a lot of fluoride. A substance that if swallowed, requires you to seek medical help.
Causes :
Unlike many other dental and gums diseases, fluorosis has nothing to do with brushing and flossing. The real factor behind this dental disorder is the ‘excessive intake of fluoride’ during the first eight years of life because here, at this stage, teeth are not fully mineralized.
This dental problem mainly occurs in rural areas where people used to drink water from shallow wells or hand pumps. Usually, in such areas, the water contains the fluoride content more than usual, which is 1ppm. Moreover, the below-average intake of calcium-containing foods also becomes a significant cause of fluorosis in children.
• Excessive Use of Fluoride Toothpastes: In most of the children, fluorosis occurs due to excessive use of fluoride-containing toothpaste. The teeth whitening fluoride toothpaste’s ads on television and magazines, entice people to use an excessive quantity of toothpaste while brushing.
• Fluoride Medication: Some of the infants are given fluoride drops or tablets for many reasons, one of which is the strengthening of baby teeth. If given for a longer time or excessive quantity, the chances for your child to get dental fluorosis are greater.
Symptoms :
Symptoms of dental fluorosis may vary from person to person, as in few patients, these appear as chalky white patches or yellow stains, whereas in others, it may seem like brown stains on the surface of the teeth.
Types of Dental Fluorosis
Tooth fluorosis manifests itself in different ways, depending on the severity of the condition. The greater our exposure to fluoride as a child, the more severe the type of fluorosis.
The types of fluorosis range from mild to severe, classed according to the visual appearance and physical surface of the tooth.
Mild fluorosis
Mild fluorosis appears as cloudy or pearly white lines, patches or marks on the surface of the tooth enamel. These deformations can appear on any part of the tooth, from the tip to the gum line. They may be so slight that only a dentist can pick up on them.
Moderate fluorosis
With moderate fluorosis, the white spots have a more chalky appearance, cover more of the tooth, and are much easier to see. Although this is not aesthetically pleasing, it doesn’t cause any pain and the tooth can still function as normal.
Severe fluorosis can mean damaged enamel
This is the most serious type of fluorosis. It can cause yellow or brown spots in addition to a chalky appearance on most of the tooth surface. The enamel may be rough, brittle or pitted, and parts of it may be missing completely.
Treatment
- Mild, no treatment is needed.
- The appearance of teeth affected by moderate-to-severe fluorosis can be significantly improved by a variety of techniques. Such techniques may include: – Tooth whitening and other procedures to remove surface stains – 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.
- Parental vigilance is the key to preventing fluorosis. – At home, keep all fluoride-containing products such as toothpaste, mouth rinses, and supplements out of the reach of young children.
- Since the major source of fluoride is drinking water, de-fluoridation is the best preventive measure which can be carried out at domestic as well as community level.
- Nutritional interventions like high intake of vitamin C and Calcium also helps reduce the problem.
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