Dental Fluorosis: A Cosmetic Dental Concern

Dental fluorosis is a condition caused by excessive consumption of fluoride during enamel formation and leads to hypomineralization of tooth enamel.

Dental fluorosis results in white and brown flecks and speckles on the teeth. [Wikimedia Commons]

Dental fluorosis is a condition caused by excessive consumption of fluoride during enamel formation and leads to hypomineralization of tooth enamel. It results in white and brown flecks and speckles on the teeth. It is a cosmetic dental concern and isn't harmful to the teeth.

Who is affected by fluorosis?

Research has shown that people who were overexposed to fluoride during the developmental phase of their lives, before their permanent teeth erupt, develop dental fluorosis. Generally, children aged 8 and younger who have had excessive consumption of fluoride are at the highest risk of developing dental fluorosis. It happens when the child ingests excessive fluoride, either by drinking heavily fluoridated water or swallowing fluoride toothpaste. Teeth that have already developed and erupted are free from the risk of fluorosis.

Generally, children aged 8 and younger who have had excessive consumption of fluoride are at the highest risk of developing dental fluorosis. [Unsplash]

Effect Of Fluorosis On Teeth-

Dental fluorosis neither has a detrimental effect on the oral health of an individual nor does it impair oral function. On the contrary, studies have shown that dental fluorosis makes the teeth more resistant to dental caries. These studies and research prompted the introduction of community water fluoridation, where fluoride is adjusted into the public water supply at controlled levels so as to prevent tooth decay in people but not enough to cause dental fluorosis.

The recommended fluoride concentration for drinking water is 0.7 milligrams per liter, according to the Centers for Disease Control and Prevention (CDC).

Studies and research have successfully concluded that when the fluoride concentration is above 1.5 mg/l (1.5 ppm) in the drinking water, dental fluorosis can occur. High concentrations of ionic fluoride have been found in groundwater, vegetables, fruits, and other crops, although drinking water is usually the major source of the daily fluoride intake in some parts of South Asia like India and Sri Lanka, Africa, the Middle East, Asia, and China, as well as some parts of America and Japan.

High concentrations of ionic fluoride have been found in ground waters, vegetables, fruits, and other crops, although drinking water is usually the major source of the daily fluoride intake in some parts of South Asia like India and Sri Lanka, Africa, Middle East Asia and China. [Wikimedia Commons]

Dental fluorosis is more of a cosmetic concern where the individual develops white or brown flecks and patches on the tooth due to the hypomineralization of enamel.

Dental Fluorosis In India-

Gujarat and Rajasthan are the most affected states in the northern part of India, while Andhra Pradesh is the most affected state in the southern part.

Punjab, Haryana, Madhya Pradesh, and Maharashtra are moderately affected, while West Bengal, Uttar Pradesh, Bihar, and Assam are mildly affected by dental fluorosis. All over India, fluorosis is mainly hydrofluorosis, but some parts of Gujarat and Uttar Pradesh show industrial fluorosis as well.

Symptoms Of Dental Fluorosis-

Intrinsic tooth discoloration is the only symptom of dental fluorosis, where the teeth become speckled with white or brown patches, depending on the severity of the condition.

Questionable fluorosis: This is characterized by a few white flecks or spots on the tooth surface.

Questionable fluorosis is characterized by a few white flecks or spots on the tooth surface [Wikimedia Commons]

Very mild fluorosis: This is characterized by small, opaque, paper-white areas scattered irregularly over the teeth but not involving more than 25% of the tooth surface.

Very mild fluorosis is characterized by small, opaque, paper white areas scattered irregularly over the teeth but not involving more than 25% of thetooth surface.[Wikimedia Commons]

Mild fluorosis: It is characterized by white opacity in the teeth that are more extensive but don't involve more than 50% of the surface.

Mild fluorosis is characterized by white opacity in the teeth is more extensive but don't involve more than 50% of the surface [Wikimedia Commons]

Moderate Fluorosis: All the tooth surfaces are affected and there's a marked wear on the occlusal surface which is the biting surface and brown stains may be present.

In moderate fluorosis, all the tooth surfaces are affected and there's a marked wear on the occlusal surface which is the biting surface and brown stains may be present. [Wikimedia Commons]

Severe fluorosis: All the tooth surfaces are affected, and there's a discrete or confluent pitting with brown stains on the tooth surface.

Severe Fluorosis- All the tooth surfaces are affected and there's a discrete or confluent pitting with brown stains on the teeth surface. [Wikimedia Commons]

In order to prevent dental fluorosis, one needs to be aware of the amount of fluoride an individual is exposed to. While we don't want the child to be overexposed to fluoride, we still need to make sure the child is getting enough fluoride for the development of teeth. Several studies and research have successfully concluded that making sure the child spits the toothpaste instead of swallowing it and checking the water fluoridation in the residential area are some of the ways to prevent dental fluorosis.

Dr. Samridhi Soumya [BDS], Currently practicing in South Delhi

Management Of Dental Fluorosis-

Management Of dental fluorosis involves cosmetic dental procedures and some of the ways of getting rid of discolored teeth are-

Teeth Whitening: Teeth bleaching also known as teeth whitening, is a procedure where the dentist tries to lighten the shade of the tooth using an oxidizing agent and exposure to light or laser.
Dental bonding: In this procedure, dentists use tooth-colored composite resin to cover up stains on the teeth.
Dental Veneers: Dental veneers are thin shells made of resin or porcelain that are adhered to the labial (front) surface of the tooth. These veneers are custom-made, so a dental impression needs to be taken prior to their fabrication of veneers.

Dental veneers are thin shells made of resin or porcelain and are adhered to the labial (front) surface of the tooth. These veneers are custom made, so dental impression needs to be taken prior to the fabrication of veneers. [Wikimedia Commons]

Dental Crowns: Unlike dental veneers, dental crowns enclose the entire tooth and cover all the surfaces of the tooth. These are also custom-made after taking an impression of the teeth.

Dental Crowns- Unlike dental veneers, dental crowns enclose the entire tooth and cover all the surfaces of the tooth. These are also custom made after taking the impression of the teeth. [Wikimedia Commons]

Enamel microabrasion: In this procedure, a small layer of the enamel is removed from the tooth, which helps eliminate stains caused by dental fluorosis. This procedure is often followed by teeth whitening in order to make the surface of the teeth even and uniform.

References-

https://www.cdc.gov/fluoridation/faqs/dental_fluorosis/index.htm#:~:text=What%20is%20dental%20fluorosis%3F,years%2C%20age%208%20and%20younger.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433161/

https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/dental-fluorosis

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