Dentistry

Dental Fluorosis and Teeth Whitening: Here’s What You Need for a Better Smile

Persistent stains in teeth can cause cosmetic concerns that require aesthetic solutions like teeth whitening
Procedures like teeth whitening can be useful for reducing discoloration caused by dental fluorosis.
Procedures like teeth whitening can be useful for reducing discoloration caused by dental fluorosis. (Unsplash)
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All of us make an effort to present ourselves well by paying close attention to our appearance, including our teeth. Despite brushing, flossing, and maintaining good oral hygiene, sometimes there are these white or brown spots and stains that don’t seem to go away.

One possible cause could be dental fluorosis, a condition that occurs as a result of excessive ingestion of fluoride during the early years of life. While it may not be that harmful, these persistent spots and stains can remain a cause of concern as they affect the appearance of the smile. As a result, people try various methods to get rid of this or reach out to dentists to get them treated. There are multiple options given by the dentist, one of the most common being teeth whitening. But do you know how it works?

Yellow to brown stains in the front teeth involving the enamel.
Yellow to brown stains in the front teeth involving the enamel. (Representational image: Wikimedia Commons)

What is Fluoride, and How Does it Cause Fluorosis?

Fluoride is an element that can help prevent dental caries and is most commonly found in drinking water, toothpaste, and mouth rinses. Different geographical locations have different concentrations of fluoride. The unaesthetic appearance of mild white to dark brown spots and stains is called dental fluorosis, which affects the outermost layer of the tooth, called enamel. [2,3]

It is primarily brought on by consuming too much fluoride during the tooth development. People in areas where fluoride concentration is higher have the chance to develop fluorosis. There are different types of dental fluorosis—questionable, very mild, mild, moderate, and severe—and it depends on the amount of fluoride that the person is exposed to . [1]

MedBound Times reached out to Dr. Jude Bencia G, BDS, for her thoughts on the matter:

Fluorosis is not teeth yellowing. It is ingrained fluoride from drinking water or any other source replacing calcium with calcium hydroxide that results in enamel discoloration. It can be detected with routine dental checkups, and it is advisable to check the water’s mineral content before drinking it. If left unnoticed, dental fluorosis can make the teeth brittle and may also cause skeletal fluorosis.

Dr. Jude Bencia G, BDS

What is Teeth Whitening?

It is a procedure that makes the shade of the tooth lighter. Chromogens impart color to tooth stains. These chromogens are divided into two categories based on their chemical structure:

  1. Large organic compounds

  2. Metal-containing compounds

Bleaching large organic compounds with agents such as hydrogen peroxide or sodium hypochlorite causes the chromogen to lighten. Apart from this, to break the chromogens, there are other methods used, such as abrasives and over-the-counter products such as whitening strips and rinses. The unaffected tooth structure is lightened so that it can camouflage with the hypomineralized enamel and contribute to an aesthetic appearance.

Yellow to brown stains in the front teeth involving the enamel.
Teeth whitening products can contain bleaching agents that breaks down the color compounds and reduces the discoloration. (Representational image: Wikimedia Commons)

Are There Any Risks?

There are chances of risks such as tooth sensitivity and mild irritation of the gums. These effects can occur based on the concentration of bleach component used and the length of the treatment. Some in vitro studies have reported that they can cause demineralization and erosion of teeth and also damage to the pulp. Teeth get damaged if very aggressive regimens are used. [4]

What are the Other Options?

Alternative treatment options to reduce the appearance of dental fluorosis include:

  • Crowns

  • Composite restoration

  • Microabrasion: A mechanical procedure that helps remove the superficial enamel

  • Resin infiltration: A technique that uses hydrochloric acid to etch, followed by infiltration of low-viscosity resin in the enamel.[1]

Yellow to brown stains in the front teeth involving the enamel.
Aesthetic treatment using veneers. (Representational image: Wikimedia Commons)

MedBound Times also connected with Dr. Tanneru Venkata Lakshmi Sahithi, BDS, MDS, Consultant Periodontist and Implantologist (Laser Specialist), for her thoughts on the matter:

In simple words, it is a condition that results from excessive fluoride exposure. If the amount of fluoride that is ingested, either through consumption of drinking water or any dietary source, is above 1.5 ppm, it could interfere with the development of enamel in the age group below 8 years. Fluoride interacts with the amelogenesis (enamel development) process, causing hypomineralization and leading to changes in tooth appearance. A lot of treatment methods are available, but we mostly prefer bleaching, crowns, or composite bonding. Most patients also prefer bleaching, especially laser bleaching, as it is comfortable. But it only works well if they have mild to moderate fluorosis. Good isolation should be done before the procedure for patient comfort as well as to reduce the chances of the gingiva (gums) coming in contact with the ingredients of bleach, as it could cause irritation that can continue for 2 days to a week. Crowns and veneers are a permanent solution in moderate and severe fluorosis.
Dr. Tanneru Venkata Lakshmi Sahithi, BDS, MDS, Consultant Periodontist and Implantologist (Laser Specialist)

Conclusion:

Teeth whitening may be effective for the discoloration caused by dental fluorosis. But it ultimately depends on the severity of fluorosis and the individual’s preferences to determine how well it can work. It is important to consult with a dentist to get the best treatment option and achieve your desired smile.

References:

1. Wang, Qingqing, Qingfei Meng, and Jian Meng. "Minimally invasive esthetic management of dental fluorosis: a case report." Journal of International Medical Research 48, no. 10 (2020): 0300060520967538. (Accessed on 09 January 2025) https://pmc.ncbi.nlm.nih.gov/articles/PMC7607159/

2. Carey, Clifton M. "Focus on fluorides: update on the use of fluoride for the prevention of dental caries." Journal of Evidence Based Dental Practice 14 (2014): 95-102.  (Accessed on 09 January 2025) https://www.sciencedirect.com/science/article/abs/pii/S1532338214000475

3. Niazi, Fatima C., and Tom Pepper. "Dental fluorosis." (2022). (Accessed on 09 January 2025) https://www.ncbi.nlm.nih.gov/books/NBK585039/

4. Carey, Clifton M. "Tooth whitening: what we now know." Journal of Evidence Based Dental Practice 14 (2014): 70-76. (Accessed on 09 January 2025) https://pmc.ncbi.nlm.nih.gov/articles/PMC4058574/

By Dr. Nethra Suryanarayanan

SSK

Procedures like teeth whitening can be useful for reducing discoloration caused by dental fluorosis.
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