Fluorosis is the permanent intrinsic discoloration of the teeth that causes cosmetic and psychosocial damage to the patient (1). We always wish to have the natural glowing smile, but fluorosis has a potential to damage the glow of your smile.

The excessive fluoride intake while the tooth development causes fluorosis. Hence, you must be aware of your kid’s fluoride intake as childhood is the time when teeth development takes place.

Fluorosis categorized as very mild, mild, moderate and severe forms based on the severity of the discoloration. It can be diagnosed in a routine dental check-up.

There are several treatment options available for fluorosis and some of them are bleaching, veneer, crown, etc.

However, it would be best if you could prevent fluorosis with few basic tips such as avoiding fluoridated beverages for your kid, not letting you kid to swallow the fluoridated toothpaste, etc. Let us dive deeper to know more about fluorosis.

What is fluorosis and its cause?

Fluorosis, also termed as mottled enamel, is the cosmetic damage that occurs in the tooth due to ingestion of excessive fluoride during the enamel formation. It is seen as intrinsic discoloration of the tooth that also causes physical damage to the teeth to some extent.

Patients with fluorosis have a low potential for the development of caries. Usually, fluorosis has a chance of occurrence from the time a child is born to the 8 years of his age (2).

As by this age, the crown development of all the permanent teeth complete. Genetic factors also contribute to kid’s susceptibility for fluorosis.

Depending upon the stage of tooth development while the ingestion of fluoride, fluorosis differentiated as dentin fluorosis or the enamel fluorosis.

Enamel shows yellow-brown discoloration and may sometime shows pitting surface of the tooth with white-brown lesions that look like cavities. Fluorosis does not develop once the teeth are shown up in the mouth.

Initially, fluorosis shows a change in tooth color only, without affecting the tooth structure. Later on, with increasing severity, the structure of the tooth gets affected and becomes porous.

Types and Symptoms

Symptoms of fluorosis vary with its severity. The severity of fluorosis depends upon the amount of ingested fluoride, the duration of ingestion and age of the child during the exposure, weight of the kid, bone growth, nutrition and degree of physical activity of the child.

The types and Symptoms seen in the specific type of fluorosis are –

1. Very mild fluorosis

Very mild fluorosis most commonly seen as small opaque, “paper white” areas scattered irregularly over the labial surface of the tooth, covering less than 25% of the tooth surface.

2.  Mild fluorosis

Clinically, mild fluorosis presented as the mottled patches seen on the labial surface which covers about half of the labial surface of the tooth.

It has the snowflaking appearance and lacks the clear border around the patches. These opaque white spots, narrow white lines or patches may coalesce with an entire enamel surface on most of the teeth.

3. Moderate fluorosis

In moderate fluorosis, all the surfaces of the enamel are affected. Surfaces of teeth show mottling and brown discoloration. It frequently leads to the disfigurement of the tooth structure.

4.  Severe fluorosis

Severe fluorosis shows brown discoloration and discrete or confluent pitting. Teeth often show corroded-looking appearance with surface irregularities and widespread brown stains.

Diagnosis

Diagnosis of fluorosis can be done during visual examination and routine dental check-ups. Here, fluoride patches are examined.

Dentist wipes the saliva over tooth with cotton and analyses the opaque patches under illumination. Then the diagnosis is done based on the appearance of the patches.

If the teeth are affected with fluorosis then they became vulnerable to staining and this is one of the sign during diagnosis.

Fluorosis causes subsurface porosity or hypomineralization of the enamel which extends toward the dentinal-enamel junction as the severity increases.

Because of this, the exogenous ions could easily enter in porous enamel and end up creating discoloration of the tooth.

What can you do to prevent fluorosis?

Avoiding ingestion of more fluoride is the key technique to prevent fluorosis. Some preventive measures that need to be taken care are –

  • Do not use fluoridated toothpaste for your kid until the dentist recommends.
  • Do not brush your kid’s teeth with fluoridated toothpaste more than twice in a day.
  • Apply not more than pea-sized toothpaste on the toothbrush.
  • Make sure your child spit while brushing and mouth rinsing. Supervise your kid while brushing and rising and do not let your kid drink the mouth rinse or swallow the fluoridated toothpaste.
  • Do not use fluoride supplement if you live in the fluoridated water area.
  • Avoid excessive use of beverages for the kid which are high in fluoride content such as grape juice, water with natural fruit flavor and low-calorie sweeteners, etc.

Treatment

Since fluorosis mainly causes the cosmetic damage to the teeth, the treatment mainly focused on masking the discoloration of teeth.

Visit a dentist if you have opaque patches or brownish discoloration of your or your kid’s teeth. Treatment varies depending on the severity of fluorosis and damage caused.

Mild cases of fluorosis can be treated merely with bleaching. Bleaching is the most conservative and non-invasive technique used to treat mild fluorosis. (3)

Moderate fluorosis treated by the micro-abrasion of the tooth in an acidic environment (4).  Whereas, severe fluorosis needs veneers, crowns, composition filling, etc. to mask the defects. (5)

Final words

Fluorosis is the cosmetic condition and not a dental disease. Also, fluorosis does not induce any health hazard and is mainly known to damage the aesthetic look of the patient.

The best treatment of fluorosis is conservative treatment options which will restore the appearance of the patient.

The color damage due to fluorosis is permanent, and it may get darker over time. It is best advised to visit a dentist if you see patches on your or your kid’s teeth. Take care of fluoride intake to prevent fluorosis.

Fluorosis is the cosmetic damage that occurs in the tooth due to ingestion of excessive fluoride during the enamel formation.