Dental Fluorosis. Condition or Disease?
Your permanent teeth form under your gums in the jawbone during early childhood. Except for your wisdom teeth, the crowns (the part you see in the mouth) of all of the permanent teeth fully form by the time you are about 8 years old. If you consume too much fluoride as a young child, the extra fluoride can disrupt the formation of the enamel (outer part) of your permanent teeth and lead to dental fluorosis, which varies from minor discoloration to surface irregularities of the teeth. The extra fluoride does not affect other parts of the tooth.
Once your teeth have erupted into your mouth, they are not susceptible to fluorosis. Dental fluorosis is a cosmetic condition, not a disease. Often, it is so mild that only a dental professional can detect it. Most cases of dental fluorosis result from young children taking fluoride supplements or swallowing fluoride toothpaste when the water they drink is already fluoridated.
Dental fluorosis is an irreversible condition caused by excessive ingestion of fluoride during the tooth forming years. It is the first visible sign that a child has been overexposed to fluoride. Fluoride causes dental fluorosis by damaging the enamel-forming cells, called ameloblasts. The damage to these cells results in a mineralization disorder of the teeth, whereby the porosity of the sub-surface enamel is increased.
Over the past 50 years, the prevalence of dental fluorosis has increased quite dramatically in the United States and other fluoridated countries.
Dental Fluorosis Symptoms
Teeth affected by mild fluorosis may show no visible changes or changes visible only to a dental professional. Mild to moderate fluorosis is characterized by white lines, streaks or spots. In more severe fluorosis, the teeth can become pitted and have brown, gray or black spots, and the enamel can be misshapen.
Dental fluorosis occurs because of the excessive intake of fluoride either through naturally occurring fluoride in the water, water fluoridation, toothpaste, or other sources. The damage in tooth development occurs between the ages of 6 months to 5 years, from the overexposure to fluoride. Teeth are generally composed of hydroxyapatite and carbonated hydroxyapatite; when fluoride is present, fluorapatite is created. Excessive fluoride can cause yellowing of teeth, white spots, and pitting or mottling of enamel. Consequently, the teeth become unsightly.Dental fluorosis cannot occur once the tooth has erupted into the oral cavity. At this point, fluorapatite is beneficial because it is more resistant to dissolution by acids (demineralization).
Diagnosis of Dental Fluorosis
Your dentist and dental hygienist will ask if your child received fluoride supplements, used fluoride toothpaste or drank fluoridated water in previous years. They also will ask about past and present medical conditions or disabilities that may affect your child’’s teeth. Your dentist will examine your child’’s teeth and gums and take X-rays to make sure there are no other defects in the teeth.
Other conditions may look like dental fluorosis. Developmental defects and craniofacial problems can cause disruptions in the enamel or dentin of the teeth. In addition, infants or young children who have high fevers or experience trauma (such as a fall that injures a tooth) may have discolored teeth. Young children can get cavities in their primary teeth, so any tooth discoloration should be checked at the dental office.
Dental Fluorosis Prevention
Swallowing toothpaste can cause dental fluorosis. A common source of ingested fluoride is toothpaste. All small children, but especially those younger than age 6, may not be able to reliably spit out toothpaste when brushing. That fluoride toothpaste which is swallowed can lead to the causation of dental fluorosis.
The following suggestions can help to minimize the risk for developing dental fluorosis from the ingestion of fluoride toothpaste:
- Children should be instructed in good brushing and rinsing habits and then supervised when brushing, so to avoid toothpaste swallowing.
- Read your toothpaste’’s instructions. Typically only a small dab of toothpaste is needed, one the size of a green pea. Fluoridated toothpaste should be dispensed by an adult.
- As your dentist for their recommendation but in most cases an unfluoridated baby tooth cleanser should be used with children 2 years and under.
- Store fluoridated toothpaste out of the reach of children.
- When a fluoridated toothpaste is used look for one which has the American Dental Association’’s (ADA) “Seal of Approval.” This indicates that this organization has evaluated the toothpaste and found its fluoride content to be at both a safe and effective level.
Removal of excessive fluoride from drinking-water is difficult and expensive. The preferred option is to find a supply of safe drinking-water with safe fluoride levels. Where access to safe water is already limited, de-fluoridation may be the only solution. Methods include: use of bone charcoal, contact precipitation, use of Nalgonda or activated alumina (Nalgonda is called after the town in South India, near Hyderabad, where the aluminium sulfate-based defluoridation was first set up at a water works level).
Since all methods produce a sludge with very high concentration of fluoride that has to be disposed of, only water for drinking and cooking purposes should be treated, particularly in the developing countries.
Treatment of Dental Fluorosis
Dental fluorosis can be cosmetically treated by a dentist. The cost and success can vary significantly depending on the treatment. Tooth bleaching, microabrasion, and conservative composite restorations or porcelain veneers are commonly used treatment modalities. Generally speaking, bleaching and microabrasion are used for superficial staining, whereas the conservative restorations are used for more unaesthetic situations.
Also, as a preventative measure, dentists recommend that children should not receive topical fluoride treatment until the age of three or at the earliest time that a determination can be made about a child’’s total flouride exposure.
Dental fluorosis, of esthetic concern, is an expensive condition to treat. If left untreated, it can cause embarrassment for school-aged children, resulting in psychological stress and damaged self-esteem.
Hi Alex,
I found your blog on twitter and wanted to say how refreshing it is to see a dentist commneting negatively about fluoride. Thank you for taking the time to learn the truth and share it with the public. Because the teeth reflect the condition of the bones, it is truly important to prevent dental fluorisis to avoid skeletal fluorosis (arthritis, deformities, etc)shortly down the road. Your blog will save many from harm! Thanks!
Teresa Holler
I am very pleased that my humble work is useful for anybody. Thank you too. I like a way of preventing more than treating too, as you. Thanks!