What is Dental Fluorosis?

Fluorosis is a chronic disorder of the tooth enamel structures that results from an overabundance of fluoride in the body. Teeth affected by fluorosis exhibit characteristic damage. In the early stages, this is manifested as light and dark spots on the surface of the enamel. As the disease progresses, characteristic cavities can appear in the teeth, along with tooth brittleness and other dental health problems such as tooth decay.

Causes of Fluorosis

As mentioned earlier, the primary cause of dental fluorosis is excess fluoride. Here are the factors that can contribute to its development:

• Active fluoride intake during childhood: Fluorosis is commonly a childhood disorder, particularly in countries where children lack access to clean bottled drinking water with optimal fluoride content.
• Drinking water with high fluoride content: According to World Health Organization standards, the fluoride content in water should not exceed 0.8-1 mmol/dm³.
• Diet rich in foods with high fluoride content: Foods such as sea bass, eel, cereals, and fluoride-enriched drinks and juices can contribute to the development of fluorosis.
• Abuse of toothpaste with high fluoride content: Many dentists recommend using fluoride toothpaste to strengthen tooth enamel, which is beneficial. However, like any product, fluoride toothpaste should not be overused, especially if your diet includes foods and water enriched with fluoride. It’s beneficial to alternate between high fluoride toothpaste, whitening toothpaste, and toothpastes with various natural extracts.

Fluorosis Symptoms and Signs

The key symptoms of fluorosis are visually monitored. Only professional dentists (and in some cases, pediatricians) can make an appropriate diagnosis and determine if a patient has developed fluorosis. Here are the main symptoms that may indicate the development of the disease:

• White spots (fluorosis stains): These appear as dotted spots on the enamel surface.
• White streaks and brown spots: These appear on the enamel, causing the structure to become heterogeneous.
• Non-carious cavities: These appear on the surface of teeth.
• Brittleness and increased wear of teeth.

Dental fluorosis can manifest with different symptoms depending on the stage of the disorder:

• Stage 1: This is the initial stage, characterized by white spots covering up to 25% of the tooth surface.
• Stage 2: Mild stage, with white spots covering up to 50% of the tooth surface.
• Stage 3: Moderate stage, where teeth show characteristic brown stains.
• Stage 4: Severe stage, observed in patients with brown spots and cavities in the tooth enamel.

How dental professionals diagnose fluorosis

As noted earlier, fluorosis can be diagnosed by both a professional dentist and a pediatrician. Specialists perform a visual inspection of the oral cavity and may also use diagnostic methods such as microscopy and radiography for this purpose.

Effects of Fluorosis

Depending on the stage of development of the disorder and the age of the patient, the consequences of fluorosis can vary:

• Destruction of teeth at an early age
• Disturbance of the aesthetics of the teeth
• Increased tooth erosion

In addition, increased fluoride levels in the body lead not only to the development of fluorosis. For example, in children it can cause skeletal development disorders and bone damage, and in adults it can manifest itself as increased fatigue, osteoporosis, arthritis and chronic joint diseases.

Treatment Options for Fluorosis

Dental fluorosis treatment primarily involves correcting aesthetic defects and promoting dental health. Here are some of the treatments that can be used for this purpose:

• Teeth whitening in the early stages of the disease.
• Tooth restoration.
• Placement of fillings.
• Placement of veneers, which can help visibly transform the aesthetics of the smile and hide the presence of stains.
• Placement of dental crowns when there is significant tooth decay in severe stages of the disorder.

Prevention of Dental Fluorosis

Since fluorosis is not a genetic but an acquired disorder of a chronic nature, there are simple but effective ways to help prevent its development.

Safe Fluoride Use in Children

During childhood, when the teeth and skeleton are forming, it is crucial to monitor the child’s diet and control their fluoride intake. This helps prevent the development of fluorosis and protects the health of both deciduous and permanent teeth. Poor enamel health and increased tooth erosion can otherwise lead to irreversible tooth damage and decay.

To prevent fluorosis, it is recommended to monitor the child’s fluoride levels through a balanced diet and access to clean drinking water with minimal mineral content.

Furthermore, a study published on the National Library of Medicine website highlights a method that has helped prevent severe fluorosis in adolescents: ensuring normalized calcium intake with optimal levels of vitamin D. This approach supports good calcium absorption, facilitated by optimal vitamin D levels, helping adolescents avoid the progression of fluorosis.

Fluoride Levels in Drinking Water

The most common cause of dental fluorosis in adults and children is the consumption of water with excess fluoride. According to WHO recommendations, the permissible level of fluoride in drinking water is 0.8-1 mg/dm³. To prevent the development of the disorder, it is important to consume water where this fluoride level does not exceed the recommended norm. Ideally, the fluoride level in children’s water should be even lower.

It is important to note that excessive consumption of fluoride can be harmful to health, just as a deficiency of this mineral can be. Therefore, it is crucial for both children and adults to monitor their fluoride intake. This includes assessing the fluoride content in the water we consume daily.

Timely diagnosis of dental fluorosis can help prevent the progression of the condition. In severe cases, appropriate dental treatments such as restoration, fillings, veneers, or dental crowns may be necessary to eliminate stains and cavities on the surface of the teeth.

Fluorosis: the Most Common Questions

Additional Resources

Association of dental and skeletal fluorosis with calcium intake and serum vitamin D concentration in adolescents from a region endemic for fluorosis – National Library of Medicine