Dental Fluorosis

Dental fluorosis is a condition that affects the teeth due to overexposure to fluoride during the first eight years of life. This is the time when most permanent teeth are formed, and after the teeth erupts, the teeth which are affected by fluorosis may appear mildly discolored.

Causes Of Fluorosis

  • One of the cause of fluorosis is the inappropriate use of fluoride containing dental products such as toothpaste and mouth rinses. Sometimes, kids enjoy the taste of fluoridated toothpaste so much that they swallow it instead of spitting it out in more amounts than needed which leads to fluorosis.
  • But there are other causes of fluorosis too for example, taking a higher than prescribed amount of a fluoride supplement during early childhood.
  • Other cause include high amount of fluoride content in the drinking water, in some areas this is the most common reason for dental fluorosis.
  • Fluorosis can have genetic cause also.

Fluoride Levels in Drinking Water

It is well known that fluoride occurs naturally in water. Natural fluoride levels above the currently recommended range for drinking water may increase the risk for moderate to severe dental fluorosis. In communities or areas where natural levels exceed 2 parts per million, the CDC (Centers for disease control and prevention) recommends the parents to give children water from other sources.

Out of concerns the Health and Human Services Department in January 2011, lowered its recommended level of fluoride in drinking water so that the children don’t get vulnerable to fluorosis. And the Environmental Protection Agency is reviewing its rules on the upper limit of fluoride levels in drinking water to take measures to reduce fluoride content in drinking water.


Symptoms of fluorosis range from small white specks, spots or streaks that may be unnoticeable with naked eye to dark brown stains and rough, pitted enamel that is difficult to clean. Teeth that are unaffected by fluorosis are smooth and glossy, on the other hand the teeth with fluorosis are rough and non-glossy. In severe cases of fluorosis teeth sensitivity also occurs.

Since the 1930s, the dentists have rated the severity of fluorosis using the following categories

  • Questionable - In questionable cases the enamel shows slight changes ranging from a few white flecks to occasional white spots.
  • Very mild - In very mild cases small opaque paper white areas are scattered over less than 25% of the tooth surface.
  • Mild - In mild cases white opaque areas on the surface are more extensive but still affect less than 50% of the surface.
  • Moderate - In moderate cases white opaque areas affect more than 50% of the enamel surface.
  • Severe - In severe cases all enamel surfaces are affected, and the teeth also have pitting that may be discrete or may run together.

Fluorosis Treatments

In most of the cases, fluorosis is very mild that no treatment is needed. Or, it may only affect the back teeth where it can’t be a matter of concern.

The appearance of teeth affected by moderate to severe fluorosis can be significantly improved by a variety of techniques, most of them are aimed at masking the stains and rebuilding the aesthetics.

Such techniques may include the following

  • Tooth whitening or also called as bleaching and other procedures to remove surface stains in very mild and mild cases. In severe cases bleaching is not recommended as it can worsen the teeth sensitivity.

  • Use of composites can re-establish the tooth aesthetics.

  • Crowns can be an option in severe cases of fluorosis.

  • Dental veneers, which are custom-made shells that cover the anterior surface of the teeth to improve their appearance; these are used in cases of severe fluorosis.

  • Calcium phosphate product that is also called as MI paste sometimes combined with methods like micro abrasion to minimize tooth discoloration caused due to fluorosis.

Fluorosis Prevention

Parental vigilance can become the key in preventing fluorosis. The parents should enquire about the amount of fluoride content in the drinking water and what is source of drinking that they are using to prevent fluorosis mostly in children. At home, parents should keep all fluoride-containing products such as toothpaste, mouth rinses, and supplements out of the reach of small children. If a kid consumes a large amount of fluoride in a short period of time, it may cause symptoms as mentioned below

  • Nausea
  • Diarrhea
  • Vomiting
  • Abdominal pain

Although fluoride toxicity usually doesn’t have serious consequences, but it sends several hundred children to emergency rooms each year. It’s also important to monitor child’s use of fluoridated toothpaste and only place a pea-sized amount of toothpaste on the child’s toothbrush. That is sufficient for fluoride protection, and also teach the child to spit out the toothpaste after brushing instead of swallowing it. To encourage spitting, avoid toothpastes containing flavors that children may be likely to swallow and all these can prevent dental fluorosis.

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