Fluorosis Health Article

Definition

Fluorosis is an abnormal condition of the tooth enamel caused by excessive exposure to fluoride (a nutrient used to prevent tooth decay) while a child's teeth are forming under the gums. Excessive fluoride affects the formation of tooth enamel (the hard outer surface of a

tooth). Fluorosis can be very mild, as a few white spots on a tooth; or severe, showing etching, pitting, and brown discoloration on many teeth.

Description

Fluoridated community water systems and toothpaste with fluoride have significantly contributed to the prevention and mitigation of dental caries (tooth decay) in developed countries, reducing the number of cavities by 70%. Even at the safe level of 1 ppm of fluoride in drinking water, 22% of the people drinking that water have reported some form of fluorosis. In some areas, the rate of incidence is 50%.

Though fluorosis is mainly a cosmetic problem, it has become a marker for overexposure to fluoride in a child's environment.

Causes and symptoms

Fluorosis does not affect the permanent teeth once they have fully appeared. Fluorosis may occur in primary (baby) teeth as well as permanent teeth. Most often, the condition appears on the front incisors (front teeth) and less frequently on the molars. This characteristic poses a high cosmetic problem because the front teeth are most exposed when children speak or smile.

Symptoms can range from mild to severe. Very mild fluorosis is seen as tiny white spots on 25% of a tooth surface. Mild fluorosis covers 26% to 50% of a tooth surface. Moderate fluorosis compromises all of a tooth's surface and is most characterized by brown discoloration of the tooth. Severe fluorosis involves pitting of the enamel and more serious brown staining. Approximately 94% of dental fluorosis is very mild to mild.

Excess fluoride exposure is often accidental. Naturally occurring fluoride in well water can sometimes be much higher than water from artificially fluoridated, community or municipal systems that are kept at strict levels. Drought conditions can also concentrate fluoride levels.

According to the ADA, young children under six often use too much toothpaste that contains fluoride, and they consistently swallow it. This alone has been the biggest cause of excess fluoride ingestion.

Some children drink fluoridated water and also drink large amounts of bottled beverages that have fluoride in them. Carbonated drinks and juices have fluoride in varying amounts. Often, the fluoride in these products is not printed on the labels. Still other children are offered foods high in fluoride (fish with bones, tea, poultry products, cereals, or infant formula made with fluoridated water) in addition to fluoridated water.

Finally, fluorosis may be caused by some pediatricians who prescribe fluoride supplements without determining the amount of fluoride exposure the child has in his or her environment.

Topical applications of fluoride gels applied by dentists to the surfaces of a child's teeth and fluoride mouth rinses available through dentists or over the counter (OTC) are other ways that a child can add to her fluoride quota. These methods are extremely helpful for older children and adults, but they often add to the cumulative fluoride exposure a young child can have, especially if she swallows fluoride residues.

Diagnosis

Fluorosis can be identified through examination by a dentist or dental hygienist. Very mild fluorosis sometimes can be detected only through x rays. Often the dentist uses the Fluorosis Index to classify the severity of the condition from very mild to severe. (See Causes & Symptoms for details of each classification.)