Dental Fluorosis Causes & Treatments

Fluoride is a natural mineral that is very effective in preventing tooth decay. Most toothpastes sold in the United States contain fluoride. Fluoride can also be found in the local water supply. Certain foods and beverages, such as fish, tea, grapes, and certain vegetables, naturally contain fluoride too. These sources typically give you enough fluoride to lower your risk of dental caries.

However, too much fluoride consumed during tooth development can result in visible changes in the enamel surface of the teeth. These changes are broadly called dental fluorosis. Severe dental fluorosis is not harmful but can cause cosmetic concerns.

Please continue reading to learn more about the causes and treatments for dental fluorosis.

Does everyone need fluoride toothpaste?

Everyone should use fluoride toothpaste to protect teeth against dental caries. Some areas have suboptimal levels of fluoride in drinking water, and fluoridated toothpaste can provide protection.

Studies have shown that children in areas with low fluoride levels (where the water supply is not fluoridated) have poor oral health and up to 5 times more tooth decay than children living in more affluent areas with fluoridated water.

Even in areas that have optimum water fluoridation, fluoride toothpaste provides extra protection and can help prevent cavities.

How much fluoride is adequate?

Children younger than 3 years of age should use fluoridated toothpaste with at least 1000 ppm (parts per million) of fluoride. The American Dental Association recommends children younger than 2 years old use a “smear” of fluoride toothpaste (approximately 0.1 gram of toothpaste or 0.1 milligram of fluoride) for children younger than 2 years and a pea-sized amount (approximately 0.25 g toothpaste or 0.25 mg fluoride) for children from 2 to 6 years of age.

People over the age of 3 years should use fluoridated toothpaste that contains 1350-1500 ppm of fluoride.

In areas where the local water supply has suboptimal levels of water fluoridation, the American Dental Association recommends giving fluoride supplements to children between the ages of 6 months and 16 years who are at high risk of tooth decay.

What deficiency causes fluorosis?

Fluorosis is not caused by a deficiency. Rather, it is instead a dental condition resulting from too much fluoride intake during tooth development or during the early years of life.

What causes enamel fluorosis?

As mentioned, the risk of developing fluorosis is linked to too much fluoride intake in the early years of life when the permanent teeth are developing. The severe form of fluorosis can occur if children under 7 years of age, who live in areas with fluoridated drinking water, take fluoride supplements. The risk of developing dental fluorosis also increases if young children swallow too much toothpaste.

Who can develop fluorosis?

According to the Centers for Disease Control and Prevention, dental fluorosis occurs when a child takes in too much fluoride over a long period at an age when tooth formation occurs (when the teeth are developing under the gums). Therefore, the risk of developing fluorosis is present in children aged 8 years and younger with permanent teeth are developing. Older children (over 8 years of age), teenagers, and adults cannot develop fluorosis. However, the effects on the tooth enamel from dental fluorosis are permanent and may be visible in older children, adolescents, and adults.

What are the symptoms of too much fluoride?

Mild fluorosis appears as fine white or pearly lines on less than 25% of the surface of the tooth enamel. This flecking of the enamel surface on a child’s teeth from mild dental fluorosis is often challenging to notice without a dental examination and may only be identifiable by a trained dentist or dental professional.

People with moderate forms of dental fluorosis may have a few white flecks on 20-50% of the enamel surfaces. The affected teeth may display noticeable white or brown spots, and the enamel may have a rough texture.

In severe forms of enamel fluorosis, the enamel can be significantly affected, with discoloration and pitting covering over 50% of the enamel surface. The teeth may appear stained, brown, or black, and the tooth enamel may be significantly damaged, leading to sensitivity and increased susceptibility to decay.

Can infant formula cause fluorosis in baby teeth?

Ready-to-feed formula does not have a high fluoride content. However, powdered formula and concentrated liquid, which are mixed with water, can introduce fluoride and increase the risk of dental fluorosis, especially if they are the baby’s main food source and the water supply is fluoridated.

Does fluorosis need treatment?

The treatment for fluorosis depends on the severity of the condition and the cosmetic concerns of the individual. In many cases, mild to moderate fluorosis does not require treatment. It is not harmful and does not affect tooth function. However, cases of moderate dental fluorosis can be a cosmetic concern due to the discolored and mottled enamel. For more severe cases of fluorosis, where the tooth surface has significant discoloration, pitting, or rough texture, cosmetic treatments may be considered to improve the appearance of the teeth.

Can you reverse dental fluorosis?

Unfortunately, there is no way to reverse dental fluorosis once it develops. However, treatments are available to mask the appearance of this condition.

What is the best treatment for dental fluorosis?

As mentioned, mild forms of dental fluorosis are frequently only detected by the child’s dentist. However, more severe forms of fluorosis may result in discoloration that is easily noticeable. In severe cases, the tooth enamel can develop large white spots or turn yellow or brown. People with a severe form can also develop roughly pitted enamel.

Treatment for severe forms of dental fluorosis may consist of the following;

Professional Teeth Whitening

Brushing and flossing at home cannot remove the white flecks from dental fluorosis. However, your dentist can apply a bleaching gel to your teeth to lighten the tooth enamel so that the dental fluorosis is less visible. Teeth whitening works well for mild fluorosis.

Dental Bonding

This treatment involves the use of a composite tooth-colored resin to hide dental fluorosis stains. The application of the resin is followed by polishing to give a natural appearance to the teeth.

Dental Veneers

These are custom-made thin shells of porcelain or resin that are bonded to the front surfaces of your teeth. They can mask the scattered white flecks caused by dental fluorosis.

Dental Crowns

Crowns are custom-made restorations that cover the entire tooth and hide dental fluorosis. A small amount of the natural enamel needs to be removed to apply the crown properly.

Enamel Microabrasion

This treatment involves removing a thin layer of enamel from the teeth to remove fluorosis stains. It is often followed by teeth whitening to give the teeth a uniform color.

How to prevent severe fluorosis?

To prevent fluorosis, parents should supervise young children when they brush their teeth until they are about 7 years old. They should ensure the child uses the proper amount of children’s fluoride toothpaste. The child should be encouraged to spit out after brushing and not swallow the fluoridated toothpaste.

Additionally, parents should find out the fluoride concentration in their drinking water, especially if they have young children under 8 years old at home. This information can be used to make decisions about using fluoride-containing dental products, especially dietary supplements containing fluoride, such as tablets or drops, for a young child. Fluoride supplements should not be used if the fluoride level in drinking water is the recommended 0.7 mg/L or higher.

Last but not least, it is important to take every child for regular visits to the dentist to prevent tooth decay. This will also help to optimize a child’s dental health and aid in the early identification of conditions such as dental fluorosis.

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