Dental fluorosis

Dental fluorosis is a change in the hard outer layer of the teeth (the enamel). It happens when a child takes in too much fluoride while teeth are still forming. This can make the enamel look different. The color may change. In strong cases, the enamel can be weaker than normal.

In very mild cases, there are small white spots that cover less than one quarter of the tooth. In mild cases, the white areas can cover up to half of the tooth. In moderate cases, all surfaces are affected. Brown stains may show. In severe cases, the enamel may have many pits. Teeth can look brown and rough.

People with fluorosis often get fewer cavities than others. But the color changes can cause worry about appearance. In moderate to severe cases, teeth can be weaker and may wear down more easily.

 Diagnosis 
Dentists usually diagnose fluorosis by looking at clean, dry teeth with good light. The look of fluorosis can change from person to person. It depends on how long, how much, and when the child took in fluoride. Mild fluorosis often shows as small, white, cloudy areas without clear borders. With more severe fluorosis, the enamel under the surface becomes more porous (less mineral). Yellow or brown stains can appear. Pits may also appear in strong cases.

Other tooth problems can look like fluorosis. These include:
 Turner's hypoplasia (often in one area)
 Enamel changes from untreated celiac diseaseDental Enamel Defects and Celiac Disease  National Institutes of Health (NIH)
 Some mild forms of amelogenesis imperfecta and enamel hypoplasia
 Enamel defects after infection or trauma in the baby tooth
 Tooth decay (sometimes confused with fluorosis)

 Classification 
Dentists use simple scales to record how strong fluorosis is.

 Dean's index 
The dentist gives a score from 0 to 5. The score is based on the most affected two or more teeth.
 Class  Code  Short descriptionNormal0Enamel looks normal. Smooth and shiny.Questionable1A few white flecks or small spots.Very mild2Small white spots cover less than 25% of tooth.Mild3White areas cover up to half of tooth.Moderate4All surfaces affected. Wear and brown stains common.Severe5All surfaces affected with many pits. Tooth shape may change. Brown stains are widespread.

 TF index 
The Thylstrup–Fejerskov index (TF index) gives a score from 0 to 9. It helps describe mild to very severe changes in more detail.

 Causes 
Fluorosis happens only while teeth are forming in childhood. The risk is highest from birth to about 6 years old. It may be most important in the first two years of life. After about age 7, most permanent teeth (except wisdom teeth) have finished forming, so the risk becomes very low.

Too much fluoride can come from many places. Examples include swallowing toothpaste, using too much mouth rinse, taking fluoride tablets when not needed, some foods and drinks, and public water fluoridation.
Very high natural fluoride in well water, some brick teas, or smoke from coal with high fluoride can also cause severe fluorosis.

Genes may affect who gets fluorosis more easily than others.

 How it happens 
Scientists think fluoride changes how enamel forms. It may affect the cells that make enamel (ameloblasts). It may also change the way certain proteins and minerals are broken down or removed. The result is enamel with less mineral. This enamel looks more opaque and can be brittle in strong cases.

 Management 
Dental fluorosis may or may not be a cosmetic concern. In some cases, there can be social or personal worry. Treatment choices include:
 Mild cases: Tooth bleaching
 Moderate cases: Enamel microabrasion (removes a thin outer layer)
 Severe cases: Composite fillings, micro-abrasion, veneers, or crowns

 Epidemiology 
Fluorosis is common in the United States. One report found 41% of adolescents with definite fluorosis and another 20% with “questionable” signs. Later surveys also showed increases compared with the 1980s and 1990s.

 Prevention 
To prevent fluorosis, keep total fluoride intake low during early childhood. Examples:
 Use only a small smear or pea-sized amount of fluoride toothpaste for young children, and help them spit it out.
 Follow local advice about water fluoride levels.
 Ask a dentist or pediatrician before using supplements in fluoridated areas.
Public health groups say water fluoridation is safe and helps prevent tooth decay, but too much fluoride in early childhood can cause mild fluorosis.Frequently Asked Questions, American Dental Association (archived)

 History 
Writers in ancient times may have described teeth like fluorosis. In 1901, a U.S. dentist, Frederick McKay, reported “Colorado brown stain.” Later work showed the cause was fluoride in drinking water during childhood. H. Trendley Dean studied the problem and made a simple scale (Dean’s Index) that is still used today. Over time, scientists also found that the right amount of fluoride helps prevent tooth decay.

 References 

 Other websites 

Category:Developmental tooth disorders
Category:Toxic effects of dietary elements
Category:Fluorine