http://en.wikipedia.

org/wiki/Dental_fluorosis

Dental fluorosis
From Wikipedia, the free encyclopedia
Dental fluorosis
Classification and external resources

A mild case of dental fluorosis (the white

streaks on the subject's upper right central
incisor) observed in dental practice
ICD-10 K00.3
ICD-9 520.3

Dental fluorosis is a health condition caused by a child

receiving too much fluoride during tooth development. The critical
period of exposure is between 1 and 4 years old; children over age 8
are not at risk.[1][2] In its mild form, which is the most common,
fluorosis appears as tiny white streaks or specks that are often
unnoticeable. In its severest form, which is also called mottling of
dental enamel, it is characterized by black and brown stains, as well
as cracking and pitting of the teeth.[3]

The severity of dental fluorosis depends on the amount of

fluoride exposure, the age of the child, individual response, as well
as other factors including nutrition.[1] Although water fluoridation can
cause fluorosis, most of this is mild and not usually of aesthetic
concern.[4] Severe cases can be caused by exposure to water that is
naturally fluoridated to levels well above the recommended levels,
or by exposure to other fluoride sources such as brick tea or
pollution from high fluoride coal.[5]

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Contents

1 Physiology
2 Dean's Index
3 Prevalence
4 American Dental Association
advisory
5 Treatment
6 References
7 External links

1. Physiology

Dental fluorosis occurs because of the excessive intake of

fluoride, either through fluoride in the water supply, naturally
occurring or added to it; or through other sources. The damage in
tooth development occurs between the ages of 3 months to 8 years,
from the overexposure to fluoride. Teeth are generally composed of
hydroxyapatite and carbonated hydroxyapatite; when fluoride is
present, some fluorapatite is generated. Excessive fluoride can
cause white spots, and in severe cases, brown stains or pitting or
mottling of enamel. Fluorosis cannot occur once the tooth has
erupted into the oral cavity. At this point, fluorapatite is beneficial
because it is more resistant to dissolution by acids
(demineralization). Although it is usually the permanent teeth which
are affected, occasionally the primary teeth may be involved.

The differential diagnosis for this condition may include Turner's

hypoplasia (although this is usually more localized), some mild forms
of amelogenesis imperfecta, and other environmental enamel
defects of diffuse and demarcated opacities.

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2. Dean's Index

A severe case of dental fluorosis, or "mottled dental enamel."

H.T. Dean's fluorosis index was developed in 1942 and is

currently the most universally accepted classification system. An
individual's fluorosis score is based on the most severe form of
fluorosis found on two or more teeth.[6]

Dean's Index
Classifica
Criteria – description of enamel
tion
Normal Smooth, glossy, pale creamy-white translucent surface
Questiona
A few white flecks or white spots
ble
Small opaque, paper white areas covering less than 25%
Very Mild
of the tooth surface
Opaque white areas covering less than 50% of the tooth
Mild
surface
All tooth surfaces affected; marked wear on biting
Moderate
surfaces; brown stain may be present
All tooth surfaces affected; discrete or confluent pitting;
Severe
brown stain present

3. Prevalence

As of 2005 surveys conducted by the National Institute of Dental

Research in the USA between 1986 and 1987[7] and by the Center of
Disease Control between 1999 and 2002[8] are the only national
sources of data concerning the prevalence of dental fluorosis.

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NIDR and CDC findings

198 200
Deans Index
7 2
Questionable 11.8
fluorosis 17% %
Very mild fluorosis 19%
5.83
Mild fluorosis 4%
%
Moderate fluorosis 1% 0.59
Severe fluorosis 0.3% %
22.3 37.2
Total
% %

The U.S. Center of Disease Control found a 9% higher

prevalence of dental fluorosis in American children than was found in
a similar survey 20 years ago. In addition, the survey provides
further evidence that African Americans suffer from higher rates of
fluorosis than Caucasian Americans.

The condition is more prevalent in rural areas where drinking

water is derived from shallow wells or hand pumps. It is also more
likely to occur in areas where the drinking water has a fluoride
content greater than 1 ppm (part per million), and in children who
have a poor intake of calcium.

Dietary reference intakes for fluoride[7]

Adequate
Reference Tolerable upper
Age group intake
weight kg (lb) intake (mg/day)
(mg/day)
Infants 0-6
7 (16) 0.01 0.7
months
Infants 7-12
9 (20) 0.5 0.9
months
Children 1-3
13 (29) 0.7 1.3
years
Children 4-8
22 (48) 1.0 2.2
years

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Children 9-13
40 (88) 2.0 10
years
Boys 14-18
64 (142) 3.0 10
years
Girls 14-18
57 (125) 3.0 10
years
Males 19 years
76 (166) 4.0 10
and over
Females 19
61 (133) 3.0 10
years and over

If the water supply is fluoridated at the level of 1 ppm, one must

consume one litre of water in order to take in 1 mg of fluoride. It is
thus improbable a person will receive more than the tolerable upper
limit from consuming optimally fluoridated water alone.

Fluoride consumption can exceed the tolerable upper limit when

someone drinks a lot of fluoride containing water in combination
with other fluoride sources, such as swallowing fluoridated
toothpaste, consuming food with a high fluoride content, or
consuming fluoride supplements. The use of fluoride supplements as
a prevention for tooth decay is rare in areas with water fluoridation,
but was recommended by many dentists in the UK until the early
1990s. Coal burning can pollute air with fluoride: indoor air with
approximately 60 µg F/m³ and drinking water with 3.6 mg F/L are
similarly toxic to developing permanent teeth.[9]

Dental fluorosis can be prevented by lowering the amount of fluoride

intake to below the tolerable upper limit.

4. American Dental Association advisory

In November 2006, the American Dental Association began

recommending to parents that infants from 0 through 12 months of
age should have their formula prepared with water that is fluoride-
free, or contains low levels of fluoride to reduce the risk of fluorosis.
[10]

5. Treatment

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Before and after porcelain laminate veneers

Dental fluorosis can be cosmetically treated by a dentist. The

cost and success can vary significantly depending on the treatment.
Tooth bleaching, microabrasion, and conservative composite
restorations or porcelain veneers are commonly used treatments.
Generally speaking, bleaching and microabrasion are used for
superficial staining, whereas the conservative restorations are used
for more unaesthetic situations.

6. References

1. ^ a b Alvarez JA, Rezende KMPC, Marocho SMS, Alves FBT,

Celiberti P, Ciamponi AL (2009). "Dental fluorosis: exposure,
prevention and management" (PDF). Med Oral Patol Oral Cir
Bucal 14 (2): E103–7. PMID 19179949.
http://medicinaoral.com/medoralfree01/v14i2/medoralv14i2p1
03.pdf.
2. ^ "... appropriate amount of fluoride is essential to prevent
tooth decay. But fluoride intake above optimal amounts can
create a risk for enamel fluorosis in teeth during their
development before eruption through the gums...""Interim
Guidance on Reconstituted Infant Formula". ADHA.
http://www.ada.org/1767.aspx. Retrieved 2010-11-23.
3. ^ "Enamel fluorosis". American Academy of Pediatric
Dentistry.
http://www.aapd.org/publications/brochures/fluorosis.asp.
Retrieved 2009-02-04.
4. ^ Yeung CA (2008). "A systematic review of the efficacy and
safety of fluoridation". Evid Based Dent 9 (2): 39–43.
doi:10.1038/sj.ebd.6400578. PMID 18584000. Lay
summary – NHMRC (2007).

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5. ^ Fawell J, Bailey K, Chilton J, Dahi E, Fewtrell L, Magara Y

(2006). "Environmental occurrence, geochemistry and
exposure" (PDF). Fluoride in Drinking-water. World Health
Organization. pp. 5–27. ISBN 92-4-156319-2.
http://www.who.int/water_sanitation_health/publications/fluori
de_drinking_water_full.pdf. Retrieved 2009-01-24.
6. ^ (PDF) Fluoridation Facts. American Dental Association.
2005. pp. 28–29.
http://web.archive.org/web/20070307065553/http://www.ada.
org.au/media/Fluoridenow/Documents/AmDA+fluoridation_fac
tsRO.pdf.
7. ^ a b (PDF) Fluoridation Facts. American Dental Association.
2005. p. 29.
http://web.archive.org/web/20070307065553/http://www.ada.
org.au/media/Fluoridenow/Documents/AmDA+fluoridation_fac
tsRO.pdf.
8. ^ "Table 23, Surveillance for Dental Caries, Dental Sealants,
Tooth Retention, Edentulism, and Enamel Fluorosis --- United
States, 1988--1994 and 1999--2002". Centers for Disease
Control and Prevention. 2005.
http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5403a1.htm
#tab23. Retrieved 2006-10-29.
9. ^ Ruan JP, Bårdsen A, Astrøm AN, Huang RZ, Wang ZL,
Bjorvatn K (2007). "Dental fluorosis in children in areas with
fluoride-polluted air, high-fluoride water, and low-fluoride
water as well as low-fluoride air: a study of deciduous and
permanent teeth in the Shaanxi province, China". Acta
Odontol. Scand. 65 (2): 65–71.
doi:10.1080/00016350600931217. PMID 17453423.
10.^ What is the ADA’s interim guidance on infant formula and
fluoride? American Dental Association Website accessed May
28, 2008
http://www.ada.org/public/topics/fluoride/infantsformula_faq.a
sp#2

7. External links

• What is fluorosis? has images of very mild, mild, and

moderate dental fluorosis.

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• Dental Fluorosis (Mottled Teeth) - Peter Meiers, fluoride-

history.de