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DENTAL FLUOROSIS

What is dental fluorosis?

Dental fluorosis is caused by too much fluoride intake during tooth development, which is usually before the age of eight. An excessive amount of fluoride may come into the body in several ways. During toothbrushing children can swallow fluoride toothpaste, which is normally not a problem if it is used in a recommended amount, specially in the countries where fluoride isn’t added anywhere else. It can become a bigger problem in a countries where additional fluoride is added in a water, milk, salt, etc. and it’s concentration is harder to control. Teeth can become discolored.Fluorosis can be mild or severe. Mild fluorosis can be seen in a form of a white spots and lines, whereas severe fluorosis may be seen as pitted brown discolouration of the teeth. Fluorosis is irreversible, which means stains on teeth remain, unless they are treated. Teeth affected by fluorosis are generally more resistant to caries, but otherwise they are healthy. Problem is mostly esthetics, especially in front teeth. Removing these teeth is therefore not a good solution, because there are many other less invasive procedures.

How to prevent fluorosis?

Fluorosis can be prevented with limited intake of fluoride supplements given to children. The amount of toothpaste should be in a size of a pea grain (if it is swallowed, it has no adverse effect). In other words, children’s toothpaste should be applied to a children’s tootbrush transversely rather than longitudinally.

What is treatment of dental fluorosis?

Treatment of dental fluorosis in permanent teeth can take place in several ways:
  1. Microabrasion. This is the least invasive method. On teeth is first applied acid and then they are sandblasted. This removes a thin layer of enamel. At the end, there is applied a fluoride coating which helps remineralize enamel. The topical application of fluoride does not cause fluorosis, only systemic intake can cause it. Progress in the appearance of teeth is largely dependent upon the amount of abrasion of the enamel. This procedure often has to be repeated several times in order to achieve a satisfactory result.
  2. Dental porcelain veneers. They are the most aesthetic solution. Thin porcelain veneer adheres on the front of defective teeth. Teeth are needed to be prepared with dental bur in the thickness of 1 mm. Dentist takes an impression and dental technician makes a dental veneer. On the next visit it can be cemented on teeth if it fits perfectly. There can be some issues with masking the color of a very dark teeth, because a dental veneer is quite thin. Dentist should know which option is the best for each individual.
  3. Direct composite veneers. This procedure is similar to the procedure of making porcelain veneers. Tooth’s front surface is prepared with a dental bur and then in one session composite material is applied. The downside of this method is that it is not such a long-term solution as porcelain veneer and they need to be replaced after a few years with a porcelain veneer or a crown.
  4. Dental crown. The entire tooth must be prepared with a dental bur, which is why this is the least conservative method. On prepared tooth artificial dental crown is fitted. Fluorosis is often solved in this way, especially in the cases of severe fluorosis.

What other conditions can mimic dental fluorosis?

  1. calcium deficiency,
  2. phosphorus deficiency,
  3. vitamin D deficiency,
  4. amelogenesis imperfecta,
  5. bottle caries

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