Dental fluorosis in perspective

Article Abstract:

The causes and prevention of enamel fluorosis (a condition of the teeth in which the enamel becomes discolored) are discussed in this article. Fluorosis can appear in various forms, from a faint frosty white streaking to an obvious opaque white mottling. In extreme cases, pitting and brown staining occur. The tissues appear as an inadequately mineralized zone beneath the tooth's surface, covered over with a well-mineralized surface enamel layer. Fluorosis is related to excessive ingestion of fluoride; water is fluoridated at levels below those that cause the disorder. Water fluoride concentrations of 1 ppm (part per million) are optimal, and this level is not associated with adverse effects. However, the incidence of fluorosis has increased in regions where water is fluoridated and in regions where it is not. This is largely due to the increased availability of fluoride in supplements, vitamins, toothpastes, beverages, and other products. Such sources contain unpredictable amounts of fluoride. Even though enamel fluorosis is not a health hazard, excessive use of fluoride should not be encouraged. Children from the ages of three to six are the most vulnerable for fluorosis of permanent teeth. This appears to be associated with the use of fluoride supplements, even at recommended dosages; it is likely that dosage regimens will be reformulated. Evidence for the contribution of fluoridated toothpastes to fluorosis is equivocal, but the use of only pea-sized amounts of toothpaste by children is recommended. The introduction of a low-fluoride toothpaste for young children is also desirable. Infant formula manufacturers reduced the fluoride content of their products in the 1970s. When fluoride is used to prevent tooth decay, attention should be paid to the possibility of excess levels causing fluorosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Mottled enamel

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Risk of fluorosis in a fluoridated population: implications for the dentist and hygienist

Article Abstract:

Children who grow up in communities with optimal water fluoridation may have an increased risk of fluorosis if they brush their teeth at least twice per day with more than a pea-sized amount of toothpaste. Fluorosis results from excessive fluoride ingestion that causes mottled teeth. Researchers used parental surveys to identify fluorosis risk factors in 248 middle-school-aged children who grew up in optimally fluoridated communities. Of these, 146 children had mild to moderate fluorosis on their upper front teeth and 102 were fluorosis-free. Brushing at least twice a day with more than the recommended pea-sized amount of toothpaste during the first eight years of life accounted for 71% of fluorosis cases. Unnecessary fluoride supplements during the first eight years of life accounted for 25% of fluorosis cases. Brushing more than once a day with a pea-sized amount of toothpaste or less and formula feeding during infancy were not associated with an increased risk of fluorosis.

Health aspects, Risk factors, Cover Story

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Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional

Article Abstract:

Parents should be careful not to expose their young children to excess fluoride levels. In a study of 633 young children, over 60% of the children with fluorosis had used too much toothpaste or received fluoride supplements. Fluorosis is a tooth disease caused by excess fluoride.

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