S.S Hotchandani

•
•
•
•
White Spots?
White Streaks?
Cloudy Splotches?
Brown Stains?

• Fluorosis is a defect of tooth enamel
caused by too much fluoride intake
during the first 8 years of life.
• Although fluorosis can be cosmetically
treated, the damage to the enamel is
permanent.
• Common causes of fluorosis include:
– fluoridated drinking water (particularly
during infancy),
– ingestion of fluoride toothpaste,
– use of fluoride tablets,
– consumption of processed foods made with
fluoridated water.

• Worldwide in distribution
• Endemic in 22 countries
• Asia and in Asia,India and China are
worst affected
• Mexico in North and Argentina in
Latin America
• East and North Africa are also
endemic

• Developmental Disturbance.
• NOT a disease but rather affects the
way that teeth look.
• Dental fluorosis is a defect of the teeth
marked by increased porosity of the
enamel (a condition known as
“Hypomineralization“).

• The safe level for daily fluoride intake is
0.05 to 0.07 mg F/Kg/day. Above this
level, the risk of developing fluorosis
due to chronic fluoride consumption
will be evident

• Teeth are generally composed of
hydrooxyapatite and
Carbonated Hydro oxyapatite;
– as the intake of fluoride increases, so
does the teeth's composition of
fluroapatite.

• Inappropriate use of fluoridecontaining dental products such as
Toothpastes and mouth rinses.
• taking a higher-than-prescribed
amount of a fluoride supplement
during early childhood.
• taking a fluoride supplement when
fluoridated drinking water or fluoridefortified fruit juices and soft drink
already provide the right amount.

• Tiny white specks or streaks
• Dark brown stains and rough, pitted
enamel .
• Teeth that are unaffected by fluorosis
are smooth and glossy.
• They should also be a pale creamy
white.

• Dental fluorosis comes in various
stages of severity.
• The severity of fluorosis increases
with the dose of fluoride the child
consumes, and can be exacerbated
by nutritional deficiencies and
kidney impairment.

• Dentists generally use the “Dean Index” to
diagnose the severity of a child’s fluorosis.
• Developed in the 1930s and 1940s by the
“Father of Fluoridation”
(H. Trendley Dean),
• Dean Index classifies fluorosis into five
types:
–
–
–
–
–
“questionable,”
“very mild,”
“mild,”
“moderate,”
“severe.”

• The enamel discloses slight aberrations
from the translucency of normal enamel,
ranging from a few white flecks to
occasional white spots.
• This classification is utilized in those
instances where a definite diagnosis of
the mildest form of fluorosis is not
warranted and a classification of ‘normal’
is not justified.”

Small opaque paper-white areas are scattered
over less than 25% of the tooth surface.

White opaque areas on the surface are more
extensive but still affect less than 50% of the
surface.

All enamel surfaces of the teeth are affected,
and the surfaces subject to attrition show
wear. Brown stain is frequently a disfiguring
feature.”

All enamel surfaces are affected and hypoplasia is so marked that
the general form of the tooth may be affected. The major
diagnostic sign of this classification is discrete or confluent pitting.
Brown stains are widespread and teeth often present a corrodedlike appearance.

• Mild, no treatment is needed.
• The appearance of teeth affected by
moderate-to-severe fluorosis can be
significantly improved by a variety of
techniques.
• Such techniques may include:
– Tooth whitening and other procedures to
remove surface stains
– Bonding, which coats the tooth with a hard
resin that bonds to the enamel
– Crowns
– Veneers, which are custom-made shells
that cover the front of the teeth to
improve their appearance

• Parental vigilance is the key to preventing
fluorosis.
– At home, keep all fluoride-containing products
such as toothpaste, mouth rinses, and
supplements out of the reach of young children.
• Since the major source of fluoride is drinking
water, de-fluoridation is the best preventive
measure which can be carried out at domestic
as well as community level.
• Nutritional interventions like high intake of
vitamin C and Calcium also helps reduce the
problem.