Fluorosis

What Is It?

Your permanent teeth form under your gums in the jawbone during early childhood. They appear in your mouth after the primary or "baby" teeth are lost. The crowns of nearly all of the permanent teeth are fully formed by the time you are about 8 years old. The exception is the wisdom teeth, which form in young adulthood. The crown is the part of a tooth you can see in your mouth.

Consuming too much fluoride while the teeth are being formed can lead to fluorosis. This condition causes white or brown discoloration or spots on the enamel, or tooth surface. The effects can range from minor color changes to surface irregularities of the teeth. Fluorosis does not develop after teeth have erupted into the mouth.

Fluorosis is a cosmetic condition, not a disease. Often, it is so mild that only a dental professional can detect it. Most cases of fluorosis result from young children taking fluoride supplements or swallowing fluoride toothpaste when the water they drink is already fluoridated.

Symptoms

Teeth affected by mild fluorosis may show no changes or changes visible only to a dental professional. Mild to moderate fluorosis produces white lines, streaks or spots. In more severe fluorosis, the teeth can become pitted and have brown, gray or black spots. The enamel also may have an unusual shape.

Diagnosis

Your dentist and dental hygienist will ask about your child's fluoride intake. This will help to determine if the discoloration seen is a result of fluorosis. They also will ask about past and present medical conditions or disabilities that may affect your child's teeth. Your dentist will examine your child's teeth and gums and take X-rays to make sure the teeth have no other defects or cavities.

Other conditions may look like fluorosis. Developmental defects and problems with the skull or bones of the face can disrupt the enamel or dentin of the teeth. In addition, high fevers or trauma (such as a fall that injures a tooth) in infants or young children may discolor teeth. Young children can get cavities in their primary teeth, so any tooth discoloration should be checked at the dental office.

Expected Duration

The spots and stains left by fluorosis are permanent. They may darken over time.

Prevention

If you have a child under 6, put only a small pea-sized amount of toothpaste on his or her toothbrush. Encourage your child to spit rather than swallow after brushing. Avoid toothpastes with flavors that may encourage swallowing. Keep all fluoride-containing products out of the reach of young children. These include toothpastes and mouthwashes.

Adding fluoride to drinking water is one of the great preventive disease programs of the 20th century. Children should take fluoride supplements only if the water they drink does not contain enough fluoride. If your child is taking fluoride supplements now, check the amount of fluoride in your water. If you are on a public water supply, call your supplier to ask about the fluoride level. You can also have your dentist check a sample of your water. Then discuss with your dentist or pediatrician whether your child needs fluoride supplements.

Some foods and drinks contain fluoride. For example, many fruit juices and soft drinks contain fluoride at levels similar to fluoridated water. Some bottled waters now have added fluoride. All of this can add up. It is important to know how much fluoride your child consumes.

Treatment

Remember that fluorosis affects only the appearance of teeth. It does not result in cavities. As a result, most of the treatment for fluorosis consists of masking the stain.

Many cases of fluorosis are minor enough not to need treatment. Sometimes fluorosis occurs only on the back teeth, where it can't be seen. More serious cases and cases involving the front teeth can be treated by removing the surface-stained areas through tooth whitening or other procedures. Severe cases of fluorosis can be covered with bonding, crowns or veneers.

When To Call a Professional

If you notice white streaks or spots on your child's teeth or notice that one or more teeth are discolored, contact your dental office.

Prognosis

Teeth affected by fluorosis are not diseased. Fluorosis will not result in cavities or other dental problems. Concerns about appearance can be addressed with whitening to remove surface stains and veneers or other procedures to cover the discoloration.