Fluorosis is a lesion of tooth enamel associated with constant and prolonged ingestion of excessive amounts of fluoride. Pathology can be endemic and professional in nature. It is manifested by the appearance of whitish, and then yellow spots or stripes on the teeth, erosive or destructive changes in the enamel. In severe cases, it is accompanied by damage to the skeletal bone tissue. In case of diagnosis of fluorosis, the patient first needs to change the drinking water he uses. Treatment consists mainly in aesthetic and mineral restoration of the affected teeth. For this purpose, bleaching, remineralization, restoration, installation of crowns are carried out.
Cases of fluorosis were described as early as 1890. For a long time, these changes in teeth were called “spotted enamel” and the causes of their occurrence were not known. It was only in 1931 that a link was established between the disease and too much fluorine in the water, which formed the basis of its name — “fluorosis” (from the Latin “fluorom” – fluorine). Endemic fluorosis is common in those regions where the fluoride content in 1 liter of drinking water exceeds 1.5 mg. Much less common is professional fluorosis, which develops in workers of the aluminum industry and is associated with an increased concentration of fluoride in the inhaled air.
Fluorine is a trace element that, along with calcium, potassium, magnesium and others, participates in physiological processes occurring in the human body. The greatest amount of fluoride is found in bone tissue and in teeth. Its entry into the body occurs with food and water. However, the fluorine contained in the products is absorbed only in a small amount, the bulk of the fluoride entering the body falls on fluorides dissolved in water. Water with a fluorine content of 1 mg/l is considered optimal. A lower concentration of fluoride in water leads to an insufficient amount of this trace element entering the body and can cause the development of dental caries. An increased concentration of fluoride causes fluorosis.
Fluorosis is most often observed in the eruption of permanent teeth in children who lived up to 3-4 years in areas with an increased concentration of fluoride in water. This gives reason to believe that the development of fluorosis is associated with the negative impact of excess fluoride on the formation of the rudiments of permanent teeth. The defeat of milk teeth by fluorosis is practically not found, since their rudiments are formed during intrauterine development, when excess fluoride is delayed by the placenta and is not transmitted to the fetus. Fluorosis of already formed teeth in adults can be observed with a sharply increased concentration of fluoride in water — from 6 mg / l and above.
Due to the occurrence, dentistry distinguishes endemic and professional fluorosis. According to clinical manifestations, there are 5 forms of the disease: spotted and dashed, chalky-speckled, erosive and destructive. The first two forms are attributed to mild fluorosis. The chalky-speckled form is considered to be a moderate fluorosis, and the erosive and destructive forms are considered to be a severe degree of fluorosis.
Often, in a patient with a pronounced degree of fluorosis, different groups of teeth are affected by different forms of the disease. According to the observation of some authors, the resulting form of fluorosis persists in the patient for life and does not transform into another form even when the concentration of fluoride in the consumed water changes.
Endemic fluorosis is manifested by the appearance of white spots or stripes on the buccal surface of the teeth. Within a few years, there is a change in the color of the spots to yellow and even brown. The most common lesion of the incisors of the upper, less often — the lower jaw. With a significantly increased concentration of fluoride in water, there is damage to other teeth, the erasure of tooth enamel, the formation of erosions and chips.
The dashed form of fluorosis is manifested by the appearance of chalk strokes or stripes on the vestibular surface of the incisors. In some cases, they are clearly visible, but more often they are poorly expressed and become better visible when the dental surface is dried. It is possible to merge the stripes into spots, but at the same time, individual stripes can always be distinguished in the structure of the spot.
Spotty form of fluorosis – on the dental surface there are clearly visible multiple whitish spots without stripes, which, when merged, can form a large diameter spot. The surface of the fluorosis spots is shiny and smooth, the borders are not pronounced sharply and smoothly turn into healthy enamel.
The chalky-speckled form of fluorosis is characterized by a matte shade of the entire enamel of the affected teeth with clearly defined pigmented spots and dots located on it. In some cases, the enamel has a yellow tint. There may be areas of destruction on it — specks with a depth of 0.1-0.2 mm and a diameter of up to 1.5 mm, having a pigmented bottom. With this form of fluorosis, patients experience rapid erasure of the enamel with the exposure of dark brown dentin located under it.
The erosive form of fluorosis is characterized by the presence of areas of enamel destruction much larger than the speckles of the chalky-speckled form of fluorosis — erosions. In the area of erosion, there is no enamel at all. There is a pronounced erasure of enamel on the chewing surface of the teeth.
The destructive form of fluorosis is accompanied by erosive lesions and the erasure of not only the enamel, but also the underlying hard tissues of the tooth. Tooth tissues become brittle, prone to breakage, due to which the shape of the dental crown is disrupted. However, the deposition of replacement dentin prevents the opening of the dental cavity. The destructive form of fluorosis is usually observed in regions where the fluoride content in water exceeds 10 mg/l.
Professional fluorosis is manifested by damage to the bones of the skeleton (osteoporosis, osteosclerosis) with impaired mobility in the joints. Stains on the teeth may be absent. At a late stage of professional fluorosis, vegetative-vascular disorders and liver damage are added. It is possible to develop a malignant neoplasm of bones — osteosarcoma.
When detecting fluorosis, the patient is recommended to take the drinking water he uses for analysis to determine the fluoride content in it. With an increased concentration of fluoride, it is necessary to change the source of drinking water or use water purified from fluoride. Further drinking of water with an increased content of fluoride can lead to the appearance of a more severe form of fluorosis in the patient with the destruction of the affected teeth. Patients with fluorosis should refrain from using toothpastes and other oral care products containing fluoride.
Removal of the affected areas of the tooth with subsequent filling with fluorosis is not used, as this often leads to the loss of the seal and further destruction of the tooth. A patient with fluorosis is recommended to take calcium and phosphorus preparations.
With a mild form of fluorosis, chemical, LED or laser teeth whitening is performed. After it, the tooth is necessarily remineralized, which consists in applying phosphorus and calcium compounds to the tooth enamel using ultraphonophoresis, electrophoresis or by application. Remineralization of a tooth with fluorosis requires at least 10 procedures, optimally 15-20 procedures per course of treatment.
The bleaching procedure turns out to be ineffective with pronounced chalky-speckled and erosive and destructive forms of fluorosis. In these cases, dental restoration using veneers or lumineers is used. In severe fluorosis with destructive changes in tooth tissues, treatment with an orthopedist with the installation of a ceramic or metal-ceramic crown is indicated.
The main direction of preventive measures in regions with an increased amount of fluoride in water is to reduce the amount of fluoride entering the body. To do this, it is necessary to use purified drinking water or water with a normal fluoride content brought from other areas; avoid the use of toothpastes and gels with fluoride; limit the use of fluoride-containing products (fish, butter, etc.).
In the prevention of fluorosis in children, a rational diet rich in dairy products and vitamins is of great importance. If necessary, calcium supplements, vitamins C and D, multivitamin complexes are additionally used.
- Abanto Alvarez J., Rezende K.M., Marocho S.M., Alves F.B., Celiberti P., Ciamponi A.L. Dental fluorosis: exposure, prevention and management // Med Oral Patol Oral Cir Bucal. — 2009; 14(2): E103-7.link
- Zhang Y., Cheng R., Cheng G., Zhang X. Prevalence of dentine hypersensitivity in Chinese rural adults with dental fluorosis // J Oral Rehabil. — 2014; 41(4): 289-95. link
- Aussi G. S. Hereditary disorders of the development of hard tissues of teeth // Nutrition of experimental and clinical medicine. – 2013. – No. 17, T. 2. – S. 236241.
- Iordanishvili A. K., Soldatkina A. S. Diseases of organs and tissues of the oral cavity in young people // Institute of Dentistry. – 2015. – No. 3. – S. 38-41.
- Kirillova E.V., Matelo S.K., Merchant T.V. Dental fluorosis is a status issue in modern aesthetic dentistry // Modern Dentistry. – 2010. – No. 5. – S. 14-14. link