Fluorosis

Depending upon the severity and the extent of tooth discoloration, fluorosis can be categorised as follows:

• Questionable: Only a few light-white spots and flecks on the tooth surface.
• Very mild: Light-white areas covering less than 25% of the tooth surface.
• Mild: Light-white areas covering up to 50% of the tooth surface.
• Moderate: Light brown or white patches covering over 50% of the tooth surface.
• Severe: White or dark brown spots affecting nearly all teeth, often with pitting of the enamel. 

Fluorosis symptoms typically present as:

• Visible discoloration of teeth (white or brown spots)
• In severe cases, surface irregularities (pitting of enamel)

Dental fluorosis primarily develops when children are exposed to excess levels of fluoride during their developmental years, before the eruption of the adult (permanent) teeth. Teeth that have already erupted cannot develop fluorosis. Common sources of fluoride include: 

• Swallowing fluoride toothpaste
• Drinking water with high fluoride levels
• Unsupervised use of fluoride supplements 

Given that fluorosis only affects the developing teeth (under the gums), it does not occur in adults.

Fluorosis is often diagnosed during routine dental examinations. Dentists visually examine the teeth to differentiate fluorosis from other causes of discoloration. 

Since brushing and flossing cannot remove fluorosis stains, cosmetic dental treatments are the main option. Several factors, including the severity of fluorosis and the patient’s personal preferences and budget, influence the choice of treatment. The common methods for fluorosis treatment are:

• Teeth whitening: The teeth are treated with a bleaching gel for a specific time duration which lightens the tooth enamel to a shade that matches the white specks of fluorosis. This is often a viable option for patients with mild fluorosis.
• Dental bonding: A tooth-coloured composite resin is used to conceal the fluorosis stains. Then, the dentist then polishes and shapes the teeth for a natural look.
• Dental veneers: Custom-made veneers (thin resin, ceramic, or porcelain shells that adhere permanently to the front surfaces of the teeth) are created by making a dental impression to achieve the correct size and fit.
• Dental crowns: Similar to veneers, crowns are often custom-made. However, because crowns are fit over the entire tooth, some enamel removal is done to ensure a proper fitting of the crown.
• Enamel microabrasion: A small layer of tooth enamel is removed to eliminate several fluorosis stains. Often, enamel microabrasion is combined with teeth whitening to ensure uniformity in teeth colour.

If the fluorosis stains are noticeable and affect confidence, or pitting appears on multiple teeth, patients are advised to schedule an appointment with a dentist, who will discuss the treatment options in detail.

Fluorosis can be prevented by managing fluoride exposure in children:

• Supervise brushing and ensure children do not swallow toothpaste.
• Use only a pea-sized amount of fluoride toothpaste.
• Check local water sources for fluoride levels.

For diagnosis and treatment of fluorosis, consult a:

• General dentist (for assessment, preventive advice, and mild treatment)
• Cosmetic dentist or Prosthodontist (for advanced cosmetic treatments like veneers, crowns, or bonding)