DENTAL FLUOROSIS Logic and Thato

DEFINITION  Dental fluorosis is an enamel defect caused by an excessive intake of fluorides during the time of enamel formation.

FLUORIDES AND TEETH Fluoride is the most electronegative of all elements, has not only notable chemical qualities, but also physiological properties of great interest and importance for human health and well being. The chemical activity of this fluoride ion makes it more physiologically active than any other metal ion

With low conc. Of the fluoride ion, enzymatic processes maybe inhibited or stimulated, ALSO, interactions with other organic or with inorganic body compartments may occur that are of great importance in physiology Fluorides in very small doses have remarkable influences in dental system ;

(1) A strong influence on the dental system ; Fluoroapatite, which is much more resistant to organic acids (2)On the other hand, with higher doses, a disturbance of enamel formation

SOURCES OF FLUORIDES Toothpastes Fluoridated water Beverages and food processed with fluoridated water Dietary prescription supplements that contain fluorides( tablets and drops) Other professional dental products (e.g., mouth rinses, gels

OVERVIEW-FLUOROSIS Proper amount of Fluorides prevents and controls tooth decay in kids and adults Fluorides work both while teeth are developing and everyday after teeth have developed through the gums Fluorides consumed during tooth development can result in a range of visible changes to enamel of the tooth.......

Hence..... ‘’Fluorosis is the change in the appearance of the tooth’s enamel. These changes can vary from barely noticeable white spots in mild forms to staining and pitting in severe forms‘’ Only occurs when younger children consume too much F, from any source, over long periods, when teeth are developing under gums

Teeth with fluorosis have an increased porosity of the enamel In Milder forms, the porosity is mostly limited to the subsurface enamel In advanced forms; the porosity impacts the surface enamel as well, resulting in extensive pitting, chipping, fracturing and decay of teeth

Discolouration induced by fluorosis, particularly in its advanced forms can cause : Significant embarrassment and stress to the impacted child This may in turn result in adverse on esteem and emotional health

WHO DEVELOPS DENTAL FLUOROSIS Only children aged 8 years and younger can develop dental fluorosis because this is when permanent teeth are developing under the gums. Once the teeth erupt through the gums and are in the mouth, they can no longer develop fluorosis. The teeth of children older than 8 years, adolescents, and adults cannot develop dental fluorosis

FORMS OF DENTAL FLUOROSIS 1.Normal 2.Questionable The enamel represents the usual The enamel discloses slight translucent semivitriform type of structure . aberrations from the translucency of The surface is smooth, glossy, and normal enamel, ranging from a few usually of a pale creamy white color.  white flecks to occasional white spots

3.Very mild 4.Mild 3. Small opaque, paper white areas scattered irregularly over the tooth but not involving as much as 25% of the tooth surface. 4. The white opaque areas in the enamel of the teeth are more extensive but do not involve as much as 50% of the tooth

5.Moderate 6.Severe 5.All enamel surfaces of the teeth are affected, and the surfaces subject to attrition show wear. Brown stain is frequently a disfiguring feature. 6. 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 corroded-like appearance.

CASE STUDY My name is Jennifer and I have severe dental fluorosis. I am now 20 and have had this since I was very young. This has really affected my life to the fullest extent. In elementary, middle, and high school, I was teased really bad by the other kids. People did not understand what I was talking about when I tried to explain, they thought I just did not brush my teeth. I can't smile or even look people in the eye when I talk to them. It is completely devastating. Thank God I am finally getting it fixed. I am going in one month for a Composite Bonding. I wish more people knew how exactly this affects children. Especially when they grow older, everyone would like a nice smile, but this makes it so much worse, especially since it is permanent. To everyone else that has it, remember you are not the only ones!!

Dental Fluorosis: A Cosmetic Effect? "It is a toxic effect and a cosmetic effect. These are not mutually exclusive. It's toxic and it's cosmetic.“ "it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion."  "Common sense should tell us that if a poison circulating in a child's body can damage the tooth-forming cells, then other harm also is likely."

"Like bones, a child's teeth are alive and growing "Like bones, a child's teeth are alive and growing. Flourosis is the result of fluoride rearranging the crystalline structure of a tooth's enamel as it is still growing. It is evidence of fluoride's potency and ability to cause physiologic changes within the body, and raises concerns about similar damage that may be occurring in the bones."

"It seems prudent at present to assume that the ameloblasts are not the only cells in the body whose function may be disturbed by the physiological concentrations of fluoride which result from drinking water containing 1 ppm" 

"The safety of the use of fluorides ultimately rests on the assumption that the developing enamel organ is most sensitive to the toxic effects of fluoride. The results from this study suggest that the pinealocytes may be as susceptible to fluoride as the developing enamel organ."

TREATMENT - Abrasion: Abrasion involves finely sanding off the outer layer of the enamel. It is a common approach when the fluorosis is mild. However, if the fluorosis is of a more advanced severity, abrasion is probably not a good idea as it can bring to the surface of the teeth a highly-porous enamel that will be prone to attrition.

Composite bonding: Composite bonding first involves lightly roughening the area of the damaged enamel. After etching the enamel, a composite resin (with a color matching your teeth) is "glued" on to the exterior of the tooth.

 Porcelain veneers/laminates: Made out of porcelain, veneers form a ceramic shell over the surface of the tooth. Veneers may need to be replaced after several years, however, which can become quite expensive. Treatment options for fluorosis vary and will depend in part on the severity of the fluorosis and what you can afford (some of the treatments are very expensive).

COMPLICATIONS Adverse Thyroid Function; Toxicological Risk of fluoride in Drinking Water, 2006] also outlines the detrimental effect that fluoride has on the endocrine system, especially the thyroid. Total endocrine function has never been adequately studied in relation to total fluoride intake. Bone Cancer; research showes that boys exposed to fluoride between the ages of six to ten were 500–700% more likely to develop osteosarcoma in their late teens than boys that hadn’t been exposed to fluoride. The age that boys are exposed to fluoride is the determining factor. This research has not been disproven.

New science proves there is no significant benefit from swallowing fluoride. Tooth decay decline is often attributed to the practice of water fluoridation. Since tooth decay has also declined in unfluoridated areas worldwide, fluoridation is being questioned by consumers and professionals alike.