Dental fluorosis by Dr. B.K.G Thilakarathne

Source: Newsletter of the College of General Dental Practitioners of Sri Lanka

Dental fluorosis is a public health problem in many parts of the world, including the dry zone of Sri Lanka. It is an enamel defect that results from excessive intake of fluoride during the developmental stages of teeth. The window of susceptibility for dental fluorosis is from birth to eight years of age. The clinical appearance of dental fluorosis varies from minor white striations to more extensive opacities with or without pitting of enamel. Due to the disfiguring nature of severe forms of dental fluorosis it could affect the quality of life of an individual. From the available evidence it is clear that consumption of water with high concentration of fluoride, infant formulas used before the age of six years, inadvertent use and ingestion of fluoridated toothpaste during tooth development stages, use of fluoride supplements,
professionally applied topical fluorides, black tea consumption, use of amoxicillin, and some sociodemographic factors such as socio-economic status, sex are risk factors for dental fluorosis.

Dental fluorosis is a preventable condition. According to the WHO water quality guidelines (2017) it is recommended that, if fluoride concentration in drinking water exceeds 1.5ppm, it is necessary to defluoridate the water prior to consumption. If de-fluoridation is not possible, people living in high
fluoride areas should use water from alternative sources such as from wells tested for low fluoride levels, bottled water or harvested rain water.
Dental practitioners should be aware that children are exposed to fluoride from multiple sources in recent times. Clinicians should provide advice to parents regarding the proper use of fluoridated toothpastes.
Children under the age of 3 years should be given only a smear layer of fluoridated toothpaste on the toothbrush while those between the ages of 3-8 years should use only a pea-sized amount of fluoride toothpaste. Tooth brushing in young children should be supervised by parents to prevent ingestion of fluoridated toothpaste.

Different treatment modalities are available for dental fluorosis and they include enamel micro and macro abrasion, direct composite veneers, porcelain veneers and crown restorations.