DENTAL FLUOROSIS

Presented By : Shubham Shegokar Final Year – Part IIGuided By : Dr. Rehan Khan

(Dept. of Pediatric Dentistry)

Content Introduction Causes Mechanism of action Signs & Symptoms Mottled Enamel Classification of Dental Fluorosis Treatment Prevention

Dental Fluorosis also termed as mottled enamel is an extremely common disorder, characterized by hypomineralization of tooth enamel caused by ingestion of excessive fluoride during enamel formation.

It is a cosmetic condition that occurs during first eight years of life

Causes Excess fluoridation of drinking water Ingestion of fluoride toothpaste Overuse of Fluoride tablets Consumption of processed food made with fluoridated water

Mechanism of Action• Structurally, an increase in fluoride

intake results in an increase in degree and extent of porosity of enamel.

• Enamel changes described may be a result of fluoride damage of secretory ameloblast.

• There can either be due to fluoride induce change in compositon of enamel matrix or be a result of disturbance of the cellular processes during enamel maturation.

SignsChalk like discoloration of teeth with white spot or lines on tooth enamel

In more severe cases, the affected area have yellow or brown

discoloration.

In extreme forms, fluorosis may result in pitted tooth surface

Symptoms : Discolored tooth

Mottled Enamel It is a condition indicates the fluorosis

characterized by minute white flecks or yellow or brown spots or area scattered irregularly streaked over the surface of tooth

It is score according to method described by Al Alousi et al as follows Type A : White area less than 2 mm Type B : White area more than 2 mm Type C : Brown area less than 2 mm Type D : Brown area more than 2 mm Type E : Horizontal white lines Type F : Horizontal brown lines

Classification of Dental FluorosisClassificatio

nDescription

Normal Smooth, Glossy, Pale, Creamy white translucent surface

Questionable

Ranging from few white flecks to occassional white spot

Very mild Small opaque paper white area scattered over the tooth but not involving as much as 25 % of tooth surface

Mild The white opaque areas in the enamel of the tooth are more extensive but do not involve as much as 50% of the tooth

Moderate All enamel surface of teeth are affected and the surface subject to attrition show wear. Brown stain is frequently a disfiguring feature

Severe All enamel surfaces are affected discrete or confluent pitting . Brown stains are widespread and teeth often present a corroded like appearance.

Normal

Smooth, Glossy, Pale, Creamy white translucent surface

Questionable

Ranging from few white flecks to occassional white spot

Very Mild

Small opaque paper white area scattered over the tooth but not

involving as much as 25 % of tooth surface

Mild

The white opaque areas in the enamel of the tooth are more extensive but do not

involve as much as 50% of the tooth

Moderate

All enamel surface of teeth are affected and the surface subject to attrition show

wear. Brown stain is frequently a disfiguring feature

Severe

All enamel surfaces are affected discrete or confluent pitting . Brown stains are

widespread and teeth often present a corroded like appearance.

TreatmentMicroabrasion : ( Conservative removal of outer layer of enamel )Followed by tooth whitening can make the brown discoloration less apparent

Bonding It coats the teeth with hard resin that

bonds to the enamel.

Crown

Veneers These are the customized shells that

cover the front of teeth to improve the appearance.

Fluorosis Prevention To prevent fluorosis , fluoridation of drinking

water should not exceed normal range

Normal range : 0.7 to 1.2 ppm

Fluoride supplement should only be prescribed

for children living in nonfluoridated

Use only acceptable amount of toothpaste for

children under 6 year ( pea size )

It is important to teach the child to spit out the

toothpaste after brushing instead of swallowing

Differentiation between fluorosis and white lesions

FEATURES OF WHITE CARIOUS LESIONS More defined shape Well differentiated from surrounding enamel Often located in the middle of the crown Randomly distributed If the growth stops brownish discoloration is seen which

is known as arrested caries.

FEATURES OF DENTAL FLUOROSIS White/Yellowish lesion Not well defined They are visible without drying of teeth. These usually have a smooth surface. Symmetrically distributed

Carious White Spot Lesions A number of factors can lead to the

development of white spot on tooth sometimes these spots are caused by nutrition, genetics, or an excessive intake of fluoride while other times they become evident after braces have been removed.

Usually white spots that appear on teeth are actually areas of decalcified enamel and sometimes this problem leads to the deterioration of teeth

First evidence of tooth decay is a white spot lesion and by this the tooth enamel has taken on an opaque colour in the area where cavities begin to form

White spot on the tooth can appear after the changes have occurred in the mineral content of teeth

White spot can appear in connection with condition called fluorosis which results of having excess intake of fluoride.

White spot lesion are also commonly attributed to orthodontic braces

TYPES OF WHITE CARIOUS LESIONS

Smooth surface caries They are defined as the caries present

on the proximal surfaces and along the gingival 1/3rd of the tooth surface.

Pit and Fissure caries Pits are defined as small depressions

present along the terminal ends of the development clefts.

Fissures are defined as long clefts present on the occlusal surface of molars and premolars.

Patient with orthodontic braces have difficulty in brushing their teeth and results in build up of plaque

The acid in the plaque can severely harm to the enamel and eventually cause cavities.

The first evidence of this type of tooth decay is white decalcified enamel spot or lesion that becomes apparent when braces are removed.

Treatment

Fluoride treatment

Bonding & Porcelain laminate placement depending on the severity of the problem

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