Fluorosis is a discoloration of the teeth due to chronic excessive exposure to fluoride during tooth development. It is a cosmetic issue that does NOT affect systemic health.

Clinical Appearance

  • Usually consists of white mottling

Prevalence & Risk Factors

  • Prevalence of fluorosis (mostly mild) in the United States is 0.2%–27% and rising.
  • The risk of developing fluorosis is greatest at an intake of more than 0.06 milligram per kilogram of body weight per day.
  • Varnish is not a major risk factor for fluorosis as it is an irregular source of fluoride rather than a daily one.

Risk Reduction

  • Determine the fluoride content of the child's drinking water before prescribing supplements.
  • Avoid duplicate fluoride prescriptions.
  • Follow current dosage schedules for systemic fluoride supplementation.
  • Tell the child's caregiver to place only a smear (under two years) or pea size dab (children over age 3 or when the child can spit effectively) of fluoridated toothpaste on the child's toothbrush.
  • Keep fluoride-containing products out of the reach of small children.

Moderate Fluorosis

Joanna Douglass, BDS, DDS
Joanna Douglass, BDS, DDS

Severe Fluorosis

John McDowell, DDS
John McDowell, DDS


Pendrys DG. Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. Journal of the American Dental Association. 2000;131(6):746-55.

Skotowski MC, Hunt RJ, Levy SM. Risk factors for dental fluorosis in pediatric dental patients. J Public Health Dent. 1995 Summer;55(3):154-9.

Do LG, Spencer AJ. Risk-benefit balance in the use of fluoride among young children. J Dent Res. 2007 Aug;86(8):723-8.

Chankanka O, Levy SM, Warren JJ, Chalmers JM. A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects / oral health-related quality of life. Community Dent Oral Epidemiol 2010.

Wright JT, Hanson N, Ristic H et al. Fluoride toothpaste efficacy and safety in children younger than 6 years: A systematic review. JADA. 2014. 145(2): 182-189.