Fluorosis
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
- Wide variability in presentation.
- Enamel white flecks, spots, and lines in most cases.
- More severe cases the enamel can be pitted and stained dark yellow or brown.
Prevalence & Risk Factors
- Prevalence of fluorosis (mostly mild) in the United States is 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 intermittent source of fluoride rather than a daily intake.
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 (age two years and under) 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
Severe Fluorosis
References
Wong MCM, Zhang R, Luo BW, Glenny AM, Worthington HV, Lo ECM. Topical fluoride as a cause of dental fluorosis in children. Cochrane Database Syst Rev. 2024 Jun 20;6(6):CD007693
Clark MB, Keels MA, Slayton RL; AAP Section on Oral Health. Fluoride use in caries prevention in the primary care setting. SECTION ON ORAL HEALTH. Pediatrics. 2020; 146Â (6).
American Academy of Pediatric Dentistry. Fluoride therapy. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023: 352-8.
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.