Dental fluorosis can be present in a variety of grades/ scores ( DEAN) that is linked to the severity of enamel tissue involvement.
Slight to moderate levels of fluorosis leads to a sort of protection against tooth decay but more severe levels leads to pitting and even staining and tissue destruction that can be followed by cavitation that will need restoration.
Fluoridated toothpaste can be used but they won't have one of this main functions that is the mineral reinforcement through the incorporation of Fluoride to the hydroxiapatite and posterior transformation in fluorapatite that is more resistant to bacterial acidic challenges as enamel with fluorosis had already passed by this chemical reaction. It's use is not contra indicated, as it won't make any harm and still we need to protect the teeth against plaque accumulation. Another point is that most all toothpastes on the market are fluoridated so it will be a little difficult to avoid them.
Thanks Caroline for the reply. I just need a clarification. Do you mean that fluoride toothpaste use has no fluoride derived benefit to the patient with severe fluorosis? and non-fluoridated toothpaste use is the best option if possible?
Is there any study indicating Fluorosed teeth has a tendency to remove Ca from the tooth substance?
Dear Sunethra, being clear the point is that when we have severe fluorosis the enamel is so brittle that can occur confluent pitting and loss of structure with exposure of dentin. The logic point here is that you still can use fluoridated toothpastes for decreasing the sensibility of exposed dentin and prevention of root caries in cases of recessions but restoration are needed.
Teeth with fluorosis doesn't lose calcium, the hydroxiapatite losses the radical OH and turns to fluorapatite.
thanks Dr Amin for the response. cosmetic restorative dentistry is a must. What about the people with high ground water fluoride levels with no provision for defluoridated drinking water ? Will it add to the detrimental systemic effects of excess fluoride?
Hi in answer to your questions:
What about the people with high ground water fluoride levels with no provision for defluoridated drinking water ? Will it add to the detrimental systemic effects of excess fluoride?
answer: I am afraid that the end result will be very toxic especially in high level of fluorides here is a paper published to show that levels higher than over 2.0 mg/L can lead to liver damages
Dose–effect relationship between drinking water fluoride levels and damage to liver and kidney functions in children
Original Research Article
Environmental Research, Volume 103, Issue 1, January 2007, Pages 112-116
XianZhi Xiong, JunLing Liu, WeiHong He, Tao Xia, Ping He, XueMin Chen, KeDi Yang, AiGuo Wang
Abstract
Therefore, our results suggest that drinking water fluoride levels over 2.0 mg/L can cause damage to liver and kidney functions in children and that the dental fluorosis was independent of damage to the liver but not the kidney. Further studies on the mechanisms and significance underlying damage to the liver without dental fluorosis in the exposed children are warranted.
cheers
prof galil
thanks Prof Gail for the answer and the reference.
regards,
Sunethra
All Expert Opinion based on available scientific evidence prove beyond doubt that even for areas with endemic fluorosis manifests as dental fluorosis, use of fluoride toothpaste is the best and safe option to prevent and control dental caries.
Topical action of fluoride in the form of fluoridated toothpaste has been the most cost-effective strategy to reduce the prevalence and incidence of dental caries among children and adults across the globe including Sri Lanka. The scientific evidence for prevention and control of dental caries by inhibiting demineralization of the enamel, promoting re-mineralization of the enamel and anti-bacterial effect of topical fluorides emerged from 1930s. However, endemic fluorosis is a public health problem in many parts of the world including some regions in Sri Lanka. Despite being a lower-middle-income developing country, only 55% has pipe-born water supply. Hence, providing safe drinking water for all Sri Lankans is a great public health need. Dental fluorosis is an indicator for exposure to excessive levels of fluorides >1 ppm from 1-8 years of life and highlights the need for providing/consuming safe water rather than promulgating anti-fluoride campaigns and promoting non fluoride containing herbal toothpastes.
Topical fluorides in the form of tooth pastes are beneficial against dental decay.
I have attached (AAPD) American Academy of Pediatric Dentistry guidelines for the reference.
About tooth pastes and their use is also there in it.
Thank you .
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