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Fluorosis Overview

Fluorosis is a cosmetic condition that affects the teeth. It’s caused by overexposure to fluoride during the first eight years of life. This is the time when most permanent teeth are being formed.

After the teeth come in, the teeth of those affected by fluorosis may appear mildly discolored. For instance, there may be lacy white markings that only dentists can detect. In more severe cases, however, the teeth may have:

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  • Stains ranging from yellow to dark brown
  • Surface irregularities
  • Pits that are highly noticeable

How Widespread Is Fluorosis?

Fluorosis first attracted attention in the early 20th century. Researchers were surprised by the high prevalence of what was called “Colorado Brown Stain” on the teeth of native-born residents of Colorado Springs. The stains were caused by high levels of fluoride in the local water supply. People with these stains also had an unusually high resistance to dental cavities. This sparked a movement to introduce fluoride into public water supplies at a level that could prevent cavities but without causing fluorosis.

Fluorosis affects nearly one in every four Americans ages 6 to 49. It’s most prevalent in those ages 12 to 15. The vast majority of cases are mild, and only about 2% are considered “moderate.” Less than 1% are “severe.” But researchers have also observed that since the mid-1980s, the prevalence of fluorosis in children ages 12 to 15 has increased.

Although fluorosis is not a disease, its effects can be psychologically distressing and difficult to treat. Parental vigilance can play an important role in preventing fluorosis.

Fluorosis Causes

A major cause of fluorosis the inappropriate use of fluoride-containing dental products such as toothpaste and mouth rinses. Sometimes, children enjoy the taste of fluoridated toothpaste so much that they swallow it instead of spitting it out.

But other things can cause fluorosis. For example, taking a higher-than-prescribed amount of a fluoride supplement during early childhood can cause it. So can taking a fluoride supplement when fluoridated drinking water or fluoride-fortified fruit juices and soft drink already provide the right amount.

Fluoride Levels in Drinking Water

Fluoride occurs naturally in water. Natural fluoride levels above the currently recommended range for drinking water may increase the risk for severe fluorosis. In communities where natural levels exceed 2 parts per million, the CDC recommends that parents give children water from other sources.

Prompted by concerns that children may be getting too much fluoride, the Health and Human Services Department in January 2011 lowered its recommended level of fluoride in drinking water. And the Environmental Protection Agency is reviewing its rules on the upper limit of fluoride levels in drinking water.

Fluorosis Symptoms

Symptoms of fluorosis range from tiny white specks or streaks that may be unnoticeable to dark brown stains and rough, pitted enamel that is difficult to clean. Teeth that are unaffected by fluorosis are smooth and glossy. They should also be a pale creamy white.

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