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    Fluorosis Overview

    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.

    Contact your dentist if you notice that your child’s teeth have white streaks or spots or if you observe one or more discolored teeth.

    Since the 1930s, dentists have rated the severity of fluorosis using the following categories:

    • Questionable. The enamel shows slight changes ranging from a few white flecks to occasional white spots.
    • Very mild. Small opaque paper-white areas are scattered over less than 25% of the tooth surface.
    • Mild. White opaque areas on the surface are more extensive but still affect less than 50% of the surface.
    • Moderate. White opaque areas affect more than 50% of the enamel surface.
    • Severe. All enamel surfaces are affected. The teeth also have pitting that may be discrete or may run together.

    Fluorosis Treatments

    In many cases, fluorosis is so mild that no treatment is needed. Or, it may only affect the back teeth where it can’t be seen.

    The appearance of teeth affected by moderate-to-severe fluorosis can be significantly improved by a variety of techniques. Most of them are aimed at masking the stains.

    Such techniques may include:

    • Tooth whitening and other procedures to remove surface stains; note that bleaching teeth may temporarily worsen the appearance of fluorosis.
    • Bonding, which coats the tooth with a hard resin that bonds to the enamel
    • Crowns
    • Veneers, which are custom-made shells that cover the front of the teeth to improve their appearance; these are used in cases of severe fluorosis.
    • MI Paste, a calcium phosphate product that is sometimes combined with methods like microabrasion to minimize tooth discoloration

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