The Symptoms, Causes, Diagnosis, and Treatment of Fluorosis

Fluorosis, also called dental fluorosis, is a condition that changes the appearance of tooth enamel in young children as a result of being exposed to too much fluoride. Children are only at risk for fluorosis while their permanent teeth are still forming. Adults and children older than 8 do not get fluorosis. 

A child can develop fluorosis any time during the years when teeth are beginning to form (birth to 8 years) if they are exposed to high levels of fluoride. Excess fluoride may be consumed through toothpaste, drinking water, and fortified foods. Low levels of fluoride have been shown to help prevent cavities and are often recommended as a preventative measure for dental health in children and adults. Excess fluoride can alter the appearance of tooth enamel in children whose permanent teeth haven't come in yet.

Fluorosis is a painless cosmetic condition. If a child has developed fluorosis, the appearance of the tooth enamel will change, usually becoming stained with white "splotches" or "streaking." 

The majority of cases are mild and do not permanently damage teeth, and severe cases of fluorosis are not common. However, signs of severe fluorosis include:

• Brown spots on tooth enamel
• Pitting of the enamel
• Permanent damage to the tooth enamel

Fluorosis is caused by high levels of fluoride. Fluoride is a naturally-occurring mineral that has been shown to help prevent cavities. Fluoride is typically found in toothpaste and mouthwash and is added to public drinking water sources in many places around the world. This practice, called water fluoridation, is considered safe and effective by the American Dental Association and the Centers for Disease Control and Prevention.

Children younger than 8, especially toddlers, tend to ingest more fluoride than older children and adults because they are prone to swallowing toothpaste when they brush. Fluoride in toothpaste and mouth rinse is very concentrated. Over time, swallowing toothpaste or mouth rinse adds to a child's intake of fluoride and can cause fluorosis to develop. 

School-based fluoride treatment programs are common throughout the United States and contribute to a child's fluoride exposure. 

The discoloration from fluorosis is usually very mild; parents and caregivers may not notice it until a child's dentist, pediatrician, or another trained healthcare provider (such as a school nurse) mentions it. 

Regular dental checkups, ideally started by the time a child has their first birthday, can help promote good dental health and can help identify conditions like fluorosis or dental caries (cavities) early. 

Most cases of fluorosis are mild and do not need treatment. In more severe cases, whitening of the teeth, veneers, or other cosmetic dentistry techniques can be used to correct any permanent discoloration.

Once a child reaches the age of 8 they are no longer at risk for developing fluorosis. Prior to that time, parents and caregivers can help prevent fluorosis by:

• Using only a small amount of toothpaste on a child's toothbrush
• Supervising children while they brush to make sure they are spitting out, not swallowing, toothpaste or mouth rinses that have fluoride
• Keeping toothpaste and mouth rinse out of reach of children
• Finding out more about the water fluoridation practice in their community 
• Asking a child's school about fluoride treatment programs

Most cases of fluorosis are mild, not painful, and don't cause any permanent damage to a child's teeth. If severe fluorosis occurs, it can usually be treated through a number of cosmetic dentistry techniques such as whitening or veneers. Parents and caregivers can help prevent fluorosis by supervising children, especially toddlers, while they brush their teeth and make sure children start having regular dental check-ups by the time they're a year old.