The aesthetic appeal of dentition is an important factor that determines self-confidence when communicating with others. The natural snow-white shade of the enamel determines the visual beauty of the smile, but it is not always possible to keep it. Tissue damage is a consequence of the development of pathological processes in the body, the elimination of which requires timely intervention and the use of topical therapeutic methods. Among the anomalies characterized by the greatest impact on the appearance of the protective coating of crowns, dental fluorosis deserves special attention – this is a disease in which stains with a changed shade appear and spread over the entire surface of the row, provoking further changes.
Systemic pathology is caused by Dental fluorine intoxication and manifests itself in the form of patchy formations affecting the enamel. Characteristic anomalous manifestations are areas of a chalky, yellow, or brown hue – depending on the stage – that violate the integrity of the elements. At the same time, the functional properties of the crowns remain unchanged and an increased resistance to caries is observed. Several experts consider dental fluorosis as a form of hypoplasia, which has a specific origin, due to the endemic nature of the disease.
Reasons for development
The main etiological factor is the systematic intake of an excessive amount of dental fluorine into the body, the main source of which is drinking water. The daily intake of a trace element in adults is about 3 mg, of which about 80% is found in drinks. Dissolved dental fluorides are absorbed much better, which leads to the rapid progress of the pathology at a concentration of more than 1.5-2 mg/l. The content of more than six milligrams initiates the process of destruction of hard dental tissues.
In addition, the cause of the manifestation and development of dental fluorosis may be the oversaturation of the air with dental fluorine-containing elements. Such a microclimate is typical for specific manufacturing and industrial enterprises, the work which requires the observance of certain precautions and safety precautions. In this case, the pathological condition is not always accompanied by the appearance of spots, but the negative consequences remain similar.
In the early stages of the development of the body, characterized by the formation of the bone structure, excessive consumption of dental fluorine leads to a violation of the natural protein matrix, as well as a deviation in the balance of tissue mineralization. The microelement that interacts with calcium forms the CaF2 compound, the connection of which with the enamel is insufficient. As a result, the looseness of the protective coating of the crowns, as well as the deterioration of its visual properties.
Endemic character, that is, binding to a certain geographical area, is observed quite often. The largest number of diagnosed cases occurs in administrative districts, where drinking water has a high fluoride content. At the same time, it should be noted that dental fluorosis is a disease that depends on the state of the immune system. In many people living in a potential risk zone, the anomaly does not manifest itself in any way.
The sources of dental fluoride in the daily diet are products of plant and animal origin, tea and coffee, certain types of medicines and toothpaste, as well as rinses. The recommended daily intake of a microelement is considered to be 0.05 mg/kg, while it is important to take into account the different intensities of assimilation. Studies show that the correlation between the prevalence of pathology relative to the concentration in drinking water is as follows:
Content, mg/l Share of infected, %
Over 2.5 Over 50
Today on the Internet it is not difficult to find a photo of tooth enamel fluorosis in adults and children, however, treatment should be started only after passing a comprehensive examination, confirming the correctness of the diagnosis. Common symptoms that warrant a visit to a doctor include:
- Symmetrical white spots on the vestibular or chewing surface of the coating.
- Loss of natural enamel gloss, matte shade.
- The formation of chips due to the unnatural fragility of the outer layer of crowns.
- Intensive abrasion caused by mechanical stress on the dentition.
The area of primary manifestation, as a rule, is the frontal incisors, however, with a systematic oversaturation of the body, the pathological condition extends to other elements of the maxillary region. Spotting is caused by the specifics of light refraction associated with a violation of the enamel structure, as well as the process of tissue mineralization. For multiple formations that occur against the background of an increased content of dental fluorine (more than 2 mg/ml), a convex shape is characteristic. Depending on the intensity of the development of the pathology, from 25 to 100% of the crown surface may be affected. The severe stage is characterized by the presence of darkened destructive areas that destroy the tooth – while there is a pronounced sensitivity to temperature changes, caused by the penetration of the defect into the deep layer of dentin.
The differentiation adopted by the World Health Organization provides for five degrees of severity:
- Very light – not accompanied by pronounced changes.
- Light – the manifestation of white lines and small spots, the total area of the lesion is no more than 1/4.
- Moderate – the formation of pigmented areas within 50%.
- Moderate – the appearance of segments of yellow or brown color, haze of the enamel coating, mottled distribution.
- Severe – the formation of erosive areas and irregularities, a cloudy shade of enamel, and chips on individual elements that are subjected to the greatest chewing load
Differential classification of fluorosis facilitates the diagnosis, prevention, and treatment of pathology. There are the following types of diseases.
The formation on the surface layer of separate short stripes is visually similar to chalk strokes. They are diagnosed as part of a routine checkup. They are most clearly visualized when dried, affecting the front incisors of the upper and lower rows. The altered areas lose their luster but do not appear on radiographic images, because they have a low density. Corresponds to the first degree of severity. They are eliminated with timely mineralization, abrasive treatment, as well as complex treatment of the pathological condition.
The appearance of individual segments of the dentition of rounded spots that have relatively small dimensions. They are characterized by a smooth and shiny surface, an intense chalky or yellowish color in the central part, and a descending one in the radial part, smoothly turning into a natural shade. There are no bands, separate formations can be combined into a common structure, usually affecting elements with a single period of development, or all groups of units, depending on age indicators, as well as the duration of consumption of an increased amount of fluorine.
Formation on pigmented segments of areas where the enamel is completely absent. Erosion zones differ in pattern, rough texture, penetration depth, and shade, and are yellow or brown. The preserved coating has a fragile structure, it is easily chipped and deformed under mechanical stress. Intensive erasure is observed, accompanied by a noticeable sensitivity to temperature changes, as well as the occurrence of pain when eating. The radiograph shows deep defects that appear as dark spots.
The severe stage is diagnosed mainly in regions belonging to the high-risk zone, where drinking water contains more than 10 mg / l of fluorides. Symptoms – fragility, vulnerability, abrasion, the atypical configuration of damaged crowns, dentin damage. On hardware diagnostics, extensive and in-depth penetration of the pathology is revealed. The perception of thermal stimuli is heightened. It requires immediate medical intervention, with the involvement of qualified specialists who know how fluorosis is treated and what to do in such a situation.
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The enamel coating loses its natural luster, small depressions form on the outer layer – specks, mostly yellow and brown. The diameter of the spots is up to one and a half millimeters, and the surface of the walls and bottom is rough. It is characterized by group coverage of adjacent elements of the jaw row, which leads to extended chips and deformations, often to exposure of the dentin layer, which is also subject to pigmentation. Not visible on the x-ray.
The methods used as part of a comprehensive examination are not limited to standard procedures for visual examination and patient interviews. In addition to studying the anamnesis, the following are also used to form a clinical picture:
- Vital staining of tooth enamel. Provides for the application of a blue solution containing 2% methylene to the surface area, while the areas that have undergone a pathological change do not interact with the pigment.
- Drying of the tooth. Helps to identify cloudy segments, and also allows you to evaluate the structure of the enamel coating on these formations for roughness and haze.
- Luminescent diagnostics. Analysis of fluorescent emission under the action of UV rays. For the normal state, as well as the primary stage of the lesion, a light bluish tint is characteristic, while in severe forms, a total extinction of the primary glow is observed.
- Radiography. It is prescribed at the middle and late stages, with the localization of the penetration of the defect into the structure of the dentin layer, and allows you to determine the degree of spread of the pathology.
The significance of differential diagnosis is determined, among other things, by the similarity of the external manifestations of the disease with other anomalies – for example, with a deficiency in the body of vitamins A and D.
Fluorosis Treatment methods
How to cure fluorosis and get rid of stains on teeth? It all depends on the degree of development of the pathological condition. With a mild form of damage, standard remineralizing therapy helps to cope with the disease, during which the elements of the series are treated with a gel with an increased level of calcium and phosphorus. A prerequisite is preliminary cleaning with a paste with a small content of abrasive elements that remove soft plaque from the vestibular surface. The composition is applied for 15-20 minutes, within one course it will take up to 15 applications, and the concentration of useful components in which is sufficient for optimal tissue saturation.
The first and second stages, characterized by the formation of chalky and dark spots, are treated with microabrasion. This method is implemented exclusively in a clinical setting and involves the use of a special composition for the treatment of enamel, one of the ingredients of which is a moderately concentrated acid. The paste “works through” the layer up to 0.2 mm deep, which allows you to completely remove the pigmented area, or make it almost invisible from the outside.
In case of severe defects, either a composite restoration or the installation of overlays that do not contain metal components, such as ceramic veneers or artificial crowns, usually helps to remove dental fluorosis. In this case, the treatment is coordinated with the orthopedist.
It is carried out with symptoms characteristic of a mild or moderate degree of development. Provides a course of 10-15 procedures, during which a solution containing up to 20-30% hydrochloric or phosphoric acid is used, as well as – for washing – calcium gluconate concentrate 10%. A technically complex and unsafe procedure, which excludes self-implementation at home.
In the presence of convex formations, a paste containing carborundum or silicon gel is used. The procedure consists of three stages – mechanical surface treatment, installation of a perhydrol tampon, and irradiation with a quartz lamp for 3-4 minutes. Not effective for severe lesions, as an alternative, aesthetic restoration or prosthetics with artificial crowns is recommended.
Complications after dental fluorosis
Prolonged ignoring of the pathological process leads to the development of a destructive form that affects the structure of skeletal bones. Excessive accumulation of fluorine provokes osteosclerosis, and in the late phase – osteosarcoma, that is, a malignant neoplasm in the bone tissue. Typical symptoms are pain, decreased joint mobility, deterioration of muscle tone, dystrophy, and dysfunction of internal organs. In addition, the microelement negatively affects the state of the parathyroid glands, causing hyperparathyroidism and excessive production of hormones responsible for the level of calcium in the blood. As a result, increased fragility of the skeleton.
Detection and treatment of pathology in the early stages allow for leveling pigmentation and restoring the natural shade of the enamel surface. With dental fluorosis, remineralization pastes are recommended, saturated with calcium and phosphorus, which strengthen the tissue structure.
The list of preventive recommendations is to reduce the consumption of foods and drinking water, supersaturated with dental fluorides, as well as to increase the presence in the diet of vitamins A and D, calcium, and other trace elements that help strengthen tissues and enamel. In the presence of a genetic predisposition, one should periodically, at least once a year, undergo a scheduled examination – diagnostic methods used by the specialists of Dentika dental centers guarantee timely detection of the first signs of the disease.
So, now you know what dental fluorosis is, how it manifests itself, and how to treat it. We hope that this information will help to avoid the development of pathology and will contribute to maintaining a healthy smile for many years.