Dr.

Afshan Hussain
Assistant Professor Oral Pathology FMH College of Medicine and Dentistry.

Fluorosis

Sign of excess fluoride in drinking water Mottled enamel

Features of dental fluorosis

Fluorides in drinking water exceeds 2 parts per million----mottling of enamel Communities drinking fluoride-free water do not have this problem Living in a high fluoride area during dental development show mottling.

Permanent
Mottled

teeth are affected

teeth are less susceptible to caries than normal teeth from low fluoride areas.
Paper-white
Brown

enamel opacities

opacities acquired after eruption

Clinical Features
Mottling ranges from paper white patches to opaque, brown, pitted and brittle enamel. Individual variation in the effects of fluorides. Differential diagnosis--- Amelogenesis imperfecta.

Grading of mottled enamel

Very mild. Small paper-whites areas involve less than 25% of surface. Mild. Opaque areas involve up to 50% of surface

Moderate. The whole enamel surface may be affected with paper-white or brownish areas or both.

Severe. The enamel is grossly defective, opaque, pitted, stained brown and brittle.

Pathology

Fluoride combines to form calcium fluorapatite in place of part of hydroxyapatite Damage to ameloblasts leading to defective matrix formation when the concentration of fluorides are exceptionally high. Levels (2 to 6 ppm) the matrix is normal in structure and quantity. The form of tooth is unaffected, but there are patches of incomplete calcification beneath the surface layer

Pathology (cont.)

Appear as opacities because of high organic and water content. Level (over 6 ppm) the enamel is pitted and brittle with severe wide spread staining. Deciduous teeth are rarely mottled , excess fluoride is taken by the maternal skeleton. Levels (Over 8 ppm), as in parts of India, mottling of deciduous teeth may be seen.

Other effects

Severe mottling Sclerosis of skeleton Radiographically, increased density of the skeleton. Mild dental fluorosis is not readily distinguishable from non fluoride defects and non specific defects are more common in areas where the water contains less than 1ppm of fluorine.

Effects on enamel of raised fluoride levels

> 0.5 ppm --- Very mild or mild defects in up to 6 % of patients. 0.5 to 1.5 ppm --- At the upper limit. 22% show very liquid defects.

2.5 ppm --- Very mild or mild defects in over 50%. Moderate or severe defects in nearly 10% 4.5 ppm --- Nearly all patients affected in some degree ; 46% have moderate and 18 % have severe defects 6.0 ppm and more --- All patients affected; 50 % disfiguring.