DENTAL FLUOROSIS

The ADA recommends the use of fluoridated dentifrices as soon as the primary teeth erupt, so as to reduce the incidence of dental caries. However young children can ingest a significant amount of dentifrice during normal toothbrushing; this is a potential problem because the permanent teeth are at risk from fluorosis for the first seven years of life. the objective of this paper was to review the literature on the role of fluoride dentifrices in causing dental fluorosis. a search for literature was performed using MEDLINE, OVID with the key words fluorosis, dentifrice, ingestion, and children. The search was limited to English language publications. Subsequently, 31 articles were retrieved, additional relevant articles were collected from the references cited in the initially identified papers. Ultimately, 96 articles were retrieved for review. Fluoride, should be used with caution so that the benefits out-way the adverse affects. Oral health care providers need to systematically as...

Dental fluorosis is a developmental disturbance of dental enamel, caused by successive exposures to high concentrations of fluoride during tooth development, leading to enamel with lower mineral content and increased porosity. The severity of dental fluorosis depends on when and for how long the overexposure to fluoride occurs, the individual response, weight, degree of physical activity, nutritional factors and bone growth. The risk period for esthetic changes in permanent teeth is between 20 and 30 months of age. The recommended level for daily fluoride intake is 0.05 - 0.07 mg F/Kg/day, which is considered of great help in preventing dental caries, acting in remineralization. A daily intake above this safe level leads to an increased risk of dental fluorosis. Currently recommended procedures for diagnosis of fluorosis should discriminate between symmetrical and asymmetrical and/or discrete patterns of opaque defects. Fluorosis can be prevented by having an adequate knowledge of t...

Resumen: Las anomalías y síndromes dentales, suponen una problemática que puede afectar severamente a la población. Estas, Poseen causantes: genéticos, culturales, de sexo y raza se ven implicados en estas anormalidades que, de ser tratadas desde su primera instancia, pueden proporcionar una significativa mejoría para quienes las padecen. Por esto, es de suma importancia el poder identificar lo antes posible, mediante los métodos y características tanto clínicas como radiológicas, la presencia de factores desencadenantes y concurrentes de las diversas patologías fisiológicas e histológicas bucales. En el siguiente trabajo, se presenta un compendio de las anomalías y síndromes con implicaciones dentales más relevantes, ahondando desde lo etiológico y característico con su respectiva ejemplificación clínica y radiográfica.

Fluoride in drinking water has a profound effect on teeth and bones. Up to a small level (1–1.5 mg/L) this strengthens the enamel. Concentrations in the range of 1.5–4 mg/L result in dental fluorosis whereas with prolonged exposure at still higher fluoride concentrations (4–10 mg/L) dental fluorosis progresses to skeletal fluorosis. High fluoride concentrations in groundwater, up to more than 30 mg/L, occur widely, in many parts of the world. This review article is aimed at providing precise information on efforts made by various researchers in the field of fluoride removal for drinking water. The fluoride removal has been broadly divided in two sections dealing with membrane and adsorption techniques. Under the membrane techniques reverse osmosis, nanofiltration, dialysis and electro-dialysis have been discussed. Adsorption, which is a conventional technique, deals with adsorbents such as: alumina/aluminium based materials, clays and soils, calcium based minerals, synthetic compounds and carbon based materials. Studies on fluoride removal from aqueous solutions using various reversed zeolites, modified zeolites and ion exchange resins based on cross-linked polystyrene are reviewed. During the last few years, layered double oxides have been of interest as adsorbents for fluoride removal. Such recent developments have been briefly discussed.

Developmental defects of the human dentition are not uncommon and can adversely affect the physical and psychological health of children. This paper reviews briefly the most common dental defects that can occur during childhood and discusses in more detail defects of enamel and dentine. Guidelines are provided for clinicians to identify children who deviate from normal dental development in order to provide appropriate interventions or make appropriate referrals.

Fluoride is commonly and widely used to prevent and even arrest caries. The clinical effects of fluorides depend on the chemical compounds utilized and the methods used to apply the fluoride ion to the surface of the tooth. Fluorosis has been reported in conjunction with increased doses of fluoride. A coordinated approach to fluoride delivery is essential to avoid the risk of fluorosis.

Dental fluorosis manifests itself as white stains on the enamel of teeth exposed to excessive doses of fluoride during their formation. Fluorosis usually occurs as a result of the ingestion of dentifrices, gels and fluoridated solutions. It may be diagnosed as mild, moderate or severe, and in some cases, it may cause the loss of the surface structure of dental enamel. The aim of this study was to report the clinical case of a female patient of 18 years with moderate fluorosis, whose smile was reestablished by the use of an enamel microabrasion technique, followed by in-office bleaching. A microabrasion technique with 6% hydrochloric acid associated with silica carbide showed to be a safe and efficient method for removing white fluorosis stains, while dental bleaching was useful for obtaining a uniform tooth shade. The association of these techniques presented excellent results and the patient was satisfied. Both techniques are painless, fast and easy to perform, in addition to prese...

Resumo:A relação entre ambiente e saúde humana é uma temática que tem exigido o envolvimento de diferentes ramos científicos. Nessa perspectiva, estudos que avaliam a distribuição de elementos químicos no ambiente são de grande relevância, dado a correlação entre padrões anormais e efeitos à saúde. Com o intuito de identificar padrões de distribuição dos elementos químicos no Paraná, Licht (2001) realizou um levantamento geoquímico nos hidrossistemas superficiais e subterrâneos do estado. Dentre outros resultados, assinalou, no nordeste paranaense, um desvio dos padrões geoquímicos regionais – 0,16 mg/L, obtidos por meio do cálculo de background. Ademais, estudos epidemiológicos locais assinalaram a ocorrência de fluorose dentária, patologia associada ao consumo de flúor. Visando identificar com maior precisão a extensão espacial desta anomalia, e avançar na avaliação dos impactos à saúde local, foram coletadas 211 amostras de água superficial, in natura, em cinco mananciais de abastecimento público: Rio das Cinzas, Itararé, Tibagi, Paranapanema I e II. Análises químicas laboratoriais, destas amostras, foram realizadas no departamento de Química da Universidade Estadual de Londrina. Para a região, foram elaborados mapas hidrogeoquímicos, por meio método de interpolação Inverse Distance Weighted. Considerando que o Ministério da Saúde (1974) alerta para a necessidade de observância das variações climáticas locais, na presente pesquisa adotou-se como valor médio recomendado – VMR concentrações de flúor entre a faixa de 0,6 mg/L e 0,8 mg/L. O consumo de teores abaixo do VMR são considerados insuficientes na prevenção da cárie dental, por outro lado concentrações acima podem ocasionar a fluorose dentária. A análise dos mapas hidrogeoquímicos permitiu assinalar concentrações de flúor acima do VMR em três amostras. As quais estão situadas localmente em cursos d’água da bacia hidrográfica do Rio das Cinzas, respectivamente nos municípios de Santo Antônio da Platina, no qual obteve-se teores de 1,10 e 1,19 mg/L; e Ribeirão do Pinhal, de 1,15 mg/L. Ao contrário dos padrões hidrogeoquímicos assinalados por Licht (2001), as anomalias identificadas são pontuais, destoando da configuração local. No intento de buscar correlações entre a distribuição espacial dos teores de flúor e efeitos à saúde no contexto investigado, consultou-se, no banco de dados do DATASUS, dados de morbidade hospitalar, nos últimos cinco anos. Considerando a ausência de informações de fluorose dentária no referido banco de dados, realizou-se entrevistas informais com dentistas e odontopediatras nos municípios de Santo Antônio da Platina e Ribeirão do Pinhal. Os resultados obtidos não ensejaram definir quaisquer correlações positivas, mas possibilitaram a articulação de hipóteses. Contudo, é nítida a geração de um “cinturão” alinhavado pela sequência de picos das anomalias de flúor, que coincidem com as bordas de ocorrência das rochas vulcânicas da Formação Serra Geral, as quais por sua vez alojam o Aquífero Serra Geral.

Abstract: The relationship between the environment and human health it’s a theme that has required the involvement of different scientific branches. In that perspective, studies evaluating the environment distribution of chemical elements have great relevance, due to the correlation between abnormal standards and its effect to human health. Litch (2001) conducted a geochemical research on Parana state superficial and undergrounded hydro systems, seeking to identify distribution standards of the chemical elements. Among other results, he pointed out a deviation from the regional geochemistry standard of 0.16 mg/L, obtained by background calculations. Furthermore, local epidemiological studies pointed out the occurrence of dental fluorosis, a fluoride consumption associated pathology. Aiming to identify the space extension of this anomaly with greater accuracy and due to go further with the evaluation of its impact on the local health, 221 samples were collected from surface water, on five public supply fountains, on the rivers: Das Cinzas, Itararé, Tibagi, Paranapanema I e II. The chemical laboratory analyses of this samples, where conducted on the Chemistry department of the State University of Londrina. Hydro geochemistry maps were elaborated for the region, using the Arcgis 9.0 software. Aiming to establish the fluoride RAV of the investigated context, it was considered its effect on the mouth health. Considering the warning of Brazil Health Department (1974) to observe the variations on the local weather, the research considered as average recommended value – ARV fluoride concentrations of 0.6 mg/L to 0.8 mg/L. The ingestion of levels under the ARV are considered as insufficient to dental caries prevention, on the other hand concentrations above the ARV can lead to dental fluorosis. Those are located in watercourses on the hydrographic basin on the river das Cinzas, respectively on the cities of Santo Antônio da Platina, in which afforded 1.10 e 1.19 mg/L levels of fluoride; and Ribeirão do Pinhal with a 1.15 mg/L level. The identified anomalies are punctual, on the contrary of the hydro geochemistry standards pointed out by Licht (2001). Aiming to seek correlations between the space distribution of fluoride and health effects on the investigated context, it was consulted the morbidity data of the last five years on the DATASUS databank. Due to the absence on the databank of teeth fluorosis information, informal interviews were conducted on Santo Antônio da Platina e Ribeirão do Pinhal cities, with dentists. The obtained results didn’t allowed any positive correlation to be defined, but it allowed to articulate some hypothesis. However, it was clear the generation of a “belt” due to some peaks of fluoride anomalies, matching with the edge occurrence of the volcanic rocks of the Serra Geral Formation, witch on the other hand hosts the Serra Geral Aquifer.

Dental fluorosis is a developmental disturbance of dental enamel, caused by successive exposures to high concentrations of fluoride during tooth development, leading to enamel with lower mineral content and increased porosity. The severity of dental fluorosis depends on when and for how long the overexposure to fluoride occurs, the individual response, weight, degree of physical activity, nutritional factors and bone growth. The risk period for esthetic changes in permanent teeth is between 20 and 30 months of age. The recommended level for daily fluoride intake is 0.05 - 0.07 mg F/Kg/day, which is considered of great help in preventing dental caries, acting in remineralization. A daily intake above this safe level leads to an increased risk of dental fluorosis. Currently recommended procedures for diagnosis of fluorosis should discriminate between symmetrical and asymmetrical and/or discrete patterns of opaque defects. Fluorosis can be prevented by having an adequate knowledge of t...

Purpose: To investigate the contribution of different sources of fluoride related to dental fluorosis. Methods: This population-based, matched, case-control study (67 pairs) used a representative sample of 271 schoolchildren. Dental fluorosis was measured using Dean's index. Children's caregivers were interviewed about nine risk factors. Data were analyzed using conditional logistic regression. Results: The prevalence of questionable cases was 18.8 percent, and the prevalence of very mild, mild, or moderate cases of dental fluorosis was 11.5 percent, with no severe case. Age of start of toothbrushing, drinking water from wells, frequency of toothbrushing, type of tooth-paste, standard/ children's mouthrinse usage, and fluoride supplements were not significant (P>0.15). Drinking water from wells and using supplements were underpowered (N less than six). Children who frequently ate toothpaste had an odds ratio of 5.56 (95% confidence interval (CI) 1.75 to 17.73) times more fluorosis; those applying toothpaste to cover the bristles had 5.55 times more fluorosis (95% CI 1.44 to 21.42); and those using an adult size toothbrush had 3.17 times more flurosis (95% CI 1.15 to 8.71). There was a significant additive interaction (P<0.01). Conclusion: In a community with water fluoridation, the factors associated with dental fluorosis are intentional toothpaste ingestion and tooth-paste applied on the whole toothbrush.
(Pediatr Dent 2016;38(3):)

Abstract– The purpose of this comparative study of caries and dental fluorosis experience in Chilean children was to estimate the optimal range of fluoride concentration in tap water under conditions currently prevailing in Chile. The sample included 2431 schoolchildren 7, 12 and 15 years old, life-long residents of five communities with fluoride concentrations in their tap water in the range 0.07–1.1 mg/L. The study population received an oral clinical examination including caries experience and an enamel fluorosis evaluation of the permanent dentition (Dean's scoring system). For 15-year-old children, the DMFT index changed from 5.06 to 2.60, and for 12-year-olds it changed from 3.10 to 1.36 when fluoride water concentration changed from 0.07 to 1.10 mg/L. For 7-year-old children the dmft index correspondingly changed from 3.67 to 1.59. The relationship between DMFT for 12-year-olds and water fluoride concentration was best fitted by a logarithmic function (r2=0.98). The Community Fluorosis Index (CFI) was used to assess enamel fluorosis in the study population, and it showed a linear relationship (r2=0.983) with increasing fluoride concentration of water for the 12-year-old group. Results obtained suggest that under current Chilean conditions, the optimal range of fluoride concentration in potable water should lie in the 0.5–0.6 mg/L range.

Recently, mostly as a result of drinking water fluoridation, the number of young patients affected by fluorosis increased considerably. This study describes a minimally invasive technique, using in-office dental bleaching (35% hydrogen peroxide) and enamel microabrasion (silicon carbide and 12% hydrochloric acid) to eliminate fluorosis like stains. The association of techniques was efficient and can be recommended as a good conservative alternative for the treatment of fluorosis affected teeth.

In Northern Thailand, incidences of fluorosis resulting from the consumption of high-fluoride drinking-water
have been documented. In this study, we mapped the high-fluoride endemic areas and described the relevant
transport processes of fluoride in enriched waters in the provinces of Chiang Mai and Lamphun. Over one thousand
surface and sub-surface water samples including a total of 995 collected from shallow (depth: ≤30 m) and
deep (N30 m) wells were analysed from two unconnected high-fluoride endemic areas. At the Chiang Mai site,
31% of the shallow wells contained hazardous levels (≥1.5 mg/L) of fluoride, compared with the 18% observed
in the deep wells. However, at the Lamphun site, more deep wells (35%) contained water with at least
1.5 mg/L fluoride compared with the shallow wells (7%). At the Chiang Mai site, the high-fluoride waters originate
from a nearby geothermal field. Fluoride-rich geothermal waters are distributed across the area following
natural hydrological pathways of surface and sub-surface water flow. At the Lamphun site, a well-defined, curvilinear
high-fluoride anomalous zone, resembling that of the nearby conspicuous Mae Tha Fault, was identified.
This similarity provides evidence of the existence of an unmapped, blind fault as well as its likely association to
a geogenic source (biotite-granite) of fluoride related to the faulted zone. Excessive abstraction of ground
water resources may also have affected the distribution and concentration of fluoride at both sites. The distribution
of these high-fluoride waters is influenced by a myriad of complex natural and anthropogenic processes
which thus created a challenge for the management of water resources for safe consumption in affected areas.
The notion of clean and safe drinking water can be found in deeper aquifers is not necessarily true. Groundwater
at any depth should always be tested before the construction of wells.

To contrast the sensitivity, specificity, and positive–negative predictive values between dental fluorosis prevalence scored on 28 (DF28) and on six permanent teeth (DF6), we undertook a cross-sectional study on 1,538 adolescents (12 and 15 years old) residing in Hidalgo State, Mexico, a naturally fluoridated (>0.7 ppm) area at an elevated altitude (>2,500 m above sea level). Dental fluorosis was scored using Deans modified index. Using the scores obtained for all teeth present (DF28) as a gold standard, we calculated the sensitivity, specificity, positive–negative predictive values, and receiver operating characteristic and concordance index pertaining to the scores based on six teeth (upper incisors and canines). DF28 fluorosis prevalence was 81.7%; based on DF6, it was 58.7% (23% difference). Among 12 year olds, the difference between DF28 and DF6 was 20.1% (84.5 vs. 64.4%); among 15 year olds, it was 25.4% (79.4 vs. 54%). Among girls, it was 23.2% (81.1 vs. 57.9%) and among boys, 22.8% (82.2 vs. 59.4%). The fluorosis community indices were 1.75 (DF28) and 1.11 (DF6). All positive predictive values reached 100% while negative predictive values were below 45%. Concordance between DF28 and DF6 was 53.9%, and kappa coefficient was 0.40. Partial scoring of fluorosis based on esthetically important permanent teeth underestimated prevalence, compared to full-mouth scoring. The decision to use an abridged Dean’s index protocol must take into account the number of teeth examined, and which specific teeth are examined, to appraise the benefit of reduced data collection effort against possible information loss.