What Is It?
Your permanent teeth form under your gums in the jawbone during early childhood. Except for your wisdom teeth, the crowns (the part you see in the mouth) of all of the permanent teeth fully form by the time you are about 8 years old. If you consume too much fluoride as a young child, the extra fluoride can disrupt the formation of the enamel (outer part) of your permanent teeth and lead to fluorosis, which varies from minor discoloration to surface irregularities of the teeth. The extra fluoride does not affect other parts of the tooth. Once your teeth have erupted into your mouth, they are not susceptible to fluorosis.
Fluorosis is a cosmetic condition, not a disease. Often, it is so mild that only a dental professional can detect it. Most cases of fluorosis result from young children taking fluoride supplements or swallowing fluoride toothpaste when the water they drink is already fluoridated.
Teeth affected by mild fluorosis may show no visible changes or changes visible only to a dental professional. Mild to moderate fluorosis is characterized by white lines, streaks or spots. In more severe fluorosis, the teeth can become pitted and have brown, gray or black spots, and the enamel can be misshapen.
Your dentist and dental hygienist will ask if your child received fluoride supplements, used fluoride toothpaste or drank fluoridated water in previous years. They also will ask about past and present medical conditions or disabilities that may affect your child's teeth. Your dentist will examine your child's teeth and gums and take X-rays to make sure there are no other defects in the teeth.
Other conditions may look like fluorosis. Developmental defects and craniofacial problems can cause disruptions in the enamel or dentin of the teeth. In addition, infants or young children who have high fevers or experience trauma (such as a fall that injures a tooth) may have discolored teeth. Young children can get cavities in their primary teeth, so any tooth discoloration should be checked at the dental office.
The spots and stains left by fluorosis are permanent and may darken over time.
If you have a child under 6, put only a small smear or pea-sized amount of toothpaste on his or her toothbrush and encourage him or her to spit rather than swallow after brushing. Avoid toothpastes with flavors that may encourage swallowing. Keep all fluoride-containing products (toothpastes, mouthwashes, etc.) out of the reach of young children.
The addition of fluoride to drinking water is one of the great preventive disease programs of the 20th century. Children should take fluoride supplements only if the water they drink does not contain enough fluoride. If your child is taking fluoride supplements now, check the amount of fluoride in your water. If you are on a public water supply, call your supplier to ask about the fluoridation level. You can also have your dentist check a sample of your water. Then discuss with your dentist whether your child needs fluoride supplements.
Some foods and beverages contain fluoride. For example, many fruit juices and soft drinks contain fluoride at levels similar to fluoridated water. Some bottled waters now have added fluoride. Young children should drink limited amounts of these beverages.
Many cases of fluorosis are minor enough not to need treatment or the fluorosis may occur only on the back teeth, where it can't be seen. More serious cases and cases involving the front teeth can be treated by removing the surface-stained areas through tooth whitening or other procedures. Severe cases of fluorosis can be covered with restorations, such as bonding, crowns or veneers.
When To Call a Professional
If you notice white streaks or spots on your child's teeth or notice that one or more teeth are discolored, contact your dental office.
Teeth affected by fluorosis are not diseased. Cosmetic concerns can be addressed with whitening to remove surface stains and veneers or other restorative procedures to cover the discoloration.