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HEALTH EFFECTS:
Mild Forms of Dental Fluorosis
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Fluorosis
> Mild Forms
PICTURES
- Mild Dental Fluorosis:
Classification Criteria
- Mild Dental Fluorosis: (back
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| Classification
Criteria for Mild Dental Fluorosis - Dean's
Fluorosis Index |
| Score |
Criteria |
| Normal |
The enamel represents the usual translucent semivitriform
type of structure. The surface is smooth, glossy, and usually
of a pale creamy white color. |
| Very Mild |
Small opaque, paper white areas scattered
irregularly over the tooth but not involving as much
as 25% of the tooth surface. Frequently included in this classification
are teeth showing no more than about 1-2 mm of white opacity
at the tip of the summit of the cusps of the bicuspids or second
molars. |
| Mild |
The white opaque areas in the enamel of
the teeth are more extensive but do not involve as much
as 50% of the tooth. |
| To see Dean's
complete index, with descriptions
of moderate to severe fluorosis, click
here) |
Current Prevalence
- Mild Dental Fluorosis: (back
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"The prevalence of fluorosis at a
water fluoride level of 1.0 ppm was estimated to be 48%
and for fluorosis of aesthetic concern it was predicted to be
12.5%."
SOURCE: McDonagh, M. et al. (2000). A Systematic Review of
Public Water Fluoridation. NHS Center for Reviews and Dissemination,
University of York.
"[S]everal reports of prevalence for
mostly mild fluorosis are in the 20 percent
to 80 percent range."
SOURCE: Levy SM, Guha-Chowdhury N. (1999). Total fluoride intake
and implications for dietary fluoride supplementation. Journal
of Public Health Dentistry
59: 211-23.
"Current studies support the view that dental
fluorosis has increased in both fluoridated and non-fluoridated
communities. North American studies
suggest rates of 20 to 75%
in the former and 12 to 45%
in the latter."
SOURCE: Locker, D. (1999). Benefits
and Risks of Water Fluoridation. An Update of the 1996 Federal-Provincial
Sub-committee Report. Prepared for Ontario Ministry of Health
and Long Term Care.
Impact on Tooth Quality
- Mild Dental Fluorosis: (back
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Note: For more information on the biology of dental fluorosis,
click here
"Dental fluorosis is defined as a permanent
hypomineralization of enamel, characterized by greater
surface and subsurface porosity than in normal enamel,
that results from excess fluoride (F) reaching the developing
tooth during developmental stages."
SOURCE: Burt BA ; Eklund SA. (1999). Dentistry, Dental Practice,
and the Community (5th Ed). WB Saunders Co; Philadelphia.
"Any use of fluorides, whether systemic or topical, in caries
prevention and treatment in children results in ingestion and
absorption of fluoride into the blood circulation. The mineralization
of teeth under formation may be affected so that dental fluorosis
may occur. Dental fluorosis reflects an increasing
porosity of the surface and subsurface enamel, causing
the enamel to appear opaque. The clinical features represent a
continuum of changes ranging from fine white opaque lines running
across the tooth on all parts of the enamel to entirely chalky
white teeth. In the latter cases,
the enamel may be so porous (or hypomineralized) that the outer
enamel breaks apart posteruptively and the exposed porous subsurface
enamel becomes discolored."
SOURCE: Fejerskov O, et al. (1990).
The nature and mechanisms of dental fluorosis in man. Journal
of Dental Research 69(Spec
Iss): 692-700.
Impact on Bone Quality?
- Mild
Dental Fluorosis: (back
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SOURCE:
Alarcon-Herrera MT, et al. (2001). Well Water Fluoride, Dental
fluorosis, Bone Fractures in the Guadiana Valley of Mexico.
Fluoride 34(2): 139-149. ( See
paper) |
"A linear correlation between the Dean
index of dental fluorosis and the frequency of bone fractures
was observed among both children and adults."
SOURCE: Alarcon-Herrera MT, et al. (2001). Well Water Fluoride,
Dental fluorosis, Bone Fractures in the Guadiana Valley of Mexico.
Fluoride 34(2): 139-149.
"it is illogical to assume that tooth
enamel is the only tissue affected by low daily doses of fluoride
ingestion."
SOURCE: Dr. Hardy Limeback, Head of Preventive Dentistry, University
of Toronto. (2000). Why I am
now Officially Opposed to Adding Fluoride to Drinking Water.
"Common sense should tell us that if a
poison circulating in a child's body can damage the tooth-forming
cells, then other harm also is likely."
SOURCE: Colquhoun J. (1997). Why I changed my mind about Fluoridation.
Perspectives in Biology and
Medicine 41:29-44.
"The safety of the use of fluorides ultimately
rests on the assumption that the developing enamel organ is most
sensitive to the toxic effects of fluoride. The results from this
study suggest that the pinealocytes
may be as susceptible to fluoride as the developing enamel organ."
SOURCE: Luke J. (1997). The
Effect of Fluoride on the Physiology of the Pineal Gland.
Ph.D. Thesis. University of Surrey, Guildford. p. 176.
"It seems prudent at present to assume
that the ameloblasts are not the only cells in the body whose
function may be disturbed by the physiological concentrations
of fluoride which result from drinking water containing 1 ppm"
SOURCE: Groth, E. (1973), Two
Issues of Science and Public Policy: Air Pollution Control in
the San Francisco Bay Area, and Fluoridation
of Community Water Supplies. Ph.D.
Dissertation, Department of Biological Sciences, Stanford University,
May 1973.
Perception/Psychological Effects
- Mild
Dental Fluorosis: (back
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Note: For information on the psychological impact of moderate
to severe fluorosis, click here
"Many participants reported that they
were at least occasionally distressed or worried over the appearance
of the children's teeth, that it hindered children from smiling
freely, and that it was an unsatisfactory appearance."
SOURCE: Martinez-Mier EA, et al. (2004). Development of a questionnaire
to measure perceptions of, and concerns derived from, dental fluorosis.
Community Dental Health
21:299-305.
"Mildly fluorosed enamel is fully functional, but may
be cosmetically objectionable."
SOURCE: Agency for Toxic Substances & Disease Registry [ATSDR].
(2003). Toxicological profile
for Fluorides, Hydrogen Fluoride, and Fluorine.
Atlanta, GA: U.S. Department of Health and Human Services, Public
Health Service.
"There is some evidence that members of
the public can be aware of even mild changes due to fluorosis
and may display a preference for 'normal' over mildly fluorotic
teeth. Our studies of esthetic perceptions of dental fluorosis
found that members of the public had strong preferences about
variations from normal tooth appearance. For example, all
respondents had a preference for teeth with normal colour over
teeth with mild fluorosis, whereas about two-thirds preferred
the appearance of an open bite to that of moderate fluorosis.."
SOURCE: Levy SM. (2003). An update on fluorides and fluorosis.
Journal of the Canadian Dental
Association 69: 286-91.
"Mild fluorosis was assessed less favorably
than normal/control, midline diastema was less favorable
than mild fluorosis, and mild fluorosis was less favorable than
isolated opacity."
SOURCE: McKnight CB, et al. (1999). A pilot study of dental students'
esthetic perceptions of computer-generated mild dental fluorosis
compared to other conditions. Journal
of Public Health Dentistry
59: 18-23.
"Although many dental professionals often
state that very mild fluorosis is not a cosmetic problem, these
results suggest that it is perceived otherwise. Even
parents of children suffering from very mild fluorosis showed
an increase in dissatisfaction with their child's apperance."
SOURCE: Lalumandier JA, Rozier RG. (1998). Parents' satisfaction
with children's tooth color: fluorosis as a contributing factor.
Journal of the American Dental
Association 129: 1000-6.
"South Australian children 10- to 17-years-old were able
to recognize very mild and mild fluorosis and register changes
in satisfaction with the colour and appearance of teeth.
Even mild changes were associated with psycho-behavioural impacts.
Hoskin and Spencer asked eight questions on psycho-behavioural
impact, such as embarrassment of teeth or self consciousness because
of the appearance of the teeth... The most dramatic
finding was the strength of the association of TISF
score with psycho-behavioural impact was similar to that of
crowding and overbite, both considered key occlusal traits driving
the demand for orthodontic care. "
SOURCE: Spencer AJ, et al. (1996). Water fluoridation in Australia.
Community Dental Health
13(Suppl 2): 27-37.
"Not unexpectedly, children with fluorosis
on anterior teeth ranging between TSIF
scores of "2" to "6" appear to have increased
concerns about tooth color."
SOURCE: Clark DC, et al. (1994). Aesthetic concerns of children
and parents in relation to different classifications of the Tooth
Surface Index of Fluorosis. Community
Dentistry and Oral Epidemiology
22: 461-4.
"The results, based on just over 3000 responses, showed
that lay and dental observers could distinguish between different
fluorosis levels. In response to a statement
that the teeth appeared pleasing, a large majority agreed when
the TF (fluorosis) score was 0, but
agreement declined as the TF score increased; when the TF score
was 3, most people disagreed. Similarly, observers
felt that the appearance would increasingly embarrass the child
as the TF score increased. Observers, except the dentists,
tended to feel
that higher TF scores indicated neglect on the part of the child."
SOURCE: Riordan PJ. (1993). Perceptions of dental fluorosis. Journal
of Dental Research 72: 1268-74.
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