What is enamel fluorosis?

Enamel fluorosis is a hypomineralization of the enamel surface of the tooth that develops during tooth formation. Clinically this appears as a range of cosmetic changes varying from barely noticeable white spots to pitting and staining. Severe forms can occur when young children consume excess fluoride, from any source, during critical periods of tooth development.


Who is at risk for enamel fluorosis?

Only children 8 years old and younger are at risk, because this is the time when permanent teeth are developing under the gums.
Once the teeth erupt (emerge through the gums), they are no longer at risk for fluorosis.
Adults, adolescents, and children older than 8 years cannot develop enamel fluorosis.

What does enamel fluorosis look like?

Very mild and mild forms may have scattered white flecks, white tips of teeth, or fine, lacy chalklike lines. Most people with fluorosis have these barely noticeable forms.
Moderate and severe forms may have stains and rough, irregular enamel surfaces. These rarely occurring forms may be considered cosmetically objectionable.

What causes enamel fluorosis?

The occurrence of enamel fluorosis is reported to be most strongly associated with fluoride intake during enamel development, with the severity of the condition depending on the dose, duration, and timing of fluoride intake.

The transition and early maturation stages of enamel development appear to be most susceptible to the effects of fluoride; these stages occur at varying times for different tooth types. The risk for enamel fluorosis, even for posterior (back of mouth) teeth that do not show, ends when children reach age 8, because the pre-eruptive maturation of the tooth is complete and the enamel is no longer susceptible.


What are the sources of fluoride?

Toothpaste
Drinking water
Processed beverages and food
Dietary supplements that include fluoride (tablets or drops)
Other dental products (mouth rinses, gels, and foams)

What accounts for most of the fluoride intake?

In the United States, water and processed beverages (e.g., soft drinks and fruit juices) can provide approximately 75% of a person's fluoride intake. Inadvertent swallowing of toothpaste and inappropriate use of other dental products containing fluoride can result in greater intake than desired.


In which communities can enamel fluorosis be found?

Enamel fluorosis occurs among some persons in all communities, even in communities with a low natural concentration of fluoride.