7 Signs You Have Fluorosis & What To Do About It

Dental fluorosis is a damaging dental condition that occurs during childhood when a child is exposed to excessively high levels of fluoride. According to the CDC, these sources are usually their daily water intake, swallowing fluoridated toothpaste, or overuse of prescription supplements when a child already receives adequate fluoride from other sources.

What Is Dental Fluorosis?

Fluorosis is a condition caused by ingesting or consuming too much fluoride. It is most commonly found in children, as their developing teeth are more susceptible to staining and mineral deposits as their tooth enamel forms. And just like our bones need calcium to develop properly, our bodies need fluoride. But the key is that fluoride needs to come in specific amounts. After all, too much of anything good can still be bad for you, even water! 

The American Dental Association (ADA) supports the use of fluoride in toothpaste and community water fluoridation as safe and effective measures to prevent tooth decay in both children and adults.

Symptoms of enamel fluorosis often include white spots or lines on the teeth, as well as brown discoloration. In some cases, the enamel may also become pitted or misshaped. Dental fluorosis isn't always a health risk, but it can cause the teeth to look unattractive and make them more vulnerable to tooth decay if the condition is severe. To prevent fluorosis, it is important for young children not to consume too much fluoride in their diet, water intake, or oral hygiene products. Regular dental checkups with a dental health care professional can help detect any early signs of fluorosis so that appropriate action can be taken.

What Causes Fluorosis?

Fluorosis is caused by excessive intake of fluoride. While fluoridated water, toothpaste, and other fluoride-containing products are important for healthy teeth, it’s important not to overuse them. For example, you will not want to give your child prescription fluoride drops if you live in an area where your municipal water source is already fluoridated. Nor would you want to allow your child to use prescription fluoride gels unsupervised, with the risk of ingesting them every day.

Fluoride toxicity usually occurs in children under the age of 8 when teeth are still developing, making them more susceptible to overexposure.

Other causes of fluorosis include drinking or bathing in water that is too high in fluoride concentration (such as unregulated well water) or taking supplements without consulting a doctor first.

Finally, exposure to high levels of naturally occurring fluoride can also cause fluorosis.

All these factors can contribute to this condition if you’re not careful. Make sure you’re being mindful of your child’s dental health by visiting a family or pediatric dentist by the time their first tooth erupts, or no later than age 1, and scheduling oral health checkups every six months after that. Chronic fluoride toxicity, particularly when it leads to severe dental fluorosis, underscores the importance of balancing the beneficial anti-cariogenic properties of fluoride with its potential negative effects.

Signs You Have Fluorosis

Most people don’t realize they or their child has fluorosis until the teeth start to erupt, particularly because the risk of developing fluorosis is most significant up until the age of 8. This is a crucial period during which parents and caregivers should be vigilant about their child's fluoride exposure to prevent developing fluorosis. The discoloration and mottling caused by fluorosis are not immediately noticeable and may not be visible until the permanent teeth start to come in, which usually starts around 6 years of age and continues until a child is closer to 12-13 years old when their final teeth erupt. Internalized symptoms of fluorosis may be more difficult to screen for or diagnose due to the need for bone X-rays or soil/water testing.

1. Discoloration of the teeth: 

The most common symptom of fluorosis is white or brown spots on the teeth. These mottled surfaces tend to detract from your smile and pose major aesthetic concerns. Mottling and discoloration happen when fluoride becomes concentrated in a particular area, leaving visible marks in your enamel. The good news is that even with brown spots on your teeth, it doesn't necessarily mean that you have a cavity.

Treatment:

Aesthetic treatment of white spots caused by enamel fluorosis can often involve techniques like microabrasion, at-home bleaching, and resin infiltration treatments such as ICON. More aggressive discolorations, such as brown spots, may require bonding over those surfaces or elective cosmetic veneers. Unfortunately, severe discoloration caused by enamel fluorosis rarely responds to bleaching products, including professional whitening gels. 

2. Enamel defects: 

Excessive fluoride intake during tooth development can cause permanent changes to the texture of the enamel. Fluorosis will often create grooves, pits, and white or brown spots on the surfaces of your teeth, depending on which teeth were forming when the fluoride exposure occurred. 

Tooth development begins earlier than most people realize, with tooth enamel forming during gestation before the child is even born. Their baby and then adult teeth continue forming several years thereafter. Basically, high levels of fluoride exposure during pregnancy or preschool are equally dangerous. 

Treatment:

Pitted enamel or misshaped teeth often require fixed restorations such as white composite fillings, porcelain crowns, or cosmetic veneers to mask those flaws. Full-coverage restorations such as crowns also offer added reinforcement for biting and chewing, which is needed if the tooth is significantly misshaped. Because the restoration is crafted out of tooth-colored material, your dentist will also be able to improve the appearance of your tooth during the treatment process. 

3. Pain and tenderness in the bones: 

In addition to structural changes in your teeth, your bones may also be affected. This can lead to issues like daily chronic pain or overall tenderness, making you more sensitive to injury, movement, or fatigue. Just like calcium, bones use fluoride minerals during development as they grow and calcify. When you look at it that way, it's easy to see how too much—or too little—of a mineral like fluoride can permanently affect bone formation and long-term function. 

One study showed that fluorosis patients were significantly more at risk of developing osteoarthritis in their knees than people without excessive fluoride exposure. 

Treatment:

While there is no known treatment to address fluorosis in the bones, physicians and medical experts can help patients manage their symptoms and side effects. For example, people with osteoarthritis will want to work with their orthopedist or rheumatologist to develop a long-term care plan. Many people take over-the-counter medications to reduce their day-to-day discomfort, while others may require steroids or surgery. 

4. Stiffness and difficulty in movement: 

Have you ever experienced chronic joint stiffness or difficulty moving? If so, it could be a symptom of dental fluorosis. Fluorosis can cause stiffness and difficulty in moving your fingers, wrists, and ankles, making everyday activities like walking or writing difficult, if not painful. This happens because fluoride interferes with calcium metabolism and disrupts the proper functioning inside of your joints. Some people will even experience structural joint abnormalities or an increased risk of osteoarthritis, adding to their mobility concerns. 

Treatment:

If conditions like joint pain, swelling, or similar osteoarthritis symptoms develop, care will typically involve the need for an orthopedist or rheumatologist, as well as possible prescription medication or surgery (in more severe cases.)

5. Swelling and deformities: 

Fluorosis can be a serious health problem, especially when severe cases affect the bones in your body. When bone tissues are exposed to too much fluoride during early development, it can cause the bone to become porous, weak, or excessively dense. This can lead to swelling and deformities in the bones, especially in the hip and knee joints. Swelling and deformities in bones, particularly in the long bones of the body, such as the thigh bone and upper arm bone, are most common. In advanced stages, the spine and other bones may also be affected.

Treatment:

Skeletal fluorosis is relatively rare and occurs primarily in areas where the water supply is contaminated with high levels of fluoride. Fluorosis is particularly dangerous for children since their bones are still growing and developing, so it's important to monitor their exposure to fluoride. Particularly when it comes to their water intake and daily supplements. 

6. Dental Cavities in Permanent Teeth:

Even though fluoride makes your teeth stronger, sometimes fluorosis can increase your risk of getting dental cavities. Since it essentially erodes away at enamel and exposes the dentin layer below it, the situation can lead to both tooth sensitivity as well as a greater chance of developing tooth decay. Interestingly, patients with dental fluorosis are relatively resistant to dental caries, especially in mild to moderate cases, due to fluoride's role in caries prevention. However, severe cases of dental fluorosis may increase the risk of dental caries, dentin hypersensitivity, dark discoloration, and tooth wear.

Ironically, the areas with excessive fluorosis are actually quite strong and more resistant to acids and bacteria. But that doesn’t mean you can skimp on brushing and flossing!

Treatment:

If you already know that you are prone to tooth decay, your dental team can provide a preventative care plan to help you reduce your risk of new cavities. Such as composite bonding over "soft spots" in your teeth and adjusting your oral hygiene routine (including the use of topical treatments to strengthen your enamel.) Restorative crowns or white dental fillings are necessary if there are already active cavities in your weakened tooth enamel. 

It's also important to limit surface contact with acidic substances like certain foods or drinks such as soda, sports drinks, juice, or processed carbs that are consumed regularly, as these can increase plaque levels and lead to a higher risk of decay. 

7. Developmental problems: 

Fluorosis can be an incredibly concerning issue for parents of young children. It's important to understand why fluorosis causes developmental problems and what the implications may be. Generally, the amount of fluoride in the drinking water is higher than necessary for good dental health and tooth development. When children are exposed to too much fluoride over childhood, it can interfere with brain function as well as bone development, resulting in difficulty learning, poor memory, and behavioral problems. 

Treatment:

To avoid fluorosis, it's best to ensure that your children only consume safe amounts of fluoride through regulated sources like toothpaste or tablets recommended by your dentist. Unfortunately, many parents will not realize that their child's behavioral health is affected by fluorosis until excessive fluoride intake has already occurred. A preventative approach is key to avoiding fluorosis, so regular dental checkups and pediatric well-visits are essential. Treatment for attention or learning challenges is best managed with a combination of therapy and medication. 

What Does Fluorosis Look Like?

Fluorosis can lead to discoloration and mottling of the teeth. The severity of fluorosis can vary, but in mild cases, it may cause white spots on the teeth. In more severe cases, the teeth may become discolored or even brown, and the enamel may become pitted or rough. It's important to note that not all cases of fluorosis will have visible symptoms.

If you have fluorosis in your bones, it can be a bit harder to detect than dental fluorosis, as the symptoms may not be as visible. However, on x-rays, bones affected by fluorosis may appear denser and appear whiter than normal bones. In some cases, the bones may also appear thicker or harder than usual. It's important to note that these changes may be similar to those seen in other bone conditions, so a proper diagnosis should be made by a medical professional.

What Problem Can Severe Dental Fluorosis Cause?

Remember, fluoride is a mineral, and too much of any mineral is likely to lead to unwanted side effects, particularly when it's absorbed during rapid periods of physical development, such as during pregnancy, infancy, and childhood. 

Fluorosis can have a major effect on the appearance and function of your teeth, so it's important to understand what it is, how to prevent it, and what you can do if you suspect that you have it. Severe fluorosis can also impact your skeletal system, leading to issues with joint pain and overall mobility. And unfortunately, we may also see it impact the neurological system, contributing to cognitive function concerns when ingested at extremely high levels over a regular basis. 

How To Prevent Fluorosis From Fluoride Toothpaste

The best treatment for fluorosis is prevention. Fortunately, accurate information about fluoride use and dosage can help prevent overexposure to this mineral. 

If your family is on well water rather than a municipal water source, be sure to connect with your local agricultural office to have the mineral levels checked in the soil. This can tell you whether there's too much or too little fluoride so that you can supplement accordingly (or install a filtration system in your water source.) 

Communities without regulated fluoride will usually require adding drops to their infant or child's bottles/drinks. But these fluoride drops should only be used as directed to ensure proper dosing. Remember, fluoridated water is safe and proven to help reduce cavity risks in children, but it is carefully regulated and measured to ensure a safe dosage. 

Fluorosis Recap

Fluorosis is when too much fluoride is absorbed into your body during tooth development. It can affect both your teeth and your bones, as well as daily life. While fluoride is safe and essential at moderate levels, excessive fluoride intake will cause permanent physical defects. Always talk to your dentist about local fluoride levels in your community, especially before adding extra fluoride (outside of dental checkups) to your or your child's daily oral hygiene routine. Issues like well water or added fluoride supplements should be addressed carefully. Thankfully your dentist can help address the issues caused by enamel fluorosis with the help of cosmetic or restorative treatments.