Dental Fluorosis: Too Much Fluoride Stains Teeth

Dental Fluorosis: Too Much Fluoride Stains Teeth

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Dental Fluorosis Stains Teeth Chalky White
©Dozenist/Wikimedia Commons

Dental fluorosis happens when children swallow too much fluoride before their teeth have finished forming (usually before age 8.)  It was actually dental fluorosis that led researchers to eventually find that small amounts of fluoride can be beneficial for the teeth.

Dental fluorosis can range in severity from mild to severe.  The mild form appears as white specks on the teeth, as seen in the picture below.

Dental Fluorosis

The severe form of fluorosis is usually brown in color as seen in the picture below:

Severe Dental Fluorosis

It also looks like that person in the above picture has some cavities (the black spot on the tooth in the upper left of the picture and the other gray/white areas near the gumline)

Causes of Dental Fluorosis

Dental fluorosis is caused by swallowing too much fluoride.  This can happen in a number of ways, including:

  • Children being prescribed unnecessary fluoride supplements by their dentist (it does happen!)
  • Swallowing too much toothpaste when brushing
  • Babies drinking infant formula mixed with fluoridated water

How to Prevent Dental Fluorosis

You can reduce the risk that your child will get dental fluorosis by doing the following:

  • Not giving your child fluoride supplements if your child is not at risk for cavities
  • Using a fluoride-free  “training” toothpaste until your child can spit out all of the toothpaste when they’re done brushing
  • Mix infant formula with water that does not contain added fluoride

Conclusion

Dental fluorosis is a preventable condition.  By monitoring your child while they brush their teeth and taking steps to prevent unnecessary exposure to fluoride for your children, you can avoid this problem.  Remember, an ounce of prevention is worth a pound of cure!

Do you have any questions about dental fluorosis?  Please leave your questions and comments below and I’ll get back with you.

20 COMMENTS

  1. hi, i used nursery water with two of my children from about birth to one year with formula. they both have mild fluorosis on their baby teeth. will this definately affect their permanent teeth? i was told that this was great to use, and now am really stressing over how this will affect the permanent teeth…i had no idea!

    • Hi Carrie – The enamel of your children’s baby teeth started forming while you were still pregnant with them. The enamel of the four front baby teeth is usually done forming by about 2 months of age. In order for them to have fluorosis on their front baby teeth, I would imagine that they would have had to receive fluoride before they were born (if you took fluoride drops/pills or drank highly fluoridated water) or ingest lots of fluoride before they turned 2 months old.

      The enamel of the permanent central incisors begins forming around 3 to 4 months of age and finishes around age 5.

      Since the enamel of the permanent central incisors takes over four years to form, I would imagine that if you are careful about fluoride exposure between the ages of 1 and 5 that your kids may not have noticeable fluorosis.

      Keep in mind that this is just a guess. Some kids get fluorosis without being exposed to very much fluoride and some kids don’t get it even when they are exposed to a lot of fluoride.

      Sorry I can’t give you a very specific answer. I guess the only way to really find out is to wait and see how the permanent teeth look when they come in. Thanks for your comment, Carrie! Let me know if you have any other questions.

  2. Hi, approximately how much fluoride in mg/day is expected to cause fluorosis? Of course it’s going to be a different per person, but what is the doctor’s estimate?
    Thanks!
    -Sam

    • Hi Sam – I’m not sure about exact numbers. We learned that when water is fluoridated above 1.2 PPM, then fluorosis dramatically increases without a substantial decrease in the number of cavities. That’s why for a long time, it was recommended to fluoridate water supplies anywhere from 0.7 PPM to 1.2 PPM.

      Here’s an article that was published in the Journal of Public Health Dentistry. If you look at figure 2 (on the 5th page of the PDF), you can see the increase in fluorosis compared to the fluoride level in the water.

      One of the problems with estimating fluoride intake is that fluoride isn’t just found in the water, it’s found in many of the foods that we eat every day. Due to the complexity of calculating exactly how much fluoride people are ingesting, most studies seem to focus on how prevalent fluorosis is in comparison to the concentration of fluoride in the water supply.

      I hope that helps! Let me know if you have any other questions, Sam.

      • If we cannot calculate exactly how much individuals are ingesting in their foods because of the inherent complexities, then we should not be adding it to sources (ie. drinking water) that do not normally have it. We should probably remove it from water sources that have calcium fluoride (not the same as sodium fluoride that is used as the additive) naturally occurring. Now I know what is really wrong with my mother’s teeth. And her bones. Tea, for some reason, also contains fluoride. She is getting two types of fluoride in her tea because of the drinking water. Her health is failing and the doctors cannot figure out the reason. Dental and skeletal fluorosis. Symptomatically, she is about in stage two of the skeletal form (plus she has Hepatitis C). Her teeth are worse than any picture on google (and she has pyorrhea). I would suggest anyone supporting the fluoridation of drinking water to reverse their decision, because there are far more factors to calculate than the complexities of an omnivorous diet. The risks outweigh the benefits.

  3. Is it necessary to use tap water with fluoride for babies formula before 6 months, or is it fine to use bottled water. My doctor said I should use tap water for her formula because it has fluoride. I have read mixed views on this matter, and that you should not give the fluorinated water before 6 months of age.

    • Hi Michelle – Initially it was thought that fluoride would help teeth before they developed, but fluoride’s main effect is exerted AFTER the teeth have erupted and the fluoride comes into direct contact with the tooth.

      From what I’ve read, babies should have their formula mixed with water that has NOT been fluoridated so that the risk of dental fluorosis is minimized.

      The cover story of the October 2010 issue of the Journal of the ADA talked about fluorosis and infant formula. The article can be found here. A part that you may be interested in states, “Greater fluoride intakes from reconstituted powdered formulas (when participants were aged 3–9 months) and other water-added beverages (when participants were aged 3–9 months) increased fluorosis risk.”

      I’m a firm believer that fluoride does help teeth AFTER they come into the mouth, so I don’t think it’s a good idea to give babies fluoridated water since it is associated with dental fluorosis.

      I hope that helps – Let me know if you have any other questions. Thanks for your comment, Michelle!

      • Hello,

        Can I use the photo of severe tooth spots due to elevated fluoride in drinking water from the websitehttps://www.google.se/search?q=fluorosis&source=lnms&tbm=isch&sa=X&ei=MOroUr-GMIn24QS4lID4DA&sqi=2&ved=0CAcQ_AUoAQ&biw=1241&bih=656#facrc=_&imgdii=_&imgrc=jGenxfBqTB-W1M%253A%3BhINBd6BaH0R76M%3Bhttp%253A%252F%252Fupload.wikimedia.org%252Fwikipedia%252Fen%252Fa%252Fa7%252FSevere_fluorosis.JPG%3Bhttp%253A%252F%252Fen.wikipedia.org%252Fwiki%252FFile%253ASevere_fluorosis.JPG%3B1077%3B401
        I need an answer very quickly,
        It’s fo a book Drinking water minerals and mineral balance –importance, health significance, safety precautions.

        Ingegerd Rosborg

  4. Is well water safe for babies? I boil her water on the stove, but we don’t have ”county water”, we have well water, and its a very HARD water.

    • Hi Ashley – I’m not a pediatrician so I can’t really offer a good answer to your question. I was raised on well water and I like to think I turned out pretty normal! There are various ways to get your water tested for contaminants to see if it really is safe.

      I hope that helps. Thanks for your comment!

      • Boiling fluoridated water only serves to concentrate the impurities. Reverse osmosis and (better and cheaper) ion-exchange filters will remove fluoride.

  5. Hi, my dentist said that i suffer from flourosis but he didn’t suggest any treatment for it. I’m already 26 and my upper molars seem to have shrunk and lost their crowns. The enamel on my teeth seems to melt too, at a rapid rate. Is this normal for someone who’s suffering from flourosis? I just noticed these changes this june 2011 but my dentist didn’t suggest any treatment for it. I’m afraid that i might lose all of my teeth if flourosis has the capacity to shrink them? Is what i’m experiencing normal flourosis symptoms?

    • Hi Sidney – That’s not normal. Fluorosis doesn’t cause your crowns to shrink, it’s probably something else and your dentist may be able to give you a better idea of what’s going on.

      You can read my article on dental fluorosis treatment to learn more about how this condition is treated. Thanks for your comment – let me know if you have any other questions.

  6. Thanks for the reply Tom, my dentist can’t seem to find anything wrong with my teeth that can explain what’s happening.. So basically there isn’t any dental disease that causes the enamel and crowns to shrink rapidly right? Or there is such a disease? Since flourosis doesn’t seem to fit the symptoms. Thanks.

    • No problem, Sidney. The only thing I can think of would be erosion of your teeth by acid. That would occur if you were drinking a lot of pop or citrus beverages.

      I hope that helps! Let me know if you have any other questions, Sidney.

  7. Hi Tom I need some sort of science behind fluorosis as I am doing a chemistry assignment on it can you please tell me how flurosis works and why the teeth are stained brown?

  8. Hello,
    My son, who is 8, has mild/moderate dental fluorosis in this top front two teeth. Our dentist indicated that there really isn’t a treatment option right now and in the future the only options would be placing composite on the teeth to try to even out the appearance or veneers. He said bleaching is not an option, as it may only serve to further whiten the already really white areas. Is there anything else that can be done? We are desperate to do something to improve the appearance.

    Thank you for your assistance.

    Alison

  9. Hi doctor Tom, is their any particular tooth paste to be use with patients having mild dental fluorosis? thank you and God bless – mayen

  10. My baby is 10 months and we gave her fluoride drops prescribed by her doctor at 6 months for a month. She has developed mild fluorosis. Will her permanent teeth be affected as well?

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