dental fluorosis

Last edited 03/2022 and last reviewed 03/2022

  • dental fluorosis is a developmental disturbance of enamel which occurs during enamel forming (1)

    • caused by systemic overexposure to fluoride during the first six years of life, when the enamel of the crowns of permanent teeth is formed
      • enamel contains more protein, is porous, opaque and less transparent
      • enamel fluorosis and primary dentin fluorosis can only occur when teeth are forming, and therefore fluoride exposure (as it relates to dental fluorosis) occurs during childhood
        • in the permanent dentition, this would begin with the lower incisors, which complete mineralization at approximately 2-3 years of age, and end after mineralization of the third molars

    • clinical manifestation vary from narrow, white horizontally running lines, larger patches or yellow to light brown colored areas of porous enamel, to (qualitative) loss of enamel in varying degrees
      • white opaque appearance of fluorosed enamel is caused by a hypomineralized enamel subsurface
        • in more severe dental fluorosis, pitting and a loss of the enamel surface occurs, leading to secondary staining (appearing as a brown color)
      • patients fluorosis are relatively resistant to dental caries (2)

      • severity of the condition is dependent on the dose, duration, and age of the individual during the exposure
        • in moderate to severe fluorosis, there is physical damage to the affected teeth

      • "very mild" (most common)
        • characterized by small, opaque, "paper white" areas scattered irregularly over the tooth, covering less than 25% of the tooth surface

      • "mild" form of the disease
        • mottled patches can involve up to half of the surface area of the teeth

      • "moderate" fluorosis
        • all of the surfaces of the teeth are mottled and teeth may be ground down and brown stains frequently "disfigure" the teeth

      • severe fluorosis
        • characterized by brown discoloration and discrete or confluent pitting; brown stains are widespread and teeth often present a corroded-looking appearance

        • Mild Fluorosis

Treatment of dental fluorosis:

  • treatments for fluorotic teeth are limited
    • mildest forms of fluorosis - bleaching may be recommended
    • moderate dental fluorosis include microabrasion, where the outer affected layer of enamel is abraded from the tooth surface in an acidic environment
    • severe fluorosis - options include composite restorations combined with microabrasion or application of aesthetic veneers
      • in some very severe cases - prosthetic crowns may be necessary

Use of fluoride toothpaste in children:

For the optimal effect of fluoride toothpaste, it is important to follow recommended guidelines for the use of products containing fluorides - Recommended use of fluoride toothpaste for children. Source: European Academy of Paediatric Dentistry (EAPD), 2009.

  • Age Fluoride concentration Daily use Daily amount
    6 months-2 years 500 ppm 2x pea size
    2-6 years 1000 ppm 2x pea size
    6 years and over 1450 ppm 2x 1-2 cm
  • in this way, the probability for fluorosis is decreased and the protective effect of fluoride on the development of caries is significantly important


  • in England, around 10% of the population receives public drinking water served by a fluoridation scheme (4)

    • water fluoridation schemes aim to achieve a level of 1mg of fluoride per litre of water
    • World Health Organization (WHO) guidance recommends a maximum concentration of fluoride in public water supplies of 1.5mg/l, this being protective against any known harmful effect over a lifetime of consumption
      • in the most deprived 20% of areas, the chance of 5 year old children having cavities was 25% lower in areas with a fluoridation scheme than in areas without
      • 5 year olds in areas with higher fluoride concentrations were less likely to experience dental cavities than in areas with low fluoride concentrations
      • up to 56% of hospital admissions for the removal of decayed teeth among children and young people could be prevented in the most deprived areas through water fluoridation scheme