The right amount of fluoride helps prevent and control tooth decay in children and adults. Fluoride affects the teeth both while they are developing and after they’ve erupted through the gums.
However, high levels of fluoride consumed during tooth development can lead to various visible changes to the tooth's enamel surface. These changes are a condition called dental fluorosis.
Most cases of dental fluorosis in the United States are mild. Many people experience dental fluorosis that is barely noticeable and doesn’t affect dental function.
Moderate and severe forms of dental fluorosis are far less common. In these cases, there may be more significant tooth enamel changes. In the rare, severe form, pitting may develop in the teeth. However, severe dental fluorosis cases rarely occur in communities where the level of fluoride in the local water is less than two milligrams per liter.
Dental fluorosis may occur when children regularly consume too much fluoride during the teeth-forming years. The teeth-forming years are ages eight and younger. Children older than eight years of age, adolescents, and adults are unlikely to form dental fluorosis.
When children consume too much fluoride over a long period when the teeth are developing under the gums, fluorosis is likely to occur.
The severity of fluorosis depends on the dose of fluoride, the duration it’s consumed, and the timing of fluoride intake.
Dental fluorosis is more likely to occur when the following sources of fluoride are consumed to prevent tooth decay:
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Symptoms of fluorosis include:
Unaffected teeth are typically glossy and smooth. They should also be a pale white color.
A child’s teeth with mild fluorosis may have scattered white flecks, occasional white spots, frosty edges, or fine, chalk-like lines. Most times, these changes aren’t noticeable and are only detected by a dental health care professional.
Moderate and severe types of dental fluorosis may result in larger white spots on the teeth. Rare, severe cases may lead to teeth with rough, pitted surfaces and dark brown stains.
If you have young children, it’s essential to know the fluoride concentration in your primary drinking water source. This information can help you make decisions about using other fluoride products.
For example, your physician or dentist may prescribe fluoride tablets or drops for your child to prevent tooth decay. However, fluoride supplements shouldn’t be consumed if your drinking water has the recommended fluoride concentration of 0.7 mg/L or higher.
If you live in a state that participates in the Centers for Disease Control and Prevention (CDC)’s My Water’s Fluoride program, you can learn of your water system’s fluoride status online. If you use a public water system, you can speak with your water utility company to request a copy of its most recent Consumer Confidence Report.
For children younger than two, it’s essential to speak to your doctor or dentist regarding the use of fluoride toothpaste, mouth rinses, and other products. You should clean your baby’s teeth as soon as the first tooth erupts by brushing with a small, soft-bristled toothbrush. The AAPD recommends using a tiny amount of fluoridated toothpaste (the size of a grain of rice) on the toothbrush when brushing baby's teeth.
If you have children aged from two to six years of age, you should apply no more than a pea-sized amount of toothpaste when they brush their teeth. You should also monitor their teeth brushing at this age, encouraging your child to spit out the toothpaste instead of swallowing it. Until around the age of six, children cannot control their swallowing reflex well and often ingest a lot of the toothpaste from their brush.
When you feed your child instant infant formula, there are types you can avoid to prevent your child from developing dental fluorosis. Powdered or liquid concentrates of formula mixed with water may increase the chances of dental fluorosis. This is especially if the infant formula is your child’s primary food source, and the water is fluoridated.
Consider choosing a ready-to-feed formula for your baby, as this contains little fluoride.
Dental fluorosis is generally less noticeable over time. However, if you don’t like the condition's appearance, there are various professional treatment options available.
Enamel microabrasion treats white spots on teeth with dental fluorosis. During this treatment, a dentist removes a small amount of enamel from the teeth. This procedure may reduce the appearance of white spots.
This treatment is often followed by teeth bleaching.
Teeth bleaching or whitening reduces the look of white spots and other stains on teeth affected by dental fluorosis. There are over-the-counter (OTC) options that you can buy, including whitening strips and special toothpaste. You can also purchase these products online.
Dentists can also perform professional teeth whitening treatments for better results. These treatments often use more potent bleaching formulas than those available OTC.
There are home remedies and treatment options available to help prevent further damage while whitening the teeth for those experiencing mild fluorosis.
Consuming certain fruits and vegetables is also food for treating the symptoms of dental fluorosis. Some fruits to eat for teeth include carrots, celery, and apples. These fruits are high in vitamin C, which kills bacteria. Vitamin C also removes plaque by helping you produce more saliva.
It would be best if you also tried to avoid acidic foods like tomato sauces, balsamic vinegar, and oranges. These foods can encourage the discoloration of the teeth.
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Fluorosis, Centers for Disease and Protection (CDC), 2019, https://www.cdc.gov/fluoridation/faqs/dental_fluorosis/index.htm
Bottled water, Centers for Disease and Protection (CDC), 2013, https://www.cdc.gov/fluoridation/faqs/bottled_water.htm
Study: Dental fluorosis generally less noticeable over time, American Dental Association, 2020, https://www.ada.org/en/publications/ada-news/2020-archive/march/dental-fluorosis-generally-less-noticeable-over-time
DenBesten, Pamela, and Wu Li., Chronic fluoride toxicity: dental fluorosis., Monographs in oral science vol. 22, 2011, 81-96, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3433161/
How can I prevent dental fluorosis in my children?, U.S. Department of Health & Human Services (HHS), 2020, https://www.hhs.gov/answers/health-insurance-reform/how-can-i-prevent-dental-fluorosis/index.html
Questions and Answers on Fluoride, United States Environmental Protection Agency, 2011, https://www.epa.gov/sites/production/files/2014-12/documents/2011_fluoride_questionsanswers.pdf