fluorosis-picsFluorosis is a condition that affects the teeth due to the presence of excessive fluoride in the tooth structure. The condition is also known as enamel mottling or mottling of the tooth.

The cause of the condition as earlier stated is the excessive incorporation of fluoride, the same substance added in tooth pastes, mouth-rinses and dentifrices to make the teeth more resistant to dental caries, tooth decay. Fluoride is similarly available as supplements in the tablet form, in gels where they are used for topical application especially in children; fluoride is similarly available in its ionic forms in sources of water, spring water, bore-hole water, bottled water in various concentrations.

Fluorosis itself is a developmental disturbance by which it means that it is a result of a disturbance during the development of the tooth structure. Fluorosis is common in Nigeria in some parts of the north central and North- eastern regions notably in Maiduguri, Adamawa and Yobe states.

Fluorosis affects both sets of dentition that is the primary  (deciduous ) and the permanent dentition, however the risks of it occurring in the deciduous dentition is higher because the danger of overexposure is higher in children during the developmental, stages of the dentition.

The general appearance of fluorosed teeth depends on the degree of severity and the concentration of fluoride in the drinking water. The appearance varies from specks to streaks of discoloration, stains and sometimes very severe brownish stains on the teeth.
The tooth structure is made of layers of enamel, dentine and the nutritive part of the tooth the pulp where the nerves and blood vessels run.

The enamel which is the outer-most layer is made of hydroxyl apatite crystals of calcium. The substance fluoride is able to get incorporated into the enamel structure to make it stronger and less resistant to attack by acid produced by bacteria acting on the carbohydrate substance, debris in the mouth. So fluoride is a good guy in the scheme of things. Fluoride makes it more difficult for the tooth to be dissolved by the acid, in this case lactic acid. The danger of teeth getting exposed gets less by the time the teeth erupts into the mouth. Excessive fluoride will therefore lead to the staining of the teeth and pitting of the enamel surfaces. Fluoride excess also affects other bones of the body especially the long bones.

The severity of the condition depends on factors such as the amount of fluoride the affected individual is exposed to, age of the child, other individual variations like weight, nutrition and bone growth, The concentration of fluoride in toothpastes, mouth-rinses, bottled water, public water supplies, food types consumed, types of supplements and several other sources which have not undergone biochemical assays.

It is the duty of the water boards and corporations to carry out these assays and monitor the ionic content of even packaged sachet water and make these findings available in public domain. Government fluoridation programmes where carried out should be meticulous to assess fluoride ion concentration in drinking water so as not to make the fluoride concentration higher than the optimum level of one part of fluoride per million of water.

Fluoride is also available in tea and brick tea and pollution from high fluoride coal, so societies with a high consumption of tea need to be aware of these, a note here, the writer is not discouraging the consumption of tea or saying the consumption of tea causes fluorosis.

There are conditions that mimic the appearance of fluorosed teeth, some are genetic and some are developmental examples are enamel defects caused by environmental factors, amelogenesis imperfecta just to mention a few.
Drinking of water from shallow wells may likewise increase the incidence of fluorosis, similarly the use of hand pumping water machines.

The risk of teeth fluorosis from the consumption of drinking water alone is minimal. It is the combination of drinking water fluoride ion concentration and fluoride ion concentration from other sources including children swallowing tooth-pastes, fluoride mouth-wash, mouth rinses, un-assayed food supplements sold over the counter and high fluoride containing food that is most likely contributor to fluorosis.

The individual with fluorosis has aesthetics as major concern, personal experience in practice, there is a higher number of female adult patients (some about to wed, seeking new ‘shiners’ for their wedding day) seeking treatment. I hope am not accused of gender bias, just saying it as I see it. Treatment is via micro abrasion to remove stains, the use of tooth bleaching with various levels of satisfaction, veneers and crowns to improve aesthetics.
Should an individual have fluorosis a visit to the dental surgery will help.

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