The Nature and Mechanisms of Dental Fluorosis in Man

Abstract

Any use of fluorides, whether systemic or topical, in caries prevention and treatment in children results in ingestion and absorption of fluoride into the blood circulation. The mineralization of teeth under formation may be affected so that dental fluorosis may occur. Dental fluorosis reflects an increasing porosity of the surface and subsurface enamel, causing the enamel to appear opaque. The clinical features represent a continuum of changes ranging from fine white opaque lines running across the tooth on all parts of the enamel to entirely chalky white teeth. In the latter cases, the enamel may be so porous (or hypomineralized) that the outer enamel breaks apart posteruptively and the exposed porous subsurface enamel becomes discolored. These changes can be classified clinically by the TF index to reflect, in an ordinal scale, the histopathological changes associated with dental fluorosis. Compared with Dean's and the TS1F index, we consider the TF index to be more precise. Recent studies on human enamel representing the entire spectrum of dental fluorosis have demonstrated a clear association between increasing TF score and increasing fluoride content of the enamel. So far, no useful data on dose (expressed in mg fluoride/kg b.w.) -response (dental fluorosis) relationships are available. In this paper, we have, therefore, re-evaluated the original data by Dean et al. (1941, 1942), Richards et al. (1967), and Butler et al. (1985) from the USA, by applying the equation of Galagan and Vermillion (1957) which permits the calculation of water intake as a function of temperature. By so doing, it can be demonstrated that there is a linear association between fluoride dose and dental fluorosis (r² = 0.87). Even with very low fluoride intake from water, a certain level of dental fluorosis will be found in a population. When the linear dose-response curve is applied to previous data from the use of fluoride supplements, these data are in full accordance. This indicates that we already have useful data available which to some extent allows us to predict prevalence and severity of fluorosis in a child population which is exposed to a known amount of fluoride. Because dental fluorosis may occur in some individuals and populations to a higher prevalence and degree than expected, and there exist rare cases who exhibit clinical changes similar to those of fluorosis—but with no known excessive fluoride background—it is concluded that it is important to intensify studies on factors which alone or in combination can make individuals more or less susceptible to the effect of fluoride.