“Whitish discolouration of teeth?” what is this?
There are some conditions where, along with yellow discolouration of teeth, there will be whitish discolouration of teeth. One of such diseases is DENTAL FLUOROSIS.
WHAT IS DENTAL FLUOROSIS?
Dental fluorosis is a condition where fluoride gets deposited into teeth at the time of formation of teeth. It hinders proper mineralisation of teeth resulting in areas of white and yellow pigmentations.
They are internal stains and cannot be removed by regular teeth cleaning.
HOW DO THEY APPEAR?
The presence of dental fluorosis varies from person to person. It appears as
- Yellow pigmented areas intermixed with white spots
- Presence of brown spots. The color ranges from light brown to dark brown based on the degree of demineralization of teeth.
Dental fluorosis occurs in mild, moderate and severe variants.
The mild variant of dental fluorosis appears as uniform soft yellow hue with areas of crystal white pigmentations. These are areas of fluoride deposition in teeth.
The moderate variant of dental fluorosis has definite areas of brownish discolouration associated with regular chalky white irregular surfaces on teeth.
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Few areas of severe hypoplastic enamel appear as amber coloured stains on teeth. At times patients think of them as stains and consult a dentist for its removal.
The severe form of dental fluorosis is classically observed with distinct pitting of enamel, representing denuded enamel areas.
Along with them, multiple amber coloured or brownish discoloured regions appear on the teeth surface. It results in more roughed teeth surfaces escalating calculus formation around the teeth.
ARE THESE STAINS REMOVABLE?
No! These stains are not removable. Patients should understand that these are intrinsic stains and form at the time of teeth development.
But the severity of these stains can be treated to some extent. But all these treatments and their outcome depend on the type of dental fluorosis.
HOW DO THEY OCCUR?
According to WHO, the maximum permissible level of fluoride in water is 1.5mg/lit [*]. Dental fluorosis appears more in people who live in areas where groundwater contain significant concentrations of fluoride (>1.5mg/lit).
People who drink underground such water at the time of teeth development are more prone to dental fluorosis. It usually manifests along with skeletal fluorosis or may be confined to teeth.
The enamel matrix in the teeth contains HYDROXY-APPETITE CRYSTALS. When the teeth are in the developing stage, and at the time of enamel formation, fluoride crystals get deposited into the hydroxy-apetite crystals of teeth.
As a result, FLUORO- HYDROXY-APETITE CRYSTALS [FHAC] will appear on the developing teeth. These FHACs are more opaque and appear as chalky white areas on the teeth.
Because of FHAC, enamel matrix mineralisation will not occur properly, resulting in multiple dark brown or yellow pigmented areas on teeth.
The more the FHAC, the more will be the brittleness of teeth, resulting in chipping of enamel, thus forming multiple pits on enamel.
ARE FLUORIDE TEETH MORE RESISTANT TO CARIES?
It is not a myth! Yes, fluoride teeth are more resistant to caries. The FHAC in teeth is resistant to acidic degeneration of caries-producing bacteria.
Hence these teeth are more resistant to caries than its counterpart.
WILL I GET DENTAL FLUOROSIS IF I DRINK FLUORIDE WATER NOW?
It depends on the age and the period in which the patient exposes to high fluoride-containing water. Generally, if a patient drinks fluoride water when the teeth are in developing stage (up to 13 – 14 years), he can be at a potential risk to develop dental fluorosis.
Otherwise, there will not be any effect of fluoride on teeth, once the tooth formation is complete. Hence only the children and teenagers are more affected with dental fluorosis, than adults.
WHAT ARE THE BEST TREATMENT OPTIONS AND THEIR COSTS, FOR DENTAL FLUOROSIS?
Does fluorosis require treatment? It depends on the severity of Fluorosis. In very mild cases, where we see only a few teeth with white chalky surfaces, require no treatment at all.
Dean has introduced grading or scoring of Fluorosis, which is called Dean’s Community index for dental fluorosis [FCI]. FCI score below 0.4 does not produce any adverse effect on teeth.
But FCI score above 0.6 is observed to produce a notable deterioration on the strength of teeth and requires treatment. Your dentist usually evaluates these parameters.
Based on the severity of dental fluorosis, treatment options will change.
MILD DENTAL FLUOROSIS
In patients with mild dental fluorosis, bleaching can produce better results to some extent. But this treatment has few disadvantages also.
Bleaching makes teeth more porous and sensitive. Hence the overall sensitivity of the teeth may increase in few cases.
MODERATE DENTAL FLUOROSIS
In moderate and severe cases, composite camouflage and veneers are the best-suited treatment options. Composite camouflage is a procedure where the outer surfaces of the teeth are scraped a few millimetres and are restored with composite material.
One disadvantage of this treatment is, there are chances of staining of teeth, as days pass. Composite fillings cost somewhere between $135 to $240* per tooth, in the United States (1).
This cost varies from region to region. In countries like India, the treatment costs range from 1000 to 5000 * rupees per tooth. But on an average, their price will be on a higher side when compared to conventional amalgam or tooth coloured fillings
The third treatment option is similar to composite camouflage. Instead of restoration, here we use veneers on the outer surface of teeth.
Veneers are prosthetic replacements of the outer surface of teeth that are cemented a few millimetres onto the tooth surface. They produce the right aesthetic outfit and are better than composite restorations.
Veneers cost varies according to the type opted by the patient. Generally, they cost around $250 (composite veneers) to $2500* (porcelain veneers), per tooth (2).
Dental veneers are different from crowns. A veneer covers only one surface of teeth, while a crown covers the entire tooth like a cap.
Veneers are the best and conservative options for patients with dental fluorosis. In India, the costs range between 3000 rupees to 10000* rupees.
SEVERE DENTAL FLUOROSIS
In case of severe dental fluorosis, the dental crowns act as final solutions. They also aid in strengthening these brittle teeth, increasing their longevity.
Dental crown cost around $800 to $3000* per tooth.
There are wide ranges of crowns starting from complete metal crowns, porcelain fused to metal and Zirconia crowns (3). The high-end zirconia crowns cost between 7000* rupees to 20000 rupees (based on the types) in India.
*standard disclaimerThe prices are subjected to change from region to region based on the type of material used. The prices shown here are just for educating patients regarding cost of dental treatments, and are subjected to change according to region.
However, your dentist is the best judge to formulate a correct treatment plan, based on the stage of dental fluorosis.
[su_box title=”THE TAKE HOME MESSAGE” box_color=”#1ea3be”]First of all patients with dental fluorosis should visit their dentist at least twice a year for a regular dental checkup.
Dental fluorosis occurs when teeth are in developing stage. Hence children living in fluorosis areas are more affected than adults. Make sure that children are not drinking water containing high fluoride.
Patients with severe dental fluorosis undergo bleaching or teeth whitening treatment. It can potentially increase sensitivity as the teeth become more porous and brittle after dental bleach.[/su_box]
Toothpaste and fluorosis in children
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