Enamel Fluorosis
The proper amount of fluoride helps prevent and control tooth decay.
Fluoride works both before the tooth erupts into the mouth (i.e., while
the teeth are developing) and every day once the teeth have erupted. Fluoride
consumed during tooth development can also result in a range of
changes in the enamel surface of the tooth. These changes have been
broadly termed enamel fluorosis. More can be learned about enamel
fluorosis in
Recommendations for Using Fluoride to Prevent and Control Dental Caries
in the United States. MMWR, August 17, 2001;50(RR–14):1–42.
Recommendations on how to reduce the risk for enamel fluorosis.
What is enamel fluorosis?
Enamel fluorosis is a hypomineralization of the enamel surface of the tooth
that develops during tooth formation. Clinically this appears as a
range of cosmetic changes varying from barely noticeable white spots
to pitting and staining. Severe forms can occur when young children
consume excess fluoride, from any source, during critical periods of
tooth development.
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Who is at risk for enamel fluorosis?
- Only children 8 years old and younger are at risk, because this is
the time when permanent teeth are developing under the gums.
- Once the teeth erupt (emerge through the gums), they are no longer at risk for fluorosis.
- Adults, adolescents, and children older than 8 years cannot
develop enamel fluorosis.
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What does enamel fluorosis look like?
- Very mild and mild forms may have scattered white flecks, white
tips of teeth, or fine, lacy chalklike lines. Most people with
fluorosis have these barely noticeable forms.
- Moderate and severe forms may have stains and rough, irregular
enamel surfaces. These rarely occurring forms may be considered
cosmetically objectionable.
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What causes enamel fluorosis?
The occurrence of enamel fluorosis is reported to be most strongly
associated with fluoride intake during enamel development, with the
severity of the condition depending on the dose, duration, and timing
of fluoride intake.
The transition and early maturation stages of enamel development
appear to be most susceptible to the effects of fluoride; these stages
occur at varying times for different tooth types. The risk for enamel fluorosis,
even for posterior (back of mouth) teeth that do not show, ends when children reach
age 8, because the pre-eruptive maturation of the tooth is complete and
the enamel is no longer susceptible.
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What are the sources of fluoride?
- Toothpaste
- Drinking water
- Processed beverages and food
- Dietary supplements that include fluoride (tablets or drops)
- Other dental products (mouth rinses, gels, and foams)
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What accounts for most of the fluoride intake?
In the United States, water and processed beverages (e.g., soft
drinks and fruit juices) can provide approximately 75% of a person's
fluoride intake. Inadvertent swallowing of toothpaste and
inappropriate use of
other dental products containing fluoride can result in greater intake
than desired.
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In which communities can enamel fluorosis be
found?
Enamel fluorosis occurs among some persons in all communities, even
in communities with a low natural concentration of fluoride.
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What can be done to reduce the risk?
CDC has developed recommendations to reduce the risk for enamel
fluorosis. These can be found by following the links at the top of
this page.
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Date last reviewed: October 8, 2008
Date last modified: August 9, 2007
Content source:
Division of Oral Health, National Center for Chronic Disease Prevention and
Health Promotion |
