What is Dental Fluorosis?

Dental fluorosis or brown tooth staining is a tooth defect indicated by an increase in porosity of the enamel. This mineralization defect occurs on the tooth surface, also known as hypomineralization. Hypomineralization is a result of excessive fluoride ion exposure during the developmental stage; critical ages are one through four years of age up to the age of eight. Fluorosis is no longer a risk when teeth are fully erupted.

Stages of severity depend on the amount of fluoride ingested and are classified into five types:

dental fluorosis chart

Lite Dental Fluorosis

Questionable dental fluorosis – slight aberrations, few flecks to occasional white spotting

Very mild dental fluorosis – small paper white areas scattered irregularly involving less than 25% of the tooth surface

Moderate Dental Fluorosis

Mild dental fluorosis – more extensive white areas on the enamel but does not involve more than 50% of the tooth surface

Moderate dental fluorosis- involving all tooth surfaces, marked wear on the biting surfaces, brown staining may be visible

Severe Dental Fluorosis

Severe dental fluorosis – all surfaces are involved, widespread brown staining, along with possible irregular tooth formation including pitting and corroded like appearance

Risk’s associated with dental fluorosis

There are no known risk factors associated with dental fluorosis that will affect the health of the tooth. Known risks are limited to the ascetic appearance of the tooth and the embarrassment incurred by the person. Tolerable fluoride intake based on age and weight can be found in the chart below titled "Dietary reference intakes for fluoride."

Dietary reference intake for fluoride (min/max)

Age Group
Adequate intake
mg/ day
Maximum tolerable intake
0-6 months
7 kg/16 lbs
7-12 months
9 kg/20 lbs
1-3 years
13 kg/29 lbs
4-8 years
22 kg/48 lbs
9-13 years
22 kg/48 lbs
14-18 years
60 kg/120 lbs
70 kg/160 lbs

Dental fluorosis is on the rise

The CDC and NIDR compared the number of children reported by dentist as suffering from dental fluorosis back in 1987 to the number reported in 2002. Data can be seen in the table to the right. Their collective data suggest that there has been an 80% increase. Dental fluorosis is most common in rural areas using well water or those areas with fluoride concentrations greater than 1ppm (part per million).

According to epa.gov, their maximum fluoride contaminant level/goal is 4mg or 4ppm per liter. This means that if children consume more than 1/2 of a liter of water per day they will exceed their maximum allowance of fluoride and be at risk for dental fluorosis. Our water supply is being saturating the with up to 5 times the recommended limit.

  Severity 1987 2002
  Low 17% 11.8%
  Mild 17% 19.95%
  Moderate 4% 5.83%
  High 1% 2.71%
  Severe .03% 2.71%
  Total % of child population 22.3% 40.19%

Treating Dental Fluorosis with cosmetic teeth whitening

Treatment options for dental fluorosis depend directly on severity of the fluorosis. These options include; micro abrasion, bleaching with custom fitted teeth whitening trays and carbamide peroxide whitening gel, bonding or filling restorations, veneers (cost varies but may be the best option for moderate to severe cases), and crowns. Tooth Bleaching and micro abrasion treatments are used for superficial staining, whereas the restorative approach is used for the more unaesthetic situations.

Bleaching dental fluorosis staining can initially cause the white spotting to be brighter. As the teeth gradually rehydrate, the fluorosis stains can become less noticeable. Whitening mild and less severe cases of fluorosis can be beneficial with the expectation of blending rather than removing the fluorosis. Those looking to remove fluorosis would need to consider an alternative plan of action for the teeth of concern.

The appropriate method of treatment for dental fluorosis needs to be selected on a case-by-case basis. Scheduling a dental appointment for unanswered concern is always advised.

Erin Stelbrink

Erin Stelbrink is a Registered Dental Hygienist with 11+ years of experience as a licensed hygienist and oral health care professional. She holds a passion for researching and acquiring awareness of the latest technologies and methods for providing valuable health care service and clinical treatment. Have more questions? Email Erin at erin@smilebrilliant.com