Do you have white/brown spots on your teeth? You may not know that it's fluorosis! Let's talk about this!

Have you ever looked at your teeth, or at your child's teeth, and noticed tiny white, sometimes brown spots? Some people experience pain in their bones and joints, making it difficult to walk. One of the reasons for these things is that we have too much of a mineral called fluoride in our bodies. That's what we call fluorosis . Don't be afraid, don't think this is a serious disease when you hear it. Let's talk about this simply, in a way that you can understand.

What exactly is Fluorosis?

Simply put, fluorosis is a condition caused by too much fluoride in the body. Fluoride is a naturally occurring mineral found in soil and water. To be precise, in small amounts, it helps prevent tooth decay. That's why you may have noticed that some toothpastes contain fluoride. However, like anything, too much of it can be harmful to your health. As the saying goes, "too much of anything is not good." Even the water we drink contains some fluoride. Depending on where you live, the amount of fluoride in the water you use may be lower or higher. Organizations like the U.S. Department of Health and Human Services say that the optimal level of fluoride in our drinking water is about 0.7 milligrams (mg/L). This means that while it helps reduce tooth decay, it is important to maintain a balance that does not cause other health problems.

What are the types of fluorosis?

There are several main types of fluorosis. Let's take a look at what they are:

What is Dental Fluorosis?

This is the type we see and talk about most often. It affects your teeth. This condition occurs when you ingest too much fluoride, especially during the first eight years of life, when your teeth are forming. Dental Fluorosis can range from mild to severe. But it is not a painful condition. It is often considered a cosmetic problem, meaning it affects the appearance of your teeth. It usually does not have a significant impact on the function or health of your teeth.

Let's learn about Skeletal Fluorosis

This is a type that you need to be a little careful about. It affects your bones and joints. This can have negative effects on your overall health. For example , osteoporosis ( a condition where bones become weak and break easily), arthritis (joint inflammation), and long-term joint pain can occur. This condition occurs when too much fluoride is continuously ingested over many years.

What is Non-skeletal Fluorosis?

This is actually the early stage of skeletal fluorosis. It mainly affects your digestive system (gastrointestinal tract) . This means you may experience symptoms like stomach cramps, constipation, diarrhea, bloating, and loss of appetite.

How common is fluorosis?

Dental Fluorosis is a common condition seen all over the world. It is said that about 23% of the population in a country like America has this condition. However, Skeletal Fluorosis is very rare in countries like America. However, it is common (endemic) in some parts of Asia and Africa. Especially in India and China, the most patients are reported. It is difficult to say exactly how many people in the world have this skeletal fluorosis. However, one study found that 94 out of 445 people who were in an area with high fluoride concentrations had this condition. Now, look, in many parts of America, the fluoride level in the water is less than the previously mentioned 0.7 milligrams per liter (mg/L). That is why many local authorities there add fluoride to drinking water. However, in other parts of the world, for example, parts of Asia and Africa, natural groundwater contains high levels of fluoride. In India, the average fluoride concentration in drinking water is said to be around 2.37 milligrams per liter (mg/L). In some places, levels as high as 9.22 milligrams per liter (mg/L) have been reported. So, people living in such areas are at a higher risk of developing fluorosis. In Sri Lanka, there are also some areas, especially in the dry zone, where fluoride levels in the water need to be considered. Therefore, it is very important to be aware of the water sources in your area.

What are the symptoms of Fluorosis?

Symptoms vary depending on the type of fluorosis you have. In general, the more fluoride you are exposed to, the more severe your symptoms may become.

Symptoms of Dental Fluorosis

The only symptom of dental fluorosis is tooth discoloration. This discoloration varies depending on the severity of the condition. Dentists use the following terms to classify it:

• Questionable: Only a few very light white spots and a few white spots .
• Very mild: Light white spots covering less than 25% of the tooth surface.
• Mild: Light white spots covering less than 50% of the tooth surface.
• Moderate: White or light brown spots on more than 50% of the tooth surface.
• Severe:White, light brown, or dark brown spots all over the surface of your teeth. Your teeth may also have small pitting or the enamel may look worn away.

Symptoms of Skeletal and Non-skeletal Fluorosis

Early symptoms associated with non-skeletal fluorosis may include:

• Stomach ache
• Bloating​
• Constipation
• Diarrhea
• Joint pain and stiffness
• Back pain
• Muscle wasting
• Nausea and vomiting

As the condition worsens and symptoms of skeletal fluorosis begin to appear, you may experience the following:

• Bone fractures
• Bone and spinal deformities
• Mild cognitive impairment - that is, minor impairments in things like memory and attention
• Myelopathy - pain caused by compression of the spinal cord
• Osteosclerosis - abnormal thickening of the bones
• Radiculopathy - pain caused by a pinched nerve in the spine
• Skin rash
• Sleep disorders

What are the causes of fluorosis?

Fluorosis is caused by excessive fluoride ingestion. This means that you swallow too much fluoride over a long period of time. The way this happens varies depending on the type of fluorosis. Dental Fluorosis occurs when a child's permanent teeth are still growing under the gums, when too much fluoride is ingested. This can be caused by drinking water or milk with high fluoride content, or by swallowing large amounts of fluoride toothpaste. Skeletal and Non-skeletal Fluorosis occurs when someone of any age ingests too much fluoride over a period of several years. This can be caused by drinking water high in fluoride, or by continuously consuming beverages such as tea and coffee made with water high in fluoride.

Risk factors for developing fluorosis

A risk factor is something that increases the chance of developing a certain condition. The following are risk factors for fluorosis:

• Living in an area with high levels of fluoride in groundwater.
• The fluoride content in drinking water is usually greater than 0.7 milligrams per liter (mg/L).
• Swallowing large amounts of fluoride toothpaste regularly. (Swallowing a very small amount is okay. However, swallowing large amounts over a long period of time can cause fluorosis.)
• Giving fluoride-containing infant formula mixed with fluoride-containing water for a long time. (If you use fluoride-containing formula, make it with fluoride-free water. If you use fluoride-containing water, look for a fluoride-free infant formula.)

Some household products, such as sealants, lubricants, and air dust cleaners, contain fluorocarbons. People who inhale these chemicals are at increased risk of developing skeletal and non-skeletal fluorosis. Intoxication from these chemicals can cause seizures, arrhythmias, and even sudden death.

If you are addicted to these substances and need help recovering, it is very important to seek appropriate medical advice or counseling.

How is Fluorosis diagnosed?

A dentist can diagnose dental fluorosis during a routine dental exam. Sometimes, they may also take X-rays of your teeth to rule out other conditions. Skeletal and Non-skeletal Fluorosis can be a little more difficult to diagnose because its symptoms are similar to those of many other conditions. So doctors usually have to do a few tests. These may include:

• Imaging tests to check your bones. Examples include X-rays , CT scans (Computed Tomography scans) , and bone density tests (DXA) .
• Blood tests to check the level of fluoride in your serum.
• Urinalysis to check the level of fluoride in your urine.

What are the treatments for fluorosis?

Treatment for fluorosis varies depending on the type of fluorosis you have. Dental fluorosis can be corrected with cosmetic dentistry. Treatment for skeletal fluorosis is a bit more complicated. It depends on several factors, especially the severity of the symptoms and which parts of the body are affected.

Treatment of Dental Fluorosis

If you have dental fluorosis, your dentist may recommend one of these cosmetic treatments:

• Teeth whitening: Your dentist will apply a bleaching gel to your teeth for a specific amount of time. This gel will lighten your tooth enamel, making it match the fluorosis spots. This is often used to treat mild cases of fluorosis.
• Dental bonding: In this method, the dentist uses a tooth-colored composite resin to cover fluorosis stains. The teeth are then shaped and polished to a beautiful finish.
• Dental veneers: These are thin shells made of resin or porcelain that cover the front surfaces of your teeth. Since veneers are custom-made for each individual, dental impressions are taken to ensure they are the right size for your needs.
• Dental crowns: These are also custom-made tooth caps. They cover your entire tooth. In order for the crown to fit properly, a small amount of your natural tooth enamel must be removed.
• Enamel microabrasion: In this procedure, the dentist removes a very thin layer of your tooth enamel. This can remove many fluorosis stains. Often, doctors will also perform teeth whitening after enamel microabrasion to even out the color of your teeth.

Treatment of Skeletal and Non-skeletal Fluorosis

The main goal here is to eliminate the source of the problem. To do this, you need to remove fluoride from your drinking water. You can use methods such as reverse osmosis , distillation , or activated carbon filters to filter your water. (Boiling water will not do this. Although boiling removes impurities from water, fluoride is not something that can be broken down by heat, and it is very strong.) In addition, doctors may recommend treatments such as:

• Anabolic steroids:These medications can reduce the symptoms of osteoporosis.
• Calcium and Vitamin D: These two can reduce bone density when taken together. They can also affect the way you absorb fluoride from your intestines.
• NSAIDs (Nonsteroidal anti-inflammatory drugs): These medications help control the pain and swelling that comes with skeletal fluorosis.

This is not a complete list. Your doctor will tailor a treatment plan to your needs.

Can Fluorosis be prevented?

The only way to prevent fluorosis is to control the amount of fluoride you consume. Here are a few tips:

• Check with your local water board or a relevant agency about the rules and regulations regarding adding fluoride to water in your area.
• Check the fluoride levels in your well water or municipal water supply.
• Find out more about fluoride concentrations in your area.

To reduce your child's risk of developing fluorosis, be careful about the amount of fluoride he or she is exposed to. You should avoid giving your child too much fluoride, and make sure they get the right amount during the teething period. This balance is very important for your child's health.

What to expect when living with fluorosis?

The outcome of Dental Fluorosis is usually good, as it is not a harmful condition. It can be corrected with dental treatment. The outcome of Skeletal Fluorosis depends on how quickly you detect it. The sooner you stop fluoride intake, the better the chance of long-term recovery.

How long does fluorosis last?

In general, fluorosis is not a reversible condition. That is, once it occurs, it does not go away. Some studies have shown that treatment can improve the symptoms of skeletal fluorosis to some extent. But it depends on how severe your symptoms are to begin with.

How do I take care of myself?

If you have fluorosis, or if you live in an area where it is common, the best thing you can do is be informed. Know exactly how much fluoride is in the water you drink. Once you know those levels, you can make informed decisions about your health.

When should you see a doctor?

If you think you have dental fluorosis, see your dentist to discuss treatment options. Also, if you suddenly develop symptoms of skeletal fluorosis, such as nausea, joint pain, or frequent bone fractures, you should tell your doctor. He or she can run tests to find the cause.

In small amounts, fluoride strengthens our teeth and protects them from decay. But too much can be harmful. Knowledge is power. The best way to prevent fluorosis is to be aware. Check your water source. Find out about the laws in your area about adding fluoride to water. If you have specific questions about how fluoride affects your health, talk to your doctor.

The most important thing to remember from this article (Take-Home Message)

Okay, so, from what we've talked about, these are the most important things you need to remember:

• Fluorosis is a condition caused by excess fluoride in the body.
• There are two main types: Dental Fluorosis (affecting the teeth) and Skeletal Fluorosis (affecting the bones and joints).
• Dental Fluorosis causes white/brown spots on the teeth, but is painless. It can be corrected with cosmetic treatments.
• Skeletal Fluorosis is a bit more severe and can cause joint pain and bone fractures.
• The most important thing is to be aware of the amount of fluoride in the water you drink.
• Be careful about swallowing fluoride toothpaste while your children are teething.
• If you have any symptoms, seek medical advice immediately.

Remember, fluoride is something we need in moderation. The problem is getting too much of it. So, it's important for us all to be aware of this and protect our own and our children's health. Fluorosis, Fluoride, Tooth Stains, Bone Disease, Drinking Water, Dental Health, Minerals