In some people, the enamel has an uneven color and heterogeneous structure, covered with spots, chips and other defects. This disease is called fluorosis, it has a chronic course. Pathology is typical only for certain areas, so it can be prevented in a timely manner.
Fluorosis - classification
There are 5 types of the disease under consideration, which differ in symptom and severity of the course. The first 3 forms of fluorosis flow easily and do not provoke a loss of dental tissue, other types lead to its partial loss. Classification includes the following variants of the disease:
- dashed;
- spotted;
- mellovid-mottled;
- erosive;
- destructive.
The dashed form of fluorosis
The presented type of pathology is distinguished by the easiest current, it is rarely noticed in its early stages. The dashed form of fluorosis is characterized by the appearance on the teeth, mainly the upper incisors, of small chalk strips. At first they are almost indistinguishable, but eventually merge into a spot. If you look at it, you can find obvious longitudinal strokes. Such a fluorosis of teeth can be cured with timely and correct therapy. This type of disease does not cause complications and destruction of enamel.
Spotted form of fluorosis
This type of disease is accompanied by the appearance of pronounced light inclusions on the surface of several teeth, especially the upper and lower incisors. Gradually described enamel fluorosis progresses, small spots merge with each other, forming large formations. Sometimes they change color from white to yellow or light brown. The peculiarity of the presented type of disease - enamel in the spot zone is very smooth and shiny.
Melotic-mottled form of fluorosis
The considered type of pathology is characterized by different manifestations, which are strongly visible visually and cause psychological discomfort. It is important to immediately start treating such a fluorosis - a melovid-mottled form is accompanied by the formation on all teeth of well-defined white, yellow or brown spots with a matte surface. Without timely treatment, the enamel is destroyed. This dental fluorosis in some cases is combined with its thinning in certain areas. It looks like shallow depressions of about 0.1-0.2 mm in depth with a diameter of 1-1.5 mm.
Erosive form of fluorosis
With this type of disease, the enamel has a pronounced yellowish or brown hue. Against the background of pigmentation, areas with large defects are clearly visible. Disease fluorosis of the described form leads to the emergence of extensive and deep erosion. If you do not take any medical measures, the enamel is quickly erased, and already dentin is destroyed. Sometimes the progression of pathology ends in the loss of large areas of teeth.
Destructive form of fluorosis
The presented type of disease is considered the most difficult option. Chronic destructive fluorosis causes a strong pigmentation of the enamel, which acquires a dirty yellow or dark brown color. On its surface, immediately seen multiple chips, erosion, stains and other defects. Destructive fluorosis of teeth in parallel provokes the destruction of their tissue. The body tries to compensate for this process by isolating the substitution dentin, but this is not enough. Teeth become brittle, often break down under low pressure.
The cause of fluorosis
The described pathology begins to develop even before the eruption of permanent teeth . Endemic fluorosis affects people living in areas with high levels of fluoride in water. The optimal concentration of this substance is 1 mg / l, maximum - 1.5 mg / l. If a child uses water with a higher amount of fluorine for more than 3 consecutive years, the disease of fluorosis already damages his permanent teeth, even if they have not yet grown. Very rarely the disease affects milk enamel.
An adult who has moved to an area with an excessive fluoride content in water is not exposed to fluorosis. The risk of permanent enamel damage exists only if the concentration of the specified chemical is higher than 6 mg / l. The chance of getting sick with fluorosis depends on the level of fluoride in the water. The number of affected populations in endemic areas according to the concentration of the element:
- less than 1 mg / l - 10-12%;
- 1-1.5 mg / l - 20-30%;
- 1,5-2 mg / l - 30-50%
- more than 2 mg / l - more than 50%.
Fluorosis - symptoms
It is easy to notice the onset of progression of pathology even in the early stages. The fluorosis of the teeth and the severity of its clinical picture depend on the severity of the disease. The more damaged the surface of bone structures, the easier it is to diagnose the disease. External signs of fluorosis include enamel defects on symmetrical, predominantly anterior teeth:
- bands;
- speckles;
- strokes;
- stains;
- erosion;
- hollows;
- chips and others.
Stages of fluorosis
In dentistry, the disease in question is classified into 5 degrees of severity:
- Very light. The manifestation of fluorosis is insignificant and almost imperceptible. The color of the enamel is practically unchanged.
- Easy. On single teeth, there are rare milky-white spots or short streaks. The total surface of the lesion is up to 25% of the total enamel.
- Moderate. Strokes, spots and petty inclusions are clearly visible visually. The area of the tooth crown is damaged approximately by 50%.
- Average. In addition to white matte defects (melovid), there are yellow and brown spots, sometimes large. Due to the thinning of the enamel and exposure of the dentin, susceptibility to tooth decay and other infections of the oral cavity is observed.
- Heavy. More than 70% of tooth crowns are damaged. Pigmentation of the enamel is very pronounced, has an uncharacteristic yellow or brown color. Surface defects quickly deepen and turn into extensive erosion. The enamel is erased and discolored, the teeth are strongly deformed and often destroyed. If the fluorosis at this stage progresses, complications arise. A common problem is the loss of teeth and damage to the bones of the skeleton.
Fluorosis - Diagnosis
To detect damage to the enamel on the background of an excess of fluoride in the body can not only the dentist, but also the pediatrician and the therapist. The symptomatology of the disease and the collection of anamnesis help to reveal it unmistakably. Differential diagnosis of fluorosis is necessary when suspected caries in the stain. To distinguish these pathologies is very simple by specific features.
Fluorosis affects the vestibular and lingual surfaces of the teeth, characterized by multiple lesions of the enamel. Caries localizes in the contact and cervical areas, looks like single whitish spots of small size. Another feature of fluorosis - the appearance immediately after the eruption of permanent teeth. Caries occurs on the bone structures of the breast.
Fluorosis of the teeth - treatment
Therapy of damage to the enamel is developed taking into account the form and stage of the pathological process. If erosive or destructive fluorosis is diagnosed, the treatment involves the restoration of the shape and color of the crown part of the teeth with the help of:
- Orthopedic structures ( veneers );
- composite filling materials;
- fixing pins with artificial crowns .
The dashed, melovid-speckled and spotted fluorosis of the tooth surface is accompanied by changes in only the shade of the enamel, less often there are minor damages to its thin topcoat. To treat such forms of pathology, there is enough local bleaching and remineralization, which are conducted by several consecutive courses in the dentist's office.
Pastes with fluorosis
Personal hygiene is extremely important in the therapy of this disease. One of the auxiliary ways to treat fluorosis is the constant use of special toothpastes. Such products should not contain fluoride, it is desirable that they contain easily digestible calcium, whitening components and substances that prevent the development of caries . Recommended toothpaste for teeth affected by fluorosis:
- President Unique. Contains pantothenate, lactate and calcium glycerophosphate - compounds that strengthen and restore enamel. Even in the composition there is papain, dissolving plaque, and xylitol, which slows its formation, and neutralizes the acidic environment in the oral cavity.
- SPLAT Maximum, Biocalcium. Both pastes have papain and polydon, which contribute to a soft but effective removal of the plaque. Calcium is presented in the form of hydroxyapatite and lactate - easily digestible forms. SPLAT Maximum additionally contains a complex of enzymes, zinc citrate and licorice extract, providing a comprehensive oral care.
- Asepta. In the paste there is nothing superfluous - hydroxyapatite calcium, papain and potassium citrate. The product helps to improve the enamel state, prevents the formation of plaque and reduces the sensitivity of the teeth.
- ROCS Active ingredient is calcium glycerophosphate, which is easily digested and integrated into damaged areas of the enamel. To prevent the formation of plaque and the formation of caries in the paste included bromelain and xylitol.
- New Pearls. The most affordable option for fluorosis. In this agent there are no enzymes that bleach and remove the plaque substances, but there is the most "friendly" calcium compound - citrate.
Teeth whitening with fluorosis
Remove visible defects from the enamel only in the dentist's office. Professional bleaching with fluorosis is performed in one of 3 ways:
- The laser. First, the teeth are covered with a gel based on hydrogen peroxide. To show the normal color of the enamel, they are illuminated by a laser beam.
- By chemical means. As bleaching agents, solutions of carbamide peroxide and hydrogen, inorganic acids (hydrochloric, phosphoric) are used. Immediately after the procedure, the teeth are remineralized with calcium gluconate or a Remodent, a fluorine-lacquer coating.
- Shlifovkoy. The top layer of the enamel is removed using a special abrasive paste based on carborundum, hydrochloric acid and a silicon gel. After grinding, the treated crown is covered with perhydrol and is irradiated with a quartz lamp. At the end of the manipulation, remineralization is performed.
For one session of any of the listed procedures, it will not be possible to fully whiten the teeth. At the next visits to the dentist, active preparations will be used only in the darkest areas of the enamel, but to achieve the desired results, 3-20 manipulations are required (the amount depends on the degree of fluorosis and the color of the defects). Repeated treatment should be done after 6-8 months, during which the dentists advise to take glycerophosphates and calcium preparations inside, strictly observe the rules of personal oral hygiene.
Prevention of tooth fluorosis
Preventive measures can be individual and collective. In the first case, the prevention of fluorosis includes:
- limiting the use of products with fluoride (spinach, sea fish, animal oil);
- control of the quality and composition of drinking water;
- enrichment of the diet with vitamins C, D, calcium gluconate;
- application of toothpastes without fluoride;
- regular use of dairy products.
It is especially important to prevent illness in newborns in endemic areas. Parents should not early introduce lure, it is desirable to avoid artificial milk formula. It is recommended to give water either from bottles, or replace it with milk, juices. As the child grows up, doctors advise each summer to take him away for 2-3 months to a safe place (in terms of fluoride concentration).
Collective activities to prevent dental fluorosis in the population, is engaged in local government. Prevention requires:
- replacement of the water source for consumers;
- reduction of the amount of fluoride by special filtration;
- Mixing of water from different sources (for example, wells and springs).