Fluorosis – Causes and Treatment

Almost a quarter of all children suffer from fluorosis.¹ This takes the form of chalky-white mottling on the teeth and is often seen on the anterior central teeth. This is caused by a mineralisation disorder during tooth development, which can lead to mottled teeth and even dental enamel defects. This is due to excessively high fluoride intake during tooth development. Depending on the severity of fluorosis, special and expensive treatment approaches can be considered.

Fluorosis manifests itself in a relatively simple way; as described above it takes the form of white marks principally on the anterior incisors:

• It is mostly the central anterior teeth that are affected by fluorosis, the posterior teeth are less frequently affected. As it is the anterior teeth that are seen at first glance, sufferers often feel a sense of embarrassment or self-consciousness. Many ask whether this is in fact caries.
• Given, in most cases, the chalk-white nature of the discolouration, dentists refer to these as "white spots".
• Brown discolourations are seen less frequently. Mostly just a few teeth are affected, in severe cases the majority of the teeth are discoloured.
• Mild forms result in small, white areas of mottling on the teeth, with more severe overdoses causing enamel defects and even enamel hypoplasia.

If between the ages of one and seven, the intake of fluoride is too high – e.g. from the simultaneous use of fluoride tablets and fluoride-based toothpaste or via the normal daily consumption of fluoridated salt – this can compromise the healthy development of dental enamel and lead to fluorosis. The phase around the second and third year through to the fifth year of life is particularly sensitive.

High fluoride consumption when the teeth are developing renders the enamel surface more sensitive, the enamel is frequently more porous and discolourations result.

The risk in children is so high as they are susceptible to overdoses due to their low body weight and frequently swallow toothpaste when brushing their teeth. Just by swallowing toothpaste, small children can consume the same amount of fluoride as in a fluoride tablet or fluoridated salt. Additionally, many products used in day-to-day life are either enriched with fluoride or naturally contain fluoride, making it difficult to determine how much fluoride is actually consumed.

In the case of fluorosis, the first and most important step is to stop the increased supply of fluoride immediately. With mild forms of fluorosis, additional treatment steps are not always absolutely necessary from a medical perspective. The damage caused by excessive amounts of fluoride, for the most part manifested in unattractive white spots on the teeth, cannot be reversed without intensive dental care.
Modern dentistry offers a wide range of treatment options, ranging from special polishing pastes to veneers made of ceramic, composite fillings and bleaching. A consultation with the dentist helps to identify possible courses of treatment. White spots caused by fluoride are not always harmful and do not indicate caries, yet, from an aesthetic perspective, can be a cause of suffering to those affected.
As a rule, the treatment of white spots and discolourations on teeth is complex and cost-intensive. Prevention is therefore better than cure.

Our tip: Do not allow fluorosis in children to occur in the first place.

The vast majority of children's toothpastes on the market contain fluoride. Kinder Karex, on the other hand, combats caries without fluoride and, instead, contains a modern active ingredient inspired by nature: BioHAP, or biomimetic hydroxyapatite to use the full technical term, the substance from which our teeth are made. BioHAP forms a protective layer on the tooth making it harder for bacteria to adhere. As a result, plaque is reduced and initial caries lesions can be remineralised. The effectiveness of the active ingredient has been proven in scientific studies.

BioHAP is also suitable for young children who are not yet able to spit out toothpaste properly. Should they accidentally swallow some toothpaste, the well-tolerated active ingredient simply dissolves in the stomach. There is thus no risk of fluorosis. Kinder Karex can be used from 0 years upwards.

Good caries prophylaxis is vital in children as this age group is frequently affected by caries. Almost half of all children in their first year at school suffer or have suffered from caries. This is caused by a cariogenic diet and insufficient plaque removal and, in particular, the low enamel thickness of the milk teeth, which is only half as thick compared to permanent teeth. Consequently, children's teeth are affected by caries more rapidly.

Caries in the primary dentition considerably increases the risk of caries in the permanent teeth, which is why parents need to ensure good dental care from the word go. Kinder Karex is a modern, fluoride-free dental care product that is ideal for all ages.

For more information on Kinder Karex, see: Toothpaste for children without fluoride

Here you can find out more about changing teeth in children and how mixed teeth can be optimally cared for!

Dentists and paediatricians have been unable to agree upon a suitable fluoride exposure for infants and young children for years. This is often unsettling for parents as there are no standard recommendations for action.

• As of the emergence of the first tooth, paediatric dentists recommend cleaning the child's teeth daily with a fluoride-based toothpaste and also using fluoridated salt.
• Paediatric medical societies, however, advise giving children fluoride tablets up to around the age of four and avoiding fluoride-based toothpastes.

Critics argue that there is a risk of an overdose with tablets if fluoride is also provided via table salt enriched with fluoride. It is often very difficult to assess the total amount ingested. Moreover, the tablet affects the entire body instead of just locally on the surface of the tooth. On the other hand, with fluoride-based toothpastes, there is a risk of swallowing an unknown amount of fluoride. What's more, some children's toothpastes with fluoride contain twice as much fluoride than others (500 ppm vs 1000 ppm fluoride).

The use of a toothpaste containing fluoride in early childhood is also not without controversy. Lots of children frequently swallow large amounts of toothpaste. That's why, the Federal Institute for Risk Assessment advises to only have one source of fluoride (fluroide salt OR fluroide toothpaste OR vitamin D preparation with fluroide) in the home. With fluoride toothpastes for children, the dosage recommendations are particularly important in order to avoid fluorosis. Yet what child brushes his or her teeth with a rice grain-sized amount of toothpaste?

What is certain is that, under no circumstances, should fluroride tablets and toothpastes containing fluoride be used at the same time. The Kinder Karex Toothpaste offers parents an effective fluoride-free alternative. Since the active ingredient BioHAP is similar to the body, it is completely harmless if swallowed.

[1] https://www.ncbi.nlm.nih.gov/pubmed/20406274

[2] https://www.dge.de/wissenschaft/referenzwerte/fluorid/