Fluorosis – Causes and Treatment
- Symptoms of fluorosis - white marks and tooth discolouration
- What causes fluorosis?
- Fluorosis in adults
- Fluorosis in children and on milk teeth
- Treatment of fluorosis
- Which toothpaste to treat fluorosis?
- Risk of caries in the primary dentition
- Fluoride with children and babies
- Fluoride-free alternatives for effective dental care
- Fluoride in foods, salt and drinking water
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.
Symptoms of fluorosis - white marks and tooth discolouration
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.
What causes fluorosis?
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.
Fluorosis in adults
Around a quarter of the population suffers from fluorosis as a result of consuming too much fluoride during childhood.
The damage that arises during infancy through to six or seven years of age does not go away without treatment. Depending on the severity, sufferers find this aesthetically unpleasing, yet the damage can also have a negative impact on tooth health if the resilience of the tooth surface is affected. Once the dental enamel is damaged, remedying this is a complex and costly process, and, as such, prevention really is better than cure!
Fluorosis in children and on milk teeth
In order to avoid fluorosis, it is important that children consume the right amount of fluoride according to their age. A precise recommendation in milligrams for the overall intake is given for each age group. For more information see below. That's why it is important that parents take note of all fluoride sources (e.g. toothpaste with fluoride, drinking water, foods, fluoridated salt).
Various professional societies have developed recommendations for action to help parents avoid overdoses. We recommend the use of a fluoride-free children's toothpaste as this prevents a fluoride overdose if the toothpaste is swallowed.
Treatment of fluorosis
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.
Which toothpaste to treat fluorosis?
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.
Risk of caries in the primary dentition
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
Fluoride with children and babies
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).
Fluoride-free alternatives for effective dental care
The use of a toothpaste containing fluoride in early childhood is also not without controversy. Effectiveness also depends on the amount of fluoride contained. At the end of 2018, dental professional societies increased the recommended amount of fluoride in children's toothpastes from 500 ppm to 1000 ppm. In order to avoid the risk of an overdose, parents should stick strictly to the dosage recommendations.
One thing is certain, under no circumstances should fluoride tablets and fluoride toothpaste be used simultaneously. The Kinder Karex toothpaste offers parents an effective fluoride-free alternative. Thanks to the active ingredient BioHAP, which is similar to that found in the body, the toothpaste can even be safely swallowed.
Fluoride in foods, salt and drinking water
Fluoride can be found in almost all foods and drinking water. Frankfurter sausages contain 0.17 mg/100 g, pork liver 0.29 mg/100 g and soybeans 0.36 mg/100 g. Fish such as herring (0.35 mg) and kipper (0.36 mg) as well as walnuts with 0.7 mg are very high in fluoride.
Fluoridated salt contains 250 mg fluoride/kg.
The fluoride content of drinking water in Germany is around 0.3 mg/kg, with some mineral waters containing much higher amounts of fluoride. The fluoride content only has to be clearly stated as of 1.5 mg/l. Water suitable for preparing baby foods must not contain more than 0.7 mg.
The German Nutrition Society (DGE) provides detailed guidelines on the total daily fluoride intake.2 These are precisely regulated in milligrams according to age: Infants up to four months of age should not intake more than 0.25 mg, children up to four years 0.7 mg per day, children aged between 4 and 10 1.1 mg, female adolescents 2.9 mg, male adolescents 3.2 mg and adults 3.1 mg (for women) and 3.8 mg (for men).
These recommendations should not be exceeded in order to avoid fluorosis. With a fluoride-free toothpaste such as Kinder Karex, parents can protect their children's teeth from caries without the risk of fluorosis from swallowing.
By the way, fluoride is not a trace element. Trace elements are essential for humans. Fluorides are not required for a specific bodily function.