Case Report International Journal of Oral Health Dentistry. January – March 2016;2(1):50-55 50 Prevention of Dental Fluorosis and its Varied Treatment Options ‘A Case Series’ Vivek Govila 1,* , Smita Govila 2 , Satya Gupta 3 , Deepika Singh 4 1 Professor & HOD, 3 Post-Graduate Student, Dept. of Periodontics 2 Reader, Dept. of Conservative & Endodontics, Babu Banarasi Das College of Dental Sciences, BBD University, Faizabad Road, Lucknow, Uttar Pradesh - 226028 4 Senior Lecturer, Dept. of Conservative & Endodontics Vardhaman Mahaveer College of Dental Science, Moradabad, Uttar Pradesh. *Corresponding Author E-mail: govilavivek@gmail.com Abstract Dental fluorosis is a known adverse effect of fluoride overuse. Enamel or dental fluorosis is a condition caused by 'excessive' intake of fluoride over an extended period of time. The most common symptom of dental fluorosis is a chalk-like discoloration of teeth with white spots or lines on tooth enamel. In more severe cases the affected areas have a yellow or brown discoloration. In extreme forms, fluorosis may result in a pitted tooth surface. Fluorosis has been reported way back in 1901. The treatment options for fluorosis are varied depending upon individual cases. The purpose of this article is to report various treatment options available for dental fluorosis; it also dwells on the need for the dentists to be aware of their local indigenous pathologies to treat it in a better manner. Keywords: Dental fluorosis, endemic fluorosis areas, fluorosis, treatment options for fluorosis Access this article online Quick Response Code: Website: www.innovativepublication.com DOI: 10.5958/2395-499X.2016.00008.3 Introduction Dental fluorosis is a health condition caused by a child receiving too much fluoride during tooth development. The critical period of exposure is between 1 and 4 years old; children over age 8 are not at risk. [1] In its mild form, which is the most common, fluorosis appears as tiny white streaks or specks that are often unnoticeable. In its severest form, which is also called mottling of dental enamel; it is characterized by black and brown stains, as well as cracking and pitting of the teeth. [2] It is well documented that fluoride can have both beneficial and detrimental effects on the dentition ever since Mc Kay and G.V. Black in 1916 published the effect of fluoride on dentition. [1] The beneficial effects of fluoride on dental caries are due primarily to the topical effect of fluoride after the teeth have erupted in the oral cavity. In contrast, detrimental effects are due to systemic absorption during tooth development resulting in dental fluorosis. [2] Dean, 1934, who developed a classification for fluorosis, which is still widely used, based on his interpretation of clinical appearance. [3] Dean and Mckay suggested that optimum level of water fluoride should be below 0.9 - 1.0 PPM. [4] The severity of dental fluorosis depends on the amount of fluoride exposure, the age of the child, individual response, as well as other factors including nutrition. [1] Although water fluoridation can cause fluorosis, most of this is mild and not usually of aesthetic concern. [3] Severe cases can be caused by exposure to water that is naturally fluoridated to levels well above the recommended levels, or by exposure to other fluoride sources such as brick tea or pollution from high fluoride coal. [4] The earliest manifestation of dental fluorosis is an increase in enamel porosity along the striae of Retzius. [9] Clinically, the porosity in the subsurface of enamel reflects as opacity of the enamel. With an increased exposure to fluoride during tooth formation, the enamel exhibits an increased porosity in the tooth surface along the entire tooth surface. Very severely hypo mineralized enamel will be very fragile and hence as soon as they erupt into oral cavity they undergo surface damage as a result of mastication, attrition and abrasion. The definite evidence that fluoride can induce dental fluorosis by affecting the enamel maturation was given by Richards et al. [10] Thylstrup and Fejerskov proposed a way of recording dental fluorosis (TF index) based on the histopathological features. [11] Human and animal studies have shown that the enamel hypomineralization in fluorotic teeth are due to aberrant effects of fluoride on the rates at which enamel matrix protein breakdown or rates at which the byproducts of enamel matrix degradation are withdrawn, resulting in retardation of crystal growth in enamel maturation stage. [12] Dean's index: [3] 1. Questionable - occasional white flecking’s and spotting’s of enamel 2. Mild - white opaque areas involving more of the tooth surface