One of many enamel defects
Dental fluorosis appears as markings on the enamel surface of teeth. It is one of 90 or so 'enamel defects' that may affect teeth, and is caused when children ingest excessive amounts of fluoride from all available source while their teeth - primary and permanent - are developing in the gums.
Mostly pearly white flecks visible only to experts under good lighting
In most cases, dental fluorosis appears as barely visible pearly white flecks on the surface of the tooth and is undetectable except by an expert. In other words, most people whose teeth are affected by fluorosis are unlikely to notice it. Nor are they likely to notice the majority of cases of fluorosis in other people.
The cosmetic impact of tooth decay
Tooth decay in children's front teeth may be unsightly and painful. The adverse cosmetic and health aspects of tooth decay - and the role of fluoride in reducing tooth decay - should be taken into account when the risk of dental fluorosis is discussed.
One in a Million
Our One in a Million online database includes a comprehensive section on dental fluorosis.
Cochrane Oral Health Group review of fluorosis studies
In a review published in 2015, the Cochrane Oral Health Group authirs say that, in its mildest form, fluorosis is visible only to trained examiners under controlled examination conditions. In addition, they acknowledge that moderate dental fluorosis, where a larger area of the total tooth surface is affected, could be considered to be an 'unwanted' effect rather than an adverse one.
York review of fluorosis studies
In 2000, researchers at the University of York in 2000 published their findings from a review of fluorosis studies from around the world. Combining data from all these sources, they estimated that there was a 10% to 12% prevalence of dental fluorosis of aesthetic concern in fluoridated areas, compared with a 6% prevalence in non-fluoridated areas. Most of the ‘fluoridated’ areas had naturally, rather than artificially, fluoridated water and were located in countries with hot climates and therefore higher average water intakes.
Australian NHMRC review of fluorosis studies
This 2016 review concluded that the York and Cochrane review findings on fluorosis were of "limited relevance" to fluoridation in Australia, and reaffirmed that dental fluorosis which may be of aesthetic concern is "uncommon".
Revised prevalence estimates based on European studies
Using data from previous studies conducted in Europe, in 2002 the Medical Research suggested that the prevalence of fluorosis of aesthetic concern was likely was likely to be around 3% to 4% in artificially fluoridated areas and around 1% in non-fluoridated areas. The MRC figures exclude the outcomes of studies conducted in naturally fluoridated countries of Africa and Asia with much hotter climates, which had been included in the York review published two years earlier.
Studies of interest
Study of tooth decay and fluorosis in Newcastle and Manchester
A study of 11 to 13 year olds, published in 2012, found a higher prevalence of dental fluorosis among those living in fluoridated Newcastle upon Tyne (7.1%) than those living in non-fluoridated Manchester (1.2%).
Newcastle children had significantly lower levels of tooth decay. Neither of these findings was a surprise, as the scientific evidence accumulated over many years has consistenly shown that there is less tooth decay and more fluorosis in fluoridated communities.
Survey of children’s fluorosis levels in the Irish Republic and Northern Ireland
A survey of children across the whole of Ireland, published in 2002, found higher levels of dental fluorosis in fluoridated areas of the Irish Republic than in non-fluoridated areas of the Republic and in wholly non-fluoridated Northern Ireland. The prevalence of mild, moderate or severe fluorosis (the types of fluorosis generally regarded to be of possible aesthetic concern) was 7% for fluoridated areas and 2% for non-fluoridated areas. Most of these cases were mild fluorosis,
Average fluoride intake of 1 to 7 year olds within recommended limits for minimising fluorosis risk
Figures cited in a paper by Maguire and Zohoori (British Dental Journal, June 2013) show that British children's total daily fluoride intake is generally within recommended limits for minimising the risk of dental fluorosis.