Therapeutic management of dental fluorosis

Dental fluorosis is a specific condition due to chronic ingestion of excessive fluoride during enamel formation. The cleavage and removal of enamel proteins are disturbed. Retention of the proteins and water results in varying degrees of subsurface porosities related to the severity of fluorosis. The porosities may attract extrinsic stains, causing enamel discoloration. Posteruptively, occlusal trauma may cause detachment of surface enamel weakened by the subsurface porosities. The therapeutic management options include bleaching, microabrasion, veneering and crowning. The bleaching agents break down the chromogens into smaller molecules, resulting in teeth with lighter and brighter shades. The microabrasion is aimed at removing the superficial microporous zone together with the entrapped extrinsic stains, while laminate veneers and crowns provide esthetic masking of the discolored fluorosed enamel. It is suggested that mild-to-moderate fluorosis be treated by microabrasion and bleaching, while severe fluorosis, with loss of some surface enamel, is managed by veneering and crowning, depending on the extent of surface enamel loss. Long-term clinical trials are needed to evaluate the appropriateness of the various management options for fluorosis of varying severity.