Fluorides and dental fluorosis

This paper attempts to review present knowledge on the ingestion and metabolism of fluoride in relation to the occurrence of endemic dental fluorosis, a condition caused by an excessive intake of fluoride during tooth formation. The clinical appearance of dental fluorosis is characterized by lustreless opaque white patches in the enamel which may become striated, mottled and/or pitted. The opaque areas may become stained yellow to dark brown. The affected teeth may show a pronounced accentuation of the perikymata and, in more severe cases, multiple pits and larger areas of hypoplasia of the enamel appear so that the normal morphology of the tooth is lost. Due to the universal presence of fluoride in water, soil and the atmosphere it is not surprising that humans are exposed to various levels of fluoride intake , not only through food and water, but in industrial and pharmaceutical products and other sources. Water-borne fluoride, however, has been said to represent the largest single component of this element's daily intake, except where unusual dietary patterns exist. The daily amount of fluoride intake through water varies with climate (maximum daily temperature) and age. It has been postulated that significant changes in patterns of food and beverage ingestion, because of changes in available products and the ways in which they are marketed as well as many foods and beverages being processed in fluoridated communities, may have caused a change in the prevalence and severity of dental fluorosis over the past 30 years. Since fluoride remains pre-eminent among the measures available for increasing the resistance of teeth to caries attack, continued and renewed research on the ingestion and metabolism still has high priority.