Dental Fluorosis Classification Based On Its Severity

The use of fluoride in a long time during enamel formation result clinical changes, from the emergence of a small white line on the enamel to severe that enamel becomes white as chalk and opaque and may partially broken immediately after tooth eruption. Severity depends on the amount of use of fluorine during the period of tooth formation.

Normal enamel is a solid material, containing a lot of pores that are very small, consisting of hydroxyl apatite crystals which arranged in a regular pattern and forming the enamel rods (enamel prisms). In normal enamel, the crystals are bonded  very tight to each other with very small gaps, so it will look translucent. Normal enamel surface is usually smooth and shiny, the color is white or light cream. These properties will persist even if the surface is dried in a long time.

Dental fluorosis describes a series of  tooth enamel's changes, the clinical characteristics of dental fluorosis can be divided into four levels, based on the severity: 

1. Very Mild Dental Fluorosis


The earliest signs of dental fluorosis is the presence of a white line running crossing on the surface of the teeth or enamel, but it does not cover more than 25% of the surface of the teeth. This line is most easily seen on the incisal that does not contain (or only a thin layer of) dentin beneath the enamel. In some cases, it can also occur what we called as snow cap, where the peak of the cusps, incisal edge and marginal bridge looks opaque and not more than 1-2 mm. Areas that are often included in this group are premolars or second molars that usually shows opacities on cusp peak.

2. Mild Dental Fluorosis


In the teeth suffering dental fluorosis a little worse than before (very mild form), white lines appear wider and more prominent, causing small spots, irregular and teeth surface looks gloomy as foggy.

3. Moderate Dental Fluorosis


The severity of fluorosis at this level is characterized by an irregular opaque areas that fuses to the entire surface of the teeth so that teeth appear as white as chalk (chalky white). After the tooth erupts into the mouth, teeth shows damage on the surface so that if the white area is rubbed firmly, then part of the enamel will be detached.

4. Severe Dental Fluorosis


On this severity, the entire teeth surface appears opaque and shows very clearly hypoplasia or loss of outer enamel surface that result the formation of white spots on teeth. The common area is in the middle of the incisal or occlusal teeth. Teeth that suffer severe fluorosis can also indicate a loss of almost all of the enamel surface. Part of teeth where the enamel surface has been lost become dark brown as a result of the absorbed stain. This brown staining spreads and causes damage like corrosion.


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