ENAMEL FLUOROSIS IN PRIMARY TEETH :DEFINITION

It's a health condition caused by an overdose of .fluoride In it's severe form ,it's characterized by black and brown stains,as well as cracking and pitting of the .teeth

:PHYSIOLOGY

Dental fluorosis occurs because of the excessive intake :of fluoride either through .Fluoride in the H2O supply (Naturally occurring or added to it ) ..Or through other sources The damage in tooth development occurs between the ages of 6 monthes to 5 years,from the overexposure to .fluoride Teeth are generally composed of HA crystals and ;carbonated HA .When fluoride is present,fluoroapatite is created Excessive fluoride can cause yellowing of teeth,white .spots,and pitting or mottling of enamel Fluorosis cannot occur once the tooth has erupted into .the oral cavity At this point,fluoroapatite is beneficial because it's more resistant to dissolution by .(acids(Demineralization It's usually the permanent teeth which are affected,occasionally the primary teeth may be .involved Levy et al observed fluorosis of primary teeth in 12,1% .of 504 children

.It was observed most often on second primary molars The middle of the first year of life seamed to be the most important time with regard to the development of fluorosis in the primary dentition based on their estimate of fluoride ingestion prenatally and during the .the first year of life in their children The existence of a genetic influence on the development of fluorosis is supported by the finding that some inbred stains of mice are much more susceptible to fluorosis than other strains who receive .the same fluoride dosage under identical conditions

In mild cases,few white fleks or small pits on the .enamel .In more severe cases,brown stains

:CLINICAL PICTURE

:DIFFERENTIAL DIAGNOSIS

(Turner's hypoplasia (this is usually more localized .Some mild cases of Amelogenesis imperfecta Other environmental enamel defects and demarcated .opacities

:DEAN'S INDEX

H.T. Dean's fluorosis index was developed in 1942 and is currently the most universally accepted classification .system An individual's fluorosis is based on the most most .severe form of fluorosis found on two or more teeth

:AMERICAIN DENTAL ASSOCIATION ADVISORY . In November 2006,the ADA began Recommendation to Parents and Infants from 0 through 12 monthes of age should have their formula prepared with H2O that is floride-free,or contains low levels of fluoride to reduce .the risk of fluorosis

:TREATMENT .1Can be cosmetically treated by a dentist

:Treatment modalities are .A)TOOTH BLEACHING B)MICROABRASION USED FOR SUPERFICIAL STAINING C)CONSERVATIVE COMPOSITE RESTORATION USED FOR MORE UNAETHETIC SITUATIONS D)PORCELAINE VENEERS :2Preventive measures Dentists recommend that children should not receive topical fluoride until the age of three or at the earliest time that a determination can be made about a child's .total fluoride exposure

:REFERENCES Enamel fluorosis from Americain Academy -1 .of Pediatric dentistry .Fluoridation facts,ADA,28-29 -2

.Mcdonald textbook in pediatric dentistry -3