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Thursday, August 27, 2009

Case Study #1


Patient Case Study #1: Moderate fluorosis resulting in "mottled" appearance post-treatment.

Treating Fluorosis Cases
Pre-treatment consultations are extremely important; especially when treating fluorosis cases. The examination will allow the dental professional an opportunity to check for possible fluoride spots and inform patients ahead of the treatment that the tooth enamel will not be entirely even in color immediately following the treatment.

Uninformed patients will be surprised by the mottled appearance of the enamel immediately following the treatment, and may be unhappy with the results. In less severe cases, mottling may be limited to one or two white spots. However in moderate to severe fluorosis cases, mottling can be more noticeable.

The white spots will become less noticeable within the 24-48 hour immediately following the treatment as the post-treatment color settles. Patients should be informed of this before the treatment.

Treatment schedules should be designed based on the severity of fluorosis. Mild to moderate discolorations can be treated during a single, in-office visit. (Vary 8-12 minute cycles depending on severity.) Severe cases should be treated with multiple, in-office visits (Week 1: Three cycles, 8-12 minutes each cycle; Week 2: Two to three cycles, 8-12 minutes each cycle.) Depending on severity, a pre-treatment acid etch of the enamel layer may also be necessary.


Causes of Fluorosis
The ingestion of excessive fluoride levels (higher than 1 ppm) in drinking water, or another medium, before the permanent teeth are fully formed can result in irregular calcification of the teeth formation of the enamel layer.

The higher the levels of fluoride intake, the more serious the individual case will be. Fluoride stains almost always occur balanced on the tooth arch, although this can vary between teeth.

Fluoride rarely affects deciduous teeth because it is not absorbed through the placenta. Premolar teeth, upper incisors, and second primary molars are the most easily affected. The next most likely to be affected are the canine teeth, first primary molars, and lower incisors, in that order.

The appearance of fluoride stains vary depending on which teeth are affected. In premolars and second primary molars, the stains are seen as white spots or stripes. In less severe cases, the discolorations may be yellow, brown, or black in color and accompanied by irregular enamel layer formations, resulting in uneven ridges on the enamel layer.

Clinical observations of teeth discolored by fluoride have produced important findings on the structural irregularities caused by fluoride. On the surface of fluoresced teeth, enamel fractures along the ends of the enamel columns are evident. The result of malcalcification, these damaged enamel cells fail to form a satisfactory enamel base.

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