Conservative esthetic management of severe dental fluorosis with in-office power bleaching.

Fluorosis is an endemic disease, prevailing in about 25 countries globally. Dental fluorosis is an acquired defect of enamel due to the exposure of an individual to excessive fluoride levels during tooth development. It could result in mild-to-severe discoloration of teeth, which might necessitate esthetic correction. Bleaching is one of the common treatment modalities used in the esthetic correction of such cases. In-office power bleaching is one of the techniques of tooth bleaching that involves clinical application and activation of the bleaching agent with light to accelerate the bleaching process. This case report describes the esthetic correction of severe dental fluorosis by power bleaching, without any need for invasive treatment. This report suggests that in-office power bleaching is an effective and conservative method for esthetic correction of tooth discoloration in severe dental fluorosis.

Résumé La fluorose est une maladie endémique, qui prévaut dans environ 25 pays dans le monde. La fluorose dentaire est un défaut acquis des l'émail dû à l'exposition d'un individu à des niveaux excessifs de fluor pendant de développement des dents. Cela pourrait aboutir à une décoloration légère à sévère des dents, qui nécessite une correction esthétique. Le blanchiment est l'une des modalités de traitement courantes utilisées dans la correction esthétique de ces cas. "In-office power" le blanchiment est l'une des techniques de blanchiment des dents qui implique l'application clinique et l'activation de l'agent de blanchiment avec de la lumière pour accélérer le processus de blanchiment. Ce rapport de cas décrit la correction esthétique de la fluorose dentaire sévère par blanchiment "power", sans aucun besoin pour d'un traitement invasif. Ce rapport suggère que le blanchiment "In-office power" est une méthode efficace et conservatrice pour la correction esthétique de la décoloration dentaire dans la fluorose dentaire sévère.

[Role of enamel microabrasion associated with external bleaching in the management of patients with dental fluorosis]. / La micro-abrasion amélaire associée à l'éclaircissement externe: intérêt dans la prise en charge de la fluorose.

Dental fluorosis is a developmental anomaly affecting aesthetic appearance. The association between microabrasion and external bleaching has shown satisfactory outcomes because it improves aesthetic outcome in patients with light dental fluorosis. The purpose of this study was to update the role of this association as well as its different effects on the enamelled surface.

Atorvastatin attenuates spinal cord injury by chronic fluorosis in rats.

The aim of the study was to explore the effect of atorvastatin on improvement of the function of the spinal cord in rats with chronic fluorosis. Sixty 3-month-old Wistar rats were separated randomly into three groups: normal group (N group), control group (C group) and atorvastatin group (A group). The Basso Beattie and Bresnahan scale and oblique board test showed that the rats in A group got higher score and better hind-limb motor function than C group. Immunohistochemistry and western blotting revealed that compared with N group, matrix metalloproteinase 9 (MMP-9) and p53 were highly expressed and myelin basic protein (MBP) was low expressed in spinal cord of C group. Meanwhile, MMP-9 and p53 expression were decreased and MBP was upregulated by atorvastatin compared with C group. In conclusion, the improvement of the function of the spinal cord in rats can be found when they were treated with atorvastatin.

Interdisciplinary approach to complete-mouth rehabilitation: a clinical report.

Dental fluorosis results from excess fluoride ingestion during tooth formation and is commonly seen in certain endemic areas. Its clinical manifestations may range from white opaque patches of enamel in mild cases to pitting and loss of enamel in severe cases. The treatment of fluorosis is important not only because of esthetic and functional concerns but also to help improve a patient's self-esteem; therefore, a multidisciplinary approach is often necessary. This article describes a multidisciplinary approach to complete-mouth rehabilitation of a patient affected with fluorosis. A confluence of the endodontic, periodontal, orthodontic, and prosthodontic disciplines resulted in improved esthetics and enhanced masticatory efficiency.

Fluorosis increases the risk of postmenopausal osteoporosis by stimulating interferon γ.

Estrogen deficiency in postmenopausal women frequently activates osteoclasts (OC), accelerates bone resorption, and leads to osteoporosis (OP). Previous studies have demonstrated that interferon γ (IFNγ) could increase bone resorption and may be involved in postmenopausal OP. Fluorosis also increased the risk of fractures and dental fluorosis, and fluoride may enhance osteoclast formation and induce osteoclastic bone destruction in postmenopausal women, but the underlying mechanisms are as yet unknown. Here, we show that serum fluoride and IFNγ levels are negatively correlated with bone mineral density (BMD) in postmenopausal women residing in a fluorotic area. Estrogen suppresses IFNγ, which is elevated by fluoride, playing a pivotal role in triggering bone loss in estrogen-deficient conditions. In vitro, IFNγ is inhibited by estrogen treatment and increased by fluoride in Raw264.7 cell, an osteoclast progenitor cell line. In ovariectomized (Ovx) mice, estrogen loss and IFNγ promote OC activation and subsequent bone loss in vivo. However, IFNγ deficiency prevents bone loss in Ovx mice even in fluoride conditions. Interestingly, fluoride fails to increase IFNγ expression in estrogen receptor α (ERα)-deficient conditions, but not in ERß-deficient conditions. These findings demonstrate that fluorosis increases the bone loss in postmenopausal OP through an IFNγ-dependent mechanism. IFNγ signaling activates OC and aggravates estrogen deficiency inducing OP. Thus, stimulation of IFNγ production is a pivotal ''upstream'' mechanism by which fluoride promotes bone loss. Suppression of IFNγ levels may constitute a therapeutic approach for preventing bone loss.

Higher Fluorosis Severity Makes Enamel Less Resistant to Demineralization.

Fluorotic teeth could either be more resistant or more susceptible to the caries process than sound ones due to their higher enamel fluoride concentration and higher porosity (subsurface hypomineralization), respectively; however, there is no consensus on this subject. In this study, a total of 49 human unerupted third molars presenting Thylstrup and Fejerskov (TF) fluorosis scores 0-4 were used. Two enamel slabs were obtained from each tooth. The rest of the tooth crown was powdered, and the enamel was separated from the dentine. In purified powdered enamel, the calcium (Ca), inorganic phosphate (Pi), and fluoride (F) concentrations were determined. The F concentration gradient throughout the enamel and in the enamel volume was determined in one slab. The other enamel slab was isolated with acid-resistant varnish, subjecting the exposed enamel surface half to a pH-cycling model to evaluate its demineralization resistance and to calculate the demineralization area. The nonexposed surface was used to determine the natural hypomineralization area found in fluorotic enamel and normalize the demineralization data. The hypomineralization and demineralization areas were assessed by cross-sectional microhardness. For statistical analyses, the data for TF1 and 2, and for TF3 and 4 were pooled. Concentrations of powered enamel Ca and Pi were not significantly different (p > 0.05) among groups TF0, TF1-2 and TF3-4, but a higher F concentration was found in fluorotic enamel (p < 0.05). Highly fluorotic teeth (TF3-4) presented a greater hypomineralization subsurface area and demonstrated lower demineralization resistance than sound enamel (p < 0.05). The findings suggest that a higher severity of fluorosis makes enamel less resistant to the caries process due to its greater subsurface mineral area exposed to demineralization and deeper acid diffusion through the enamel.

Natural history and long-term impact of dental fluorosis: a prospective cohort study.

OBJECTIVE: The study assessed longitudinal changes in the presentation of dental fluorosis and evaluated the impact of fluorosis on the perception of oral health among young adults. DESIGN AND SETTING: Prospective follow-up study during 2011-12 of a population-based study in South Australia conducted between 2003 and 2004. PARTICIPANTS: 8-13-year-old children initially examined in 2003 and 2004. MAIN OUTCOMES: Dental fluorosis was assessed with the Thylstrup and Fejerskov (TF) Index. The impact on perceptions of oral health by the study participants and their parents was assessed with the Global Rating of Oral Health (GROH). Pairwise comparative analysis of the presentation of fluorosis was conducted at the individual and tooth levels. Multivariable models of changes in fluorosis were generated. An ordinal logistic regression model was used to evaluate the association between GROH with dental fluorosis, caries and other factors. RESULT: A total of 314 participants completed the follow-up questionnaires and dental examination. Over 60% of teeth scored as TF 1 at baseline were scored as TF 0 at follow-up; 66% of teeth scored as TF 2 or 3 at baseline were scored as TF 0 or 1 at follow-up. In multivariable models, changes in fluorosis were not significantly associated with socio-economic factors or oral health behaviours, confirming that they were the result of a natural process. Perceptions of poor oral health were significantly associated with the number of untreated decayed tooth surfaces at follow-up, but not with fluorosis. CONCLUSION: Very mild and mild dental fluorosis diminished with time. Dental fluorosis did not have a negative impact on perceptions of oral health.

Factors Affecting the Shear Bond Strength of Orthodontic Brackets - a Review of In Vitro Studies.

The adhesive material used to bond orthodontic brackets to teeth should neither fail during the treatment period, resulting in treatment delays, untoward expenses or patient inconvenience nor should it damage the enamel on debonding at the end of the treatment. Although the effectiveness of a bonding system and any unfavorable effects on the enamel may be studied by conducting in-vivo studies, it is nearly impossible to independently analyze different variables that influence a specific bonding system in the oral environment. In-vitro studies, on the other hand, may utilize more standardized protocols for testing different bonding systems and materials available. Thus, the present review focused attention on in-vitro studies and made an attempt to discuss material-related, teeth-related (fluorotic vs non-fluorotic teeth) and other miscellaneous factors that influences the shear bond strength of orthodontic brackets. Within the limitations of this review, using conventional acid-etch technique, ceramic brackets and bonding to non-fluorotic teeth was reported to have a positive influence on the shear bond strength of orthodontic brackets, but higher shear bond strength found on using ceramic brackets can be dangerous for the enamel.

'Pitted' to 'Pleasing' in 20 min.

In recent times, as a result of extensive drinking water fluoridation, the number of patients affected by fluorosis has increased considerably. The purpose of this clinical report is to describe the use of enamel microabrasion for a patient with severe fluorosis using 37% phosphoric acid and pumice mixture. The results were pleasing, and hence 37% phosphoric acid can be recommended as a safe and easily available alternative in microabrasion procedures.

Revisión Sistemática sobre los Efectos Adversos de la Fluoración del Agua / Systematic Review of the Adverse Effects of Water Fluoridation

Durante las últimas décadas, una considerable atención científica ha sido puesta en la seguridad de los fluoruros, dada la amplia variedad de fuentes de ingestión a la que la población se encuentra expuesta y los riesgos a la salud de las personas que esto puede acarrear. El objetivo de esta investigación fue determinar si la fluoración del agua a concentraciones de 0,6 a 1 ppm se asocian a una mayor proporción de efectos adversos en la población general al compararlo con concentraciones subóptimas. Se realizó una revisión sistemática de la literatura en MEDLINE, EMBASE, COCHRANE, SCIELO, LILACS, CRD, BBO, PAHO y WHOLIS, limitada desde el 2002 al 2012. Se incluyeron estudios primarios y secundarios en español, inglés y portugués con al menos dos poblaciones comparadas, una con niveles óptimos de flúor en agua (0,6­1 ppm) y otra sin fluoración del agua (<0,3 ppm) o con niveles subóptimos (>0,3 < 0,6 ppm). Dos investigadores de forma independiente realizaron evaluación de la calidad de los artículos seleccionados y que cumplieron los criterios de inclusión. La búsqueda arrojó 1024 artículos de los cuales 24 cumplieron los criterios de inclusión y 10 fueron incluidos como evidencia. Con excepción de fluorosis dental, no hay asociación entre fluoración del agua con fracturas óseas, cáncer u otro efecto adverso. A pesar de la mayor prevalencia de fluorosis en zonas fluoradas, esta fue principalmente del tipo cuestionable a leve y la proporción de fluorosis con daño estético no difiere significativamente de la presente en zonas sin fluoración del agua.

During the last decades, considerable scientific attention has been paid to the safety of fluoride, given the wide variety of sources of intake at which the population is exposed and the risks to the health of people this may produce. The aim was to determine whether water fluoridation at concentrations from 0.6 to 1 ppm is associated with a higher proportion of adverse effects in the general population when comparing them to suboptimal concentrations. A systematic review was conducted of the literature in MEDLINE, EMBASE, COCHRANE, SCIELO, LILACS, CRD, BBO, PAHO and WHOLIS, limited to 2002 to 2012. Included were primary and secondary studies in Spanish, English and Portuguese with at least two compared populations, one with optimal fluoride levels in the water (0.6­1 ppm) and another without water fluoridation (<0.3 ppm) or with suboptimal levels (>0.3 < 0.6ppm). Two researchers independently evaluated the quality of the articles selected and which met the inclusion criteria. The search revealed 1024 articles, of which 24 met the inclusion criteria and 10 were included as evidence. With the exception of dental fluorosis, there is no association between any other adverse effect and water fluoridation. Despite the greater prevalence of fluorosis in fluoride than in non-fluoride zones, this was mainly questionable to slight and the proportion of fluorosis with esthetic damage does not differ significantly from this in zones without water fluoridation.

Deficit in learning and memory of rats with chronic fluorosis correlates with the decreased expressions of M1 and M3 muscarinic acetylcholine receptors.

To reveal the molecular mechanism of deficit in learning and memory induced by chronic fluorosis, the expression of muscarinic acetylcholine receptors (mAChRs) and oxidative stress were investigated. Sixty Sprague-Dawley (SD) rats were divided randomly into two groups (30 cases in each), i.e., the control group (<0.5 ppm fluoride in drinking water) and the fluoride group (50 ppm fluoride) for 10 months of treatment. The pups born from SD mothers with or without chronic fluorosis were selected at postnatal days 1, 7, 14, 21 and 28 for experiments (10 for each age). Spatial learning and memory were evaluated by Morris water maze test. The expressions of M1 and M3 mAChRs at the protein and mRNA levels were determined by Western blotting and real-time PCR, respectively. In addition, the contents of (·)OH, H2O2, O2(·-) and malondialdehyde (MDA), and activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) in brains were quantitated by biochemical methods. Our results showed that as compared to controls, the abilities of learning and memory were declined in the adult rats and the offspring rats of postnatal day 28 in the fluoride groups; the expressions of both M1 and M3 mAChRs were significantly reduced at protein and mRNA levels; and the levels of (·)OH, H2O2, O2(·-) and MDA were significantly increased, while the activities of SOD and GSH-Px decreased. Interestingly, the decreased protein levels of M1 and M3 mAChRs were significantly correlated with the deficits of learning and memory and high level of oxidative stress induced by chronic fluorosis. Our results suggest that the mechanism for the deficits in learning and memory of rats with chronic fluorosis may be associated with the decreased expressions of M1 and M3 in mAChRs, in which the changes in the receptors might be the result of the high level of oxidative stress occurring in the disease.

The analog of Ginkgo biloba extract 761 is a protective factor of cognitive impairment induced by chronic fluorosis.

Ginkgo biloba extract EGb761 is widely used to treat patients with learning and memory impairment in Alzheimer's disease and Parkinson's disease in China. However, it is not yet clear whether the analog of EGb761 (EGb) has a protective effect on the learning and memory damage induced by chronic fluorosis. In this study, 30 Wistar rats were randomly divided into three groups: a control group, a sodium fluoride (NaF) + EGb group, and a NaF group. The rats were administered 0.5 ml water containing NaF (100 mg/l) and EGb (120 mg/kg) per day via gavage. After 3 months, the rats' capacity for learning and memory was tested using a Y-maze. Damage to hippocampal neurons was evaluated by histological examination of the CA3 area. Superoxide dismutase (SOD) activity and the levels of glutathione peroxidase (GSH-Px) and malondialdehyde (MDA) were measured. Furthermore, the expression levels of Bcl-2 and Bax and the levels of cleaved Caspase3 in the hippocampus were evaluated by RT-PCR and Western blotting. The results showed that EGb could improve learning and memory abilities, enhance the activities of SOD and GSH-Px, attenuate the level of MDA, upregulate the ratio of Bcl-2/Bax, and downregulate the level of cleaved Caspase3.

Comparison of enamel microabrasion with a combined approach to the esthetic management of fluorosed teeth.

OBJECTIVE: To compare in vivo the efficacy of enamel microabrasion alone or in combination with vital tooth bleaching for the management of tooth discoloration caused by fluorosis. METHODS: A total of 118 maxillary and mandibular fluorosed incisors and canines in 10 patients, scored from 1 to 7 according to the Tooth Surface Index of Fluorosis, were included in this study. All of the teeth were initially treated with enamel microabrasion (Opalustre, Ultradent Products Inc, South Jordan, UT, USA), and after 24 hours, an in-office bleaching technique (Opalescence Boost, Ultradent) was utilized (n=118). Standardized images of the teeth were taken using a digital camera prior to treatment and 24 hours after the enamel microabrasion and after the in-office bleaching therapy. The study groups were assigned according to evaluation time: a) after enamel microabrasion (Group 1) and b) after the combined approach (enamel microabrasion and in-office bleaching) (Group 2). Two calibrated and blinded examiners scored Group 1 and Group 2 images by comparing each with baseline images for "improvement in appearance," "changes in brown stains," and "changes in white opaque areas" using the visual analogue scales (VAS) that range from 1 to 7. "Patient satisfaction," "tooth sensitivity," and "gingival problems" were also recorded. The data were analyzed using two sample paired Wilcoxon signed-rank, Kruskal-Wallis, and Mann-Whitney U-tests (α=0.05). RESULTS: The combined therapy revealed significantly higher scores than the enamel microabrasion procedure in terms of all of the evaluated criteria (p<0.001). Enamel microabrasion provoked less tooth sensitivity but led to lower patient satisfaction scores than the combined therapy (p<0.001); however, in terms of gingival problems, no differences were found between both groups. CONCLUSION: The combined therapy, including enamel microabrasion and in-office bleaching, was more effective than enamel microabrasion alone in the esthetic management of fluorosed teeth.

Clinical status of permanent first molars in children aged seven to ten years in a Brazilian rural community

Aim: To evaluate the clinical status of permanent first molars and associations with dental caries, gingival bleeding, dental fluorosis and malocclusion. Methods: An observational study wascarried out in a rural community denominated Morro do Saboó in the city of São Roque, state of São Paulo, Brazil. A total of 194 children aged seven to ten years were examined for dental caries using the index proposed by the World Health Organization. Other conditions were determined using the Gingival Alterations Index, Dean’s Index and Dental Aesthetic Index. The chi-squared test was used for the statistical analysis of the data. Results: A total of 85.5% of the sample exhibited gingival bleeding and 69.9% exhibited malocclusion. A total of 53.6% had a clinical aspect of normality with regard to dental fluorosis. There was a predominance of sound teeth in the upper arch and teeth with carious lesions in the lower arch. No significant differences were found between sexes regarding gingival bleeding, dental fluorosis or malocclusion. Significant associations were found between tooth status and oral alterations (gingival bleeding, malocclusion and fluorosis) in teeth 16, 26 and 46 and between tooth status and gingival bleeding in tooth 36 (p<0.001). Conclusions: Caries activity in the permanent first molars was mainly associated with dental fluorosis and malocclusion. Strategies aimed at health promotion should be adopted on a large scale to minimize the prevalence of oral diseases.

Re-establishing esthetics of fluorosis-stained teeth using enamel microabrasion and dental bleaching techniques.

Dental fluorosis manifests itself as white stains on the enamel of teeth exposed to excessive doses of fluoride during their formation. Fluorosis usually occurs as a result of the ingestion of dentifrices, gels and fluoridated solutions. It may be diagnosed as mild, moderate or severe, and in some cases, it may cause the loss of the surface structure of dental enamel. The aim of this study was to report the clinical case of a female patient of 18 years with moderate fluorosis, whose smile was reestablished by the use of an enamel microabrasion technique, followed by in-office bleaching. A microabrasion technique with 6% hydrochloric acid associated with silica carbide showed to be a safe and efficient method for removing white fluorosis stains, while dental bleaching was useful for obtaining a uniform tooth shade. The association of these techniques presented excellent results and the patient was satisfied. Both techniques are painless, fast and easy to perform, in addition to preserving the dental structure. Treatment showed immediate and permanent results; this technique must be divulged among professionals and their patients.

[Pregnant women living in areas of endemic fluorosis in Senegal and low birthweight newborns: case-control study]. / Femme enceinte vivant en zone de fluorose endémique au Sénégal et faible poids du nouveau-né à la naissance : étude cas-témoins.

BACKGROUND: In developing countries, maternal and neonatal mortality is high. Among the causes of death during the neonatal period, low birth weight is crucial. A dose of fluoride beyond 2mg/L causes enamel damage, possibly affecting the fetus. The aim of this study was to search for an association between dental fluorosis in the mother and low birthweight of the newborn. METHODOLOGY: This was a case-control study performed in an endemic area in Senegal (Diourbel). It included 108 mothers who gave birth to newborns weighing less than 2500 g (cases) and 216 mothers with newborns weighing greater or equal to 2500 g (controls). Data on socio-demographic, lifestyle, history and pregnancy variables were collected. Those related to water consumption during pregnancy and dental fluorosis (Dean's index) were measured. The data were analyzed by R software. Logistic regression was used to identify associations and the statistical significance level was set to 0.05. RESULTS: The proportions of mothers consuming well water were 62% among cases versus 43.5% among controls. The score 4 of Dean's Index was reported for 25.9% of cases versus 6.9% of controls. The water consumed and the modal score of Dean's Index were significantly associated with the occurrence of low birthweight adjusted for gender, consanguinity, anemia and hypertension. CONCLUSION: Low birthweight was associated with pregnant women living in endemic areas. Defluoridation programs and access for pregnant women and children to high quality water are necessary in areas of endemic fluorosis.

Effects of fluorosis on QT dispersion, heart rate variability and echocardiographic parameters in children.

OBJECTIVE: Chronic fluoride poisoning is called fluorosis. The aim of the study was to investigate effects of fluorosis on cardiovascular system in children by measuring QT dispersion (QTd), corrected QT dispersion (QTcd), heart rate variability (HRV) and echocardiography findings. METHODS: Thirty-five children with dental fluorosis and 26 children as control group were included in this cross-sectional study. Dean index was used for the clinical diagnosis. The fluoride levels of subjects measured by ion electrode method in spot urine higher than 0.6 ppm were included in the study. Serum electrolytes and thyroid function tests were analyzed. Electrocardiography (ECG), echocardiography and 24-hour ambulatory Holter monitorizations were applied, and all the data were analyzed for measuring HRV, and calculation of QTd and QTcd intervals. Corrected QT (QTc) intervals were determined with the Bazzett formula. Difference between the longest and shortest intervals was considered as dispersion. Statistical analysis was performed Kruskal-Wallis test and Pearson correlation test. RESULTS: Low free thyroxine hormone (FT4) (Control Group, Group 2 1.11 (0.85-1.64) ng/dL, 0.96 (0.85-1.11) ng/dL, p<0.05), calcium (Control Group, Group 1, 2, 9.80 (9.30-10.70) mg/dL, 9.60 (8.90-10.70) mg/dL, 9.50 (8.90-10.10) mg/dL, p<0.05) and high serum sodium levels (Control Group, Group 2 139 (136-142) mEq/L, 141 (138-148) mEq/L, p<0.01), increased QT (Control Group, Group 2 329.8 (300.0-363.5) msec, 351.8 (318.0-372.0) msec, p<0.05) and QTc intervals (Control Group, Group I2 390.6 (309.0-418.5) msec, 366.8 (318.2-468.5) msec, p<0.05) were found in subjects with fluorosis. No significant difference was found with respect to echocardiography and HRV variables. CONCLUSION: Endemic fluorosis is a risk factor for decrease in calcium and FT4 levels, increase in sodium levels and QT prolongation. These findings might be related with some cardiovascular system dysfunctions such as arrhythmias or syncope. Subjects with fluorosis should be monitored in terms of long QT and QTc intervals.

Why does fluorosed dentine show a higher susceptibility for caries: an ultra-morphological explanation.

BACKGROUND: Chronic endemic dental fluorosis is a malformation of teeth caused by excessive ingestion of fluoride during period of tooth development. Apatite crystallites and collagen fibrils determine the caries susceptibility related properties of dentine. Information relating the effect of dental fluorosis with dentine crystallite and collagen structure is currently unavailable. This study examined structural aberrations of apatite crystallites and collagen fibrils in human fluorosed dentine. METHOD: Superficial dentine of thirty six normal (Thylstrup-Fejerskov index - 0) and thirty six severely fluorosed (Thylstrup-Fejerskov index - 7 to 9) extracted human molars from individuals living in an area which is endemic for dental fluorosis were morphologically analyzed using transmission electron microscopy with selected area electron diffraction and dynamic force microscopy. RESULTS: A statistically significant enlargement in the size of crystallites was found in fluorosed dentine (p<0.05). These crystallites were not homogenously arranged. Selected area electron diffraction revealed a lower density of crystallites in fluorosed dentine. Randomly distributed collagen fibrils showed a less complex lay out in contrast to normal dentine tissue. CONCLUSION: Ultrastructure aberrations of the dentine explain the caries susceptibility of the tissue and suggest the necessity of special approach in dental caries treatment for patients with chronic severe endemic dental fluorosis.

El flúor y la prevención de la caries en la infancia. Actualización (II) / Fluoride and prevention of dental caries in childhood. Update (II)

La administración de suplementos orales de fluoruro se recomienda solamente si se trata de grupos de riesgo y si el agua contiene menos de 0,3 mg/L de flúor. Para evitar una ingesta superior a 0,1 mg/kg/día, se recomienda emplear agua con menos de 0,3 mg/L de flúor. Las pastas dentífricas fluoradas en los menores de 6 años deben contener hasta 500 microg/g de pasta; los niños tienen que cepillarse 2 veces al día con una cantidad de pasta semejante a un guisante y deben ser supervisados por un adulto. El adecuado empleo sistémico y tópico del flúor permite evitar tanto la caries dental como la fluorosis dental (AU)

The administration of oral fluoride supplements is indicated only if we are talking about a risk groups and if the water contains less than 0.3 mg/L of fluoride. To avoid a consumption higher than 0.1 mg/kg/day it is recommended to use water with less than 0.3 mg/L of fluoride. The Fluoride toothpaste in children under 6 years of age must contain until 500 mcg/g, brushing should be supervised and only a pea-sized portion of toothpaste twice a day. The appropriate use of systemic and topical fluoride is beneficial to prevent dental caries and dental fluorosis (AU)