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Too much fluoride may cause spotsDear Dr Reitz: From the time my front teeth appeared in my mouth they have looked ugly because of two large brown spots in the center of each tooth. I have tried the over-the-counter whitening strips and whitening toothpaste, but nothing is making a difference. I am 18 years old and will be leaving for college next year. Is there anything that can be done to remove the brown spots? - Colleen Dear Colleen: It's impossible to diagnosis the cause of the brown spots without seeing your teeth, but from what you are describing it sounds like brown enamel dysmineralization indicative of mild fluorosis. Fluorosis is the improper formation of the enamel because of excess fluoride available when the teeth are forming. It's believed that both brown and white spots on the surface of the teeth are the result of fluorosis. The brown spot actually occurred when the tooth was forming under your gums. The most likely source of the excess fluoride intake is from toothpaste. Children often like the taste of toothpaste and swallow after brushing, instead of spitting. When this becomes a habit between the ages of 2 and 5 there is a possibility of enamel hypomineralization, which appears as white or brown spots on the teeth. The risk of getting too much fluoride also increased if you were receiving fluoride vitamin supplements during the same time of tooth development. There is some controversy now as to whether fluoride supplements should be given to children because of this side effect. Often the area of fluorosis is only on the surface of the teeth and can be removed or lightened by a dentist with a combination of procedures called macroabrasion and microabrasion. During a normal dental prophylaxis the hygienist uses a rubber cup with prophy paste to clean the stain off teeth. Microabrasion is using a rubber cup with an abrasive grit paste in a mild acid solution. The goal is to polish away the discolored area of the tooth. Often the discolored area is too deep to just polish away, that is when macroabrasion is necessary. Macroabrasion is the process of using a dental drill and finishing burr to remove most or all of the dysmineralized enamel. In many cases a combination of both procedures is necessary to remove the offending brown spot. You will want to finish the process with tooth whitening to remove any remaining brown that is too deep to abrade away. The column is written by John Reitz, DDS, and does not represent the opinion of the Pennsylvania State Dental Board. Dr Reitz answers questions from readers. E-mail them via his Web site at reitzdds.com or mail to John Reitz, DDS, 30 Commerce Drive, Wyomissing PA 19610 John
V. Reitz, D.D.S., F.A.G.D. Copyright
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