Which fluoride causes the most staining

In the twenties, as the teeth begin to show a yellow cast, teeth-whitening may require a little more effort. By the forties, the yellow gives way to brown and more maintenance may be called for. By the fifties, the teeth have absorbed a host of stubborn stains which can prove difficult but not impossible to remove.

Starting color : We are all equipped with an inborn tooth color that ranges from yellow-brownish to greenish-grey, and intensifies over time. Coffee and tea are two of the most common causes of yellow teeth, but red and white wine are also to blame. Other culprits include dark and light sodas and sports drinks with artificial flavoring.

Tetracycline antibiotics stain teeth when they're developing in the gums. According to the National Intitutes of Health , if your mother took antibiotics in the second half of her pregnancy, or you took them before the age of eight, you may have permanently stained adult teeth that merit an in-office bleaching treatment.

Fluoride is good for teeth, but excess fluoride can cause yellow or brownish yellow spots called fluorosis. Fluoridated water, fluoride toothpaste and prescribed fluoride tablets and treatments are your biggest sources of fluoride. Ask your dentist if you're concerned you or your child is taking too much through these means. Impact of an accident or physical trauma can crack tooth enamel and damage the tooth's interior, leading to discoloration that may indicate bleeding that needs professional attention.

Tooth grinding is an unconscious habit some people have when they're stressed, especially while asleep. Also known as bruxism, it's quite harmful to tooth enamel, weakening it to the point of cracking and yellowing. This article is intended to promote understanding of and knowledge about general oral health topics.

It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Shop Now. Our Mission. Contact Us. Recommend daily 0. Tetracycline grayish brown discoloration Ingestion of tetracycline during tooth development Cannot be removed by scaling or selective polishing. Your session is about to expire. Do you want to continue logged in?

Cancel Continue. Chromogenic bacteria and fungi Penicillum and Aspergillus species from poor oral hygiene most often seen in children with enamel irregularities.

Should not be scaled because of underlying demineralized enamel. Iron in saliva; iron-containing oral solutions; Actinomyces species; industrial exposure to iron; manganese, and silver. Chromogenic bacteria Serratia marcescens and Flavobacterium lutescens from poor oral hygiene. Brown stains Tobacco Food. Tars from smoking, chewing, and dipping spit tobacco Food and beverage pigment and tannins. Chewing betel nut, betel leaf, and lime pan ; found in Western pacific and South Asian cultures.

These estimates are based on studies that used classification indexes for scoring enamel fluorosis, and are not based on an assessment of aesthetics. None of the available indexes allow for making distinctions between fluorosis on the anterior and posterior teeth, so the percentage of children with moderate enamel fluorosis.

The committee found only one study Morgan et al. A group of pediatric patients of a dental practice between the ages of 7 and 11 were examined for enamel fluorosis. The study was limited by the fact that an aggregate measure of fluoride exposure was unrelated to enamel fluorosis and few if any of the children had severe enamel fluorosis. Several methodologic issues have hindered the assessment of the aesthetic importance of unattractive teeth in general and enamel fluorosis in particular.

First, assessing the perception of aesthetics is by its very nature subjective. Second, it is not clear who should make judgments about the aesthetic appearance of teeth.

The perceptions of the affected individual, as a child and in subsequent life, as well as those of parents, friends, teachers, and other acquaintances can all be important.

A sizeable proportion of parents and children have expressed dissatisfaction with the color of teeth even in the absence of enamel fluorosis. On the other hand, judgments made by professionals might not reflect the perception of the public.

Cultural influences can play a role in how the condition is perceived. It also appears that perceptions of the appearance of teeth can be modified by the attractiveness of other facial features. Fourth, when the public or dental professionals are asked to assess aesthetic acceptability, their perceptions might change during the evaluation session.

Research needs to focus specifically on severe enamel fluorosis in those areas in which it occurs with appreciable frequency. In addition, research needs to include not only affected children while they are still children, but after they move into adulthood. Finally, parents might experience psychological and behavioral effects when their children develop.

Unfortunately, research on parental effects is completely lacking. Fewer studies have been conducted in the United States of overall caries experience in communities with naturally occurring fluoride concentrations higher than those produced by fluoridation.

The studies of children are shown in Table A study of New Mexico adults gave similar results Eklund et al. Another study suggested little or no difference Jackson et al. The evidence from studies conducted in other countries is no more consistent Binder ; Olsson ; Kunzel ; Chen ; Lewis et al. As previously noted, it is suspected within the dental research community that the enamel pitting that occurs in severe fluorosis might increase caries risk by reducing the thickness of the protective enamel layer and by allowing food and plaque to become entrapped in enamel defects.

The possibility is thus raised that in a community with a water fluoride concentration high enough to produce an appreciable prevalence of severe fluorosis, the specific subset of children who develop this condition might be placed at increased caries risk, independent of the effect of the fluoride itself on the remainder of the population.

Many of them would develop mild to moderate fluorosis, however, while others might develop no fluorosis. It would be unreasonable, however, to assume that some children would skip all the way down from severe fluorosis to no fluorosis when the water concentration is reduced, while others would have mild to moderate fluorosis at either concentration.

As the desired fluorosis severity. Results for such comparisons are summarized in Table for studies reporting the mean number of decayed, missing and filled tooth surfaces DMFS , in Table for studies reporting the number of decayed, missing and filled teeth DMFT , and in Table for studies reporting the per-.

Not all researchers reported P -values for the specific contrasts in these tables. Moreover, the results are not independent, as some researchers studied more than one age group or reported results for more than one caries frequency measure or for more than one type of teeth. Nevertheless, in 11 of the 14 available contrasts, the measure of caries frequency was higher among those with severe fluorosis than among those with mild to moderate forms.

In some comparisons, the differences were slight. Descriptively, the most pronounced differences were for all teeth among children age years in Israel Mann et al. Mixed evidence comes from correlation or regression analyses. In studies in Uganda Rwenyonyi et al.

In the same study, no correlation between fluorosis and caries. The studies on severe enamel fluorosis and caries are limited by being cross-sectional in design and conducted in a wide range locales.

In most of the studies, there was no adjustment for oral hygiene, dental care, or other determinants of caries risk. Moreover, as previously noted, measures of the role of chance i. Nevertheless, the hypothesis of a causal link between severe enamel fluorosis and increased caries risk is plausible and the evidence is mixed but supportive. Fluoride may affect tooth dentin as well as enamel.

The patterns of change observed in bone with age also occur in dentin, a collagen-based mineralized tissue underlying tooth enamel. Dentin continues to grow in terms of overall mass and mineral density as pulp cells deposit more matrix overall and more mineral in the dentin tubules.

Several investigators have observed that, like older bone, older dentin is less resistant to fracture and tends to crack more easily Arola and Reprogel ; Imbeni et al.

Aged dentin tends to be hypermineralized and sclerotic, where the dentin tubules have been filled with mineral and the apatite crystals are slightly smaller Kinney et al. Unlike bone, however, dentin does not undergo turnover.

Some preliminary studies show that fluoride in dentin can even exceed concentrations in bone and enamel Mukai et al. Enamel fluorosis, which accompanies elevated intakes of fluoride during periods of tooth development, results not only in enamel changes as discussed above but also in dentin changes.

It has now been well established that fluoride is elevated in fluorotic dentin Mukai et al. Whether excess fluoride incorporation in fluorotic teeth increases the risk for dentin fracture remains to be determined, but the possibility cannot be ruled out. Questions have also been raised about the possibility that fluoride may delay eruption of permanent teeth Kunzel ; Virtanen et al.

The hypothesized mechanisms for this effect include prolonged retention of primary teeth due to caries prevention and thickening of the bone around the emerging teeth Kunzel However, no systematic studies of tooth eruption have been carried out in communities exposed.

Delayed tooth eruption could affect caries scoring for different age groups. One of the functions of tooth enamel is to protect the dentin and, ultimately, the pulp from decay and infection. Severe enamel fluorosis compromises this health-protective function by causing structural damage to the tooth. The damage to teeth caused by severe enamel fluorosis is a toxic effect that the majority of the committee judged to be consistent with prevailing risk assessment definitions of adverse health effects.

This view is consistent with the clinical practice of filling enamel pits in patients with severe enamel fluorosis and restoring the affected teeth. This view has been based largely on the absence of direct evidence that severe enamel fluorosis results in tooth loss, loss of tooth function, or psychological, behavioral, or social problems.

The majority of the present committee finds the rationale for considering severe enamel fluorosis only a cosmetic effect much weaker for discrete and confluent pitting, which constitutes enamel loss, than it is for the dark yellow to brown staining that is the other criterion symptom of severe fluorosis.

Moreover, the plausible hypothesis of elevated caries frequency in persons with severe enamel fluorosis has been accepted by some authorities and has a degree of support that, though not overwhelmingly compelling, is sufficient to warrant concern. The literature on psychological, behavioral, and social effects of enamel fluorosis remains quite meager. None of it focuses specifically on the severe form of the condition or on parents of affected children or on affected persons beyond childhood.

Two of the 12 members of the committee did not agree that severe enamel fluorosis should now be considered an adverse health effect. They judged that demonstration of enamel defects alone from fluorosis is not sufficient to change the prevailing opinion that severe enamel fluorosis is an adverse cosmetic effect. Strong evidence exists of an approximate population threshold in the United States,. Occasional cases would still arise for reasons such as excessive fluoride ingestion e.

Despite the characterization of all forms of enamel fluorosis as cosmetic effects by previous groups, there has been general agreement among them, as well as in the scientific literature, that severe and even moderate enamel fluorosis should be prevented. Specifically, as described in Chapter 2 Tables and , nonnursing.

Water Intake Distribution, by Age Group. Corresponding values are 0. For children with certain medical conditions associated with high water intake, estimated fluoride intakes from all sources excluding fluoride supplements range from 0. As noted above, the majority of the committee concludes it is no longer appropriate to characterize enamel pitting as a cosmetic effect. Thus, the basis of the SMCL should be discoloration of tooth surfaces only. However, from a cosmetic stand-.

No new studies of the prevalence of moderate enamel fluorosis in U. The degree to which moderate enamel fluorosis might go beyond a cosmetic effect to create an adverse psychological effect or an adverse effect on social functioning is also not known.

Additional studies, including longitudinal studies, of the prevalence and severity of enamel fluorosis should be done in U. These studies should focus on moderate and severe enamel fluorosis in relation to caries and in relation to psychological, behavioral, and social effects among affected children, their parents, and affected children after they become adults. Methods should be developed and validated to objectively assess enamel fluorosis. Consideration should be given to distinguishing between staining or mottling of the anterior teeth and of the posterior teeth so that aesthetic consequences can be more easily assessed.

More research is needed on the relation between fluoride exposure and dentin fluorosis and delayed tooth eruption patterns. Most people associate fluoride with the practice of intentionally adding fluoride to public drinking water supplies for the prevention of tooth decay.

However, fluoride can also enter public water systems from natural sources, including runoff from the weathering of fluoride-containing rocks and soils and leaching from soil into groundwater. Fluoride pollution from various industrial emissions can also contaminate water supplies.