Occurrence and management of dental fluorosis

Treatment of Cases with Different Grades of Fluorosis by Lithium Disilicate Glass-Ceramic CAD/CAM Materials: A Case Report of Two Cases

Over exposure to high amount of fluoride during the development of enamel leads to fluorosis. Dental fluorosis is considered to be the most common color disorders of the enamel. It presents with different clinical signs on the enamel of the patients. The diagnosis of dental fluorosis is very challenging in the clinical practice since the enamel defects could be confusing. This case report presented two cases and their treatment for different grades of dental fluorosis to improve the esthetic appearance of the teeth. Keywords: Dental fluorosis, Fluorosis index, Lithium disilicate glass-ceramic, Microabrasion, Resin infiltration.

L-arginine and lisinopril supplementation protects against sodium fluoride-induced nephrotoxicity and hypertension by suppressing mineralocorticoid receptor and angiotensin-converting enzyme 3 activity

Sodium fluoride (NaF) is one of the neglected environmental toxicants that has continued to silently cause toxicity to both humans and animals. NaF is universally present in water, soil, and atmosphere. The persistent and alarming rate of increase in cardiovascular and renal diseases caused by chemicals such as NaF in mammalian tissues has led to the use of various drugs for the treatment of these diseases. The present study aimed at evaluating the renoprotective and antihypertensive effects of L-arginine against NaF-induced nephrotoxicity. Thirty male Wistar rats (150-180 g) were used in this study. The rats were randomly divided into five groups of six rats each as follows: Control, NaF (300 ppm), NaF + L-arginine (100 mg/kg), NaF + L-arginine (200 mg/kg), and NaF + lisinopril (10 mg/kg). Histopathological examination and immunohistochemistry of renal angiotensin-converting enzyme (ACE) and mineralocorticoid receptor (MCR) were performed. Markers of renal damage, oxidative stress, antioxidant defense system, and blood pressure parameters were determined. L-arginine and lisinopril significantly (P < 0.05) ameliorated the hypertensive effects of NaF. The systolic, diastolic, and mean arterial blood pressure of the treated groups were significantly (P < 0.05) reduced compared with the hypertensive group. This finding was concurrent with significantly increased serum bioavailability of nitric oxide in the hypertensive rats treated with L-arginine and lisinopril. Also, there was a significant reduction in the level of blood urea nitrogen and creatinine of hypertensive rats treated with L-arginine and lisinopril. There was a significant (P < 0.05) reduction in markers of oxidative stress such as malondialdehyde and protein carbonyl and concurrent increase in the levels of antioxidant enzymes in the kidney of hypertensive rats treated with L-arginine and lisinopril. The results of this study suggest that L-arginine and lisinopril normalized blood pressure, reduced oxidative stress, and the expression of renal ACE and mineralocorticoid receptor, and improved nitric oxide production. Thus, L-arginine holds promise as a potential therapy against hypertension and renal damage.

Laminate veneer ceramics in aesthetic rehabilitation of teeth with fluorosis: a 10-year follow-up study

Background

Fluorosis is one of the color anomalies seen in teeth. White lines and blurred areas associated with mild fluorosis are barely noticeable; in its severe form, tooth enamel surface changes ranging from staining and pitting may be observed. The treatment of fluorosis not only provides aesthetic and functional correction but also helps to improve the patient's self-esteem.

Methods

The present retrospective study evaluated the clinical quality, success rate, and estimated survival of porcelain laminate veneers in teeth with anterior fluorosis. Three hundred fifty-eight porcelain laminate veneers (254 in the anterior maxilla and 104 in the mandible) were "functional" restorations that covered the incisal edge and part of the palatal/lingual side of the tooth with a 1 mm high palatal bevel. Ceramic veneers were fabricated with lithium disilicate reinforced glass–ceramic material (IPS e.max Press, Ivoclar Vivadent, Schaan, Liechtenstein). The modified United States Public Health Service criteria were used for clinical evaluation of the restorations.

Results

On the basis of these criteria, marginal adaptation, color match, marginal discoloration, surface roughness, restoration fracture, tooth fracture, restoration wear, antagonist tooth wear, caries and postoperative sensitivity were evaluated yearly. The survival rate in the current study was ≥ 0.997 for 10 years.

Conclusions

The results of this clinical study should encourage clinicians to consider ceramic veneers over crown restorations when restoring the smile of patients with advanced fluorosis.

Dental fluorosis among people and livestock living on Gihaya Island in Lake Kivu, Rwanda

BACKGROUND

Dental fluorosis is caused by prolonged exposure to excessive fluoride during the period of permanent tooth formation and is characterized by tooth discoloration, pitting, and loss of shape. Communities living near Lake Kivu in Western Rwanda exhibit a high prevalence of dental fluorosis; however, data on prevalence and risk factors are scarce.

METHODS

This cross sectional, quantitative study used a One Health approach to investigate dental fluorosis prevalence among people and livestock and to measure fluoride content in the environment. In 2018, oral health examinations were conducted to assess the prevalence of fluorosis in children (aged 9 to 15 years), cattle and goats residing on Gihaya Island (Rwanda, East Africa). All children and cattle/goats meeting basic eligibility criteria (e.g., island residence) were invited to participate. Presence and severity of dental fluorosis was categorized according to the Dean's Fluorosis Index. Samples of local foods, water, soil and grass were collected from communal sources and individual households and analyzed for fluoride content using standard laboratory techniques. Descriptive and binomial analyses (Fisher Exact Test) were used to assess this dataset.

RESULTS

Overall, 186 children and 85 livestock owners (providing data of 125 livestock -23 cattle and 102 goats) participated. Dental fluorosis was recorded in 90.7% of children and 76% of livestock. Moderate to severe fluorosis was observed in 77% children while goats and cattle most often exhibited mild or absent/questionable severity, respectively. Water from Lake Kivu (used primarily for human cooking water and livestock drinking water) contained fluoride levels that were consistently higher than the maximum threshold (1.5 mg/L) recommended by the World Health Organization. Other sources (borehole and rainwater) were within safe limits. All food, soil and grass samples contained fluoride. The highest levels were observed in porridge (0.5 mg/g) and small fishes (1.05 mg/g).

CONCLUSIONS

Altogether, dental fluorosis was highly prevalent among children and goats on Gihaya Island with various food and water sources contributing a cumulative exposure to fluoride. An immediate and coordinated response across human, animal and water professionals is needed to reduce fluoride exposure within safe limits for island residents.

Comprehensive Management of Severe Dental Fluorosis with Adhesively Bonded All-Ceramic Restorations

Dental fluorosis is a common disorder caused by excessive fluoride intake during tooth development. The esthetic consequences of dental fluorosis can negatively affect oral health-related quality of life and have lasting psychosocial effects. In severe cases, where the fluorosed enamel is prone to chipping, flaking, and developing caries, minimally invasive procedures are ineffectual and a more substantial restorative approach is required to restore optimal function and esthetics. However, no definitive guidelines exist for the management and treatment of severe dental fluorosis due to the limited evidence available in the literature. This case report describes the full-mouth rehabilitation of a patient with severe dental fluorosis utilizing adhesively bonded all-ceramic crowns, veneers, and overlays. The successful follow-up on this case indicates that adhesively bonded restorations may provide a viable option in the functional and esthetic management of severely fluorosed dentition.

Esthetic Management of Incisors with Diffuse and Demarcated Opacities: 24 Month Follow-up Case Report

CLINICAL RELEVANCE

A minimally invasive esthetic treatment can provide longevity and color stability.

SUMMARY

This clinical case report describes a minimally invasive approach to mask diffuse and demarcated opacities in permanent anterior teeth in an eight-year-old child who was upset with the appearance of her incisors. Clinical examination showed diffuse opacities in teeth 7, 8, 9, and 10, diagnosed as dental fluorosis associated with yellow demarcated opacity in tooth 9 related to molar-incisor hypomineralization. The treatment was based on conservative dentistry using the low-viscosity resin infiltration technique and resin composite restoration in an attempt to mask the lesions. The follow-up time was 24 months.

Esthetic management of white spot lesions by using minimal intervention techniques of bleaching and resin infiltration: A clinical report

Dental fluorosis and hypocalcification manifest as white spot lesions and/or brown discolorations. With dental fluorosis, mottled layers in enamel can also be present depending on severity. Treatment options have varied in such situations, depending on severity, and can range from conservative to more invasive. This clinical report focuses on a combination of bleaching and resin infiltration as one of the more conservative treatment options.

Underlying Resin Infiltration and Direct Composite Veneers for the Treatment of Severe White Color Alterations of the Enamel: Case Report and 13-Month Follow-Up

Pronounced white color alterations due to structural anomalies of the enamel are often insufficiently masked by bleaching techniques or resin infiltration procedures alone. This frequently leads to the choice of more invasive prosthetic restorations in order to correct tooth color and form. This article describes a minimally invasive treatment option for esthetic and functional rehabilitation in the case of a 13-year-old female patient with suspected severe fluorosis and misalignment of the anterior teeth. The restorations were performed using underlying resin infiltration to homogenize the tooth shade. In a second step, direct composite veneers were applied on top to attain a natural tooth color and adjust tooth alignment and form. By joining the two minimally and noninvasive techniques, this treatment option combines the directive for preservation of hard tooth structure while treating adolescents with the benefits of easy adaptation and repair when the occlusion is still in adjustment.

Influence of the mode of application of universal adhesive systems on adhesive properties to fluorotic enamel

The objective of this study is to compare the resin-enamel bond strength (mμSBS), in-situ degree of conversion (DC), and the enamel-etching pattern (SEM/EDX) of universal adhesive systems when applied to sound and fluorotic enamel. Ninety-eight human molars were sectioned into 4 parts and divided into 24 groups according to 1) enamel surface (sound or fluorotic enamel), 2) adhesive system (Clearfil Universal Bond [CUB], Futurabond U [FBU], iBond Universal [IBU], and Scotchbond Universal [SBU]), and 3) application mode (etch-and-rinse [ER], active self-etch [Active-SE], and passive self-etch [Passive-SE]). Specimens were stored at 37 °C, for 24 hours and tested at 1.0 mm/min (μSBS). Enamel-resin interfaces were evaluated for in-situ DC. The enamel-etching pattern was evaluated under a SEM/EDX. Data from mμSBS and in-situ DC was analyzed using a three-way ANOVA and Tukey's test at 5 % level of significance. For all adhesives, the ER resulted in a statistically significant higher mean mμSBS than the passive-SE in both substrates (p < 0.001). For all adhesives, active-SE resulted in mean mμSBS (p > 0.31) and in-situ DC (p > 0.45) that were statistically similar to those obtained with the ERs in both substrates. A statistically significant, higher mean mμSBS and in-situ DC were obtained in sound enamel (p < 0.001) than in fluorotic enamel. In general, SBU showed higher mean values for mμSBS and in-situ DC compared to those of CUB and IBU (p < 0.001). ER and active-SE showed the deepest enamel-etching pattern in both substrates. A higher amount of fluor was observed in fluorotic enamel. The active application of universal adhesives in the SE-mode may be a viable alternative to increase the adhesive properties in sound and fluorotic enamel.

Effects of at-home bleaching and resin infiltration treatments on the aesthetic and psychological status of patients with dental fluorosis: A prospective study

OBJECTIVE

This study aims to evaluate the effect of the combination approach of at-home bleaching (HB) and resin infiltration (RI) techniques on different severity degrees of dental fluorosis (DF) and further analyze the psychological changes caused by HB and RI in patients.

METHOD

Twenty-two patients (4 males, 18 females, 27.8 ± 1.6 yrs) with 186 fluorotic teeth were included in this study and classified into mild (N = 56), moderate (N = 100) and severe (N = 30) DF groups according to the Dean's index. The treatment effects on patients with DF were assessed by questionnaires including the changes in patients' subjective evaluation of their teeth and psychological status before and after treatments. Standardized digital photographs were taken at each time point of the treatment process, including baseline (T1), after bleaching (T2), immediately after RI treatment (T3) and more than six months after RI treatment (T4). The color alterations (ΔE) between the fluorotic (F2) and the surrounding relatively sound areas (F1) were analyzed.

RESULTS

Bad tooth appearance caused 13.64% of patients often depressed, frustrated, or disappointed, whereas 72.72% occasionally had these feelings. After treatment, the satisfaction of DF patients regarding tooth appearance increased from 0% (satisfied) to 58.82% (satisfied) and 23.53% (very satisfied). Moreover, these treatments improved all patients' confidence in smiling, laughing and showing their teeth. The percentage of fluorotic teeth with ΔE values more than 3.0 and 3.7 units decreased gradually from T1 stage to T3 stage in mild and moderate DF groups (p < 0.05), whereas the ΔE value in T3 stage was significantly lower than that of T2 stage in severe DF group (p < 0.05). In T4 stage, no significant difference was observed in the ΔE values between T4 and T3 stages (p > 0.05).

CONCLUSION

This study shows the obvious positive aesthetic effect of HB and RI treatment on different severity degrees of DF and the great improvements in psychological discomforts.

CLINICAL SIGNIFICANCE

The combination treatment of RI and low concentration HB gel improves the aesthetics of DF and may have a stable effect after 6-months follow-up, suggesting that this approach is a valuable clinical choice for dentists to treat DF.

Interventions in management of dental fluorosis, an endemic disease: A systematic review

Objective:

Mottling and pitting of enamel due to excess fluoride consumption may affect one's self-esteem due to unaesthetic appearance and also in turn can affect the quality of life. This present study was conducted to assess various treatment approaches available for patients with dental fluorosis.

Materials and Methods:

Literatures were searched from August 1998 to August 2019 for articles in the management of dental fluorosis. The databases used were National Center for Biotechnology Information (NCBI) and Google Scholar. In NCBI, the filters were modified to randomized controlled trial, clinical trial, human trial, and free full-text articles. The following queries were used in order to search for the article: treatment for dental fluorosis, intervention of dental fluorosis, and management of dental fluorosis.

Results:

All the five studies selected after screening were randomized controlled trials. Total number of patients included in this study were 304 with the mean age of 17.7 years old. They were treated with microabrasion, bleaching, resin infiltration or combination of microabrasion with bleaching, and resin infiltration with bleaching. Microabrasion resulted in less esthetic improvement compared with bleaching. Meanwhile, resin infiltration showed a greater improvement in esthetics in comparison to bleaching. Resin infiltration with additional infiltration time and combination of resin infiltration with bleaching are the best treatment options.

Conclusion:

Based on this systematic review, resin infiltration with increased infiltration time is the best treatment approach in treating dental fluorosis.

Smile Makeover by Veneers – Case Report

Ceramic veneers have evolved in the last few years as an aesthetic restoration in the field of aesthetic dentistry. It is a conservative option as compared to full coverage crowns for improving the patients smile. Ceramic veneers are widely used for smile designing in patients with fluorosis, midline diastema, hypoplastic teeth, and peg shape laterals. Clinical relevance: This article highlights the smile designing of a young patient with fluorosis using ceramic veneers, which not only improves the smile of the patient but has positive psychological benefits.

Aesthetic treatment of dental fluorosis in a 9-year-old girl: Case report

Background/Aim: Dental fluorosis is a specific disturbance of tooth formation caused by excessive intake of fluoride. The discoloration of teeth is the most common reason for parents to seek treatment. The purpose of this paper is to describe the therapeutic management performed in a 9-year-old girl with fluorosis. Case report: A clinical case of a 9-year-old girl diagnosed with fluorosis is reported. The treatment of this clinical case was achieved using microabrasion, which is a minimally invasive method. This technique improves the aesthetics of the teeth without causing significant loss of dental tissue; a characteristic making microabrasion applicable to children as well. Its implementation involved the combined use of 18% hydrochloric acid and pumice on the enamel surface of upper incisors. The improved appearance of the teeth was aesthetically pleasing and, consequently, the patient gained in self-confidence. Conclusions: In the literature, several treatment choices are proposed, depending on the severity of the fluorosis. In our case, microabrasion was applied and the aesthetic outcome satisfied both the patient and the dentist.

Minimally Invasive Approach for Improving Anterior Dental Aesthetics: Case Report with 1-Year Follow-Up

Dental aesthetics have become highly important in recent years. Treating aesthetic demands with noninvasive or minimally invasive techniques can preserve the natural tissues. A 20-year-old female patient presented to the clinic with aesthetic concerns. After the clinical and radiographic examinations, hypomineralization was identified in the maxillary anterior teeth except the maxillary right canine. An external discoloration was also identified in the maxillary left canine tooth. Moreover, the right canine tooth was identified as a Turner's tooth according to the patient's anamnesis. The resin infiltration technique was applied to the maxillary anterior teeth except the maxillary right canine. The bleaching treatment was applied to the maxillary left canine tooth. Then, a laminate veneer restoration was applied to the upper right canine tooth with Turner's hypoplasia. Following the treatment, a satisfactory aesthetic restoration was achieved. After 1-year examination, no clinical failures were observed.

Interventions for dental fluorosis: A systematic review

OBJECTIVE

Dental fluorosis has considerable implications on the patients' quality of life. The present study assesses the comparative effectiveness of the various interventions for the treatment of fluorosed enamel.

MATERIALS AND METHODS

Nine databases were searched from inception to December 2016 for randomized trials. After duplicate study selection, data extraction, and risk of bias assessment, mean differences (MD) or Relative Risks and the corresponding 95% confidence intervals (CIs) were calculated and assessed with the GRADE approach.

RESULTS

Six trials with a total of 348 patients (at least 40% male/60% female) with a mean age of 17.7 years treated with bleaching, microabrasion, or resin infiltration were included. Evidence of low quality indicated that microabrasion resulted in smaller esthetic improvement compared to bleaching (MD = -2.9; 95% CI = -3.4 to -2.5). Evidence of moderate quality indicated that compared to bleaching a greater esthetic improvement was seen with resin infiltration (MD = 3.6; 95% CI = 2.7-4.6) or a combination of bleaching with resin infiltration (MD = 3.5; 2.8-3.7). However, all comparisons were supported from single trials and therefore caution is warranted.

CONCLUSIONS

Based on the existing limited evidence, resin infiltration seems to be the most promising treatment for dental fluorosis, followed by bleaching and microabrasion.

CLINICAL SIGNIFICANCE

For this systematic review, which was registered beforehand in PROSPERO (CRD42016053492), we synthesized evidence from existing randomized clinical trals on humans to see which treatment is most effective for the esthetic rehabilitation of dental fluorosis, the prevalence of which is seeing a worldwide steady increase. We found that resin infiltration seems to be the most effective treatment approach for lesions of mild to moderate severity, followed by bleaching, and finally microabrasion. Our study's strengths are its a priori registration, wide search, quality check according to Cochrane guidelines, and the use of a new robust analytic method to provide valid clinical recommendations according to the principles of evidence-based medicine.

A comparison of dental fluorosis in adult populations with and without lifetime exposure to water fluoridation

OBJECTIVES

There is a lack of evidence on the proportion and severity of fluorosis in adult populations exposed and not exposed to fluoridated water over their lifetimes. The aim of this study was to compare the proportion and severity of fluorosis in adults with lifetime exposure to water fluoridation with a nonexposed sample. A secondary aim was to report the gradient of fluorosis severity by age.

METHODS

A cross-sectional study recruited a sample with lifetime exposure to water fluoridation and a matched, nonexposed group. 580 participants, aged 18-52 years (mean 34.3, SD 9.4) and 64% female, were recruited in general dental practices located in fluoridated (Birmingham and County Durham) and nonfluoridated areas (Manchester). Three digital images were taken of their incisors and an experienced examiner who was blind to exposure status viewed the images remotely and allocated fluorosis scores using the Thylstrup and Fejerskov (TF) scale.

RESULTS

At TF ≥ 1 (any fluorosis), a significantly higher proportion of participants from the fluoridated area had fluorosis (F 39% NF 21.3%, P < 0.001), at the threshold TF ≥ 3 ("aesthetic concern"), the difference was no longer statistically significant (F 4.1%, NF 2.2%, P = 0.25). There was a gradient by age, whereby fluorosis was highest in the youngest and lowest in the oldest age group.

CONCLUSIONS

Although fluorosis is more common in adults with lifetime exposure to water fluoridation than those with no exposure, the aesthetic impact of fluorosis seems to diminish with age.

Effect of phosphoric acid concentration used for etching on the microtensile bond strength to fluorotic teeth

To evaluate the effects of different etching concentrations of phosphoric acid on the microtensile bond strength of Adper Single Bond 2 to fluorotic teeth.Deidentified extracted teeth were collected, including 30 sound teeth, 30 teeth with mild fluorosis, 30 teeth with moderate fluorosis, and 30 teeth with severe fluorosis. The teeth in each group were randomly divided into 3 subgroups (n = 10) that were subjected to acid etching using 35%, 40%, or 45% phosphoric acid. Adper Single Bond 2 (3M, Saint Paul, MN) was used as the adhesive for bonding Z250 universal resin (3M) to the etched dental enamel. Microtensile testing was used to determine the bond strength. After the microtensile test, the fractured specimens were examined under scanning electron microscopy (SEM).Both dental fluorosis and concentrations of phosphoric acid significantly affected the microshear bond strength of Adper Single Bond 2 to dental enamel. The maximum bond strength was achieved by using 40% phosphoric acid. Failure analysis showed that most failures occurred at the bonding interface. The rates of failures at the bonding interface decreased as the degree of fluorosis increased and as the concentration of phosphoric acid increased from 35% to 45%.The bond strength of fluorosis tooth was lower than that of healthy tooth, the bond strength increased with the increasing concentration of phosphoric acid, but an excessively high acid concentration can conversely lead to an apparent decline in bond strength.

Aesthetic Rehabilitation of a Severe Dental Fluorosis Case with Ceramic Veneers: A Step-by-Step Guide

The selection of an appropriate treatment plan for cases of dental fluorosis depends on the severity of the condition. Ceramic veneers are considered the treatment of choice for moderate to severe cases of fluorosis given the optimum aesthetics, wear resistance, biocompatibility, and long-term results of these veneers. This case report describes a step-by-step rehabilitation of fluorosed teeth, using ceramic veneers in a 26-year-old Yemeni male. The patient presented at the restorative dentistry clinics at King Saud University complaining of an unpleasant smile and generalized tooth discoloration.

Minimally invasive esthetic improvement in a patient with dental fluorosis by using microabrasion and bleaching: A clinical report

Dental fluorosis is a condition that produces unesthetic coloration of enamel because of excessive fluoride ingestion during enamel formation. Its appearance can range in severity from mildly white and opaque to dark brown and can lead a patient to seek dental treatment. Historically, these lesions have been masked, either with direct or indirect restorations, but more conservative treatment options are now available, including the combination of microabrasion and bleaching. This clinical report describes the use of these treatment options to address a young patient's dental fluorosis.

Treatment of Fluorosis Spots Using a Resin Infiltration Technique: 14-month Follow-up

The aim of this study was to report a clinical case of moderate fluorosis spots treated with infiltration of low-viscosity resin. A commercial resin was applied to the facial surfaces on the anterior teeth in both the maxillary and mandibular arches. The white spots of fluorosis lost their whitish appearance and appeared similar to sound enamel. This technique, which might constitute an alternative to white-masking of fluorosis spots, showed optimal esthetic results.

Evaluation of Novel Microabrasion Paste as a Dental Bleaching Material and Effects on Enamel Surface

PURPOSE

Dental fluorosis is an enamel dysplasia that can cause serious aesthetic and psychological problems. An examination of the literature shows that the microabrasion method is the most effective way to treat fluorosis. This study aimed to produce a prototype microabrasion paste for the treatment of fluorosis stains and to examine the effects of the paste on tooth structure and color in vitro.

MATERIAL AND METHODS

Forty extracted upper incisor teeth were used in this study. The teeth were divided into four treatment groups: a prototype microabrasion paste group (N = 10), an Opalustre paste group (N = 10), a 37% phosphoric acid gel group (N = 10), and a distilled water (control) group (N = 10). Following treatment, all specimens in each of the four groups were examined by scanning electron microscopy for changes in their surface enamel. Changes in tooth color changes of the 1st and 2nd groups were measured before and after treatment by a VITA Easyshade Advance spectrophotometer.

RESULTS

In scanning electron microscopy evaluations, significant differences were not observed between the 1st and 2nd groups. Differences in three color-measuring coordinates between the 1st and 2nd were also not statistically significant (p > 0.05).

CONCLUSIONS

The study demonstrated that the prototype paste is a viable treatment option for dental fluorosis.

CLINICAL SIGNIFICANCE

The findings in this study demonstrated that the tested prototype microabrasion paste is extremely harmless, minimally invasive agent, and able to improve the color, shine and chrome values of the teeth.

Complete oral rehabilitation in a case with severe dental fluorosis

The authors have presented a technique of full occlusal rehabilitation in a case of severe dental fluorosis. In this technique, maxillary and mandibular anterior teeth were simultaneously prepared and restored first. This was followed by simultaneous preparation of maxillary and mandibular posterior teeth that were restored in canine guided occlusion. The technique and sequence followed here is unique and is not available in dental literature. This technique reduces number of appointments while fulfilling all objectives. Periodontal follow-up over 3 years was satisfactory. A restorative treatment protocol has been devised for fluorosis which will act as a guide for the dental practitioners.

THE MICROMECHANICAL AND TRIBOLOGICAL FEATURE OF MILD MOTTLED ENAMEL

The relationships between the basic mechanical and wear properties of mottled enamel, especially during the mastication process, are important factors and must be explored. This study evaluated mottled enamel's micro-tribological behavior under artificial saliva conditions in vitro. The basic mechanical properties were determined by nanoindentiation testing. A conical diamond nanoindenter tip was used to scratch mottled enamel and normal enamel. The scratches were sliding with a constant normal load of 2 mN, with different cycles during the tests. The hardness, elastic modulus and friction coefficient were obtained to analyze the mechanical properties. The results showed that the hardness and elastic modulus of mottled enamel were 10% and 14.6% less, respectively, than those of normal enamel. Mottled enamel showed a lower friction coefficient and a higher wear rate, compared to normal enamel. The friction coefficient did not appear to be related to the wear rate for either type of enamel. The wear mechanism for normal enamel was plastic deformation for early wear, while the combination of plastic deformation and delamination was the main damage feature of mottled enamel.

Dental fluorosis in the paediatric patient

Exposure to excessive fluoride intake during the early childhood years can disrupt the normal development of enamel, resulting in dental fluorosis. This varies in severity, ranging from white opacities in mild cases to more severe black and brown discoloration or enamel pitting. This article aims to give the reader a better understanding of the aetiology, diagnosis and subsequent treatment of dental fluorosis in the paediatric patient.

CLINICAL RELEVANCE

Fluorosis can have a marked effect on dental aesthetics. The prevalence of fluorosis in the United Kingdom may increase following the publication of Delivering Better Oral Health, published by the Department of Health in 2007, which suggested changes to fluoride levels in children's toothpastes. This article highlights the importance of accurate diagnosis of fluorosis and also explains the treatment options available to paediatric patients.

Use of clinical bleaching with 35% hydrogen peroxide in esthetic improvement of fluorotic human incisors in vivo

AIM

The aim of the study was to evaluate esthetic improvement with the use of 35% hydrogen peroxide clinical bleaching as related to the different grades of enamel fluorosis in vivo and to study adverse effect of clinical bleaching with 35% hydrogen peroxide on teeth and gingiva.

MATERIALS AND METHODS

A total of 60 children of different grades of fluorosis were included in the study. With 35% hydrogen peroxide-based dual activated bleaching system, in-office vital teeth bleaching was carried out for each subject. Clinical evaluation for improvement in esthetics, effect on teeth and gingiva were performed for each child during preoperative, immediate postoperative and later 6 months postoperative period. For evaluation and comparison, all the collected data were subjected to statistical analysis.

RESULTS

Although in all the subjects, partial shade relapse was seen over a period of time, good homogeneous and esthetic results were seen in very mild and mild cases. A total of 35% hydrogen peroxide in-office bleaching has no adverse effect on teeth and gingiva.

CONCLUSION

Comparing all the three groups who participated in the study, 35% hydrogen peroxide in-office bleaching seems to be very effective in very mild and mild forms of fluorosis.

CLINICAL SIGNIFICANCE

In very mild and mild forms of fluorosis, in-office vital tooth bleaching with 35% hydrogen peroxide is the most conservative and effective approach in esthetic improvement.

Minimally invasive treatment for esthetic management of severe dental fluorosis: a case report

Dental fluorosis is a developmental disturbance of enamel caused by excessive fluoride on ameloblasts during enamel formation. Patients often present to the dentist with a main goal of improving their esthetic appearance. This case report describes a minimally invasive technique for treating a severe case of enamel fluorosis with brown surface aspect and small defects. A selective mega-abrasion and microabrasion were used to recreate macro- and micro- surface morphology, followed by power bleaching, home bleaching, and resin infiltration to improve the esthetic appearance.

Alternative esthetic management of fluorosis and hypoplasia stains: blending effect obtained with resin infiltration techniques

STATEMENT OF PROBLEM

New light-polymerized resin composites optimized for rapid infiltration of enamel lesions with resin light curing monomers are commercially available today to prevent enamel lesions from further demineralization and provide a highly conservative therapy. In addition, this technique has proved to be effective treatment for blending white spot lesions because the microporosities of infiltrated lesions are filled with resin.

PURPOSE

This clinical report presents and describes cases in which the minimally invasive infiltrant resin technique was used for blending different microporous lesions, mild-to-moderate fluorosis, and hypoplasia stains related to traumatic dental injuries.

RESULTS

The fluorosis stain showed visually perceptual improvements. In the cases of hypoplasia, stains were not completely blended. However, the general clinical outcomes of these cases were considered successful and recovered the patients' self-esteem.

CONCLUSION

Based on the results obtained, it could be concluded that the resin infiltration technique shows promising results and could be considered a minimally invasive procedure for mild-to-moderate fluorosis and hypoplasia stains.

CLINICAL SIGNIFICANCE

This case study allows a better understanding of the concept of the resin infiltration technique applied in other types of porous lesions, increasing its use as a therapeutic alternative for esthetic purposes in the philosophy of minimally invasive dentistry.

Fluorosis varied treatment options

Fluorosis has been reported way back in 1901. The treatment options for fluorosis are varied depending upon individual cases. This article comes from Madurai in India where its surrounding towns are fluorosis-prone zones. The purpose of this article is to report various treatment options available for dental fluorosis; this is the first time that complete full mouth rehabilitation for dental fluorosis is being reported. This article also dwells on the need for the dentists to be aware of their local indigenous pathologies to treat it in a better manner.

Microtensile bond strength of porcelain laminate veneers bonded to fluorosed teeth

PURPOSE

The aim of this study was to evaluate the microtensile bond strengths (MTBSs) of porcelain laminate veneers bonded to normal and fluorosed teeth.

MATERIALS AND METHOD

Forty human incisors, including 20 normal and 20 moderately fluorosed teeth [Thylstrup Fejerskov Index (TFI) = 4 to 6], were collected. The labial surfaces of the teeth were ground up to 1 mm and polished with #600 silicon carbide abrasive paper. The surfaces were bonded to 1-mm-thick ceramic slices (5 x 5 mm(2)) previously made (VitaVM7) using one of two ceramic cement systems (RelyX or Clapearl) following the manufacturers' instructions. A resin composite was added on top of the ceramic slices and built up to 5-mm thickness to serve as grips. The specimens were stored in water (37 degrees C) for 24 hours, and beams of adhesive interface with a surface area of approximately 1.25 mm(2) were obtained. Then the beams were subjected to MTBS tests at a crosshead speed of 1.0 mm/min. The data were analyzed with two-way ANOVA.

RESULTS

The results of the MTBS test (MPa) were 20.55 +/- 5.83 (RelyX/fluorosed), 20.16 +/- 4.61 (RelyX/normal), 18.74 +/- 2.88 (Clapearl/fluorosed), and 21.06 +/- 4.99 (Clapearl/normal). There were no significant differences in the MTBSs among the four groups (p > 0.05).

CONCLUSIONS

The MTBSs of ceramic cement systems used were not influenced by the moderately fluorosed teeth.

Micro-shear Bond Strength of Two All-in-one Adhesive Systems to Unground Fluorosed Enamel

The aim of this study was to evaluate the micro-shear bond strengths of two all-in-one adhesive systems to unground fluorosed enamel. Buccal surfaces of 24 normal and 24 moderately fluorosed teeth (Thylstrup and Fejerskov index, TFI=4-6) were bonded using G-Bond and Clearfil Tri-S Bond. The surfaces were then restored with a resin composite, stored for 24 hours in water, and tested for micro-shear bond strength (MSBS). Fracture modes, etching patterns, and adhesive interfaces were studied under a scanning electron microscope (SEM). Data were analyzed with two-way ANOVA, whereby no significant differences in MSBS were found among the four groups (p>0.05). Through SEM examination, it was shown that 1 microm of resin tag-like extensions had penetrated into the enamel for both adhesives at the enamel-adhesive interface. Based on the results obtained, it was concluded that MSBS was not influenced by the severity of fluorosis. Furthermore, there were no differences in enamel bond strength between G-Bond and Clearfil Tri-S Bond.

Quantification of dental fluorosis using fluorescence imaging

Fluorescence imaging hardware and software have been recently employed to assess demineralization due to early dental caries. Dental fluorosis also presents as diffuse surface hypomineralization of enamel and in principle similar measurement methods might be applicable to both. The caries analysis system requires the user to select an area of sound enamel around the lesion so that the affected surface can be reconstructed and the lesion subtracted. Whereas early caries presents as discrete isolated lesions fluorosis is characterized by diffuse opacities covering most of the tooth. Consequently it is difficult to use commercial QLF software for the assessment of fluorosis, as there is typically no sound area of enamel to use for reconstruction. This study describes a fluorescent imaging device capable of recording digital images of the anterior teeth and also software that is able to objectively measure fluorosis area and severity. A convenience sample of 26 subjects with a range of fluorosis from TF scores 0-3 took part in the study. The upper left central incisor of these subjects was scored for fluorosis using the TF index, photographed using a conventional digital camera and imaged using the fluorescence imaging device. The TF index was then used to visually score the digital photographs and the fluorescence images. The data from the fluorescence method demonstrated a strong correlation with TF scores from fluorescence images (Kendall's tau = 0.862). The fluorescence imaging method shows promise as an objective, potentially blinded system for the longitudinal assessment of enamel fluorosis in vivo.

Position of the American Dietetic Association: the impact of fluoride on health

The American Dietetic Association reaffirms that fluoride is an important element for all mineralized tissues in the body. Appropriate fluoride exposure and usage is beneficial to bone and tooth integrity and, as such, has an important, positive impact on oral health as well as general health throughout life. Fluoride is an important element in the mineralization of bone and teeth. The proper use of topical and systemic fluoride has resulted in major reductions in dental caries (tooth decay) and its associated disability. The Centers for Disease Control and Prevention have named fluoridation of water as one of the 10 most important public health measures of the 20th century. Nearly 100 national and international organizations recognize the public health benefits of community water fluoridation for preventing dental caries. However, by the year 2000, over one third of the US population (over 100 million people) were still without this critical public health measure. Fluoride also plays a role in bone health. However, the use of high doses of fluoride for prevention of osteoporosis is considered experimental at this point. Dietetics professionals should routinely monitor and promote the use of systemic and topical fluorides, especially in children and adolescents. The American Dietetic Association strongly reaffirms its endorsement of the appropriate use of systemic and topical fluorides, including water fluoridation, at appropriate levels as an important public health measure throughout the life span.