Dental fluorosis

An 8-year-old boy was brought by his father for his dental problem to our medical camp at Jharkhand state, India, where people from six villages of Berhait Block were using fluoride-contaminated well water for drinking, cooking, and other household purposes. A total of 258 children attended this medical camp and 85 had mild to severe teeth problems. The boy’s father first noticed yellowish discoloration of his child’s teeth at about 2 years of age and deformation of the teeth at about 5 years. History revealed that the boy used to drink a lot of the contaminated well water. His 6-year-old sister had similar but milder discoloration of her teeth. Neither child used fluoride-containing medicines or toothpaste. His parents had painful bent back and multiple joint pains, consistent with fluoride poisoning. The boy had no clinical complaints in his daily activities but showed typical findings of dental fluorosis (see figure). He was malnourished and had poor oral hygiene. The incisor and canine teeth were primarily involved. The color was yellowish in some places and brownish in other parts. The external surfaces of teeth were eroded with chipped edges. The buccal surface was deep brown in color. No clinical abnormalities were noted in the cardiovascular, respiratory, gastrointestinal, or urogenital systems. Many biochemical and radiological investigations were not available, but fluoride levels in his urine and in the well water were 2.04 mg/L (reference level 0.1 mg/L) and 15.74 mg/L (reference level 1.5 mg/L), respectively. At the time of our investigation, the boy was not drinking well water. The boy’s condition was diagnosed as typical dental fluorosis. Most probably, several factors, such as high fluoride intake, malnutrition, and poor oral hygiene, influenced the deposition of black or brown or yellow pigment on the eroded enamel and pits over external tooth surface. Moreover, frequent drinking of fluoride-contaminated water resulted in high concentration of fluoride during the preeruptive stage of the teeth that ultimately led to the hypomineralization of the tooth enamel.