Effects of Fluoride on Teeth
In this chapter, the committee reviews research on the occurrence of enamel fluorosis at different concentrations of fluoride in drinking water, with emphasis on severe enamel fluorosis and water fluoride concentrations at or near the current maximum contaminant level goal (MCLG) of 4 mg/L and the secondary maximum contaminant level (SMCL) of 2 mg/L. Evidence on dental caries in relation to severe enamel fluorosis, aesthetic and psychological effects of enamel fluorosis, and effects of fluoride on dentin fluorosis and delayed tooth eruption is reviewed as well. Evidence on caries prevention at water concentrations below the SMCL of 2 mg/L is not reviewed. Strengths and limitations of study methods, including issues pertaining to diagnosis and measurement, are considered.
Fluoride has a great affinity for the developing enamel because tooth apatite crystals have the capacity to bind and integrate fluoride ion into the crystal lattice (Robinson et al. 1996). Excessive intake of fluoride during enamel development can lead to enamel fluorosis, a condition of the dental hard tissues in which the enamel covering of the teeth fails to crystallize properly, leading to defects that range from barely discernable markings to brown stains and surface pitting. This section provides an overview of the clinical and histopathological manifestations of enamel fluorosis, diagnostic issues, indexes used to characterize the condition, and possible mechanisms.
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