Dental Fluorosis or "mottled enamel" is a disfigurement associated with the ingestion of toxic amounts of fluorides during the period of calcification of the teeth in infancy and early childhood i.e birth to 6years old. The permanent teeth, mainly, are affected, although dental fluorosis can sometimes appear in baby teeth.' The mottling has been described by the American Medical Association as "the most delicate criterion of harm" from fluoride and acknowledged that this will inevitably result from water containing 1 part per million fluoride.¹

The degree of severity depends mainly on the level of fluoride consumption but some children are more sensitive to fluoride and develop severe dental fluorosis even with a low intake. Water fluoridated at the recommended level of I part per million (ppm) used for drinking, in food preparation and manufacture, as well as in beverages, is usually the main source of fluoride intake. Most foods contain only very low levels of fluoride; exceptions are some fish and tea, which is particularly high in fluoride. Fluoride tablets and fluoride toothpaste - some of  which is inevitably swallowed by young children - can also cause dental fluorosis.^2,3 Baby formulas prepared with fluoridated water can contain over 100 times more fluoride than mothers' milk, which studies have shown to contain 0.004 - 0.008 ppmm⁴ fluoride.

There are two kinds of mottling: non-fluoride "idiopathic mottling" and dental fluorosis. The two are quite different and are readily distinguished.^5,6 Dental  fluorosis  is  the  outward  sign  of  a  poisoned organism. It should alert health officials to the long term adverse health effects. It is irresponsible to ignore this and merely consider the aesthetic implications. Ways to treat mottled teeth permanently are to conceal them with porcelain crowns, mask with plastics or bleach the enamel surface.⁷ This treatment is expensive and not generally available on the Medical Card Scheme.

Fluoride can have adverse effects on people of all ages. Reversible adverse effects include eczema, dermatitis, epigastric distress, headache, excessive thirst, chronic fatigue, muscular weakness, mouth ulcers, lower urinary tract infection and the flare-up of old allergies.^8,9,10,11 These complaints tend to disappear relatively quickly after patients discontinue using fluoridated water, tablets or toothpaste. The causal link has been established through double-blind tests. Prolonged ingestion of water fluoridated at 1 ppm can lead  to  skeletal  fluorosis,^9,13  rheumatic  arthritic complaints and impaired renal function,¹³ to name but a few of the more serious health effects. These, like fluoride-mottled teeth, are irreversible.According to Professor D.M. O'Mullane of Cork. 50% of children living in fluoridated areas have dental fluorosis.¹⁴  Prof. Clarkson, Dublin Dental Hosp., recently admitted that, “fluoride changes the structure of teeth”.¹⁵ How can fluoride cause tooth change without bone change? In fact, it also changes the structure of the bone. A recent study on children with dental fluorosis indicated structural bone change.¹⁶ In December 1995, the Journal of the American Dental Association stated: “concerns have been raised about the increased prevalence and severity of dental fluorosis in the United States due to the widespread ingestion of fluoride from a variety of sources. Local and regional studies . . . have found the prevalence of dental fluorosis to range from about 20 to 80 percent.” The optimal level of fluoride intake has never been determined scientifically.

References:

1.  Dean, H-Trendley. Journal of'American Medical Association.   107,1269,1936.

2.  Dowell, T.B and Bechal, S.J., British Dental Journal. 150.273,1981.

3.  Benfield, J.W., National Fluoridation News 19, No.4 Oct-Dec 1973.

4.  Ekstrand, J. ct al., Fluoride Balance Studies on Infants in lppm water  fluoride areas. Caries Research 18, 87, 1984.

5.  Jenkins, G.N., The Physiology and Biochemistry of the Mouth - Blackwell, Oxford (2nd Ed) 1978, 466.

5.  Moller, I.J., Fluorides and Dental Fluorosis. International Dental Journal 32. 135, 1982.

7.  McCloskey, R.J., Journal of the American Dental Association, 109,63,1984.

8.  Moolenburgh, H.C., Communication to National Pure Water Association, Feb. 1978.

 9.  Waldbott, G.L., Burgstahler, A.W., and McKinney, H.L., Fluoridation: the Great Dilemma, Coronado Press, Lawrence, Kansas, 1978.

10.  Petraborg, H.T., Fluoride, 7, 47, 1974.

11.  Petraborg, H.T., Fluoride. 10. 165, 1977.

12.  Jolly, S.S. et al., Fluorosis in Punjab. Skeletal Aspect. Fluoride, 6, 4, 1973.

13.  Juncos, L. and Donadio, J., Renal Failure and Fluorosis. Journal of the American Medical Association, 222.783, 1972.

14.  Prof. D. M. O Mullane, Journal of Dental Research  Special Supplement, February 1990.

15.  Interview with Prof. J. Clarkson, Anna Livia FM, The Green Light, February 9, 2000.

16.  D. Chlebna-Sokol and E. Czerwinski, Fluoride, Research Report, Vol.26,  No.4, 37-44, 1993.