Abstract
Dental fluorosis (DF) is an endemic disease caused by excessive fluoride exposure during childhood. Previous studies mainly focused on the acid resistance of fluorotic enamel and failed to reach a consensus on the topic of the caries susceptibility of DF patients. In this review, we discuss the role of DF classification in assessing this susceptibility and follow the “four factors theory” in weighing the pros and cons of DF classification in terms of host factor (dental enamel and saliva), food factor, bacteria factor, and DF treatment factor. From our analysis, we find that susceptibility is possibly determined by various factors such as the extent of structural and chemical changes in fluorotic enamel, eating habits, fluoride levels in diets and in the oral cavity, changes in quantity and quality of saliva, and/or oral hygiene. Thus, a universal conclusion regarding caries susceptibility might not exist, instead depending on each individual’s situation.
Highlights
Dental fluorosis (DF) bears an “endemic nature” [7,8], namely happening mostly in high fluoride areas; b. the DF prevalence in deciduous dentition is relatively low [9,10], which might owe to the function of the placental barrier, regulating the infusion of F from maternal to fetal blood, and the poor transportation of F from plasma to breast milk [11]; and c. dental enamel is at the frontier, where acid produced by bacteria first attacks and signs of caries tend to earliest appear, to conduct our analysis we mainly focus on the corresponding situation: permanent teeth affected by DF in endemic areas
A study found that the concentration of an important salivary component, sialic acid, which is capable of accelerating the aggregation of bacteria that contributes to the acquired pellicle formation and dental plaque, was reduced with increasing fluorosis severity [55]
Previous studies have intensively centered on whether fluorotic teeth were more resistant to acid, mainly adopting the acid-etching manner, and ignored ambient intraoral conditions and the interplay between cariogenic bacteria and fluorotic enamel
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Dental fluorosis (DF) is an enamel malformation caused by the chronic intake of excessive fluoride during tooth development, and is characterized by hypomineralization (or porosity). This porous characteristic is demonstrated by clinical features ranging from enamel opacities, discoloration, or stains to structural defects (pits, cracks, and fissures) [1,2]. We searched for studies that discussed the relationship between DF and dental caries, the morphological and compositional changes of DF in the oral cavity, the influence of mastication exertion on saliva secretion, and the environmental features of high fluoride areas. We used both controlled vocabulary and free text terms and inspected the citations and references of relevant studies
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