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I am an orthodontist and recently had a 24-year-old Hispanic man come for treatment with severe fluoride staining. In your experience, would you expect braces to have acceptable bond strengths to be useful for two years of treatment? Is there a special protocol to help?
Dr. David Lehman
I’m going to generalize my answer so it is useful to as many people as possible.
My experience, of course, was with doing dental bonding procedures on patients with fluorosis. For the lay person reading this post, that is the clinical name of fluoride staining, and it comes from consuming excessive amounts of fluoride during childhood. We don’t see it too much in the United States, because the vast majority of our water supply is adjusted for optimal fluoride content. I’m guessing that this Hispanic man grew up in another country, which may explain the fluorosis.
I did not see extreme fluorosis in my practice, but did see mild to moderate fluorosis, and never had any problem bonding to those affected teeth with normal etching. If the staining is severe, my understanding is that the recommendation is to double the etch time. There was a study done on this some years ago, and I believe that was the conclusion, and I concluded from the data that doubling the etch time, when fluorosis is severe, should produce a bond that would be equal to that of normal enamel.
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About David A. Hall
Dr. David A. Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does advanced internet marketing for dentists.
If dental bonding doesn’t work, would porcelain veneers work in this situation? Will they cover the stains better?
Response by Dr. Hall
Porcelain veneers still have to be bonded with the same basic etching and bonding procedure, so that won’t change the durability of the work. But as long as the etching time is increased, either technique should work.
But as far as covering the stains, yes, in my opinion the treatment of choice would be porcelain veneers. So after this patient gets his braces, if he is ready for further smile improvement and can afford it, I would recommend porcelain veneers.
Thank you for the information.