Dr. Hall, I’m writing about my 9 year old daughter. She has severe fluorosis stains on her teeth. Her bottom central and lateral incisors are extremely yellow (those are the only permanent bottom teeth she has so far). Her top central and lateral incisors are very blotchy, and one of them is jagged on the side. She currently has braces correcting the problems resulting from years of sucking her fingers. Her teeth have bothered her for some time. The only reason we put braces on now, instead of waiting for the 12 yr molars, is to give her more self-confidence with her smile. It also gives us a little more time to figure out how to correct the fluorosis.
Thanks, Carly from Arizona
Carly,
You say your daughter has severe fluorosis. When fluorosis is severe, you need to cover the stained teeth with porcelain veneers – cover all of the teeth that are part of her smile.
Fluorosis is caused by consuming too much fluoride while the teeth are forming. Much natural drinking water has some fluoride in it. There is some natural water that doesn’t have enough fluoride, which makes teeth more susceptible to decay. Communities where this occurs generally add fluoride to the drinking water to bring it to the optimal level of about one part per million. But some communities naturally have water that has too much fluoride, and then some of it needs to be removed. If it isn’t, drinking that water for extended periods while the teeth are forming can cause fluorosis. Or, where people are drinking their own untreated well water, this can occur. Fluorosis can also be caused by mistakenly consuming fluoride supplements when it isn’t needed or by swallowing too much fluoridated toothpaste.
Mild fluorosis causes spotting of the teeth, and the spots can be white or brown, depending on the severity. Often direct bonding can be used in these cases, which just covers the affected spots.
If the fluorosis spotting is extensive, then the teeth need to be covered more extensively, and porcelain veneers would be the treatment of choice.
If there is just a general yellowish color, but that color is even – not mottled – then I would try teeth bleaching first. If that is the case, you’re probably not dealing with fluorosis but some other cause of the staining.
Just be sure you go to a highly experienced and capable cosmetic dentist. This is beyond the ability of your family dentist. Beyond the technical ability and beyond his or her artistic understanding.
You’ll want to wait until the braces come off. And the dentist will need to know how to time the work. I don’t know how long the braces will be on, but when they come off it may be possible that her very front teeth still haven’t fully erupted. In that case, it may be best to do some direct bonding temporarily, or something else. There will be a lot of different ways to tackle the problem, and a lot will depend on her attitude toward the problem. Dentists who aren’t artistically sensitive just aren’t equipped to handle these self-image issues very well, but experienced cosmetic dentists are quite used to them.
There is no minimum age for porcelain veneers, as long as the dentist knows what he or she is doing, and properly factors in the degree of present and future tooth eruption and other factors. Children can also have teeth bleaching.
– Dr. Hall
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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.