Fluoride Action Network



The prevalence of fluorosis of the permanent teeth has increased during the past few decades in the United States and Canada. However, primarytooth fluorosis has been largely overlooked, because it is often difficult to recognize. This article describes primarytooth fluorosis, both as characterized in the literature and as seen clinically.


The authors review and summarize previous studies of primarytooth fluorosis and discuss its etiology. In addition, the authors describe the condition, based on findings from the literature, and their own experiences in characterizing it as part of a longitudinal investigation of fluoride exposures, dental fluorosis and dental caries.


Several studies indicate that primarytooth fluorosis can be prevalent and severe in areas of very high water fluoride concentrations. In these areas, primarytooth fluorosis is likely the result of both pre- and postnatal exposures. Studies have documented that primarytooth fluorosis does occur in areas with optimal or suboptimal water fluoride concentrations, and that in these settings primarytooth fluorosis is most likely caused by postnatal exposures and is seen most commonly in the primary molars. Primarytooth fluorosis, however, is often more difficult to identify than fluorosis in permanent teeth, and clinicians may be unfamiliar with its characteristics and may not recognize its somewhat subtle appearance.


Primarytooth fluorosis may be related to occurrence of fluorosis in the permanent dentition, so that its recognition by the clinician should raise awareness of possible increased risk for the permanent dentition.


The detection of primarytooth fluorosis in a young child should prompt the clinician to carefully review the child’s past fluoride exposures and current fluoride practices, as well as those of any younger siblings.

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