Dental fluorosis and fluoride: etiology, clinical pathogenesis, diagnosis and contemporary management

Abstract

Dental fluorosis is a systemic condition resulting from chronic ingestion of excessive fluoride during enamel mineralization, leading to hypomineralized, porous enamel with characteristic discolorations and structural changes. Fluoride is ubiquitous in the environment, primarily entering the human body through drinking water, foods, and dental products. While optimal fluoride levels reduce dental caries, concentrations above 1.5 mg/L in water are strongly associated with an increased prevalence of fluorosis globally. The condition exhibits endemic patterns in regions with high geological fluoride concentrations, particularly in groundwater. The pathogenesis involves disruption of ameloblast function, altered protein processing in the enamel matrix, and defective fluorapatite deposition, resulting in dose‑dependent enamel changes. Diagnosis relies on standardized clinical indices and assessment of fluoride exposure history. Contemporary approaches emphasize prevention through controlled fluoride exposure, regular monitoring of water sources, and public health measures in endemic regions. Management focuses on minimally invasive aesthetic enhancement for moderate or severe cases. Given the balance between caries prevention and fluorosis risk, understanding the etiological and pathophysiological mechanisms is crucial for effective public health strategies and clinical protocols.