Chalky to brown patches on teeth

Introduction The clinical manifestations of fluorosis are characterized by white to brown patches on the enamel erupted during the same period, and severe enamel defects are also present in severe cases. Clinically, it is divided into three types: white (milk), pigmented (moderate) and defective (severe) according to its light, medium and severe.

Cause

Causes of white to brown plaque on teeth

In 1931, Churchill first confirmed that the high fluoride content in water was the cause of this disease. In the same year, smith used fluoride as a rat experiment, which proved that the fluorine content was too high to produce this disease. It is generally considered that the fluorine content in the water is preferably 1 ppm (1 mg/L), and the concentration is effective against mites and does not cause fluorosis. However, individual factors and other living conditions have some differences in the sensitivity to fluorine. Drinking water is one of the largest sources of fluoride. Water fluoride intake is determined by: 1 person's age; 2 climatic conditions; 3 eating habits. The optimum concentration of water and fluorine mainly depends on the local average annual maximum temperature, which is 0.7-1.2ppm in the United States and 0.7ppm in Guangzhou. China has a vast territory, and the temperature difference between the north and the south is very large, so it is not possible to have only one suitable concentration. Therefore, China's current water quality standard fluorine concentration of 0.5 ~ 1ppm should be appropriate.

The absorption of fluoride in food depends on the solubility of the inorganic fluoride in the food and the calcium content. If a calcium compound is added, the absorption of fluorine is significantly reduced. Animal experiments have confirmed that adequate vitamins A, D and the right amount of calcium and phosphorus can reduce the damage of fluoride to the body. This shows that the high fluoride content is not the only cause of fluorosis, because the area with slightly higher fluoride content in water is not everyone suffering from this disease.

In addition, the occurrence of fluorosis depends on the entry of too much fluoride into the body. Fluoride mainly damages the enamel cells of the tooth germ in the enamel development stage. Therefore, excessive fluoride can enter the body only during the mineralization of the teeth, and fluorosis can occur. If you live in the epidemic area with high fluoride content in drinking water for a long time before the age of 6 or 7 years, even if you move to another place in the future, you can't avoid the permanent teeth that are erupted later. Otherwise, if you move to the high fluoride area after 7 years old. , there is no fluorosis.

Alkaline phosphatase can hydrolyze a variety of phosphates to provide sufficient inorganic phosphorus in bone and tooth metabolism as a raw material for bone salt formation. When the concentration of fluorine is increased, the activity of alkaline phosphatase can be inhibited, and bone diseases such as enamel dysplasia, incomplete mineralization and bone brittleness are caused. The result is poor inter-column mineralization and excessive mineralization of the glaze column. In this case, the enamel of the surface layer is more remarkable; the amount of fluorine in the surface enamel is about 10 times that of the deep enamel. Therefore, the surface enamel of fluorosis is porous, and it is easy to adsorb foreign pigments such as manganese and iron compounds to produce fluorine spots. The microporous volume of severe fluorosis can be as high as 10% to 25%, located between the glaze columns and distributed along the transverse stripes. If the porosity of this porosity is large, the surface of the enamel will collapse and the fossil enamel will be incompletely developed.

an examination

Related inspection

Endodontic temperature test (cold and hot diagnosis)

Examination of white to brown patches on teeth

1. The clinical manifestations of fluorosis are characterized by white to brown patches on the enamel erupted during the same period, and severe enamel defects are also present in severe cases. Clinically, it is divided into three types: white (milk), pigmented (moderate) and defective (severe) according to its light, medium and severe.

2. More common in permanent teeth, very few occur in the deciduous teeth, to a lesser extent. This is because the occurrence of deciduous teeth is in the embryonic stage and the infantile stage, respectively, and the placenta has a certain barrier effect on fluorine. Therefore, fluorosis is generally found in permanent teeth, but if the fluoride intake is too much, beyond the limit of its screening function, it can also be expressed irregularly on the deciduous teeth.

3. Poor resistance to friction, but strong resistance to acid etching.

4. Patients with severe chronic fluorosis may have proliferative changes in the bone, and the periosteum and ligaments may be calcified, and thus the symptoms of the waist, legs and body joints may be produced. Symptoms of acute poisoning are nausea, vomiting, and diarrhea. Because blood calcium binds to fluorine, it forms insoluble calcium fluoride, causing tendon, collapse, and difficulty breathing, leading to death.

Differential diagnosis

Symptoms of plaque on white to brown plaque on teeth

The teeth are brownish black: the color of the teeth changes abnormally and appears brownish black. Coloration in the teeth is the discoloration of the teeth caused by the tissue structure or nutrient change of the teeth. Common necrosis of the pulp, enamel enamel and drug deposition cause tooth discoloration. Coloring outside the teeth means that the surface of the teeth is pigmented.

Yellow teeth: yellow teeth due to various reasons

Abnormal color of teeth: Because the surface of the tooth is covered with a layer of enamel, it is transparent or translucent, and its deep part is dentin, which is pale yellow. The color of the teeth is related to the degree of calcification of the enamel. The higher the degree of calcification, the more transparent the enamel is, and the true color of the deep dentin through it makes the teeth pale yellow, and the color of the teeth is abnormal in various dental diseases.

Dark spots of teeth: Some people drink or eat foods that are easy to dye for a long time, or long-term exposure to certain minerals, such as long-term use of potassium permanganate water to gargle, silver nitrate treatment of oral diseases can be exposed to mercury. Both can make the teeth black. Contact with iron, sulfur and other substances, it is easy to make the teeth appear black and green. In addition, enamel hypoplasia, dentin hypoplasia, hereditary opal teeth, dental fluorosis, tetracycline teeth, dental caries, etc. can make the teeth yellow, brown, black.

The crown is translucent opalescent: the clinical manifestation of hereditary opalescent teeth is translucent opalescent, which can be either light yellow or brownish yellow. X-ray films showed that the early medullary cavity was larger, and after enamel abrasion, calcification atresia gradually appeared in the medullary cavity and root canal. Periodontal support tissue is normal. Sometimes a shel tooth is seen, which is characterized by a large medullary cavity, a thin dentin layer, and an abnormally short root, but no root absorption.

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