Differential Diagnosis between Milder Forms of Dental Fluorosis (Questionable,

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Differential Diagnosis between Milder Forms of Dental Fluorosis (Questionable,

Very Mild, And Mild) and Nonfluoride Opacities of Enamel.

Characteristic	Milder Forms of Fluorosis	Nonfluoride Enamel Opacities
Area affected	It is usually seen at the tips of the cusps or incisal edges or near them.	It is usually centered on the smooth surface; It can affect the whole crown.
Shape of lesion	It resembles the shadow of a line drawn in pencil; the lines follow the incremental lines of the enamel; they form irregular flakes at the tip of the cusps	Often, rounded or oval.
Demarcation	The shadow diffuses imperceptibly into normal enamel.	It differs clearly from the adjacent normal enamel.
Color	Slightly more opaque than normal enamel; white like paper. The incisal edges and the tip of the cusps may look frosty. It does not present pigmentation at the time of the eruption (in these milder degrees, and it is very rare at any time).	It is usually pigmented at the time of the eruption often from yellow-cream to dark orange-reddish.
Teeth affected	It is more frequent in teeth that calcify slowly (canines, premolars, second and third molars). Rare in lower incisors. It is usually seen in six or eight counterpart teeth. Extremely rare in primary teeth.	Any tooth can be affected. Frequent on the vestibular surfaces of the lower incisors. It can happen in isolation. Usually one to three affected teeth. Common in primary teeth.
Gross Hypoplasia	Any. No enamel fractures occur in the milder forms. The surface of the enamel has a glazed appearance, is smooth as the tip of the probe passes gently over the surface	Absent to severe. The enamel surface may appear demineralized, it may be rough when the probe passes.
Detection	Frequently invisible under strong light; It is more easily detected by a line of sight tangential to the crown of the tooth.	It is seen more easily under strong light, in a line of sight perpendicular to tooth surface
Russell AL. The differential diagnosis of fluoride and non-fluoride enamel opacities. J Public Health Dent 1961;21:143-6.

Clinical cases of mild fluorosis.

It is characterized by normal, smooth, translucent and crystalline enamel of uniform color. These characteristics remain even after drying with prolonged air.

Smooth, translucent and crystalline enamel, with thin horizontal strips of whitish color.

Smooth, translucent and crystalline enamel accompanied by thick whitish horizontal lines.

Opaque spots due to mild fluorosis should be differentiated with codes 1 and 2 of ICDAS. In fluorosis the enamel appears bright; while in the process of decay a white chalk appearance is observed. (without brightness)

In blue countries with endemic areas of fluorine in the drinking ground water.