Sunday, July 18, 2010

Treatment for Dental Fluorosis

From the Journal of Conservative Dentistry, Volume 13, Issue 1, 2010

Fluorosis: Varied Treatment

In case A, patient had mild grade of fluorosis and therefore in-office vital bleaching procedure with McInnes solution was advocated. McInnes solution has been successfully used for treating mild fluorosis. Advantage of this procedure is that it is relatively non-invasive compared to other restorative procedures and also it could be done with minimum chair side time. The main disadvantage of this procedure is the postoperative sensitivity it produces and that it cannot be employed in patients with more severe grade of fluorosis. [24] Vital bleaching is more successful for fluorosis in younger patients presenting with opaque to orange colour stain rather than older patients with darker type of brown stains. [25]

In case B patient had mild grade fluorosis and micro and macro abrasion were employed. Advantage of micro and macro abrasion being its much faster procedure in achieving the desired result compared to other treatment options. However, the main disadvantage is that these procedures employ high speed rotary instrument which can lead to excessive removal of tooth structure is operator does not have the desired skill level. [17]

Abrasion techniques can be successfully employed for discoloration presented either as single line discoloration or patchy type of discoloration, it cannot be successfully employed for discoloration which is more diffuse in nature. [26] Both the bleaching technique and abrasion procedures could be employed only for mild to moderate grade fluorosis. [25],[26] Most of the times, a combined treatment regimen of bleaching and abrasion procedures is employed to produce the desired aesthetic result in patients with yellowish discoloration due to fluorosis. [27]

In case C, the patient had moderate type of fluorosis which necessitated that the patient was treated by veneer procedure. Veneers have been successfully employed for management moderate grade fluorosis, [15] Because of the time constraint given by patient, direct composite veneer treatment option was selected. Advantage of direct composite veneer is that it is done with minimal chair time when compared to indirect ceramic veneers, disadvantage being its long term wear resistance, color stability. [17]

In case D, patient had loss of vertical dimension of occlusion and patient's inter-occlusal space was 4mm at rest. Therefore a treatment plan was evolved to increase the vertical dimension of occlusion by 4mm which was within the limit for the patient. [20] Full mouth restorations were planned with metal ceramic crowns. This treatment option of restoring vertical dimensions of occlusion for severe fluorosis patients requires careful investigations and preparation. This treatment option is limited to cases with severe fluorosis and loss of inter-occlusal space. Advantage of this procedure is that it is an extensive procedure by which the desired aesthetic results and functional efficiency is achieved. The main disadvantage is also its extensiveness in treatment procedure which requires extensive lab procedure and operator skill, knowledge.

In each of the treatment options described above, each one has its own advantages and disadvantages; a good clinician should be aware of all the treatment options available assess its merits and demerits and select the best treatment option according to individual patient needs.

The rest of the article is here: