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Medical Forum / General / Dentistry / January 2008Cosmetic help for severe fluorosis
I have pretty bad case of fluorosis. My permanent teeth came in brown and mottled with hardly any enamel and looked bad from the start. Dentists have theorized that I must have been given large doses of fluoride as a baby, perhaps my mom took something when she was pregnant, I grew up in an area with abnormal amounts of fluoride in the water, etc. I am very meticulous about dental care. I brush after every meal with my electric toothbrush the dentist recommended, don't snack in between, floss, mouthwash etc. I'm a model dental patient, yet, I look like I don't brush and have never visited a dentist. In fact, I know people who brush once a day and rarely visit the dentist that have much nicer teeth than mine! Despite my best efforts, I have several new, ugly cavities a year. The areas with no cavities just have ugly stains. The hygienists tell me that my teeth are pretty clean when I go in, and that I seem to do a good job at fighting plaque. Every dentist I've seen has been surprised at the severity of the fluorosis and they always ask where I'm from. (Apparently certain areas have higher levels of fluoride in the water with worse fluorosis.) I also have very tiny teeth if that means anything. I have been told by four dentists that my fluorosis is too bad to do much with. Two dentists recommended just keeping up with regular fillings until there wasn't enough tooth left to hold them. One recommended crowning every tooth. Finally, one told me to just pull all the teeth and get some attractive dentures because it would be much cheaper than all the dental work I'd need =( This is very embarrassing. I come from a good family, good area, am well educated etc., but people look at me like I'm a hillbilly. I've been told that the staining is too severe for normal bleaching and stain removal. I've inquired around about veneers, caps, bonding, etc. and several specialists told me that I don't have enough enamel on my teeth to hold the bonds required for these things. Is this true? I want to preserve my natural teeth even if they're ugly, but would like to have cosmetic work to hide the ugliness. Can anyone recommend what I can do to enhance my teeth without removing them or grinding them down for crowns? I'm barely 30, and desperately need a way to protect my non-enamel teeth! > I have pretty bad case of fluorosis. My permanent teeth came in brown > and mottled with hardly any enamel and looked bad from the start. [quoted text clipped - 38 lines] > removing them or grinding them down for crowns? I'm barely 30, and > desperately need a way to protect my non-enamel teeth! I have only occasionally seen fluorosis with focal areas of hypoplastic enamel. Usually this is seen in families with similar dietary habits living in the same area or nearby. I have never seen fluorosis so severe that ALL the teeth have little or no enamel. If you had excessive fluoride as a baby you would expect the teeth mineralizing at the time to be infected, but not all of them. It is likely in my mind that you have one of the genetic enamel or dentin dysplasias, such as amelogenesis imperfecta or dentinogenesis imperfecta. There are a whole family of similar conditions where the entire dentition is variably affected. Most people I've seen with this condition affecting all the teeth eventually need full crowns on all existing teeth in order to save them. Steve On Jan 30, 7:53 pm, Steven Bornfeld <dentaltwinm...@earthlink.net> wrote: > I have never seen fluorosis so > severe that ALL the teeth have little or no enamel. If you had [quoted text clipped - 6 lines] > Most people I've seen with this condition affecting all the teeth > eventually need full crowns on all existing teeth in order to save them. Thanks for the reply. As a young teenager, I was told it was amelogenesis imperfecta. In fact, my dentist was excited to see a "rare case". After a year or so, he changed his mind and decided it was just a bad case of fluorosis. I've asked several other dentists about amelogenesis and they've all decided it was fluorosis. Obviously I'm not a dentist, so I'm not sure about the science behind why they picked one over the other. It is interesting that you say not all teeth would be affected by fluoride. The only teeth that look normal are my wisdom teeth and they didn't come in until my late 20's. Could they be normal because they were developing later? Also, I did grow up in an area with more fluoride than normal in the water, and I have always drank water almost exclusively. You mentioned that fluoride would affect only the teeth mineralizing when I got too much fluoride, but maybe it affected all of them because it was ongoing exposure? I do have several teeth that are definitely in need of a crown because they already have multiple fillings and there isn't much left to fill. However, some of my teeth do not have cavities, they are just tiny, mottled and stained. This includes my two front teeth, and I'd hate to whittle them down for crowns before it is structurally necessary. In the meantime, would caps or something else work for the teeth without decay? Or is it true that they can't "stick" without at least some decent enamel? I ask all these questions because I just got a new insurance plan and have to find a new dentist. I want to know all of my options so I can discuss them. I've had so much dental work, and need so much more every year... I think dentists are very happy to see me ;) > Thanks for the reply. As a young teenager, I was told it was > amelogenesis imperfecta. In fact, my dentist was excited to see a [quoted text clipped - 24 lines] > discuss them. I've had so much dental work, and need so much more > every year... I think dentists are very happy to see me ;) If the local water had that much fluoride I would expect a significant proportion of the local population to be similarly affected. OTOH, I believe most variants of amelogenesis imperfecta are inherited as an autosomal dominant, so at least one of your parents would have had a similar condition. You don't need enamel for crowns per se; you need sufficient bulk for the crowns to be retained when cemented. The problem with teeth with little or no enamel is that they wear very rapidly, so usually much dentin is worn as well. Your dentists who see you are in a better position to help you. Steve As long as the patient is ready to spend $30,000 and address any dietary issues. The full mouth crown restrative process is also a little tougher than your typical 3 unit bridge. Experience helps. D Your dentists who see you are in a better > position to help you. > > Steve > As long as the patient is ready to spend $30,000 and address any dietary > issues. The full mouth crown restrative process is also a little > tougher than your typical 3 unit bridge. Experience helps. That sure beats the $35,000 quote I got a few years ago! In response to various posts: Most recently, I was told that the issue wasn't as bad as I feared. The dentin appears to be fine, as do the nerves. My gums and roots are fine as well. I am always nervous that I will get the nightmare diagnosis of losing a tooth, but my dentist said I didn't need to worry about that now or for a while. Neither of my parents has this issue. Perhaps that is why the dentists lean towards fluorosis. I do know that my mom took a medication during pregnancy that was later banned for causing birth defects. The defects it caused weren't necessarily dental, but the dentist told me that my problems could be related to that or something else she took. Also, this definitely isn't a diet issue. For blood sugar reasons, I completely avoided refined sugar for ten years. Only recently did I start trying the tiniest bit as a treat. I never drink soda or anything other than water throughout the day. I do not snack between meals. I eat a very high calcium diet. I don't think I could get much safer as far as avoiding sugar. The origins of this issue are a mystery and my mom can't remember exactly what she might have taken or if she might have given me fluoride. I just wish I could be like a "normal" person and get pretty veneers to hid the defects! Anyway, I have my dentist appointment lined up and I'm reading my new health care coverage praying they pay a significant portion of crown costs! Thanks for the ideas and advice everyone. First, don't be dissin' us hillbillies! <G> Might not be Fluorosis at all. Dentinogenisis imperfecta is another possibility. At any rate, the salvation of the teeth (if your description is accurate) is very likely a mouthful of crowns and maybe a few root canals in the process. Along with the restorative work, a hard look at your diet and clenching habits would be in order. Sipping or nibbling through the day will decay almost anyones teeth, regardless of brushing. Clenching can destroy the new crowns. JMWAG, D > I've been told that the staining is too severe for normal bleaching > and stain removal. [quoted text clipped - 8 lines] > removing them or grinding them down for crowns? I'm barely 30, and > desperately need a way to protect my non-enamel teeth! |
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