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23 January 2019

Which therapy is more effective for the treatment of fluorosis?

Simona Chirico


INTRODUCTION 
Dental fluorosis is a chronic condition due to excessive ingestion of fluoride. This leads to a disturbed enamel formation characterized by hypomineralization of tooth enamel, seen as diffuse, symmetrical, discolored white opaque stains and striations. Enamel surface lesions, such as pitting, porosity, and brownish areas often occur in the more severe forms of fluorosis. These clinical signs depend on the amount of fluoride uptake, duration of fluoride exposure and stage of amelogenesis. A wide range of interventions have been proposed to treat fluorotic enamel, such as:

  • microabrasion: based on the application of an etching gel (mostly HCl) followed by pumicing with slow rotation handpiece;
  • external bleaching:  based on the application of acids (mostly H2O2) that produces peroxide ions to penetrate enamel and dental tubules;
  • enamel infiltration with low viscosity light-cured resins: to hide fluorotic stains, because of the resin’s similar to enamel refractive index.

Which of these is the best? A review published on the 2018 Journal of Esthetic and Restorative Dentistry compared all these treatments to give an answer. 

MATERIALS AND METHODS 
The authors searched from nine database only randomized clinical trials from 2016. Only six studies were included, with a total of 348 patients (40% male and 60% female) with a mean age of 17,7 years. They were divided into three groups and treated with bleaching, microabrasion or resin infiltration. All the groups were compared by calculating: mean differences (MD), relative risks (RR) and the corresponding 95% confidence intervals (CI). 

RESULTS
Bleaching was adopted as a reference intervention, because it contributed with the largest number of trials.
Compared to no treatment, bleaching improved all colorimetric aspects,
even if fewer bleached fluorotic areas tended to have discernable color differences from healthy enamel (RR = 0.68; 95% CI = 0.43-1.08).
In the comparison between microabrasion and bleaching, microabrasion resulted in smaller esthetic improvement compared to bleaching (MD: -2,9; 95% CI: -3,4 to -2,5).
In the comparison between resin infiltrations and bleaching, resin infiltrations had a greater esthetic improvement compared to bleaching (MD: 3,6; 95% CI: 2,7 to 4,6). 

CONCLUSIONS
Based on current evidence, resin infiltrations seems to be the most effective treatment for dental fluorosis, followed by bleaching and microabrasion.


For additional informations:
Interventions for dental fluorosis: A systematic review

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