Orthodontic Bracket Bonding Challenge for Fluorosed Teeth

Dental fluorosis is a developmental disturbance of dental enamel, caused by successive exposures to high concentrations of fluoride during tooth development, leading to enamel with lower mineral content and increased porosity. Fluorosis, which seriously adversely effects, is not only the teeth and bones but also damages the DNA and chromosomes, resulting in the genetic mutations which may prove very damaging to the health of an individual. The damage caused by fluorosis is permanent, making prevention very important in regions of the world, where the problem is endemic like Pakistan, India, and China. Fluorosis appears to be especially common in the developing world. The severity of dental fluorosis depends on when and for how long the overexposure to fluoride occurs, the individual response, weight, degree of physical activity, nutritional factors, and bone growth. Esthetics changes in permanent dentition are the greatest concern in dental fluorosis, which is more prone to occur in children who are excessively exposed to fluoride between 20 and 30 months of age. It is also important to remind that the critical period to fluoride overexposure is between 1 and 4 years old, and the child would not be at risk around 8 years old. Fluorosis can be prevented by monitoring the amount of fluoride that children up to 6 years old are exposed; therefore, the dentist must be aware of the main sources of fluoride to prevent fluorosis and instruct parents or caregivers on how daily dose should be managed to achieve success in prevention. Bonding of orthodontic brackets to fluorosed enamel is a challenge for all dental clinicians. The objective of this case report is how to manage dental fluorosis patients for the success of orthodontic bracket bonding by the use of microabrasion technique. The recommended microabrasion protocol saves chair side time of the orthodontist, improves the success rate of the treatment and minimizes the cost of the treatment by preventing recurrent bond failures.