The Hidden Burden of Excess Fluoride: A Case Report

Abstract

Dental fluorosis is a developmental enamel alteration associated with excessive fluoride exposure during tooth formation and may present clinically as white opacities, discolouration, surface irregularities, or pitting. This case report describes the conservative aesthetic management of moderate dental fluorosis in a 15-year-old male who presented with a five- to six-year history of discolouration and roughness involving the maxillary anterior and posterior teeth. Clinical examination demonstrated yellowish-brown discolouration of the molars and maxillary anterior teeth, together with irregularities of the labial enamel surfaces. Based on the clinical history, examination findings, and Dean's Fluorosis Index, moderate dental fluorosis was diagnosed. A minimally invasive treatment strategy was selected. The maxillary anterior teeth were treated by enamel microabrasion using 15% hydrochloric acid and pumice to reduce superficial discolouration and surface irregularities. Direct composite resin layering was subsequently performed to improve residual colour discrepancies, translucency, anatomical contour, and surface morphology. Posterior teeth with carious lesions and structural defects were restored with direct composite resin restorations following cavity preparation and an adhesive protocol. Clinical photographs obtained during the treatment sequence demonstrated visible improvement in the appearance of the anterior teeth after treatment. This case illustrates the use of a staged conservative approach combining enamel microabrasion and direct composite resin restoration for the aesthetic management of moderate dental fluorosis while limiting unnecessary removal of tooth structure.