Clinical Manifestations
Fluorosis affects enamel symmetrically — homologous teeth on the left and right are affected similarly, and all teeth developing at the same time show similar patterns. This symmetry is a key diagnostic clue.
Mild fluorosis: white opaque spots, flecks, or horizontal white lines on the enamel surface. These are most visible when the tooth is slightly desiccated.
Moderate fluorosis: chalky white appearance of the entire tooth with brown staining. The brown color is from extrinsic staining — the porous enamel absorbs pigments from food and beverages.
Severe fluorosis: pitting — discrete or confluent holes in the enamel surface, structural collapse of enamel, and black-brown staining. Significant structural compromise can impair function.
Fluorosis is present from tooth eruption and does not progress — unlike caries or erosion which are active processes.