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Fluoride prevents tooth decay by making the enamel more resistant to the action of acids. They and accelerate the buildup of healthy minerals in the enamel, further slowing the occurrence of decay.
Fluoride works primarily via topical mechanisms which include (1) inhibition of demineralization at the crystal surfaces inside the tooth, (2) enhancement of remineralization at the crystal surfaces (the resulting remineralized layer is very resistant to acid attack), and (3) inhibition of bacterial enzymes.
Kleinjans, Environmental expert, Ameco Environmental Consultancy Group, Utrecht. . Usually the cause of the fluorosis lies in the use of drinking water that has a fluoride content in excess of 1.5 mg/l. Especially in the rural areas of the developing countries fluorosis may be rampant. endemic fluorosis in developing countries - IRC Wash ircwash.org default files 245.4-9038.pdf ircwash.org default files 245.4-9038.pdf
SCHER agrees that topical application of fluoride is most effective in preventing tooth decay. Topical fluoride sustains the fluoride levels in the oral cavity and helps to prevent caries, with reduced systemic availability.
Dental caries increased with increasing severity of dental fluorosis, both in moderate- and high-fluoride areas. Thus, a positive relationship between dental caries and dental fluorosis was observed across various tooth types, in both areas. The relationship between dental caries and dental fluorosis in areas nih.gov nih.gov
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Fluoride Promotes Remineralization Fluoride enhances tooth remineralization by accelerating the growth of fluorapatite crystals on the partially demineralized sub-surface crystals in the carious lesion. Fluoride adsorbs into this surface and attracts calcium ions. The Role of Fluoride on Caries Prevention - StatPearls - NCBI nih.gov books NBK587342 nih.gov books NBK587342
Fluoride acts on the acids of oral bacteria such as Mutans Streptococci (MS) and reduces the formation of these acids. This effect is considered a topical effect that leads to a reduction in tooth colonization by bacteria and thus leads to a decrease in enamel demineralization.
Severe fluorosis is characterized by brown discoloration and discrete or confluent pitting; brown stains are widespread and teeth often present a corroded-looking appearance. People with fluorosis are relatively resistant to dental caries (tooth decay caused by bacteria), although there may be cosmetic concern. Dental fluorosis - Wikipedia wikipedia.org wiki Dentalfluorosis wikipedia.org wiki Dentalfluorosis

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