<unk>  is caused by a higher than normal amount of fluoride ingestion whilst teeth are forming. Primary dentine<unk>  and enamel<unk>  can only happen during tooth formation, so fluoride exposure occurs in childhood. Enamel<unk>  has a white opaque appearance which is due to the surface of the enamel being hypomineralised. The most superficial concern in<unk>  is aesthetic changes in the permanent dentition (the adult teeth). The period when these teeth are at highest risk of developing<unk>  is between when the child is born up to 6 years old, though there has been some research which proposes that the most crucial course is during the first 2 years of the child's life. From roughly 7 years old thereafter, most children's permanent teeth would have undergone complete development (except their wisdom teeth), and therefore their susceptibility to<unk>  is greatly reduced, or even insignificant, despite the amount of intake of fluoride. The severity of<unk>  depends on the amount of fluoride exposure, the age of the child, individual response, weight, degree of physical activity, nutrition, and bone growth. Individual susceptibility to<unk>  is also influenced by genetic factors. Many well-known sources of fluoride may contribute to overexposure including dentifrice/fluoridated mouthrinse (which young children may swallow), excessive ingestion of fluoride toothpaste, bottled waters which are not tested for their fluoride content, inappropriate use of fluoride supplements, ingestion of foods especially imported from other countries, and public water fluoridation. The last of these sources is directly or indirectly responsible for 40% of all<unk> , but the resulting effect due to water fluoridation is largely and typically aesthetic. Severe cases can be caused by exposure to water that is naturally fluoridated to levels above the recommended levels, or by exposure to other fluoride sources such as brick tea or pollution from high fluoride coal.<unk>  has been growing in the United States concurrent with fluoridation of municipal water supplies, although disproportionately by race. A 2010 CDC report acknowledges an overall incidence of<unk>  of 22% from 1986-87 increased to 41% in the early 21st century, with an increase in moderate to severe<unk>  from 1% to 4%. The 2011-12 NHANES figures documented another 31% overall increase among American teens since the previous decade, with a total adolescent population impact of 61% afflicted. More than one in five American teens (23%) have moderate to severe<unk>  on at least two teeth.
Dental fluorosis
Skeletal fluorosis
Chronic periodontitis
Oral candidiasis
Dental plaque
Dental abscess
Periodontal disease
Ebullism