Multi-modal management of dental fluorosis in a family: A case series.

RATIONALE: This case series addresses the management of dental fluorosis, a condition caused by excessive fluoride intake during tooth development. The 3 patients in this report, all from the same family, exhibited varying degrees of dental fluorosis, impacting both aesthetics and function. Treatments ranged from conservative approaches like bleaching and macro-abrasion to more extensive restorative options like veneers and crowns, aiming to improve dental appearance and oral health. PATIENT CONCERNS: All 3 patients were concerned with the discoloration and aesthetic issues caused by dental fluorosis. Each expressed a desire to improve their smile and address any functional impacts on their teeth. DIAGNOSES: The patients were diagnosed with dental fluorosis of varying severity. Diagnosis was made based on clinical examination, history of fluoride intake, and radiographs. The condition was classified using the Thylstrup and Fejerskov index, which assesses the extent of fluorosis based on enamel opacity, pitting, and discoloration. INTERVENTIONS: Case 1 (moderate fluorosis): The patient underwent home bleaching, composite restorations, and the application of laminate veneers after gingivectomy. Case 2 (moderate-to-severe fluorosis): The patient had several teeth extracted due to failed endodontic treatment, followed by the placement of lithium disilicate crowns and a zirconia bridge. Case 3 (mild fluorosis): This patient received in-office and at-home bleaching, followed by macro-abrasion and resin infiltration to improve the appearance of white spots. OUTCOMES: Each treatment successfully addressed the functional and aesthetic concerns of the patients. The use of bleaching, veneers, crowns, and resin infiltration significantly improved their smiles. All patients reported satisfaction with the results, achieving a more natural tooth appearance and improved confidence in their dental health. LESSONS: This case series highlights the importance of a multi-modal, individualized approach to managing dental fluorosis. By tailoring treatment to the severity of the condition, aesthetic and functional improvements were consistently achieved across different fluorosis severities. Dental fluorosis management should prioritize minimally invasive options while maintaining a focus on long-term aesthetic and functional restoration.