FLUOROSIS INDEX
CONTENTS Fluorosis Difference between dental fluorosis and non
fluoride enamel opacities Different index Dean’s Fluorosis Index Thylstrup and Fejerskov Other index at a glance
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Dental fluorosis is a hypoplasia or hypo mineralization of tooth enamel or dentine
produced by the chronic ingestion of excessive amounts of fluoride
during the period when teeth are developing.
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Colorado Springs
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Clinical features
Lustreless, opaque white patches on the enamel which may become mottled, striated and pitted.
Mottled areas may become stained yellow or brown.Hypoplastic areas may also be present to such an extent in severe cases that normal tooth form is lost.
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Characteristic Mild form of fluorosis Non fluoride enamel opacities
Area affected Near tips of cusp or incisal edge
Centered in smooth surface; affect whole crown
Shape of lesion Pencil shading; follow incremental lines in enamel
Round and oval
Demarcation Shades off imperceptibly into surrounding normal enamel
Clearly differentiated from adjacent normal enamel
Colour “paper white”; no stain at the time of eruption
“creamy-yellow”- “dark orange”; Pigmented at time of eruption
Teeth affected Teeth that calcify slowly; rare on lower incisors; rare deciduous teeth involvement; usually bilateral
Any tooth ; deciduous tooth may be involved ; may affect single tooth
Gross hypoplasia None ; enamel has glazed appearance-smooth to explorer tip
Absent-severe; enamel surface can be etched-rough to explorer
Detection Strong light- line of sight tangential to the crown
Strong light- line of sight perpendicular to tooth surface
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Fluorosis specific
• Dean’s fluorosis index
• Thylstrup and Fejerskov index
• Tooth Surface Index for Fluorosis
• Fluorosis Risk Index
Descriptive • Developmental
effects of Enamel Index
• Jackson Al- Alousi Index
• Murray Shaw Index
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Dean’s fluorosis Index“ Dean’s Classification System For Dental Fluorosis”
Trendley H. Dean – 1934Devised an index for assessing the presence and severity of mottled enamel.
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The fluorosis index set criteria for categorization of dental fluorosis on a 7 point
scale.
Although no numbers were used it was considered to
be on an ordinal scale.
Under his classification all those showing hypoplasia
other than mottling of enamel were placed in
normal category.
Children who had not lived in the community
continuously or ha obtained domestic water from other
than public supply are eliminated.
Salient Features
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Mouth mirror and probes were utilized for
examination.
Examinations are made in good natural light with the subject sitting facing
the window
Each individual receives a score corresponding to clinical appearance of
two most affected teeth
If there is doubt, lower score is recorded.
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Original Criteria- 1934 Normal Questionable
Very mild Mild
Moderate Moderately severe
Severe
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Dean’s fluorosis index- Modified Criteria (1942)
Combined “moderately severe” and “severe”6 point ordinal scaleExtensively used todayRecommended by WHO in its basic survey manual(W.H.O, 1997)
The scoring system 0-4
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Normal - 0• Usual translucent
semivitriform • Smooth, glossy
and usually pale creamy white in colour
Questionable – 0.5• Slight aberration from
translucency to occasional white spots
• ‘’Normal’ is not justified
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Very mild - 1• Small opaque paper white areas
scattered irregularly over the tooth- not involving more than 25% of the tooth
• <1-2 mm opacity at tip of summits of cusps of bicuspids or second molar
Mild - 2• White opaque areas –
more extensive • <50% of tooth
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Moderate – 3• All enamel surfaces of teeth are
affected• Surfaces subjected to attrition show
wear• Brown staining is frequently a
disfiguring feature
Severe – 4• All enamel surfaces effected• Marked hypoplasia• Major diagnostic sign- discrete
or confluent pitting and widespread brown stains
• Corroded like appearance
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Community fluorosis index (CFI) To determine the severity and calculating the prevalence of dental fluorosis in a group or community.( 1946)
CFI= n x w
n- number of individuals in each category w- the weighing for each category N- total population
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Range of scores for community
fluorosis index
Public health significance
0.0- 0.4 Negative
0.4-0.6 Borderline
0.6- 1.0 Slight
1.0- 2.0 Medium
2.0- 3.0 Marked
3.0- 4.0 Very marked
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Limitations 1. Does not give sufficient information on
distribution of fluorosis within the dentition.
2. Isolated defects are not recorded.3. The distinction amongst the categories is
unclear, indistinct and lacking sensitivity.4. Even though Dean’s scale is ordinal , it
involves averaging of the scores which is inappropriate.
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Thylstrup and Fejerskov Index for Fluorosis1978TFI given By Thylstrup A. and Fejerskov O.Purpose-to refine modify and extend the Dean’s Index.10 point classification system designed to characterize the macroscopic appearance of teeth in relation to the underlying histological condition of enamel.
In 1988 TFI was modified by Fejerskov - 0nly one surface examined.
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SALIENT
FEATURES
Examination is done on a
portable chair out in daylight.
Mouth mirror & probes are used
Prior to examination the teeth are dried
with cotton wool rolls
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It is possible to produce exact and comparable estimates of severity of dental fluorosis in various populations by
1. Frequency distribution of TF score of individual teeth.2. Cumulative distribution of severity of the TF scores.INTERPRETATION (based on Dean’s Index)
TF SCORE CLASSIFICATION
1 Questionable
2-3 Very mild
3-4 Mild
4 Mild
5-9 Severe
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Advantages
It attempts to validate the visual appearance against the histological defect.
Most sensitive of all fluorosis measuring indices. Studies have concluded that the T-F index is the most indicated for work
where detailed information about the problem is required. [Cleaton-Jones and Hargreaves (1990) ; Granath et al. (1985)]
Clarkson (1989) reported that in TF index drying of teeth creates an unnatural situation due to which changes in score 1 and 2 are very minor.
The aesthetic significance of these changes are questionable.
Disadvantages
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Tooth surface fluorosis index It was developed by HOROWITZ et al. in 1984 at National Institute of Dental
Research U.S.A
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Fluorosis Risk Index Introduced by DAVID G. PENDRYS in 1990AIM To improve researcher’s ability to relate the risk of fluorosis to developmental stage of permanent dentition at the time of exposure to fluorosis.
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FR1- those begin to form in first year
of life
FR2- those who do not
begin to form until 2nd year of
life
Surface zones which do not come under
above groups are left
unassigned
Incisal edges of 11 21 32 31 41 42 and occlusal tables of 16 26 36 46.
Cervical third of incisors, middle third of canines, occlusal table, incisal third and middle third of bicuspid and 2nd molars
Enamel Zones
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References Essentials of public health dentistry- Soben Peter 5 th edition PubMed Antonio Carlos PEREIRA ;Ben-Hur Wey MOREIRA; Analysis of Three
Dental Fluorosis Indexes Used in Epidemiologic Trials, Braz Dent J (1999) 10(1): 1-60
Pendrys DG, Katz RV, Morse DE. Risk factors for enamel fluorosis in a fluoridated population. Am J Epidemiol 1994;140:461-71
R.G Rosier, Epidemiologic Indices for Measuring the Clinical Manifestations of Dental Fluorosis: Overview and Critique; ADR June 1994 vol. 8 no. 1 39-55
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