Fluorosis index

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

Fluorosis Index- Department of Public Health Dentistry 2

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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.

Fluorosis Index- Department of Public Health Dentistry


Colorado Springs


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.


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


8Fluorosis Index- Department of Public Health Dentistry

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.

Fluorosis Index- Department of Public Health Dentistry


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


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.


Original Criteria- 1934 Normal Questionable

Very mild Mild

Moderate Moderately severe

Severe


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


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


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


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


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


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


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.


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.


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




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


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


Tooth surface fluorosis index It was developed by HOROWITZ et al. in 1984 at National Institute of Dental

Research U.S.A


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.


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



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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Health & Medicine

Fluorosis index