DEAN’S FLUOROSIS INDEX 1943 (PUBLIC HEALTH DENTISTRY)

INTRODUCTION
INDEX:“A NUMERICAL VALUE DESCRIBING THE RELATIVE STATUS OF A POPULATION ON A GRADUATED SCALE WITH DEFINITE UPPER AND LOWER LIMITS, WHICH IS DESIGNED TO PERMIT AND FACILITATE COMPARISION WITH OTHER POPULATIONS CLASSIFIED BY THE SAME CRITERIA AND METHODS.”
-RUSSELL A.L.
INDICES USED TO MEASURE FLUOROSIS
DEAN’S FLUOROSIS INDEX
Introduced by TRENDLEY H. DEAN in 1934.
Devised an index for assessing the presence and severity of mottled enamel.
It is also known as ‘DEAN’S CLASSIFICATION SYSTEM FOR DENTAL FLUOROSIS.’
DEAN’S FLUOROSIS INDEX- Modified Criteria (1942)
SCORING CRITERIA
COMMUNITY FLUOROSIS INDEX (CFI)
SUMMARY

1. DEPARTMENT OF PUBLIC HEALTH DENTISTRY DEAN’S FLUOROSIS INDEX PRESENTED BY: JEBAN JYOTI SAHU ROLL NO.: 1879032 KIDS, KIMS, BBSR-24 TOPIC OF PRESENTATION:

2. CONTENTS INTRODUCTION INDICES USED TO MEASURE FLUOROSIS DEAN’S FLUOROSIS INDEX DEAN’S FLUOROSIS INDEX - Modified Criteria (1942) SCORING CRITERIA COMMUNITY FLUOROSIS INDEX (CFI) SUMMARY CONTENTS

3. INTRODUCTION INDEX: “A NUMERICAL VALUE DESCRIBING THE RELATIVE STATUS OF A POPULATION ON A GRADUATED SCALE WITH DEFINITE UPPER AND LOWER LIMITS, WHICH IS DESIGNED TO PERMIT AND FACILITATE COMPARISION WITH OTHER POPULATIONS CLASSIFIED BY THE SAME CRITERIA AND METHODS.” -RUSSELL A.L. FLUOROSIS: DENTAL FLUOROSIS IS A HYPOPLASIA OR HYPOMINERALISATION OF TOOTH ENAMEL OR DENTINE PRODUCED BY CHRONIC INGESTION OF EXCESSIVE AMOUNTS OF FLUORIDE DURING THE PERIOD WHEN TEETH ARE DEVELOPING. INTRODUCTION

4. Difference between milder forms of dental fluorosis & non fluoride enamel opacities. (Russell 1961) Characteristic Mild form of fluorosis Non fluoride enamel opacities Area affected Usually seen n ear tips of cusp or incisal edge Centered in smooth surface; may affect whole crown Shape of lesion s Resembles line shading in p encil s ketch ; lines follow incremental lines in enamel Often r ound or oval Demarcation Shades off imperceptibly into surrounding normal enamel Clearly differentiated from adjacent normal enamel Colour “ P aper white”; Incisal edges, tips and cusps-frosted appearance; no stain at the time of eruption Pigmented at time of eruption ; Often creamy yellow to dark reddish orange Teeth affected Most frequent: cuspids, bicuspids, 2nd & 3rd molars; Rare: lower incisors; Extremely rare: deciduous teeth Any tooth ; Frequent: labial surface of lower incisors; Common: deciduous teeth; may affect single tooth Gross hypoplasia None ; enamel has glazed appearance-smooth to explorer tip Absent to severe; enamel surface may seem etched , be rough to explorer Detection Often invisible under s trong light ; line of sight tangential to the crown Seen most easily under s trong light ; line of sight perpendicular to tooth surface

5. INDICES USED TO MEASURE FLUOROSIS FLUOROSIS SPECIFIC: DEAN’S FLUOROSIS INDEX (1943) {Modified: 1942} THYLSTRUP AND FEJERSKOV INDEX FOR FLUOROSIS (1978) TOOTH SURFACE INDEX OF FLUOROSIS (1986) FLUOROSIS RISK INDEX (Pendrys, 1990) ICMR INDEX FOR DENTAL FLUOROSIS (2013) OTHER DESCRIPTIVE INDICES FOR FLUOROSIS: DEVELOPMENTAL DEFECT OF ENAMEL JACKSON AL-ALOUSI INDEX MURRAY SHAW INDEX INDICES USED TO MEASURE FLUOROSIS

6. DEAN’S FLUOROSIS INDEX Introduced by TRENDLEY H. DEAN in 1934. Devised an index for assessing the presence and severity of mottled enamel. It is also known as ‘DEAN’S CLASSIFICATION SYSTEM FOR DENTAL FLUOROSIS.’ DEAN’S FLUOROSIS INDEX (1934)

7. DEAN’S FLUOROSIS INDEX (1934) FOLLOWING CLASSIFICATION WAS USED (7 categories): NORMAL QUESTIONABLE VERY MILD MILD MODERATE MODERATELY SEVERE SEVERE DEAN’S FLUOROSIS INDEX (1934)

8. Dean’s fluorosis index- Modified Criteria (1942) Combined “moderately severe” and “severe” . 6 point ordinal scale . Extensively used today . Recommended by WHO in its basic survey manual (W.H.O, 1997) The scoring system 0-4 . Dean’s fluorosis index- Modified Criteria (1942)

9. Dean’s fluorosis index- Modified Criteria (1942) 1. NORMAL (0) The enamel represents the usual transluceny semivitriform type of structure. The surface is smooth, glossy and usually of pale creamy white color. Dean’s fluorosis index- Modified Criteria (1942)

10. 2. QUESTIONABLE (0.5) The enamel discloses slight aberrations from the translucency of normal enamel, ranging from a few white flecks to occasional white spots. This classification is used in those instances where a definite diagnosis of the mildest form of fluorosis is not warranted and a classification of “normal” not justified. Dean’s fluorosis index- Modified Criteria (1942)

11. 3. VERY MILD (1) Small opaque, paper-white areas scattered irregularly over the tooth but involving less than 25% of the tooth surface. Includes teeth showing 1-2 mm of white opacity at tip of the summit of cusps of bicuspids or second molar. Dean’s fluorosis index- Modified Criteria (1942)

12. 4. MILD (2) The white opaque areas in the enamel of teeth are more extensive, but do not involve as much as 50% of tooth. Dean’s fluorosis index- Modified Criteria (1942)

13. 5. MODERATE (3) All enamel surfaces of teeth are affected and surfaces subject to attrition show wear. Brown stain is frequently a disfiguring feature. Dean’s fluorosis index- Modified Criteria (1942)

14. 6. SEVERE (4) All the enamel surfaces are badly affected and hypoplasia is so marked that the general form of tooth may be affected. There are pitted or worn areas and brown stains are widespread; the teeth often have a corroded appearance. Dean’s fluorosis index- Modified Criteria (1942)

15. SCORING CRITERIA Dean’s Index results in a single score for an individual. If fluorosis is present, the individual will be scored based upon the two most affected teeth. If the two teeth are not equally affected, the less affected tooth is scored. Examinations are made in good natural light with the subject sitting facing the window. Mouth mirror and probes were utilized for examination. If there is doubt, lower score is recorded. SCORING CRITERIA

16. COMMUNITY FLUOROSIS INDEX (CFI) In 1946, Trendley H. Dean devised a method of calculating the prevalance and severity of fluorosis in a group or community. n x w CFI = N Where, n = Number of individuals in each categories w = The weighting for each category N = Total population COMMUNITY FLUOROSIS INDEX (CFI)

17. INTERPRETATION 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 INTERPRETATION

18. ADVANTAGES: Simple to use. Universally accepted. Attempts to validate visual appearance against the histological defect. Most sensitive of all fluorosis measuring indices. DISADVANTAGES / LIMITATIONS: Only two index teeth. It does not measure the extent of defects on remaining teeth. The score gives no idea of location or surface involved. Isolated defects are not recorded. Distinction amongst categories is unclear. Teeth are examined wet - may overlook minor opacities.

19. SUMMARY Dean’s fluorosis index is the most widely used index to measure dental fluorosis. It still remains the one recommended by WHO in its basic survey manual. SUMMARY

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