Fluorosis index

Fluorosis,
Difference between dental fluorosis and non fluoride enamel opacities,
Dean’s Fluorosis Index,
Thylstrup and Fejerskov,
tooth surface fluorosis imdex,
Fluorosis Risk Index.

1. FLUOROSIS INDEX Nameeda K S IV BDS

2. 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

3. 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 3

4. Fluorosis Index- Department of Public Health Dentistry 4 Colorado Springs

5. 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. Fluorosis Index- Department of Public Health Dentistry 5

6. Fluorosis Index- Department of Public Health Dentistry 6 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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9. Dean’s fluorosis Index “ Dean’s Classification System For Dental Fluorosis” Trendley H. Dean – 1934 Devised an index for assessing the presence and severity of mottled enamel. Fluorosis Index- Department of Public Health Dentistry 9

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12. Fluorosis Index- Department of Public Health Dentistry 12 Original Criteria- 1934

13. 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 Fluorosis Index- Department of Public Health Dentistry 13

14. Fluorosis Index- Department of Public Health Dentistry 14 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

15. Fluorosis Index- Department of Public Health Dentistry 15 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

16. Fluorosis Index- Department of Public Health Dentistry 16 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

17. Community fluorosis index (CFI) To determine the severity and calculating the prevalence of dental fluorosis in a group or community.( 1946) Fluorosis Index- Department of Public Health Dentistry 17 CFI= n x w n- number of individuals in each category w- the weighing for each category N- total population

18. Fluorosis Index- Department of Public Health Dentistry 18 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

19. Limitations Does not give sufficient information on distribution of fluorosis within the dentition. Isolated defects are not recorded. The distinction amongst the categories is unclear, indistinct and lacking sensitivity. Even though Dean’s scale is ordinal , it involves averaging of the scores which is inappropriate. Fluorosis Index- Department of Public Health Dentistry 19

20. Thylstrup and Fejerskov Index for Fluorosis 1978 TFI 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. Fluorosis Index- Department of Public Health Dentistry 20

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24. It is possible to produce exact and comparable estimates of severity of dental fluorosis in various populations by Frequency distribution of TF score of individual teeth. Cumulative distribution of severity of the TF scores. INTERPRETATION (based on Dean’s Index) Fluorosis Index- Department of Public Health Dentistry 24 TF SCORE CLASSIFICATION 1 Questionable 2-3 Very mild 3-4 Mild 4 Mild 5-9 Severe

25. 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. Fluorosis Index- Department of Public Health Dentistry 25 Disadvantages

26. Tooth surface fluorosis index It was developed by HOROWITZ et al. in 1984 at National Institute of Dental Research U.S.A Fluorosis Index- Department of Public Health Dentistry 26

27. Fluorosis Risk Index Introduced by DAVID G. PENDRYS in 1990 AIM To improve researcher’s ability to relate the risk of fluorosis to developmental stage of permanent dentition at the time of exposure to fluorosis. Fluorosis Index- Department of Public Health Dentistry 27

28. Fluorosis Index- Department of Public Health Dentistry 28 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 2 nd molars Enamel Zones

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30. 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 Fluorosis Index- Department of Public Health Dentistry 30

31. Thank you and God bless Fluorosis Index- Department of Public Health Dentistry 31