Dental Fluorosis

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Community Dentistry
Third Year

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Dental Fluorosis

  1. 1. Dental Fluorosis Distribution and Measurement PDS 372 Dr. Asim Al-Ansari
  2. 2. Introduction • What is dental fluorosis (DF)? – Hypomineralization of the dental enamel – caused by the excessive ingestion of fluoride during tooth development (pre-eruptive stage) – Retention of enamel proteins and production of fluoroapatite – Critical age is about 22 months to 5-7 years of age
  3. 3. Introduction • What is dental fluorosis (DF)? – Severity is related to quantity and frequency (timing) • Dose-response relationship – Clinical appearance ranges from mild to severe
  4. 4. • Prevalence of Fluorosis
  5. 5. Introduction • Prevalence of Fluorosis 6-7 12-13 15-19 20-29 35-44 65-74 Total Normal 92% 72 66 62 67 80 75 Questionable 3 9 13 13 9 5 8 V. Mild 1.7 6 10 10 11 4 5 Mild 1.9 6 6 7 9 5 5 Moderate 1 4 3 5 3 2.5 3 1.5 1.5 2 1.5 2 Severe
  6. 6. Introduction • Prevalence of Fluorosis
  7. 7. Introduction • Prevalence of Fluorosis
  8. 8. Introduction • Prevalence of Fluorosis
  9. 9. Risk Factors for Dental Fluorosis • Age – Young children are more prone to Fluorosis (the pre-eruptive period). • Race or ethnicity – no evidence of difference • Socio-economic status (SES) – exposure to F from toothpastes may vary according to SES
  10. 10. Risk Factors for Dental Fluorosis • Fluoridated Water – Water fluoridation is “the controlled adjustment of fluoride concentration in public water supply to the optimum level that will prevent dental caries” – In U.S., 7 – 16% of children in areas with fluoridated water have mild to moderate fluorosis
  11. 11. Risk Factors for Dental Fluorosis • Fluoride dietary supplement – Tablets or drops have good role in preventing caries – More supplements means more fluorosis
  12. 12. Risk Factors for Dental Fluorosis • Fluoride toothpaste – Children can swallow 0.3 – 0.5g of F at each brushing – Studies were able to confirm that • Over use is associated with increased risk of fluorosis • Early use is also associated with fluorosis – The threshold for fluorosis: • 0.03 to 0.1mg F/kg
  13. 13. Fluorosis and Caries • Do people with fluorosis have less caries? – In mild to moderate fluorosis >>> less caries – Severe fluorosis >>> higher risk of caries
  14. 14. ?
  15. 15. Measuring Dental Fluorosis
  16. 16. Measuring Dental Fluorosis • What is a measure (or measurement)? – Quantification of observations • What is “index”? – Is a scale with upper and lower limits with scores corresponding to specific criteria
  17. 17. Measuring Dental Fluorosis • How can we measure fluorosis? – Dean’s Fluorosis Index – Community Fluorosis Index (CFI) – Tooth Surface Index of Fluorosis – Fluorosis Risk Index
  18. 18. Dean’s Fluorosis Index • Introduced in early1930s • Seven-point ordinal scale
  19. 19. Dean’s Fluorosis Index • Introduced in early1930s • Seven-point ordinal scale • In 1942, it was revised to be a six-point scale
  20. 20. Dean’s Fluorosis Index • • • • • Introduced in early1930s Seven-point ordinal scale In 1942, it was revised to be a six-point scale Each tooth is rated according to the scale The individual’s score depends on the two most severely affected teeth • Commonly used in “prevalence” studies due to its simplicity
  21. 21. Measuring Dental Fluorosis • How can we measure fluorosis? – Dean’s Fluorosis Index – Community Fluorosis Index (CFI) – Tooth Surface Index of Fluorosis – Fluorosis Risk Index
  22. 22. Community Fluorosis Index (CFI) • Modification of the Dean’s Index • Numerical value is given to each category • Its mainly used for comparative studies
  23. 23. Measuring Dental Fluorosis • How can we measure fluorosis? – Dean’s Fluorosis Index – Community Fluorosis Index (CFI) – Tooth Surface Index of Fluorosis (TSIF) – Fluorosis Risk Index
  24. 24. Tooth Surface Index of Fluorosis (TSIF) • Developed in 1984 • Measures the prevalence and severity of fluorosis that is of public health significance • More sensitive than Dean’s Index in identifying the mildest forms of fluorosis • A scale from 0 – 7 to each tooth surface in the mouth • No need to dry teeth • It can be used in primary and permanent dentitions
  25. 25. Tooth Surface Index of Fluorosis (TSIF) Scale Description 0 No evidence of Fluorosis 1 2 Definite evidence of F. white areas less than onethird of enamel White area at least 1/3 but less than 2/3 3 At least 2/3 of visible surface 4 Enamel staining in addition to any of the above 5 Discrete pitting w/o staining 6 Discrete pitting with staining 7 Confluent (fused) pitting, large areas of enamel may be missing or affected
  26. 26. Measuring Dental Fluorosis • How can we measure fluorosis? – Dean’s Fluorosis Index – Community Fluorosis Index (CFI) – Tooth Surface Index of Fluorosis – Fluorosis Risk Index
  27. 27. Fluorosis Risk Index • Designed for use in analytic studies • Help identify risk factors for fluorosis • Relates the risk factor to the developmental stage
  28. 28. Fluorosis Risk Index • Divides the buccal and occlusal surfaces of each tooth into four zones based on the age at which calcification begins • Each zone is classified as – Class 1: formation began in 1st year of life – Class 2: formation began 3-6 years of life
  29. 29. Summary • Fluorosis is a dose-response condition – More F at critical period of tooth development, more fluorosis • Fluorosis can be controlled with proper use of fluorides • Different indexes are used to classify Fluorosis

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