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Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
Dental Fluorosis
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Dental Fluorosis

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Community Dentistry …

Community Dentistry
Third Year

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  • 1. Dental Fluorosis Distribution and Measurement PDS 372 Dr. Asim Al-Ansari
  • 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. 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. • Prevalence of Fluorosis
  • 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. Introduction • Prevalence of Fluorosis
  • 7. Introduction • Prevalence of Fluorosis
  • 8. Introduction • Prevalence of Fluorosis
  • 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. 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. Risk Factors for Dental Fluorosis • Fluoride dietary supplement – Tablets or drops have good role in preventing caries – More supplements means more fluorosis
  • 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. Fluorosis and Caries • Do people with fluorosis have less caries? – In mild to moderate fluorosis >>> less caries – Severe fluorosis >>> higher risk of caries
  • 14. ?
  • 15. Measuring Dental Fluorosis
  • 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. 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. Dean’s Fluorosis Index • Introduced in early1930s • Seven-point ordinal scale
  • 19. Dean’s Fluorosis Index • Introduced in early1930s • Seven-point ordinal scale • In 1942, it was revised to be a six-point scale
  • 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. 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. Community Fluorosis Index (CFI) • Modification of the Dean’s Index • Numerical value is given to each category • Its mainly used for comparative studies
  • 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. 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. 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. 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. Fluorosis Risk Index • Designed for use in analytic studies • Help identify risk factors for fluorosis • Relates the risk factor to the developmental stage
  • 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. 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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