SlideShare a Scribd company logo
1 of 29
Dental Fluorosis
Distribution and Measurement
PDS 372
Dr. Asim Al-Ansari
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
Introduction
• What is dental fluorosis (DF)?
– Severity is related to quantity and frequency (timing)
• Dose-response relationship

– Clinical appearance ranges from mild to severe
• Prevalence of Fluorosis
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
Introduction
• Prevalence of Fluorosis
Introduction
• Prevalence of Fluorosis
Introduction
• Prevalence of Fluorosis
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
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
Risk Factors for Dental Fluorosis
• Fluoride dietary supplement
– Tablets or drops have good role in preventing
caries
– More supplements means more fluorosis
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
Fluorosis and Caries
• Do people with fluorosis have less caries?
– In mild to moderate fluorosis >>> less caries
– Severe fluorosis >>> higher risk of caries
?
Measuring Dental Fluorosis
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
Measuring Dental Fluorosis
• How can we measure fluorosis?
– Dean’s Fluorosis Index
– Community Fluorosis Index (CFI)
– Tooth Surface Index of Fluorosis
– Fluorosis Risk Index
Dean’s Fluorosis Index
• Introduced in early1930s
• Seven-point ordinal scale
Dean’s Fluorosis Index
• Introduced in early1930s
• Seven-point ordinal scale
• In 1942, it was revised to be a six-point scale
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
Measuring Dental Fluorosis
• How can we measure fluorosis?
– Dean’s Fluorosis Index
– Community Fluorosis Index (CFI)
– Tooth Surface Index of Fluorosis
– Fluorosis Risk Index
Community Fluorosis Index (CFI)
• Modification of the Dean’s Index
• Numerical value is given to each category
• Its mainly used for comparative studies
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
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
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
Measuring Dental Fluorosis
• How can we measure fluorosis?
– Dean’s Fluorosis Index
– Community Fluorosis Index (CFI)
– Tooth Surface Index of Fluorosis
– Fluorosis Risk Index
Fluorosis Risk Index
• Designed for use in analytic studies
• Help identify risk factors for fluorosis
• Relates the risk factor to the developmental
stage
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
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

More Related Content

What's hot

Oral habits - pedodontics
Oral habits - pedodonticsOral habits - pedodontics
Oral habits - pedodontics
Dr. Elvis David
 
Early childhood caries
Early childhood cariesEarly childhood caries
Early childhood caries
shayonisen2012
 
Amelogeneis Imperfecta
Amelogeneis ImperfectaAmelogeneis Imperfecta
Amelogeneis Imperfecta
shabeel pn
 
Biology Of Tooth Movement
Biology Of Tooth MovementBiology Of Tooth Movement
Biology Of Tooth Movement
shabeel pn
 
Myofunctional Appliances
Myofunctional AppliancesMyofunctional Appliances
Myofunctional Appliances
Dr. Shirin
 

What's hot (20)

Epidemiology of dental caries
Epidemiology of dental cariesEpidemiology of dental caries
Epidemiology of dental caries
 
Fluorides...........
Fluorides...........Fluorides...........
Fluorides...........
 
Indices for dental caries
Indices for dental cariesIndices for dental caries
Indices for dental caries
 
Oral habits - pedodontics
Oral habits - pedodonticsOral habits - pedodontics
Oral habits - pedodontics
 
working length
working lengthworking length
working length
 
Interceptive orthodontics
Interceptive orthodonticsInterceptive orthodontics
Interceptive orthodontics
 
Caries Vaccine ppt
Caries Vaccine pptCaries Vaccine ppt
Caries Vaccine ppt
 
Infant oral health care
Infant oral health careInfant oral health care
Infant oral health care
 
Early childhood caries
Early childhood cariesEarly childhood caries
Early childhood caries
 
MECHANISM OF ACTION OF FLUORIDE
MECHANISM OF ACTION OF FLUORIDEMECHANISM OF ACTION OF FLUORIDE
MECHANISM OF ACTION OF FLUORIDE
 
Topical fluorides in dentistry
Topical fluorides in dentistryTopical fluorides in dentistry
Topical fluorides in dentistry
 
Juvenile Periodontitis
Juvenile Periodontitis Juvenile Periodontitis
Juvenile Periodontitis
 
Anchorage in Orthodontics
Anchorage in OrthodonticsAnchorage in Orthodontics
Anchorage in Orthodontics
 
Amelogeneis Imperfecta
Amelogeneis ImperfectaAmelogeneis Imperfecta
Amelogeneis Imperfecta
 
Stainless steel crowns
Stainless steel crownsStainless steel crowns
Stainless steel crowns
 
Caries prevention
Caries preventionCaries prevention
Caries prevention
 
Dental restorative material in pediatric dentistry
Dental restorative material in pediatric dentistryDental restorative material in pediatric dentistry
Dental restorative material in pediatric dentistry
 
Acid Etching of Enamel and Bond Strength
Acid Etching of Enamel and Bond StrengthAcid Etching of Enamel and Bond Strength
Acid Etching of Enamel and Bond Strength
 
Biology Of Tooth Movement
Biology Of Tooth MovementBiology Of Tooth Movement
Biology Of Tooth Movement
 
Myofunctional Appliances
Myofunctional AppliancesMyofunctional Appliances
Myofunctional Appliances
 

Viewers also liked

Dental fluorosis
Dental fluorosisDental fluorosis
Dental fluorosis
dentist
 
Amelogenesis Imperfecta
Amelogenesis ImperfectaAmelogenesis Imperfecta
Amelogenesis Imperfecta
shabeel pn
 

Viewers also liked (20)

Dental Fluorosis
Dental FluorosisDental Fluorosis
Dental Fluorosis
 
Dental fluorosis
Dental fluorosisDental fluorosis
Dental fluorosis
 
Dental Fluorosis
Dental FluorosisDental Fluorosis
Dental Fluorosis
 
Fluorosis
FluorosisFluorosis
Fluorosis
 
Fluorosis
FluorosisFluorosis
Fluorosis
 
indices measuring dental fluorosis
indices measuring dental fluorosisindices measuring dental fluorosis
indices measuring dental fluorosis
 
Fluorosis original
Fluorosis originalFluorosis original
Fluorosis original
 
Patologia - Fluorosis Dental
Patologia - Fluorosis DentalPatologia - Fluorosis Dental
Patologia - Fluorosis Dental
 
Presentation regarding Fluorosis
Presentation regarding FluorosisPresentation regarding Fluorosis
Presentation regarding Fluorosis
 
SEMINAR ON ENDEMIC FLUROSIS
 SEMINAR ON ENDEMIC FLUROSIS SEMINAR ON ENDEMIC FLUROSIS
SEMINAR ON ENDEMIC FLUROSIS
 
Flourosis
FlourosisFlourosis
Flourosis
 
fluoride toxicity
fluoride toxicityfluoride toxicity
fluoride toxicity
 
Amelogenesis Imperfecta
Amelogenesis ImperfectaAmelogenesis Imperfecta
Amelogenesis Imperfecta
 
Dentinogenesis
DentinogenesisDentinogenesis
Dentinogenesis
 
Tooth development
Tooth developmentTooth development
Tooth development
 
Amelogénesis
AmelogénesisAmelogénesis
Amelogénesis
 
Helping severe fluorosis affected people
Helping severe fluorosis affected peopleHelping severe fluorosis affected people
Helping severe fluorosis affected people
 
Dr.kamaraj
Dr.kamarajDr.kamaraj
Dr.kamaraj
 
3521 (1)
3521 (1)3521 (1)
3521 (1)
 
Dentalfluorosisconversionpresentation
DentalfluorosisconversionpresentationDentalfluorosisconversionpresentation
Dentalfluorosisconversionpresentation
 

Similar to Dental Fluorosis

CRITICAL EVALUATION OF DENTAL CARIES INDICES.pptx
CRITICAL EVALUATION OF DENTAL CARIES INDICES.pptxCRITICAL EVALUATION OF DENTAL CARIES INDICES.pptx
CRITICAL EVALUATION OF DENTAL CARIES INDICES.pptx
DrLasya
 
Exposição ao flúor e fluorose dental uma revisão de literatura
Exposição ao flúor e fluorose dental uma revisão de literaturaExposição ao flúor e fluorose dental uma revisão de literatura
Exposição ao flúor e fluorose dental uma revisão de literatura
edounioeste
 
Chronic Periodontitis.pdf (1).pdf
Chronic Periodontitis.pdf (1).pdfChronic Periodontitis.pdf (1).pdf
Chronic Periodontitis.pdf (1).pdf
AboodSamoudi1
 

Similar to Dental Fluorosis (20)

Measuring Florosis
Measuring FlorosisMeasuring Florosis
Measuring Florosis
 
Fluorosis
FluorosisFluorosis
Fluorosis
 
chronic periodontitis
chronic periodontitischronic periodontitis
chronic periodontitis
 
fluoride indices in dentistry
fluoride indices in dentistry fluoride indices in dentistry
fluoride indices in dentistry
 
Prevention of dental disease and pit and fissure
Prevention of dental disease and pit and fissurePrevention of dental disease and pit and fissure
Prevention of dental disease and pit and fissure
 
Case presentation Fluorosis
Case presentation FluorosisCase presentation Fluorosis
Case presentation Fluorosis
 
Gingivitis
GingivitisGingivitis
Gingivitis
 
Oral disease burden amongst adults in india
Oral disease burden amongst adults in indiaOral disease burden amongst adults in india
Oral disease burden amongst adults in india
 
Dental disease burden and treatment needs among adolescents
Dental disease burden and treatment needs among adolescentsDental disease burden and treatment needs among adolescents
Dental disease burden and treatment needs among adolescents
 
CURRENT CONCEPTS OF FLOURIDE USE
CURRENT CONCEPTS OF FLOURIDE USECURRENT CONCEPTS OF FLOURIDE USE
CURRENT CONCEPTS OF FLOURIDE USE
 
Critical evaluation of dental indices
Critical evaluation of dental indicesCritical evaluation of dental indices
Critical evaluation of dental indices
 
PERIODONTICS 4th stage
PERIODONTICS 4th stagePERIODONTICS 4th stage
PERIODONTICS 4th stage
 
CRITICAL EVALUATION OF DENTAL CARIES INDICES.pptx
CRITICAL EVALUATION OF DENTAL CARIES INDICES.pptxCRITICAL EVALUATION OF DENTAL CARIES INDICES.pptx
CRITICAL EVALUATION OF DENTAL CARIES INDICES.pptx
 
Exposição ao flúor e fluorose dental uma revisão de literatura
Exposição ao flúor e fluorose dental uma revisão de literaturaExposição ao flúor e fluorose dental uma revisão de literatura
Exposição ao flúor e fluorose dental uma revisão de literatura
 
Chronic Periodontitis.pdf (1).pdf
Chronic Periodontitis.pdf (1).pdfChronic Periodontitis.pdf (1).pdf
Chronic Periodontitis.pdf (1).pdf
 
Early childhood caries, rampant, chronic and arrested caries
Early childhood caries, rampant, chronic and arrested cariesEarly childhood caries, rampant, chronic and arrested caries
Early childhood caries, rampant, chronic and arrested caries
 
Dental fluorosis.
Dental fluorosis.Dental fluorosis.
Dental fluorosis.
 
DEAN’S FLUOROSIS INDEX 1943 (PUBLIC HEALTH DENTISTRY)
DEAN’S FLUOROSIS INDEX 1943 (PUBLIC HEALTH DENTISTRY)DEAN’S FLUOROSIS INDEX 1943 (PUBLIC HEALTH DENTISTRY)
DEAN’S FLUOROSIS INDEX 1943 (PUBLIC HEALTH DENTISTRY)
 
Oral health for orthodontists by Almuzian
Oral health for orthodontists by AlmuzianOral health for orthodontists by Almuzian
Oral health for orthodontists by Almuzian
 
008.periodontal indices
008.periodontal indices008.periodontal indices
008.periodontal indices
 

More from IAU Dent

More from IAU Dent (20)

Odontogenic Infection
Odontogenic InfectionOdontogenic Infection
Odontogenic Infection
 
Odontogenic Tumors
Odontogenic TumorsOdontogenic Tumors
Odontogenic Tumors
 
Maxillofacial injuries
Maxillofacial injuriesMaxillofacial injuries
Maxillofacial injuries
 
Impacted teeth
Impacted teethImpacted teeth
Impacted teeth
 
Odontogenic Cysts
Odontogenic CystsOdontogenic Cysts
Odontogenic Cysts
 
Chronic gingivitis
Chronic gingivitisChronic gingivitis
Chronic gingivitis
 
Plaque control
Plaque controlPlaque control
Plaque control
 
8. hypotension & hypertension
8. hypotension & hypertension8. hypotension & hypertension
8. hypotension & hypertension
 
8. Prescription Writing
8. Prescription Writing8. Prescription Writing
8. Prescription Writing
 
7. Adrenocorticosteriods
7. Adrenocorticosteriods7. Adrenocorticosteriods
7. Adrenocorticosteriods
 
7.a. histamine & antihistaminics
7.a. histamine & antihistaminics7.a. histamine & antihistaminics
7.a. histamine & antihistaminics
 
8 anticancer drugs
8  anticancer drugs8  anticancer drugs
8 anticancer drugs
 
7 antibiotic-dental
7 antibiotic-dental7 antibiotic-dental
7 antibiotic-dental
 
7.b. sedative hypnotics
7.b. sedative hypnotics 7.b. sedative hypnotics
7.b. sedative hypnotics
 
6. peptic ulcer drugs 323
6. peptic ulcer drugs 3236. peptic ulcer drugs 323
6. peptic ulcer drugs 323
 
6. anti drenergic
6. anti drenergic 6. anti drenergic
6. anti drenergic
 
6 beta lactum drugs dental
6  beta lactum drugs dental6  beta lactum drugs dental
6 beta lactum drugs dental
 
4.anti colinergic
4.anti colinergic 4.anti colinergic
4.anti colinergic
 
5 aminoglycosides,macrolides, anti tb dental
5 aminoglycosides,macrolides, anti tb dental5 aminoglycosides,macrolides, anti tb dental
5 aminoglycosides,macrolides, anti tb dental
 
5. opioid analgesics
5. opioid analgesics5. opioid analgesics
5. opioid analgesics
 

Recently uploaded

The basics of sentences session 4pptx.pptx
The basics of sentences session 4pptx.pptxThe basics of sentences session 4pptx.pptx
The basics of sentences session 4pptx.pptx
heathfieldcps1
 
Liberal & Redical Feminism presentation.pptx
Liberal & Redical Feminism presentation.pptxLiberal & Redical Feminism presentation.pptx
Liberal & Redical Feminism presentation.pptx
Rizwan Abbas
 
會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文
會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文
會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文
中 央社
 

Recently uploaded (20)

slides CapTechTalks Webinar May 2024 Alexander Perry.pptx
slides CapTechTalks Webinar May 2024 Alexander Perry.pptxslides CapTechTalks Webinar May 2024 Alexander Perry.pptx
slides CapTechTalks Webinar May 2024 Alexander Perry.pptx
 
MichaelStarkes_UncutGemsProjectSummary.pdf
MichaelStarkes_UncutGemsProjectSummary.pdfMichaelStarkes_UncutGemsProjectSummary.pdf
MichaelStarkes_UncutGemsProjectSummary.pdf
 
Features of Video Calls in the Discuss Module in Odoo 17
Features of Video Calls in the Discuss Module in Odoo 17Features of Video Calls in the Discuss Module in Odoo 17
Features of Video Calls in the Discuss Module in Odoo 17
 
Research Methods in Psychology | Cambridge AS Level | Cambridge Assessment In...
Research Methods in Psychology | Cambridge AS Level | Cambridge Assessment In...Research Methods in Psychology | Cambridge AS Level | Cambridge Assessment In...
Research Methods in Psychology | Cambridge AS Level | Cambridge Assessment In...
 
philosophy and it's principles based on the life
philosophy and it's principles based on the lifephilosophy and it's principles based on the life
philosophy and it's principles based on the life
 
Post Exam Fun(da) Intra UEM General Quiz 2024 - Prelims q&a.pdf
Post Exam Fun(da) Intra UEM General Quiz 2024 - Prelims q&a.pdfPost Exam Fun(da) Intra UEM General Quiz 2024 - Prelims q&a.pdf
Post Exam Fun(da) Intra UEM General Quiz 2024 - Prelims q&a.pdf
 
The Benefits and Challenges of Open Educational Resources
The Benefits and Challenges of Open Educational ResourcesThe Benefits and Challenges of Open Educational Resources
The Benefits and Challenges of Open Educational Resources
 
Matatag-Curriculum and the 21st Century Skills Presentation.pptx
Matatag-Curriculum and the 21st Century Skills Presentation.pptxMatatag-Curriculum and the 21st Century Skills Presentation.pptx
Matatag-Curriculum and the 21st Century Skills Presentation.pptx
 
INU_CAPSTONEDESIGN_비밀번호486_업로드용 발표자료.pdf
INU_CAPSTONEDESIGN_비밀번호486_업로드용 발표자료.pdfINU_CAPSTONEDESIGN_비밀번호486_업로드용 발표자료.pdf
INU_CAPSTONEDESIGN_비밀번호486_업로드용 발표자료.pdf
 
The basics of sentences session 4pptx.pptx
The basics of sentences session 4pptx.pptxThe basics of sentences session 4pptx.pptx
The basics of sentences session 4pptx.pptx
 
Telling Your Story_ Simple Steps to Build Your Nonprofit's Brand Webinar.pdf
Telling Your Story_ Simple Steps to Build Your Nonprofit's Brand Webinar.pdfTelling Your Story_ Simple Steps to Build Your Nonprofit's Brand Webinar.pdf
Telling Your Story_ Simple Steps to Build Your Nonprofit's Brand Webinar.pdf
 
Open Educational Resources Primer PowerPoint
Open Educational Resources Primer PowerPointOpen Educational Resources Primer PowerPoint
Open Educational Resources Primer PowerPoint
 
Liberal & Redical Feminism presentation.pptx
Liberal & Redical Feminism presentation.pptxLiberal & Redical Feminism presentation.pptx
Liberal & Redical Feminism presentation.pptx
 
2024_Student Session 2_ Set Plan Preparation.pptx
2024_Student Session 2_ Set Plan Preparation.pptx2024_Student Session 2_ Set Plan Preparation.pptx
2024_Student Session 2_ Set Plan Preparation.pptx
 
會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文
會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文
會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文會考英文
 
Incoming and Outgoing Shipments in 2 STEPS Using Odoo 17
Incoming and Outgoing Shipments in 2 STEPS Using Odoo 17Incoming and Outgoing Shipments in 2 STEPS Using Odoo 17
Incoming and Outgoing Shipments in 2 STEPS Using Odoo 17
 
Gyanartha SciBizTech Quiz slideshare.pptx
Gyanartha SciBizTech Quiz slideshare.pptxGyanartha SciBizTech Quiz slideshare.pptx
Gyanartha SciBizTech Quiz slideshare.pptx
 
Basic Civil Engg Notes_Chapter-6_Environment Pollution & Engineering
Basic Civil Engg Notes_Chapter-6_Environment Pollution & EngineeringBasic Civil Engg Notes_Chapter-6_Environment Pollution & Engineering
Basic Civil Engg Notes_Chapter-6_Environment Pollution & Engineering
 
UNIT – IV_PCI Complaints: Complaints and evaluation of complaints, Handling o...
UNIT – IV_PCI Complaints: Complaints and evaluation of complaints, Handling o...UNIT – IV_PCI Complaints: Complaints and evaluation of complaints, Handling o...
UNIT – IV_PCI Complaints: Complaints and evaluation of complaints, Handling o...
 
Post Exam Fun(da) Intra UEM General Quiz - Finals.pdf
Post Exam Fun(da) Intra UEM General Quiz - Finals.pdfPost Exam Fun(da) Intra UEM General Quiz - Finals.pdf
Post Exam Fun(da) Intra UEM General Quiz - Finals.pdf
 

Dental Fluorosis

  • 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
  • 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. ?
  • 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