Dental fluorosis is a condition caused by excessive fluoride intake during tooth development, characterized by hypomineralization of enamel. It is commonly seen in areas where drinking water contains over 1 ppm fluoride. The Dean's Fluorosis Index classifies fluorosis severity on a scale of 0 to 4 based on appearance, from questionable white flecks to severe pitting and brown staining of all tooth surfaces. States in India with highest prevalence include Gujarat, Rajasthan, and Andhra Pradesh.

1. BHARATI VIDYAPEETH DENTAL
COLLEGEAND HOSPITAL,
SANGLI
DEPARTMENT OF ORAL PATHOLOGY
“DENTAL FLUOROSIS”

2. WHAT IS DENTAL FLUOROSIS?
• Dental fluorosis is a common disorder characterized by hypo-
mineralization of the tooth enamel caused by ingestion of
excessive fluoride during enamel formation.
• Seen where Water consumed contains Fluoride >1ppm.
• Severity of the condition depends on: Dose
Duration
Age during exposure

3. PREVALANCE
• Worst-affected states in
India-
Gujarat
Rajasthan
Andhra Pradesh

4. DEAN’S FLUOROSIS INDEX
• Given by: Dr. Trendley H. Dean
(1934)
• Purpose: To assess presence and
severity of mottled enamel
• Individual’s fluorosis score is based
on the most severe form of
fluorosis found on 2 or more
teeth.

5. ORIGINAL CRITERIA- 1934
NORMAL QUESTIONABLE VERY MILD
MILD MODERATELY SEVEREMODERATE
SEVERE

6. MODIFIED CRITERIA-1942
• It is a 6-point ordinal scale.
• Combines ‘moderately severe’ and ‘severe’ and is used
extensively today.
• Recommended by the World Health Organization in its
basic survey manual (1997).
• Scaling system used- 0(normal) to 4(severe).

7. NORMAL- 0
• Enamel is the usual
translucent, semi- vitriform.
• Smooth, glossy and usually
pale creamy white in colour.
• No white spots, pitting or
brownish discolouration
seen.

8. QUESTIONABLE- 0.5
• Slight aberration from
translucency of normal
enamel, ranging from a few
white flecks to occasional
white spots.
• White spots if present can
range 1-2mm in diameter.

9. VERY MILD - 1
• Small opaque paper white
areas scattered irregularly
over the tooth not involving
more than 25% of the tooth.
• Less than 1-2mm opacity on
the summits of cusps of
bicuspid and 2nd molars.

10. MILD - 2
• White opaque areas.
• More extensive.
• Less than 50% of the tooth.

11. MODERATE - 3
• All enamel surfaces of the
teeth are affected.
• Surfaces subjected to attrition
show wear.
• Brown staining is a frequent
disfiguring feature.

12. SEVERE - 4
• All enamel surfaces are
affected.
• Marked hypoplasia.
• Major diagnostic sign- Discrete
or confluent pitting and
widespread brown stains.
• Corroded like appearance.