MEASURING DENTAL FLUOROSIS CHAPTER 17 MEASURING DENTAL FLUOROSIS

DENTAL FLUOROSIS MOTTLED ENAMEL A hypomineralized dental enamel caused by excessive ingestion of fluoride during tooth development Severity of fluorosis depends on the amount of excess fluoride consumed over a period of time while teeth are developing, usually between ages 6 months to 6 years Chronic endemic form of _____________ of dental enamel Teeth with dental fluorosis are less susceptible to dental caries

DENTAL FLUOROSIS / MOTTLED ENAMEL Occurs in primary and permanent dentition Maxillary central incisors are at greatest risk for fluorosis from 15 to 24 months of age for ________ and from 21 to 30 months for ___________ Once teeth have erupted, fluorosis cannot develop Clinical appearance ranges from fine, lacy markings to white specks to severe pitting with heavily stained and friable enamel Brown stain results from the formation of stannous sulfide or brown oxide from the reaction of tin ion in fluoride compound

DENTAL FLUOROSIS MOTTLED ENAMEL CAUSES: 1. Fluoride concentration of the water supply 2. Children swallowing excessive amounts of fluoride - containing dentifrices 3. Inappropriate prescription and use of dietary fluoride supplements 4. Prolonged use of infant formula made from powder and mixed with fluoridated water Studies indicate that 7% - 16% of children born and reared in an optimally fluoridated community exhibit mild or very mild dental fluorosis in the permanent dentition

DENTAL FLUOROSIS Mild to moderate fluorosis is associated with use of fluoride supplements, especially in higher socioeconomic groups Swallowing or overenthusiastic use of fluoridated toothpaste by young children is a concern Infant formula, especially soybean-based formulas, should be used in moderation in fluoridated communities Fruit juices and drinks with moderate to high concentrations of fluoride consumed by children may contribute to fluorosis

BALANCING DENTAL CARIES PREVENTION WITH RISK OF FLUOROSIS Bottled water manufacturers should be encouraged to list fluoride levels on labels Fluoride labels should be displayed on juice and soft drink containers Infant formula fluoride levels should be below 0.3ppm Manufacturers of infant baby foods should be encouraged to reduce fluoride levels of some of their products

STRATEGIES TO IMPLEMENT FLUORIDATION Develop and implement a plan of action to maintain the efficacy of water fluoridation as a proven public health measure Effectively translate fluoridation information into languages for all racial and ethnic groups Develop new and innovative strategies to meet the challenge of fluoridation opponents, past and present Implement a national surveillance system to collect, analyze, and evaluate risk factor data related to fluorides

FLUORIDE’S CONTRIBUTION TO SOLVING PUBLIC HEALTH PROBLEMS Fluoridation improves quality of life Community water fluoridation is a cost- effective preventive oral health measure Large influence on the practice of dentistry and dental hygiene

DEAN’S FLUOROSIS INDEX A conventional index used to assess dental fluorosis One of the most universally accepted classifications for dental fluorosis Each tooth present in an individual’s mouth is rated according to the following classifications known as: 6 - point ordinal scale

TOOTH SURFACE INDEX OF FLUOROSIS (TSIF) Developed in 1980’s Used for both permanent and primary teeth More sensitive than Dean’s Index in identifying the most mild forms of fluorosis Teeth are not dried before scoring, therefore, mildest forms of fluorosis are likely to be missed

THYLSTRUP-FEJERSKOV INDEX Teeth are dried before scoring, making it more accurate than TSIF index Only 1 surface per tooth is assessed since fluorosis affects all tooth surfaces equally Can be used on selected teeth or whole dentition Results expressed by distributions rather than by mean scores

FLUOROSIS RISK INDEX (FRI) Designed for analytic studies that seek to identify risk factors for fluorosis Risk of fluorosis is related to fluoride exposure at particular stages of dentition development Divides the B and O surfaces of each permanent tooth into 4 zones based on the age at which calcification begins

DEVELOPMENTAL DEFECTS OF DENTAL ENAMEL INDEX (DDE) PURPOSE: to avoid necessity for diagnosing fluorosis before recording enamel opacities