1. MEASURING DENTAL FLUOROSIS
CHAPTER 17
MEASURING DENTAL FLUOROSIS

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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: point ordinal scale

10. 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

11. 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

12. 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

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