This document discusses methods of measuring dental fluorosis, focusing on the Dean's Fluorosis Index. It provides an introduction to dental fluorosis and indices used to measure it. It then describes the Dean's Fluorosis Index in detail, including the original 1934 index and modified 1942 criteria. The modified criteria consists of a 6-point ordinal scale ranging from normal to severe. Scoring criteria and the Community Fluorosis Index are also discussed. In conclusion, the Dean's Fluorosis Index is highlighted as the most widely used and recommended index for measuring dental fluorosis.
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DEAN’S FLUOROSIS INDEX 1943 (PUBLIC HEALTH DENTISTRY)
1. DEPARTMENT OF PUBLIC
HEALTH DENTISTRY
DEAN’S FLUOROSIS INDEX
PRESENTED BY:
JEBAN JYOTI SAHU
ROLL NO.: 1879032
KIDS, KIMS, BBSR-24
T O P I C O F P R E S E N T A T I O N :
2. CONTENTS
• INTRODUCTION
• INDICES USED TO MEASURE FLUOROSIS
• DEAN’S FLUOROSIS INDEX
• DEAN’S FLUOROSIS INDEX- Modified Criteria (1942)
• SCORING CRITERIA
• COMMUNITY FLUOROSIS INDEX (CFI)
• SUMMARY
CONTENTS
3. INTRODUCTION INDEX:
“A NUMERICAL VALUE DESCRIBING THE RELATIVE STATUS OF A
POPULATION ON A GRADUATED SCALE WITH DEFINITE UPPER
AND LOWER LIMITS, WHICH IS DESIGNED TO PERMIT AND
FACILITATE COMPARISION WITH OTHER POPULATIONS
CLASSIFIED BY THE SAME CRITERIA AND METHODS.”
-RUSSELL A.L.
FLUOROSIS:
DENTAL FLUOROSIS IS A HYPOPLASIA OR HYPOMINERALISATION
OF TOOTH ENAMEL OR DENTINE PRODUCED BY CHRONIC
INGESTION OF EXCESSIVE AMOUNTS OF FLUORIDE DURING THE
PERIOD WHEN TEETH ARE DEVELOPING.
INTRODUCTION
4. Difference between milder forms of dental fluorosis & non fluoride enamel
opacities. (Russell 1961)
Characteristic Mild form of fluorosis Non fluoride enamel opacities
Area affected Usually seen near tips of cusp or incisal edge
Centered in smooth surface;
may affect whole crown
Shape of lesions
Resembles line shading in pencil sketch;lines
follow incremental lines in enamel
Often round or oval
Demarcation
Shades off imperceptibly into surrounding normal
enamel
Clearly differentiated from adjacent normal
enamel
Colour
“Paper white”; Incisal edges, tips and cusps-frosted
appearance; no stain at the time of eruption
Pigmented at time of eruption; Often creamy
yellow to dark reddish orange
Teeth affected
Most frequent: cuspids, bicuspids, 2nd & 3rd
molars; Rare: lower incisors; Extremely rare:
deciduous teeth
Any tooth; Frequent: labial surface of lower
incisors; Common: deciduous teeth; may
affect single tooth
Gross hypoplasia
None ; enamel has glazed appearance-smooth to
explorer tip
Absent to severe; enamel surface may seem
etched, be rough to explorer
Detection
Often invisible under strong light; line of sight
tangential to the crown
Seen most easily under strong light; line of
sight perpendicular to tooth surface
5. INDICES
USED
TO
MEASURE
FLUOROSIS
FLUOROSIS SPECIFIC:
• DEAN’S FLUOROSIS INDEX (1943) {Modified: 1942}
• THYLSTRUP AND FEJERSKOV INDEX FOR FLUOROSIS (1978)
• TOOTH SURFACE INDEX OF FLUOROSIS (1986)
• FLUOROSIS RISK INDEX (Pendrys, 1990)
• ICMR INDEX FOR DENTAL FLUOROSIS (2013)
OTHER DESCRIPTIVE INDICES FOR FLUOROSIS:
• DEVELOPMENTAL DEFECT OF ENAMEL
• JACKSON AL-ALOUSI INDEX
• MURRAY SHAW INDEX
INDICES USED TO MEASURE FLUOROSIS
6. DEAN’S
FLUOROSIS
INDEX
• Introduced by TRENDLEY H. DEAN in 1934.
• Devised an index for assessing the presence and
severity of mottled enamel.
• It is also known as ‘DEAN’S CLASSIFICATION SYSTEM
FOR DENTAL FLUOROSIS.’
DEAN’S FLUOROSIS INDEX (1934)
7. DEAN’S FLUOROSIS INDEX (1934)
FOLLOWING CLASSIFICATION WAS USED (7 categories):
1. NORMAL
2. QUESTIONABLE
3. VERY MILD
4. MILD
5. MODERATE
6. MODERATELY SEVERE
7. SEVERE
DEAN’S FLUOROSIS INDEX (1934)
8. Dean’s
fluorosis
index-
Modified
Criteria
(1942) • Combined “moderately severe” and “severe”.
• 6 point ordinal scale.
• Extensively used today.
• Recommended by WHO in its basic survey manual
(W.H.O, 1997)
• The scoring system 0-4.
Dean’s fluorosis index- Modified Criteria (1942)
9. Dean’s fluorosis index- Modified Criteria (1942)
1. NORMAL (0)
• The enamel represents the usual transluceny semivitriform type of
structure.
• The surface is smooth, glossy and usually of pale creamy white
color.
Dean’s fluorosis index- Modified Criteria (1942)
10. 2. QUESTIONABLE (0.5)
• The enamel discloses slight aberrations from the translucency of
normal enamel, ranging from a few white flecks to occasional
white spots.
• This classification is used in those instances where a definite
diagnosis of the mildest form of fluorosis is not warranted and a
classification of “normal” not justified.
Dean’s fluorosis index- Modified Criteria (1942)
11. 3. VERY MILD (1)
• Small opaque, paper-white areas scattered irregularly over the
tooth but involving less than 25% of the tooth surface.
• Includes teeth showing 1-2 mm of white opacity at tip of the
summit of cusps of bicuspids or second molar.
Dean’s fluorosis index- Modified Criteria (1942)
12. 4. MILD (2)
• The white opaque areas in the enamel of teeth are more
extensive, but do not involve as much as 50% of tooth.
Dean’s fluorosis index- Modified Criteria (1942)
13. 5. MODERATE (3)
• All enamel surfaces of teeth are affected and surfaces subject to
attrition show wear.
• Brown stain is frequently a disfiguring feature.
Dean’s fluorosis index- Modified Criteria (1942)
14. 6. SEVERE (4)
• All the enamel surfaces are badly affected and hypoplasia is so
marked that the general form of tooth may be affected.
• There are pitted or worn areas and brown stains are widespread;
the teeth often have a corroded appearance.
Dean’s fluorosis index- Modified Criteria (1942)
15. SCORING
CRITERIA
• Dean’s Index results in a single score for an individual.
• If fluorosis is present, the individual will be scored based
upon the two most affected teeth.
• If the two teeth are not equally affected, the less affected
tooth is scored.
• Examinations are made in good natural light with the
subject sitting facing the window.
• Mouth mirror and probes were utilized for examination.
• If there is doubt, lower score is recorded.
SCORING CRITERIA
16. COMMUNITY
FLUOROSIS
INDEX
(CFI)
• In 1946, Trendley H. Dean devised a method of calculating
the prevalance and severity of fluorosis in a group or
community.
n x w
CFI =
N
Where,
n = Number of individuals in each categories
w = The weighting for each category
N = Total population
COMMUNITY FLUOROSIS INDEX (CFI)
17. INTERPRETATION
Range of scores for
community fluorosis
index
Public health
significance
0.0- 0.4 Negative
0.4-0.6 Borderline
0.6- 1.0 Slight
1.0- 2.0 Medium
2.0- 3.0 Marked
3.0- 4.0 Very marked
INTERPRETATION
18. ADVANTAGES:
• Simple to use.
• Universally accepted.
• Attempts to validate visual
appearance against the
histological defect.
• Most sensitive of all fluorosis
measuring indices.
DISADVANTAGES /
LIMITATIONS:
• Only two index teeth. It does not
measure the extent of defects on
remaining teeth.
• The score gives no idea of location or
surface involved.
• Isolated defects are not recorded.
• Distinction amongst categories is
unclear.
• Teeth are examined wet - may
overlook minor opacities.
19. SUMMARY
• Dean’s fluorosis index is the most widely used index to
measure dental fluorosis.
• It still remains the one recommended by WHO in its basic
survey manual.
SUMMARY