Distinguishing between enamel fluorosis and other enamel defects in permanent teeth of children


Despite the extensive use of well documented indices of dental fluorosis (Dean, 1942; Fejerskov, 1988), there is inconsistency in the reports on the prevalence rates of fluorosis for a given level of fluoride in drinking water.

Most probably, this inconsistency in the prevalence of fluorosis occurs due to subjective perception of fluorosis by examiners.

Therefore, there is a strong possibility that other Developmental Defects of Enamel (DDE) rather than excess intake of fluoride are being misdiagnosed as fluorosis (Atar & Körperich, 2010).

The two widely-used indices of dental fluorosis are Dean’s Index (Dean, 1934; Dean, 1942) and the Thylstrup and Fejerskov Index (TF Index or TFI) (Thylstrup & Fejerskov, 1978; Fejerskov, 1988).

None of them clearly distinguish between defects caused by fluorosis and caused by other factors. The differences between some of the diagnostic categories are uncertain, vague, or insensitive (a clear example is the ‘‘questionable’’ category in Dean’s Index).

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In Dean’s Index, each individual is given one score, as a score for the whole mouth, according to the two teeth most affected by fluorosis.

This index categorizes each tooth as normal, questionable, very mild, mild, moderate, moderately severe, and severe. The classification is based on color and extent of discolored enamel together with added hypoplasia in case tooth belongs to the last two categories.


°Aira Sabokseir / Ali Golkari / Aubrey Sheiham

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