HEALTH
EFFECTS: Dental Fluorosis Classification Criteria
DIRECTORY: FAN
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Teeth >
Fluorosis
> Classification
Dental Fluorosis
- Classificiation Criteria:
1) The Dean Index
2) The Thylstrup-Fejerskov
Index
| Criteria for Dean's
Fluorosis Index |
| Score |
Criteria |
| Normal |
The enamel represents the usual translucent semivitriform
type of structure. The surface is smooth, glossy, and usually
of a pale creamy white color. |
| Questionable |
The enamel discloses slight aberrations from the translucency
of normal enamel, ranging from a few white flecks to occasional
white spots. This classification is utilized in those instances
where a definite diagnosis of the mildest form of fluorosis
is not warranted and a classification of "normal"
is not justified. |
| Very Mild |
Small opaque, paper white areas scattered irregularly over
the tooth but not involving as much as 25% of the tooth surface.
Frequently included in this classification are teeth showing
no more than about 1-2 mm of white opacity at the tip of the
summit of the cusps of the bicuspids or second molars. |
| Mild |
The white opaque areas in the enamel of the teeth are more
extensive but do not involve as much as 50% of the tooth. |
| Moderate |
All enamel surfaces of the teeth are affected, and the surfaces
subject to attrition show wear. Brown stain is frequently a
disfiguring feature. |
| Severe |
Includes teeth formerly classified as "moderately severe
and severe." All enamel surfaces are affected and hypoplasia
is so marked that the general form of the tooth may be affected.
The major diagnostic sign of this classification is discrete
or confluent pitting. Brown stains are widespread and teeth
often present a corroded-like appearance. |
| Source: Dean, 1942. As Reproduced in "Health
Effects of Ingested Fluoride" National Academy of Sciences,
1993. pp. 169. |
Bone
fractures vs Dean
dental fluorosis index |
|
SOURCE:
Alarcon-Herrera MT, et al. (2001). Well Water Fluoride, Dental
fluorosis, Bone Fractures in the Guadiana Valley of Mexico.
Fluoride 34(2): 139-149. ( See
paper) |
"A linear correlation between the Dean index
of dental fluorosis and the frequency of bone fractures was observed
among both children and adults."
SOURCE: Alarcon-Herrera
MT, et al. (2001). Well Water Fluoride, Dental fluorosis, Bone Fractures
in the Guadiana Valley of Mexico. Fluoride 34(2): 139-149.
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| Clinical Criteria
and Scoring for the TF
(Thylstrup-Fejerskov) Index |
| Score |
Criteria |
| 0 |
Normal translucency of enamel remains after prolonged air-drying. |
| 1 |
Narrow white lines corresponding to the perikymata. |
| 2 |
Smooth surfaces: More pronounced lines of opacity
that follow the perikymata. Occasionally confluence of adjacent
lines.
Occlusal surfaces: Scattered areas of opacity <2
mm in diameter and pronounced opacity of cuspal ridges. |
| 3 |
Smooth surfaces: Merging and irregular cloudy
areas of opacity. Accentuated drawing of perikymata often
visible between opacities.
Occlusal surfaces: Confluent areas of marked opacity.
Worn areas appear almost normal but usually circumscribed
by a rim of opaque enamel. |
| 4 |
Smooth surfaces: The entire surface exhibits
marked opacity or appears chalky white. Parts of surface exposed
to attrition appear less affected.
Occlusal surfaces: Entire surface exhibits marked
opacity. Attrition is often pronounced shortly after eruption.
|
| 5 |
Smooth surfaces and occlusal surfaces: Entire surface
displays marked opacity wtih focal loss of outermost enamel
(pits) <2 mm in diameter. |
| 6 |
Smooth surfaces: Pits are regularly arranged
in horizontal bands <2 mm in vertical extension.
Occlusal surfaces: Confluent areas <3 mm in diameter
exhibit loss of enamel. Marked attrition. |
| 7 |
Smooth surfaces: Loss of outermost enamel in
irregular areas involving <1/2 of entire surface.
Occlusal surfaces: Changes in the morphology caused
by merging pits and marked attrition. |
| 8 |
Smooth and occlusal surfaces: Loss of outermost enamel
involving >1/2 of surface. |
| 9 |
Smooth and occlusal surfaces: Loss of main part of
enamel with change in anatomic appearance of surface. Cervical
rim of almost unafffected enamel is often noted. |
| Source: Thylstrup and Fejerskov, 1978. As Reproduced
in "Health Effects of Ingested Fluoride" National
Academy of Sciences, 1993. pp. 171. |
TF Index
- Studies Correlating Effects
with TF Ranking:
"The reviewed study suggests an increased
risk of caries among children with fluorosis. The results are
reinforced by the observed dose-response relationship: the higher
the fluorosis, the higher the caries prevalence. However
this was not a linear relationship; the threshold
at which fluorosis appears to start increasing the risk of caries
was at TF score 3."
SOURCE: Cunha-Cruz J, Nadanovsky P. (2005). Dental fluorosis increases
caries risk. Journal of Evidence Based Dental Practice
5: 170-171.
"The children in the high-fluoride
area who had dental fluorosis at or above
a TF score of 3 had higher levels of dental caries than those
with milder degrees of fluorosis present. This finding suggests
that if fluoride intake is too high, severe enamel hypomineralization
may result in increased caries risk."
SOURCE: Cortes DF, et al. (1996). Drinking water fluoride levels,
dental fluorosis, and caries experience in Brazil. Journal
of Public Health Dentistry
56: 226-8
"Not unexpectedly,
children with fluorosis on anterior teeth
ranging between TSIF scores of "2" to "6"
appear to have increased concerns about tooth color."
SOURCE: Clark DC, et al. (1994). Aesthetic concerns of children
and parents in relation to different classifications of the Tooth
Surface Index of Fluorosis. Community
Dentistry and Oral Epidemiology
22: 461-4.
"The results, based on just over 3000 responses, showed
that lay and dental observers could distinguish between different
fluorosis levels. In response to a statement
that the teeth appeared pleasing, a large majority agreed when
the TF score was 0, but agreement declined as the TF score increased;
when the TF score was 3, most people disagreed. Similarly,
observers felt that the appearance would increasingly
embarrass the child as the TF score increased. Observers,
except the dentists, tended to feel that higher TF scores indicated
neglect on the part of the child."
SOURCE: Riordan PJ. (1993). Perceptions of dental fluorosis. Journal
of Dental Research 72: 1268-74.
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