Dental Fluorosis

Question 1

Dental Fluorosis cause

Answer 1

• Change in the appearance of enamel due to disruption during formation.
• Caused by higher than optimal amounts of fluoride ingestion during development.
  – For perm teeth - birth to 5 yrs.
  – Fluorosis cannot occur after enamel formation.
• Severity depends on the dose, duration, and timing of fluoride intake.

Question 2

What is Dental Fluorosis

Answer 2

o Permanent hypomineralization of the enamel
o Increased porosity compared to normal enamel
o Dose-response condition: From white markings to brown stains
o More often noted in permanent vs. primary dentition

Question 3

Clinical Characteristics of Fluorosis

Answer 3

• Fluorotic lesions are usually bilaterally symmetrical and
  tend to show a horizontal striated pattern across the tooth.
• The premolars and second molars are most frequently affected, followed by the maxillary incisors (mandibular
  incisors are least affected).
• Defects falling into the “questionable” to “mild” categories –may consist of fine white lines or patches and tend to fade into the surrounding enamel.

Question 4

The differential diagnosis of fluoride and nonfluoride enamel opacities

Answer 4

slide 6

Question 5

Dean’s Fluorosis Index

Answer 5

• 1930 (1st Index).
• Ordinal Scale 7 categories (normal, questionable, very mild, mild, moderate, severe moderate and severe (modified in 1939).
• CFI (Community Fluorosis Index) 1935 – ordinal scale 7 categories (negative to very pronounced).
• Added numerical weights (values) to generate a score.
• Related to fluoride concentration in water (lineal correlation).
• CFI < 0.4 non significant for public health.

Question 6

which cities had the highest severity of infection for the Dean’s Fluroisis Index Study

Answer 6

• Lubbock, Texas
• Amarillo, Texas
• Conway, S.Car.
• Plainview, Texas
• Colorado Springs, Colorado

Question 7

Coding for Fluorosis Index

Answer 7

• Done on the basis of the two most severely affected teeth.
• If the two teeth are not equally severely affected, the score is based on the appearance of the less affected tooth.
• When the teeth are scored, the examiner should start at the higher end of the index, “severe”, and eliminate each score until he or she arrives at the condition present.
• If there is any doubt, the lower score should be given.

Question 8

Criteria

Answer 8

0 = Normal. Enamel surface is smooth, glossy and usually a pale creamy white colour.
1 = Questionable. The enamel shows slight aberrations in the translucent normal enamel and which may range from a few white flecks to occasional spots.
2 = Very mild. Small, opaque, paper-white areas scattered irregularly over the tooth but involving less than 25% of the labial tooth surface.
3 = Mild. White opacities of the enamel involving more than 25% (see Code 2) but less than 50% of the tooth surface.
4 = Moderate. The enamel surfaces show marked wear, and brown staining is frequently a disfiguring feature.
5 = Severe. The enamel surfaces are severely affected and the hypoplasia is so marked that the general form of the tooth may be affected. There are pitted or worn areas and brown stains are widespread; the teeth often have a corroded appearance.
8 = Excluded (e.g. a crowned tooth).
9 = Not recorded

Question 9

Other Indexes

Answer 9

• TSIF : Tooth Surface Index of Fluorosis (NIDCR 1980’s).
• Thylstrup-Fejerskov.
• FRI: Fluorosis Risk Index (Pendrys DG 1989 – NYU).
• DDE: Developmental Defects of Enamel (FDI 1992)

Question 10

Percent Distribution of dental fluorosis among persons aged 6-49 in the U.S. from 1999-2004

Answer 10

• less than 1/4 of persons had dental fluorosis

Question 11

what age group had the largest percent of dental fluorosis?

Answer 11

12-15 years old at 40.6 percent
(slide 34)

Question 12

did the amount of children aged 12-15 have an increase or decrease in fluorosis prevelance from the years 1986-1987 to 199-2004?

Answer 12

increase in all, very mild, mild and moderate to severe

Question 13

Reducing Dental Fluorosis…

Answer 13

• Parents supervise the use of F TP by children under the age of 6 (encourage to spit out excess TP).
• Avoid use of F mouth rinses in children who are younger than 6 because could be repeatedly swallowed
• Use no more than a smear or rice-size amount of F TP for children <3.
• Use no more than a pea-size amount of F TP for children aged three to six.
• Teeth should be brushed twice a day, and rinsing after brushing should be kept to a minimum or eliminated altogether.
• Know the fluoride concentration of your drinking water