CHAPTER 17 MEASURING DENTAL FLUOROSIS 1 DENTAL FLUOROSIS

CHAPTER 17 MEASURING DENTAL FLUOROSIS 1

DENTAL FLUOROSIS MOTTLED ENAMEL n A hypomineralized dental enamel caused by excessive ingestion of fluoride during tooth development n 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 n Chronic endemic form of _______ of dental enamel n Teeth with dental fluorosis are less susceptible to dental caries 2

DENTAL FLUOROSIS / MOTTLED ENAMEL n Occurs in primary and permanent dentition n Maxillary central incisors are at greatest risk for fluorosis from 15 to 24 months of age for ____ and from 21 to 30 months for ______ n Once teeth have erupted, fluorosis cannot develop n Clinical appearance ranges from fine, lacy markings to white specks to severe pitting with heavily stained and friable enamel n Brown stain results from the formation of stannous sulfide or brown oxide from the reaction of tin ion in fluoride compound 3

DENTAL FLUOROSIS MOTTLED ENAMEL n CAUSES: n 1. Fluoride concentration of the water supply n 2. Children swallowing excessive amounts of fluoride - containing dentifrices n 3. Inappropriate prescription and use of dietary fluoride supplements n 4. Prolonged use of infant formula made from powder and mixed with fluoridated water n 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 4

DENTAL FLUOROSIS n Mild to moderate fluorosis is associated with use of fluoride supplements, especially in higher socioeconomic groups n Swallowing or overenthusiastic use of fluoridated toothpaste by young children is a concern n Infant formula, especially soybean-based formulas, should be used in moderation in fluoridated communities n Fruit juices and drinks with moderate to high concentrations of fluoride consumed by children may contribute to fluorosis 5

BALANCING DENTAL CARIES PREVENTION WITH RISK OF FLUOROSIS n Bottled water manufacturers should be encouraged to list fluoride levels on labels n Fluoride labels should be displayed on juice and soft drink containers n Infant formula fluoride levels should be below 0. 3 ppm n Manufacturers of infant baby foods should be encouraged to reduce fluoride levels of some of their products 6

STRATEGIES TO IMPLEMENT FLUORIDATION n Develop and implement a plan of action to maintain the efficacy of water fluoridation as a proven public health measure n Effectively translate fluoridation information into languages for all racial and ethnic groups n Develop new and innovative strategies to meet the challenge of fluoridation opponents, past and present n Implement a national surveillance system to collect, analyze, and evaluate risk factor data related to fluorides 7

FLUORIDE’S CONTRIBUTION TO SOLVING PUBLIC HEALTH PROBLEMS 1. Fluoridation improves quality of life 2. Community water fluoridation is a costeffective preventive oral health measure 3. Large influence on the practice of dentistry and dental hygiene 8

DEAN’S FLUOROSIS INDEX n A conventional index used to assess dental fluorosis n One of the most universally accepted classifications for dental fluorosis n Each tooth present in an individual’s mouth is rated according to the following classifications known as: 6 - point ordinal scale 9

TOOTH SURFACE INDEX OF FLUOROSIS (TSIF) n Developed in 1980’s n Used for both permanent and primary teeth n More sensitive than Dean’s Index in identifying the most mild forms of fluorosis n Teeth are not dried before scoring, therefore, mildest forms of fluorosis are likely to be missed 10

THYLSTRUP-FEJERSKOV INDEX n Teeth are dried before scoring, making it more accurate than TSIF index n Only 1 surface per tooth is assessed since fluorosis affects all tooth surfaces equally n Can be used on selected teeth or whole dentition n Results expressed by distributions rather than by mean scores 11

FLUOROSIS RISK INDEX (FRI) n Designed for analytic studies that seek to identify risk factors for fluorosis n Risk of fluorosis is related to fluoride exposure at particular stages of dentition development n Divides the B and O surfaces of each permanent tooth into 4 zones based on the age at which calcification begins 12

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