Transcript Reporting the extent of dental fluorosis and enamel

Reporting the Extent of Dental
Fluorosis and Enamel Opacities Using
Different Indices
J. McLoughlin1, J. Clarkson1, R. AlAyaha2
1Trinity College, Dublin
2Riyadh Armed Forces Hospital, Saudi Arabia
Introduction
• Dental fluorosis levels are increasing in both
fluoridated and non fluoridated communities
• Studies reporting levels of fluorosis use
different indices and report results differently
• Comparison of the levels of fluorosis & enamel
opacities from different studies is
problematical
Indices
Fluorosis:
• Dean’s Index (DI)
– (Dean et al 1942)
• Thylstrup &
Fejerskov Index (TF)
– (Thylstrup & Fejerskov 1978)
• Tooth Surface Index
of Fluorosis (TSIF)
– (Horowitz et al 1984)
Enamel Defects:
Modified
Developmental
Defects of Enamel
Index (DDE)
- (Clarkson & O’Mullane
1989)
Differences Between Indices
Index
No of
teeth
Dean's
2
Condition Light
Wet
Natural
No of
codes
6
TSIF
2-28
Wet
Artificial
7
TF
2-28
Dry
Natural
9
DDE
8-10
Wet
Natural
9/4
Studies of Fluorosis & Enamel
Opacities
Authors
Driscoll et al
Evans
Year Indices No of teeth
1986 Dean's NS
& TSIF
1991 DDE
4
Ellwood &
O'Mullane
Riordan &
Banks
Tabari et al
1995 DDE & 8
TF
1991 TF
1
2000 TF
2
Osuji et al
1988 TF
NS
Ismail et al
1998 TSIF
28
Clark et al
1993 TF
NS
Wet/Dry
NS
Light
Artificial
Wet
Wiped
Dry
1 min
Polished Dry
2-3mins
Dry
1 min
NS
NS
Dry
wiped
Wet
FO
NS
NS
Natural
FO
Artificial
Recording Fluorosis & Opacities
Methods
Partial
Central incisor
st
Central incisor/1 molar
st
1 premolar
Two most affected teeth
References
Riordan & Banks (1991)
Sampaio et al (1999)
Wenzel & Thylstrup (1982)
Dean (1934)
Angelillo et al (1999)
Reporting Fluorosis & Opacities
Full-mouth recording
Reference
Mean
Median
Frequency of scores
van Palenstein et al (1997)
Rwenyonyi et al (2000)
Thylstrup & Fejerskov (1978)
Rwenyonyi et al (1999)
Aim of the Study
To determine how standardised reporting of
results using different indices could provide
improved information about the public
health importance of fluorosis and enamel
defects
Materials & Methods
• School children (354) in 6th class in
primary school
• Life time residents in area with fluoridated
water (0.8-1.0ppm)
• Dean’s Index, TF and Modified DDE
• Artificial light 1 metre away
• Teeth wet for Dean’s Index & DDE
• Allowed to dry for 2 mins for TF
Dean’s Index
Number & percentage of subjects with different scores
Score
None Quest V Mild Mild Mod Total
Number
249
58
Percentage 70.3 16.4
35
10
2
354
9.9
2.8
0.6
100
Thylstrup & Fejerskov (TF) Index
Number & percentage of subjects with at least
one tooth affected by the different scores
Score
TF1
TF2
TF3
TF4
Number
192
Percentage 54.2
77
21.8
17
4.8
8
2.3
Modified Developmental Defects
of Enamel Index (DDE)
Number & percentage of subject with
at least one tooth affected by the different scores
Score
DDE1
DDE2
DDE3
DDE4
Number
108
183
1
18
Percentage 30.5
51.7
0.3
5.1
Mean Number of Teeth (SD)
Affected by DDE 2 and TF Scores
Score
Mean SD
DDE2
2.05
2.76
TF1
1.77
2.12
TF2
0.65
1.43
TF3
0.15
0.80
TF4
0.11
0.83
Number and Percentage of Children With
up to Half (1-4) the Index Teeth With the
Various TF Scores.
Base: Children with at least one affected tooth.
Score
TF1
TF2
TF3
TF4
Number
Percentage
148
77.1
67
87.0
14
82.3
4
50.0
Number and Percentage of Children With
up to Half (1-5) the Index Teeth With the
Various DDE Scores
Score
DDE1
DDE2
DDE3
DDE4
Number
Percentage
106
98.1
134
73.2
1
0.3
18
100
Mouth & Tooth Prevalence
Mouth
Prevalence
Dean's
29.7%
TF > 0
74.3%
DDE2
51.7%
Tooth
Prevalence
Up to Half
Index teeth
affected
TF> 0 57.8%
TF1
77%
TF2
87%
DDE2 24.6%
DDE2 73%
Variations in the Levels of
Fluorosis & Enamel Opacities
• According to the index used
– (Dean’s, TF, DDE)
• Reporting of data
– (Mouth v tooth prevalence)
Conclusions
• Reporting the proportion of index teeth
affected by fluorosis may be useful in
determining the public health importance of
dental fluorosis
• Standardisation of recording and reporting
of dental fluorosis is required in order to
allow for valid comparison between studies