Deans Fluorosis Index

Dr Minahil Aruj
What are the sources of fluoride?
Fluoride Toxicity
• Dental fluorosis typically signals the first sign of fluoride toxicity and the
development of more severe health effects caused by fluoride.3
• As the effects of fluoride do not start and stop at the teeth.
• Matter of fact, as fluoride circulates the body it affects several different parts,
causing much greater damage then what’s observed in dental fluorosis.
• In essence, dental fluorosis acts as a red flag to the development of fluoride
induced health effects that are not as easily seen with the naked eye:
• Skeletal Fluorosis: broken bones, arthritis, reduced mobility.
• Pineal Gland Calcification: poor sleep, lower melatonin.
• Fluoride’s Brain Effects: lowered IQ, autism, ADHD
What is Dental Fluorosis
• Dental fluorosis is a non-hereditary disorder that is solely caused by
the ingestion of fluoride while teeth are developing. It’s through
fluorides direct effects on ameloblasts, the developing matrix and
processing of the matrix that disrupts normal development.
 How does fluorosis occur?
Inhibition of Disruption of Altered Protein
Excessive Fluoride
Enzymes (e.g., Glycolysis and Synthesis (e.g.,
Intake
Enolase) Energy Balance Amelogenin)

Ionic Exchange with Matrix Enamel

pH Imbalance and
Calcium and Metalloproteinase Hypomineralization
Acid-Base Changes
Phosphate Ions Inhibition and Altered Matrix

Increased Formation of White

Susceptibility to Spots, Staining, and
Acid Pitting (Dental
Demineralization Fluorosis)
How to identify Fluorosis?
 Normal

• The surface is smooth, glossy

and usually of pale creamy
white color giving off a glass-
like appearance.
 Stage 1
“Questionable”

• Appearance ranges from a

few white flecks to occasional
white spots, however from a
visual could not be
considered “normal”.
 Stage 2
“Very MIld”

• Small opaque paper-white

areas are scattered over less
than 25% of the tooth surface
 Stage 3
“Mild”

• Traditionally considered “mild”

however mild is inappropriate when
considering up to 50% of the tooth
can have white opaque areas in the
enamel of the teeth of this stage.
 Stage 4
“Moderate”

• White opaque areas affect more

than 50% of the enamel
surface. Brown stains start to
emerge.
 Stage 5
“Severe”

• All enamel surfaces are affected. The

main diagnostic sign of the stage is
discrete or confluent pitting, with
widespread brown-like stains.
 No. of Individuals Weightage of Weightage x No. of
Category Affected(n) Category(w) Individuals(nxw) n x w /N
Normal 50 0 0 0

Questionable 20 0.5 10 0.05

Very Mild 60 1 60 0.3
Mild 40 2 80 0.4
Moderate 25 3 75 0.37
Severe 5 4 20 0.1
Total N 200 Total CFI 1.175
Treatment Options
• Dental fluorosis treatment is limited.
• While enamel damage is permanent, tooth discoloration can be
reduced and sometimes eliminated. The type of treatment that can
treat discoloration, depends on the stage of dental fluorosis:
• Mild: Tooth-bleaching.
• Moderate: Micro-abrasion, involves sanding off the outer layer of the
enamel.
• Advanced: Composite Bonding. Porcelain Veneers are also an option
which are custom-made shells of teeth that cover the surface of
teeth. Both extremely expensive options
 Recap
• What is fluorosis? • What are the stages of Deans Fluorosis
• Sources of fluoride? Index?
• How is Dental application of fluoride • What are the characteristics of stage 1?
done? • What are the characteristics of stage 2?
• What are the characteristics of stage 3?
• How does fluorosis happen?
• What are the characteristics of stage 4?
• What is an Index? • What are the characteristics of stage 5?
• What are the indexes available for
fluorosis?
• Difference btw normal enamel and
fluorosis?
 Recap
• What is modified Deans Index?
• What tooth is given score 0?
• What tooth is given score 0.5?
• What tooth is given score 1?
• What tooth is given score 2?
• What tooth is given score 3?
• What tooth is given score 4?
• What is CFI?
• How is it calculated?
• What are the advantages and disadvantages of Deans Fluorosis Index?
• What are the treatment options for Fluorosis?