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A visual analog scale for measuring dental fluorosis severity
Anya P G F Vieira1, Herenia P Lawrence, Hardy Limeback
1Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Canada.
Background:
To date, no continuous scale exists for measuring the severity of dental fluorosis (DF).
Objectives:
The authors developed and validated a visual analog scale (VAS) for DF. They tested the scale in clinical (DF-endemic area) and laboratory settings.
Methods:
Dentists and nondentists (23 per group) were asked to grade the DF severity in photographs of 23 anterior teeth with different DF levels (using a 100-millimeter VAS) to create a VAS for DF. Statistical analysis was performed to validate the new scale. The authors used clinical and laboratory (unerupted third molars) analyses to assess the usefulness of the VAS.
Results:
The authors used an intraclass correlation coefficient (ICC) to assess the interexaminer (ICC = .79: good agreement) and intraexaminer (.88 < ICC < .97: excellent agreement) reliability during creation of the scale. They used the Spearman rank correlation (r(s)) to validate the VAS against the gold standards (that is, the Thylstrup-Fejerskov index [TFI] and Dean's index [DI]) (the results showed excellent or good correlation for 45 examiners). Two dentist examiners clinically tested the new VAS, and the results showed excellent (r(s) = .922, P < .001) correlation and excellent ICC between the examiners (ICC = .96), as well as good ICC between the TFI and the VAS for DF (ICC = .6). The laboratory study showed better correlation between fluoride concentration and the VAS for DF than between fluoride concentration and the TFI.
Conclusion:
Because of its simplicity, precision and utility in statistical applications, the VAS for DF can be useful in DF studies.
