Indexes for measuring dental fluorosis

Dental fluorosis, a hypoplasia or hypomineralization of tooth enamel or dentin, ranges in intensity from barely noticeable whitish striations to confluent pitting and staining. Various indexes or classification systems have been used in surveys to measure the presence and severity of enamel fluorosis. Other systems and indexes record all defects in enamel, based on a premise that an etiology for the condition should not be presumed. If all defects are recorded, a retrospective attempt to reconstruct which of them are fluorosis is inappropriate. Dean's classification system has been used most frequently over the years for assessing fluorosis. Therefore, its continued use is sometimes important for historical comparisons. Dean's system, however, has several shortcomings, principally its inability to measure fluorosis in different tooth surfaces. As it has been traditionally used, it also does not permit specifying the cosmetic importance of the most severe fluorosis detected in a dentition. The Tooth Surface Index of Fluorosis (TSIF) eliminates or reduces some of the shortcomings of Dean's method. Use of the TSIF in a survey in Illinois was able to discriminate between the prevalence and severity of fluorosis in four groups of communities with different concentrations of fluoride in their drinking water.