Evaluation of aesthetics for the different classifications of the Tooth Surface Index of Fluorosis

The prevalence of dental fluorosis for children both from fluoridated and non-fluoridated communities has increased dramatically in some regions of North America. This study evaluated the aesthetics of dental fluorosis for school-aged children from a reference population of 1131 children. The methodology from the Social Acceptability Scale of Occlusal Conditions (SASOC), part of the Dental Aesthetics Index (DAI), was used to assess fluorosis-related aesthetics. Pairs of semantic differentiated adjectives adapted from SASOC were used to rate fifty 35 mm slides of anterior teeth. Sampling of children from the different categories of the Tooth Surface Index of Fluorosis (TSIF) on anterior permanent teeth was weighted to permit sufficient numbers of slides for the different classifications of the TSIF. Each slide was presented to a stratified random sample of pairs of parents and children who were participants in the original study. A convenience sample of dental professionals was also included. Analysis compared different classifications of "affected" slides (non-zero TSIF scores), with the mean aesthetic score computed from all "non-affected" slides (TSIF = 0). Results from children, parents, and professionals showed that there were highly significant differences between ratings of low and high TSIF scores. The only non-significant differences were between TSIF 4 and TSIF 5 & 6, which all three groups did not distinguish, as well as TSIF 1 versus TSIF 2 & 3, which children could not distinguish.