Classification of Fluorosis Stains on Tooth

Dental Fluorosis definition – It’s outlined because the Hypoplasia or Hypomineralization of the Enamel or Dentin of the tooth produced by Persistent Ingestion of extreme quantities of fluoride throughout the interval of tooth improvement.

The age at which Fluorosis can have an effect on the growing enamel ranges between – 22 months to 5-7 years of age.

In easy phrases, Dental Fluorosis is whitish, yellowish to brownish discoloration of enamel attributable to overexposure of growing everlasting enamel to fluoride. Normally Fluorosis isn’t dangerous however only a beauty concern. Fluorosis is attributable to when the growing enamel are uncovered to fluoride throughout growing levels – beneath 8 to 10 years of age. Already erupted enamel can’t be affected by extra publicity to fluoride.

What’s the Supreme Fluoride ranges in Consuming water by Age:

• Beginning to six months – Not required

• 6 months to three years – 0.25 mg/day for <0.3 ppm

• 3-6 years – 0.50 mg/day (<0.3 ppm) and 0.25 mg/day (0.3 to 0.6 ppm)

• 6-16 years – 1 mg/day (<0.3 ppm) and 0.50 mg/day (0.3 to 0.6 ppm)

What’s the Supreme quantity of Fluoride in Toothpaste for Kids:

• 0.3 to 0.5 grams of Fluoride may be swallowed whereas brushing
• The utmost threshold for Fluorosis is 0.03 to 0.1 mg F/kg

There are 4 Indices that are used measure Dental Fluorosis:

• Deans Fluorosis Index
• Neighborhood Fluorosis Index (CFI)
• Tooth Floor Index of Fluorosis
• Fluorosis Threat Index

Deans Fluorosis Index Classification- 

1. Regular – Clean, shiny, pale creamy-white translucent enamel floor
2. Questionable – Just a few white flecks or white spots (Chalk like) additionally known as as Mottled Enamel
3. Very Delicate – Small opaque, paper white areas masking lower than 25% of the tooth floor
4. Delicate – Opaque white areas masking lower than 50% of the tooth floor
5. Reasonable – All tooth surfaces affected, marked put on on biting surfaces, brown stain could also be current
6. Extreme – All tooth surfaces affected, discrete or confluent pitting, brown stain current

Neighborhood Fluorosis Index (CFI)-

It’s a modification of Deans Index the place a numerical worth is given to every class, which is beneficial in comparative research. It’s carried out on the idea of the quantity and distribution of particular person scores, a group index for dental Fluorosis (Fci) may be calculated by the system. 

Fci = Sum of (variety of people) / variety of people examined

Tooth Floor Index of Fluorosis (TSIF)

It’s used to measure the prevalence and Severity of Fluorosis which is critical to Public well being. That is thought-about to be extra delicate in figuring out mildest types of fluorosis as in comparison with Deans Index. This can be utilized in each main and everlasting dentition. 

• 0 – No proof of Fluorosis
• 1 – Particular proof of Focal white areas lower than one-third of enamel
• 2 – White space a minimum of 1/3 however lower than 2/3
• 3 – Not less than 2/3 of seen floor 
• 4 – Enamel staining along with any of the above
• 5 – Discrete pitting w/o staining
• 6 – Discrete pitting with staining 
• 7 – Confluent pitting (fused), giant areas of enamel could also be affected or lacking

Fluorosis Threat Index

Utilized in Analytic research which is used to determine danger elements for fluorosis. It divides the buccal and occlusal surfaces of every tooth into 4 zones based mostly on the age at which calcification begins. 

• Class 1 – formation started in 1st yr of life
• Class 2 – formation started 3-6 years of life

Mechanism of Motion of Fluorosis:

As we all know Fluorosis is triggered attributable to extra consumption of Fluoride throughout the developmental levels of tooth improvement. The supply of extra Fluoride may be from any of the next sources – 

• Extra Fluoride in Consuming water (Commonest)
• Extra use of Fluoride toothpaste
• Consuming meals or drinks comprised of fluoridated water
• Extra use of Fluoride tablets

As a result of extra consumption of Fluoride results in injury of the secretory ameloblast leading to modifications seen on the Enamel floor. It results in porosity in Enamel attributable to both change in composition of Enamel matrix or attributable to a disturbance of the mobile processes throughout the maturation of enamel. That is known as as Mottled Enamel which is characterised by minute white flecks or yellow or brown spots or irregularly scattered over the floor of the enamel.

Mottled Enamel can also be Labeled by Al Alousi et al into 6 sorts as follows: 

• Kind A: White space lower than 2 mm
• Kind B: White space greater than 2 mm
• Kind C: Brown space lower than 2 mm
• Kind D: Brown space greater than 2 mm
• Kind E: Horizontal white strains
• Kind F: Horizontal brown strains

The enamel most incessantly affected by Fluorosis are Canine and Pre Molars/ together with 2nd and third molars. The decrease incisors are those that are not often affected whereas the deciduous enamel are the very not often affected tooth. 

References:

Dental Fluorosis – The Threat of Misdiagnosis 

Dental Fluorosis – ScienceDirect.com