An enamel opacity is defined as a qualitative defect of enamel identified visually as an abnormality in the translucency of enamel. Developmental enamel opacities have wide ranging causes including infection of a primary tooth predecessor, trauma during development or excessive fluoride ingestion. Excessive fluoride ingestion during tooth formation in early childhood can lead to enamel fluorosis. In its mildest form it is characterised by fine white lines or paper white opacities in the enamel of the teeth. The teeth may have to be dried to see this appearance. It has no known health effects but represents a risk that accompanies the well described benefits of Fluoride in the prevention of dental caries. There is a variety of sources of both topical and systemic fluoride in Europe, it is important to monitor fluorosis to detect changes in levels of fluoride ingestion.
Classification of enamel opacities for epidemiological reasons can be aetiological or descriptive. For example the Developmental Defects of Enamel Index (Al-Alousi et al 1975) describes all opacities and hypoplasia present on the scored surfaces; it doesn’t require the examiner to ascribe an aetiology. In contrast Dean’s Index of Fluorosis records only the appearance of dental fluorosis following a judgement of fluorosis by the examiner.
Dean’s Index of Fluorosis (1947) is the oldest index of fluorosis. It is widely used and provides a basis for current and historical comparisons of fluorosis. It is uncomplicated and provides a whole mouth score in one code.
We have used this index many times in surveys of oral health in Ireland, we have trained examiners in many different countries to use it, it is always a challenge to standardise examiners in its use. Once examiners are standardised the next challenge is for them to maintain their standard and not drift from it. There is no doubt that the index is subjective, variation in scoring can arise from the angle at which you examine the teeth, the drying time before inspection and the lighting conditions, Variations in contrast between the opaque areas and surrounding enamel can also skew your scoring. The use of photography has helped in the recording of fluorosis and a good technique will generate standardised high quality images, but the images must still be read. The goal of this application is to provide a standardised training, calibration and assessment of fluorosis recording for those wishing to conduct studies of fluorosis.
We hope you find it useful, if you do we would appreciate acknowledgement in any ensuing publications using the reference e-training for Dean’s Index Version 2: Whelton H., Browne D., Felicia P., Whelton J. Oral Health Services Research Centre, University College Cork, Ireland (www. accessed on )
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