A new method for assessing the prevalence of dental fluorosis—the Tooth Surface Index of Fluorosis

doi:10.14219/jada.archive.1984.0268

The Journal of the American Dental Association

Volume 109, Issue 1, July 1984, Pages 37-41

https://doi.org/10.14219/jada.archive.1984.0268 Get rights and content

A new index of fluorosis was used in seven Illinois communities to determine its effectiveness and sensitivity to different water-fluoride concentrations.

The most widely adopted system for classifying dental fluorosis has been in use since 1942. There may be a better method.

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Cited by (185)

Esthetic management of white spot lesions by using minimal intervention techniques of bleaching and resin infiltration: A clinical report
2021, Journal of Prosthetic Dentistry
Dental fluorosis and hypocalcification manifest as white spot lesions and/or brown discolorations. With dental fluorosis, mottled layers in enamel can also be present depending on severity. Treatment options have varied in such situations, depending on severity, and can range from conservative to more invasive. This clinical report focuses on a combination of bleaching and resin infiltration as one of the more conservative treatment options.
Clinical Criteria and Categorizations for the Tooth Surface Index of Fluorosis (TSIF)
2020, Burt and Eklund's Dentistry, Dental Practice, and the Community, Seventh Edition
Dental fluorosis is a hypomineralization of enamel associated with elevated fluoride intake during the process of enamel formation. Dental fluorosis appearance ranges from barely discernable fine flecks or lines of opaque white enamel in its mildest form to discrete pits, which can be accompanied by areas that are stained orange to dark brown in its severe form. In this chapter the description, etiology, measurement, distribution, risk factors and indicators, and public health significance of dental fluorosis are presented.
Evidence of Skeletal Fluorosis at the Ray Site, Illinois, USA: a pathological assessment and discussion of environmental factors
2019, International Journal of Paleopathology
Citation Excerpt :
More work must be done to establish differences between dental changes due to fluorosis and those that may derive from a variety of systemic or local factors. It is now widely accepted by dental researchers that dental opacity observed in fluorosis is not true linear enamel hypoplasia, and therefore, linear enamel hypoplasia should not be considered a diagnostic feature of fluorosis (Aoba and Fejerskov, 2002; Fejerskov et al., 1977, 1996; Horowitz et al., 1984; Thylstrup and Fejerskov, 1979). Therefore, we did not include dental linear enamel hypoplasia as a diagnostic feature, however, in the Ray Site population we did observe and record dental defects including opacities, mottling, and dental pitting, which are pathological features associated with dental fluorosis.
To carefully assess skeletal lesions in close environment context in order to evaluate whether skeletal fluorosis was present in individuals living in the prehistoric Midwest, USA.
Skeletal remains from minimally 117 individuals recovered from the Ray Site, located in western Illinois (USA) and dated to the Middle/early Late Woodland periods (50 BC-AD 400).
Macroscopic evaluation of all recovered skeletal elements.
Eight individuals display a constellation of abnormal bony changes, including osteosclerosis, a high frequency of fractures, and dental abnormalities.
The osteosclerotic changes along with the naturally high fluoride content of west central Illinois soil and water suggests the presence of skeletal fluorosis.
This is the first report of skeletal fluorosis from archaeologically recovered human remains from North America.
The ambiguous nature of the skeletal changes associated with fluorosis, especially in the less severe stages of the disease, renders determination of the etiology difficult.
The continuation of paleopathological investigations of fluoride toxicity within archaeological communities recovered from this region with emphasis on the incorporation of biomedical and environmental data. Furthermore, complementary analyses of the chemical composition and the histological presentation of the skeletons could provide support for this diagnosis.
Minimally invasive esthetic improvement in a patient with dental fluorosis by using microabrasion and bleaching: A clinical report
2018, Journal of Prosthetic Dentistry
Citation Excerpt :
Radiographically, all maxillary anterior teeth displayed a uniform periodontal ligament space and intact laminae dura. The color, texture, and extension of the white and brown lesions present on the maxillary central incisors led to the diagnosis of dental fluorosis (Fig. 2) with a TSIF score of 4.4 The treatment plan presented to the patient included enamel microabrasion with 6.6% hydrochloric acid slurry followed by at-home whitening with a 10% carbamide peroxide gel.
Dental fluorosis is a condition that produces unesthetic coloration of enamel because of excessive fluoride ingestion during enamel formation. Its appearance can range in severity from mildly white and opaque to dark brown and can lead a patient to seek dental treatment. Historically, these lesions have been masked, either with direct or indirect restorations, but more conservative treatment options are now available, including the combination of microabrasion and bleaching. This clinical report describes the use of these treatment options to address a young patient’s dental fluorosis.
Aluminium fumarate metal organic framework incorporated polyacrylonitrile hollow fiber membranes: Spinning, characterization and application in fluoride removal from groundwater
2018, Chemical Engineering Journal
Novel mixed matrix hollow fiber membranes (MMM) were prepared by phase inversion technique using polyacrylonitrile (PAN) as base polymer and aluminium fumarate (AlFu) metal organic framework (MOF) as additive. The membranes were characterized in terms of surface morphology, surface charge, permeability, molecular weight cut off, porosity, pore size and contact angle. Permeability of the membrane increased from 3.5 × 10⁻¹⁰ to 4.5 × 10⁻¹⁰ m/Pa.s with increment of MOF concentration from 0 to 10 wt%. The contact angle of the corresponding membranes decreased from 80° to 51° indicating an increase in hydrophilicity. The MH10 (10 wt% concentration) membrane sustained up to 20, 19 and 17.5 h of operation with fluoride concentration of 4, 8 and 12 mg/l, respectively, at 35 kPa transmembrane pressure and 30 l/h cross flow rate with a membrane area of 0.026 m². Regeneration study and performance of the MMM in real life ground water samples were also investigated. Filter performance was successfully predicted by a modified model available in literature.
Grading and quantification of dental fluorosis in zebrafish larva
2016, Archives of Oral Biology
Citation Excerpt :
In the more severe forms, the enamel loses its smooth surface and has some pits, cracks, and fissures (Bronckers et al., 2009). Some indexes such as “Dean Index”, “Thylstrup-Fejerskov Index,” (TF Index) and “Total Surface Index of Fluorosis” (TSIF) are used to diagnose the severity of fluorosis (Dean, 1934; Horowitz, Driscoll, Meyers, Heifetz, & Kingman, 1984). The dose dependent effect of fluoride has been reported in several human and animal data (Dhar & Bhatnagar, 2009).
The prevalence and severity of dental fluorosis in primary teeth are different from permanent teeth. Previous animal models of dental fluorosis mainly focus on juvenile rats, mice and zebrafish. Our experiment aims to set a dental fluorosis model using zebrafish larva and explore the characteristics of the first generation teeth by fluoride treatment.
After the zebrafish eggs were laid, they were exposed to excess fluoride (19 ppm, 38 ppm and 76 ppm) for five days. The morphological characteristics of first generation teeth were examined by H&E staining, whole-mount alizarin red and alcian blue staining, and scanning electron microscope (SEM) technique.
With whole-mount alizarin red and alcian blue staining, the tooth cusps presented red in normal control. 19 ppm and 38ppmm fluoride resulted in extensive red staining from tooth cusps to the lower 1/3 of teeth. 76 ppm fluoride caused malformed teeth with uneven red staining. H&E staining showed that excess fluoride caused cystic-like changes in 38 ppm and 76 ppm groups. SEM revealed the dose dependent pathological changes in zebrafish enameloid with fluoride treatment. Based on SEM findings, we set 0–4 dental fluorosis index (DFI) score to label the severity of dental fluorosis.
Excess fluoride presented a dose dependent fluorosis changes in the teeth of zebrafish larva. The DFI scores in our experiment reflect dose dependent fluorosis changes in a good way and will benefit the future research of dental fluorosis.

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