1. Oral Health Training & Calibration Programme
Measurement of Dental Fluorosis

2. Measurement of Dental Fluorosis

3. Dean’s Fluorosis Index
Index Codes
Normal: Dean’s 0
Questionable: Dean’s 1
Very Mild: Dean’s 2
Mild: Dean’s 3
Moderate: Dean’s 4
Severe: Dean’s 5
All 4 anterior teeth absent: Code 6

4. Dean’s Fluorosis Index- Code Definition
Dean’s 0 Normal
The enamel surface is smooth, glossy and usually a pale creamy-white colour.
Dean’s 1 Questionable
The enamel shows slight aberrations from the translucency of normal enamel, which may range from a few white flecks to occasional spots.
Dean’s 2 Very mild
Small opaque, paper-white areas scattered irregularly over the tooth, but involving less than 25% of the labial tooth surface.
Dean’s 3 Mild
The white opacity of the enamel of the teeth is more extensive than for code 2, but covers less than 50% of labial tooth surface.

5. Dean’s Fluorosis Index continued
Dean’s 4 Moderate
The enamel surfaces of the teeth show marked wear and brown stain is frequently a disfiguring feature
Dean’s 5 Severe
The enamel surfaces are badly affected and hypoplasia is so marked that the general form of the tooth may be affected. There are pitted or worn areas and brown stains are widespread; the teeth often have a corroded appearance.
Code 6
All 4 anterior teeth absent

6. Fluorosis Ages 6-12 Examine the maxillary four anterior teeth*
Decide if they are typical of fluorosis
bilaterally symmetrical horizontally striated
consist of fine white lines or patches, usually near the incisal edges
paper-white or frosted in appearance, snow-capped mountain tend to fade into the surrounding enamel
*Teeth with brackets or bands should be excluded from the assessment

7. Fluorosis Assessment Examine the maxillary four anterior teeth
Recording is made on the basis of the two teeth that are most affected (they do not need to be a matched “Pair” of teeth, it could be 11 with the 22)
Record the score for the less affected of the two teeth
If only one of the 4 teeth is available, record based on that tooth
Start at the higher end of the index, i.e. “severe”, and eliminate each score
If there is doubt, the lower score should be used

8. General Technique Wipe plaque off teeth
Probe to confirm quantitative defects
Exclude white spot caries
When in doubt score ‘normal’
Wet teeth
Examine from front with patient upright
Defects > 1mm
Natural light (if possible)

9. Opacities

10. Opacities

11. Hypoplasia

12. Normal Deans 0

13. Normal Deans 0

14. Normal Deans 0

15. Normal Deans 0

16. Normal Deans 0

17. Questionable Deans 1

18. Questionable Deans 1

19. Questionable Deans 1

20. Very Mild Deans 2

21. Very Mild Deans 2

22. Very Mild Deans 2

23. Mild Deans 3

24. Mild Deans 3

25. Mild Deans 3

26. Moderate Deans 4

27. Moderate Deans 4

28. Moderate Deans 4

29. Severe Deans 5

30. Severe Deans 5

31. Severe Deans 5