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Dental fluorosis

Extracts of the Fourth edition of "Oral Health Surveys - Basic methods", Geneva 1997.

 (Please observe that the Fifth edition is available, see Methods and Indices)

This extract concerns: Dental fluorosis and the codes and criteria for diagnosis. Pages 35 - 36.

Dental fluorosis

(box 53)

Fluorotic lesions are usually bilaterally symmertrical and tend to show a horizontal striated pattern across the tooth. The premolars and second molars are most frequently affected, followed by the upper incisors. The mandibular incisors are least affected.

The examiner should note the distribution pattern of any defects and decide if they are typical of fluorosis. The defects in the "questionable" to "mild" categories (the most likely the occur) may consist of fine white lines or pathches, usually near the incisal edges or cusp tips. They are paper-white or frosted in appearance like a snow-capped mountain and tend to fade into the surrounding enamel.

It is recommended that Dean's index criteria (3) be used. The recording is made on the basis of the two teeth that are most affected. If the two teeth are not equally affected, the score for the less affected of the two should be recorded. When teeth are scored, the examiner should start at the higher end of the index, i.e. "severe", and eliminate each score until he or she arrives at the condition present. If there is any doubt, the lower score should be given.




The enamel surface is smooth, glossy and usually a pale creamy-white colour.



The enamel shows slight aberrations from the translucency of normal enamel, which may range from a few white flecks to occasional spots.


Very mild

Small, opaque, paper-white areas scattered irregularly over the tooth but involving less than 25% of the labial tooth surface.



The white opacity of the enamel of the teeth is more extensive than for code 2, but covers less than 50% of the tooth surface.



The enamel surfaces of the teeth show marked wear and brown stain is frequently a disfiguring feature.



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.


(e.g. a crowned tooth)



Not recorded



Examples of coding of fluorosis are illustrated in photograph in "Oral Health Surveys".

Last updated by Marie Nordström