Dean's+Index



 Dean's Index of fluorosis The Dean's Index is a measurement of dental fluorosis. It was created in 1934 by H. T. Dean, in an attempt to identify if fluorosis was in fact a health problem that needed to be addressed (National Research Counsel, 1993). Originally the index had seven categories: normal, questionable, very mild, mild, moderate, moderately severe, and severe. Later, in 1942 he combined the moderately severe and severe categories into one category for severe. This is the index that is used today (NRC, 1993). The criteria for each category are as follows:

**Normal**: Enamel is smooth and uniform in color

**Questionable**: Enamel may exhibit some white flecks or small white spots. These are cases where there is not definitive fluorosis, but teeth do not qualify as "normal" either.

**Very Mild:** Less than 25% of the tooth surfaces displays irregular white areas. Often these include cases where there are 1-2 mm of the tooth surface just at the cusp tips are affected.



**Mild:** More than 25% of the tooth surface but less than 50% is affected.



**Moderate:** Generalized areas of hypocalcification on all surfaces of the tooth, may exhibit attrition on susceptible tooth surfaces and brown spots may be present.



**Severe**: Generalized pitting of the enamel on all surfaces, generalized brown discolorations, tooth shape may be affected as well.


 * Category information from Fluoride Action Network, date of publication unknown
 * Images from Google Images

This index is performed without first drying the teeth. Patients are assessed using the above scale, and then classified based off of the two most severely affected teeth. For example, if someone presents with two teeth that are moderately affected, but the rest are normal, they would still be classified as "moderate." This would be the same classification for someone who has all teeth moderately affected. There is a lack of distinction between patients with fewer or more affected teeth. For this reason, this index is best used for collecting more generalized data about communities and regions in order to demonstrate prevalence rather than for more specific cases. For more specific data, another index, the TF (Thylstrup-Fejerskov) Index may be a better choice. (For more information about the TF index: http://www.fluoridealert.org/health/teeth/fluorosis/criteria.html)

**Index Category: Dental Caries** This index is most relevant to dental caries due to the fact that fluorosis causes hypocalcification of the teeth, and patients with fluorosis, especially the more severe cases, are going to be at an increased risk for caries. This can be an indication that in communities with more incidence of fluorosis may also have a higher incidence of caries.

Dental fluorosis is not reversible once it has affected the tooth. However, the condition is more prevalent in primary teeth. While the tooth itself will not change as to the level of fluorosis, if the patient does not exhibit fluorosis on permanent teeth after exfoliating the fluorosed teeth, that patient could move from "moderate" to "normal." Once the index is applied to the permanent teeth it would not be reversible, as the fluorsis cannot be reversed. Doctors may try to treat the cosmetic appearance with veneers.

**References:**

National Research Counsel. (1993). Health effects of ingested fluoride. Retrieved from: http://books.google.com/books?id=CMQd6nkX86EC&pg=PA27&lpg=PA27&dq=dean%27s+index+of+fluorosis&source=bl&ots=ktX6xWW4jx&sig=dQZKV9eN-BVQyrg8MsDwKmuvV68&hl=en&ei=2TNvTZKQN4W6sAO76fnKCw&sa=X&oi=book_result&ct=result&resnum=8&ved=0CFIQ6AEwBzgK#v=onepage&q=dean%27s%20index%20of%20fluorosis&f=false

Fluoride Action Network. (Date Unknown). Dental fluorosis classification criteria. Retrieved from: http://www.fluoridealert.org/health/teeth/fluorosis/criteria.html


 * Megan - very nice review and the images are an effective learning tool. Ms. Lesser **