Comparison of case-based and lecture-based learning in dental fluorosis diagnostic ability with visual analog scale assessment.

OBJECTIVE: This study aimed to compare the impact of case-based learning (CBL) versus lecture-based learning (LBL) on dental students' clinical decision-making regarding DF severity using Visual Analog Scale (VAS) scoring. METHODS: Eighty first-year graduate dental students were randomly assigned to either the CBL (n = 38) or LBL (n = 42) groups. Both groups received instruction on DF diagnosis, with CBL involving small group sessions analyzing real cases and LBL involving traditional lectures. Effectiveness was assessed by presenting 32 dental fluorosis cases with Thylstrup-Fejerskov Index (TSIF) scores ranging from 0 to 7 through slide presentations to both groups for VAS assessment. Five evaluators of each group randomly selected were asked to repeat the rating 2 weeks later. Statistical analysis included two-way ANOVA for group and gender differences, intra-class correlation coefficient (ICC) for reliability, and Spearman correlation coefficients for validity. RESULTS: Variations in VAS scores were observed between CBL and LBL groups, with no significant gender impact. Excellent inter- and intra-evaluator agreement was found for VAS scoring in both groups, indicating its reliability. Validation against established indices (such as DI and TSIF) demonstrated strong correlations, with CBL students exhibiting higher correlations. CONCLUSIONS: CBL enhances students' clinical decision-making and proficiency in DF diagnosis, as evidenced by more consistent and accurate VAS scoring compared to LBL. These findings highlight the importance of innovative educational strategies in dental curricula, with implications for improving training quality and clinical outcomes. TRIAL REGISTRATION: The study was registered at the Clinical Research Center, Hospital of Stomatology, Wuhan University (Registration code: HGGC-036).

Are there associations between the occurrence of dental fluorosis and the experience of dentine hypersensitivity? A cross-sectional study.

Objectives: Associations between the occurrence of dentine hypersensitivity (DH) and dental fluorosis (DF) have been suggested. Testing this association requires studies among populations with both conditions. This study aimed to determine the association between DF and the experience of DH among a population endemic for DF. Methods: This was a cross-sectional study conducted in 2021 over 6 months among 428 adult patients. Participants' demographics were collected, followed by verbal screening for DH and oral examinations. Clinical assessment for DH was carried out by tactile and evaporative methods. The presence and severity of DF were also assessed using the Thylstrup and Fejerskov Index. Data analysis included Chi-square and correlation statistics to assess the presence and strength of associations. Results: The overall prevalence of DH was 31.1%. A higher proportion (41.1%, P < 0.001) of participants with DF had DH than those without DF. The association between DH and DF was minimal but statistically significant (r = 0.174, P < 0.001). Among those with DF, the prevalence of DH was highest in participants with severe fluorosis (50%, P = 0.740). The proportion of sensitive teeth to the teeth examined was significantly higher (P < 0.0001) for participants with DF (289/4167, 6.9%) than participants without DF (267/6758, 4%). This proportion was also highest for severe DF (20/254, 7.9%, P = 0.572) than the mild and moderate forms. Conclusion: DH was more prevalent among individuals with DF. The prevalence of DH was not dependent on the severity of DF.

Epidemiology of Erosive Tooth Wear, Dental Fluorosis and Molar Incisor Hypomineralization in the American Continent.

Non-carious dental lesions such as developmental defects of enamel (DDE) and erosive tooth wear (ETW) are the subject of intensive research. This paper aims to give perspectives on both DDE, including dental fluorosis and molar incisor hypomineralization (MIH), and ETW, presenting epidemiological data from the Americas and associated diagnostic aspects. Besides, it is important to present evidence to guide the clinical assessment process, supporting the clinicians' management decisions towards better oral health of their patients. The overall increase in the worldwide prevalence of non-carious lesions discussed in this this paper may reflect the need of perceptual changes. Although the number of publications related to these conditions has been increasing in the last years, there is still a need for clinical diagnostic and management awareness to include these conditions in routine dental practice. Besides, it is important to provide recommendations for standardized clinical assessment criteria, improving the process and helping clinicians' adherence. In this sense, this paper discusses the most commonly implemented indices for each condition. Thus, despite the wide range of diagnostic indices, BEWE is proposed to be the index recommended for ETW assessment, Dean or Thylstrup & Fejerskov indices for fluorosis and preferably the EAPD criteria (or modified DDE index) for MIH. Overall, non-carious lesions are a growing concern, and it is important to implement preventive measures that control their severity and progression, and accurate diagnosis by the dental clinician.

Diagnosis of Fluorosis by Analysis of Fluoride Content in Body Fluids Using Ion Selective Electrode Method.

Analysis of fluoride in body fluids (urine and serum) is essential for fluorosis diagnosis. Although 24-h urine collection is adopted to assess community defluoridation/fluoride supplementation program/research studies, but not feasible for Clinical/Pathological laboratories. Patients are reluctant to bring 24-h urine samples. Hence, spot urine samples are collected in clean, dry polypropylene bottles (not glass) without any preservative and analyzed on the same day by the Ion analyzer (ISE method). Equal volumes of Total Ionic Strength Adjustment Buffer (TISAB) solution are then added with body fluids before analysis and mixed well to eliminate interference from other ions besides pH adjustment and to provide a constant ionic strength. Results are reported as mg of Fluoride/l (ppm). High fluoride level in body fluids is an indication of confirmed cases of fluorosis. Two interventions, e.g. withdrawal of fluoride intake and intake of nutritive diet was introduced for prevention and control of fluorosis. The present study is to provide useful guidelines for monitoring of fluorosis disease in human beings, those who are at the risk of fluoride exposure.

[Differential diagnosis of dental enamel focal demineralization and fluorosis by means of spectrophotometry]. / Differentsial'naia diagnostika ochagovoi demineralizatsii émali zubov i fliuoroza s pomoshch'iu spektrofotometricheskogo metoda.

The article presents the results of spectrophotometric tooth enamel scanning for differential diagnosis of focal enamel demineralization and fluorosis. Research was conducted in vivo on teeth affected by these diseases. VITA EasyShade spectrophotometer measurements were made on the affected area and on the visually healthy part of enamel. The lightness appeared as the only one differential significant optical characteristics of tooth enamel. Lightness metrics were higher in the case of initial caries than on the healthy part of enamel when these metrics were lower in the case of fluorosis than on the healthy part of enamel.

In vitro Validation of Quantitative Light-Induced Fluorescence for the Diagnosis of Enamel Fluorosis in Permanent Teeth.

This study aimed to validate quantitative light-induced fluorescence (QLF) as a diagnostic tool for mild and moderate enamel fluorosis in permanent teeth, comparing it to visual diagnosis and histological assessment completed using polarized light microscopy (PLM). The buccal surfaces of 139 teeth were visually classified using the Thylstrup and Fejerskov Index (TFI) into sound (TFI 0; n = 17), mild (TFI 1-2; n = 69), and moderate (TFI 3-4; n = 43) fluorosis. Fluorosis was then assessed with QLF (variables ΔF, A, and ΔQ at 5-, 15-, and 30-radiance thresholds) using as reference areas the entire surface and a region of interest (ROI), identified as the most representative region of a fluorosis lesion. PLM images of longitudinal thin sections including the ROI were assessed for histological changes. Correlations among TFI, PLM, and QLF were determined. A receiver-operating characteristic curve was conducted to determine QLF's diagnostic accuracy when compared to the TFI and PLM assessments. This was used to assess the probability that the images were correctly ranked according to severity as determined by PLM and TFI. A positive correlation was found between QLF and PLM, and between QLF and TFI. QLF showed the highest sensitivity and specificity for the diagnosis of mild fluorosis. There was also a strong agreement between TFI and PLM. The selection of a ROI resulted in a stronger correlation with TFI and PLM than when the entire surface was used. The study results indicate that defining an ROI for QLF assessments is a valid method for the diagnosis of mild and moderate enamel fluorosis.

Validation of ICMR index for identification of dental fluorosis in epidemiological studies.

BACKGROUND & OBJECTIVES: The Indian Council of Medical Research (ICMR) formulated a Task Force on dental fluorosis and recommended the subgroup to develop a simplified index for identification and grading of dental fluorosis to be used by the health workers. This study was conducted to pre-test the 'ICMR Index for Dental Fluorosis' in the field to check its reliability and reproducibility. METHODS: A total of 600 photographs were taken, 150 in each grade of fluorosis by screening 14-17 yr school children from eight schools of Hisar (Haryana) and South west Delhi. Eighty photographs were finalized (20 in each grade) before calibration to be used for training of field workers. Calibration exercise was conducted involving the five member survey team on 100 diagnosed cases of dental fluorosis. The members again screened 74 children with dental fluorosis in the field to categorize in to different grades of fluorosis for assessment of inter-examiner reliability. RESULTS: The ICMR criteria showed more difference in agreement in very mild and mild categories during calibration. The inter-examiner reliability (κ) ranged from 0.59-1. The criteria was further modified and inter- examiner reliability (κ) found to be 0.83-0.98 which was almost perfect agreement. INTERPRETATION & CONCLUSIONS: The tool developed by the ICMR to assess dental fluorosis can be used in a field set up by non-dental personnel reliably with high degree of reproducibility.

Examiner reliability in fluorosis scoring: a comparison of photographic and clinical methods.

OBJECTIVE: To assess examiner reliability when scoring dental fluorosis in Malaysian children using clinical (Dean's Index) and photographic methods. METHOD: The upper central incisors of 111 children were examined both clinically and photographically for fluorosis status using Dean's index. Twenty children were re-examined after a two-week interval for intra-examiner reliability by a single examiner. In addition, two independent examiners and the clinical examiner scored 111 photographic images of the same children in a standardized manner. Fluorosis scores were compared individually between examiners for both clinical and photographic scoring. Examiner reliability was assessed using both simple and weighted kappa statistics at tooth level. Sensitivity, specificity, positive-negative predictive values and a Receiver Operating Characteristic (ROC) curve were also calculated to determine the accuracy of the test. RESULTS: Across the three examiners, the prevalence of fluorosis (Dean's score ≥ 2) using photographs was lower (ranged from 23% to 26%) than the prevalence recorded by clinical examination (30%). The kappa score for intra-examiner reliability for the duplicate clinical examination was excellent (0.89). Inter-examiner reliability between the photographic method and the clinical examination (gold standard) for each examiner was substantial with weighted kappa values ranging from 0.74 to 0.77. The photographic method indicated higher specificity (99%) than sensitivity (79%) and the area under the ROC curve was also high (0.89) which suggests good accuracy of the diagnostic test. CONCLUSION: These results suggest that photographic examination of fluorosis on central incisors can be recorded with good examiner reliability. The recorded fluorosis prevalence was lower using the photographic scores.

Early detection of dental fluorosis using Raman spectroscopy and principal component analysis.

Raman spectroscopic technique has the potential to provide vibrational spectra of minerals by analyzing scattered light caused by monochromatic laser excitation. In this paper, recent applications of Raman spectroscopy in the study of dental hard tissues are reported. Special attention is given to mineral components in enamel and to calcium fluoride formed in/on enamel. The criteria used to classify the dental hard samples were according to the Dean Index (DI), which consists into healthy or control, mild, moderate, and severe, indicating the amount of dental fluorosis observed on enamel. A total of 39 dental samples (9 control, 9 mild, 10 moderate, and 11 severe) were analyzed in the study. Dental samples were positioned under an Olympus microscope, and around 10 points were chosen for Raman measurement. All spectra were collected by a Horiba Jobin-Yvon LabRAM HR800 Raman Spectrometer with a laser of 830-nm and 17-mW power irradiation. Raw spectra were processed by carrying out baseline correction, smoothing, and normalization to remove noise, florescence, and shot noise and then analyzed using principal component analysis (PCA). In the spectra of dental samples, we observed the main bands as the broad band due to CO[Formula: see text] (240-300 cm (-1)), CaF 2 (322 cm (-1)), PO[Formula: see text] vibrations (437 and 450 cm (-1)), PO[Formula: see text] vibrations (582, 598, and 609 cm (-1)), PO[Formula: see text] vibrations (960 cm (-1)), PO[Formula: see text] vibrations (1,045 cm (-1)), and CO[Formula: see text] vibration (1,073 cm (-1)). Nevertheless, the intensity of the band at 960 cm (-1) associated to symmetric stretch of phosphate, PO[Formula: see text], decreases as the amount of dental fluorosis increases, suggesting that the intensity of this band could be used to quantitatively measure the level of fluorosis on a dental sample. On the other hand, PCA allowed to identify two large clusters discriminating between control, and severe and moderate samples with high sensitivity and specificity. PCA was able to discriminate mild from moderate samples with 100 % sensitivity and 89 % specificity and mild from severe samples with 91 % sensitivity and 100 % specificity. In addition, PCA was also able to discriminate between mild samples and group formed by the moderate and severe samples with 95 % sensitivity and 89 % specificity. Finally, PCA allowed us to define the wavelength differences between the spectral bands of the healthy teeth with sound enamel and those with fluorosis by confirming that the main chemical differences among control and severe fluorosis samples were associated to the vibrational modes of phosphate (PO[Formula: see text], PO[Formula: see text], PO[Formula: see text], and PO[Formula: see text] and carbonate (CO[Formula: see text]) ions. The preliminary results suggest that Raman-PCA technique has the potential to be a noninvasive real-time tool for the early detection and monitoring evolution of dental fluorosis.

The relationship between Alu I polymorphisms in the calcitonin receptor gene and fluorosis endemic to Chongqing, China.

OBJECTIVE: This study explored the association between an Alu I polymorphism at position 1,377 of the calcitonin receptor (CTR) gene and endemic fluorosis. SUBJECTS AND METHODS: A case-control study of 321 participants was conducted in regions with high fluorosis rates (Wushan and Fengjie counties) and those without high fluorosis rates (Yubei Qu county; termed nonfluorosis areas) in Chongqing, China. The participants were divided into three groups: the fluorosis group (FG) from areas with high fluoride exposure (121), the nonfluorosis group (NFG) from areas with high fluoride exposure (130), and a control group (CG) from areas with no excessive fluoride exposure (70). An Alu I polymorphism in the CTR gene was genotyped using polymerase chain reaction-restriction fragment length polymorphism analysis. RESULTS: The genotype distributions within each group were as follows: CC 60.33% (73/121), CT 30.58% (37/121) and TT 9.09% (11/121) for the FG; CC 74.62% (97/130), CT 21.54% (28/130) and TT 3.85% (5/130) for the NFG, and CC 68.57% (48/70), CT 31.43% (22/70) and TT 0% (0/70) for the CG. Significant differences in Alu I genotypes were observed among the groups (χ(2) = 12.317, υ = 4, p = 0.015). Allele frequencies of CTR genotypes differed significantly among the groups (χ(2) = 8.859, υ = 2, p = 0.012): C 75.62% (183/242) and T 24.38% (59/242) for the FG, C 85.38% (222/260) and T 14.62% (38/260) for the NFG, and C 84.29% (118/140) and T 15.71% (22/140) for the CG. CONCLUSION: An association between fluorosis and the Alu I polymorphism in the CTR gene was observed in fluoride-exposed populations.

Early diagnosis and complete recovery from fluorosis through practice of interventions.

OBJECTIVES: The objective of this communication is to disseminate scientific and technical information for early diagnosis of Fluorosis; recent developments in care and management of patients of Fluorosis. MATERIAL AND METHODS: Body fluids collected from patients suspected of Fluorosis referred by hospitals, samples of drinking water used by them are the materials that have been investigated. Fluoride level in body fluids and water samples are tested by the ion selective electrode (ISE) potentiometry. Forearm X-ray radiograph is taken to assess interosseous membrane calcification. Upon diagnosis of the disease, two corrective measures, namely diet editing and diet counselling are introduced for practice in daily life. In the former, all sources of fluoride ingestion and use are withdrawn whereas in the latter, the patient is encouraged to consume a diet rich in essential nutrients, antioxidants and micronutrients through fruits, vegetables and dairy products. The patients are monitored at intervals to assess fluoride in body fluids. Reduction in fluoride levels has a direct relationship with disappearance of health complaints and subsequent recovery. RESULTS: Eight case studies (5 male + 3 female) are described. Patients'complaints are gastrointestinal discomfort, polyuria, polydipsia, muscle weakness, fatigue and joint pain. Body fluids may have high fluoride with normal or high fluoride level in drinking water.The main source(s) of fluoride entry identified are (i) consuming fluoride contaminated food/snacks/beverages laced with black rock salt; (ii) drinking of untreated ground water; (iii) using fluoridated toothpaste. The duration of recovery varies from patient to patient depending upon their body physiology and the seriousness with which the interventions were practiced. Recurrence of the disease may occur in some patients due to change in life-style, not practicing interventions, entry of fluoride inadvertently. CONCLUSION: This communication provides an overview of Fluorosis, its occurrence, manifestations, diagnostic tests, results, interventions practiced, monitoring and recovery from the disease.

Oral health status of 12-year-old male schoolchildren in Medina, Saudi Arabia.

Studies from Saudi Arabia have reported that the prevalence of dental caries among children is relatively high compared with other developing countries The aim was to determine the oral hygiene status and significant caries (SiC) index of 12-year-old males in Medina . In a cross-sectional, analytical study 360 students participated from 4 boys' schools. Dental caries, plaque, gingivitis, fluorosis and malocclusion were recorded using standard methods and indices. The mean DMFT score was 1.53 (SD 1.88). Caries prevalence was low (57.2%) but the mean SiC index was relatively high [3.63 (SD 1.66)]. The prevalences of plaque and gingivitis were high (82.8% and 70.8% respectively). Lower molars had the highest rate of caries. No children presented with dental fluorosis and 82.5% had a class I jaw relationship. Oral hygiene awareness programmes at schools, together with brushing and flossing programmes, are recommended in order to maintain and improve the oral health of young children in Medina.

[Expression of sonic hedgehog signaling pathw ay and its inhibition by cyclopamine in rat liver with chronic fluorosis].

OBJECTIVE: To investigate the expression of sonic hedgehog (Shh) signaling pathway in liver fluorosis and to explore related mechanism. METHODS: To establish animal model, 48 normal SD rats (aged 4-5 weeks) were randomly divided into 4 groups (12 each): control group, fluoriosis group, blocking group and blocking control group. After 6 months, the blocking group and blocking control group were injected intraperitoneally once every 2 days for 3 times with 10 mg/kg cyclopamine or dimethysulfoxide, respectively. Rats were sacrificed at the end of the experiment and the fluoride content in urine and liver function was determined. The expression of Shh and Gli1 protein and mRNA in hepatocytes was detected by immunohistochemistry and real-time fluorescence quantitative PCR, respectively. RESULTS: The fluoride contents in the urine and the incidence of dental fluorosis increased in the fluoride and blocking control groups as compared with those in the control group, but decreased in the blocking group compared with those of the fluoride and blocking control group. Compared with the control group, the titers of aspartate transaminase (AST) and alanine transaminase (ALT) significantly increased, while the activity of total protein and albumin decreased in the fluoride and blocking control groups. Compared with the fluoride and blocking control groups, the activity of the ALT slightly declined and the AST, total protein and albumin slightly increased in the blocking group. Histologically, the cells were disorganized and swollen with cytoplasmic clearing (balloon cells), compared with the control group. The expression of Shh and Gli1 significantly increased in all but the control group. Compared with the fluoride and blocking control groups, the expression of Shh and Gli1 declined in the blocking group. CONCLUSIONS: The overexpression and cyclopamine inhibition of the Shh signaling pathway are closely related to the content of fluoride in the liver. The Shh signaling pathway plays an important role in the pathogenesis of liver injury caused by fluorosis, suggesting a preventive and therapeutic target of the disease.

Evaluation of total oxidative status and total antioxidant capacity in patients with endemic fluorosis.

The objective of the present study was to determine the plasma total oxidative status (TOS) and total antioxidant capacity (TAC) in patients with endemic fluorosis. A total of 79 (35 males and 44 females; mean age 44.0 ± 11.9 years) patients with endemic fluorosis and 55 (23 males and 32 females; mean age 48.3 ± 8.5 years) age-, sex- and body mass index-matched healthy controls were included in this study. The urine fluoride levels and plasma TOS and TAC levels were measured. The urine fluoride levels of fluorosis patients were significantly higher than control subjects as expected (1.91 ± 0.15 vs. 0.49 ± 0.13 mg/L, respectively; p < 0.001). TOS was significantly higher in fluorosis group than in control group (17.55 ± 3.82 vs. 15.06 ± 4.31 µmol H(2)O(2) Eq/L, respectively; p = 0.001). TAC was significantly lower in fluorosis group than in control group (1.60 ± 0.36 vs. 1.82 ± 0.51 mmol Trolox Eq/L, respectively; p = 0.004). Oxidative stress index (OSI) was significantly higher in fluorosis group than in control group (11.5 ± 3.8 vs. 8.8 ± 3.7, respectively; p < 0.001). Correlation analysis in all the groups indicated that TAC was negatively correlated with urine fluoride (r = -0.25, p = 0.003), TOS was positively correlated with urine fluoride (r = 0.34, p < 0.001) and OSI was positively correlated with urine fluoride (r = 0.36, p < 0.001). The results of our study demonstrate that oxidative stress plays an important role in the pathogenesis of the endemic fluorosis.

Dental fluorosis in the paediatric patient.

UNLABELLED: Exposure to excessive fluoride intake during the early childhood years can disrupt the normal development of enamel, resulting in dental fluorosis. This varies in severity, ranging from white opacities in mild cases to more severe black and brown discoloration or enamel pitting. This article aims to give the reader a better understanding of the aetiology, diagnosis and subsequent treatment of dental fluorosis in the paediatric patient. CLINICAL RELEVANCE: Fluorosis can have a marked effect on dental aesthetics. The prevalence of fluorosis in the United Kingdom may increase following the publication of Delivering Better Oral Health, published by the Department of Health in 2007, which suggested changes to fluoride levels in children's toothpastes. This article highlights the importance of accurate diagnosis of fluorosis and also explains the treatment options available to paediatric patients.

Multi-scale characterization of Developmental Defects of Enamel and their clinical significance for diagnosis and treatment.

Developmental Defects of Enamel (DDE) such as Dental Fluorosis (DF) and Molar Incisor Hypomineralization (MIH) are a major public health problem. Their clinical aspects are extremely variable, challenging their early and specific diagnosis and hindering progresses in restorative treatments. Here, a combination of macro-, micro- and nano-scale structural and chemical methods, including, among others, Atom Probe Tomography recently applied on tooth enamel, were used to study and compare MIH, DF and healthy teeth from 89 patients. Globally, we show that DF is characterized by an homogenous loss of mineral content and crystallinity mainly disrupting outside layer of enamel, whereas MIH is associated with localized defects in the depth of enamel where crystalline mineral particles are embedded in an organic phase. Only minor differences in elemental composition of the mineral phase could be detected at the nanoscale such as increased F and Fe content in both severe DDE. We demonstrate that an improved digital color measurement of clinical relevance can discriminate between DF and MIH lesions, both in mild and severe forms. Such discriminating ability was discussed in the light of enamel composition and structure, especially its microstructure, organics presence and metal content (Fe, Zn). Our results offer additional insights on DDE characterization and pathogenesis, highlight the potentiality of colorimetric measurements in their clinical diagnosis and provide leads to improve the performance of minimally invasive restorative strategies. STATEMENT OF SIGNIFICANCE: Developmental Defects of Enamel (DDE) are associated to caries and tooth loose affecting billions of people worldwide. Their precise characterization for adapted minimally invasive care with optimized materials is highly expected. Here In this study, first we propose the use of color parameters measured by a spectrophotometer as a means of differential clinical diagnosis. Second, we have used state-of-the-art techniques to systematically characterize the structure, chemical composition and mechanical optical properties of dental enamel teeth affected by two major DDE, Dental Fluorosis (DF) or Molar Incisor Hypomineralization (MIH). We evidence specific enamel structural and optical features for DF and MIH while chemical modifications of the mineral nanocrystals were mostly correlated with lesion severity. Our results pave the way of the concept of personalized dentistry. In the light of our results, we propose a new means of clinical diagnosis for an adapted and improved restoration protocol for these patients.

Quantitative light fluorescence (QLF) and polarized white light (PWL) assessments of dental fluorosis in an epidemiological setting.

BACKGROUND: To determine if a novel dual camera imaging system employing both polarized white light (PWL) and quantitative light induced fluorescence imaging (QLF) is appropriate for measuring enamel fluorosis in an epidemiological setting. The use of remote and objective scoring systems is of importance in fluorosis assessments due to the potential risk of examiner bias using clinical methods. METHODS: Subjects were recruited from a panel previously characterized for fluorosis and caries to ensure a range of fluorosis presentation. A total of 164 children, aged 11 years (±1.3) participated following consent. Each child was examined using the novel imaging system, a traditional digital SLR camera, and clinically using the Dean's and Thylstrup and Fejerskov (TF) Indices on the upper central and lateral incisors. Polarized white light and SLR images were scored for both Dean's and TF indices by raters and fluorescence images were automatically scored using software. RESULTS: Data from 164 children were available with a good distribution of fluorosis severity. The automated software analysis of QLF images demonstrated significant correlations with the clinical examinations for both Dean's and TF index. Agreement (measured by weighted Kappa's) between examiners scoring clinically, from polarized photographs and from SLR images ranged from 0.56 to 0.92. CONCLUSIONS: The study suggests that the use of a digital imaging system to capture images for either automated software analysis, or remote assessment by raters is suitable for epidemiological work. The use of recorded images enables study archiving, assessment by multiple examiners, remote assessment and objectivity due to the blinding of subject status.

Knowledge of paediatricians regarding child oral health.

BACKGROUND: In dentistry, clinical practice is directed towards attitudes that promote oral health and the paediatricians occupy a privileged position in this process. AIM: To assess the knowledge and attitudes of paediatricians in relation to the oral health of their patients. DESIGN: A cross-sectional study was carried out at the Institute of Integrative Medicine Professor Fernando Figueira, Recife, Brazil. A total of 182 paediatricians participated by filling out a questionnaire. RESULTS: A total of 63.9% believed the first visit to the dentist should occur before the child completes 1 year of life. Moreover, 67.8% considered their knowledge on oral health to be insufficient. Approximately 78% of the paediatricians diagnosed caries through an analysis of cavities. Only 29.9% always recommended fluoride dentifrice. The term 'fluorosis' was unknown by 48.3% of the respondents. Concerning pacifiers, 32.6% did not allow it and 66.9% did not either recommend it or restrict it. A total of 83.4% classified the oral health content in their medical education as either nonexistent or deficient; this figure remained high (72.4%) in relation to residency. CONCLUSIONS: It is important to develop oral health information programmes to paediatricians. Information on oral health should be included in medical curricula and residency.

Investigation of the value of a photographic tool to measure self-perception of enamel opacities.

BACKGROUND: The standard measurement of oral conditions that are mainly of cosmetic concern can be carried out by a trained clinical professional, or they can be assessed and reported by the individuals who may have the condition or be aware of others who have it. Enamel opacities of anterior teeth are examples of such a condition. At a public health level the interest is only about opacities that are of aesthetic concern, so the need for an index that records opacities that the public perceive to be a problem is clear. Measurement methods carried out by highly trained professionals, using unnatural conditions are not indicated at this level. This study reports on the testing of a novel epidemiological tool that aims to report on the prevalence and impact of self-perceived enamel opacities in a population of young adolescents. METHODS: A dental health survey was carried out using a random sample of 12-year-old school pupils during 2008/09 by Primary Care Organisations (PCOs) in England. This included the use of a novel self-perception tool which aimed to measure individual's self-perception of the presence and impact of enamel opacities to produce population measures. This tool comprised questions asking about the presence of white marks on their teeth and whether these marks bothered the volunteers and a sheet of grouped photographs of anterior teeth showing opacities ranging from TF 0, TF 1-2 to TF 2-3. Volunteers were asked which of the groups of photographs looked more like their own teeth. Examining teams from a convenience sample of 3 PCOs from this survey agreed to undertake additional measurements to assess the value of the self-perception tool. Volunteer pupils were asked the questions on a second occasion, some time after the first and clinical examiners recorded their assessments of the most closely matching set of photographs of the volunteers on two occasions. RESULTS: The tool was feasible to use, with 74% of pupils making a response to the first question about the presence of white marks on front teeth, 94% to the second (do these marks bother you?) and 79% to the third about which set of images most closely matched the volunteer's own, with regard to white marks. Responses to these sequential questions showed coherence with pupils who perceived themselves as having white marks on their teeth being more likely to select images that showed teeth with opacities to match with their appearance. Pupils who reported themselves concerned about their white marks were the most likely to select images with the most severe opacities. Repeatability was good among pupils (Kappa = 0.65) and very good among examiners (Kappa = 0.87). Agreement levels between pupil's and examiner's choice of images was poor as examiners were less likely than pupils to select images that showed more severe levels of mottling. CONCLUSIONS: With regard to feasibility, coherence and repeatability the standardised epidemiological tool under scrutiny, with operator training, appears to be a suitable method for measuring the prevalence and impact of self-perceived enamel opacities in a population of young adolescents.