COMMUNITY FLUOROSIS INDEX

By: Tan, Candice Trixia T. Umandap, Krista M.

12- A

Introduction

To determine the severity of dental

fluorosis as a public health problem,

Trendley H. Dean in 1935 devised a

method of calculating the prevalence and

severity of fluorosis in a group or

community.

What is Fluorosis?

DENTAL FLUOROSIS is a disfigurement of teeth which affects large sections of populations exposed to fluorides, whether from air, water, supplements, toothpaste or from foods.

Fluorosis Index

Index is used to measure fluorosis.

Fluorisis is the hypomineralization of the enamel caused by excessive exposure to fluoride during tooth development.

The amount of fluorosis is dependent on the amount of fluoride an individual has been exposed to overtime.

The index have been developed to asses the amount of change in the enamel following the exposure to high levels of fluoride.

Community Fluorosis Index (CFI) Computation Community Fluorosis Index can be calculated as follows:

In CFI, numerical statistical values (weights) as a score for each degree is given. Each individual is allotted a score according to the following scale below.

Fluorosis Category: Numerical Weight:

Normal 0 Questionable 0.5 Very Mild 1.0 Mild 2.0 Moderate 3.0 Severe 4.0

Each of the 6 classification is given numerical weights to derive a numerical CFI.

The number of people in each category is multiplied by the corresponding numerical weight, the products thus obtained for the various categories are added up and the sum total number of people surveyed.

*Only when the CFI value is greater than 0.6 is Fluorosis considered to be a public health problem in that area.

CFI FORMULA

Sum of (number of individuals x statistical weights)

CFI = Number of individuals examined

Community Fluorosis Index Scores

A classification of mild or less is not considered a

problem; a Community Fluorosis Index (CFI) is

assigned based on the mean of all scores of

study population. In 1946 Dean H.T related the

numerical scale of CFI to what defined as the

“Public Health Significance of Community

Fluorosis Index Scores”.

CFI Scores

Range Significance of Scores

0.0 – 0.4 Negative0.4 – 0.6 Borderline0.6 – 1.0 Slight1.0 – 2.0 Medium2.0 – 3.0 Marked3.o – 4.0 Very

Marked

A CFI score less than 0.6 is not considered objectionable.

CRITERIA FOR FLUOROSIS INDEX

Normal (0)

- The enamel presents the usual translucent semivitriform type of structure. The structure is smooth ,glossy and usually of a pale creamy white color.

Questionable (0.5)

- The enamel discloses slight aberrations from the translucency of normal enamel, ranging from a few white flecks to occasional white spots. This classification is utilized in those instances where a definite diagnosis of the mildest form of fluorosis is not warranted and a classification of "normal" is not justified.

CRITERIA FOR FLUOROSIS INDEX Very Mild (1)

- Small opaque, paper white areas scattered irregularly over the tooth but not involving as much as 25% of the tooth surface. Frequently included in this classification are teeth showing no more than about 1-2 mm of white opacity at the tip of the summit of the cusps of the bicuspids or second molars.

CRITERIA FOR FLUOROSIS INDEX Mild (2)

- The white opaque areas in the enamel of the teeth are more extensive but do not involve as much as 50% of the tooth.

CRITERIA FOR FLUOROSIS INDEX

Moderate(3)

- All enamel surfaces of the teeth are affected, and the surfaces subject to attrition show wear. Brown stain is frequently a disfiguring feature

CRITERIA FOR FLUOROSIS INDEX

Severe (4)

- Includes teeth formerly classified as "moderately severe and severe." All enamel surfaces are affected and hypoplasia is so marked that the general form of the tooth may be affected. The major diagnostic sign of this classification is discrete or confluent pitting. Brown stains are widespread and teeth often present a corroded-like appearance.

Example

a) 1000 6-y.o. children are examined, 120 are found to have questionable discoloration of teeth, 80 are found to have very mild, and 50 have mild discoloration, the index is

CFI= Sum of( Number of individuals X statistical weights)

Number of Individuals examined

= (120x0.5) + (80 x 1) + (50x2)1000

= 240 100

= 0.24

** the FCI is 0.24 considered to be negative and not a public health problem.

b) 2000 individuals were examined for possible discoloration of teeth and 284 were diagnosed to be severe, 112 were diagnosed to be very mild and 76 were diagnosed to be moderate.

CFI = Sum of( Number of individuals X statistical weights)

Number of Individuals examined

= (284x4)+(112x1)+(76x3) 2000 

= 1136+112+228 2000

  

= 1476 2000

  

= 0.738 ~ 0.74  **Hence, the FCI = 0.74 is considered to be a slight

problem in that community.

Historical Background

CFI is a spin-off from the Fluorosis Index, which Dean defined in 1935 on a seven point ordinal scale. But by 1942, it was revised into the six point scale, (combining the moderately severe and severe category into a single “severe”) again ranging from negative and borderline to marked and very marked.

Dean related this index to the concentration of fluoride in a water supply and was able to show a linear correlation.

Dean also subjectively related his numerical CFI scale to what he termed “Public Health Significance” of fluorosis.

With cosmetic sensitivity probably a lot higher now that it was in the 1930 it is questionable whether Dean’s estimation on this score have much relevance for the 1990.

= (284x4)+(112x1)+(76x3) 2000

= 1136+112+228 2000

= 1476 2000= 0.738 ~ 0.74

**Hence, the FCI = 0.74 is considered to be a slight problem in that community.

REFERENCES  Essentials of Preventive and community Dentistry

By: Dr. Soben Peter M.D.S, F.A.G.E2nd edition ARYA(medi) Publishing housePages 213-215

Dentistry, Dental Practice, and the Community by: Brian A. Burt and Stephen A. Euklund, 6th edition. Page-210

   Murray JJ, Rugg-Gunn AJ, Jenkins GN. Fluorides in caries prevention, 3rd

ed. Butterworth-Heinemann Ltd: Oxford; 1991. p.225,232.  Pillai KS, Stanley VA. Implications of ß uoride: An endless uncertainty. J

Environ Biol 2002;23:81-7.  Mollert IJ. Endemic dental ß uorosis. In: Prabhu SR,Wilson DF, Daftary

DK, Johnson NW, editors. Oral diseases in the tropics. Oxford University Press: Delhi; 1993. p.68.