 Hello everyone, welcome back to a new session on dentistry and more. So today we have fluorosis index. So fluorosis index, we are not dealing all indices, we are just seeing Dain's fluorosis index. So let's see some basic factors about fluorosis, we have already studied what is fluorosis. It is nothing but hyperplasia or hypermenalization of tooth enamel or dentine produced by chronic ingestion of excessive monofluoride that is more than 2 ppm or 1 ppm while teeth are developing. So it is affecting only when the mineralization of teeth is happening. So we have seen all these history of fluoride, the Colorado Springs, the great Frederick McKay and GV Black. So this is how a motile enamel or fluorosis looks like. The fluoridated water, arrow, pin points, discolored cracks or pitted areas. So before that we need to differentiate what is fluorosis and what is non-fluoride enamel opacities. So how a fluoride affects a tooth and other reasons for enamel opacities. While the area affected, we can see the fluorosis will always be near the cusp tip or incisor ledge but in other non-fluoride thing it will be smooth surface and it will be centered and affects the whole crown. Shape of the region will be always pencil shading because it follows incremental lines where the deposition of minerals occur. This will be round and oval. Demarcation is like shades of imperceptibly into surrounding normal but there will be a clear demarcation between the normal and adjacent from this. Opacities, color will be paper white, this will be creamy yellow and dark orange. Teeth affected, that teeth calcify slowly, molas and trimolas, rare on lower incisor and very rare on deciduous teeth. But this can happen non-fluoride, opacities can happen on any tooth, deciduous tooth may be involved. Those hypoplasia will not be there, enamel has glazed appearance and enamel surface we etched rough to explore it. Detection will be strong light, line of light should be tangential, strong light, line of sight should be perpendicular to tooth surface. So we have many incisors we are not checking in detail, we will be seeing only teens fluorosis index. So this is a famous trendly estine who has performed shulada survey and 21 cities study. He has put forward the deets classification of dental fluorosis for assessing presence and severity of mortal enamel. So the salient features of fluorosis index is, it is a 7 point scale and although non-numbers were used it was considered to be an ordinal scale. Ordinal scale means it is kept in order, the lowest one means not affected and the highest one means very severely affected, it goes in order. So 1, 2, 3, 4, 5, 6 as it goes higher more severity is reported. So that is ordinal scale and all those showing hypoplasia other than modeling of enamel were placed in normal category and children were not lived in the community continuously not obtained the domestic water from other than public supply are removed from the category. So how do we check a patient with mouth mirror and throw a good natural light with subject facing the window and each individual receives a score corresponding to clinical appearance of two most affected teeth. So we put score for each tooth of that patient and we take up the two highest affected tooth. Suppose two highest affected tooth are the scores are 3 and 4 we take the lowest score that is 3. If the two highest scores are similar 4 and 4 we take 4 if it is 3 and 3 we take 3. So out of 28th whichever tooth has got the highest that scores will take not the tooth the scores we take. If it is 1 and 0.5 the highest score we take 0.5 if the highest two scores are 1 and 1 we take 1. So whichever tooth score is coming highest we take up. So if the score 3 has repeated more than twice we definitely take 3. So the highest two scores are taken and if there is a doubt lower score is recorded. So this is the original criteria in 1934 the normal questionable very mild mild moderate moderately severe and severe but in 42 the modified version combined moderately severe and severe. So it becomes 6 point ordinal scale. So these two combined so it was before it was 7 point ordinal scale now it is 6 point ordinal scale. Now this one is extensively used and WSU recommended in basic survey manual 97 that is 4th edition and scoring system is between 0 to 4. So let's see what is the scores normal 0 means there are translucent semi which forms smooth glossy pale creamy color but the questionable point 5 is slight change that is slight aberration from translucency to occasional there will be occasional white spots. Very mild means small opaque paper white areas scattered over 25 percentage of the tooth and it will be less than 1 to 2 mm opacity at the tip of the summit of CUS. This is mild at least 50% of the tooth will be affected this paper white area will be more extensive. Second tree all the enamel surface are affected surface may be attrition are involved and brown staining might be there. Severeity 4 that is score 4 means all the enamel surface are affected there will be major diagnosis and discreet or confluent pitting discreet means the borders are very demarcated confluent means the borders cannot be distinguished and there will be corroded like appearance that is severity number score and why it is 4 because there is 0 and there is a 0.5 and rest are 1 2 3 4 5 2 3 4 not 5 1 2 3 4 and 0 and 0.5 so it is a 6 point ordinal scale so that's all about teens fluorosis index so I explained it's little bit of history the classification modification. So come up with a new session on dentist enamel thank you.