A Quantitative Look at Fluorosis, Fluoride Exposure, and Intake in Children Using a Health Risk Assessment Approach

The prevalence of dental fluorosis in the United States has increased during the last 30 years. In this study, we used a mathematical model commonly employed by the U.S. Environmental Protection Agency to estimate average daily intake of fluoride via all applicable exposure pathways contributing to fluorosis risk for infants and children living in hypothetical fluoridated and non-fluoridated communities. We also estimated hazard quotients for each exposure pathway and hazard indices for exposure conditions representative of central tendency exposure (CTE) and reasonable maximum exposure (RME) conditions. The exposure pathways considered were uptake of fluoride via fluoridated drinking water, beverages, cow’s milk, foods, and fluoride supplements for both age groups. Additionally, consumption of infant formula for infants and inadvertent swallowing of toothpaste while brushing and incidental ingestion of soil for children were also considered. The cumulative daily fluoride intake in fluoridated areas was estimated as 0.20 and 0.11 mg/kg-day for RME and CTE scenarios, respectively, for infants. On the other hand, the RME and CTE estimates for children were 0.23 and 0.06 mg/kg-day, respectively. In areas where municipal water is not fluoridated, our RME and CTE estimates for cumulative daily average intake were, respectively, 0.11 and 0.08 mg/kg-day for infants and 0.21 and 0.06 mg/kg-day for children. Our theoretical estimates are in good agreement with measurement-based estimates reported in the literature. Although CTE estimates were within the optimum range for dental caries prevention, the RME estimates were above the upper tolerable intake limit. This suggests that some children may be at risk for fluorosis

Accuracy of dental images for the diagnosis of dental caries and enamel defects in children and adolescents: A systematic review

Aim: The aim of this review was to determine if photographic examination and subsequent image analysis provides comparable accuracy to visual inspection for the diagnosis of common dental conditions in children and adolescents

Agreement in the diagnosis of dental fluorosis in central incisors performed by a standardized photographic method and clinical examination Concordância no diagnóstico da fluorose dentária em incisivos centrais realizado por um método fotográfico padronizado e pelo exame clínico

The aim of this study was to assess agreement in the diagnosis of dental fluorosis performed by a standardized digital photographic method and a clinical examination (gold standard). 49 children (aged 7-9 years) were clinically evaluated by a trained examiner for the assessment of dental fluorosis. Central incisors were evaluated for the presence or absence of dental fluorosis and were photographed with a digital camera. Photographs were presented to three pediatric dentists, who examined the images. Data were analyzed using Cohen's kappa and validity values. Agreement in the diagnosis performed by the photographic method and clinical examination was good (0.67) and accuracy was 83.7%. The prevalence of dental fluorosis was reported to be higher in the clinical examination (49%) compared with the photographic method (36.7%). The photographic method presented higher specificity (96%) than sensitivity (70.8%), a positive predictive value (PPV) of 94.4% and a negative predictive value (NPV) of 77.4%. The diagnosis of dental fluorosis performed using the photographic method presented high specificity and PPV, which indicates that the method is reproducible and reliable for recording dental fluorosis.<br>O objetivo do estudo foi comparar o diagnóstico de fluorose dentária realizado por um método fotográfico com o exame clínico (padrão ouro). Quarenta e nove crianças, de 7 e 9 anos, foram clinicamente examinadas por um examinador calibrado para fluorose dentária. Os incisivos foram fotografados com câmera digital e as fotografias foram apresentadas a três odontopediatras, que examinaram as imagens. A concordância por kappa entre o método fotográfico e o padrão ouro foi boa (0,67) e a acurácia foi de 83,67%. A prevalência de fluorose dentária foi levemente maior pelo método clínico (49%) do que pelo fotográfico (36,7%). O método fotográfico apresentou maior especificidade (96%) que sensibilidade (70,83%), valor de predição positivo (VPP) de 94,44% e valor de predição negativo (VPN) de 77,42%, com poucos casos de falsos positivos (6%). O diagnóstico de fluorose dentária usando-se o método fotográfico apresentou alta especificidade e VPP, indicando que é adequado para registrar fluorose dentária, com poucos casos de falsos positivos. O método é reprodutível e confiável quando comparado com o diagnóstico clínico e pode ser usado para o diagnóstico da fluorose dentária

Evaluating the use of fluorescent imaging for the quantification of dental fluorosis

<p>Abstract</p> <p>Background</p> <p>The quantification of fluorosis using fluorescence imaging (QLF) hardware and stain analysis software has been demonstrated in selected populations with good correlation between fluorescent image metrics and TF Index scores from photographs. The aim of this study was to evaluate the ability of QLF to quantify fluorosis in a population of subjects (aged 11–13) participating in an epidemiological caries and fluorosis survey in fluoridated and non-fluoridated communities in Northern England.</p> <p>Methods</p> <p>Fluorescent images of the maxillary incisors were captured together with standardized photographs were scored blind for fluorosis using the TF Index. Subjects were excluded from the analysis if there were restorations or caries on the maxillary central incisors.</p> <p>Results</p> <p>Data were available for 1774 subjects (n=905 Newcastle, n=869 Manchester). The data from the fluorescence method demonstrated a significant correlation with TF Index scores from photographs (Kendall’s tau = 0.332 p<0.0001). However, a number of additional confounding factors such as the presence of extrinsic stain or increased enamel translucency on some subjects without fluorosis or at low levels of fluorosis severity had an adverse impact on tooth fluorescence and hence the outcome variable. This in conjunction with an uneven distribution of subjects across the range of fluorosis presentations may have resulted in the lower than anticipated correlations between the fluorescent imaging metrics and the photographic fluorosis scores. Nevertheless, the fluorescence imaging technique was able to discriminate between a fluoridated and non-fluoridated population (p<0.001).</p> <p>Conclusions</p> <p>Despite confounding factors the fluorescence imaging system may provide a useful objective, blinded system for the assessment of enamel fluorosis when used adjunctively with photographic scoring.</p