Advances in Dental Research, Vol 3, 104-109, Copyright © 1989 by International & American Associations for Dental Research
Review of terminology, classifications, and indices of developmental defects of enamel
J. Clarkson
A wide variety of terms and definitions are used to describe various
developmental defects of enamel. Some are simple descriptive clinical
terms, and others are linked with the causative agent or the histopathology
of the defect. Some confusion exists as to the most appropriate type of
index to use to measure defects of enamel due to fluoride ingestion (dental
fluorosis). This is primarily due to difficulties some researchers have in
distinguishing between defects of fluoride and non-fluoride origin. This
problem has resulted in the development of specific fluorosis indices and
purely descriptive indices. The main fluorosis indices are those of Dean,
Thylstrup and Fejerskov, and the TSIF Index. Dean's Index does not provide
adequate information on the distribution of fluorosis within the dentition
and is not sensitive at high fluorosis levels. The Thylstrup and Fejerskov
Index is related to the histology of florosis; however, the initial minute
changes observed on dry enamel surfaces are of little esthetic importance.
The TSIF Index does overcome some of the limitations of Dean's Index. The
DDE Index has replaced the Al-Alousi Index as the main descriptive index.
The DDE Index is time-consuming, and the analyses of data are complicated.
Modifications have now been proposed to make it simpler to use and the data
more meaningful. Further research needs to be carried out into both the
validity of the fluorosis indices and making the DDE Index more universally
acceptable.
