Fluoride is widely recognized for reducing the prevalence of dental caries. However, ingesting excess amounts of fluoride during teeth formation can lead to dental fluorosis (DF). The methods currently used to diagnose DF rely on subjective measurements which have resulted in inconsistencies in data summary and report. This study is part of a larger investigation that is aiming at developing objective methods for fluorosis diagnosis. Objective: The specific aim of this study was to asses the use of visual examination to digital intraoral photography (DIP)for fluorosis diagnosis and calibration of examiners. Methods: Ninety children received a fluorosis exam. Severity of fluorosed surfaces were measured using the Tooth Surface Index of Fluorosis (TSIF). Children were assigned as TSIF 1 to 5 cases according to the highest score received for their anterior teeth. All children were photographed (facial view) using a (DIP) system. Images were scored by a student investigator ad a previously calibrated examiner. Results obtained by the student investigator were compared to the scores given by the calibrated examiner and kappa values were calculated Results: Six percent of the children were diagnosed as sound cases; 40% were diagnosed as mild fluorosis cases (TSIF 1) and 54% were diagnosed as moderate to severe cases (TSIF 2-5) in vivo. When results of examinations were compared, percent agreements were 82.0% (weighted Kappa of 0.57) for visual diagnosis of calibrated examiner vs. photographic diagnosis of student and 92.5% (weighted Kappa of 0.85) for photographic diagnosis of student vs. photographic diagnosis of the calibrated examiner, showing a moderately strong agreement. All Kappas showed that there was substantial agreement between original fluorosis calls and those from photographic scoring Conclusion: The calibration exercise was performed successfully; a moderately strong agreement was achieved. Photographs were a useful tool for calibration purposes.

Supported by NIH supplement 5R21DE016034-02

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