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Objective: The aim of the study was to evaluate the use of two different indices (Thylstrup and Fejerskov
index and modified Developmental Defects of Enamel index) devised for measurement of enamel opacities
(defects) using photographic method of assessment.
Material and Methods: Using the indices, the scoring for enamel defects (on upper central incisor
teeth) was made from a sample of 1000 colour photographs (slides). These photographs were of incisor
teeth of 10-year-old children living in an area with water fluoride levels below 0.45 parts per million. The
slides were viewed using Kodak Carousel S-A 2000 Projector.
Results: Results relate to photographs of 987 children, including a total of 1957 teeth. Enamel defects
that fulfilled criteria described by Thylstrup and Fejerskov as characteristic of "fluorosis" were recorded
in 181(18.3%) children and 358(18.3%) upper central incisor teeth. In majority of the cases, the score was
of mild fluorosis. On modified Developmental Defects of Enamel (DDE) index, 652(66.0%) children and
1086(55.5%) teeth (upper central incisors) were scored as having enamel defects. Diffuse defects were the
onclusion: It is concluded that both the Thylstrup and Fejerskov index and the modified Developmental
Defects of Enamel (DDE) index can be used with reasonable reproducibility to measure enamel defects.
However, if diffuse defects recorded on the modified DDE index were taken to be a result of fluoride
intake, then fluorosis may be over-estimated in relation to fluorosis as recognized by Thylstrup and
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