Thylstrup A, Fejerskov O
Community Dent Oral Epidemiol. 1978 Nov;6(6):315-28. doi: 10.1111/j.1600-0528.1978.tb01173.x.
Based on studies in Northern Tanzania a new classification system of dental fluorosis is proposed. The classification system includes 10 scores designed to characterize the degree of dental fluorosis affecting buccal/lingual and occlusal surfaces. With aid of polarized and ordinary light microscopy the histologic features behind the individual scores are described. The macroscopic appearance of increasing degrees of dental fluorosis were well correlated to the degree of subsurface porosity. Above a certain level of subsurface hypomineralization various degrees of loss of surface enamel occurred, presumably as a result of posteruptively acquired injuries. Application of the new classification system to samples of children born in areas with 3.5, 6.0 and 21.0 parts/10(6) F- in the water supplies revealed that the distribution of dental fluorosis within the individual followed the same pattern irrespective of fluoride concentration in the water. While the classical Dean index was unable to distinguish between dental fluorosis in the 6.0 and the 21.0 parts/10(6) area it was possible with the new system to disclose that particularly the posterior teeth were significantly more affected in the latter area. Comparisons of degree of dental fluorosis with available measurements of enamel thickness proved that the within-tooth as well as within-dentition variations are determined by enamel thickness rather than length of exposure to body fluids. The limitations of the Dean index are discussed with special attention to its validity as a biological index in relation to current efforts to determine the minimal toxic effect of fluoride on the dental hard tissues.
基于在坦桑尼亚北部开展的研究，提出了一种新的氟斑牙分类系统。该分类系统包括10个评分，旨在描述影响颊面/舌面及咬合面的氟斑牙程度。借助偏光显微镜和普通光显微镜，描述了各个评分背后的组织学特征。氟斑牙程度增加时的宏观表现与表面下孔隙率程度密切相关。在表面下矿化不足达到一定程度后，会出现不同程度的表面釉质丧失，这可能是萌出后受到损伤的结果。将新的分类系统应用于出生在供水氟含量分别为3.5、6.0和21.0 ppm地区的儿童样本，结果显示，无论水中氟化物浓度如何，个体内氟斑牙的分布模式相同。虽然经典的迪恩指数无法区分6.0 ppm和21.0 ppm地区的氟斑牙情况，但新系统能够揭示，在后者地区，尤其是后牙受影响更为显著。将氟斑牙程度与现有的釉质厚度测量结果进行比较，结果表明，牙齿内部以及牙列内的差异是由釉质厚度决定的，而非接触体液的时长。讨论了迪恩指数的局限性，特别关注其作为生物学指标的有效性，这与当前确定氟化物对牙齿硬组织最小毒性作用的努力相关。
