Criteria for Dean’s Fluorosis Index

Normal: The enamel represents the usual translucent semivitriform type of structure. The surface is smooth, glossy, and usually of a pale creamy white color.

Questionable: The enamel discloses slight aberrations from the translucency of normal enamel, ranging from a few white flecks to occasional white spots. This classification is utilized in those instances in which a definite diagnosis of the mildest form of fluorosis is not warranted and a classification of “normal” not justified.

Very mild: Small, opaque, paper-white areas scattered irregularly over the tooth but not involving as much as approximately 25% of the tooth surface. Frequently included in this classification are teeth showing no more than about 1-2 mm of white opacity at the tip of the summit of the cusps of the bicuspids or second molars.

Mild: The white opaque areas in the enamel of the teeth are more extensive but do not involve as much as 50% of the tooth.

Moderate: All enamel surfaces of the teeth are affected, and surfaces subject to attrition show marked wear. Brown stain is frequently a disfiguring feature.

Severe: Includes teeth formerly classified as “moderately severe” and “severe.” All enamel surfaces are affected and hypoplasia is so marked that the general form of the tooth may be altered. The major diagnostic sign of this classification is the discrete or confluent pitting. Brown stains are widespread and teeth often present a corroded appearance.