March 2007

Volume 24, Issue 1

Agreement amongst examiners assessing dental fluorosis from digital photographs using the TF index.

Authors: J. Tavener R.P. Ellwood R.M. Davies


Objective To compare the scoring of dental fluorosis by experienced examiners from digital photographs using the TF index. Basic Research design 120 images were selected from 703 photographs obtained during a clinical trial (Tavener et al., 2004). The selection process was stratified so that the full range of defects seen in the main study was included. The children, aged 8-10 years, were from deprived areas of Manchester, England with fluoride levels in the drinking water of less the 0.1 ppm F. The photographs of the upper and lower anterior sextants were taken after cleaning and drying the teeth. The examiners were identified by searching Medline for individuals who had previously used the TF index or had experience of scoring dental fluorosis. Of the 12 examiners identified, 10 agreed to take part. Each examiner was provided with identical CDs containing a PowerPoint presentation of the images. Twelve images were duplicated and interspersed amongst the 120 images to assess intra examiner agreement. Each examiner was also supplied with a table listing the criteria and illustrations for each of the TF index scores (Fejerskov et al., 1988). Results The prevalence of fluorosis (TF>0) amongst the 10 examiners ranged from 43% to 70% and from 2% to 13% for the more severe scores (TF 3 or 4). Paired agreements amongst subject scores for the 10 examiners, measured using a weighted Kappa score, ranged from 0.40 to 0.71. Conclusion It is concluded that although the criteria for the TF index are well defined, it is possible that examiners may interpret the criteria in different ways and conditions in which images are viewed may need to be standardised. This study may explain some of the differences in the prevalence and severity of fluorosis reported in different studies. There is a need to standardise the methods used to score dental fluorosis. Key words: dental fluorosis, digital images, reproducibility, TF index


Other articles in this issue

Article Pages Access
Editorial - Expanding dental undergraduate clinical outreach programmes into general dental practice. 2-3 Download
Community effectiveness of fissure sealants and the effect of fluoridated water consumption 4-11 Download
Financial systems’ impact on dental care; a review of fee-forservice and capitation systems 12-20 Download
Agreement amongst examiners assessing dental fluorosis from digital photographs using the TF index. 21-25 Download
Frequency and distribution patterns of sealants among 15-year-olds in Denmark in 2003 26-30 Download
Enamel defects and its relation to life course events in primary dentition of Brazilian children: A longitudinal study 31-36 Download
Oral health care and status of elderly care home residents in Glasgow. 37-42 Download
Knowledge of and attitudes toward severe acute respiratory syndrome among a cohort of dental patients in Hong Kong following a major local outbreak 43-48 Download
Conversion tables for the Corah and Modified Dental Anxiety Scales 49-54 Download
An audit of paediatric dental treatments carried out under general anaesthesia in a sample of Spanish patients 55-58 Download
BASCD Survey - The dental caries experience of 5-year-old children in Great Britain (2005/6). Surveys co-ordinated by the British Association for the Study of Community Dentistry. 59-63 Download


Online (Single user only)
Institution Online (IP address validation)

Back issues may be obtained from the publisher

Consider recommending subscription to your institution's library

You can view Open Access papers without a subscription.