The Use of Intraoral Camera, Quantitative Light Fluorescence, and Visual Examinations for the Detection and Assessment of Enamel Fluorosis
To evaluate the in vivo and in vitro performance of an intraoral camera (IC), visual examination using the Thylstrup and Fejerskov Index (TFI), and quantitative light-induced fluorescence (QLF) to detect and quantify enamel fluorosis (EF). Calibrated examiners performed IC-qualitative (ICQual), TFI, IC-quantitative (ICQuant), and QLF (Area, Fluorescence loss [ΔF], and ΔQ: Area×ΔF) on 150 extracted teeth in vitro and 150 children in vivo. Polarized light microscopy (PLM) was the gold standard for the in vitro phase. Cross tabulation, agreement, correlation, comparison of means from quantitative measures, sensitivity, and specificity were calculated for TFI, QLF, ICQual, and ICQuant. For the in vivo phase, TFI scores were cross tabulated with ICQuant and ICQual, and Kendall's Tau was used to measure correlation. Agreements of TFI and ICQual with PLM were 53.77% and 47.17%, respectively. Correlation coefficients for QLF (area, ΔF, ΔQ) and ICQuant with PLM scores were 0.47, 0.56, 0.51, 0.46, respectively. Sensitivity/specificity for TFI, ICQual, ICQuant, and ΔQ were 0.86/0.58, 0.86/0.62, 0.86/0.58, and 1.00/0.13, respectively. For the in vivo phase, correlations of ICQual and ICQuant with TFI were 0.55 and 0.52, respectively. Quantitative measurements of ICQuant by TFI scores showed consistent separation in means, while those for QLF were neither as clear nor as consistent. All methods were able to detect and quantify enamel fluorosis. However, there were consistent and significant differences among them.SUMMARY
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Agreement of clinical examination results (Visual and ICQual) with TFI scores. Percent agreement between visual and ICQual = 69.0% and weighted Kappa = 0.62. Abbreviations: TFI, Thylstrup and Fejerskov Index; ICQual, intraoral camera qualitative.
Scatter plots for the correlation between quantitative ICQuant scores and TFI scores. Kendall's Tau correlation of TFI with ICQuant (r=0.55). Abbreviations: TFI, Thylstrup and Fejerskov Index; ICQuant, Intraoral camera quantitative
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