Quantitative Light Fluorescence (QLF) and Polarized White Light (PWL) assessments of dental fluorosis in an epidemiological setting

Narumanas Korwanich,Andrew Taylor,Mohammed Owaise Sharif,Iain A Pretty,Christian Zakian,Michaela Goodwin,E Angeles Martinez-Mier,Timothy Iafolla,Bruce A Dye,Roger P Ellwood,Patcharawan Srisilapanan,Michael Mcgrady

doi:10.1186/1471-2458-12-366

Abstract

BackgroundTo determine if a novel dual camera imaging system employing both polarized white light (PWL) and quantitative light induced fluorescence imaging (QLF) is appropriate for measuring enamel fluorosis in an epidemiological setting. The use of remote and objective scoring systems is of importance in fluorosis assessments due to the potential risk of examiner bias using clinical methods.MethodsSubjects were recruited from a panel previously characterized for fluorosis and caries to ensure a range of fluorosis presentation. A total of 164 children, aged 11 years (±1.3) participated following consent. Each child was examined using the novel imaging system, a traditional digital SLR camera, and clinically using the Dean’s and Thylstrup and Fejerskov (TF) Indices on the upper central and lateral incisors. Polarized white light and SLR images were scored for both Dean’s and TF indices by raters and fluorescence images were automatically scored using software.ResultsData from 164 children were available with a good distribution of fluorosis severity. The automated software analysis of QLF images demonstrated significant correlations with the clinical examinations for both Dean’s and TF index. Agreement (measured by weighted Kappa’s) between examiners scoring clinically, from polarized photographs and from SLR images ranged from 0.56 to 0.92.ConclusionsThe study suggests that the use of a digital imaging system to capture images for either automated software analysis, or remote assessment by raters is suitable for epidemiological work. The use of recorded images enables study archiving, assessment by multiple examiners, remote assessment and objectivity due to the blinding of subject status.

Highlights

To determine if a novel dual camera imaging system employing both polarized white light (PWL) and quantitative light induced fluorescence imaging (QLF) is appropriate for measuring enamel fluorosis in an epidemiological setting
The software should produce metrics that are strongly correlated with the clinical scores. The aim of this current study is to report on the effectiveness of this new dual imaging system (QLF + PWL) and the reliability of the remotely graded dental fluorosis images versus the dental fluorosis scores obtained from clinical examination
Data were available for 164 consenting children, 36 children were unavailable for examination as they were absent from school during the study

Summary

Introduction

To determine if a novel dual camera imaging system employing both polarized white light (PWL) and quantitative light induced fluorescence imaging (QLF) is appropriate for measuring enamel fluorosis in an epidemiological setting. Changes in the appearance of tooth enamel can occur if ingestion of excessive amounts of fluoride occurs during critical time periods during tooth development [3,4]. These changes can result in dental fluorosis, which in its mildest forms presents as areas of white striations following the developmental lines of enamel [5]. High fluoride exposure, such as seen in areas with naturally occurring water fluoridation in excess of 1 ppm, may result in more severe presentations of fluorosis that include enamel pitting, brown discoloration and enamel loss [5] (Figure 2)

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