Complete oral rehabilitation in a case with severe dental fluorosis

Table 1 Restorative treatment protocol for dental fluorosis of varied severity

Modified dean’s fluorosis index score	Clinical findings	Suggested treatment options
Normal (0)	Enamel represents usual transparency, semi-vitriform type of structure. The surface appears smooth, glossy and usually of a pale, creamy white colour	No treatment
Questionable (0.5)	Few flecks to occasional white spots	No treatment/bleaching
Very Mild (1)	Small, opaque, paper white areas scattered over < 25% of the tooth surface	No treatment /bleaching
Mild (2)	White opaque areas in enamel of the teeth are more extensive, but do not involve as much as 50% of the tooth	Bleaching/composite restoration
Moderate (3)	All enamel surfaces of the teeth are affected and surfaces subject to attrition show wear. Brown stain is frequently a disfiguring feature	If discolorations accompanied by wear: Full coverage If only discoloration without any wear: 1 Bleaching or 2 Veneers (Direct or indirect) or 3 Bleaching followed by Veneers (Direct or indirect)
Severe (4)	All enamel surfaces affected, severe hypoplasia, discrete or confluent pitting. Brown stains are widespread and teeth often present a corroded-like appearance	Full coverage