Quantitative Light Fluorescense (QLF) and Polarized White Light (PWL) assessments of dental fluorosis in an epidemiological setting.
ABSTRACT BACKGROUND: 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 use of remote and objective scoring systems is of importance in fluorosis assessments due to the potential risk of examiner bias. METHODS: Subjects 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 examined using the Dean's and Thylstrup and Fejerskov (TF) Indices. Polarized white light and SLR images were scored for both Dean's and TF indices and fluorescence images were automatically scored using software. RESULTS: Data 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. CONCLUSIONS: The study suggests that the use of a digital imaging system to capture images for either automated software analysis, or remote assessment by human readers is appropriate 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.