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BMC Public Health

, 12:366

First Online: 20 May 2012Received: 08 November 2011Accepted: 05 May 2012DOI: 10.1186-1471-2458-12-366

Cite this article as: Pretty, I.A., McGrady, M., Zakian, C. et al. BMC Public Health 2012 12: 366. doi:10.1186-1471-2458-12-366


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.

AbbreviationsΔFDelta F – the % change in fluorescence

ΔQDelta Q – the composite metric of DF and area in mm2

CCDCharged coupled device camera

CRDCentres for Review and Dissemination

LEDLight emitting diode

NHANESNational Health and Nutrition Examination Survey

PWLPolarized white light image

QLFQuantitative light induced fluorescence

RGBRed, green and blue

SLRSingle lens reflex

TFThylstrup and Fejerskov Index

TSIFTooth Surface Index of Fluorosis


WLA standard white light image obtained from a 35 mm digital SLR camera.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-12-366 contains supplementary material, which is available to authorized users.

Iain A Pretty, Michael McGrady, Christian Zakian, Roger P Ellwood, Andrew Taylor, Timothy Iafolla, Patcharawan Srisilapanan, Narumanas Korwanich, Michaela Goodwin and Bruce A Dye contributed equally to this work.

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Autor: Iain A Pretty - Michael McGrady - Christian Zakian - Roger P Ellwood - Andrew Taylor - Mohammed Owaise Sharif - Timothy 

Fuente: https://link.springer.com/

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