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Project Title

Enhancing Surveillance of Fluorosis Using Imaging Technology

Funding Dates



Current assessment of dental fluorosis (DF) relies on subjective visual indices, such as Thylstrup and Fejerskov’s Fluorosis Index (TFI). Quantitative methods, such as quantitative light induced fluorescence (QLF), have a positive correlation with visual examinations to correctly classify dental fluorosis. Visual methods, which rely on examiner judgement, are affected by subjectivity, potential examiner fatigue and increase in error, and the potential for the over/underestimation of prevalence. We propose three aims to improve community surveillance methods of DF: (1) To determine the validity of developed algorithms to propose different thresholds to classify DF by analyzing existing images of the Early Life Exposures in Mexico to ENvironmental Toxicants (ELEMENT) cohort; (2) To conduct a pilot study with a subset of ELEMENT participants to clinically compare new QLF devices and software using TFI as the gold standard; and (3) Convene a panel of experts to: a) evaluate available data on existing diagnostic technologies and provide recommendations on validity, reliability, sensitivity, specificity, and feasibility of the methods to assess DF; and b) determine a threshold acceptable for fluorosis surveillance using such technologies to ensure comparability to data obtained through the use of traditional visual examinations.

Research Areas 

Additional Topics

Principal Investigator

Eric Everett, PhD


Centers for Disease Control and Prevention