OBJECTIVE: This study aimed to compare the impact of case-based learning (CBL) versus lecture-based learning (LBL) on dental students\' clinical decision-making regarding DF severity using Visual Analog Scale (VAS) scoring.
METHODS: Eighty first-year graduate dental students were randomly assigned to either the CBL (n = 38) or LBL (n = 42) groups. Both groups received instruction on DF diagnosis, with CBL involving small group sessions analyzing real cases and LBL involving traditional lectures. Effectiveness was assessed by presenting 32 dental fluorosis cases with Thylstrup-Fejerskov Index (TSIF) scores ranging from 0 to 7 through slide presentations to both groups for VAS assessment. Five evaluators of each group randomly selected were asked to repeat the rating 2 weeks later. Statistical analysis included two-way ANOVA for group and gender differences, intra-class correlation coefficient (ICC) for reliability, and Spearman correlation coefficients for validity.
RESULTS: Variations in VAS scores were observed between CBL and LBL groups, with no significant gender impact. Excellent inter- and intra-evaluator agreement was found for VAS scoring in both groups, indicating its reliability. Validation against established indices (such as DI and TSIF) demonstrated strong correlations, with CBL students exhibiting higher correlations.
CONCLUSIONS: CBL enhances students\' clinical decision-making and proficiency in DF diagnosis, as evidenced by more consistent and accurate VAS scoring compared to LBL. These findings highlight the importance of innovative educational strategies in dental curricula, with implications for improving training quality and clinical outcomes.
BACKGROUND: The study was registered at the Clinical Research Center, Hospital of Stomatology, Wuhan University (Registration code: HGGC-036).

Over exposure to high amount of fluoride during the development of enamel leads to fluorosis. Dental fluorosis is considered to be the most common color disorders of the enamel. It presents with different clinical signs on the enamel of the patients. The diagnosis of dental fluorosis is very challenging in the clinical practice since the enamel defects could be confusing. This case report presented two cases and their treatment for different grades of dental fluorosis to improve the esthetic appearance of the teeth. Keywords: Dental fluorosis, Fluorosis index, Lithium disilicate glass-ceramic, Microabrasion, Resin infiltration.

This study focuses on identifying fluoride (F‒) concentrations and its health risk assessment (HRA) in drinking water sources in south-eastern Türkiye. Groundwater quality was assessed using some graphical approaches such as Schoeller and Piper diagrams and GIS mapping. Average daily exposure dosages through oral and dermal contact exposure routes were considered to determine the potential health risk of F‒ in groundwater. Groundwater samples were taken from 53 points in spring, summer, autumn, and winter seasons. The results showed that the average annual F‒ concentrations in water resources in the study area were 0.26‒3.62 mg/L. According to the HRA results, the highest F‒ health risk in this region was observed in children, followed by teenagers and adults. This study indicated that there is a strong relationship between the high health risk (4.28 > 3.5) in children and dental fluorosis caused by high F‒ concentration in groundwater.

Dental fluorosis can be a disease of social inequity in access to safe drinking water. This dental public health issue becomes prominent in socially disadvantaged agrarian communities in fluoride endemic areas where the standard irrigation system is unavailable and groundwater containing natural fluoride is the major drinking water source. This study aimed to determine the prevalence and severity of dental fluorosis in children and to evaluate its association with fluoride in groundwater in the aforementioned setting in Thailand.
A cross-sectional survey of 289 children in Nakhon Pathom Province was conducted in 2015. Children with very mild to severe fluorosis were regarded as \'cases\' while their counterparts were \'controls\' for a subsequent case-control study. Records of fluoride concentrations in groundwater used for household supply corresponding to resident and number of years by age of each child during 2008-2015 were retrieved. Other exposure variables were measured using a questionnaire. Prevalence ratio (PR), a measure indicating the relative effect of different levels of fluoride on dental fluorosis, was obtained from Poisson regression with robust standard error.
There were 157 children with very mild to moderate dental fluorosis (54.3% prevalence). The univariable analysis revealed that the prevalence of dental fluorosis among children with fluoride concentrations in water sources of 0.7-1.49 (index category 1) and ≥ 1.5 ppm (index category 2) was 1.62 (95% CI; 0.78, 3.34) and 2.75 (95% CI; 1.42, 5.31) times the prevalence among those with fluoride < 0.7 ppm (referent category). After adjusting for all covariates, the adjusted prevalence ratios in both index categories were 1.64 (95% CI; 0.24, 11.24) and 2.85 (95% CI; 0.44, 18.52) which were close to their corresponding crude estimates. Since the magnitude of confounding, measured by (PRcrude-PRadjusted)/PRadjusted, were less than 10% for both index categories; this indicated the limited confounding effect of all covariates.
In fluoride endemic areas, groundwater containing natural fluoride utilized for household consumption resulted in high dental fluorosis prevalence, particularly in the groundwater with fluoride concentrations of ≥ 1.5 ppm.

Dental fluorosis is a dental condition caused by excessive intake of fluoride during enamel formation, which can lead to color abnormalities or defects on the tooth surface. The resultant abnormal appearance ranges in severity from mildly white and opaque to dark brown, which substantially affects patients\' esthetic characteristics and self-confidence. Treatment methods include tooth whitening or restoration. This clinical report describes the use of a minimally invasive esthetic technique in a 22-year-old woman with moderate dental fluorosis. The treatment plan included enamel microabrasion, at-home bleaching for 2 weeks, and subsequent resin infiltration for each tooth under a rubber dam. After 2 years of follow-up, evaluation of the patient\'s esthetic appearance revealed that teeth affected by dental fluorosis could be successfully treated with a minimally invasive technique involving microabrasion, at-home bleaching, and resin infiltration.

This case report describes the treatment of a patient who had molar-incisor hypomineralization associated with dental fluorosis, a diagnosis established through a comprehensive review of the clinical record, an intraoral clinical examination, and assessment of photographic records. First, dental hypersensitivity was treated with fluoride varnish, which was applied separately to each dental quadrant. Subsequently, the functional and esthetic reconstruction of the permanent maxillary central incisors was completed in a single session through the placement of direct composite resin veneers. After the treatment, the patient was reexamined monthly for 12 months to evaluate the durability of the restorations. At the 12-month follow-up, no fractures or pigmentations were observed, and only a slight loss of brightness of the restorations was noted. The dental hypersensitivity had been eliminated. When an adhesive restorative technique with composite resin is well executed, it is possible to obtain satisfactory and long-lasting esthetics and relief of painful symptoms.

Pronounced white color alterations due to structural anomalies of the enamel are often insufficiently masked by bleaching techniques or resin infiltration procedures alone. This frequently leads to the choice of more invasive prosthetic restorations in order to correct tooth color and form. This article describes a minimally invasive treatment option for esthetic and functional rehabilitation in the case of a 13-year-old female patient with suspected severe fluorosis and misalignment of the anterior teeth. The restorations were performed using underlying resin infiltration to homogenize the tooth shade. In a second step, direct composite veneers were applied on top to attain a natural tooth color and adjust tooth alignment and form. By joining the two minimally and noninvasive techniques, this treatment option combines the directive for preservation of hard tooth structure while treating adolescents with the benefits of easy adaptation and repair when the occlusion is still in adjustment.

It is very common for a dentist to detect white discolorations (WDs) of the teeth. The most common causes for this condition are fluorosis, early caries demineralization, molar incisor hypomineralization (MIH), and trauma or infection of the corresponding primary tooth. In cases of severe enamel discoloration, invasive approaches such as resin composite restorations, ceramic veneers or even crowns are generally chosen. This clinical report describes a combined minimally invasive treatment of a teenager\'s maxillary teeth affected by fluorosis. Dental bleaching, microabrasion, and resin infiltration were performed. The satisfactory clinical result has made it possible to avoid more invasive and expensive treatments.

Prevalence of fluorosis is a worldwide public health issue, especially in the West Azerbaijan province of Iran. The aim of this study was to investigate fluoride concentration in drinking water resources within Maku city, in both the warm and cold seasons, to perform a health risk assessment. Fluoride were measured using UV-visible spectrophotometry. The spatial distribution was calculated by the software ArcGIS and Hazard Quotients (HQs) were calculated according to the US EPA method. The fluoride concentrations ranged between 0.29 to 6.68 and 0.1 to 11.4 mg/L in the cold and warm seasons, respectively. Based on this report, 30.64 and 48.15% of the samples revealed a fluoride level higher than the permissible level in the cold and warm seasons, respectively. Moreover, results showed that the HQ value in the warm season for different age groups was higher than the HQ value in the cold season. In both seasons, the non-carcinogenic risks of fluoride for the four exposed populations varied according to the order: children > teenagers > adults > infants. The HQ values for three age groups (children, teenager and adults) for both seasons were higher than 1 with a high risk of fluorosis. The results of this study, support the requests that government authorities better manage water supplies to improve health quality.

The present clinical case report describes the clinical steps of enamel microabrasion associated with dental bleaching to restore severely-pitted fluorosed teeth. The process of removing the fluorotic superficial stains started by using macroabrasion with a water-cooled fine tapered 3195 FF diamond bur. Rubber dam isolation of the operative field was used to remove the remaining enamel stains and superficial irregularities with the Opalustre microabrasive compound (6.6% hydrochloric acid associated with silicon carbide particles) followed by polishing using fluoridated paste and subsequent 2% neutral fluoride gel topical application. After one month, dental bleaching was performed using 10% carbamide peroxide in custom-formed acetate trays for two hours/day for 42 days. The association of enamel microabrasion with dental bleaching was effective for reestablishing the dental esthetics of a patient with severe dental fluorosis.