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J Public Health Dent. 2000 Winter;60(1):57-9.

Dean's fluorosis index: an assessment of examiner reliability.

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Bureau of Dental Health, New York State Department of Health, Albany 12237-0619, USA.



This report describes the interexaminer reliability achieved using Dean's Index in a study of dental fluorosis, and shows the effect on kappa values of assigning different weights to the various components of Dean's Index.


Three dentists conducted replicate fluorosis examinations on 202 children in Newburgh and Kingston, NY. Examiner reliability was assessed by computing percent agreement and weighted and unweighted kappa statistics.


Agreement on the presence or absence of fluorosis using Dean's definition of fluorosis ranged from 92 to 97 percent and the respective kappa values ranged from 0.75 to 0.94. A comparison of subject-level severity scores for Dean's Index resulted in percent agreement ranging from 79.6 percent to 86.8 percent and kappa values ranging from 0.67 to 0.76. Weighting the kappa statistics improved agreement and reduced the differences.


Examiners showed good to excellent agreement beyond chance in the use of the index. Subject level kappa scores were higher than tooth-level scores.

[Indexed for MEDLINE]

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