A comparison of clinical and photographic scoring using the TF and modified DDE indices for recording enamel opacities

To compare the results of clinical and photographic scoring of enamel opacities using the TF and modified DDE indices. A total of 204 school children between 8-11 years were examined using cluster sampling methodology. The clinical examinations for children were conducted twice. First, enamel opacities on the two maxillary central incisors were recorded using Thylstrup and Fejerskov Index (Fejerskov et al., 1988) and two weeks later it was scored according to Modified Developmental Defects of Enamel Index (Clarkson and O'Mullane.,1989). Following the clinical examinations, an intra-oral colour photograph was taken of the upper central incisors of each subject and was scored on two occasions, first using TF Index and secondly Modified DDE Index. The obtained data was subjected to statistical analysis. Agreement between clinical and photographic scoring was good for both TF and modified DDE indices, Kendall's rank correlation coefficient being 0.93 and 0.88 respectively. There was fair and moderate agreement between the distributions of scores for the two indices as indicated by Kendall's rank correlation coefficient being 0.58 for clinical scores and 0.63 for photographic scores respectively. The fact that fair/moderate correlations were found between the two scoring systems, using both clinical and photographic recording gives reassurance that either will yield broadly comparable results where fluoride-induced opacities will form a significant proportion of all enamel defects found.