Dean's Fluorosis Index scoring 4 indicates?

• A. Severe = brown stains, pits, and surface damage on most or all teeth
• B. Moderate = all tooth surfaces show white areas with some brown stains
• C. Very mild = white flecks
• D. Questionable fluorosis

Answer: (A)

Dean's Fluorosis Index groups enamel fluorosis by how severe the changes are. The most severe category is defined by brown stains, pits, and surface damage that involve most or all of the teeth. That description matches what you’d see in a high-grade fluorosis case, where the enamel is significantly hypomineralized and stained, leading to visible surface breakdown. The less severe levels show progressively fewer and milder changes: very mild appears as white flecks or patches, mild to moderate involve white areas with some brown staining but not extensive pitting, and questionable denotes only faint or barely noticeable changes. So the description of brown stains with pits and surface damage on most teeth corresponds to the highest severity in the index.