• The Foundation's Fluorosis Diagnostic Facility is one of its kind in India catering to a large number of the public / patients referred to by the Clinicians from various hospitals in the country.
• The Facility assists the public / patients / Clinicians in the proper diagnosis of Fluorosis and its management.
• The Facility besides being a National Facility, has also emerged as a Global Consultation Centre.
• Large number of patients suspected of fluoride poisoning / or suffering from Fluorosis, consult the Facility through " Internet / E-mail".
• The Facility offers not only early detection of the disease but also management of Fluorosis through appropriate Interventions.

---

ESSENTIAL TESTS :

---

While suspecting Fluorosis, it is mandatory to get the disease correctly  diagnosed.

1. A requisition form/slip should be send to the hospital/laboratory for testing fluoride content in (1) serum, (2) urine and (3) drinking water/water used for consumption. The fluoride content in the 3 samples should be assessed as essential tests for correct diagnosis of Fluorosis.

2. Spot sample of urine drawn any time during the day should be fine. Fasting and / or 24 hour urine sample not required

3. Patient should be informed to collect the sample in a plastic bottle/vial and not glass bottle. [ why glass bottle should not be used is for the reason: fluoride binds  with silica in the glass  and would lead to erroneous results. One molecule of silica can bind with 6 ions of fluoride (SiF6)]. When testing for fluoride, the free fluoride ions are tested. If fluoride is bound with silica, the sample would provide erroneous results.

4. Besides fluoride levels, for final diagnosis, a fore-arm X-ray Radiograph is also necessary to assess whether interosseous membrane is calcified or not.  Fore-arm X-ray radiograph is the best though there is no pain. It would reveal very early or late stages of calcification of interosseous membrane calcification along the margin of the two bones lying parallel in the forearm.

Normal reference range for Fluoride:
Urine = 0.1-1.0 mg/l
Serum = 0.02 - 0.05 mg/l    
Drinking Water = 1.0 mg/l upper limit; less the better as fluoride is injurious to health

---

FOR DENTAL FLUOROSIS :

---

Diagnosis of Dental Fluorosis from Dental Caries.

• Unlike Dental Fluorosis Dental Caries is a bacterial disorder.
• Dental Caries also reveal discoloration of teeth; but unlike Dental Fluorosis, the discolouration in Dental Caries may be brown with no pattern.
• Unlike Dental Fluorosis, Dental Caries shall reveal prominent cavities visible to the naked eye. The acids produced by the bacteria shall chew-up the teeth; only the stub of the teeth shall remain towards later stages.
• The cavities in Dental Caries shall begin between two teeth or near the base of the crown, closer to the gums where the tooth brush does not reach and food debris collects enabling the bacteria to breed and produce acids.
• A typical set of teeth with Dental Fluorosis & Dental Caries seen below

Dental Fluorosis	Dental Caries

Note: Fluoride has very little role to play in rectifying cavities; except it can kill the bacteria so that no acids are formed. The same fluoride does more damage to tissue enzymes and therefore diseases surface. Using fluoride for preventing Dental Caries is an out-dated and unethical concept.

Diagnosis of Dental Fluorosis from dirty teeth.

• In Dental Fluorosis the discolouration will be on the enamel surface
• In the child shown below, the teeth of the upper jaw, the two central incisors have discolouration horizontally aligned on the enamel surface, away from the gums. It is due to Dental Fluorosis and is a permanent feature of the teeth.

• In dirty teeth there will be discolouration of all shades but the discolouration will be along the gums (masuda) and not on the enamel surface.
• The dirty teeth can be cleaned and polished by a Dentist; but not in Fluorosis.
• Whereas in the teeth of the lower jaw, there is discolouration along the gums and is due to dirty teeth, which can be cleaned by a Dentist.

---

FOR SKELETAL & NON-SKELETAL FLUOROSIS :

---

Fluorosis Diagnostic Tests: In Adults
Fluoride to be tested in

• • Drinking Water ( to collect in plastic bottle only )
  • Blood (Serum) [ fasting not required ]
  • Urine (spot urine sample)
• Radiograph of the fore-arm
• Hemoglobin

In Children
Tests :

• Fluoride in • drinking water of the child / OR if an infant or new born, the drinking water of the mother.
• Blood (serum) of the child; if an infant or new born, the blood serum of the mother
• Urine of the child / infant

Additional tests :

• Thyroid hormone levels T3 and T4
• Thyroid Stimulating Hormone (TSH)
• Iodine in urine

In Industrial workers

Fluoride to be tested in:

• Drinking water
• Blood (Serum)
• Urine & urinary pH
• Nail clippings
• Hemoglobin
• Retrieval of health complaints
• Retrieval of information related to food habits