Differential diagnosis of dental fluorosis

Differentiating between fluorotic and non-fluorotic defects of dental enamel is an important diagnostic decision in epidemiology and public health dentistry. The commonly accepted diagnostic criteria for fluorosis discriminate between non-discrete symmetrical and asymmetrical distributions of opacities of dental enamel. These criteria appear to identify most cases of dental fluorosis. However, it is not yet confirmed that the pattern and distribution of dental fluorosis are a unique phenomenon. Metabolic, physiological, other trace elements, and malnutrition have been reported to induce bilateral symmetrical developmental enamel opacities. Misdiagnosis of non-fluoride-induced opacities remains a possibility. Reports of unexpectedly high population prevalence and individual cases of fluorosis, where such diagnoses are incompatible with the known fluoride history, indicate the need for a more precise definition and diagnosis of dental fluorosis. A more discriminating diagnostic procedure is recommended. This calls for a positive identification of the levels of fluoride available to communities and individuals before a diagnosis of fluorosis is confirmed. We believe a more critical approach to the diagnosis of fluorosis will be helpful in the rational use and control of fluorides for dental health, and in the identification of factors associated with inducing developmental defects of enamel.