the diagnosis of chronic fluoride intoxication including the use of serum and urinary fluoride ion levels and a forearm radiograph in the diagnosis of stage ii and iii skeletal fluorosis

The current issue contains a comprehensive review by choubisa of the occurrence, in both humans and animals, in india’s largest state, rajasthan, of endemic hydrofluorosis. the presence of elevated serum and urinary fluoride ion (f) levels and of interosseous membrane calcification on a forearm radiograph may be helpful in making a diagnosis in humans of stage ii and iii skeletal fluorosis, particularly in countries without widespread elevated drinking water f levels where clinicians may have a lower index of suspicion for the condition. illustrative case histories are given of 19 patients, who were heavy consumers of tea or users of fluoridated toothpaste, where the serum and urinary f levels assisted in making a diagnosis of skeletal fluorosis, or probable skeletal fluorosis, in the usa, uk, france, and new zealand. although radiographs of the spine were taken in 9 of the 19 patients, in only 1 patient was the use of a forearm radiograph referred to and greater use might be made of this test in appropriate patients.