Fluorosis known as endemic disease in India is mainly divided into three categories; dental fluorosis, skeletal fluorosis and nonskeletal fluorosis. It is estimated that more than 66 million people are suffering from this disease in 17 among 32 states in its country. According to the survey work by the director of health services in Dharmapuri, the Indian State of Tamil Nadu, approximately 6 million people seem to be classified in severe skeletal fluorosis. However, we doubt this survey performance is based on the plausible evidence.

This time our members of Department of Hygiene and Public Health at Osaka Medical College, Japan were invited to participate in the project as an expert and consultant of fluorosis from the Japan International Cooperation Agency (JICA).

Through our inspection we noticed that the accuracy of medical diagnosis was extremely low and many people were diagnosed as skeletal fluorosis only form their external deformity without having clear diagnostic criteria.

Moreover, the analysis of urinary fluoride, which is essential to diagnosis was not performed at all and no markers of bone metabolism were measured. As a result, the person who was not really skeletal fluorosis was often diagnosed by mistake as a patient of skeletal fluorosis. At present, there is no effective treatment for the skeletal fluorosis except early detection or prevention itself. Therefore the supply of fluoride-free drink water that comes from surface water is an urgent matter in this region.

The output of medical approach in this JICA Fluorosis Mitigation Project Phase2 is expected to improve the diagnostic skill or technique of healthcare workers(doctors, dentists, dieticians and laboratory technicians)for confirming fluorosis. Based on the result of our checklist, however, strengthening medical facilities, maintenance of equipment and training for special tests was not absolutely sufficient.

It should be necessary that the infrastructure for fluorosis diagnosis would be further developed and the equipment of measuring urine and blood fluoride and X-ray images would be better maintained and the technique and training for laboratory technicians would be more enhanced in the future.

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1. Mid-term Overview of Japan International Cooperation Agency (JICA) Fluorosis Mitigation Project Phase 2 (2011) in Southern India            3. Dental Approach
2. Risk of fluoride compounds in the workforce: reports of three occupational exposure cases
3. Mid-term Overview of Japan International Cooperation Agency (JICA) Fluorosis Mitigation Project Phase 2 (2011) in Southern India 1.The Report of the Water Analysis for Fluoride and Trace Elements in Krishnagiri and Dharmapuri Districts, India