Diagnosis
Diagnosis is clinical, based on visual examination of the enamel. The TF (Thylstrup-Fejerskov) index or Dean's Community Fluorosis Index are used to score severity.
Key diagnostic criteria: bilateral symmetry, horizontal white lines or streaks following the striae of Retzius, entire tooth surface involvement in moderate-severe cases, and history of elevated fluoride exposure during childhood.
Differential diagnosis: white spot lesions from caries (asymmetric, at gingival margin, active); amelogenesis imperfecta (genetic, entire family affected, no fluoride history); molar-incisor hypomineralization (MIH) — demarcated lesions on first molars and incisors, genetic/environmental cause other than fluoride.
Dental history: key questions about location of residence during early childhood, water source, fluoride supplement use, and toothpaste swallowing habits.