Fluorosis is extensively prevalent in India and is a core problem of public health concern. Around six million Indian population is poorly affected because of fluorosis. At Several places in our country, groundwater is richly supplemented with fluoride and large numbers of Indian population depends on groundwater for various purposes. Ingestion of very high levels of fluoride over a longer period of time fallouts in dental as well as skeletal fluorosis depending on years he stayed in particular endemic area. Initial symptoms of exposure to high quantity of fluoride include, burning sensation and aches in hand and feet, stiff joints, weak muscles, decreased appetite, gastrointestinal problems and weight loss. In the later stages, long bones usually affected with osteoporosis and calcification of the bones also occur. In further stages, bones and joints become weak making movement of person difficult and tender. Fusion of vertebrae is a common finding in several areas of spine particularly in the cervical areas of spine. In more severe cases spinal canal becomes narrow with calcification of the neural arch and intervertebral foramina. Late manifestation of skeletal fluorosis results in “Poker back” spine where the whole spine seems as one continuous column of backbone. In the last stage, the patient is crippled. In a routine orthopedics outpatient department majority of patients complain about pain in joints, chronic fatigue and stiffness of joints etc. and quite often for these complaints consultant prescribe opioids, NSAID and other anti-inflammatory and analgesics drugs as management. These patients also comprise those patients who are also suffering from skeletal fluorosis. So, these patients are getting symptomatic treatment. There are many clinical symptoms of skeletal fluorosis that mimic to arthritis and other skeletal disorder hence skeletal fluorosis could be easily misdiagnosed. Fluoride level estimation in urine can be estimated easily that gives an idea of patient affected with skeletal fluorosis. Dental fluorosis can be an indicator for skeletal and non-skeletal fluorosis.