TOPICAL FLUORIDE

Presented by-

Dr. ANCHAL CHANDAK

B.D.S ( FINAL YEAR)

CONTENTS

Introduction History Fluoride delivery methods Factor affecting topical fluoride deposition Mechanism of action Method of application Advantages Disadvantages conclusion

INTRODUCTION

fluoride is the ionic form of the element fluorine.

It is the member of the halogen family and it is the most electronegative and reactive of all the elements .

The word flourine is derivd from the latin term “fluore”meaning to flow .

HISTORY OF TOPICAL FLUORIDE

In early 1940’s it was demonstrated that extracted teeth when exposed to dilute solution of fluoride on for few seconds were found to have completely bound fluoride on the enamel surface which subsequently was less soluble than the original enamel surface .

These two fact brought forth the idea of topical application of fluoride solution of dental caries prevention .

In 1941 began the era of topical fluoride when the first clinical study of sodium fluoride was carried out by Bibby using a 0.1% sodium fluoride solution.

In early 1950’s stannous fluoride occupied a central role in the saga of preventive dentistry.

After the discovery sodium fluoride a wide variety of other fluoride compounds were tried like potassium, lead ,

silicon, tin and zirconium.All yielded some cariostatic benefit but stannous fluoride was

found to be 3 time more effective than sodium fluoride

FLUORIDE DELIVERY METHODS

Fluoride can be derived as

A.Topical fluoridesB.Systemic fluorides

Topical fluorides Systemic fluorides These are placed

directly on the teeth. Some preparation

provide high or low concentration of fluoride over a short period of time

These circulate through the bloodstream and are incorporated into the developing teeth.

They provide a low concentration of fluoride over along period of time.

INDICATIONS

Caries active individuals. Children shortly after a period of tooth eruption. Patient with eating disorder or who are undergoing

a change in lifestyle which may affect eating or oral hygiene habits conductive to good oral health.

Mentally and physically challenged individuals. Patient with fixed or removable prosthesis and after

placement or replacement of restorations. Patient with reduce salivary flow due to

medications Patient reciving radiation of head and neck

Factors affecting topical fluoride deposition

Tooth condition

Treatment formulation

Application procedure

TOPICAL FLUORIDES PRODUCTS ARE DIVIDED INTO TWO CATEGORIES

PROFESSIONALLY APPLIED SELF APPLIED

1.Sodium fluoride Toothbrushing dentrifices

2. Stannous fluoride Toothbrushing solutions

3.Acidulated phosphate fluoride

Mouthrinses

4.Fluoride varnishes5.Fluoride gel

SODIUM FLUORIDE – 2 %

METHOD OF PREPERATION:- 9040ppm at pH 7

Sodium fluoride solution can be prepared by dissolving 20 gms of of sodium fluoride powder in 1 litre of distilled water in a plastic bottle.

KNUTSON TECHNIQUE

RECOMMENDED AGES

Full series of four treatment is recommended at ages 3,7,11and13 YEARS

MECHANISM OF ACTION OF NaF

NaF + Hydroxyapatite crystal Calcium Fluoride

CHOCKING OFF

Calcium Fluoride + Hydroxyapatite crystal

Fluoridated Hydroxyapatite

Advantages :- Accepted taste Stable if stored in plastic bottle Non-irritating to gingiva Does not discolor the teeth Inexpensive

Disadvantages : Four visits relatively at short period of time which

is difficult from the patient and parent’s point of veiw

STANNOUS FLUORIDE

It has been used in 8 % and 10% concentrations.

Method of preparation; 19360 ppm at PH 2.1-2.3

A solution of stannous fluoride are not stable . Soon after mixing they become cloudy due to formation of tin hydroxide .

A fresh solution of stannous fluoride be prepared for each patient.

Muhler's technique

Do a thorough prophylaxis Isolate a quadrant with cotton roll and dry the

teeth Apply the freshly prepared 8% stannous

fluoride continuously to the teeth with cotton applicators

Reapply the solution every 15-30 sec ,so that the teeth are kept moist for 4 min.

Instruct the patient not to eat, drink, rinse for 30 sec

Application is recommended once a year

Mechanism Of Action OF STANNOUS FLUORIDE

SnF2+hydroxyapatite Stannous

Tri-Fluorophosphate

Other end products:-1. Tin hydroxyphosphate2. Calcium-tri fluorostannate3. Calcium fluoride

Advantages:- Application required only once per year Rapid penetration of tin and fluoride within 30

sec.

Disadvantages :- Has to be prepared freshly each time before

use Metallic taste Causes gingival irritation Discoloration of teeth Staining of margins of restoration

ACIDULATED PHOSPHATE FLUORIDE- 1.23%

Method Of Preperation [Brudevolds Solution ] :-

By dissolving 20 gms of sodium fluoride in 1 litre of 0.1 M Phosphoric acid.

To this 50% hydrofluoride acid added to adjust the pH at 3.0 and fluoride conc. At 1.23 %.

APF GEL :- A gelling agent methylcellulose is to be added

to the solution and the pH is to be adjusted between 4-5.

MECHANISM OF ACTION OF APF

APF Gel applied on

tooth

Dehydration and shrinkage in volume of

hydroxyapatite crystalsOn Further

hydrolysis intermediate

product dicalcium phosphate dihydrate

(DCPD)highly reactive with

fluoride

Fluoride penetrate

deeply into crystals

through the openings

produced by shrinkage and

leads to formation of fluoroapatite

Advantages-1. Required only 2 applications in a year.2. The gel preparations can be self applied and

thus, cost of application also get reduced.3. It has the ability to deposit fluoride in

enamel to deeper depth.disadvantages-4. Practical difficulties like the teeth should be

kept wet for 4min.5. It is acidic sour and bitter in taste.6. It can be stored in glass container only.

FLUORIDE VARNISHES

Fluoride varnishes are developed in order to increase the retention of topical fluoride on to the enamel for a longer period of time.

Thus, providing an improved cariostatic action.

TECHNIQUE OF FLUORIDE VARNISHES

After prophylaxis teeth are dried but not isolated cotton rolls since, varnish sticks to cotton.

Total of 0.3-0.5 ml of varnish is required to cover full dentition.

Application is first done on lower arch then upper, using single tufted small brush, starting with proximal surfaces.

Patient is asked to sit with mouth open for 4min to let duraphat set on teeth.

Duraphat

This fluoride varnish contains sodium fluoride.

Made by alcoholic solution of natural varnishes

It sets very faster rapidly in the presence of moisture when applied .

It remains on to the applied tooth surface for upto the next 12 hours after application.

Fluoroprotector

It contain 2% difluorosilane. The varnish form is made by

polyurethane lacquer which is dissolved in chloroform .

Sets faster than duraphat

Method Of Application

Oral prophylaxis

Dried the tooth surface

Applied varnish over all the surfaces

Pt. is instructed not to close the mouth and to remain wide open for 4 minutes

Pt is instructed not to eat drink or rinse for 1 hour

SELF APPLIED FLUORIDE

Fluoride dentifrices Fluoride mouth rinses Fluoride gels

FLUORIDE DENTIFRICES

1. High Potency Fluoride Dentifrices (>1000ppm)2. Low Potency Fluoride Dentifrices (< 1000ppm)

Fluoride dentifrices for children are currently widely available in market.

They contain 500ppm

A pea size amount of toothpaste is appropriate for children 2-5 yrs of age

Recommendation for use of fluoride toothpaste

Child age :

Below 4 years: not recommended 4-6 years: once daily by fluoridated

toothpaste 6-12 years: brushing twice daily with

fluoridated toothpaste and once with non fluoridated

Above 12 years: brushing three times with fluoridated toothpaste.

FLUORIDE MOUTH RINSES

They used as an adjunct to fluoride dentifrices for caries control and prevention .

They provide 35% reduction in dental caries

Commonly used fluoride mouth rinses are:-1. 0.2% Sodium Fluoride – 900 ppm (Weekly ) 2. 0.05% Sodium Fluoride – 225 ppm (Daily )3. 0.01% Acidulated Sodium Fluoride At Ph 4 –

45ppm 4. Stannous Fluoride Mouth Rinses

FLUORIDE GELS

Fluoride gel product include neutral sodium fluoride and APF with a fluoride concentration of 5000ppm and stannous fluoride with a concentration of 1000ppm.

The gels are either applied in trays or brushes on teeth.

Self applied once a day or more, while professionally applied given twice a year.

Home fluoride gels are not recommended to children before 2years and younger.

CONCLUSION

Fluoridation is universally accepted by the dentist as being useful in preventing tooth decay.

They can be useful in areas where fluoride concentration is low in water supply.

It helps in maintaining a good oral health.

REFERENCE

1. Essential Of Preventive And Community Dentistry; 11th edition ; Soben Peter.

2. Topical fluoride- Amit Tiwari.3. Textbook of pediatric dentistry; 3rd edition;

Nikhil Marwah.

4. Textbook of pediatric dentistry: 2nd edition; Shobha Tandon