-KARAN HIRAL MEHTABDS - III YEAR

DSCDS

What is Fluoride?

• Fluoride is the ionic form of the element fluorine.

• Fluoride is a mineral found throughout the earth's crust and widely distributed in nature.

• Found in soils rich in fluorspar,cryolite,and other minerals.

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Sources

Small amounts:fruits,vegetables,cereals.

Rich amounts:sea foods and tea leaves.

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Chief Source of Flouride.

• Water

• Topical agents (toothpaste).

According to WHO

• Flouridated Salt / Milk

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Distribution of Flourides.

• Teeth and skeleton have the highest concentrations of fluoride.

--Due to the affinity of fluoride to calcium.

• Fluoride content of teeth increases rapidly during early mineralization periods and continues to increase with age,but at as lower rate.

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Use of Flouride.

• Fluoride helps to prevent cavities.

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Summary of Anti-Caries Activity of Fluoride.

• Fluoride prevents demineralization.

• Fluoride enhances remineralization.

• Fluoride alters the action of plaque bacteria.

• Fluoride aids in posteruptive maturation of enamel.

• Fluoride reduces enamel solubility.

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Fluoride prevents demineralization.

• Formation of fluorohydroxyapatite (FAP).

• Inhibition of mineral loss from enamel.

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Fluoride enhances remineralization.

• formation of a fluoride reservoir.

• creation of supersaturated solutions.

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Fluoride alters the action of plaque bacteria.

At low pH, fluoride combines with hydrogen ions and diffuses into oral bacteria as hydrogen fluoride (HF)

Inside the cell HF dissociates, acidifying the cell and releasing fluoride ions

Fluoride ions inhibit glycolysis

As fluoride is trapped inside the cell this becomes a cumulative process

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Prevention of cavities by Flouride.

Two different ways:

• Fluoride concentrates in the growing bones and developing teeth of children, helping to harden the enamel on baby and adult teeth before they emerge.

• Fluoride helps to harden the enamel on adult teeth that have already emerged.

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Fluorides Delivery Methods

Application Types of Flourides.

• Topically (On the surface).

• Systematically (Throughout the body).

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TOPICAL FLUORIDES:

Definition: The term “topically applied fluorides” is used

to describe those delivery systems which provide fluoride

for a local chemical reaction to the exposed surfaces of

erupted dentition.

INDICATIONS

1.Caries active individuals

2.Children shortly after periods of tooth eruption,

especially those who aren’t caries free.

3.Those who take medication that reduce salivary flow or

radiation therapy.

4.Post periodontal surgery when roots are exposed.

Topical Fluorides products can be divided into two broad categories:-

Professionally Applied Fluorides Product

Self Applied Fluorides Products

Professionally applied topical fluorides:

It was introduced by Bibby in 1942.

Involve the use of high fluoride concentration products

ranging from 5000-19,000ppm, which is equivalent to 5-

19 mgF/ml.

Self applied products:

Include fluoride dentifrices, mouth rinses & gels

Are low fluoride concentration products ranging from

200-1000ppm or 0.2-1 mgF/ml.

Topical fluorides are divided into two categories:

Topical Flouride Sources.

• Toothpaste.

• Mouthrinses.

• Professionally applied gels, foams, rinses.

• Our own saliva.

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• Toothpaste :- Brushing.

• Mouth Rinses :- Gargling.

• Foams :- Professionally used & are put into a mouth guard.

• Gels :- Can be painted on or applied via a mouth guard.

PROFESSIONALLY APPLIED

TOPICAL FLUORIDES:

1.FLUORIDE VEHICLES:

Aqueous solutions & gels

The gel adheres to teeth &

eliminates the continuous wetting

of enamel surfaces required

when solutions are used.

Thixotropic solutions are not

gels, but have a high viscosity

under storage conditions &

become fluid under conditions of

high stress

FLUORIDATED

PROPHYLACTIC PASTES:

If prophylaxis pastes

containing fluoride are used,

the lost fluoride is

replenished & there is a

significant gain in the

concentration of fluoride.

FOAM:

Developed to minimize the risk of fluoride over dosage

as well as to maintain the efficacy of topical fluoride

treatment.

Advantages :

Its lighter than a conventional gel & therefore only a

small amount of agent is needed for topical application

The surfactant has cleansing action by lowering surface

tension, this facilitates the penetration of material into

interproximal surfaces.

It doesn’t require suctioning so it offers advantages for

home use

FLUORIDE VARNISH:

Increasing the time of contact between enamel surface & Topical

fluoride agents favors the deposition of fluorapatite &

fluorhydroxyapatite.

DURAPHAT:

It s a viscous yellow material, containing 22,600 ppm fluoride as

sodium fluoride in a neutral colophonium base.

FLUORPROTECTOR:

Its a clear polyurethane based product containing 7000 ppm

fluoride from difluorosilane.

Its dispensed in iml ampules each ampule containing 6.21mgof

fluoride.

CAREX:

It has low fluoride concentration than duraphat & has equal efficacy to

that of duraphat as caries preventive agent.

• FLOURIDE APPLICATION • FLOURIDE VARNISH

Flourided Toothpaste.

• Important component of toothpaste

• Protects the tooth by making the enamel harder.

• Toothpastes are classified as drugs, not cosmetics.

• Level of fluoride must be carefully controlled and measured accurately.

• Introduced around the world in the mid 1950s.

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Protection by Saliva.

• After you eat, your Saliva contains acids that cause demineralization.

• At other times when your saliva is less acidic it does just the opposite, replenishing the calcium and phosphorous that keep your teeth hard. This process is caused remineralization.

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Topical Applications.

Helps to Prevent.

• Cavities by strengthening the surface of the teeth (the enamel).

• Reducing the ability of bacteria contained in dental plaque to produce acid.

• Re-mineralizing existing dental cavities.

Fluoride can actually heal small cavities in some cases, and prevent the need for dental fillings. 26

Topically fluoride application by a Dentist , Dental Hygienist or anyother Dental Auxiliary has become an established Caries-Preventive

Procedure in the Dental History. The three agents currently used asprofessionally applied fluorides are:-

1. Neutral Sodium Fluoride (NaF)

2. Acidulated Phosphate Fluoride (APF)

3. Stannous Fluoride (SnF2)

The fluoride may be used in an aqueous solution, a viscous gel, aprophylactic paste or as a dental varnish and can be applied using thePaint on Technique or the Tray Technique.

TOPICAL FLUORIDES USED IN PREVENTIVE

DENTISTRY:

1.SODIUM FLUORIDE:

2.STANNOUS FLUORIDE

3.ACIDULATED PHOSPHATE FLUORIDE

4.AMINE FLUORIDE

NEUTRAL SODIUM FLUORIDE

A minimum of four applications with a 2% sodium fluoride

solution gives a caries reduction of 30%.

METHOD OF PREPARATION:

It is prepared by dissolving 20 gms of NaF powder in 1L of

distilled water in a plastic bottle

KNUTSONS TECHNIQUE:

At the initial appointment teeth are cleaned with pumice slurry &

then isolated with cotton rolls & dried with compressed air.

Using cotton-tipped applicator sticks ,the 2% NaF is painted on

air dried teeth so that all tooth surfaces are visibly wet. The

solution is allowed to dry for 3-4 min.

This procedure is repeated for each of the isolated segments

until all the teeth are treated.

A 2nd, 3rd and 4th fluoride application, each not preceded by a

prophylaxis, is scheduled at intervals of approximately one week;

The four-visit procedure is recommended for ages 3, 7, 11 and 13

years, coinciding with the eruption of different groups of primary

and permanent teeth.

Advantages of neutral sodium fluoride solution :

It is relatively stable when kept in a plastic container;

The taste is well accepted by patients;

The solution is non-irritating to the gingiva;

It does not cause discoloration of tooth structure;

The series of treatments must be repeated only 4 times in the

general age range of 3 to 13, rather than at annual or semiannual

intervals.

Disadvantage of neutral sodium fluoride solution :

The major disadvantage of the use of sodium fluoride is that the patient

must make 4 visits to the dentist within a relatively short period of

time.

STANNOUS FLUORIDE : (SnF2) :

Stannous fluoride has been used at 8% and 10% concentrations

Method of preparation of stannous fluoride solution :

Solutions of stannous fluoride are not stable. Soon after mixing

they become cloudy due to the formation of tin hydroxide.

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

To prepare 8% stannous fluoride solution, the content of one

capsule which is 0.8 grams (‘0’ No. of gelation capsule) is dissolved

in 10 ml of distilled water in a plastic container.

Technique of application (Muhler’s technique) :

1. Each tooth surface is cleaned with pumice or other dental

cleaning agent for 5 to 10 seconds;

2. Unwaxed dental floss is passed between the interproximal areas;

3. Teeth are isolated and dried with air;

4. Stannous fluoride is applied using the paint-on technique and the

solution is kept for 4 minutes. Repeat applications are made

every 6 months or more frequently if the patient is susceptible to

caries.

Advantages of stannous fluoride :

Using an 8% stannous fluoride solution at 6 to 12 months

intervals conforms to the practicing dentist’s usual patient –

recall system;

Administrative difficulties are avoided.

Disadvantages of stannous fluoride :

1. In aqueous solution the material is not stable;

2. 8% solution is quite astringent and disagreeable in taste, its

application is unpleasant;

3. The solution occasionally causes a reversible tissue irritation

manifested by gingival blanching;

4. Causes pigmentation of teeth which has a characteristic light

brown colour

ACIDULATED PHOSPHATE FLUORIDE (APF) :

Method of preparation of acidulated phosphate fluoride :

An aqueous solution of acidulated phosphate fluoride is

prepared by dissolving 20 grams of sodium fluoride in 1 liter

of 0.1 M phosphoric acid and to this is added 50%

hydrofluoric acid to adjust the pH at 3.0 and fluoride ion

concentration at 1.23%. It is also called as Brudevold’s

solution

For the preparation of acidulated phosphate fluoride gel, a

gelling agent methylcellulose or hydroxyethyl cellulose is

added to the solution.

Technique of application :

Acidulated phosphate fluoride is recommended for application at 6 or 12

months intervals.

Oral prophylaxis is done;

The teeth to be treated are completely isolated and thoroughly dried

with air;

Clinical application of APF gels should be done using trays that fit the

patient’s upper and lower dental arches. A disposable foam-lined tray

is preferred;

To reduce ingestion of fluoride, a minimum amount of fluoride gel that

will permit complete coverage of the tooth surfaces should be

dispensed;

After the trays have been properly positioned saliva ejector is used to

evacuate the stimulated saliva and excess fluoride;

It is reapplied every 15-30 seconds so as to keep the teeth moist with

the fluoride solution throughout the 4 minute period;

The patient is instructed not to eat, drink or rinse his mouth for at least

30 minutes.

FLUORIDE TRAYS

Advantages of acidulated phosphate

fluoride

Requires only 2 application in a year;

The gel preparation can be self applied and

thus the cost of application also gets

reduced;

It has the ability to deposit fluoride in

enamel to a deeper depth;

Disadvantages of acidulated

phosphate fluoride : Practical difficulties like the teeth should be

kept wet for for 4 minutes;

It is acidic, sour and bitter in taste;

It cannot be stored in glass containers.

Comparison

Characterstics Sodium Flouride(NaF)

Stannous Fluoride(SnF2)

APF

Percentage 2% 8% 1.23%

Fluoride concn.(ppm) 9,200 19,500 12,300

pH Neutral 2.4 - 2.8 3.0

Frequency of Application 4 at weelky intervals3,7,11,13 yrs

Biannually Biannually

Adverse effect - Tooth pigmentationGingival irritation

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Caries reduction 30% 32% 28%

Recommendation For Topical

Fluoride ApplicationAccording to Lecompte (1987), the recommendation for Topical Application of

high potency fluorides are:-

1. Not more than 2gm of gel per tray or approximately 40% of tray capacity should be dispended. Even more conservative amount should be considered for small children.

2. To prevent the swallowing of saliva during 4 min topical application , use of Saliva Ejector is recommended.

3. Following the 4 min of application procedure, the patient should be instructed to expectorate thoroughly for 30 sec-1 min, regardless the use of suction cause the Expectoration is the only single most effective way of reducing orally retained fluoride.

4. When utilising custom individually fitted trays for patients requiring daily or weekly application of a high fluoride concentration product utilise only 5-10 drops of products per tray.

SELF-APPLIED TOPICAL FLUORIDES

It includes:

Dentifrices

Mouth rinses

Gels

DENTIFRICES:

The active agent was NaF which had been added to a

conventional dentifrice containing dicalcium phosphate

as the abrasive.

FLUORIDE MOUTH

RINSES:

Mouth rinsing is a practical

and effective means for self-

application of fluoride.

Persons excluded from the

practice are :

1. Children under 6 years of

age;

2. Those of any age who

cannot rinse because of

oral-facial musculature

problems or other

handicap.

Method of use :

1. Rinse daily with 1 teaspoonful (5 ml) after brushing

before bed;

2. Swish between teeth with lips tightly closed for 60

seconds; expectorate.

Flouride rinses can be used as daily mouth rinse by

community and fortnightly in schools.

Advantages :

30-40% average reduction in dental caries incidence.

Disadvantages :

Requires community participation.

Dental fluorosis?

• Dental fluorosis is a developmental disturbance of dental enamel caused by excessive exposure to high concentrations of fluoride during tooth development.

• Due to Inappropriate use of fluoride-containing dental products.

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When fluoride appropriately used, is safe and effective agent that can beused to prevent and control dental caries. Fluoride has been contributing toimprove the dental health of persons all over the world. Fluoride is neededregularly to prevent and protect the teeth from being decayed.

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