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Fluorides in preventive dentistry

y y y y y

Topical fluoride applications Fluoridation Brief note on Fluoride mouthwashes and dentrifices. Dietary fluoride supplements Tray technique for home application of fluorides

What are professional topical fluoride applications? 1. Topical fluorides are used to speed the rate and increase the concentration of Fluoride acquisition above the level, which occurs naturally. 2. Best time to apply is soon after eruption.\

3. Initial caries lesion, characterized by a white spot, is porous and accumulates fluoride at a much higher concentration than sound enamel. 4. Periodic application of fluoride would enable vulnerable enamel sites that are partiall demineralised to accumulate fluoride.

Characteristic 1. Percent fluoride 2. Ppm fluoride 3. Frequency of application

NaF 2%

SnF2 8%

APF 1.23%F

4. Taste 5. Stability

9200 19500 4 at weekly 1 or 2 years intervals at ages 3,7,11,&13 Bland Disagreeable Stable Unstable

12300 1 or 2 years

Acidic Stable in plastic containers No No 28%

6. Tooth Pigmentation 7. Gingival irritation 8. Average effectiveness ( caries reduction)

No No 29%

Yes Occasional transient 30%

Procedures for Topical Fluoride Applications

y A) Preparation of tooth:- Scaling and Polishing of teeth. y B) Application:- 2 methods.

y Cotton roll isolation with paint on gel or Soln. y Trays that over the teeth of each dental arch.

y Apply F for 4 minutes without dilution by Saliva and do not swallow.

1. Paint-On Technique: Soln or Gel

y Seat the patient upright. y Isolate teeth with cotton rolls. y Use high power suction and Dry teeth with air. y Apply quickly F prep for 04 minutes, use timer. y Advise not to rinse, drink for 30 minutes.

2. Tray Technique - Gel

y Type of tray, custom made, thermoplastic. y Seat the patient upright. y Dry teeth. y Insert tray with 2-5 ml gel loaded. y Set timer 4 minutes, high power suction. y Patient not to rinse, eat, drink, brushing for 30 minutes.

y Self Application of Fluoride

y A) Tray Technique. y B) Rinsing. y C) Tooth brushing.

1. Tray Technique
y Rampant caries, hypersensitivity. Xerostomia, Radiation therapy,

y Gel: APF 0.5%, NaF 1.1%, SnF2 0.4% y Use disposable or custom-made polyvinyl tray. y Use tooth brush and floss before applying tray. y Apply for 04 minutes, do not swallow. y Patient not to rinse, eat, drink, brushing for 30 minutes. y Can be used daily, weak prep of F.

2. Fluoride Mouth Rinses

y Gen Prevention of Caries, root exposure, rampant caries, p/denture xerostomia, school dental, health programme. y NaF 0.05% (F contents 0.025%, F-225ppm) y Rinse not to be used by children under 6 years of age. y Rinse daily for 60 seconds with 5 ml after brushing.

3. Oral Rinse Supplements

y A) Acidulated NaF (0.04%), swished and swallowed to provide daily systemic supplement. y B) Can be used for rampant caries and hypersensitivity. y C) NaF 0.2%, use weekly 5 ml for 60 seconds. y D) Weekly rinse in school based programme.

What is fluoridation?
Adjustment of fluoride concentration in the domestic water supply to the optimum physiological concentration that will provide max protection against dental caries and enhance the appearance of the teeth with a minimum possibility of producing objectionable

Brief note on Fluoride mouthwashes and dentrifices.

Dentrifices have been classified as y y therapeutic ( which has cosmetic effects) and cosmetic ( which has therapeutic effects).

FUNCTIONS:

a)Physico-Mechanical Function:
 Usual brushing even when accompanied by flossing leaves a significant amount of plaque in proximal areas, around the necks of the teeth and in the occlusional fissures.  Using tooth brush and dentrifice may reduce the cariogenecity of the remaining plaque by rinshing or flushing action that removes fermentable materials, disrupts the delicate balance of environmental conditions necessary for acid-formation and hence prevent the formation of thicker, more cariogenic plaues.  Using a fluoride containing dentrifice, deposits fluoride in residual plaque thus providing it, when most needed, for the possible inhibition of acid formation and enamel dissolution.

b) Chemical functions:
 Function based on the potential anticaries mechanism of F. it includes reactions mediated thru the deposition of F into the enamel and plaque.  Deposition of the F into enamel as fluorapatite increases the acid resistance of the enamel. Although it is important that this occur in sound enamel, so that it can withstand the attack of acid of a caries attackF from dentrifices is deposited in the

largest amounts in the porous enamel of incipient lesions ( i.e the site where it is most needed.)
COMPOSITION: Generally a mixture of : 1. 2. 3. 4. 5. 6. 7. An abrasion or polishing agent A detergent Humectants Binding or thicking agents Surface active agents Flavouring agents Substances necessary to facilitate their preparation and use.

Mouthwashes: F mouthwashes act by inhibiting the bacterial metabolism and plaque acid formation. Caries are prevented by an efficient delivery of ionic F to the site in adequate concentration and duration. The mouthwash/rinse can be used for patients in F-deficient communities. Mouthwashes are available as NaF rinses, Acidified NaF rinses, Stannous Fluoride rinses. However research has proven that NaF rinses most sufficient cariostatic activity.

Dietary Fluoride Supplements

Most common method of systemic/ dietary supplements are: 1. 2. 3. 4. Fluoride drops with/without vitamins Fluoride tablets with/without tablets Lozenges, intended to be sucked slowly or permitted to dissolve slowly in the mouth Oral rinse supplements ( swish and swallow)

Compounds use are: NaF and APF ( acidulated phosphate fluoride).

Frequency of use of supplements is they should be taken on a daily basis according to the prescribed dosage schedule These dietary supplements are intended for use in: 1. Areas where there are no central water supplies 2. As an interim measure in these communities with a central water system that have not yet implemented community water fluoridation 3. In areas where water fluoridation or salt fluoridation cannot be implemented. 4. In families where there is a high degree of mobility, inv frequent changes in the place of work and where parents wish to ensure daily F supplements themselves. Supplements provide systemic and topical beneficial effects for primary and permanent teeth.