Uses of Fluoride in Dental Practices BY: Sulafa El-Samarrai Preventive &pedodontic department
General Mechanisms of Action in Caries Reduction 1-Increase enamel resistance or reduction in enamel solubility Ca10(PO4)6 (OH)2 + 2 FCa10 (PO4)6 (OH)2 + 20 F- Ca10(PO4)6 F2 + 2 OH CaF2 + 6PO43- + 2OH- 2-Re mineralization of incipient lesion 3-Interference with plaque microorganism 4-Improved tooth morphology. Systemic and Topical Fluoride Therapy
Dietary Fluoride Supplements Indications: 1- High risk to dental caries. 2- Medically compromised children. Recommendation: - Co operation of parents. - Non fluoridated area (less than 0.3 ppm). - Bottled water (0.3 0.8).
Fluoridated tablets (drops ). NaF 2.2mg (1 mg F). 1.1mg (0.5 mg) Age Conc. 0-2 yr. 0.25 mg 2-4 yr. 0.5 mg 4- yr. 1.0 mg Drops: 10 drops = 1 mg F/ L = 1ppm
Another Program: - Started at 3 years of age (0.5 mg/day). - Dental caries (0.25 mg/day till 3 years then 0.5 mg /day). Instructions: 1- Given daily (once or twice). 2- Tablets crushed between teeth.
Topical Fluoride Therapy - Newly erupted teeth (post eruptive maturation period). Outer enamel surface. Enhance fixation of fluoride 1- Frequency. 2- Continuously.
Topical Fluoride Therapy Self applied (low conc. Frequently). About 1000 ppm 1- Tooth paste. 2- mouth rinses 3- Gel -once or twice daily. - one or more than one type a day. - Children, adults, elderly
Dentifrices Daily Home Use Sodium fluoride (NaF). Stannous fluoride (SnF2) Sodium monofluorophosphate (MPF) Amine fluoride Combination of NaF and MPF Conc. 525 1450 ppm
Children under 5-year 1- small pea-sized amount of paste. 2- supervision. 3- spitting 4- low conc. 525 ppm. Children above 5-year High conc of Fluoride.
Mouth rinses NaF (0.2%, 900 ppm F) weekly (0.05%, 225ppm) daily Acidified sodium fluoride 0.01% NaF. Stannous Fluoride (100, 200, 250ppm) Others Amine fluoride, ammonium fluoride
Indication of use Primary preventive programs for children and adults In subjects with high risk to dental caries. Patients with rampant caries. Patients with hypo salivations or xerostomia. Patients with sensitive teeth due to tooth wear as (abrasion, attrition, erosion) or because of exposed root. Patients with periodontits and root caries. Patients with orthodontic appliance.
A 10 ml of rinse used by forcefully swishing of liquid around the mouth for one minute then expectorate. should not be given 1- To children under six years of age, as they cannot control muscles of swallowing. 2- Children living in fluoridated area or receiving fluoride supplements.
Fluoridated Gel NaF or APF (5000 ppm). 2- SnF2 (1000 ppm), glycerin based solution. Patients with rampant caries. Patients with xerostomia. Patients with sensitive teeth due to tooth wear as (abrasion, attrition, erosion) or because of exposed root. Root caries.
Used by trays or brush. Expectoration.. 4 weeks course. Not used for children under 6 years.
Professionally applied fluoride Medicaments typically dispensed by dental professional in the dental office to prevent or arrest dental caries The concentration range of fluoride in these agents is 9000 22000 ppm.
Method of application Gels, Solutions, Varnishes, Pumice Paint on technique. Tray technique. Technique 1- Isolation 2- Dryness 3- Application (all surfaces). 4- Expectoration.
Indications Prevention of dental caries (once or twice a year). High risk group and rampant caries (every 3 or 6 months). Initial caries(3 or 6 months) Desensitizing agents (once a week then every 3 6 months)
Patients with Xerostomia ( 3-6 months). Patients with hypoplasia or calcifications (as amelogensis imperfecta or dentionogensis imperfecta). Root caries
Types Neutral Sodium Fluoride Conc. 0.1-2% ( 9000 ppm). Acidulated Phosphate Fluoride Conc. 1.23%, PH 3.2 Stannous fluoride SnF2 8%, 10 %.,
Fluoridated varnishes Slow release or semi-slow release agents. Prolonged exposure time and high fluoride concentrations result in the formation of a large calcium fluoride reservoir. Fluoride release continues for a long time, as for at least 8 hours or even for several weeks according to the type used.
- Duraphate It contains 5% NaF (2.26% F). - Fluor protector 0.9% silane fluoride (0.1% F). -Bifluoride 12 containing 6% NaF and 6% CaF2
1- Cleaning teeth. 2- Apply varnish by brush. Indication - high risk group. - Initial caries even for children under 6 years of age as can be applied on the affected surface only. - Highly indicated for sensitive teeth - Root caries.
Prophylactic paste SnF2 Zirconium silicate. APF Silicon dioxide. Should Not Replaces Topical Fluoride.
Conclusions Fluoride Used systemically and topically to reduce and prevent dental caries. Systemically: Given during period of tooth formation. Topically: Given in the post eruptive maturation period through out life Multiple fluoride therapy.