TOPICAL FLUORIDES

Vanitha Elavarasi. JCRI

SELF APPLIED TOPICAL APPLICATIONS

• FLUORIDE DENTIFRICES• FLUORIDE IMPREGNATED DENTAL FLOSS• FLUORIDE RINSES• SUSTAINED RELEASE FLUORIDE

Fluoride Dentrifices • Contains between 1000 and 1500 ppm fluoride formulated

from either sodiumfluoride or sodium mono-fluorophosphate.• Used regularly two or three times a day,they provide a

frequent source of fluoride in low concentration that can inhibit demineralization and remineralization

Precautions to be considered while using fluoride dentrifices

• Pre-school age children should be supervised while brushing to avoid ingestion of excessive amount of paste.

• Only a pea sized amount of dentrifice should be used by six years of age or below

• A ribbon of dentrifice that covers the bristles• of an adult sized toothbrush contains about one gram of

dentrifice.

• Atleast one brushing with fluoride toothpaste should be done just before bed time, placing fluoride in the mouth prior to a period of low salivary flow thus prolonging fluoride availability.

Fluoride impregnated dental floss• Dental floss is an essential part in the plaque control in the

interproximal enamel surface.• If the interproximal surfaces receive the benefit of additional

fluoride dental flossing, this may increase it’s value as a caries preventive aid.

• Because of the unknown sample size and the lack of clinical size and date no definitive conclusions about this cariostatic effect could be made.

Fluoride rinses• Fluoride mouth rinses for school based health programs or in

home are currently popular as a simple way to expose the teeth to fluoride frequently.

• The early trial with neutral sodium fluoride, acidulated phosphate fluoride,and stannous fluoride and stannous fluoride rinse proved to reduce caries by 20 to 50 percent

Amount of fluoride in self applied fluoride rinses• Usually non –prescribed fluoride mouth rinses contain 0.05%

(about 225 ppm).• Prescription fluoride rinses generally contain 0.2% NaF (about

900 ppm)• They are designed to be used under supervision, once a week

for one minute.

Sustained released fluoride• Constant exposure of teeth to low levels of fluoride has found

to be more effective in reducing caries by remineralization of incipient caries lesion.

• Objective –to provide a regular release of fluoride slowly intra-orally for longer period.

• A number of dental materials containing fluoride have been develop as cements, acrylics and resins while intra-oral devices used are copolymer membrane beads and glass pellets.

Fluoride Toxicity• Dental fluorides occurs in human being consuming drinking

water containing 2.0mg/lit or more of fluoride particularly during first eight year of life .

• Skeletal fluorosis can occur if water contains more than 4ppm fluoride and is consumed regularly.

Acute toxicity• The amount of 35 to 70mgF/kg bodyweight of soluble fluoride

is said to be lethal. This is equivalent to 5 to 10 gms of sodium fluoride for an adult weighing 70 kg or about 1.0 to 2.0gm sodium fluoride for a child of 15 kg.

Chronic toxicity• Chronic toxicity is due to a long term ingestion of a smaller

amount of fluoride which usually effect the hard tissue and kidney

Defluoridation• Defluoridation is a scientific means to improve the quality of

water with high fluoride concentration by adjusting the optimal level in drinking water.

• To reduce the fluoride concentration to less than 1mg/L which is suitable for health in drinking water.

Indian technology for defluoridation

• Nalgonda Technique:• This technique first developed in India in 1975, is the most

simplest, the least expensive and the easiest to operate.• The first community plant for removal of fluoride from

drinking water was constructed in the district of Andhra Pradesh,in the town of Kathri,thus the name of technology.

Procedure

Raw water is mixed with adequate lime and alum. The amount of lime depends on the alkalinity of the raw water. If the raw water has adequate alkalinity,the lime addition is not required. Alum solution,is added after the addition of lime, stirred gently for 10 minutes and the flocs are allowed to settle. The process of floc formation , and settling requires an hour.

Topical applications• Fluoride agents in clinics: • NaF• SnF2• Knutson and Feldman technique(1948)• Clean and polish the teeth in only the first of four applications.• Isolate the upper and opposing lower quadrant with cotton

rolls.

• Sodium fluoride is applied.• The teeth are kept in contact with the solution for a period of

3 to 4 minutes.• This four- visit procedure is recommended at • the ages of 3, 7, 11,and 13 years. • Preparation: • 2gms of fluoride to be dissolved in 100 ml of water.

• Advantages: Sodium fluoride is chemically stable. Non-irritating. No discoloration. Has acceptable taste. Disadvantage: Four successive visits are required in short intervals.

Acidulated phosphate fluoride gel• Introduced by Brudevold in 1960. • Brudevold developed a solution , which was acidulated with

orthophosphoric acid and buffered to a pH of 3. • Technique of application: • 1. Solution• 2. Gel• 3. Foam

• APF gel is applied by tray method. • 5 ml of the gel is placed onto disposable foam lined trays. The

patient is asked to exert slight pressure with his cheeks and tongue.

• Simulation of biting movements is done. The gel being thixotropic flows into the interproximal area on application of pressure. Use of saliva ejector is mandatory.

Fluoride varnishes

• Fluoride varnishes were developed with the idea of prolonging

contact of fluoride with enamel and in order to have a slow release mechanism, which would release fluoride when most needed.

• Duraphat. • Fluorprotector.

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