Fluoride Preparations Overview

Fluoride Preparations and Applications Overview

• High potency and low frequency fluoride applications are recommended for specific patient groups and situations.
• Low potency and high frequency applications are recommended for daily use and long-term preventive measures.

Indications for High potency and low frequency Fluoride Applications

• School-based programs in communities with low fluoride levels and moderate to high caries activity.
• Patients with increased caries risk.
• Patients undergoing orthodontic treatment.
• Patients undergoing radiotherapy.

Contraindications

• Children below the age of 6 years.

Fluoride Rinses

• The most commonly recommended concentration for a daily rinsing program is 0.05% neutral sodium fluoride (Low potency, high frequency).
• Weekly rinses with 0.2% sodium fluoride have also been shown to be effective.

Self-Applied Fluoride Gel

• Commonly available in 0.4% stannous fluoride gel and 0.05% APF gel formats.
• Can be applied using a brush or tray.

Fluoride Toothpastes

• Fluoride toothpastes are effective in reducing dental caries.
• Widespread use of fluoridated toothpaste is attributed to the decline in dental caries prevalence in industrialized countries.
• When introduced into the mouth, fluoride in toothpaste is taken directly by dental plaque and demineralized enamel.
• It also increases the fluoride concentration in saliva.
• Toothpaste may be the most important source of fluoride globally.
• Fluoride toothpastes contain various fluoride compounds:
  • Sodium fluoride.
  • Acidulated phosphate fluoride.
  • Sodium monofluorophosphate.
• Adult strength: 1000-1500 ppm.
• Extra strength: 2500 ppm.
• Children's strength: 500-550 ppm.

Fluoride Toothpaste Safety and Usage for Children

• Fluoride toothpastes carry advice that for children under the age of 6 years, brushing should be supervised and only a very small amount (less than 5mm) should be placed on the brush.
• Children under the age of 5 years may ingest more than 0.5 mg fluoride daily from 2 brushings of toothpaste containing 1000-1500 ppm.
• Recommendations for young children:
  • Use low fluoride toothpaste (500-550 ppm).
  • Apply a small pea-sized amount of paste to a child-sized toothbrush.
  • Parents should brush their children's teeth until the child can do it properly.
  • Children should be encouraged to spit the paste out after brushing.

Fluoride Varnishes

• Properties:
  • High fluoride content.
  • Long contact time with the enamel surface.
• Mode of application:
  • Twice a year.
  • 3 consecutive applications within a 10-day period/year for 3 years (high risk).
• Indications:
  • Nervous children.
  • Failed fissure sealant.
  • Children with medical and physical problems.
  • Arresting rampant caries.
  • Reduction of secondary caries activity.
  • Preventive program against root caries.
  • In orthodontic patients.

Fluoride Prophylactic Paste

• Applied using a small brush.
• Leaves a yellow film on the teeth after application.

Titanium Tetra-Fluoride (Ti F4)

• When dental enamel is exposed to an aqueous solution of Ti F4, a glaze layer forms on the tooth surface.
• This glaze layer is a product of the interaction between Ti F4 and proteins on the enamel surface.
• Properties:
  • Hard.
  • Hydrophobic.
  • Reflecting a spectrum of colors.
• 4% Ti F4 treatment is more suitable than 1% because the glaze appears to be more tenacious and thicker after this treatment.
• Titanium Tetra-fluoride has gained recognition in various dental fields:
  • Application on the surface of hypersensitive teeth.
  • Reduced caries formation around fixed orthodontic appliances.
  • Used as a fissure sealant in primary teeth.
  • Protects teeth against erosions caused by strong acids.
  • Effective in preventing dental erosion caused by hydrochloric acid in patients with frequent vomiting or gastro-esophageal reflux.

Slow-Release Fluoride

• Intra-oral devices in the form of copolymer devices or glass devices can elevate salivary fluoride levels for up to 2 years.

Other Vehicles for Applying Topical Fluoride

• Fluoride-releasing fissure sealants.
• Amalgam containing fluoride.
• Composite resin restorations containing fluoride.
• Glass ionomer cement.
• Cavity liners with fluoride.

Fluoride Tablets

• Common tablets include neutral sodium fluoride and acidulated phosphate fluoride.
• Used as lozenges or crushed and chewed for one minute before swallowing.
• Chewing provides topical protection of teeth and systemic benefits.

Fluoride Drops

• Neutral sodium fluoride solutions are used as fluoride drops for infants.
• Dispensed using a dropper.
• Each drop contains about 0.1 mg of fluoride.
• The number of drops is adjusted according to the recommended dosage.
• Drops are placed directly on the tongue or inside the cheeks.
• Dilution in milk, juice, or water is no longer recommended.

Fluoride-Vitamin Preparations

• Recommended when a patient requires both fluoride and vitamins.
• The combined preparation may aid in motivation for continued and regular fluoride ingestion.
• The addition of vitamins has no observable effect on the decay-prevention properties of fluoride.

Dietary Fluoride Preparations

• Salt Fluoridation.
• Milk Fluoridation.
• Flour Fluoridation.

Professionally Applied Fluoride

• Different forms of fluoride are used for professional application, including:
  • Fluoride solutions.
  • Fluoride gels.
  • Thixotropic gels.
  • Fluoride foams.
  • Fluoride varnishes.
  • Fluoride-containing prophylaxis Paste.
  • Slow-released fluoride.

Fluoride Solutions

• Sodium Fluoride Solution (2.0%):
  • 45.0 mg in 5 ml → 9,050 ppm
• Stannous Fluoride Solution (8.0%):
  • 97.0 mg in 5 ml → 19,363 ppm
• Acidulated Fluoride Solution (1.23%):

Advantages of Sodium Fluoride Solution

• Stable in plastic containers.
• Acceptable taste.
• Non-irritating to the gingiva.
• Doesn't discolor or stain teeth.

Knutson Technique

• 4 applications at the ages of 3, 7, and 10 years, with four applications one week apart for each age group.

Advantages of Stannous Fluoride Solution

• More effective in adults than sodium fluoride.
• Can be applied at regular recall appointments of 6-12 months without additional appointments.

Disadvantages of Stannous Fluoride Solutions

• Unstable in aqueous solution and must be prepared daily or weekly.
• Metallic, astringent taste poorly acceptable by children.
• Can cause yellowish-brown pigmentation around carious lesions and composite restorations.
• Can cause gingival irritation and occasional sloughing of diseased gingiva.