Systemic Use of Fluoride PDF

Systemic Use of Fluoride Associate Prof. Dr. Nurul Asyikin Yahya BDS, MSc, DDPHRCS, PhD Dept. of Fam ily Oral Health, Faculty of Dentistry, UKM January 2024 Lecture Outline Community Water Fluoridation (CWF) Milk Fluoridation Salt Fluoridation Fluoride Supplements Fluoride Sys...

Systemic Use of Fluoride Associate Prof. Dr. Nurul Asyikin Yahya BDS, MSc, DDPHRCS, PhD Dept. of Fam ily Oral Health, Faculty of Dentistry, UKM January 2024 Lecture Outline Community Water Fluoridation (CWF) Milk Fluoridation Salt Fluoridation Fluoride Supplements Fluoride Systemic Use Water Milk Salt Supplements Community Water Fluoridation (CWF) Water Fluoridation Basics The mineral fluoride occurs naturally on earth and is released from rocks into the soil, water, and air. All water contains some fluoride. Usually, the fluoride level in water is not enough to prevent tooth decay; however, some groundwater and natural springs can have naturally high fluoride levels. Community water fluoridation CWF is adjusting the amount of fluoride in drinking water to a level recommended for preventing tooth decay. The artificial and controlled addition of a fluoride compound to a public water supply to adjust its fluoride concentration to an optimal level for preventing dental caries. CWF has been identified as the most cost-effective method of delivering fluoride, reducing tooth decay by 25% in children and adults. Exposure to fluoride in PWS appears highly protective against dental caries and reduces oral health inequalities. Community water fluoridation Benefits: Strong Teeth For children younger than 8, fluoride helps strengthen the adult (permanent) teeth that are developing under the gums. For adults, drinking water with fluoride supports tooth enamel, keeping teeth strong and healthy. The health benefits of fluoride include having: ❖Fewer cavities. ❖Less severe cavities. ❖Less need for fillings and removing teeth. ❖Less pain and suffering because of tooth decay. Cost Savings of Community Water Fluoridation Economic evaluations reaffirm the cost benefits of community water fluoridation. Studies show that widespread community water fluoridation prevents cavities and saves money for families and the health care system. An economic review of multiple studies found that savings for communities ranged from $1.10 to $135 for every $1 invested. Per capita annual costs for community water fluoridation ranged from $0.11 to $24.38, while per capita annual benefits ranged from $5.49 to $93.19.2 A 2016 economic analysis found that for communities of 1,000 or more people, the savings associated with water fluoridation exceeded estimated program costs, with an average annual savings of $20 per dollar invested.3 Additionally, individuals in communities that fluoridate water save an average of $32 per person by avoiding treatment for dental caries. Nationwide, this same study found that community water fluoridation programs have been estimated to provide nearly 6.5 billion dollars a year in net cost savings by averting direct dental treatment costs (tooth restorations and extractions) and indirect costs (losses of productivity and follow-up treatment). Findings indicated that CWF represents an appropriate use of communities’ resources (Mariño and Zaror, 2020). Water Fluoridation Oremove debris both floating on - water suf I submerged in water  Fluoride Used ① Sodium fluoride (NaF) ② Fluorosilicic C - - acid (H2SiF6) · Sodium fluorosilicate (Na2SiF6) C-- ❖ Choice depends on availability, material and shipping cost, solubility, safety, corrosiveness and stability in water. Statement on the Evidence Supporting the Safety and Effectiveness of Community Water Fluoridation by Centers for Disease Control and Prevention (CDC) An effective intervention A cost-saving intervention A safe intervention ‘Halo effect’ Persons in non-fluoridated areas also receive fluoride through beverages and foods processed in fluoridated areas –diminished difference in caries observed between fluoridated and non- fluoridated communities in recent years However, there is still a noticeable difference in dental caries between fluoridated and non-fluoridated communities. – Kumar JV. Is water fluoridation still necessary? Adv Dent Res 20:8-12, July 2008 Multisectoral Collaboration World Health Jabatan Bekalan Ministry of Health State government Organization Air Kementerian Environmental & Syarikat Bekalan Tenaga, Teknologi Local community Occupational Air Hijau dan Air Scientists Engineering Researchers To determ ine the optim um To ensure sustained level delivery To im prove access To m onitor safety Controversy of Water Fluoridation For Against 1 We should have freedom of choice It is unethical, as it is m ass m edication 2 Relatively inexpensive Mainly only benefits children 3 It is the safest way of adm inistering Fluoride is also used as a poison fluoride 4 It is the m ost effective way of reducing There are other m ethods of reducing caries incidence caries incidence 5 It works system ically & topically System ic: natural foodstuffs Topical: topical 6 It  the necessity of extractions under Its toxicity can lead to stom ach upsets, GA, therefore  m ortality rate m ental & physical disability & cat deaths 7 It is particularly beneficial in  caries Can cause fluorosis – im possible to in children of low SES regulate how m uch fluoride children consum e 8 Knox Report & York Review said that Som e experts have argued that it can fluoridated water does not cause cause cancer of the thyroid & bones cancer Milk fluoridation Milk Fluoridation According to O’Mullane et al. (2016), the concept of milk as a vehicle for fluoride emerged in the early 1950s and was first investigated almost simultaneously in Switzerland, the US, and Japan (18). Proposed in 1953 by Dr Ziegler in Switzerland; The first community scheme commenced in 1958 in Switzerland. Since 1986, programs aiming to validate the feasibility of community use of fluoridated milk for caries prevention were promoted and supported by the WHO International Programme for Milk Fluoridation. At present, milk fluoridation programmes, supported by the WHO and Food and Agriculture Organization, are running continuously in about 15 countries. Various channels provide fluoridated milk to children attending kindergarten and school. Milk Fluoridation: Uses and Application Fluoride form s a soluble com plex with the protein fraction of m ilk and is bioavailable after ingestion. Com munity-based m ilk fluoridation program s have been im plemented in several countries, including Bulgaria, Chile, China, Peru, the Thailand UK Russian Federation and Thailand. Fluoride is added to fresh, UHT or powdered m ilk in com munity schem es. One glass of m ilk supplem ented with fluoride is served to preschool and/or school children once daily on school days. China Chile Milk Fluoridation: Uses and Application In general, milk fluoridation is effective in preventing dental caries. To protect and reduce caries in primary teeth, it was recommended that children consume fluoridated milk early on, preferably before the age of 4 years, and at the eruption of their first permanent molars. Milk fluoridation is the addition of fluoride to milk and milk- based products at levels of 2.5 to 5 mg/L. Children are advised to drink around 200 mL of fluoridated milk daily for about 200 days per year. Milk Fluoridation: Effectiveness, Efficacy & Safety Worldwide cohort studies have consistently reported substantial caries reduction, particularly in primary dentition, with a prevented fraction equivalent to 31%. In a review on safety, milk fluoridation was reported to be safe, and the occurrence of mild fluorosis was low. No other adverse effects have been reported, but some children may not tolerate the lactose content of milk. Milk Fluoridation: Cost effectiveness The cost of milk fluoridation programmes is low, with significant savings per averted caries lesion after four years. Costs vary depending on region, availability of product and distribution. Recommendation: – Fluoridated milk is a community-based alternative for children living in countries with limited access to community dental care and/or where water fluoride is not feasible. Milk Fluoridation: Limitations Absorption < water F Lactose intolerance Varying pattern of milk consumption Logistic costs & problems of handling & delivery Inequality in distribution Salt fluoridation Salt Fluoridation: History The addition of fluoride to salt to prevent dental caries began in Switzerland in the mid- 1950s and has expanded to around 50 countries worldwide. The European Union has approved adding potassium fluoride and sodium fluoride to salt for caries prevention, and salt fluoridation programmes are currently available across Europe and South and Central America.  Salt Fluoridation: Use and Application This community-based measure is available for the consumer as table salt for domestic use and also for use in commercial food production. The addition of fluoride to certain brands of salt gives the consumer the choice to supplement their diet or use alternative products. The fluoride content is normally 200-250 ppm F. Children less than three years old have a low intake of salt and are unlikely to benefit from salt fluoridation. Salt Fluoridation: Effectiveness, Efficacy and Safety Although substantial caries reductions (50% or more) in schoolchildren from Latin America have been reported, systematic reviews have graded the confidence in the evidence as very low. It is commonly reported that the effectiveness of salt fluoridation equals that of water fluoridation amongst those who use it. Salt fluoridation is considered safe, with a minimal risk of harm and virtually no increase in the prevalence of enamel fluorosis. The combination of salt fluoridation and water fluoridation is not recommended. Salt fluoridation: Cost-effectiveness Salt fluoridation, like other community fluorides, is cost-effective in school schemes. A cost-effectiveness analysis of seven dental caries prevention programmes among schoolchildren in Chile concluded that salt fluoridation was the most cost-effective when measured as dental caries averted over six years compared to no intervention. Recommendation: – Salt fluoridation offers a freedom–of choice and could be considered an inexpensive and practical alternative where water fluoridation is not socially accepted or feasible. Fluoride supplements Fluoride Supplements: Overview When daily tooth brushing with fluoridated toothpaste is not carried out, or when the caries risk is increased, additional supplemental sources of fluoride may be recommended. Fluoride supplements may come in drops, lozenges, tablets or chewing gums. Most products contain sodium fluoride and are flavoured (mint or fruit) and sweetened by “tooth-friendly” xylitol or sorbitol. The mechanism of action is local rather than systemic. The guidelines for fluoride supplements vary across the world. Fluoride Supplements Tablets Chew or dissolve it in the mouth before swallowing so that the teeth will also absorb the fluoride Drops/Liquid Measure the dose carefully using the specially marked medicine dropper provided and swallow directly Lozenges Place the lozenge in mouth and allow it to dissolve Fluoride Supplements: Dosage Fluoride supplements should be used as prescribed by the dentist. The most common prescription for children is 1-2 tablets or lozenges daily containing 0.25 mg NaF. For adults, lozenges up to 0.75 mg NaF are available. The prescription is determined by age and by the level of fluoride in the local drinking water. Fluoride Supplements: Effectiveness, Efficacy & Safety Evidence of the effectiveness of fluoride supplements is inconsistent, and confidence in the evidence available is very low. Practitioners are encouraged to conduct a caries risk assessment before prescribing fluoride supplements. When fluoride supplements are prescribed, they should be taken daily to maximise the caries prevention benefit. The use of fluoride supplements in infants is controversial due to the risk of dental fluorosis and the total fluoride exposure from other sources must be considered. Fluoride supplements must be stored out of reach of small children. For patients aged three years and above, fluoride supplements are safe across the life course. Fluoride Supplements: Cost-effectiveness There is a lack of contemporary studies concerning the cost-effectiveness of fluoride supplements, and no current comparisons with other self-applied fluorides are available. Poor compliance with fluoride supplements is a serious drawback to their cost- effectiveness. Recommendation: – Fluoride supplements are a preventive option for subjects with increased caries risk. In particular, elderly patients with impaired saliva functions may benefit from fluoride lozenges and chewing gums, which stimulate saliva secretion. – Fluoride supplements are generally no longer a first-choice treatment option in population-based programs. Malaysian Dental Council (MDC) Does not recommend the use of fluoride supplements, salt fluoridation or milk fluoridation There should only be one form of artificially adjusted systemic source of fluorides, which already exists in the form of water fluoridation. Conclusion Systemic fluoridation has proven to be a valuable public health intervention, effectively reducing dental caries in communities. Despite ongoing debates, its demonstrated benefits in promoting oral health underscore its importance as a preventive measure. Continued research and public awareness will contribute to informed decisions on its implementation.