Fluoride Treatments PDF

 Intended Learning Skills: Be able to Describe the benefits and indications for topical fluoride application and demonstrate the appropriate procedure for their application in a clinical setting, including the recommended frequency and duration of application. Asse...

 Intended Learning Skills: Be able to Describe the benefits and indications for topical fluoride application and demonstrate the appropriate procedure for their application in a clinical setting, including the recommended frequency and duration of application. Assess the effectiveness of topical fluoride application in preventing dental caries and propose strategies for improving the use and application of topical fluorides based on the latest research findings and best practices. FLUORIDES Methods to Influence the De-/Remineralization Process Fluoride Calcium phosphate CPP–ACP and CPP–ACFP Natural Medicine Laser Nanoparticles  FA CaF Low conc. of free Fluoride ions  Smooth surface Pit and fissures Fluoride and teeth  FLUORIDES CAN BE: SYSTEMICALLY ADMINISTERED TOPICALLY ADMINISTERED  MECHANISM OF ACTION OF SYSTEMIC FLUORIDES The cariostatic mechanism of systemic fluorides can be explained under following headings: 1. Rendering enamel more resistant to acid dissolution. 2. Inhibition of bacterial enzyme systems- enzymatic action. 3. By reducing tendency of the enamel surfaces to absorb proteins. 4. Modification in the size and shape of teeth. The action of fluoride on the enamel. Fluoride incorporation in enamel:. Pre eruptive incorporation. Post eruptive incorporation:. Re mineralisation of acid dissolved enamel  Fluoride administration systemic Topical Dietary fluoride Water fluoridation Professional Self Salt fluoride School water fluoridation application application Fluoride in sugar Milk fluoridation Dietary fluoride Fluoride solution supplements varnish Fluoride drops foam Fluoride drops with vitamins Fluoride drops/lozenges gels Fluoride tablets with vitamins Fluoride sustained release Fluoride devices Fluoride rinse fluoride solution  Indications for topical Fluorides 1. Caries-active individuals i.e. those with past caries experience or those who develop new carious lesion on smooth tooth surfaces. 2. Children shortly after periods of tooth eruption, especially those who are not carries free. 3. Medication to reduce salivary flow or had undergone head and neck radiation. 4. After periodontal surgery when roots of teeth have been exposed. 5. Patients with fixed or removable prosthesis and after placement or replacement of restorations. 6. Patients with an eating disorder or who are undergoing a change in lifestyle which may affect eating or Oral Hygiene Habits conductive to good oral health. 7. Mentally or physically challenged individuals. TOPICAL FLUORIDES topical fluorides 17 DEFINITION Topical fluoride (By Stookey 1990)- Topically applied fluoride is used to describe those delivery systems which provide fluoride for a local chemical reaction to exposed surfaces of the erupted dentition. Flourides 01/10/2024 18 Aim: The aim of topical fluoride therapy is the deposition of fluoride into the surface layer of tooth enamel to form fluorapatite/ fluoridated hydroxyapatite, so as to decrease the caries susceptibility of the tissue. Professionally Applied Fluorides Topical fluoride therapy  PROFFESSIONALLY APPLIED TOPICAL FLUORIDES 20 topical fluorides-Stephen Wei topical fluorides 21 fluoride Solutions  SODIUM FLUORIDE  STANNOUS FLUORIDE  ACIDULATED PHOSPHATE FLUORIDE  Brudevold et al developed APF formula in 1960s Solution Gel APF solution : Method of preparation :  20 gms of NaF is dissolved in 1 litre of 0.1 molar phosphoric acid  To this 50% hydro fluoride acid is added to adjust the pH at 3 & fluoride conc at 1.23% Flourides 01/10/2024 25 APF Advantages of gel over solution  Gel adheres to the teeth and the continuous rewetting of the enamel surface is eliminated  Full mouth can be treated simultaneously, and  Reduction in the time of treatment  APF Gel Method of preparation :  A gelling agent methylcellulose or hydroxy-ethyl cellulose is to be added to the solution and pH is adjusted between 4 – 5  Technique of application :  Prophylaxis  Application of APF gel is done using trays that fit pts U/L dental arches  A disposable foam-lined tray is preferred  Pt is seated upright in chair  Minimum amt of APF gel should be dispensed in tray – 5 ml, custom fitted trays –1 ml  U/L trays are inserted into the mouth and pt is asked to exert slight pressure using light biting forces in order to cause the gel to flow interproximally  The gel is kept in mouth for 4 min  Instructed not to drink, eat or rinse for 30 min  In rare instances :  The fluoride tray may be removed before 4 min  Small amt of APF gel may be painted directly onto tooth surface Advantages :  Acceptable taste due to flavoring  Easy to apply  Can be self applied Disadvantages :  Irritation to gingiva and to open carious lesion topical fluorides 30 Advantages of gel over solution ▪ Gel adheres to the teeth and the continuous rewetting of the enamel surface is eliminated ▪ Full mouth can be treated simultaneously ▪ Reduction in the time of treatment  Mechanism of action : Ca(PO4)3OH + 4H+ 5Ca++ + 3HPO4-- + H2O [hydroxyapatite] [dehydration & shrinkage] Ca++ + 3HPO4-- Ca.HPO4.2H2O (DCPD) [hydrolysis] [ Di calcium phosphate dihydrate] (intermediate product) 5Ca.HPO4.2H2O + F- Ca5(PO4)3F + 3HPO4-- + H+ + H2O (DCPD) [fluorapatite] topical fluorides- Fejerskov 32 CHARACTERSTICS AND EFFECTIVENESS CHARACTERESTI NaF SnF2 APF CS Percent 2% 8% 1.23% ppm F 9,200 19,500 12,300 Frequency of 4 at weekly 1 or 2 / yr 1 or 2 /yr application intervals at ages 3,7,10&13 Taste Bland Disagreeable Acidic Stability Stable Unstable Stable in plastic container Tooth pigmentation No Yes No Gingival irritation No Transient No Average effectiveness 29% 32% 28% topical fluorides 33 Thixotropic Gel Not true gels, viscous sols. Property Advantage Fluoride uptake is comparable with conventional fluoride gel  Fluoride varnish  Discovered by Schmidt in 1964 Method of preparation :  Commercially available  Duraphat, fluorprotector, fluoritop duraflor  The composition includes a carrier comprising a resin an adhesion promoting agent comprising an alkyl phosphoric acid. A fluoride ion source (e.g., a fluoride salt such as sodium fluoride) is dispersed within the carrier so as to provide biologically available fluoride ions to the tooth tissue being treated.  Hypersensitive areas of enamel and dentine. An alternative to fissure sealants on occlusal surfaces of permanent molars for apprehensive children until such time that effective sealant placement can be undertaken. Acclimatization for nervous children. Local remineralization of white spot lesions. As part of a preventive programme for children with active caries in the primary and/or permanent dentitions. A routine preventive measure for medically compromised and other special needs patients. topical fluorides 37 Duraphat ▪ Sodium fluoride in varnish form → 22.6mg F/ml suspended in an alcoholic solution of natural organic varnishes. Modified rosin ▪ Fluoride – 22,600ppm ▪ Should be applied to dry, clean teeth ▪ Hardens into yellowish brown coating in the presence of saliva ▪ Caries reduction – 30-40% in permanent, 7-44% in primary topical fluorides 38 Fluor protector 2% Difluorosilane in a polyurethane-based lacquer Fluoride content 7000ppm Leaves a clear transparent film on the tooth Caries reduction 1%-17%  Pre-application instructions written and/or verbal: advise patient on the purpose, benefits, process, possible side effects and answer any queries recommend the patient eats and drinks normally before attending advise that fluoride supplements should not be taken for two days after the fluoride application. After that, continue as directed advise that the patients’ teeth may appear discoloured temporarily after fluoride varnish application and not to brush until the following morning.  Technique of application :  Prophylaxis  Teeth are dried  A drop of varnish is taken on brush and painted thin on the teeth  Painted first on lower arch & then on upper arch  Pt is made to sit with mouth open for 4 min  Pt is instructed not to rinse or drink or brush teeth for 1 hour  Pt is instructed to take liquids or semisolid food and avoid eating solid food  if a child gets upset or protests during any part of the procedure, then the procedure should be abandoned gently retract the right cheek with your finger or mirror and dry the upper right canine and molars with a cotton roll place the cotton roll in the upper right buccal sulcus holding the roll in place, apply a small amount of Fluoride Varnish to the buccal, palatal, approximal and occlusal surfaces of the molars remove the cotton roll retract the upper lip with a finger. Dry the incisor teeth with a cotton roll apply varnish to the buccal, approximal and palatal surfaces of the canines and incisors  repeat process for whole lower arch ensure all equipment is removed from the mouth. topical fluorides 43 Floss fluoride varnish through the interproximal contacts with care.  Primary dentition: 0.25 mL (6 mg F−). Mixed dentition: 0.40 mL (9 mg F−). Permanent dentition: 0.75 mL (17 mg F−).  Post application instructions advise the patient not to eat or drink for 30 minutes following the procedure. advise to eat soft food for the rest of the day advise that teeth should not be brushed that day but toothbrushing with fluoride toothpaste should resume the following morning fluoride supplements should not be taken for two days after fluoride application. After that, continue as directed advise that the patients’ teeth may appear discoloured temporarily  No. of application : Semiannual application/ at least three times per year for optimal effect. Advantages :  Forms a water tight protective film insulating against thermal and chemical influences  Varnish remains on tooth for several days Disadvantages :  Pt co-operation is required  Expensive  one important basic principle to obtain a good effect: apply fluoride in such a way that fluoride is present at the plaque/ enamel interface where it will control dissolution and stimulate precipitation of minerals during caries challenges  This can be achieved by frequent application of low concentration fluoride solutions or preparations, or less frequent application of high fluoride concentration preparations causing fluoride deposits in or on the enamel that will slowly be released to the plaque– enamel interface. As a general rule the fluoride should match the caries activity of the child; that is, the greater the cariogenic challenge, the more intense the fluoride treatment Fluoride in Prophy Paste ▪ Contains 4,000 to 20,000 ppm ▪ May replace the concentration of fluoride removed by polishing, but does not adequately substitute for fluoride gel or varnish in treating high risk caries patients. Self applied fluoride agents  FLUORIDE DENTIFRICE  Fluoride Mouth Rinse  Fluoride mouth rinse --- simple, well accepted, safe & inexpensive  35% protection against caries  Advantage :  Very low conc of F are associated with much higher level of F in plaque  Low conc of F are sufficient to inhibit glycolysis and acid production by plaque micro-organisms  Repeated exposure to low conc of F effectively promotes remineralization of incipient carious lesion  Recommended for persons with high caries susceptibility  Pts who have orthodontic or prosthetic appliance & those with medical or physical disabilities  Sodium fluoride mouth rinse :  Formulated at conc of 0.2% ( 900 ppm ) for weekly use and 0.05% ( 225 ppm ) for daily use  Rinses are recommended to be used by forceful swishing of about 10 ml of liquid bet the teeth and around the mouth for 60 sec before expectorating Not recommended for preschool children Children in kindergarten should rinse with 5 ml soln  Fluoride Impregnated Dental Floss  For deposition of F on interproximal tooth surface  Gillings --- developed dental floss containing NaF and SnF  Fluoride Chewing Gum  Mean F conc in whole saliva following the ingestion of chewing gum is markedly  Most F release occurs during first 5 mim  At 30 min after ingestion, conc of saliva is 1 ppm  Not recommended in preschool children