1700773099_12. Flouride and dental fluorosis.pdf

FLUORIDE AND DENTAL FLUOROSIS DENA MOHAMED CPHQ, MPH, MFDRCSI, BDS Fluoride in environment 01 Fluoride metabolism 02 Fluoride administration 03 Fluoride toxicity 04 OBJECTIVES Dental fluorosis 05 Fluoride in environment Fluori...

FLUORIDE AND DENTAL FLUOROSIS DENA MOHAMED CPHQ, MPH, MFDRCSI, BDS Fluoride in environment 01 Fluoride metabolism 02 Fluoride administration 03 Fluoride toxicity 04 OBJECTIVES Dental fluorosis 05 Fluoride in environment Fluoride is found naturally in the earth crust and water chemically bound to minerals and other chemical compounds including fluorspar, cryolite, apatite, mica All water contains fluorides in varying concentrations. Sea water contains significant quantities of fluoride at levels 0.8 – 1.4 mg/lt. In lakes, rivers the fluoride content is usually below 0.5 mg/lt. The highest natural fluoride concentration ever found in water was 2800 mg/lt Fluoride in environment Fluoride in the atmosphere originating from dust of fluoride-containing soils from gaseous industrial waste, from the burning of coal fires in populated areas and from gases emitted in areas of volcanic activity in nature. The principal source of pollution are industries and mining of phosphate and fluorspar Plants absorbs fluoride from the soil. A few species of plants are known to accumulate several hundred parts per million of fluoride, e.g. tea. Tea plant has a fluoride concentration ranging from 3.2 to 400 mg/kg. Fluoride metabolism Fluoride intake The major sources of fluoride are food, drinking water, beverages, and fluoride-containing dental products. The total daily intake of fluoride by adults is 1.7 – 3.3 mg/kg The average daily intake of dietary fluoride by young children whose water supply is optimally fluoridated is approximately 0.5 mg or 0.04 – 0.07 mg/kg per day Fluoride metabolism Fluoride absorption 75 - 90% of the ingested fluoride is absorbed from the stomach and duodenum by passive diffusion. Absorption of fluoride is inversely related to the pH of the gastric content Fluoride metabolism Fluoride absorption The ingestion of fluoride with food retards its absorption insoluble complexes with the presence of calcium, aluminum, and magnesium Calcium fluoride (0.0016% solubility) is virtually insoluble Readily soluble fluoride compounds are completely absorbed Sodium fluoride (4% solubility), stannous fluoride (10% solubility) and sodium monofluoro-phosphate (25% solubility) are highly soluble Fluoride metabolism Fluoride in plasma The fluoride found in plasma in two forms: ionic form (inorganic fluoride or free fluoride) and non-ionic or bound fluoride Fluoride may also be inhaled from air borne fluoride. Peak plasma concentration usually occurs within 30–60 minutes Fluoride metabolism Fluoride in plasma Soft tissues: fluoride from soft tissue could be diffuse back into plasma Fluoride in calcified tissues: Approximately 99% of the body burden of fluoride is associated with calcified tissues (bone and teeth) Fluoride deposition is reversible process Fluoride metabolism Fluoride excretion Absorbed fluoride is excreted primarily via urine Fluoride which not absorbed from stomach is excreted via feces Few percent of absorbed fluoride excreted in sweat Fluoride metabolism Administration of fluoride Systemic administration These circulate through the blood stream and are incorporated into developing teeth Provide a low concentration, over a long period of time Topical administration These are placed directly on the teeth Provide high or low concentrations, over a short period of time Administration of fluoride Systemic administration 1. water fluoridation 2. Salt fluoride 3. Milk fluoridation 4. Fluoride tablets Systemic administration 1. Water fluoridation controlled addition of fluoride to a public water supply Sodium fluoride (NaF), Sodium Silico Fluoride, Hydroflurosilic acid are used in water fluoridation The optimum level is 1ppm. Systemic administration – water fluoridation Community School 01 02 water fluoridation water fluoridation It is the most cost-effective method of It is effective alternative for delivering fluoride to all members of prevention of dental caries in children the community of communities where water WHO recommended a range of 0.5 - fluoridation is not feasible. 1.0ppm for all parts of the world. The fluoride concentration is 4-5ppm It reduces caries by 30 - 65% It reduce caries by 40% Systemic administration 2. Salt Fluoride It is most effective method to deliver fluoride to a target population where water fluoridation is not possible. Sodium fluoride and potassium fluoride are used The concentration of fluoride is 90mg/kg salt Systemic administration 3. Milk Fluoridation Milk is reasonable vehicle for fluoride since it is food used universally by infants, pregnant women, and children. Disadvantages: It is expensive, variation intake and quantity of milk.  Systemic administration 4. Fluoride Tablets It provides systemic effect and topical effect it should be started before 2years of age and continuous for 3-4 years. The amount of fluoride is 0.25mg, 0.5mg, 1mg The correct dosage is based on the concentration of fluoride in drinking water, age, and weight of the child. So, should prescribed by the dentist or pediatrician and not available over the counter Systemic administration 4. Fluoride Tablets Technique: First should be chewed then swish the saliva between teeth for a minute before swallow. provides caries reduction from 60% - 65% Mechanism of action of fluoride in reducing dental caries F incorporate with Ca forming Large crystals are formed with fewer fluoroapatite. This render enamel imperfections. more resistance to acid Bacterial action: bactericidal and Alter deposition of pellicle and inhibit metabolism of carbohydrate by subsequently plaque formation. microorganism. Modification in the size and shape of the teeth: Reducing in the cusp height, fissure depth, thus reduce susceptibility to caries Topical Fluoride INDICATION High caries risk patients (Rampant caries) Patients who have diabetes or take medication that decrease salivary flow Patients who have received radiation therapy to head and neck Administration of fluoride Topical administration 1. Professionally administered i. Sodium fluoride ii. Stannous fluoride iii. Acidulated phosphate fluoride 2. Self administered i. Fluoride varnish ii. Fluoride dentifrices iii. Fluoride mouth rinses Classification of topical fluoride products Professionally administered Applied by dental professionals in the dental clinic High fluoride concentration products ranging from 5.000 – 19.000 ppm is used Self administered Low fluoride concentration products ranging from 200 – 1.000 ppm Fluoridated dentifrices, mouth rinses, and gels Topical administration/ professionally administered 1. Sodium fluoride 2% Fluoride concentration 9.200 ppm 30% caries reduction Accepted taste Recommended ages: 4 weekly applications at ages 3, 7, 11 and 13. Mechanism: Sodium fluoride 2% reacts with hydroxyaptite crystal to form thick layer of calcium fluoride. Topical administration/ professionally administered 1. Stannous fluoride 8% Fluoride concentration 19.500 ppm 32% caries reduction It has no shelf life (has to be freshly prepared before use each time) Application twice per year Metallic taste and it may cause tooth pigmentation and gingival irritation Mechanism: It reacts with hydroxyaptite to produce stannous tri- fluorophosphate which is more resistant to decay. Topical administration/ professionally administered Acidulated Phosphate Fluoride 1.23% (gel) Fluoride concentration 12.300 ppm 28% caries reduction Application twice a year. Bitter taste. Mechanism: It reacts with hydroxyaptite to produce Dicalcium phosphate Dihydrate (DCPD). Topical administration/ self administered Fluoride varnish Types: 1. Duraphat 2. Fluorprotector Varnish is reservoir of fluoride; it increasing the time of contact between enamel surface and topical fluoride agents favors the deposition of fluoapatite and fluorhydroxyapatite Ions get build around the enamel, and keeps on slowly releasing and continuously reacting with hydroxyapptite over a long period of time leading to deeper penetration and formation of fluoraptite. Topical administration/ self administered Fluoride dentifrices The various compounds used in dentifrice are sodium fluoride, stannous fluoride, monofluororphosphate and amine fluoride Most toothpaste contain sodium fluoride or sodium monofluorophosphate as active ingredient, usually in concentration of 1000–1100 mg F/g. Topical administration/ self administered Fluoride dentifrices For children below 4 years of age, non fluoridated and non abrasive toothpaste is recommended After 4 years of age, fluoridated toothpaste should be used. Only very small amount (less than 5 mm) which approximates the “pea size” should be placed on the brush, should be pressed into the bristles and not on top of the brush Topical administration/ self administered Fluoride mouth rinses Practical and effective means for self-application. It is recommended for patients in fluoride deficient communities and in patients with increased caries risk Contraindication: Children under 6 years of age, handicap Method of use: forcefully swishing 10ml of the liquid around the mouth for 60 seconds before expectorating it Toxicity of Fluoride Adult 34-64mgF/kg Lethal dose Children 5mg/kg Salivation, nausea, vomiting, abdominal pain, diarrhea, cramps, cardiac Symptoms arrhythmia, and coma Toxicity of Fluoride 01 Acute toxicity 02 Chronic toxicity due to excessive ingestion of due to excessive ingestion of fluoride over short period of fluoride over long period of time. time This type of toxicity leads to causing skeletal fluorosis and GIT disturbances and death dental fluorosis Toxicity of Fluoride acute toxicity Need immediate treatment Treatment of Reduce absorption by inducing vomiting immediately Reduce bioavailability by oral administration of calcium containing solutions, large amount of lime water, milk or aluminum hydroxide gels Transfer to hospital for endotracheal tube insertion followed by gastric lavage. The treatment depends on the severity of the sign and symptoms Dental fluorosis Dental fluorosis is a cosmetic condition that affects the enamel as a result of the excessive intake of fluoride either through fluoride in the water supply, naturally occurring or added to it, or through excessive other sources. Dental fluorosis The damage in tooth occurs between the ages of 6months to 5years. Fluorosis cannot occur once the tooth has erupted in to the oral cavity, after tooth eruption fluoroaptite is formed Molars and bicuspids are most frequently affected, followed by upper incisors. The mandibular incisors are usually least affected. Fluorosis tends to be bilaterally symmetrical. Dental fluorosis Fluorosis and caries: The risk of dental caries is decreased in mild to moderate fluorosis, while in cases with severe fluorosis shows higher risk of caries Dental fluorosis Sings and symptoms 1. Chalk-like discoloration of teeth with white spots or lines on tooth enamel 2. In more severe cases the affected areas have a yellow or brown discoloration 3. In extreme forms fluorosis may result in a pitted tooth surface Dental fluorosis Depends on the severity Treatment Mild fluorosis; no treatment is needed Moderate to severe fluorosis; Micro abrasion followed by tooth bleaching Conservative composite. Porcelain veneer. crowns Dean’s fluorosis index It developed by H.Trendly Dean (father of fluoridation) Used to assess the degree and prevalence of dental fluorosis Dean’s fluorosis index Procedure method The recording based on the tow most severely affected teeth; 1. If the tow teeth are not equally affected, the score for the less affected tooth is recorded 2. When teeth are scored, the examiner should start at the higher end of index “severe” and eliminated each score or category until he or she arrives at the present condition 3. If there is any doubt, the lower score should be recorded Dean’s fluorosis index Score Criteria Definition 0 Normal Smooth, bright, pale creamy-white translucent surface. No white discoloration of teeth 0.5 Questionable A few white flecks or white spots mainly on the edge of the incisors and cusps 1 Very mild Small opaque white areas covering less than 25% of the tooth surface 2 Mild Opaque white areas covering less than 50% of the tooth surface 3 Moderate All tooth surfaces are affected; a marked deterioration of occlusal surfaces; brown stains may be present 4 Severe All tooth surfaces are affected; discrete or confluent holes; brown stains present Dean’s fluorosis index  THANK YOU ! QUESTIONS