Fluoride 1 PDF

Chapter 15 FLUORIDE Introduction 2  The goal of preventive dentistry is to have a healthy mouth for a lifetime  To achieve this goal, new and recurring disease must be prevented Partners in Prevention 3 ...

Chapter 15 FLUORIDE Introduction 2  The goal of preventive dentistry is to have a healthy mouth for a lifetime  To achieve this goal, new and recurring disease must be prevented Partners in Prevention 3  To prevent dental disease, a partnership must be formed between the patient and the dental healthcare team  Optimum oral health can become a reality when partners work together in a program that includes:  Patient education  Fluorides  Dental sealants  Proper nutrition  Plaque control program Oral Health in Infants 4 Age-Related Pathology- 5 Related Conditions  Both coronal and root caries  Alveolar bone becomes more porous  Increase of gingival recession  Systemic disease and medications causing dry mouth  Salivary gland changes causing reduced saliva flow  Older adults frequently have anemia caused by iron deficiencies resulting in red and burning tongue MN Expanded Functions 6  Application of topical fluoride is an expanded function which may be legally performed by a dental assistant Licensed by the Minnesota Board of Dentistry while under General Supervision of a licensed dentist. The “law” reads, “apply topical fluoride, including foam, gel or varnish.” Fluoride 7  Has been our primary weapon with which to combat dental caries for more than 40 years  Slows demineralization and enhances remineralization of tooth surfaces  Is a mineral that occurs naturally in food and water  A supply of both systemic and topical fluoride must be available throughout life to achieve the maximum cavity prevention benefits Ways of Receiving 8 Fluoride  Prescription-strength fluorides are applied in the dental office  Non–prescription-strength fluorides are sold over the counter for at-home use  Fluoridated water is available bottled or through the community Systemic and Topical 9 Fluoride  Systemic fluoride is ingested in food, water, other beverages, or supplements  The required amount of fluoride is absorbed through the intestine into the bloodstream and transported to the tissues where it is needed  Excess systemic fluoride is excreted by the body through the skin and kidneys and in the feces  Topical fluoride is applied directly to the exposed surfaces of the erupted teeth through the use of fluoridated toothpastes and mouth rinses and topical applications of rinses, gels, foams, and varnishes Topical Fluoride 10 From Darby ML, Walsh MM: Dental hygiene: theory and practice, ed 3, St Louis, 2010, Saunders. 11 Varnish 12 Courtesy OMNI Preventive Care, St Paul, MN. Fluoride Metabolism 13  Ingested fluoride is absorbed through gastro- intestinal tract & blood stream  Fluoride is distributed by plasma to all tissues & organs  Fluoride is particularly attracted to calcified tissues  99% of fluoride is located in calcified tissues  Amount of fluoride stored varies with intake, time of exposure, age & stage of development of individual  Teeth store small amounts with highest levels on tooth surface How Fluoride Works 14  Pre-eruptive development  When fluoride reaches tooth, part of tooth called hydroxyl ion is replaced with fluoride & is now called fluorapatite crystal  Before a tooth erupts, a fluid-filled sac surrounds it  Systemic fluoride present in this fluid strengthens the enamel of the developing tooth and makes it more resistant to acid  Before birth, source of fluoride is from mother’s diet  After birth, source is from child’s diet How Fluoride Works 15  Pre-eruptive development (cont.)  If there is excessive fluoride during this stage, normal activity of ameloblasts may be inhibited & defective enamel may form which can lead to dental fluorosis (mottled enamel)  Sources may include: ingested water, foods, tablets & drops How Fluoride Works 16  Post-eruptive development  After eruption, fluoride continues to enter the enamel and alter the structure of the enamel crystals by  Inhibiting demineralization & enhancing remineralization  These fluoride-enriched crystals are less acid soluble than the original structure of the enamel  Uptake of fluoride is rapid on enamel during first years after eruption  Can receive fluoride both topically & systemically during this period Safe and Toxic Levels of 17 Fluoride  The fluorides used in the dental office have been proven safe and effective when used as recommended  Chronic overexposure to fluoride, even at low concentrations, can result in dental fluorosis in children younger than 6 years with developing teeth  Acute overdosage of fluoride can result in poisoning or even death  Acute overdosage is very rare Mild Fluorosis 18 Moderate Fluorosis 19 Fluoride Precautions and 20 Needs Assessment  To prevent patients from receiving too much fluoride:  Evaluate the patient’s current fluoride intake  Fluoride needs assessment  Saves time by identifying risk factors  Opens communication between the dental professional and the patient  Helps “individualize” patient fluoride therapies  Allows the dentist to more accurately select the appropriate fluoride therapy Sources of Fluoride 21  Fluoridated water  For more than 40 years, fluoride has been safely added to the communal water supply  Most major cities in the United States have fluoridated water, and efforts to fluoridate water in other communities continue  From a public health standpoint, fluoridation of public water supplies is a good way to deliver fluoride to lower socioeconomic populations who may not otherwise have access to topical fluoride products such as fluoridated toothpaste and mouth rinses Fluoridated Water 22  Until recently it was believed that water fluoridation was effective in preventing tooth decay as a result of systemic uptake and incorporation of fluoride into the enamel of developing teeth  It has now been proved that the major effects of water fluoridation are topical, not systemic  Topical uptake means the fluoride diffuses into the surface of the enamel of an erupted tooth rather than being incorporated into unerupted teeth during development Fluoridated Water 23  Approximately 1 part per million (ppm) of fluoride in drinking water has been specified as the safe and recommended concentration to aid in the control of dental decay  This is approximately equivalent to one drop of fluoride in a bathtub of water  The levels of fluoride in controlled water fluoridation are so low that there is no danger of ingesting an acutely toxic quantity of fluoride Fluoridated Water 24  Warmer climates have lower concentrations of fluoride  General public tends to drink more water, resulting in ingestion of more fluoride. Bottled Water 25  Bottled water may not be equal to tap water with regard to dental health  Some bottled waters may contain fluoride; however, most are below the optimal level of fluoride  The amount of fluoride in bottled water depends on:  The fluoride content of the source water  The treatment the source water receives before bottling  Whether fluoride additives were used Sources of Systemic 26 Fluoride  Foods and beverages  Many processed foods and beverages are prepared with fluoridated water  Prescribed dietary supplements  May be prescribed by the dentist for children ages 6 months to 16 years  NOTE: Toothpaste and mouth rinses containing fluoride should not be used as a source of systemic fluoride because with proper use any excess is spit out and never swallowed Fluoride in Tablet Form 27 Sources of Topical 28 Fluoride  Toothpastes  The primary source of topical fluoride  Mouth rinses  Prescription  Nonprescription  Gels  Brush-on or reusable custom tray  Varnish  Painted on the teeth  Professional applications Common Fluoride 29 Preparations  Sodium fluoride (NaF) 2% solution  Characteristics  Relatively stable  Agreeable taste  Non-irritation to soft tissue  Doesn’t discolor teeth or restorative materials  Disadvantages  Used at one-week intervals for 4 weeks at ages 3,7,11,13  Prophylaxis, isolate, then dry teeth, apply fluoride for 3 min Common Fluoride 30 Preparations  Stannous Fluoride 8% solution  Characteristics  Not stable  Must be made up immediately before application  Disadvantages  Disagreeable taste  Astringent  Causes gingival blanching & discoloration of teeth Common Fluoride 31 Preparations  Acidulated phosphate fluoride (APF) 1.23% solution  Characteristics  Available in gel or foam  Preferred because of patient acceptability & greater uptake of fluoride by surface enamel of teeth  Not irritating to soft tissue  Doesn’t discolor teeth or restorations  Slightly astringent  Stored in plastic containers  Single application is applied for 1-4 minutes & is repeated every 6 or 12 months Application Techniques 32  Remove calculus & heavy stain  Fluoride can diffuse through acquired pellicle & plaque  Dry teeth to provide maximum absorption of fluoride  Paint On Technique  Tray Technique  Rinse Technique Paint On Technique 33  Steps  This is done for small children who cannot hold a tray in their mouth  Operator dries teeth and applies fluoride with a cotton tip applicator to all surface for the required amount of time 1-4 minutes  Inform patient to NOT swallow and use saliva ejector to remove excess Tray Technique 34  Steps- Follow steps listed on Evaluation Sheet in Course Guide Rinse Technique 35  Steps  Used on patients who cannot use trays but are able to swish without swallowing.  Not recommended for small children or adult who cannot follow verbal commands  Have patient rinse mouth for required amount of time depending on product. May rinse in two separate procedures if needed Varnish Technique 36  Steps:  Follow instructions listed in Course Guide Post Operative 37 Instructions  Instruct patient not to rinse, eat, drink, brush teeth, smoke or any other activity that could disrupt action of fluoride for at least 30 minutes  Give specific time  Fluoride Varnish- Do not brush until next morning, nothing hard, chewy or sticky for rest of day. Varnish should remain on teeth for 4+ hours Examples of Fluoride 38 Gels and Pastes, and Sodium Toothpaste Training Toothpaste for 39 Young Children From Darby ML, Walsh MM: Dental hygiene: theory and practice, ed 3, St Louis, 2010, Saunders; Colgate products courtesy Colgate Oral Pharmaceuticals, New York; Oral-B products courtesy Procter & Gamble, Cincinnati, OH. Sugar-Free Sodium 40 Bicarbonate Gum Containing Xylitol From Darby ML, Walsh MM: Dental hygiene: theory and practice, ed 3, St Louis, 2010, Saunders.  41 Questions?