Lecture 1 (22-10-2024) Topical & Systemic Fluorides PDF

Fluorides in dentistry Lecture 1 22-10-2024 By Prof. Dr. Hamida Abobakr Adel  I- Community water fluoridation Definition: Fluoridation is the adjustment of content of public water supply to the optimum concentration which will provide maxim...

Fluorides in dentistry Lecture 1 22-10-2024 By Prof. Dr. Hamida Abobakr Adel  I- Community water fluoridation Definition: Fluoridation is the adjustment of content of public water supply to the optimum concentration which will provide maximum protection against caries without damage to teeth or other structures. Depending on : i. Annual mean of maximum daily air temperature of an area. ii. Average water consumption per person per day. In hot climate water consumption is greater the concentration of fluoride must be less. It varies from 0.7 – 1.2 ppm. In hot In cold climate climate Recently, from 0.5 – 1.0 ppm.  Chemicals used in water fluoridation 1- Calcium fluoride :cheap, has a low solubility , but, large amounts of salts are required to give 1 ppm. 2- Sodium fluoride : most expensive. 3- Sodium silicofluoride: most economic. 4- Dihydrofluoride: the only compound in a liquid form.  Advantages of water fluoridation: 1.Its high degree of effectiveness in the reduction of dental caries. 2. Its safety. 3. Its ease of implementation. 4. Its low cost per person. Defluoridation  II- Fluoridation of school water supply Limitations of school water fluoridation 1. The children are already 6 years of age when they begin to attend school & some of their teeth such as incisors and 1st molars have already been calcified. 2.They drank water only when school was in session i. Nine-ten month/year. ii. Five-six days/week. iii. six-eight hours/day. The recommended optimum level of school water fluoridation = 4.5 times the level indicated for community water fluoridation. It prevents caries by about 40%. III- Fluoride supplements Fluoride supplements are in the form of : 1) fluoride tablets &lozenges. 2) fluoride drops. 3) fluoride-vitamin preparation.  Current fluoride daily dosage Supplemental fluoride dosage schedule Fluoride in Home Water (ppm) between Age Less than 0.3-0.5 More than 0.5 0.3 Birth to 6 mo. 0* 0 0 6mo. to 3 yrs. 0.25 0 0 3 yrs to 6 yrs. 0.50 0.25 0 6 yrs. To 16 yrs. 1.0 0.5 0 * milligrams of fluoride per day  1) Fluoride tablets The common tablets used are : neutral sodium fluoride and acidulated phosphate fluoride. These tablets are used as lozenges or crushed and chewed for one minute before swallowing. This chewing process gives topical protection of teeth beside its systemic benefits.  2) Fluoride drops Neutral sodium fluoride solutions are used as fluoride drops for infants. It can be dispensed with a dropper. Each drop contains about 0.1 mg of fluoride. The no. of drops is adjusted according to dosage recommended. Drops are placed directly on the tongue or inside the cheeks. Dilution in milk ,juice, or water is no longer recommended.  3) Fluoride–vitamin preparation Its use is recommended when the patient requires both fluoride and vitamins. This combined preparation may aid motivation for continued & regular fluoride ingestion. Addition of vitamins has no observable effect on the decay-prevention properties of fluoride.  Dietary Fluoride Preparation 1. Salt Fluoridation. 2. Milk Fluoridation. 3. Flour flou. I-PROFESSIONALLY APPLIED FLUORIDE 1- Fl. Solution. 2- Fl. Gel. 3- Thixotropic gel. 4- Fl. Foam. 5- Fl. Varnish. 6- Fl.- containg prophylaxis Paste. 7- Slow- released fluoride.  Fluoride Solutions 1- Sodium Fluoride Solution (2.0%). 45.0 mg in 5 ml → 9,050 ppm 2- Stannous Fluoride Solution (8.0%). 97.0 mg in 5ml → 19,363 ppm 3- Acidulated Fluoride Solution (1.23%).  SODIUM FLUORIDE SOLUTION ADVANTAGES; 1.It is stable in plastic containers. 2.The taste is well acceptable. 3.The solution is non-irritating to gingiva. 4.The solution doesn't discolor or stain teeth and anterior  Knutson Technique 4 applications at the Age of 3 years Four times one week apart 7 Years Four times one week apart 10 years Four times one week apart STANNOUS FLOURIDE SOLUTION ADVANTAGES; 1.It proves more effectiveness in adults than sodium fluoride. 2.It may be applied at the regular recall appointments of 6-12 months with no additional appointment necessary. DISADVANTAGES; 1. It is unstable in aqueous solution and must be prepared in the dental clinic daily or weekly. 2. It has a metallic, astringent taste which is poorly acceptable by children. 3. It causes yellowish brown pigmentation around carious lesions and margins of composite restorations. 4. It causes gingival irritation, and occasional sloughing of diseased gingiva.  ACIDULATED PHOSPHATE FLOURIDE ( APF) SOLUTION APF is probably the most widely used topical fluoride agent today. Almost all commercial preparations contain 1.23% fluoride ion with 0.1 molar orthophosphate acid at PH of about 3.2 to 4.5. ADVANTAGES; 1.It has produced promising clinical results. 2.Tolerated well by the patients as regard taste. 3.Easy to handle and will not stain teeth. ADVANTAGES OF FLUORIDE GEL; 1.Ease of application. 2.Its stability when stored in plastic containers, so no need to be freshly prepared before use. 3.Taste is acceptable. 4.Non-irritating to soft tissues. 5.Dont discolor the teeth. Fluoride gel trays  Thixotropic Gels ADVANTAGES; 1.They usually stable at a low PH than conventional gels. 2.They don’t run like a gel and they can be placed more precisely over the tooth surface, made with methylcellulose. 3.They may be forced more easily interproximally to these caries susceptible areas. 4.They tend to be more acceptable by children. Some of them are presently flavored with chocolate, vanilla, strawberry…. 5. Very useful in handicapped children with strong gag reflexes who generally tolerate less gels which run to their throats.  APF FOAM A new foam-based APF agent has been developed in an attempt to minimize the risk of fluoride over-dosage and maintain the efficacy of topical fluoride treatment. APF foam usually contains 1.23% fluoride, and non-ionic surfactant , its pH = 3.5.  ADVANTAGES; 1. Only small amount of agent is used for the topical application. 2.The surfactant in the foaming agent has a cleansing action by lowering the surface tension. This also may facilitate the penetration of the material into the interproximal surfaces where its action is most needed. Procedures for administering topical fluoride Two procedures are available : 1- The first, involves the isolation of teeth and continuously painting the solution onto the tooth surfaces. 2-The second, and currently more popular, procedure involves the use of fluoride gels applied with a disposable tray.  Steps recommended for applying topical fluoride 1- The administration of a dental prophylaxis prior to the topical application of fluoride must be considered optional; it should be performed if there is a general need for a prophylaxis, but it need not be performed as a prerequisite for topical fluoride applications.  2- If a prophylaxis is performed, the patient is allowed to rinse thoroughly. 3- The cotton rolls are positioned to isolate the area to be treated. 4- The isolated teeth are then dried with compressed air, and 5- The fluoride solution is applied using cotton applicators on one quadrant at a time.  6- The application is performed by swabbing or "painting" the various tooth surfaces with a cotton applicator thoroughly moistened with the fluoride solution. 7- The swabbing procedure is repeated continuously and methodically for 4 minutes. 8- the cotton rolls are removed, the patient is allowed to expectorate, and 9- the process is repeated for the remaining quadrants.  When a tray is to be used: Selection of a tray adequate for the individual patient. An adequate tray should cover all the patient's dentition; it should also have enough depth to reach beyond the neck of the teeth. With recent trays it is possible to treat both arches simultaneously.  The teeth of the arch to be treated are dried with compressed air. A ribbon of gel is placed in the trough portion of the tray and the tray seated over the entire arch.  The patient may also be instructed to bite gently against the tray to "squeeze" the gel against the teeth to ensure that the gel reaches all of the teeth and flows inter-proximally. The trays be kept in place for a 4-minute treatment period for optimal fluoride uptake. After the topical application is completed, the patient is advised NOT to rinse, drink, or eat for 30 minutes. Precautions that should be undertaken include: (1) using only the required amount of the fluoride solution or gel to perform the treatment adequately; (2) positioning the patient in an upright position; (3) using efficient saliva aspiration or suctioning apparatus; and (4) requiring the patient to expectorate thoroughly on completion of the fluoride application. FLUORIDE VARNISHES 1.Safe. 2.Easy to apply. 3.Well-accepted by the patient. 4.May offer an effective means of arresting early enamel lesions in the primary dentition.   A drop of varnish is placed in Varnish is applied to tooth surface a small dish using a small brush   Teeth are dried with a gauze After application, a yellow film square remains on the teeth  VARNISHES HAVE 2 SPECIAL PROPERTIES; 1.High fluoride content. 2.Long contact time with the enamel surface. MODE OF APPLICATION; 1.Twice a year. 2. 3 consecutive application within a 10 day period/year for 3 years {high risk}.  INDICATIONS; 1.Nervous children. 2.Failed fissure sealant. 3.Children with medical and physical problems. 4.Arresting rampant caries. 5.Reduction activity of secondary caries. 6.Preventive program against root caries. 7.In orthodontic patients.  Fluoride prophylactic paste TITANIUM TETRA-FLUORIDE (Ti F4) When dental enamel are exposed to aqueous solution of Ti F4 a glaze layer forms on the tooth surface. It is a hard, hydrophobic and reflecting a spectrum of colors. This formed glaze layer is a product of interaction between Ti F4 and proteins on the enamel surface. 4% TiF4 treatment is more suitable than 1% since the glaze appears to be more tenacious and thicker after this treatment.  Titanium Tetra-fluoride has started to gain recognition in all fields of dentistry; 1.It is applied on the surface of hypersensitive teeth. 2.Reduce caries formation around fixed orthodontic appliances. 3.Used as a fissure sealant in primary teeth. 4.TiF4 treatment protects teeth against erosions caused by strong acid. 5.TiF4 application is effective in prevention of dental erosion caused by hydrochloric acid from stomach in patients with frequent vomiting or gastro-esophageal reflux. SLOW –REALESED FLUORIDE Intra oral devices in the form of : a) Copolymer devices or b) Glass devices cause an elevation of salivary fluoride levels for up to 2 years.  Other vehicles for applying topical fluoride; 1. Fluoride releasing Fissure sealants. 2. Amalgam containing fluoride. 3. Composite resin restoration containing fluoride. 4. Glass ionomer cement. 5. Cavity liners with fluoride.  FLUORIDE RINSES The most commonly recommended concentration for a daily rinsing program is 0.05 % neutral sodium fluoride (Low potency and high frequency) An alternative ; a weekly rinse of 0.2% sodium fluoride also had been shown to be effective. (High potency and low frequency) INDICATIONS; 1.School base programs in low fluoride communities where caries activity is moderate to high. 2.Patient with increased caries risk. 3.Patients with orthodontic treatment. 4.Patients undergoing radiotherapy. CONTRAINDICATIONS; 1.Children below the age of 6 years. 1- Squeeze 10 ml into the dosage meter. 2- Then into a cup. 3-Swish the rinse around in your mouth for about 4- Then ,spit out. 60 seconds. Do not eat or drink Do not swallow.. anything for at least 30 minutes after rinsing.  Advantages of supervised mouth rinse program; 1.Inexpensive. 2.Simple to do. 3.Safe. Self Applied Fluoride Gel 0.4% stannous Fluoride gel 0.05% APF gel application by brush or tray  FLUORIDE TOOTHPASTES Use of fluoridated toothpastes proved to be an effective agent reducing the incidence of dental caries. There is now increasing evidence that decline in the prevalence if dental caries records in most industrialized countries can be attributed mainly to the widespread use of toothpaste that contain fluoride.  When introduced into the mouth, fluoride in toothpaste is taken directly by dental plaque and demineralized enamel. It also increases the fluoride concentration in the saliva. Toothpaste may be the most important source of fluoride globally.  Sodium fluoride. Acidulated phosphate fluoride. Sodium monofluorophosphate. Adult strength 1000-1500 ppm Extra strength 2500 ppm Children strength 500-550 ppm Fluoridated toothpastes tube 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 cannot rinse or spit adequately and they may ingest more than 0.5 mg fluoride daily from 2 brushings of the toothpaste containing 1000-1500pm.  These very young children should use toothpaste in the following way; 1.Use low fluoride toothpaste (500-550ppm). 2.Small pea-sized amount of paste applied to the child-sized tooth brush. 3.Parents should brush their children’s teeth until the child can do it properly. 4.Children should be encouraged to spit the paste out after brushing.  activity prepare the following topic for discussion next lecture : 1- history of fluorides 2- fluorides in nature 3- dietary fluorides. 4- importance of fluorides 5- mechanism of fluoride action 6- fluoride varnishes