Fluorides types, classification, and techniques used nowdays

2.  Introduction
 Mechanism of action
 Topical applications
 Classification
 Agents used in clinics
 Techniques

3. FLUORIDE IS THE IONIC FORM OF THE
ELEMENT
.
It is the negatively charged and will not
remain as free element .

4.  Fluoride role in decreasing the prevalence of
caries has been accepted 4 many years.
 Its effect the enamel structure and the
process of demineralization.

5. Can be divided into following
 Fluoride incorporation in enamel
 Pre eruptive incorporation
 Post eruptive incorporation
 Remineralization of acid dissolved enamel

6. Topical fluorides are directly applied to the
erupted teeth.
 INDICATION –Caries active children
 In Children shortly after periods of tooth
eruption.
 In patients with reduced salivary flow due to
medications
 Those receiving radiation of head and neck
 Patients with fixed or removable appliances
 Mentally and physically challenged individuals

7.  PROFESSIONALLY APPLIED- Fluoride products
are those medicaments typically dispensed by
Dental professionals in the Dental office and
usually involve the use of high concentration
products ranging from 5000 and 19000ppm
which is equivalent to 5-19 mgF/ml.

8. Bibby in 1942 was the first to demonstrate that the
repeated application of NA or K fluoride to teeth of
children significantly reduce there caries prevalence .
The following procedure should be kept in mind
during applied topical fluoride application.
 Seat the patient in an upright position.
 Used tray with absorptive liners.
 Limit the amount of the gel , e.g during gel
application the gel is placed in the tray to no more
than 2.5 ml
 Used suction during and after the treatment
 Have the patient expectorate thoroughly after the
trays are removed

9.  NEUTRAL SODIUM FLUORIDE
 STANNOUS FLUORIDE
 ACIDULATED PHOSPHATE FLUORIDE
 [SOLUTION AND GELS ]
 VARNISH AND FLUORIDE FOAM

10.  AMOUNT -2 % NaF [9,040ppm] pH 7
 METHODd of preparation-2% of Naf ,dissolve
20 gm of NaF powder in 1 liter of distilled
water.
 Na f should always stored in plastic bottles ,if
stored in glass container ,the F of the
solution can react with the silica of glass
forming Sif2 reducing the availability of free
active F for anticaries action.

11. Isolate the teeth
Apply the 2% NaF solution with cotton rolls applications and
allow it to dry on the teeth for about 4 minutes .
The solutions is not reapplied because once a layers of CaF
gets formed it interferes with further dissolution of F to
react with hydroxyapatitie . This is called as Choking off
phenomenon .
 The same procedure is repeated on the other quadrant
 The patient is instructed not to eat or drink for 30 mins
Patient is RE called for the 2,3,4 are done as weekly
intervals
Applications is recommended at 3, 7, 11, 13 yrs

12.  Chemically stable
 Acceptable taste because of neutral ph
 Non irritating to the gingiva
 Does not discolor the tooth
 Cheap and inexpensive
DISADVANTAGE
: Patient has to make 4 visit to the dentist
within the relatively short time

13.  AMOUNT
 8% snf2 (19 , 360 ppm )
 Method of preparation
 To prepare 8% snf2 content of one capsule is
dissolved in 10 ml of distilled water in a plastic
container and then it is shaken
 Snf2 is to be prepared just before each
application
 The sol needs to be prepared fresh everytime
because snf2 form of tin will get oxidise in the
presence of oxygen and change into stannic form
of tin thus making snf2 active for carries
prevention

14.  Clean the teeth
 Isolate with cotton rolls and dry the teeth
 Apply the freshly prepared 8% of Snf2
 Reapply the tooth sol to the tooth every 15 to
30 sec ,so that the teeth are kept moist with
the solution for 4 min
 Instruct the patient not to eat or drink or
rinse for 30 mins . This helps in prolonging
the availability of F to react with the tooth
surface
 Once per year

15.  Advantages
 The rapid penetration of tin and F within 30 sec
 Highly insoluble tin-fluorophosphate complex forms on
enamel surface that is more resistant to decay than
enamel
 Disadvantge
 Unstable in aq sol and should be prepared fresh for each
patient
 Not stable
 Mettalic taste
 Cause irritation to the gingival tissue partcularly to the
dehydrated and diseased gingival tissue
 Disscoloration of the teeth particularly in hypocalcified
areas

16.  Amount
 1.23% F APF (12,300ppm) ph 3.0
 Method of preparation
 To prepare APF sol dissolved 20 gram of NaF
in 1 L of 0.1 M phosphoric acid
 To this add 50% to hydrofluoride acid to
adjust the ph at 3 and F concentration at
1.23%

17.  Isolate a quadrant with cotton rolls
 APF sol is continuously and repeatedly
applied with cotton applicators
 Keep the teeth moist for 4 mins
 Repeat the procedure for remaing quadrant
 Instruct the patient not to eat or drink or
rinse for 30 mins
 Semiannual

18.  F uptake following the application of APF sol is
greatly accelerated whereas that following NaF
much slower . 50% more effective than NaF
 Cheap
 Can be prepared easily
 It is stable with long shelflife ,when stored in an
opaque sol
 Disadvantages
 Teeth must be kept wet with solution for 4 mins
 Acidic sore and bitter in taste

19.  Amount 1.23% F APF ( 12,300ppm) ph4 to 5
 Method
 To prepare a gel , a gelling agent methyl
cellulose or hydroxyethyl cellulose is added
to the sol and the ph is adjusted between 4 to
5

20. Patient is made to sit in an upright position
Dry the teeth
Fill the U/L tray with APF gel
both the trays can be inserted into the mouth
simultaneously along with the suction to collect the
drooled saliva
Kept in mouth for 4 min trays on the teeth
Thixotropic gels displace a high viscosity at low share rates
and a very low viscosity at low share rates .
The clinical importance of this is that the gel thins out under
biting forces and more easily penetrates between the teeth
Conversely , when it is not under stress it remains in the tray
and doesnot tend to runout the patients troat
Instruct the patient not to eat or drink or rinse for 30 mins

21.  Acceptable by the child due to flavorable taste
 Easy to apply
 Reapplication not required
 Can be selfapplied
 Thixotropic property
 Carries reduction more when compared to APF
sol
 Disadvantage
 Cause irritation to inflamed gingival tissue
 It should be applied only after restoration of all
the carious teeth

22.  Amount
 BIFluoride 12(2.71% NaF,2.92%CaF2)
 Method
 Commercially available
 Technique
 Clean the teeth to remove the plaque
 No isolation is required
 Drop the varnish into the brush or form pallate
 Paint the varnish thinly first on the lower arch ( as saliva collects
more rapidly on it ) and then on upper arch starting from
proximal surface layer which are too thick separate to easily
 Instruct the patient not to rinse or drink anything at all for that
day
 Take liq and semisolids for next morning
 Not to brush that day

23.  Forms a water tight protective flim insulating
against thermal and chemical influences
 With correct application and proper mouth
hygienes varnish remains in place for several
days during this time fluoride act on the
treated surface
 Disadvantage
 pAtient compliance is req

24.  Duraphat ( germany)
 flurprotector ( lichenstein)
 And
 Fluoritop (india)
 DURAPHAT
 NaF varnish containing 2.26%F (22,600ppm)
in organic lacquer
 FLURPROTECTOR
 Sylane fluoride with 0.7% (7000ppm)

25.  Amount
 0.92% F (9200ppm)ph4.5
 Advantage and disadvantage
 less dense than gel and is able to flow better
allowing a free movement of the fluoride ion on
the tooth surface and the interproximal surface
 Total density by weight is less than gel
application
 This reduces risk of injection and systemic
toxicity of fluoride
 Disadvantage
 Retention on to the tooth surface is less as no
polymer are added.

26.  Self applied fluoride products are usually
bought and dispensed by the individual
patients but at the recommendation of a
dental personnel.
 These products include – fluoride dentifrices
mouth rinses
gels
 Usually use the low fluoride concentration
products ranging from 200 to 1000 ppm or
0.2 – 1.0mg F/ml

27.  F Dentifrices usually are used regularly 2 to 3
times a day . They can provide a frequent
source of F in low conc they can inhibit
demineralization and enhance
remineralization.

28.  Pre school age children should be supervised
while brushing to avoid excessive amount of
paste .
 only a dab or pea size amount of dentifrices
should be used by 6 years of age or below
 a ribbon of dentifrices that covers the bristle
that covers the adult sized brush contains
about 1 gram of dentifrices

29.  F mouth rinses – Neutral Na fluoride
,Acidulated phosphate fluoride ,stannous
fluoride rinse proved to reduce caries by 20%
to 50%

30.  NA fluoride mouth rinses are usually
formulated and conc of either 0.2%
(900ppmF) for weakly use or 0.05% (225ppmF
daily)
 These rinses are intended to be used by
forcefully swishing 10ml of the liquid
around the mouth for 60 sec before
expectorating it .

31.  F gel products for self applications include neutral NaF and APF
with a fluoride conc of 5000ppm and SNF2 which has conc of
1000ppm
 The SNF2 products are conventionally called gels but actually
are glycerin based solution
 The gels are either applied in trays are brushed on the teeth
 Professionally applied topical F treatment are given twice a year
where as self applied F gels can be applied once a day or more
 Patients brush their teeth for 1 min with the gel or if tray are
used several drops are placed in each tray are held in contact
with the teeth for 5 mins
 Patient should rinse with tap water after brushing a tray
application
 F gels are not recommended for children 6 years or younger.

32.  LUSTRESS , OPAQUE WHITE PATCHES IN THE
ENAMEL which become mottled striated or
pitted .
 Mottled areas become stained yellow or
brown
 Hypoplastic areas may also be present to
such an extend in severe cases that normal
tooth form is lost

33.  Essentials of Public Health Dentistry
-Soben Peter