3. Goals of Fluoride (F) Administration
1) Do not harm the patient.
2) Prevent decay on intact dental
surfaces.
3) Arrest active decay.
4) Remineralize decalcified tooth
surfaces.
4. Recommended Optimal Fluoride Level
(ppm) in Water Supply depends on
temperature and amount already in water
Average Daily
Air Temperature
(°c)
Optimal
Fluoride
Level (ppm)
Control Range
(ppm)
(10-12)
(12-15)
(15-18)
(18-21)
(21-26)
(26-33)
1.2
1.1
1.0
0.9
0.8
0.7
1.1 to 1.7
1.0 to 1.6
0.9 to 1.5
0.8 to 1.4
0.7 to 1.3
0.6 to 1.2
DHYG 104 Pt Ed and Nutrition
Fall 2007
5. Probable toxic dose:
Symptoms:
5 mg F / kg body weight
20 kg 6 year old, PTD= 100 mg F
1. Vomiting
2. Excess
salivary and
mucous
discharge
3. Cold wet
skin
DHYG 104 Pt Ed and Nutrition
Fall 2007
4. Convulsion
at higher
dose
6. A serious systemic consequence is binding of F to Ca
which needed for heart function.
F
F
Ca
Ca
DHYG 104 Pt Ed and Nutrition
Fall 2007
7. Counter Measures:
1. Emetics
2. 1% calcium chloride
3. Calcium gluconate
4. milk
Divalent
cations like Ca
cause
precipitation,
of F and
prevent
absorbtion in
the intestine.
DHYG 104 Pt Ed and Nutrition
Fall 2007
F
Ca
F
Ca
Ca
F
8.
Can be toxic/lethal
Chemical burn
Inhibits enzyme systems (protoplasmic
poison)
Binds calcium need for nerve action
Hyperkalemia: cardio toxicity
Adult: 2.5-10g (15 mg/kg = lethal)
In industry, skeletal fluorosis, calcification
of tendons
DHYG 104 Pt Ed and Nutrition
Fall 2007
9. Emergency Treatment
4 actions
Immediate treatment:
Induced vomiting
Orally administered calcium or aluminum
preparations to protect stomach
Maintenance of blood calcium levels with
intravenous calcium
DHYG 104 Pt Ed and Nutrition
Fall 2007
11. First Aid Treatment
2. Milk or milk with eggs
Plenty of fluid including milk should be ingested
3. Lime water (CaOH)
4. Maalox (aluminum preparation)
Protects mucous membranes of upper GI from
chemical burns
Contains calcium as a binder
DHYG 104 Pt Ed and Nutrition
Fall 2007
13. Fluorosis occurs when teeth are developing. The most
critical ages are from 0 to 6 years. After 8 years, risk of
fluorosis is essentially past. During the critical ages F intake
in excess of 0.1mg/kg body weight/day can lead to
fluorosis. This is roughly 1mg/day for a 1 to 2 year old or 1.5
to 2 mg for a 5 year old. Remember that all forms of F intake
comprise the daily consumption. This includes water intake
(up to 1.5mg/day), foods (0.3 to 1.0mg) and especially
significant in young children, swallowed toothpaste.
Children under 2 years swallow 50% of toothpaste during
tooth brushing and at 5years, 25%, both of which may
amount to 1mg F/day.
14. FLUOROSIS
5 year olds swallow 25% of
toothpaste
Children under 2 years
swallow 50% of toothpaste
1 to 3 grams
Toothpaste = 1 mg F /
gram (1000 ppmF)
“pea” size amount (0.5g) is
recommenred for fluorosis susceptible
children.
16. Very Mild
Small opaque, paper white
areas scattered irregularly
over the tooth but not
involving as much as 25% of
the tooth surface. Frequently
included in this classification
are teeth showing no more
than about 1-2 mm of white
opacity at the tip of the
summit of the cusps of the
bicuspids or second molars.
Mild
The white opaque areas in
the enamel of the teeth are
more extensive but do not
involve as much as 50% of
the tooth.
Heidi Emmerling, RDH, PhD
DHYG 104 Pt Ed and Nutrition
Fall 2007
18. Moderate
All enamel surfaces of the teeth
are affected, and the surfaces
subject to attrition show wear.
Brown stain is frequently a
disfiguring feature.
Severe
Includes teeth formerly classified
as "moderately severe and
severe." All enamel surfaces are
affected and hypoplasia is so
marked that the general form of
the tooth may be affected. The
major diagnostic sign of this
classification is discrete or
confluent pitting. Brown stains
are widespread and teeth often
present a corroded-like
appearance.
Heidi Emmerling, RDH, PhD
DHYG 104 Pt Ed and Nutrition
Fall 2007
22. Systemic fluorides
Program began with the younger children
should be continued at least until all permanent
teeth except third molar erupted
Posterior teeth will erupt and need fluoride till
post eruption maturation occur
23. Water fluoridation
Water fluoridation associated with reduced tooth
decay
50-60%reduction of caries in communities have
water fluoridation between 0.7-1.2
Good cost in comparison to size of population
24. School water fluoridation
Alternative to community water fluoridation
4-5 times higher that that recommended for
community fluoridation
Student spent only part of the year on their
school also fraction of the daily water intake at
school
25. Salt fluoridation
Salt intake is difficult to determined
Research showed that salt contained of 90PPM
may be beneficial for reduction of caries
May be it is the best method in developing
countries where piped water supply is rare
26. Milk fluoridation
It is not completely supported
Milk in the gastrointestinal tract may reduce
absorption of ingested fluoride
28. Topical fluoride
Topical fluoride at office every 6 months or for
school preventive program (mouth rinsing
program at school )
Topical application at home particularaly at high
risk activity or handicapped patient or with
orthodontic appliance
Fluoride rinse 0.2%NaF ,0.4%SnFapplies
29.
Students rinse for one or two minutes with 710ml
Younger children under school age
contraindicated
Weekly program with 0.2 %Na F is
recommended for school age
31. Cotton applicators method
Seat patient upright
▪▪Isolate both upper and lower right or left quadrant using
cotton roll isolation and saliva evacuation (half mouth
technique)
▪▪ Dry isolated teeth with compressed air
▪▪ Keep tooth surfaces continually soaked with fluoride
solution for 4-minutes application if active caries
present and 1-minutes if caries inactive
▪▪ Repeat procedures on opposite side of the mouth
▪▪ Have the patient expectorate immediately and
repeatedly upon completion of the topical treatment
▪▪ Advise patient not to eat ,drink ar rinse for 30 minutes
after treatment
32. Tray technique
Teeth should be dried and free of saliva
Patient in upright
Place enough gel to fill one third of the trough
area of the tray so that they properly fit over
each dental arch
Avoid overloading to reduce oozing of gel
,which may lead to excessive ingestion
33.
Place loaded tray over the arch and squeeze the
buccual and lingual surfaces forcing gel between
teeth
With light biting presssure ,allow tray to remain
in the mouth for 4- minutes
Provide patient with drool bag or saliva ejector
to avoid swallowing excessive fluoride
After 4- minutes remove trays and use high
volume evacuation to thoroughly remove gel
that remains on teeth
34. ▪▪ Have the patient expectorate immediately and
repeatedly upon completion of the topical
treatment
▪▪ Advise patient not to eat ,drink or rinse for 30
minutes after treatment
35. APF foams and gels
(use trays)
DHYG 104 Pt Ed and Nutrition
Fall 2007
38. FLUORIDE SUPPLEMENTS
F in drinking water
AGE
Birth-6m
6m-3y
F
<0.3ppm
0
0.30.6ppm
0
>0.6ppm
0
0.25
0
0
3-6y
0.5
0.25
0
6-16y
1.0
0.5
0
Academy of Pediatric Dentistry current recommendations
39. Fluoride Protection for You
Sensitivity: This condition affects 25% of most adults.
Gum recession and natural wear can cause sensitivity.
Fluoride gels can help strengthen these area to insulate
them from hot and cold.
Root surface caries: Fluoride can help protect this
area from acid- producing bacteria.
Cavity control: Fluoride helps to remineralize enamel.
Fluoride blocks cavities by forming a more acidresistant surface layer.
DHYG 104 Pt Ed and Nutrition
Fall 2007
40. Who should receive fluoride varnish?
Children are at risk for
developing dental caries.
Risk assessment based on the
Caries Risk Assessment
41. Advantages of fluoride varnish:
There is less fluoride ingestion with a fluoride
varnish than with conventional office caries
treatments because the fluoride adheres to the
tooth surface for longer periods of time.
Duraphat releases fluoride for 28 weeks. Twothirds of the fluoride is released by 6 months.**
No special equipment is needed for the
application.
DHYG 104 Pt Ed and Nutrition
Fall 2007
42. Advantages of fluoride varnish:
Teeth do not need to be professionally
cleaned prior to varnish application.
Children can eat and drink immediately
after application.
Fluoride varnish can prevent decay in both
smooth surface and pit and groove sites.
DHYG 104 Pt Ed and Nutrition
Fall 2007
43. Advantages of fluoride varnish:
It is fast and easy and can be done in one appointment
with no injections. This varnish is a sticky, yellow semiliquid containing 5% sodium fluoride in a resin base
mixed with alcohol to dry quickly after application.
You can leave immediately after application. There are
no fluoride trays which prevents gagging.
It can be used as a cavity liner or desensitizer or painted
on cervical areas in geriatric patients. It can also be
applied to tooth surfaces between teeth for young
children.
DHYG 104 Pt Ed and Nutrition
Fall 2007
44.
45.
46.
47.
48.
49.
50. Post application instructions for
parents
Varnish will set on contact with saliva and look like a
yellowish film
Child can eat or drink right after application but
should try to eat soft foods
Instruct parent not to brush their child’s teeth until
the next day.
The first toothbrushing will remove the yellow film
on the teeth.
51. Epidemiology of pit and fissure
caries
Occlusal caries 60%of total caries experience in
children and adolescents
Morphology of pits and fissures
A-shallow,wide v-shaped fissures
B-deep,narrow ,I shaped fissures (narrow neck
and wide base )like bottle neck
DHYG 104 Pt Ed and Nutrition
Fall 2007
54. Sealant indications
Deep&retentive pits and fissures
Stained pits and fissures
No radiographic or clinical evidence of
interproximal caries
Patient receiving other preventive treatment
DHYG 104 Pt Ed and Nutrition
Fall 2007
56. Sealant limitations
Moisture control of utmost importance
Patient cooperation for dry field
Isolation with rubber dam or cotton rolls
Life span of primary tooth
DHYG 104 Pt Ed and Nutrition
Fall 2007
