Flourides/ dental courses

INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

INTRODUCTIONINTRODUCTION
CHEMISTRY & OCCURRENCECHEMISTRY & OCCURRENCE
SOURCESSOURCES
FLUORIDE METABOLISMFLUORIDE METABOLISM
HISTORYHISTORY
MECH OF ACTION IN DENTISTRYMECH OF ACTION IN DENTISTRY
EFFECT OF CARIES PROCESSEFFECT OF CARIES PROCESS
CLINICAL USE OF FLUORIDESCLINICAL USE OF FLUORIDES
SYSTEMIC FLUORIDESSYSTEMIC FLUORIDES
TOPICAL FLUORIDESTOPICAL FLUORIDES
FLUORIDE TOXICITYFLUORIDE TOXICITY
REFERENCESREFERENCES
CONCLUSIONCONCLUSION

Latin word FLUORE- to flow
Halogen family, Most electro negative
Atomic No 9
Atomic Mass 19
17th
in order of abundance

1) Fluorides in ATMOSPHERE
2) Volcanic eruptions…
Soil and water particles…..
Rain, deposition of dust, Snow, and Fog…..
Industrial wastes…. (Coal burning,
Power generation plants, Aluminium factory,
Phosphate fertilizers, Phosphoric acid
and Manf of glass, ceramic and bricks
2) Fluorides in LITHOSPHERE:
Siliceous igneous rocks
Alkalic rocks in geothermal waters and
hot springs
Volcanic gases and Fumarole
Widely distributed in earth crust
Averages about 399ppm
Constitutes about 0.837% of its weight

3) Fluorides in BIOSHPERE:
Plants – 2-20mg/g of dry wt
Leafy vegetables 11-26mg/g of dry wt
Plants grown with acidic soil…..
Some plants accumulate higher conc. of fluoride
–tea plants
Animals……..10-20ppm
Ex sardines, salmon, mackerel –20ppm
4) Fluoride in HYDROSPHERE:
All waters contains fluoride due to universal
presence in earth’s crust
Rain waters, lakes and wells
Sea water: 0.5-1.4mg/L
River water: 0.5mg/L

Others include:
Fluoride – vitamins supplements
Dentine obtundents
Drugs of osteoporosis and related metabolic
skeletal disorders
Fluoridated corticosteroids
Anesthetic solutions
Organic fluorides

1901 Dr Fredrick McKay
COLORADO STAINS
MOTTLED ENAMEL
Characterized by ” Minute white flecks or Yellow or brown
spots or areas scattered irregularly or streaked over the
surface of a tooth or it may be a condition where the
entire tooth surface is of a dead paper white like color of a
china dish

Met Dr Greene Vardiman Black
Dean of northwestern University Dental School, CHICAGO
2 Purpose:
1) He need help from recognized dental research workers
2) Needed to define the exact geographical areas
Dr G V Blacks histological findings regarding this was published in
the paper “ an endemic imperfection of the enamel of the teeth
heretofore unknown in the literature of dentistry”

In 1912 article of Dr James Eager (1902)
In residents of NAPLES, called this as “Denti di chiaie”
In 1916 McKay with Dr G V black conducted studies in 26
different Communities in various parts of USA (6873)
Concluded that there was something unidentified factor
that was responsible for Mottling of enamel

They ESTABLISHED their assumption when they came
across similar enamel mottling in residents of BRITTON
Water source changed from shallow to deep wells after 1898,
Prior to 1898 – no mottling seen
And born after 1898 had mottling of enamel
They assumed that there is something in the water that
was responsible for this
Similar results in studies of BAUXITE, In 1909 they changed
their water supply From shallow to deep wells

In 1931 Churchill H V , Chemist , Aluminium Corporation Of America,
New Kensington, Pennsylvania
Dr Trendley H Dean in 1931
Bauxite water had fluoride of Conc =13.7ppm
In 1942 mile stone discovery that 1ppm of fluoride reduced 60%
of dental caries was observed
In 1934 Trendley H Dean introduced mottling index, know as
Dean Fluorosis index

In 1945 World’s first artificial fluoridation started
IONEER FLUORIDATION STUDIES:
ate Fluoridation city control city
945 January GRANDRAPIDS, MUSKEGAN
945 May NEWBURGH KINGSTON
946 EVANSTON OAKPARK
946 BRANTFORD SARNIA

Clinical features of
Fluorosis
0.7- 0.8 ppm0.7- 0.8 ppm
1.2 ppm
1.5 ppm
2.0 ppm

3.0ppm
3.0ppm
5- 6 ppm
5- 6 ppm

> 7.0 ppm

1) Increased enamel resistance
or Reduction in enamel solubility
2) Increased rate of post eruptive maturation
3) Remineralisation of incipient carious lesion
4) Fluoride as inhibitor of demineralization
5) Interference with microorganisms
6) Modification of tooth morphology

EFFECT ON CARIES PROCESS
CHANGES IN ENAMEL DURING
EARLY
STAGES OF LESION FORMATION
•pH decrease b/w 4-7
•At critical pH 5.5 dissolution of
hydroxyappatite
•Precipitation of fluorhydroxyappatite

Fluoride Enamel Interactions
 Inhibition of demineralization
Enhancement of remineralization

N YOUR EYES …..
KNOW I WILL FIND THE LIGHT
TO LIGHT MY WAY………….

FLUORIDES
SYSTEMIC TOPICAL
PROFESSIONAL
SELF APPLIED
•Community Water Fluoridation
•School Water Fluoridation
•Dietary Supplements
•Salt Fluoridation
•Milk Fluoridation
•Fluoride Drops

TOPICAL FLUORIDES
SELF APPLIEDPROFESSIONAL
•Knutson’s Technique
•Muhler’s Technique
•APF Solu /Gels
•Amine Fluoride
•Varnish
•Others,
Mercer & Muhler’s Technique
Englader Technique….
•Dentifrices
•Mouth Washes
•Fluoride Gels

NITION:
the upward adjustment of the Conc. of fluoride ion in a public
er supply in such a way that the Conc. of the fluoride ion in the
er may be consistently maintained at one part per million (ppm)
weight to prevent dental caries with minimum possibility of
sing dental fluorosis”
JAN 1945 GRAND RAPIDS, USA
From various studies noted that 1ppm of fluoride
was considered optimal

sults of one the studies by RICHARD et al shows that:
Temperature in O
C
< 18.3
18.9 - 26.6
>26.7
Recommended ppm
1.1 -1.3
0.8 – 1.0
0.5 – 0.7
OPTIMAL FLUORIDE CONC.= 0.7 – 1.2 ppm
NOW 0.5 – 1.0 ppm
CARIES REDUCTION IS 60 -65 %

LIMITATION OF COMMUNITY WATER FLUORIDATION
Crucial requirement is well established , centralized
piped water distribution system
In developing countries and rural areas …ITS LACKING
Others includes….Funds, Strong Political WILL, ………..

ANTI FLUORIDE LOBBY…………………..

School Water Fluoridation
Used in case of ……………………
Recommended Conc. 4.5 – 6.3 ppm
40 – 50 % reduction in DMFT scores

MILK
FLUORIDATION

SALT FLUORIDATION
SWITZERLAND since 1959
By 1967, three quarter of domestic salt sold in switz.. Was
fluoridated at 90mg/kg salt(90ppm)
Later it was raised to 200, 250, &350 mg/kg salt
ADV:
-Safe
-No supervised water works nor water
distribution systems are necessary
-low cost
DISADV: No control over individual consumption

FLUORIDE TABLETS & VITAMINS
FLUORIDE DROPS

DEFLUORIDATION:
As the downward adjustment of the of fluoride ion Conc. in a public
ater supply in such a way that the Conc. of the fluoride ion in the
ater may be consistently maintained at one part per million (ppm)
y weight to prevent dental caries with minimum possibility of
ausing dental fluorosis”
Or
“Is the process of removing excess fluoride naturally
present in the water supply in order to prevent
dental fluorosis or more sever disability”

Fluoride water
Supply Disinfection Filtration
settlingFlocculation
Alum
NALGONDA TECHNIQUE

SOURCES:
PbF, K F, NH4F, Zr2F, titanium tetra F,
K fluorostannate, etc
Now, NaF, Sn2F, APF soln /Gels,
Na- Monofluorophosthate,
Amine fluoride…

INDICATIONS:
High caries risk patients
Past caries experience and incidence,
No of smooth surface lesions,
Dietary, microbiological, saliva, tooth factors
Age factors, patients knowledge regarding
Eating habits, oral hygiene, use of fluorides
This forms the basis for caries prevention regimen

ETHODS OF ENHANCING FLUORIDE FIXATION IN ENAME
Increase in frequency of application &
time exposure
Pretreatment of enamel surfaces
By Acidified, Saturated Solution of-
- Di-Calcium Phosphate di-hydrate
Use of complexing agents

1) PAINT-ON-TECHNIQUE
2) TRAY-TECHNIQUE
( Spray technique – tried by De Paola 1967
but never recommended.)
METHODS OF APPLICATION

METHOD OF APPLICATION……….
PREPARATION………
(SODIUM FLUORIDE 2 %)

ADVANTAGES:
1) Relatively stable, Needs Plastic Containers
2) Well acceptable taste, Non Irritating and no
-discoloration
3) Suited for public health programme
DISADVANTAGES…….
MECH OF ACTION……………CaF2

(STANNOUS FLUORIDE 8%)
PREPARATION………
METHOD OF APPLICATION….
MECH OF ACTION……………Stannous- tri- fluorophosphate

ADVANTAGES:
1-2 applications ….
DISADVANTAGES:
Bitter metallic taste, disagreeable taste
Needs to be freshly prepared for each appointment
Not stable in solution
May cause reversible tissue irritation and staining
at the margins of restoration

(ACIDULATED PHOSPHATE FLUORIDE)
1.23%
TION……… 20gms..1litre of (0.1M phosphoric acid)
……….added 50% hydrofluoric acid
pH adjusted to 3 & F Conc. At 1.23%
METHOD OF APPLICATION….
MECH OF ACTION……………Di Calcium Phosphate Dihydrate

ADVANTAGES:
Cheap and easily prepared
Requires only 2 applications
Gel can be self applied and
cost of application is reduced
DISADVANTAGES:
Solution is acidic so sour and bitter taste
Needs use of suction , >’s chair side timings
Cannot be stored in glass containers
Damages composite resto and porcelain resto
Irritation to soft tissues

GEL:
Relatively costly
Readily available( in India
imported)
Self application is possible
SOLUTION:
Relatively Cheap
Prepared easily
Applied by the dentist or
Auxiliary staff
COMPARISON BETWEEN APF GEL AND SOLUTION

1957 Muhlemann and co-workers
Found that organic fluoride was superior to
inorganic fluoride
Other functions includes
Antibacterial properties
Reduced plaque formation
Antiglycolytic activity
Used in dentifrices, mouthwashes, topical gels…

CHARACTER NaF SnF2
APF
Percent fluoride 2% 8% 1.23%
ppm fluoride 9200 19500 12300
Frequency of application 4@
3,7,11,1
3
1-2/
year
1-2/
Year
Taste Bland disagreeab
le
Acidic
Stability Stable Unstable Stable
Tooth pigmentation No Yes No/ma
ybe
Gingival irritation No Occasional No
Average effectiveness 29% 30% 28%
COMPARISON OF TOPICAL FLUORIDE AGENTS

Duraphat: 22600 ppm NaF
Caries reduction 30-40 % in permanent dentition
7-44% in primary dentition
Methods……
No isolation as varnish sticks to cotton
0.3-0.5 ml equivalent to 6.9-11.5mgF, enough to cover
full dentition
……4 mins
Precautions…..
Duraphat is NaF in varnish form containing 22.6mgF/ml
suspended in an alcoholic solution of natural organic varnishes

Fluoroprotector: Clear polyurethane based products
Contains silane fluoride 7000ppm
40% caries reduction
Others include CAREX

LIMITATION OF PROFESSIONAL APPLIED TOPICAL FLUORIDES:
•Personnel cost associated with one to
one method of Fluoride delivery
•% Of caries reduction is not very high
•Cannot be implemented in community based
programmes in case of shortage of dental personnel

It’s a mixture of abrasive or polishing agents, detergent,
Binders, flavoring agent, and substances necessary to
facilitate their preparation
Therapeutic paste/dentifrices contains addition one or more
Compounds intended for reduction of oral dental diseases.
Exact formulation depends on Manf but basic components
remains same

SODIUM FLUORIDE:
Caries reduction was insignificant because of incompatibity
of components of abrasive system
Na-bicarbonate, Na meta phosphate, Na phosphate are used
1973 FDA approved
NaF + Calcium pyrophosphate – 650ppmF

STANNOUS FLUORIDE:
Mulher associates at Indiana university ----CREST
1955 ---1ST
To recognized by FDA
Undergoes quick dissociation by hydrolysis and oxidation
so needs to be stabilized , 1% stannous pyrophosphate is used
Not compatible with CaHPo4 so replaced with Ca – pyrophosphate
or insoluble Meta phosphate

DISADVANTAGES:
•Staining of teeth, particularly in mouth with poor oral hygiene
•Pigmentation of hypo plastic areas and margins of restoration
•Metallic taste, due to low pH & high conc. of Sn2F
•Astringent taste and difficult to mask with flavoring agents
•Poorly accepted by children

MONO FLUOROPHOSPHATE:
1981, most widely used, with good results
Doesn’t occur in nature so prepared synthetically in
laboratory, OKALAHOMA
CONTAINS:
1 Atom of phosphate
2 atom of 02
1 Atom of fluoride

ADVANTAGES:
No staining of teeth.
Abrasive system includes
* CHALK ( calcium carbonate) &
* DICAL ( Di calcium phosphate)
MECH OF ACTION : not absolutely established , thought that
Monofluorophosphate anion has anticaries property of its own and
exchange phosphate groups in apatite crystals
Other Mech.. is by slow hydrolysis, releases F ions
PO3F2 + H2O▬> H2PO4 + F-

AMINE FLUORIDE:
1st
tested in Zurich, Switzerland
---ELMEX , GABA INT BASEL, Switzerland
Components:
Amine fluoride 297 (OLAFLUR) contains 1000ppmF
Amine fluoride 242(HETAFLUR) contains 250ppmF
Both are stable and have long life

EATURES:
Insoluble meta phosphate
* Is the abrasive & polishing agent used
* Less foaming action
* Developed to improve the affinity of fluoride to enamel by the
Organic Cationic molecule thus making more resistant to
dental caries
* Marketed in Europe and not in north America
* Have shown Higher reductions in dental caries
Other superior properties includes:
Reduced enamel solubility
Increased F uptake by enamel
Antiglycolytic property

DISADVANTAGES/LIMITATIONS:
Concern has been raised for
* Taste characteristics and
* Long range toxic effects
RETENTION OF FLUORIDE DENTIFRICES:
Continuous use at low conc. is beneficial as Fluoride conc.
in oral fluid is elevated to bring its effect

1ST
by BIBBY et al 1946
Dental students …..acidified NaF, 3 times/week for 1 year
No significant results
Past few decades used more in caries preventive-
Public health methods
1975 council on dental therapeutics of ADA accepted Neutral NaF &
APF mouth rinses as effective caries preventive agents
Later stannous fluoride mouth rinses were accepted

COMPOUNDS USED FOR MOUTH RINSING:
1) NaF mouth rinses:
Formulated either at Conc.
0.2% NaF (900ppmF) for weekly use
0.05% NaF (225ppmF) for daily use
Caries reduction is 25-30%
Intended to be used by forcefully swish 10ml of liquid around
the mouth for 60 secs before expectorating

2) Acidified NaF mouth rinses:
BIBBY and co workers
Employed 0.01% NaF soln. acidified to pH 4
3) Stannous fluoride mouthwashes:
Anticaries effect similar to NaF
Other mouth rinses used are
* Amine fluoride mouth rinses
* Ammonium fluoride mouth rinses

Earlier hypothesis was
Fluoride changes enamel structure( i.e. fluoroapatite crystal)
Bacterial growth inhibition and also acid formation
Believed that caries is prevented or arrested by an efficient
delivery of ionic fluoride to the site in adequate Conc. and duration

* Rinse and expectorate technique used in patients with fluoride
deficient communities and in high caries susceptibility
individuals
* If the Conc. Of drinking water is < 0.3ppmF ,
then 0.05% NaF used with swish and swallow technique
* >ed caries risk patients , Orthodontic treated patients,
Radiotherapy patients
* School based fluoride programmes , based on caries activity
of participants

NCLUDES:
Neutral NaF
APF with fluoride Conc. 5000ppmF
Stannous fluoride (1000ppmF)
Are conventionally called gels but actually are glycerin based solutions
ADVANTAGES:
Self applied
Can be used many times as compared to office delivery
NOTE: NOT RECOMMENDED FOR CHILDRENS 6 YEAR
AND YOUNGER

DISADVANTAGES:
Cannot guarantee whether they use it correctly or not
Danger of toxicity as large quantity is given
Are tedious to use on a daily basis over a long period of time
For a case of rampant case:
ADA recommends
Quarterly visits to dentist for topical fluoride treatment
and a minimum of 4 week course of self applied
gel use was suggested

CLASSIFICATION
1) Acute Fluoride Toxicity
2) Chronic Fluoride Toxicity

Its uncertain to say rightly…………(based on various
observation)
5-10g of sodium fluoride would certainly be fatal for a
person with a body weight of 70kg.
The dose range for adults would be32-64mgF/kg.

Chronic fluoride toxicity results from the long term ingestion of
small amounts of fluoride.
Is an endemic disease in geographic areas where the contents of
fluoride ion in the drinking water exceeds 2ppm.

Enamel fluorosis is a developmental phenomenon due to
excessive fluoride ingestion during Amelogenesis.
Occurs symmetrically within the dental arches.
The first systematic classification ........DEANS 1942.

TREATMENT
VOMITING SHOULD BE INDUCED
Emetic
1% calcium chloride or calcium gluconate
Milk
Hospital emergence department

Recommendation for use of fluoride dentifrices in very young
Children is as follows:
Below 4 year Fluoride tooth paste is not recommended
4-6 year Brushing once daily with fluoride paste and
twice without paste
6-10 year Brushing twice daily with fluoride paste and
once without paste
Above 10 year Brushing thrice daily with fluoride paste

Supplement of fluoride TAB according to F Conc. Of drinking water:
Age (year) Less than 0.3 03.-0.7 Greater than
0.7
Birth to 2 0.25 0 0
2 to 3 0.5 0.25 0
3 to 14 *
2.2 mg NaF contain
1 mg F
1.0 0.5 0
•The American Academy of Pediatrics recommends providing
•tablets through at least age 16

Fluoride releasing
materials in dentistry

References
Evaluation of a new intraoral controlled fluoride release device.
Caries Res. 2005 May-Jun;39(3):191-4
Buyukyilmaz T, Ogaard B, Caries-preventive effects of fluoride-
releasing materials. Adv Dent Res 9:377-83, 1995
Carvalho AS, Cury JA, Fluoride release from some dental materials
in different solutions. Oper Dent 24:14-9, 1999
Ten Cate JM, Current concepts on the theories of the mechanism of
action of fluoride. Acta Odontol Scanc 57:325-9, 1999
Fluroides in dentistry 2nd
edn, Ole Fejerskov
Fluorides in caries prevention 3rd
edn, J.J.Murray,A.J.Rugg

Flourides/ dental courses

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (15)

Ähnlich wie Flourides/ dental courses

Ähnlich wie Flourides/ dental courses (20)

Mehr von Indian dental academy

Mehr von Indian dental academy (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Flourides/ dental courses

Hinweis der Redaktion