Topical and systemic fluorides including sodium fluoride, stannous fluoride and APF in detail. It comes as long question in BDS final year(CCS University)
5. INDICATIONS
Caries – Active individuals
Children after tooth eruption who are
not caries free
Individuals with decreased salivary flow
When roots are exposed after
periodontal surgery
Patients with prosthesis (fixed or
removal)
Mentally and physically compromised
6. 1.PROFESSIONALLY APPLIED
TOPICAL FLUORIDES
Bibby in 1942 was first to demonstrate that
the repeated application of sodium or
potassium fluoride to the teeth of children
significantly reduced their caries prevalence.
RATIONALE:- Speed the rate and increase
the concentration of fluoride acquisition
above the level, which occurs naturally.
Best time to apply topical fluoride is soon
after eruption, since immature and porous
enamel acquires fluoride rapidly
7. FLUORIDE VARNISH
Durph
at
• First fluoride
varnish
22,600ppm
F as NaF in
colophonium
base
Fluop
r-
otecto
r
• Base-
polyurethan
e
• 7000 ppm F
as silane
fluoride
Carex
• It contains
lower fluoride
concentration
than durphant,
but efficacy
equivalent to
that of durphant
8. TECHNIQUE OF VARNISH
APPLICATION
Prophylaxis and dry the
teeth do not isolate with
cotton
Application of varnish with small
brush first on lower arch starting
with proximal surface.
It is than sit to let dry for 4
minutes before spitting
Patient is asked not to rinse
or drink for one hour
9. TOPICAL FLUORIDE COMPOUNDS
USED IN PREVENTIVE
DENTISTRY
AGETNTS
CURRENTLY IN
USE
SODIUM
FLUORIDE(NaF)
ACIDULATED
PHOSPHATE
GEL (APF)
STANNOUS
FLUORIDE(SnF₂)
10. SODIUM FLUORIDE(NaF)
METHODS OF
PREPARATION OF 2%
NaF
MECHANISM OF
ACTION
Dissolve 20 gm of NaF
powder in 1 liter(1000ml)
in plastic bottle
Silica of glass container
react with fluoride ion
forming silicon fluoride
which reduces free active
fluorides.
9,040 ppm
pH-7
NaF + Ha -> Caf₂
Thick layer of calcium
fluoride interferes with
further diffusion of F
from the topical agent
(NaF). This is known as
“choking off effect”
CaF₂ reacts with
hydroxyapatite forming
fluoridated
hydroxyapatite on the
enamel surface
12. ADVANTAGES DISADVANTAGES
Relatively stable
when kept in plastic
container
Taste is well
accepted
Non irritating to
gingiva
Does not cause
discoloration
Patient must make
four visits to the
dentist within a
relatively short
period of time.
13. STANNOUS FLUORIDE :-
METHOD OF
PREPARATION
MECHANISM OF
ACTION
It is prepared fresh
before each application
8% Snf₂ (19,360 ppm)
pH 2.4- 2.8
0.8 g of capsule is
dissolved in 10ml of
distilled water.
SnF + HA CaF +
SnHA+ calcium
trifluorostanate
+stannous
triflurophosphate
Tin-tri-
fluorophosphate is
resposible for making
the tooth structure
more stable
15. ACIDULATED PHOSPHATE
FLUORIDE
Used as 2 forms (1) Solution (2) Gel form
1.23% F (12,300 ppm)
pH -3, pH-4 (gel)
METHOD OF PREPARATION :- Dissolve 20g of NaF
in 0.1M of phosphoric acid and add 50% of
hydrofluoride to adjust the pH(3), known as
Brudevold’s solution
MECHANISM OF ACTION:- Dehydration and
shrinkage of HA crystals and forms DCPD. This DCDP
reacts with fluoride ions and forms Fluorapatite.
16. BRUDEVOLD’S TECHNIQUE
ADVANTAGES DISADVANTAGES
Requires 2
application in a year
APF is stable and
need not to be freshly
prepared
fluoride can reach to
It is acidic sour and
bitter in taste
Cannot be stored in
glass containers
Practical difficulties
PROPHYLAXI
S
PROPHYLAXIS
ISOLATE THE
QUADRANTS WITH
COTTON ROLLS
APLLY THE
SOLUTION WITH
COTTON
APPLICATOR
CONTINIOUSLY
AND REPEATEDLY
KEEP THE TEETH
MOIST FOR 4
MINUTES
ASK THE PATIENT
NOT TO EAT,
DRINK OR RINSE
FOR ONE HOUR
APPLY ONCE IN 6
MOTHS
18. 2.SELF-APPLIED TOPICAL
FLUORIDES
It includes dentifrices, gels and rinses
Intended for daily use
Expose dentition to about 0.5-3.4 mg fluoride each
time they are used
SELF APPLIED
TOPICAL
FLUORIDE
DENTIFRICES
FLUORIDE
MOUTHRINSES
FLUORIDE
GELS
19. SYSTEMIC FLUORIDE
They circulate through the bloodstream
Provides low concentration of fluoride to
teeth over a long period of time
Incorporates in developing teeth
Systemic
fluoride
Salt
fluoridation
Community
Water
fluoridation
Milk
fluoridation
Fluoride
tablets/drops/l
ozenges
20. COMMUNITY WATER
FLUORIDATION
Addition of fluoride to public water supplies
Optimal level- 1ppm (protection against caries) –reduces
caries up to 50%
Cold climate - 1.2 ppm
Hot climate - 0.8 ppm
Defined as the upward adjustment of the concentration of
fluoride in communal water supply as to achieve maximum
caries reduction and a clinically insignificant level of
fluorosis.
OPTIMAL WATER FLUORIDE CONCENTRATION:-
Galagan &Vermillion (1957) developed an empiric
formula for estimating the amount of daily fluoride intake
based on body weight & climatic conditions as follows:
21. Controlled Water Fluoridation
Studies
ppmF=0.34 ⁄ E
E= 0.038 ⁺ 0.0062 XT
‘E’ is estimated daily water intake by children
‘T’ is mean maximum daily air temp.
1.Grand-Rapids-muskegon study
2.Newburgh-Kingston study
3.evanston-Oak Park Study
4.Tiel-Culemborg fluoridation Study
22. Methodology of estimation of fluoride
concentration in drinking water
It includes :
SAMPLE COLLECTION:-500ml of water is collected
and 2 CC of 6N HCl is added to inhibit microbial
growth
METHODS OF ESTIMATION :-
Fluoride electrode
coupled with standard
pH meter
Scot-Sanchis method
23. Choice of equipment and chemicals
for water fluoridation
Fluoride compounds used in
water fluoridation.
Types of equipment for
water fluoridation.
Fluorspar
Sodium fluoride
Silicofluorides
Sodium Silicofluoride
Hydrofluosili
Ammonium Silicofluoride
The saturator system
Dry feeder
The solution –feeder
system
24. 1.SATURATOR SYSTEM
Principle: A 4% saturated solution of NaF is
produced and injected at desired concentration at
the water distribution source with the aid to pump.
• 2.DRY FEEDER:-
Principle:- Sodium fluoride or Silicofluoride in the form of
powder is introduced into a dissolving basin with the aid of
an automatic mechanism to ensure maintenance of the
correct supply of fluoride according to the amount of
water to be delivered.
• 3.Solution feeder:-
Principle:-Volumetric pump permitting the addition of a
given quantity of hydrofluorosilic acid in proportion to the
amount of water treated.
25. TECHNICAL CONSIDERATIONS FOR
WATER FLUORIDATION.
To avoid problems such as obstruction of pipes and
the hazard of toxic dusts, it is appropriate to use a
liquid fluosilicic acid rather than fluoride in powder
form.
MAINTAINANCE AND CONTROL
CONTROL AT THE WATER TREATMENT PLANTS
CONTROL OF THE QUALITY ANALYSIS
FLUORIDATION CAN BE CONSIDERED ONLY IF :-
1. Water supply reaching a reasonable no. of homes
2. People drink this water
3. Supply of a suitable F chemical is assured
4. there is sufficient money available
26. SCHOOL WATER FLUORIDATION
PROGRAMS
Suitable alternative because children would consume
it during school days
Concentration of fluoride is more due to less intake of
water
Recommended level- 4.5 -6.3 ppm
ADVANTAGES :- Effective public health measure
Target population- school children
Quite economical
DISADVANTAGES:- Need co-operation from school
authorities
Limited pre-eruptive benefits
to primary teeth
27. SALT FLUORIDATION
Controlled addition of F, pottasium or sodium F
Introduced by Wepsi in 1948 in Switzerland
Level of fluoride can be kept at 200,250 and 350 mg
of F per kg salt
PRODUCTION : BATCH PROCESSING
CONTINUOUS PROCESSING
ADVANTAGES:- Permits individuals to accept or reject
it
Does not require community water
supply
DISADVANTAGES: There can be large variations in
salt intake .
It can be decreased by
