TOPICAL FLUORIDES:Definition: The term “topically applied fluorides” is usedto describe those delivery systems which provide fluoridefor a local chemical reaction to the exposed surfaces oferupted dentition.INDICATIONS1.Caries active individuals2.Children shortly after periods of tootheruption, especially those who aren‟t caries free.3.Those who take medication that reduce salivary flow orradiation therapy.4.Post periodontal surgery when roots are exposed.
Topical fluorides are divided into two categories:Professionally applied topical fluorides:It was introduced by Bibby in 1942.Involve the use of high fluoride concentration productsranging from 5000-19,000ppm, which is equivalent to 5-19 mgF/ml.Self applied products:Include fluoride dentifrices, mouth rinses & gelsAre low fluoride concentration products ranging from200-1000ppm or 0.2-1 mgF/ml.
PROFESSIONALLY APPLIEDTOPICAL FLUORIDES:1.FLUORIDE VEHICLES:Aqueous solutions & gelsThe gel adheres to teeth &eliminates the continuous wettingof enamel surfaces requiredwhen solutions are used.Thixotropic solutions are notgels, but have a high viscosityunder storage conditions &become fluid under conditions ofhigh stress
FLUORIDATEDPROPHYLACTIC PASTES:If prophylaxis pastescontaining fluoride are used,the lost fluoride isreplenished & there is asignificant gain in theconcentration of fluoride.
FOAM:Developed to minimise the risk of fluoride over dosageas well as to maintain the efficacy of topical fluoridetreatment.Advantages :Its lighter than a conventional gel & therefore only asmall amount of agent is needed for topical applicationThe surfactant has cleansing action by lowering surfacetension, this facilitates the penetration of material intointerproximal surfaces.It doesn‟t require suctioning so it offers advantages forhome use
FLUORIDE VARNISH:Increasing the time of contact between enamel surface & opicalfluoride agents favours the deposition of fluorapatite &fluorhydroxyapatite.DURAPHAT:It s a viscous yellow material, containing 22,600 ppm fluoride assodium fluoride in a neutral colophonium base.FLUORPROTECTOR:Its a clear polyurethane based product containing 7000 ppmfluoride from difluorosilane.Its dispensed in iml ampules each ampule containing 6.21mgoffluoride.CAREX:It has low fluoride concentration than duraphat & has equal efficacy tothat of duraphat as caries preventive agent.
FLOURIDE APPLICATION FLOURIDE VARNISH
TOPICAL FLUORIDES USED IN PREVENTIVEDENTISTRY:1.SODIUM FLUORIDE:2.STANNOUS FLUORIDE3.ACIDULATED PHOSPHATE FLUORIDE4.AMINE FLUORIDENEUTRAL SODIUM FLUORIDEA minimum of four applications with a 2% sodium fluoridesolution gives a caries reduction of 30%.METHOD OF PREPARATION:It is prepared by dissolving 20 gms of NaF powder in 1L ofdistilled water in a plastic bottle
KNUTSONS TECHNIQUE:At the initial appointment teeth are cleaned with pumice slurry &then isolated with cotton rolls & dried with compressed air.Using cotton-tipped applicator sticks ,the 2% NaF is painted onair dried teeth so that all tooth surfaces are visibly wet. Thesolution is allowed to dry for 3-4 min.This procedure is repeated for each of the isolated segmentsuntil all the teeth are treated.A 2nd, 3rd and 4th fluoride application, each not preceded by aprophylaxis, is scheduled at intervals of approximately one week;The four-visit procedure is recommended for ages 3, 7, 11 and 13years, coinciding with the eruption of different groups of primaryand permanent teeth.
Advantages of neutral sodium fluoride solution : It is relatively stable when kept in a plastic container; The taste is well accepted by patients; The solution is non-irritating to the gingiva; It does not cause discoloration of tooth structure; The series of treatments must be repeated only 4 times in the general age range of 3 to 13, rather than at annual or semiannual intervals.Disadvantage of neutral sodium fluoride solution :The major disadvantage of the use of sodium fluoride is that the patient must make 4 visits to the dentist within a relatively short period of time.STANNOUS FLUORIDE : (SnF2) :Stannous fluoride has been used at 8% and 10% concentrations
Method of preparation of stannous fluoride solution :Solutions of stannous fluoride are not stable. Soon after mixingthey become cloudy due to the formation of tin hydroxide.A fresh solution of stannous fluoride be prepared for each patient.To prepare 8% stannous fluoride solution, the content of onecapsule which is 0.8 grams („0‟ No. of gelation capsule) is dissolvedin 10 ml of distilled water in a plastic container.Technique of application (Muhler‟s technique) :1. Each tooth surface is cleaned with pumice or other dental cleaning agent for 5 to 10 seconds;2. Unwaxed dental floss is passed between the interproximal areas;3. Teeth are isolated and dried with air;4. Stannous fluoride is applied using the paint-on technique and the solution is kept for 4 minutes. Repeat applications are made every 6 months or more frequently if the patient is susceptible to caries.
Advantages of stannous fluoride : Using an 8% stannous fluoride solution at 6 to 12 months intervals conforms to the practicing dentist‟s usual patient – recall system; Administrative difficulties are avoided.Disadvantages of stannous fluoride :1. In aqueous solution the material is not stable;2. 8% solution is quite astringent and disagreeable in taste, its application is unpleasant;3. The solution occasionally causes a reversible tissue irritation manifested by gingival blanching;4. Causes pigmentation of teeth which has a characteristic light brown colour
ACIDULATED PHOSPHATE FLUORIDE (APF) :Method of preparation of acidulated phosphate fluoride :An aqueous solution is acidulated phosphate fluoride is prepared by dissolving 20 grams of sodium fluoride in 1 liter of 0.1 M phosphoric acid and to this is added 50% hydrofluoric acid to adjust the pH at 3.0 and fluoride ion concentration at 1.23%. It is also called as Brudevold‟s solutionFor the preparation of acidulated phosphate fluoride gel, a gelling agent methylcellulose or hydroxyethyl cellulose is added to the solution.
Technique of application :Acidulated phosphate fluoride is recommended for application at 6 or 12months intervals. Oral prophylaxis is done; The teeth to be treated are completely isolated and thoroughly dried with air; Clinical application of APF gels should be done using trays that fit the patient‟s upper and lower dental arches. A disposable foam-lined tray is preferred; To reduce ingestion of fluoride, a minimum amount of fluoride gel that will permit complete coverage of the tooth surfaces should be dispensed; After the trays have been properly positioned saliva ejector is used to evacuate the stimulated saliva and excess fluoride; It is reapplied every 15-30 seconds so as to keep the teeth moist with the fluoride solution throughout the 4 minute period; The patient is instructed to eat, drink or rinse his mouth for atleast 30 minutes.
Advantages of acidulated phosphatefluoride Requires only 2 application in a year; The gel preparation can be self applied and thus the cost of application also gets reduced; It has the ability to deposit fluoride in enamel to a deeper depth;Disadvantages of acidulated phosphate fluoride : Practical difficulties like the teeth should be kept wet for for 4 minutes; It is acidic, sour and bitter in taste; It cannot be stored in glass containers.
SELF-APPLIED TOPICAL FLUORIDESIt includes:DentifricesMouth rinsesGelsDENTIFRICES:The active agent was NaF which had been added to aconventional dentifrice containing dicalcium phosphateas the abrasive.
FLUORIDE MOUTHRINSES:Mouth rinsing is a practicaland effective means for self-application of fluoride.Persons excluded from thepractice are :1. Children under 6 years of age;2. Those of any age who cannot rinse because of oral-facial musculature problems or other handicap.
Method of use :1. Rinse daily with 1 teaspoonful (5 ml) after brushing before bed;2. Swish between teeth with lips tightly closed for 60 seconds; expectorate.Flouride rinses can be used as daily mouth rinse by community and fortnightly in schools.Advantages :30-40% average reduction in dental caries incidence.Disadvantages :Requires community participation.