learning objectives Introduction History Of Water Fluoridation How Does Fluoride Act In Dental Caries Prevention? Goals Of F Administration Fluoride Administration Appropriate Levels Of Fluoride in Drinking Water Methods of water fluoridation -------------------------------------------------------------------- Efficacy Of topical fluorides Range Of therapeutic fluoride concentrations used to prevent caries Recommended doses

1. Fluorides in
Dentistry
Dr Qurat-Ul-Ain
Community Dentistry Department
Abbottabad International Dental
College, Islamabad

2. Learning
Objectives
 Introduction
 History Of Water Fluoridation
 How Does Fluoride Act In Dental Caries Prevention?
 Goals Of F Administration
 Fluoride Administration
 Appropriate Levels Of Fluoride in Drinking Water
 Methods of water fluoridation
 --------------------------------------------------------------------
 Efficacy Of topical fluorides
 Range Of therapeutic fluoride concentrations used
to prevent caries
 Recommended doses

3. Introduction
 Fluorides are organic and inorganic compounds
containing the fluorine element.
 Fluoride (F) therapy is the delivery of fluoride to
teeth, either topically or systematically,
 To protect them from dental caries. Extensive
evidence proved that fluoride toothpastes and water
Fluoridation reduce dental caries.
 Fluoride and water fluoridation in dentistry were
classified as one of the 10 most important public
health measures of the 20th century.

4. History of
Water
Fluoridation
 In 1901, when Dr. Frederick McKay started his dental
practice in Colorado Springs, USA, he noticed that
many of his patients had a mysterious brown
staining of their teeth, He investigated the issue
for 30 years and was stunned to notice that the
strangely stained or “mottled” teeth were also
decay free, and he strived to determine the
drinking water as the cause of this strange
phenomenon

5. History of
Water
Fluoridation
 In 1931, Dr. H. Trendley Dean, a dentist
conducted study on harmful effects of fluoride and
published results in 1950 , that small amount has
large benefits and large amount resulting in an
enamel staining (“mottling” of teeth), known later
as FLUOROSIS
 Dean suggested that water supply fluoride
concentration of about
(1ppm) (roughly equivalent to a grain of
salt in a gallon of water) will be associated with
substantially fewer cavities .
 The safety of Fluoride has been the subject

6. Appropriate
LevelsOf
Fluoride in
Drinking
Water
 Deans - 1.0 mg/l as the most appropriate concentration
of fluoride in drinking water.
 “MOST APPROPRIATE” meant the concentration at
which maximum caries reduction could be achieved while
limiting dental fluorosis to acceptable levels of prevalence
and severity.
 WHO modified fluoride concentration from 1.0 mg/l into
range 0.7 – 1.2 mg/l because of climate differences, i-e
people drinking more water in hot climate than people
living in moderate climate.

7. How does
fluoride act in
dental caries
prevention?
Three theories prevail:
1. Fluoride becomes incorporated into the
hydroxyapatite crystals of teeth, rendering them
more resistant to acid attack.
2. Presence of saliva promotes remineralization of
early carious lesions. By mean of having the molecule
F replace the molecule OH in the hydroxyapatite
and transform it to fluorapatite; this process will
make the enamel more resistant to caries, only of the
fluoride is given for a long period of time on regular
bases.
3. Fluoride interferes with metabolic pathways of
bacteria, thus reducing acid.

11. Fluoride
Administratio
n
A.Systematic
B.Topical

12. Systematic
Fluorides
 These are ingested and delivered to the oral
cavity via the blood stream.
 It provides systematic effects, i-e accruing
from ingestion & absorption of fluoride and
this can occur post eruptively via saliva and
crevicular fluid.

13. Crevicular
Fluid

14. Systematic
Fluorides
Advantages
1. Low cost
2. No motivational or behavioral changes necessary
Disadvantages
1. Political &/or emotional objections to water additives
2. Possibility of mild to moderate fluorosis if other sources of
fluoride are ingested inadvertently
3. Allege toxicity

15. Systematic
Fluorides
Administratio
n Methods
1. Water fluoridation
I. Community water fluoridation
II. School water fluoridation
2. Dietary supplements
I. F tablets / drops
II. Fluoridized salts
III. Fluoride vitamins preparation
IV. Fluoride milk & fruit juices

16. Fluoride
Compound
Used in
Water
Fluoridation
 Fluorspar : it is a mineral containing calcium fluoride
[CaF2]
 Sodium fluoride
 Silicofluorides
 Sodium silicofluorides ( mostly use because of low
cost)
 Hydrofluosilicic acid.
 Ammonium silicofluoride

17. Methods of
water
fluoridation
 3 main system used for water fluoridation
1. The Saturator system (sodium fluoride- use for
smaller & very smaller community)
2. The Dry-feeder system (sodium fluoride or
silicofluoride- mid size community)
3. The Solution feeder system (hydrofluosilicic
acid – larger community)

18. Topical Fluorides

19. Topical
Fluorides
 Large concentrations of fluoride that are
applied topically (or locally) to erupted tooth
surface to prevent the formation of dental
caries.
 Application of topical fluorides immediately
after eruption speeds fluoride uptake and
makes enamel more resistant to dental caries
because enamel is porous & immature it
acquires fluoride rapidly.

20. Topical
Fluorides

21. Topical
Fluorides
Advantages
1. Does not cause fluorosis
2. Cariostatic for people of all ages
3. Available only to people who desire it
4. Easy to use
Disadvantages
1. Person must remember to use
2. Per capital cost is high compared to water
fluoridation
3. More concentrated professional use products can
cause short term side effects like nausea
immediately after use

22. Classification
of
Topical
Fluorides
Professionally applied
A. Aqueous solutions
1. Sodium fluoride – 2%
2. Stannous fluoride – 8%
B. Fluoride Gels
1. Acidulated phosphate
fluoride 1.23%
C. Fluoride varnishes
1. Duraphat
2. Fluorprotector
D. Fluoride prophylactic paste
E. Restorative material
containing fluoride
F. Fluoride containing devices
Self Applied
A. Fluoride dentifrices
B. Fluoride mouth rinses

23. Efficacy of
Topical
Fluorides
depends on:
1. The of fluoride used
2. with which it applied and the
duration of application
3. used

25. RangeOf
Therapeutic
Fluoride
Concentration
s used to
PreventCaries
Method Fluoride concentration (ppm F)
Water supply 0.7 to 1.2
Fluoridated salt 200 To 250
0.05% NaF mouth rinse, once daily 230
0,2% NaF mouth rinse, once weekly 920
Dentifrices, children 250 to 500
Dentifrices, adult twice daily 1000 to 1500
1.1% NaF gel once daily 5000
Professionally applied solutions 2%
NaF
9,200
Professionally applied solutions ,
gels, foams (1.23% APF)
12,300
Professionally applied solutions (8%
SnF2)
19,500
Professionally applied varnishes
(5%NaF)
22,600

26. Dosage

28. Any question