By Dr hiba Hussain Aouda

2. contents
• Introduction
• Definition
• Classification of topical fluoride
• Self applied fluoride:
1. toothpaste
2. Mouth rinse
3. Gel
• Professional applied fluoride:
1. Varnish
2. SDF/SDI
3. Fluoride containing restorative materials

3. Introduction
● Dental caries is a major dental disease that impairs the
quality of life for many people causing pain and
discomfort.
● Fluorides have been proved to be the single most
effective weapon in our still limited arsenal of anti caries
agents.
● Fluoride play a role of a caries preventive agent
throughout the life of a tooth.
● Fluoride ( F- ) can have both beneficial and detrimental
effects on the dentition.

4. Definitions:
• Topical Fluoride therapy refers to, “The use of
systems containing relatively large concentrations of
fluoride that are applied locally, or topically, to erupted
tooth surfaces to prevent the formation of dental caries
• Topically applied fluorides is used to describe those
delivery systems which provide fluoride for a local
chemical reaction to exposed surfaces of the erupted
dentition.
• Topical fluoride is “A fluoride applied directly to the
teeth, especially of children, in a dental caries
prevention program.’’

5.  Indication:
1) Children with active caries
2) Newly erupted teeth
3) In patients with reduced salivary flow due to
medications
4) Those receiving radiation of head and neck region
5) Patients with fixed or removable appliances, (e.g.
before cementation of bands)
6) After placement or replacement of restorations and
before cementation of stainless steel crowns
7) Disabled children

6. Topical fluoride include 2 main types :
1. Self applied
>Dispensed at home by
individual
>but at recommendation
Low fluoride concentration
2. Professional applied
>Dispensed in dental offices
>High fluoride concentration
Classification of topical fluoride

7.  Classification of topical fluoride
application
• Self applied :
1. Fluoridated toothpaste
2. Mouth rinse
3. Gel
• Professional applied:
1. Varnishes
2. SDF /SDI.
3. Restorative Materials containing Fluoride

8. I. Self applied :
• Fluoride products are usually bought and
dispensed by the individual patients but at the
recommendation of a dental personnel.
• These products include – fluoride
dentifrices mouth rinses, gels.
• Usually use the low fluoride concentration
products ranging from 200 to 1500 ppm or
0.2 – 1.5mg F/m

9. 1. Fluoridated toothpaste
• Toothpastes contain fluoride as sodium
monofluorophosphate (SMFP), sodium fluoride,
stannous fluoride or amine fluoride.
• Adult Twice daily →1,000–1,500 ppm
• children→ 250–500 ppm

10. 2.Fluoride Mouth rinse
• NaF 0.05% (225ppm) daily use
0.2% (900ppm) weekly use
• SnF2 100,200,300 ppm.
• 10 ml swishing for 1 min.
• children below the age of 6 years should not
use fluoride mouth rinse.

11. 3.Topical fluoride gels and foams
• There are also self-applied gel formulations
of sodium fluoride (1.1% [5,000 ppm]
sodium fluoride)
• stannous fluoride (0.15% [1,000 ppm]
fluoride) available by prescription for home
use.

12. • Neutral sodium fluoride gels (NaF) are preferable to
acidulated gels (APF) in people with porcelain and
composite restorations.
 

13. II. PROFESSIONALLY APPLIED-
Fluoride products
• Are those medicaments typically dispensed by Dental
professionals in the Dental office and usually involve
the use of high concentration products ranging from
5000 and 19000ppm which is equivalent to 5-19
mgF/ml.

14. II. PROFESSIONALLY APPLIED-
Fluoride products
• These exert an anti caries effect by increasing the
concentration of fluoride in the outermost surface of
the enamel.
I. Sodium fluoride preparation.
II. Stannous fluoride preparation.
III. Acidulated phosphate fluoride preperation.
IV. Fluoride varnish.
V. Silver diamine fluoride liquid (SDF).
VI. Fluoride containing restorative materials.

15. 1. Fluoride Varnish
• Fluoride varnish is a topical fluoride treatment that has
been shown to be effective in preventing dental caries,
particularly in children and adolescents.
• Indication :
1. moderate- high caries risk patients.
2. For hypersensitive teeth.
3.Decrease post operative sensitivity ( after periodontal
scaling).
4.As cavity liner.

17. 1. Fluoride varnishes
• Usually applied with at least two applications / year.
• Types:
1. Duraphat: 22.6 mg F/ml.
2. Fluorprotector: pH lower than Duraphat and it is
available in box with 20 vials each vial contains 0.4
ml of solution.
3. Duraflour : 22.6 mg/ml.
4. Cavity shield.

18.  Method of application
1. Oral prophylaxis is done
2. Teeth are dried but not isolated with cotton rolls as
varnish sticks to cotton.
3. Paint fluoride using disposable brush on all tooth
Surfaces.
4. Varnish sets rapidly when they come in contact with
saliva, no drying is necessary.
5. After application ,patient asked to sit with mouth
open for 4 minute.

20. 2. Silver diamine fluoride liquid (SDF).
• (SDF) is a cariostatic agent used in the nonsurgical
management of caries.
• It was designed to combine the antimicrobial properties of
silver and the remineralizing effect of fluoride in
one treatment.
• Numerous studies have shown subsequently the effectiveness
of SDF in caries arrest.
• Formulation :
I. 25% silver (antimicrobial)
II. 8% ammonia (solvent)
III. 5% fluoride (remineralization)
IV. 62% water.

22.  Indication of SDF
1)Extreme caries risk (xerostomia)
2)Behavior or medical management challenges
3) More lesions than treatable at 1 visit
4) Patients without access to care
5) Patients looking for minimally invasive treatment
options

23.  Contraindication and limitation
1) Possible concerns with silver allergy.
2) May sting ulcerated gingiva (use petroleum jelly to
protect gingiva when needed)
3) Do not use if there is exposed pulp in lesion (can
cause sensitivity and “tingling” feeling).

24.  Advantage of SDF
1. Applied every 6 or 12 months.
2.Arrests caries in addition to prevent caries
3.Decreases dentinal sensitivity.
4.Expected caries prevention is about 25-70%.
5. Minimally invasive option very helpful during
pandemic situations like in COVID-19.

25.  Disadvantage of SDF
• Dark staining of demineralized tooth surfaces

26.  Selection of Teeth for the Application
of SDF
• Absence of clinical signs related to inflamed pulp or
history of spontaneous pain.
• Carious lesions that are not infringing on to the pulp.
When possible, prescribe radiographs to assess the
proximity of pulp to caries lesions.
• Carious lesions on any surface that are accessible
with a brush during SDF application
• Before placement of restoration and as a cariostatic
means.

27.  Method of application of SDF
1. Isolate using cotton roll, dry angle and/or bite block.
2. Dry teeth with air/water syringe
3. Dip micro brush in SDF and apply for 60 seconds.
4. With careful application using a micro brush, the intraoral and
extra oral soft tissue exposure can be prevented.
5. For a single complete appointment, not more than one drop of
SDF should be used. One drop is sufficient to treat 5 to 6 teeth.
6. Let solution air dry for 60 sec.(not with air/water syringe or
solution will spread to other areas).
7. Wipe with gauze or apply fluoride varnish (to mask taste of
SDF and does not wash away with saliva or contact mucosa)
8. Application frequency: The studies that had three times / year
applications showed higher arrest rates.

29. Silver modified atraumatic restorative treatment (SMART) :
(A) Before SDF application; (B) After SDF application; (C) After GIC
application

30.  SDI (SDF/Potassium iodine )
• Next generation SDF.
• The major drawback of SDF application is
the dark staining of both teeth and
restorative materials.
• Hence, its use on adult dentition is limited.
• Improving the esthetic outcome by stain
reduction would greatly enhance the
opportunity for SDF’s universal use.

31.  KEY FEATURES
• Clinically tested & proven for decades
• Esthetically pleasing for the patient - reducing staining
• Approved for Caries Arrest
• Non-invasive – suitable for MID
• Patented Technology
• Immediate dentinal hypersensitivity relief in adults
• Increased bond strengths when used with auto cure GIC.

32.  INDICATIONS of SDI :
• Anti-cavity / Anti-caries.
• Prevents, fights and/or protect against cavities or caries.
• Effective decay preventive fluoride.
• Helps reverse the tooth decay process earliest stage
before it can become a cavity.
• Helps to reduce sensitivity in cervical hypersensitivity
teeth in adults.
• Step 1 is indicated for children 3 years old to adults
• Step 2 is indicated for adults only

34. • The silver fluoride and potassium iodide action
blocks the microscopic tubules that make up dentin.
A low solubility precipitate is formed that gives
instant relief. It acts by preventing the flow of fluid
that produces sensitivity

35.  Treatment Protocol
• SDF/KI is suitable for application to any asymptomatic
carious lesion in both deciduous and permanent teeth.
• If used in conjunction with a self-cure GIC (providing the
correct treatment protocol is followed), it will arrest caries
and assist with the remineralization of the lesion to become
a caries resistant base under the restoration.
• Applied correctly, it will neither stain surrounding tooth
structures or the restoration

36. • Pre-treating tooth surfaces with SDF/KI is a great
way to enhance bonding of glass ionomers to dentine.
• SDF/KI two step patented procedure minimises the
risk of staining.
• By applying the potassium iodide solution over the
silver fluoride, a silver iodide creamy white
precipitate is formed and washed off.

37.  Caries Access
• Accessing caries is required, especially proximally, for
the correct application of SDF/KI.
• local anaesthetic is usually unnecessary.
• Occlusal caries requires minimal tooth removal.
• Proximal caries may require using an ultra
conservative “tunnel preparation” for permanent
teeth or for deciduous teeth, a small proximal slot
preparation.

38.  Surface Preparation
• Prepare the surface by first removing any loose
grossly carious dentin, followed by a 15 second etch
with 37% phosphoric acid.
• Rinse and dry the preparation.

39. Clinical Steps to SDF/KI
• Isolate the preparation
• Etch the preparation for 15 seconds, wash and dry
• Take the SDF (grey) vial and break the seal with the
hard end of the brush applicator
• Apply the SDF with the brush over the caries
• Immediately following this, similarly apply the KI
(green) vial over the SDF
• A white precipitate will appear
• Continue applying the KI solution until the white
precipitate completely disappears
• Wash away the reactant with water and dry the
preparation.

40.  GIC and Composite Placement
• A self-cure GIC restoration is indicated immediately
after SDF/KI treatment.
• If the restoration encroaches upon undermined cusps
in the tooth or has a large load bearing area, a GIC
and composite resin “co-cure” sandwich restoration is
indicated.

42. • The difference between two glass ionomer cement
restorations, one treated with SDF and the other
treated with SDF/KI.
• The tooth was stored in water for 6 weeks
exposed to direct sunlight.
SDF SDF/KI

44.  SDI Riva Star Aqua - Bottle Kit
• Riva Star Aqua from SDI is a
highly effecctive next generation
water based silver fluoride tooth
pain desensitising solution that is
also effective in arresting carious
lesions.
• containing 38% Silver Fluoride.
Indications
• Desensitising cervical tooth
hypersensitivity

45. Benefits of aqua Riva star:
• Clinical match to SDF.
• Immediate sensitivity relief .
• Reduce staining.
• Two years desensitizing effect .
• No tissue burn risk.
• No gingival barrier required.
• Improved smell.

46. 3.Fluoride containing restorative materials
• Fluoride added to dental restorative materials, luting
cements and cavity varnishes in order to impart a
cariostatic property and to reduce enamel solubility at
the margins of restoration.
• There is also accepted concept of application of
topical fluoride to the occlusal surfaces immediately
after placing pit and fissure sealants.

47. 3.Fluoride containing restorative materials
• Include :-
I. Glass ionomer cements.
II. Resin modified glass ionomer cements.
III. Polyacid modified resin composites (compomers).
IV. Resin composites.
V. Fissure sealants .
VI. Dental amalgam .