2. I. Definition
II. Fluoride delivery system
III. Indications
IV. Classification
V. Various types of professionally applied fluorides
VI. Various types of self applied fluorides
3. Topical fluoride are those
fluoride that provide a
local chemical reaction of
fluoride with exposed
surfaces of erupted tooth.
4. TOPICAL
FLUORIDES
Placed directly on the
teeth
Provide low/high
concentration of
fluoride over a short
period of time
SYSTEMIC
FLUORIDES
Circulated through
blood streams and are
incorporated into
developing teeth
Provide low
concentration of
fluoride over a long
period of time
7. Professionally applied
These are the medicaments
that are typically dispensed
by dental professionals.
These involve the use of
high fluoride
concentration products.
Fluoride concentration
range:- 5000 to 19,000 ppm
These are the products that
are dispensed by patient
after recommendation
from dentist
These involve the use of
low fluoride concentration
products.
Fluoride concentration
range:- 200 to 1000 ppm
Self applied
9. Reported by:- Knutson and Feldman
Technique:- Knutson technique
Fluoride percentage :- 2%
Caries reduction:- 30%
Fluoride concentration:- 9200 ppm
pH:- neutral
Method of preparation:- 20 % of NaF Solution can
be prepared by disolving 20g of NaF powder in 1L of
distilled water.
It is stored in a plastic bottle rather than a glass bottle because if stored in
glass containers, the fluoride ions of solution may react with silica of glass.
10. Method of application:-
1. Cleaning and polishing of teeth
2. Isolation of quadrants with a cotton roll
3. Drying of tooth
4. NaF is applied with cotton applicator on one quadrant
5. It is permited to dry on the teeth for about 4 mins
6. The procedure is repeated for remaining quadrants
7. Patient is instructed to avoid eating, drinking or rinsing for atleast 30 mins
8. 2ed 3rd and 4th application are given at weekly intervals at ages of 3,7,11 and
13 years.
11. Mechanism of action:-
When NaF is applied topically, it reacts with
hydroxyapatite crystals to form calcium fluoride.
Calcium fluoride reacts with hydroxyapatite crystals to
form flouridated hydroxyappatite.
The hydroxyapatite formed increased the concentration
of fluoride on enamel surface which in turn makes tooth
surface resistant against caries attack.
Choking effect:- A thick layer of sodium fluoride is formed,
it interfares with furthur diffusion of fluorides from topical
fluoride solution to react with hydroxyapetite and blocks
furthur entry of fluoride ions.
12. Reported by:- Dudding and mulher
Technique:- Mulher technique
Fluoride percentage:- 8%
Caries reduction:- 32%
Fluoride concentration:- 19,500 ppm
pH:- 2.4-2.8
Method of preparation:- 0.8 grams of powered SnF2
is disolved in 10 ml of distilled water.
This solution is to be freshly prepared before use everytime
because SnF2 doesn’t have good shelf life.
13. Method of application:-
1. A thorough prophylaxis is done
2. It is followed by isolation of quadrants with cotton rolls
3. Either a quadrant of half of the mouth can be treated at one time
4. A freshly prepared solution of SnF2 is applied on the teeth with a
cotton applicator via paint on technique.
5. Reapplication of the solution to a particular tooth is done every 15-30
second and the teeth are kept wet for 4 minutes.
6. Repeat applications are made every 6 months.
14. Mechanism of action:-
When stannous fluoride is applied in high concentration
calcium tri-fluro stannate gets formed along with
tin tri-flurophosphate .
The ‘tin tri-flurophosphate’ formed is responsible for
making the tooth surface more stable and less susceptible
to decay.
Rapid penetration of tin and fluoride in 30 seconds
occurs therefore continuous reapplication after 15-3o
seconds is needed.
In low concentration, it may development of metallic taste is experienced.
15. Reported by:- Brudevold et al
Technique:- Brudevold technique
Fluoride percentage:- 1.23%
Caries reduction:- 28%
Fluoride concentration:- 12,300 ppm
pH:- 3.0
Method of preparation:- 20g of NaF2 is disolved in 1L of
0.1M phosphoric acid. To this, 50% hydrofluoride acid is
added.
Furthur, for preparation of APF gel, a gelling agent like
Mthylcellulose or hydroxyethyl cellulose is added.
16. Method of application:-
A thorough oral prophylaxis is done
The teeth to be treated are completely isolated with cotton roll
Patient is asked to sit upright
Clinical application of APF gel should be done using trays that
fit the patients upper and lower arches
Usually less amount of gel is used to prevent ingestion of
fluoride but enough gel should be placed on the tray to fill
1/3rd of the area of the tray
After the tray has been properly positioned, saliva ejector is
used to evaluate stimulated saliva
17. It is re-applied after 15-30 seconds to keep the teeth
moist with fluoride solution throughout the 4 minute
period
Recommended frequency of APF topical application is
semi-anual
18. Mechanism of action:-
When APF is applied on the teeth, it initially leads to dehydration
and shrinkage in volume of hydroxyapatite crystals
Furthur, hydrolysis occurs which leads to formation of intermediate
products i.e. dicalcium phoshpate dihydrate (DCPD)
DCPD is highly reactive with fluoride ion and start forming
immediately when APF is applied
Fluoride penetrates into crystals more deepely and leads to
formation of fluroapetite
The amount and depth of fluroapetite is dependent upon amount
and depth at which DCPD gets formed
19. NaF SnF2 APF
Chemically
stable
Less appointments
required
Long shelf life
Acceptable
taste
Less administrative
difficulties
Acceptable taste
Non- irritating Non- irritating
No
discoloration
No staining
Cheep Cheep
20. NaF SnF2 APF
4 visits in short
duration of time
Light brown color
staining maybe seen
It is acidic, sour and
bitter in taste
Follow up is
difficult
Unplesant taste Increased chair side
time
Teeth has to be
kept wet for 4
minutes
Reversible tissue
irritation
Teeth has to be kept
wet for 4 minutes
21. Introduced by:- Muhlemann of university of Zurich .
Under certain conditions amine fluorides are believed to be
superior than inorganic fluorides in reducing enamel
solubility.
They are also surface active i.e. they’ve an affinity for
enamel and thus hold the fluoride on enamel surface for a
long time.
They also have anti-bacterial properties.
While the caries inhibiting potential of amine fluorides is
good and even after their surfectant and anti-bacterial
properties, they are still not considered as superior to other
available fluoride agents.
22. Introduced by:- Schimdt
Need for fluoride varnish:- Currently used tropical
fluorides agents have a major disadvantages that they
remain in contact with teeth for a very short time
(about 5-10mins) before they get diluted by saliva and
exert relatively a superficial effect on dental enamel.
Types of varnishes:-
1. DURAPHAT
2. FLUROPROTECTOR
23. Technique of application:-
1. Prophylaxis is done which is followed by drying of teeth
2. Application is done on mandibular arch first and then on
the maxillary arch
3. Varnish is applied using a single tufted small brush,
starting with proximal surfaces
4. After application, the patient is made to sit with mouth
open for 4 minutes to let the varnish set on teeth
5. Patient is asked to avoid drinking, eating or rinsing for
about an hour
24. Foam based agents were developed in an attempt to
minimize the risk of fluoride over dosage as well as to
maintain the efficacy of topical fluoride treatment.
It is much lighter than conventional gel and therefore
only a small amount of agent is needed.
It doesn’t require suctioning hence it can be used in
treatment of young children and disabled person.
They gets penetrated into interproximal surfaces.
25. Sodium fluoride is the most commonly used
tablet/drop.
Supplements contain a measured amounts of fluoride,
typically 0.25mg, 0.5mg or 1.0mg
These tablets and lozenges should be chewed, swished
and swallowed.
26. For infants, fluoride drops are more convenient.
These fluoride drops are dispensed with a measured
dropper.
Other compounds are:- Acidulated phosphate
fluoride, potassium fluoride or calcium fluoride.
27. It is a technique of introducing ionic medicinal compounds
into the body through the skin by applying a local electric
current.
A low voltage electric current is used to impregnate the
tooth with fluoride ions.
It is a iontrophic device that works electrophoretically to
desensitize the dentin.
It provides 2-6 times more fluoride ions at a time than
topical sodium fluoride.
28.
29. When placed over the crown, these devices can
significantly increase the salivary fluoride
concentration.
They have great potential for use in preventing dental
caries in children, high-caries-risk groups, and
irregular dental attendees.
30. Dental prophylaxis typically consists of placing an
abrasive paste in a rubber cup and applying the paste to the
clinical crowns of the teeth at slow speed.
Rubber cups, also called prophy cups, are used in the
hand-piece. Polishing paste used is a prophylactic paste,
usually containing fluoride.
It has been found that the release of fluoride from the
prophy cup during a simulated prophylaxis results in a
significant increase in the fluoride content of the treated
enamel.
31.
32. Fluoride-releasing restorative materials can be used as a
reservoir, releasing small amounts of fluoride to the teeth
over a long time.
The glass-ionomer dental cement, is able to release
fluoride in a sustained manner that may continue for many
years, and this is seen as clinically beneficial.
The Fluoride release by the GICs occurs by dissolution and
ion exchange, differently from the composite resins that
occur only by ion exchange, due to the low degree of
solubility of this material
34. A dentifrice is a substance used with a toothbrush
for the purpose of cleaning the accessible surface
of teeth.
They have been proven to be effective anticaries agent.
Almost 95% of available toothpastes in market are
fluoridated.
36. How to use:- These are intended to be used by
forcefully swishing 10ml of the liquid around the
mouth for 60 seconds before expectorating it.
Mechanism of action:- Fluoride changes the enamel
structure of teeth from hydroxyapatite to fluorapatite
which causes inhibition of bacterial metabolism and
plaque acid formation.
37. Most commonly used mouthwash:- ‘Sodium fluoride’
Other fluoride mouthwashes are:-
1. Stannous fluoride
2. Amine fluoride
3. Ammonium fluoride.
High caries risk individuals
Fluoride deficient communities
Less fluoride content in drinking water
38. These maybe applied in trays or brushed on teeth.
Patient brushes his teeth for 1 minute with gel and
when trays are used, several drops of gels are
placed over trays and are held in contact with teeth
for approximately 5 minutes.
39. Delivery of a high concentration of fluoride
Toxic hazards
Tedious
Note:- Patient should be cautioned to
expectorate excess gel and not to swallow it.
There is a high risk that young children with
developing teeth may swallow some gel
therefore self application is not recommended.
40. Fluoride can be incorporated into unwaxed dental floss.
Interproximal surfaces of teeth treated with fluoride
impregnated dental floss acquired significantly more
enamel fluoride than those treated with plain dental floss.
The number of Streptococcus mutans harbouring in
interproximal areas was reduced significantly .
These fluoride impregnated dental floss if placed in acid-
buffer solution results in the release of most of the fluoride
in the floss.
41. Dental tape are used to clean the surfaces between your
teeth where a brush cannot reach.
It is broader and flatter than standard floss
People with more space between their teeth often
find dental tape more comfortable to use than
standard floss.
A dental tape can be a simpler and quicker method of
flossing without compromising the quality of cleanliness.
42.
43. The wooden toothpick can be used as a vehicle for the delivery of
fluoride to the interproximal area.
The release of fluoride from the pointed section of a toothpick
impregnated higher fluoride concentrations as compared with other
fluoride-containing products.
Toothpicks impregnated in 4% NaF, 8% SnF2 or 2% chlorhexidine had
an effect on the proportion of mutans streptococci and on the decline
of pH in dental plaque, but it was small and only of short duration.
Four weeks' use of toothpicks, especially of NaF-impregnated
toothpicks, reduced the degree of demineralization of enamel and
dentine.
44. Patients with xerostomia are at a high risk of developing
caries because the loss of saliva increases the acidity of
mouth which influences the development of caries.
Artificial saliva is a substitute of saliva that temporarily
moistens and lubricates the mouth, creating a protective
film.
‘Mouth Kote’ is a oral spray that contains xylitol and
provides up to 5 hours of relief from dry mouth.
45. Artificial saliva comes in several forms, including:
1. oral spray
2. oral rinse
3. gel
4. swabs
5. dissolving tablet
