EVERYTHING YOU NEED TO KNOW ABOUT SYSTEMIC FLUORIDES. HISTORY, MECHANISM OF ACTION, METABOLISM, DIETARY SUPPLEMENTS AND RECENT ADVANCES. LETS STUDY SYSTEMIC FLUORIDE TOGETHER. LETS LEARN AND SHARE OUR KNOWLEDGE.

1. HISTORY &
MECHANISM OF
ACTION OF
SYSTEMIC
FLUORIDES
PRESENTED BY:
DR. RUCHIKA BAGARIA
1ST YEAR POSTGRADUATE
PEDIATRIC & PREVENTIVE
DENTISTRY

2. INTRODUCTION
 Derived from the Latin word ‘fluore’ means to flow.
 Pale, yellow-green gas
 Fluoride is a ubiquitous mineral.
 Trace element & halogen
 Atomic weight – 19 u , Atomic number - 9
 Combined forms Fluorspar (48.5% ), Fluorapatite & Cryolite.

3.  The Federal Register of United States Food and Drug
Administration describes fluoride as an essential nutrient in
1973.
 The WHO expert committee on trace elements included
fluorine as one of the 14 physiologically essential elements.
 1 milligram per litre = 1 ppm

4. HISTORY
1901, DR. FRED RICK MCKAY
Permanent stains present on the teeth of local inhibitants of
Colarado Spring, U.S.A. known as COLARADO STAINS noticed.
He called the stain Mottled Enamel.
1902, DR. J.M. EAGER
described similar stains present on teeth of certain italian
emigrants embarking at Naples as “denti di chiaie”
1916, DR. GREEN VARDMIN BLACK
supported MCKay work with histologic evidence reporting it as
"an endemic imperfection of the enamel of the teeth.

5. 1925,DR. F MCKAY
change of water supply from spring water of the Great Salt
Lake of Oakely, Idaho City, showed no brown stains in children.
1928,DR. F MCKAY AND GROMER KEMPT
Similar observation found in Bauxite where changed water
supply from a shallow well to foot well resulted in children with
badly stained teeth
1931,MR HV CHURCHILL
A spectrographic analysis of Bauxite city water showed the
presence of fluoride at the level of 13.7ppm.

6. 1933,DR. H TRENDLEY DEAN
Shoe Leather Survey
 5,824 children from 22 cities of 10 states of US.
 Concluded that, at a water conc. of:
 4 ppm or more—signs of discrete pitting
 3 ppm or more—mottling was widespread
 2–3 ppm—teeth had dull chalky appearance
 ≤1 ppm—no mottling of any esthetic significance

7.  He also reported that the incidence of caries in these teeth
was less as compared to non-fluoridated teeth
 Proved that 1ppm F in water wasn't hazardous for public
health.
 1934, Dean developed a standard system for classification of
dental fluorosis the "mottling index" (Dean's Index for
fluorosis)

8. 1942,DR. H TRENDLEY DEAN
The important milestone discovery was made by Dean et al
that at 1 ppm F in drinking water, a 60% reduction in caries
experience was observed.
1939, DEAN AND MCKAY
Came out with the most conclusive and direct proof that
fluoride in domestic water is primary cause of human mottled
enamel
1939,DR. H TRENDLEY DEAN
Hypothesis showing the inverse relationship between endemic
dental fluorosis and dental caries emerged with survey of four
illinois cities.

9. 1964
The WHO and the Pan American Health Organization endorsed
the practice of water fluoridation
1945
First community level water fluoridation program started in
Grand Rapids, USA
1950s
Water fluoridation started in the United States in the states of
Florida, Illinois, California (1952), Ohio (1955), and Missouri
(1957)

10. FLUORIDE METABOLISM
Because of high dissociation constant (Ka) of -3.189, 99.9% fluoride ions will be
protonated by HCI in the stomach to produce HF
It then enters the GI system where it is absorbed and metabolized
Fluoride from systemic administration (supplements, milk, water, and salt) enters
the oral cavity where it provides topical benefits before it is swallowed
Any increase of fluoride in the cell can cause interference with cellular function
In the neutral pH environment of the cytoplasm, HF dissociates into protons and
fluoride ions
HF being neutral can readily penetrate gut epithelial cell walls and enter the cell
cytoplasm

11. PRIMARY CHEMICAL CONSTITUENTS
OF TOOTH ENAMEL
Tewari A. Fluorides and Dental Caries: A compendium 1 st ed. Indore. J Indian Dental
Association. 1986;17:24-9
Na, Mg, Fluoride, chloride
Calcium, Phosphate
Hydroxyl, Carbonate ions

12. CHANGES IN ENAMEL DURING
EARLY STAGE OF CARIES
• Integrity of enamel- Chemical and composition of
surrounding fluids.
• Factors- controlling the stability- PH, concentration of
calcium, phosphate, and fluoride

13. • pH - in oral fluids --- in the solubility of enamel apatites
• 5.2- 5.5 enamel apatite get remineralized, below -- in rapid
dissolution of enamel hydroxyapatite
• Hydroxyapatite is not present in pure form, it contains
fluoride.
• The more the fluoride the apatite contains the less soluble
it will be at the same pH

14. • Fluor apatite- smaller ions
• Decrease dimensions of unit cell
• Affects physical and chemical
properties of crystals
• Pure Fluorapatite- 38000ppm fluoride

15. MECHANISM OF ACTION OF FLUORIDE
• Fluoride increases the crystal size and produces less
strain in crystal lattice, through conversion of
amorphous calcium phosphate into crystalline
hydroxyphosphate
Improved
crystallinity
• Void in the crystals decreases the stability and
increases chemical reactivity.
• Greater stability leads to lower solubility and hence
greater resistance to dissolution in acids.
Void theory
• (FAP vs HAP) Fluorapatite or fluoridated hydroxyapatite
(solubility constant of 10.60) is less soluble than
hydroxyapatite (10.55) therefore has greater stability
Acid solubility
• Fluoride has enolase inhibition effect, and it also
inhibits glucose transport.
• It inhibits nonmetalloenzymes like phosphatases, thus
leading to reduced acid production
Enzyme inhibition

16. • Stannous fluoride oxidizes the thiol group present in
bacteria, thus inhibiting bacterial metabolism.
Suppressing the
flora
• The concentration of fluoride above 2 ppm decreases the
transport of uptake of glucose into cells of oral
streptococci and also reduces ATP synthesis
Antibacterial action
• Fluoride incorporated in enamel by substitution of hydroxyl
ions reduces free surface energy and indirectly reduces the
deposition of pellicle and subsequent plaque formation
Lowering free
surface energy
• Acidic protein group binds calcium and basic to
phosphate. Fluoride inhibits the binding of acidic
protein to hydroxyapatite, thereby displaying its
beneficial effects
Desorption of
protein and bacteria

17. Modification in tooth morphology
Increase enamel resistance (or) Reduction in enamel solubility
Increased rate of posteruptive maturation
Interference with plaque microorganisms
Remineralization of incipient lesions
MECHANISM OF ACTION IN CARIES
REDUCTION

18. • carious dissolution of enamel is a cyclic phenomenon
consisting of phases of demineralization and re-precipitation.
• The presence of fluoride reduces the solubility of enamel by
promoting the precipitation of hydroxyapatite and
phosphate mineral.
Increase enamel resistance (or) Reduction in enamel solubility

19. • Newly erupted teeth often have hypomineralized areas that
are prone to dental caries.
• In addition, the entire enamel surface is at its maximum
degree of susceptibility to caries as soon as it appears in the
mouth.
Increased rate of posteruptive maturation

20. • There is a direct relationship between the amount of fluoride ingested
during tooth development and the incidence of dental caries.
• The diameters and cusp depths of teeth are smaller if fluoride is present
during tooth development.
Modification in tooth morphology

21. • Fluoride also plays a critical role in reducing dental caries by
enhancing remineralization.
• Remineralization, the deposition of minerals into previously
damaged areas of the tooth is a dynamic process that results
in reduced enamel solubility.
Remineralization of incipient lesions

22. • In high concentrations, fluoride is bactericidal. This is probably
how fluoride helps reduce plaque.
• In lower concentrations, fluoride is bacteriostatic. It helps
control the growth of bacteria without destroying them.
Interference with plaque microorganisms

23. FLUORIDE SOURCE
SYSTEMIC
WATER,SALT, MILK,
BEVERAGES, FOODS,
FLUORIDE
SUPPLEMENTS
TOPICAL
ORAL FLUIDS - SALIVA,
PLAQUE
TOPICAL FLUORIDES-
VARNISHES
DENTRIFICES

24. SYSTEMIC FLUORIDE
 Low concentration of fluoride to teeth for a long period.
 Fluoride after the ingestion can get absorbed and incor-
porated into developing enamel and can benefit teeth before
eruption.
 After teeth erupt, fluoride contacts teeth directly through
salivary secretions & gingival exudate.

26. • Water fluoridation is defined as controlled adjustment of the
concentration of fluoride in a communal water supply so as to achieve
maximum caries reduction and clinically insignificant level of fluorosis".
• The recommended levels vary between 0.7-1.2 ppm.
• Varies with climate.
• ppm F = 0.34/E
where E=-0.038+0.0062 temperature of that area in F°(T)
E-estimated daily water intake of children In oz/lb body weight
T-Mean maximum temperature in degree F of that area
WATER FLUORIDATION

28. GRAND RAPIDS-MUSKEGON STUDY
• January 25th 1945, sodium fluoride was added to GRAND
RAPIDS water supply. Muskegon town was kept as a control.
• 6.5 years later, in July 1951, the caries experience of
6-15 year old kids of Grand Rapids was half of that of
Muskegon.

29. NEWBURGH-KINGSTON STUDY
• May 2nd 1945, sodium fluoride was added to drinking water of
Newburgh on the Hudson river.
• Kingston town was kept as a control.
• After 10 years of fluoridation ,reported that the DMF rate had
fallen from 23.5% to 13.9%, confirming the caries inhibitory
property of 1 ppm fluoride in drinking water

30. EVANSTON-OAK PARK STUDY
• In January 1946, a fluoridation experiment began in Evanston.
• Oak park acted as the control town.
• After 14 years of fluoridation in Evanston, there was a
reduction of 49% in DMF values.
• Presented the most detailed data of all the
fluoridation studies.

31. THE BRANTFORD- SARNIA-STARTFORD
• Brantford, fluoride was added to water supply in June 1945.
• Community of Sarnia was established as the control town.
• In addition, the community of Stratford had naturally
available water with 1.3ppm.

32. TIEL-CULEMBORG STUDY
• In March 1953 the drinking water in Tiel was fluoridated to a
level of 1.1 ppm.
• Culemborg with water fluoride level of 0.1 ppm was the
control.

33. • Presence of caries in the community/public
• Level of fluoride concentrations in their drinking water
• Centralized water supply to the community
• Community acceptance/approval
• Installation and maintenance cost
Pre Requirements of Water Fluoridation

34. • FLUORSPAR (CaF2)
• SODIUM FLUORIDE
• SILICOFLUORIDES
• HYDROFLUOSILICIC ACID
• AMMONIUM SILICOFLUORIDE
F used for Water Fluoridation

35.  Fluoride electrode coupled with standard pH meter
 Scot-Sanchis method
Fluoride Concentration Can be Estimated By

36. • Universally acceptable, quick, simple,
economic.
• 2 electrodes are present 1 is ISE ( ion selective
electrode) and other is reference electrode
• It measure electric potential generated by the
Fluoride ion.
• The strength of this charge is directly
proportional to the concentration of that ion
in the solution.
• It also has an lon meter is one that has inbuilt
facility of converting the electrode potentials
Into concentration of fluoride in ppm
Fluoride electrode coupled with standard pH meter

37. Scot Sanchis method
• Based on reaction between fluoride and red zirconium
alizarine.
• Fluoride forms a colourless complex ion-ZrF6 & liberates free
alizarine sulphuric acid(yellow)
• As the amount of fluoride increases, the colour varies from
yellow to red.
• Fluoride level is determined by comparing the colour with
that of standards.

38. Types of Equipment
The Saturator System

39. The Solution Feeder

42. VENTURI FLUORIDATOR
• Non electrical system developed by JN Leo.
• Activated by the flow of water in the main water line and
there no possibility of accidental overdosing by surges of
fluoride when the main water pump stops.
• Tank is made up of clear acrylic thermoplastic thus enabling
the operator to make a visual inspection of level of chemical
and need to replenish.

43. SATURATION SUSPENSION CONE
• Dev in Brazil
• Consists of an upside down cone charged with a bag of sodium
silicofluoride through which a constant flow water percolates.
• The solution is collected at the top by a horizontal perforated
plastic pipe which forms the outlet.
• The quantity of salt in the cone be
never less than 25 kg.

44. • Calorimetric chemical testing through addition of zirconium
alizarin reagent and the results to be compared with the
standards.
Monitoring of F

45. • 50%-60% caries reduction in deciduous teeth if children are
exposed since birth.
• Among permanent teeth: Caries reduction is 43% on pits and
fissures, 74% on proximal surfaces, 88% on gingival surfaces.
Effects of Water Fluoridation

46. Limitations?
• It can be implemented only in the areas which have central
pipe water supply system.
• Currently, only 30% of the cities and towns in India have
piped water supply.
• Difficulties arise when there are multiple drinking water
sources which naturally have optimal fluorides.

47. • First began in 1954 in Virgin island in US.
• The current recommended regimen for school water
fluoridation is adding 4.5-6.3ppm of F.
• There has been around 25 to 40% decrease in dental caries
with this program.
SCHOOL WATER FLUORIDATION

48. Advantages
• Good results in reducing caries
• Minimal equipment
• Not expensive.
Disadvantages
• Children do not receive the
benefit until they go to school.
• Not all children go to the
school, or go the school in
poor countries and towns.
• Amount of water drunk can't
be regulated.

49. Countries with Water Fluoridation
(Textbook of Pedodontics by Shobha Tandon)
HONGKONG 100%
SINGAPORE 100%
IRELAND 70%
PUERTO RICO 63%
USA 51%
AUSTRALIA, NEW ZEALAND 50%

50. • Introduced by Wespi, 1948, Switzerland and was in the
markets by 1955.
• Ideal level of fluoride that can be kept is 200,250 & 300mg of
F/kg salt. (250 mg F/kg salt, or 0.25 mg F/gm salt)
SALT FLUORIDATION

51. • On a theoretical basis (Hedman et al. 2006), ingestion of
meals prepared with fluoridated salt:
– Increases salivary fluoride levels.
– Protection against caries.
• 2.2gm of sodium fluoride has 1 ppm of F

52. Tóth K. A study of 8 years' domestic salt fluoridation for prevention of caries. Community Dent
Oral Epidemiol. 1976;4(3):106-110.

53. Types of Processing
Batch
Processing
• Fixed amount of F is added to fixed amount, of refined salt.
• NaF is most commonly used.
• Example: 552g of sodium fluoride is needed to produce 1 ton
salt containing 250 ppm fluoride
Continuos
Processing
• Used in large production plants.
• Sprayed via nozzle onto salt passing on a conveyer belt below.
• Potassium fluoride common.
• Hygroscopic, storage difficulty.

54. Limitations?
• There may be a large variations in salt intake in different
groups, fluoridate salt consumption is the lowest when the
need for fluoride is highest- in early years of life.
• Increasing consumption of processed foods where the
processors do not use fluoridated salt.

55. • First advocated by Ziegler in 1956.
• Community based milk fluoridation scheme was by Borrow
Foundation in Bulgaria, 1988.
MILK FLUORIDATION

57. • Sodium fluoride is most commonly used for milk fluoridation.
• 1 litre of sodium fluoride is added to 1000 litres of milk.
• A high concentration of fluoride is needed for two reasons:
• the children did not drink the beverage throughout the day and
• calcium in the milk complexes with fluoride, which would reduce
its availability for topical benefits.
• 2.5-5 mg F/L is used.

58. RATIONALE
• Milk is available through school and nutritional programs
therefore it is a cost effective vehicle.
• Can be targeted at communities of greatest needs.
• Preventive effect of this milk was greater if consumption was
commenced in earlier life.

59. Limitations?
• In INDIA, majority of children population living in rural and
urban areas cannot afford milk daily.
• Central milk supply system does not exist in India.

60. • Most commonly used is Sodium Fluoride.
• Other compounds used are acidulated phosphate fluoride,
potassium fluoride or calcium fluoride.
• Supplements contain measured amount of fluorides, 0.25 mg
0.5 mg, 1.0 mg.
FLUORIDE SUPPLEMENTS

61. • First introduced in late 1940s in children of non fluoridated
areas.
• Common supplements used are:
– Fluoride drops with/without vitamins (0.125,0.25 & 0.5 mg)
– Fluoride tablets with/without vitamins (0.25 ,0.5 & 1 mg)
– Lozenges (0.25, 0.5 & 1 mg)
– Oral rinse supplements (swish and swallow) (1 mg, 5 ml)

62. • Longest clinical trial carried out by Aasenden and Peebles
- 0.5mg F tab below 3 years and 1mg thereafter, followed by 8-11
years mean caries reduction is 75 to 80%.
• Commercially available NaF (Fluoraday, Tymaflour and Luride)
– 2.2 mg NaF-1mg of F
– 1.1 mg NaF -0.5mg of F
– 0.55 mg NaF-0.25mg of F

64. Nasiri N, Malekzadeh Shafaroudi A, Elyassi Gorgi N, Arab-Nozari M, Nahvi A. Efficacy and Safety
of Fluoride in Children: A Narrative Review. Journal of Pediatrics Review. 2021; 9(1):37-46.

65. Percentage Caries Reduction with
Different Methods
Method of F Administration Average % of reduction in caries
COMMUNITY WATER
FLUORIDATION
50-60
SALT WATER FLUORIDATION 40
DIETARY SUPPLEMENTS 50-85
FLUORIDE DENTRIFICES 20-30
PROFESSIONALLY APPLIED TOPICAL
FLUORIDE
30-40
SELF APPLIED TOPICAL APPLICATION 20-50
(Textbook of Pedodontics by Shobha Tandon)

66. INDICATIONS FOR USE
• Non fluoridated areas.
• Areas without proper central pipeline system for water
fluoridation.
• In families where there is high degree of mobility involving
frequent changes in the place of work and residence.

67. Buzalaf MA, Rodrigues MH, Pessan JP, et al. Biomarkers of fluoride in children exposed to different
sources of systemic fluoride. J Dent Res. 2011;90(2):215-219.

68. FLUORIDE TOXICITY
• Probably toxic dose (PTD): Defined as the threshold dose that
could cause serious or life-threatening systemic signs and
symptoms
• Safely tolerated dose: 8–16 mg/kg body weight
• Toxic dose: 16–32 mg/kg body weight
• Lethal dose: 32–64 mg/kg body weight

69. Effect of fluoride ingestion through
fluoridated water at various levels
0.7 to 1.2 ppm

70. Bina Rani, 2014, Hazardous Fluoride Ion on Groundwater of Rajasthan State: Its Irrefutable Manifestations,
Precautionary measures & Attenuation Methodologies, INTERNATIONAL JOURNAL OF ENGINEERING
RESEARCH & TECHNOLOGY (IJERT) ETWQQM – 2014 (Volume 3 – Issue 03),
2 ppm

71. • Due to rapid excessive ingestion of fluoride at one time.
• The speed and severity is dependent on amount of fluoride
ingested , and the weight and age of the individual.
• Nausea is caused when:
Fluoride + Hydrogen (gastric juice)  Hydrofluoric acid (stomach irritant)
ACUTE TOXICITY

72. • Signs & Symptoms
o Nausea, vomiting
o Abdominal pain, diarrhoea
o Excess salivation & mucosal discharge
o Generalized weakness & carpopedal spasms
o Weak thready pulse, fall in BP
o Depression of respiratory rate

73. Management of Acute Toxicity
vomiting

74. • Ingestion of small amount of variant doses of fluoride over
prolonged period of time.
• Really high concentration of fluoride for a long duration will
cause skeletal fluorosis.
CHRONIC TOXICITY

75. • Clinical features vary depending on the severity from fine white
lines in enamel to severely chalky, opaque enamel which
breaks apart soon after tooth eruption.
Chronic toxicity effects of excessive fluoride ingestion
Effect Dosage Duration
DENTAL FLUOROSIS 2 times optimal Until 5 years
(excluding third
molars)
SKELETAL
FLUOROSIS
10-25 mg/day 10-20 years
KIDNEY DAMAGE 5-10 mg/day 6-12 months
(Textbook of Pedodontics by Shobha Tandon)

76.  DENTAL FLUOROSIS
• Dental fluorosis is a developmental disturbance of dental
enamel, caused by successive exposures to high
concentrations of fluoride during tooth development,
leading to enamel with lower mineral content and increased
porosity.
• It can be hypoplasia or hypomaturation of tooth enamel or
dentin

77. • Causes for dental fluorosis:
o Excessive fluoride in water
o Nonprescribed use of fluoride supplements
o Ingestion of topical fluoride

78.  Clinical Features
• The first signs of dental fluorosis are thin white striae
across the enamel surface
• cusp tips, incisal edges, or marginal ridges may appear
opaque white, the “snow cap” phenomenon
• White lines are broader and more pronounced.
• Merging of several lines produce smaller, irregular,
cloudy or paper-white areas.
• Entire tooth surface - irregular, opaque, or cloudy white
areas
• Cervical enamel - homogenously opaque

79. • Irregular opaque areas which merge to form chalky
white areas
• Probed vigorously, part of the surface enamel may flake
off.
• Loss of the outermost enamel.
• Small enamel defects -"pits“ which merge to form
horizontal bands
• Normal tooth morphology affected
• Dark brownish discoloration

80.  Indices for dental fluorosis
1. Dean’s index
2. Thylstrup and Fejerskov index
3. Horowitz index
4. Moller index
5. FDI index

81. • Dean’s index

82. • Modified Criteria (1942), Combined "moderately severe"
and "severe“
• 6 point ordinal scale
• Extensively used today
• Recommended by WHO in its basic survey manual (W.H.O,
1997)
• The scoring system 0-4

85. Agrawal M, Agrawal S, Adyanthaya BR, Gupta HL, Bhargava N, Rastogi R. Prevalence and severity of
dental fluorosis among patients visiting a dental college in Jaipur, Rajasthan. Indian Journal of
Research in Pharmacy and Biotechnology. 2014 Jul 1;2(4):1339.

86. Bina Rani, 2014, Hazardous Fluoride Ion on Groundwater of Rajasthan State: Its Irrefutable Manifestations,
Precautionary measures & Attenuation Methodologies, INTERNATIONAL JOURNAL OF ENGINEERING
RESEARCH & TECHNOLOGY (IJERT) ETWQQM – 2014 (Volume 3 – Issue 03),

88.  SKELETAL FLUOROSIS
• Also called as Osteofluorosis
• When fluoride is ingested in larger amounts over a period of
years, it might lead to skeletal fluorosis
• A more severe form is crippling fluorosis

89.  Clinical Features
• Increase in bone density
• Change in bone contours
• Irregular periosteal growth
• Bone appears as marble white shadows and the configuration is
wooly.
• Arthritic changes, cataract, thyroid problems, fractures, urinary, and
gallstones may also be seen.

90. • KNOCK KNEE SYNDROME: Outward bending of legs and hands
is seen in advanced stages and these parts lose their shape
and contour.

91. Choubisa SL, Choubisa D. Genu-valgum (knock-knee) syndrome in fluorosis-endemic Rajasthan and its
current status in India. Fluoride. 2019 Apr 1;52(2):161-8.

92. • CRIPPLING FLUOROSIS: in severest form of fluorosis the spine
become rigid and joints stiffen which ultimately lead to
immobilization of the patient.

93.  Classification
• According to the severity, Teotia et al. classified:
• Clinical
– Mild: Generalized bone and joint pains
– Moderate: Mild symptoms with stiffness, rigidity, and restricted
movement of spine and joints
– Severe: Symptoms of moderate fluorosis along with flexion
deformities of spine, hips, and knees.

94. • Radiological
– Mild: Osteosclerosis only
– Moderate: Signs of mild fluorosis along with periosteal bone
formation, calcifications of interosseous membrane, ligaments,
muscular attachments, capsules, and tendons
– Severe: Signs of moderate fluorosis with associated metabolic
bone disease

96. COIN TEST
CHIN TEST
STRETCH TEST

97.  Management
• Medical treatment includes supplementation with vitamin C,D,
antioxidants, serpentine(metasilicate),Calcium and treatment of
malnutrition.
• Treatment of deformities includes conservative management
through corrective plasters in children and provision of
orthopaedic appliances.

98. WATER DEFLUORIDATION
Adsorption
Technique
Bone Charcoal,
Processed bone,
tricalcium
phosphate,
activated carbon,
activated
magnesia,
tamarind gel,
serpentine,
activated
alumina, plant
material, burnt
clay.
Ion Exchange
Technique
Anion/Cation
exchange
resins
Precipitation
Technique
Nalgonda
Technique

99.  Adsorption Technique
• Most commonly used adsorbents are activated alumina and
activated carbon
• The process is pH specific, so pH of the solution should be
between 5.0-6.0
• If pH >7, silicate and hydroxide become stronger competitor
of the fluoride ions for exchange sites on activated alumina

100.  Ion-Exchange Technique
CATION EXCHANGE RESINS
• Carries acidic functional group
• Defluoron 1-sulphonated saw
dust impregnated with 2%
alum solution
• Carbon
• Magnesia
ANION EXCHANGE RESIN
• polysterine anion exchange
resins.
• They are strongly basic
quaternary ammonium type
resins, especially Tulsion A-27,
Deacodite FF (IP) and Lawatit
MIH-59

101.  Nalgonda Technique
• National Environmental Engineering Research Institute (NEERI), Nagpur
has evolved an economical and simple method for removal of fluoride
which is referred to as, “Nalgonda Technique” (Nawlakhe et al 1974).
• 3 components, ALUM, LIME & BLEACHING POWDER.

102. • Working Principle:
Addition of Sodium Aluminate or Lime, Bleaching Powder &
Filter alum (in the said order) to fluoridated water
Leads to flocculation, sedimentation and filtration
Sodium aluminate or lime hastens settlement of precipitate
& bleaching powder ensures disinfection (used for both
domestic as well community water supply)

103.  Others
o Fish bone charcoal
o Drumstick plant (Moringa cleifera)
o Askali-extract mycetial biomass
o Clay materials
o Tricalcium Phosphate

104.  Recent Advances In Fluoride
• Sustained Released Intraoral Devices
Fluoride Glass Device
Copolymer Membrane Device
Hydroxyapatite-Eudragit RS100 Diffusion
Controlled F System

105. CONCLUSION
• When used appropriately, fluoride is a safe and effective agent that can be
used to prevent dental caries.
• Systematic fluoride provide a low concentration of fluoride to the teeth
over a long period of time.
• It is easy to administer through various mediums like water, milk, salt &
helps in circulating fluorides in the blood stream and is incorporated into
developing teeth.

106. REFERENCES
• Peter S. Essentials of Public Health Dentistry. 6th Ed. New Delhi: Arya Medi
Publishing House Pvt. Ltd; 2017. 325-371p.
• Koch G. Poulsen S. Pediatric Dentistry A clinical approach. 2nd Ed. UK: Wiley
Blackwell; 2009. 99-102p.
• Fejerskov O. Nyvad B. & Kidd E. Dental Caries: The Disease and Its Clinical
Management. 3rd Ed. Oxford: Wiley Blackwell; 2015. 245-272p.
• Marwah N. Textbook of Pediatric Dentistry. 4th Ed. New Delhi: Jaypee
Brothers Medical Publishers; 2018. 315-339p.
• Tandon S. Textbook of Pedodontics. 2nd Ed. Hyderabad: Paras Medical
Publisher; 2009. 265-292p.

107. • Tóth K. A study of 8 years' domestic salt fluoridation for prevention of caries.
Community Dent Oral Epidemiol. 1976;4(3):106-110.
• Yeung A, Hitchings JL, Macfarlane TV, Threlfall A, Tickle M. Glenny AM. Fluoridated
milk for preventing dental caries. Cochrane Database of Systematic Reviews 2005,
Issue 3. Art. No.: CD003876.
• Nasiri N, Malekzadeh Shafaroudi A, Elyassi Gorgi N, Arab-Nozari M, Nahvi A.
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