3. The Basics of FluorideThe Basics of Fluoride
PreventionPrevention
The long-term exposure of teeth to
low concentrations of fluoride results
in the gradual incorporation of
fluroide into the existing
hydroxyapatite crystals to form
fluor-hydroxy-apatite that is
more resistant to acid damage.
5. Type of local fluoridesType of local fluorides
• NaF – 2% (0,2g powder 10 ml water)
• gel
• basic pH (7.5 and more)
• In plastic container
6. Type of local fluoridesType of local fluorides
• SnF2 (stannous fluoride)– 8%
(0,8mg powder 10ml water)
• pH 2,4 - 2,8
• Unfavourable taste
• not stabile
• glicerin+sorbitol+flavouring agent
• stabile
7. Type of local fluoridesType of local fluorides
• APF (acidulated phosphate-fluoride)
1.23%
• fluid
• gel – thixotropic gel (under pressure
becomes flow)
• approximally easy to applicate
• foam
• pH 3,5
• Ready made products
8. Type of local fluoridesType of local fluorides
• Amin-fluoride
9. The methods of localThe methods of local
fluoride preventionfluoride prevention
1. HOME1. HOME
• Home care
• A. toothpastes
• B. fluoride containing rinses
• C. fluoride gels
11. DENTIFRICE
1. 0.2% NaF
2. 0.76% sodium
monofluorophosphate
(MFP)
3. 0.4% stannous F
4. Amine F
1 gram of TP = 1
mg F
NaNa
FFPO4
MFP does not react with
calcium abrasives (F is
covalently bound) and has
better uptake by enamel
crystals.
NaNa
FF
The ADA requires that 60% of free F ion be
available over the shelf life of the TP. NaF
and MFP lose about 20% free F in 2 years.
F salt (all reach 1000-1500 ppm F)
F salt in TP:
FF
SnSn
FF
SnF2 exhibits less shelf life
and may cause dental
staining
FF
Amine fluoride
It adsorbs to enamel and
has anti-bacterial
properties
12. NaNa
DENTIFRICE
NaNa PO4
CO3CO3
H
CaCa
CaCa
CaCa
PO4
CO3CO3
CaCa These can be
used with MFP
It is desirable to have
PO4 and Ca and HCO3
as abrasives
H+H+
Abrasives:
Sodium metaphosphate
Sodium Silica
Na bicarbonate
Acrylic polymer
Dicalcium
phosphate
FF
2.
5.
4.
3.
1.
NaNa
6. Calcium
carbonate
CaCa
CO3CO3
CaCa
PO4
PO4
FF
13. weekly rinses (0.2% NaF, 910ppm F or
0.4% SnF2
, 970ppm F).
Patients should rinse 1x/day for 1 minute with 10ml.
Indications:
1) High caries risk patients.
2) Exposed root surfaces.
3) School prevention programs.
TEXT
Home rinsesHome rinses
14. Products and use: Home gels are available as
prescription 1.1% NaF (5000ppm F) and 0.4% SnF2
(1000ppm). These are self-administered by the
exposure of F to teeth than do rinses.
Indications:
1) High or severe (rampant) caries risk patients.
2) Exposed root surfaces when evidence of caries is
present.
3) School prevention programs.
TEXT
Home gelsHome gels
16. The methods of local fluorideThe methods of local fluoride
preventionprevention
2. PROFESSIONAL2. PROFESSIONAL
• Professional (chairside)
• A. fluoride containing fluids,
warnishes
• B. gels in dental tray
• C. iontoforesis (1,5-5 mA)
18. The rulesThe rules
• 1. adequate amount of fluid
• 2. the position of patient
• 3. effective elimination of saliva
• 4. don’t rinse, spit
• 5. no consumption for 30 minutes
19. Sample of fluoridationSample of fluoridation
• Original Knutson technique
• NaF brushing 4×1 weeks
3, 7, 10, 13 years
problem: different time of eruption!
• Galagan and Knutson method
• Brushing systematically in every 3-6
months
20. In case of active cariesIn case of active caries
• Tooth cleaning with fluoridation
(plaque,debris removal)
• plaque-controll
• Diet advices
• Restauration (if necessary)
• First 4 fl in 2-4 weeks intervalls
• Next fl after 3, 6, 12 months, hanged on
actual caries-status
22. Cariespreventive effect inCariespreventive effect in
different agesdifferent ages
• The caries disease is the same (children
and adults)
• The progression is different
• The effect of local fluorides is the same
• Efect on root c too!
23. The ideal time of startThe ideal time of start
• 2 years
• 2 years long after eruption of second
molar
• Individually formed always!!
24. WarnishWarnish
Indications: Apply to:
1) teeth during operating room procedures,
2) enamel incipiencies,
3) exposed roots,
4) margins of restorations,
5) teeth at risk which cannot be sealed such
as erupting molars or premolars or
6) carious anterior teeth in very young
children.
25. FLUORIDE VARNISH
Duraflor – 5% NaF,
26,000 ppm F, 3-6 mg F
per dose.
Fluor-Protector –
0.7% silane F. Used
as a cavity varnish
26. FLUORIDE VARNISH
White spots or
other
incipiencies
All teeth in
the OR
Exposed
roots and
root caries
Margins of
restorations
Erupting
teeth
Carious anterior
teeth in young
children
Indications:
2.
3.
4.
5.
1.
6.
27. WarnishWarnish
• Containing 5 % NaF
• 1. tooth brushing, polishing
• 2. warnishing
• 3. drying
• 4. time of effect: 24-48 hours
• In case of high caries risk
• Every 4-6 months repeat
28. WarnishWarnish
• choose the best technique idividually
(brushing or splint)
• adequate size of splint (covers the all
surfaces)
• Space for gel inside the tray
• Save the contamination of saliva
• Simultaneously upper-lower
29.
30. WarnishWarnish
• 1. individual/ready made splints
• 2. rinsing
• 3. drying
• 4. adequate amount of gel into the tray
• 5. positioning
• 6. 4 minutes
• 7. no consumption for 30 minutes
• 12.000-20.000 ppm APF!!!!!
31. Complex fluoride therapyComplex fluoride therapy
• Fluoride toothpastes
• Fluoride containing rinses
• Fluoride home gels
• Fluoride containing restorative materials
(glasionomer cementes, composites)
• Professional methods
• Never harm your patient!!
