Fluoride delivery methods

1. TOPICAL FLUORIDE
Presented by-
Dr. ANCHAL CHANDAK
B.D.S ( FINALYEAR)

2. CONTENTS
 Introduction
 History
 Fluoride delivery methods
 Factor affecting topical fluoride deposition
 Mechanism of action
 Method of application
 Advantages
 Disadvantages
 conclusion

3. INTRODUCTION
fluoride is the ionic form of the element fluorine.
It is the member of the halogen family and it is the
most electronegative and reactive of all the
elements .
The word flourine is derivd from the latin term
“fluore”meaning to flow .

4. HISTORY OF TOPICAL FLUORIDE
 In early 1940’s it was demonstrated that
extracted teeth when exposed to dilute solution
of fluoride on for few seconds were found to
have completely bound fluoride on the enamel
surface which subsequently was less soluble than
the original enamel surface .
 These two fact brought forth the idea of topical
application of fluoride solution of dental caries
prevention .

5.  In 1941 began the era of topical fluoride when the first clinical
study of sodium fluoride was carried out by Bibby using a 0.1%
sodium fluoride solution.
 In early 1950’s stannous fluoride occupied a central role in the
saga of preventive dentistry.
 After the discovery sodium fluoride a wide variety of
other fluoride compounds were tried like potassium, lead , silicon,
tin and zirconium.
All yielded some cariostatic benefit but stannous fluoride was
found to be 3 time more effective than sodium fluoride

6. FLUORIDE DELIVERY METHODS
Fluoride can be derived as
A.Topical fluorides
B.Systemic fluorides

7. Topical fluorides Systemic fluorides
 These are placed directly
on the teeth.
 Some preparation provide
high or low concentration
of fluoride over a short
period of time
 These circulate through
the bloodstream and are
incorporated into the
developing teeth.
 They provide a low
concentration of fluoride
over along period of time.


8. INDICATIONS
 Caries active individuals.
 Children shortly after a period of tooth eruption.
 Patient with eating disorder or who are undergoing a
change in lifestyle which may affect eating or oral
hygiene habits conductive to good oral health.
 Mentally and physically challenged individuals.
 Patient with fixed or removable prosthesis and after
placement or replacement of restorations.
 Patient with reduce salivary flow due to
medications
 Patient reciving radiation of head and neck

9. Factors affecting topical
fluoride deposition
Tooth condition
Treatment formulation
Application procedure

10. TOPICAL FLUORIDES PRODUCTS ARE
DIVIDED INTO TWO CATEGORIES
PROFESSIONALLY APPLIED SELF APPLIED
1.Sodium fluoride Toothbrushing dentrifices
2. Stannous fluoride Toothbrushing solutions
3.Acidulated phosphate
fluoride
Mouthrinses
4.Fluoride varnishes
5.Fluoride gel

11. SODIUM FLUORIDE – 2 %
METHOD OF PREPERATION:- 9040ppm at pH 7
 Sodium fluoride solution can be prepared by
dissolving 20 gms of of sodium fluoride
powder in 1 litre of distilled water in a plastic
bottle.

12. KNUTSON TECHNIQUE
7. 2nd , 3rd and 4th applications are done at weekly intervals
6. After completion, patient is instructed to avoid eating , drinking or rinsing for 30
minutes
5. Procedure is repeated for the remaining quadrants
4. 2% NaF is applied with cotton applicators and is permitted to dry in the teeth for
about 4 minutes.
3.Teeth are dried thoroughly
2. Isolated with cotton rolls
1. Initially clean and polishing of the teeth is done .

13. RECOMMENDED AGES
 Full series of four treatment is recommended
at ages 3,7,11and13YEARS

14. MECHANISM OF ACTION OF NaF
 NaF + Hydroxyapatite crystal Calcium
Fluoride
 CHOCKING OFF
 Calcium Fluoride + Hydroxyapatite crystal
 Fluoridated Hydroxyapatite

15. Advantages :-
 Accepted taste
 Stable if stored in plastic bottle
 Non-irritating to gingiva
 Does not discolor the teeth
 Inexpensive
Disadvantages :
 Four visits relatively at short period of time which is
difficult from the patient and parent’s point of veiw

16. STANNOUS FLUORIDE
 It has been used in 8 % and 10%
concentrations.
Method of preparation; 19360 ppm at PH 2.1-
2.3
 A solution of stannous fluoride are not stable
. Soon after mixing they become cloudy due
to formation of tin hydroxide .
 A fresh solution of stannous fluoride be
prepared for each patient.

17. Muhler's technique
 Do a thorough prophylaxis
 Isolate a quadrant with cotton roll and dry the
teeth
 Apply the freshly prepared 8% stannous fluoride
continuously to the teeth with cotton applicators
 Reapply the solution every 15-30 sec ,so that the
teeth are kept moist for 4 min.
 Instruct the patient not to eat, drink, rinse for 30
sec
 Application is recommended once a year

18. Mechanism Of Action OF STANNOUS
FLUORIDE
 SnF2+hydroxyapatite Stannous
Tri-Fluorophosphate
Other end products:-
1. Tin hydroxyphosphate
2. Calcium-tri fluorostannate
3. Calcium fluoride

19. Advantages:-
 Application required only once per year
 Rapid penetration of tin and fluoride within 30 sec.
Disadvantages :-
 Has to be prepared freshly each time before use
 Metallic taste
 Causes gingival irritation
 Discoloration of teeth
 Staining of margins of restoration

20. ACIDULATED PHOSPHATE FLUORIDE-
1.23%
Method Of Preperation [Brudevolds Solution ] :-
 By dissolving 20 gms of sodium fluoride in 1 litre of 0.1 M
Phosphoric acid.
 To this 50% hydrofluoride acid added to adjust the pH at
3.0 and fluoride conc.At 1.23 %.
 APF GEL :-
 A gelling agent methylcellulose is to be added to the
solution and the pH is to be adjusted between 4-5.

22. MECHANISM OF ACTION OF APF
APF Gel applied on
tooth
Dehydration and
shrinkage in volume of
hydroxyapatite crystals
On Further hydrolysis
intermediate product
dicalcium phosphate
dihydrate (DCPD)highly
reactive with fluoride
Fluoride penetrate
deeply into crystals
through the openings
produced by shrinkage
and leads to formation
of fluoroapatite

23. Advantages-
1. Required only 2 applications in a year.
2. The gel preparations can be self applied and
thus, cost of application also get reduced.
3. It has the ability to deposit fluoride in enamel to
deeper depth.
disadvantages-
1. Practical difficulties like the teeth should be
kept wet for 4min.
2. It is acidic sour and bitter in taste.
3. It can be stored in glass container only.

24. FLUORIDE VARNISHES
 Fluoride varnishes are developed in order to
increase the retention of topical fluoride on to
the enamel for a longer period of time.
 Thus, providing an improved cariostatic
action.

25. TECHNIQUE OF FLUORIDE VARNISHES
 After prophylaxis teeth are dried but not isolated
cotton rolls since, varnish sticks to cotton.
 Total of 0.3-0.5 ml of varnish is required to cover
full dentition.
 Application is first done on lower arch then
upper, using single tufted small brush, starting
with proximal surfaces.
 Patient is asked to sit with mouth open for 4min
to let duraphat set on teeth.

26. Duraphat
 This fluoride varnish contains sodium
fluoride.
 Made by alcoholic solution of natural
varnishes
 It sets very faster rapidly in the presence of
moisture when applied .
 It remains on to the applied tooth surface for
upto the next 12 hours after application.

28. Fluoroprotector
 It contain 2% difluorosilane.
 The varnish form is made by polyurethane
lacquer which is dissolved in chloroform .
 Sets faster than duraphat

29. Method Of Application
Oral prophylaxis
Dried the tooth surface
Applied varnish over all the
surfaces
Pt. is instructed not to close the
mouth and to remain wide open
for 4 minutes
Pt is instructed not to eat drink or
rinse for 1 hour

30. SELF APPLIED FLUORIDE
 Fluoride dentifrices
 Fluoride mouth rinses
 Fluoride gels

31. FLUORIDE DENTIFRICES
1. High Potency Fluoride Dentifrices (>1000ppm)
2. Low Potency Fluoride Dentifrices (< 1000ppm)
 Fluoride dentifrices for children are currently widely
available in market.
 They contain 500ppm
 A pea size amount of toothpaste is appropriate for children
2-5 yrs of age

32. Recommendation for use of
fluoride toothpaste
Child age :
 Below 4 years: not recommended
 4-6 years: once daily by fluoridated toothpaste
 6-12 years: brushing twice daily with fluoridated
toothpaste and once with non fluoridated
 Above 12 years: brushing three times with
fluoridated toothpaste.

33. FLUORIDE MOUTH RINSES
 They used as an adjunct to fluoride dentifrices
for caries control and prevention .
 They provide 35% reduction in dental caries
Commonly used fluoride mouth rinses are:-
1. 0.2% Sodium Fluoride – 900 ppm (Weekly )
2. 0.05% Sodium Fluoride – 225 ppm (Daily )
3. 0.01% Acidulated Sodium Fluoride At Ph 4 –
45ppm
4. Stannous Fluoride Mouth Rinses

35. FLUORIDE GELS
 Fluoride gel product include neutral sodium
fluoride and APF with a fluoride
concentration of 5000ppm and stannous
fluoride with a concentration of 1000ppm.
 The gels are either applied in trays or brushes
on teeth.
 Self applied once a day or more, while
professionally applied given twice a year.
 Home fluoride gels are not recommended to
children before 2years and younger.

36. CONCLUSION
 Fluoridation is universally accepted by the
dentist as being useful in preventing tooth
decay.
 They can be useful in areas where fluoride
concentration is low in water supply.
 It helps in maintaining a good oral health.

37. REFERENCE
1. Essential Of Preventive And Community
Dentistry; 11th edition ; Soben Peter.
2. Topical fluoride- Amit Tiwari.
3. Textbook of pediatric dentistry; 3rd edition;
Nikhil Marwah.
4.Textbook of pediatric dentistry: 2nd
edition; ShobhaTandon