This document discusses fluoride and its role in pediatric dentistry. It begins by outlining the mechanisms of action of fluoride, including both pre-eruptive and post-eruptive effects. The main caries preventive mechanisms are through post-eruptive or topical effects, where fluoride is incorporated during remineralization to make enamel less soluble. The document then discusses various methods of fluoride application in pediatric dentistry, including professionally-applied and self-applied topical fluoride treatments as well as silver diamine fluoride and systemic fluoride.
Dental management of handicapped childrenSaeed Bajafar
This document discusses dental management of handicapped children, including those with mental, physical, medical, or social conditions that interfere with normal functioning. It outlines considerations for the initial dental visit such as medical history and discussing treatment with physicians. Common oral issues in these patients include poor hygiene, cavities, malocclusion, and parafunctional habits. Treatment must be tailored based on a patient's level of dependency, disability type, health issues, oral hygiene, and behavior. Classification systems divide patients based on specific dental problems or conditions like physical, sensory, neurological, or chronic diseases. Guidelines are provided for treating patients with mental retardation or cerebral palsy.
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
This document provides an overview of pulpotomy procedures for primary teeth. It begins with definitions of pulpotomy and discusses the rationale, objectives, indications, contraindications and classification of different pulpotomy techniques. It then describes various medicaments that can be used, including formocresol, glutaraldehyde, calcium hydroxide, and ferric sulfate. The document outlines techniques for formocresol pulpotomy, electrosurgical pulpotomy, and laser pulpotomy. It also discusses recent concepts in pulpotomy including the use of bone morphogenetic protein and enamel matrix derivatives. The document concludes by examining reasons for failure of pulpotomy therapy.
The presentation features the understanding of a special child i.e. a physically or mentally challenged child for better assessment of his/her medical and dental problems to provide a proper approach for the specific treatment.
Pulpotomy is the removal of the coronal portion of the pulp while preserving the radicular pulp. It is indicated for cariously exposed primary teeth when extraction is less advantageous than retention. There are various techniques for pulpotomy including devitalization with formocresol or other chemicals to fix the pulp, preservation techniques using less harmful chemicals to maintain pulp vitality, and regeneration techniques aiming to stimulate reparative dentin formation. The goal of pulpotomy is to disinfect the exposed pulp, maintain pulp vitality, and avoid periapical issues.
This document discusses early diagnosis of dental caries. It defines dental caries and outlines various diagnostic methods including visual and tactile inspection, caries detection dyes, radiography, fiber optic transillumination, and digital methods. Radiography provides additional information compared to visual examination alone but has limitations in detecting enamel lesions. Digital radiography and subtraction techniques allow comparisons over time. Overall, early and accurate diagnosis is important for determining treatment and prognosis.
This document summarizes recent advances in rebuilding lost enamel structure through biomimetics. It discusses the mechanisms of demineralization and remineralization, and the requirements of effective remineralizing agents. Both fluoride and non-fluoride strategies are examined, including casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), nano-hydroxyapatite, bioactive glass, arginine, and tricalcium phosphate. CPP-ACP, which mimics proteins found in saliva, and bioactive glass materials like NovaMin and bioglass, are highlighted as effective remineralizing agents. The document provides details on the compositions and mechanisms of various strategies to promote remin
Dental management of handicapped childrenSaeed Bajafar
This document discusses dental management of handicapped children, including those with mental, physical, medical, or social conditions that interfere with normal functioning. It outlines considerations for the initial dental visit such as medical history and discussing treatment with physicians. Common oral issues in these patients include poor hygiene, cavities, malocclusion, and parafunctional habits. Treatment must be tailored based on a patient's level of dependency, disability type, health issues, oral hygiene, and behavior. Classification systems divide patients based on specific dental problems or conditions like physical, sensory, neurological, or chronic diseases. Guidelines are provided for treating patients with mental retardation or cerebral palsy.
Non –pharmacological behavior management in childrenDr. Harsh Shah
Overview on nonpharmacological managent of behaviour in children
Presented by : Mayuri Karad
SDDCH Parbhani
Guided by : Dr. Rehan Khan
Dept, of Pediatric and preventive dentistry
This document provides an overview of pulpotomy procedures for primary teeth. It begins with definitions of pulpotomy and discusses the rationale, objectives, indications, contraindications and classification of different pulpotomy techniques. It then describes various medicaments that can be used, including formocresol, glutaraldehyde, calcium hydroxide, and ferric sulfate. The document outlines techniques for formocresol pulpotomy, electrosurgical pulpotomy, and laser pulpotomy. It also discusses recent concepts in pulpotomy including the use of bone morphogenetic protein and enamel matrix derivatives. The document concludes by examining reasons for failure of pulpotomy therapy.
The presentation features the understanding of a special child i.e. a physically or mentally challenged child for better assessment of his/her medical and dental problems to provide a proper approach for the specific treatment.
Pulpotomy is the removal of the coronal portion of the pulp while preserving the radicular pulp. It is indicated for cariously exposed primary teeth when extraction is less advantageous than retention. There are various techniques for pulpotomy including devitalization with formocresol or other chemicals to fix the pulp, preservation techniques using less harmful chemicals to maintain pulp vitality, and regeneration techniques aiming to stimulate reparative dentin formation. The goal of pulpotomy is to disinfect the exposed pulp, maintain pulp vitality, and avoid periapical issues.
This document discusses early diagnosis of dental caries. It defines dental caries and outlines various diagnostic methods including visual and tactile inspection, caries detection dyes, radiography, fiber optic transillumination, and digital methods. Radiography provides additional information compared to visual examination alone but has limitations in detecting enamel lesions. Digital radiography and subtraction techniques allow comparisons over time. Overall, early and accurate diagnosis is important for determining treatment and prognosis.
This document summarizes recent advances in rebuilding lost enamel structure through biomimetics. It discusses the mechanisms of demineralization and remineralization, and the requirements of effective remineralizing agents. Both fluoride and non-fluoride strategies are examined, including casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), nano-hydroxyapatite, bioactive glass, arginine, and tricalcium phosphate. CPP-ACP, which mimics proteins found in saliva, and bioactive glass materials like NovaMin and bioglass, are highlighted as effective remineralizing agents. The document provides details on the compositions and mechanisms of various strategies to promote remin
This document discusses principles and guidelines for access cavity preparation in endodontic treatment. It outlines the basic principles established by G.V. Black, including outline form to establish complete access, convenience form to make procedures more convenient, and removal of remaining caries and defective restorations. Guidelines include centrality and concentricity of the pulp chamber floor, using the cementoenamel junction as a landmark, and symmetry of canal orifices. Specific access preparations are described for maxillary and mandibular molars and premolars. Considerations are provided for anatomical variations, extensive restorations, tilted/angled crowns, calcified canals, and teeth with minimal crowns.
Ethics is concerned with judging what is right and wrong in human conduct. Dental ethics refers to the moral duties of dentists towards patients, colleagues, and society. Key principles of dental ethics include non-maleficence (do no harm), beneficence (do good), respect for patient autonomy and informed consent, justice, truthfulness, and confidentiality. Unethical practices include using unregistered assistants, falsifying records, improper advertising, and undercharging to solicit patients. Historical events like the Nazi experiments, Tuskegee trials, and Declaration of Helsinki established standards to protect research participants through informed consent and review boards. Adherence to an ethical code is important for maintaining trust in the dental profession.
This document summarizes different methods of fluoride use for preventing dental caries. It discusses systemic fluorides including water fluoridation, school water fluoridation, fluoridated salt, and dietary fluoride supplements. It also discusses topical fluorides including professionally and self-applied topical fluoride treatments, fluoridated toothpastes, and fluoride mouth rinses. Water fluoridation and fluoridated toothpastes are highlighted as two of the most effective and widespread methods for caries prevention.
This document discusses the management of children with special health care needs. It begins by defining key terms like disability, handicap, and dentally handicapped. It then discusses factors that can influence disabilities, various classification systems for disabilities, and the prevalence of different disabilities in India. It also covers the Americans with Disabilities Act of 1990. The document outlines how family/parental attitudes, patient attitudes, and dentist attitudes can all impact care for children with special needs. It discusses the impacts of disabilities on oral and general health as well as barriers to care. The document concludes by discussing tools that can help in treating children with special health care needs, including concrete tools like office layout and equipment as well as conceptual tools like behavioral techniques
This document discusses topical fluoride delivery methods for preventing dental caries. It begins by introducing different types of topical fluorides including professionally-applied options like sodium fluoride, stannous fluoride, and acidulated phosphate fluoride as well as self-applied options like dentifrices and mouthwashes. It then covers the preparation, application procedures, mechanisms of action, advantages, and disadvantages of each professionally-applied fluoride type. The document concludes by comparing the characteristics of the different professionally-applied fluoride options and providing recommendations for topical fluoride application.
Serial extraction is an interceptive orthodontic procedure that involves the planned extraction of certain primary and permanent teeth in a sequence to guide the erupting permanent teeth into a favorable position. It was first described in 1929 as a way to address arch length deficiencies. The most common methods are Dewel's method, Tweed's method, and Nance method, all of which extract primary teeth first, followed by premolars and canines. Potential problems include anterior crossbites from residual spacing or skeletal discrepancies.
preventive strategies in paediatric dentistryIAU Dent
This document discusses preventive strategies in pediatric dentistry. It outlines how the old infectious disease model was deficient and has been replaced by anticipatory guidance. Anticipatory guidance provides age-specific counseling to parents on oral development, diet, fluoride, habits, hygiene, and injury prevention. It aims to address protective factors to prevent oral health problems. Starting prevention early in infancy allows for developing an individualized plan. To be effective, anticipatory guidance should be coupled with oral health risk assessment and caries risk tools to properly evaluate risk factors and customize prevention.
This document contains information about several dental devices and procedures:
1. It provides specifications for the BONART ART-E1 dental laser, including its power output, power supply requirements, and included electrode tip sets.
2. It lists contact information for Dr. Nikhil Srivastava, a professor of pedodontics.
3. It provides specifications for the Sunny gold dental laser, including its laser source, output power, wavelength, timing functions, dimensions, weight, and electrical input.
4. The remainder of the document discusses various endodontic procedures for primary and young permanent teeth such as indirect pulp therapy, pulp capping, pulpotomy, pulpectomy, and
- Preventive dentistry aims to prevent dental diseases before they occur through various levels of prevention including primordial, primary, secondary, and tertiary.
- Primary prevention removes the possibility of disease by targeting the entire population or high-risk groups through health promotion, education, environmental modifications, and specific protective measures like water fluoridation or dental sealants.
- Secondary prevention halts disease progression through early diagnosis and prompt treatment while tertiary prevention focuses on rehabilitation and reducing impairments from existing conditions.
Behavioural Management in Pediatric DentistrySwalihaAlthaf
This document provides information on behavioral management techniques used in pediatric dentistry. It defines key terms like behavior, behavior management, behavior shaping, and behavior modification. It then categorizes and describes various non-pharmacological behavior management techniques including communication, use of second language, tell-show-do, desensitization, modeling, behavior shaping, contingency management, distraction, assimilation and coping techniques.
The document defines a dental home as an ongoing relationship between a dentist and patient that provides comprehensive, accessible, and family-centered oral healthcare from infancy through adolescence. A dental home has characteristics like being accessible in the community, family-centered, providing unbiased information continuously, and being comprehensive, coordinated, and compassionate. When a parent or caregiver approaches a dental home, the dentist will take a history, do an examination, and do a risk assessment to enhance the dentist's ability to assist the child and family with optimal oral healthcare.
This document provides an overview of mixed dentition and orthodontic appliances used during this period. Mixed dentition refers to the stage when primary teeth are being replaced by permanent teeth, between ages 6-13 years. Common orthodontic problems in mixed dentition include increased overjet and open bite. Functional appliances discussed include oral screens, lip bumpers, activators, and Frankel's regulator. Other appliances mentioned are space maintainers, tongue blades for crossbite correction, and space regainers. The document outlines the principles, advantages, limitations and indications for different appliances used in intercepting and correcting malocclusions during mixed dentition.
This presentation is intended to give the GP dentists as well as specialists some essential information regarding " white spot lesions" ,which can be considered as one of the most common side effect of orthodontic treatment with fixed appliances.
This document discusses fluorides in dentistry. It describes the sources of fluoride, mechanisms of how fluoride prevents tooth decay, and methods of fluoride delivery topically and systemically. It also addresses the indications for topical fluoride use, recommended dosages of fluoride tablets/drops, and potential toxicities like dental and skeletal fluorosis from inadequate or excessive fluoride intake. When used appropriately, fluoride is an effective cariostatic agent for improving dental health.
This document discusses various methods of delivering fluorides, including topical and systemic fluorides. It focuses on topical fluoride delivery methods. Topical fluorides are divided into professionally-applied and self-applied products. Professionally-applied products include neutral sodium fluoride, acidulated phosphate fluoride, and stannous fluoride solutions. Self-applied products include fluoride dentifrices, gels, and rinses. The document provides details on the preparation, application procedures, mechanisms of action, advantages, and disadvantages of each topical fluoride product type. It recommends amounts and methods for safe and effective professional application of topical fluorides.
This document discusses caries risk assessment in dentistry. It defines risk assessment as using factors to determine a patient's likelihood of developing dental diseases. Caries risk assessment can help predict who will develop caries, increase examination suspicion for high-risk patients, identify patients early in the disease process, and determine who will benefit from prevention. The treatment plan and decisions should be based on a careful caries diagnosis, risk assessment, and classification of the patient's treatment needs. Caries risk assessment tests saliva and plaque for bacteria levels, pH, and defense factors to predict future caries development and inform prevention.
Fluoride is a mineral that is naturally present in varying amounts in water sources. Studies from the early 20th century found correlations between fluoride levels in water and rates of dental caries as well as dental fluorosis. This led to further research demonstrating that optimal levels of fluoride in community water supplies could reduce rates of dental caries. Several large-scale studies in the 1940s-1960s provided strong evidence that water fluoridation at levels around 1 part per million can reduce dental caries by around 25% on average. Fluoride works both systemically during tooth development before eruption and topically on tooth surfaces after eruption to strengthen enamel and make it more resistant to decay.
In this lecture I explain in step-by-step fashion the basics of Indirect Pulp Capping Procedure. a photo guide is attached to the guide to aid in better understanding of the topic
This document discusses various behavioral management techniques for use with pediatric dental patients. It describes goals of building a relationship through communication between the dentist and patient. Techniques discussed include using voice control, nonverbal cues, the Tell-Show-Do approach, positive reinforcement, distraction, and determining whether parents should be present or absent during treatment. Effective communication is key to establishing authority while preventing uncooperative behavior and creating a positive dental experience for children.
History
Natural Sources Of Fluoride
Physiology and metabolism of fluoride
Fluoride in Dentistry
Control of dental caries
Fluoride toxicity
Dental fluorosis
Fluorosis indices
Water defluoridation
Conclusion
Role of fluoride in dentistry esspecially preventive and pediatric dentistry to prevent caries and induce remineralizaton of enamel.Fluoride as double edge sword less amount can cause caries excess can cause mottling of enamel or fluoride toxicity
This document discusses principles and guidelines for access cavity preparation in endodontic treatment. It outlines the basic principles established by G.V. Black, including outline form to establish complete access, convenience form to make procedures more convenient, and removal of remaining caries and defective restorations. Guidelines include centrality and concentricity of the pulp chamber floor, using the cementoenamel junction as a landmark, and symmetry of canal orifices. Specific access preparations are described for maxillary and mandibular molars and premolars. Considerations are provided for anatomical variations, extensive restorations, tilted/angled crowns, calcified canals, and teeth with minimal crowns.
Ethics is concerned with judging what is right and wrong in human conduct. Dental ethics refers to the moral duties of dentists towards patients, colleagues, and society. Key principles of dental ethics include non-maleficence (do no harm), beneficence (do good), respect for patient autonomy and informed consent, justice, truthfulness, and confidentiality. Unethical practices include using unregistered assistants, falsifying records, improper advertising, and undercharging to solicit patients. Historical events like the Nazi experiments, Tuskegee trials, and Declaration of Helsinki established standards to protect research participants through informed consent and review boards. Adherence to an ethical code is important for maintaining trust in the dental profession.
This document summarizes different methods of fluoride use for preventing dental caries. It discusses systemic fluorides including water fluoridation, school water fluoridation, fluoridated salt, and dietary fluoride supplements. It also discusses topical fluorides including professionally and self-applied topical fluoride treatments, fluoridated toothpastes, and fluoride mouth rinses. Water fluoridation and fluoridated toothpastes are highlighted as two of the most effective and widespread methods for caries prevention.
This document discusses the management of children with special health care needs. It begins by defining key terms like disability, handicap, and dentally handicapped. It then discusses factors that can influence disabilities, various classification systems for disabilities, and the prevalence of different disabilities in India. It also covers the Americans with Disabilities Act of 1990. The document outlines how family/parental attitudes, patient attitudes, and dentist attitudes can all impact care for children with special needs. It discusses the impacts of disabilities on oral and general health as well as barriers to care. The document concludes by discussing tools that can help in treating children with special health care needs, including concrete tools like office layout and equipment as well as conceptual tools like behavioral techniques
This document discusses topical fluoride delivery methods for preventing dental caries. It begins by introducing different types of topical fluorides including professionally-applied options like sodium fluoride, stannous fluoride, and acidulated phosphate fluoride as well as self-applied options like dentifrices and mouthwashes. It then covers the preparation, application procedures, mechanisms of action, advantages, and disadvantages of each professionally-applied fluoride type. The document concludes by comparing the characteristics of the different professionally-applied fluoride options and providing recommendations for topical fluoride application.
Serial extraction is an interceptive orthodontic procedure that involves the planned extraction of certain primary and permanent teeth in a sequence to guide the erupting permanent teeth into a favorable position. It was first described in 1929 as a way to address arch length deficiencies. The most common methods are Dewel's method, Tweed's method, and Nance method, all of which extract primary teeth first, followed by premolars and canines. Potential problems include anterior crossbites from residual spacing or skeletal discrepancies.
preventive strategies in paediatric dentistryIAU Dent
This document discusses preventive strategies in pediatric dentistry. It outlines how the old infectious disease model was deficient and has been replaced by anticipatory guidance. Anticipatory guidance provides age-specific counseling to parents on oral development, diet, fluoride, habits, hygiene, and injury prevention. It aims to address protective factors to prevent oral health problems. Starting prevention early in infancy allows for developing an individualized plan. To be effective, anticipatory guidance should be coupled with oral health risk assessment and caries risk tools to properly evaluate risk factors and customize prevention.
This document contains information about several dental devices and procedures:
1. It provides specifications for the BONART ART-E1 dental laser, including its power output, power supply requirements, and included electrode tip sets.
2. It lists contact information for Dr. Nikhil Srivastava, a professor of pedodontics.
3. It provides specifications for the Sunny gold dental laser, including its laser source, output power, wavelength, timing functions, dimensions, weight, and electrical input.
4. The remainder of the document discusses various endodontic procedures for primary and young permanent teeth such as indirect pulp therapy, pulp capping, pulpotomy, pulpectomy, and
- Preventive dentistry aims to prevent dental diseases before they occur through various levels of prevention including primordial, primary, secondary, and tertiary.
- Primary prevention removes the possibility of disease by targeting the entire population or high-risk groups through health promotion, education, environmental modifications, and specific protective measures like water fluoridation or dental sealants.
- Secondary prevention halts disease progression through early diagnosis and prompt treatment while tertiary prevention focuses on rehabilitation and reducing impairments from existing conditions.
Behavioural Management in Pediatric DentistrySwalihaAlthaf
This document provides information on behavioral management techniques used in pediatric dentistry. It defines key terms like behavior, behavior management, behavior shaping, and behavior modification. It then categorizes and describes various non-pharmacological behavior management techniques including communication, use of second language, tell-show-do, desensitization, modeling, behavior shaping, contingency management, distraction, assimilation and coping techniques.
The document defines a dental home as an ongoing relationship between a dentist and patient that provides comprehensive, accessible, and family-centered oral healthcare from infancy through adolescence. A dental home has characteristics like being accessible in the community, family-centered, providing unbiased information continuously, and being comprehensive, coordinated, and compassionate. When a parent or caregiver approaches a dental home, the dentist will take a history, do an examination, and do a risk assessment to enhance the dentist's ability to assist the child and family with optimal oral healthcare.
This document provides an overview of mixed dentition and orthodontic appliances used during this period. Mixed dentition refers to the stage when primary teeth are being replaced by permanent teeth, between ages 6-13 years. Common orthodontic problems in mixed dentition include increased overjet and open bite. Functional appliances discussed include oral screens, lip bumpers, activators, and Frankel's regulator. Other appliances mentioned are space maintainers, tongue blades for crossbite correction, and space regainers. The document outlines the principles, advantages, limitations and indications for different appliances used in intercepting and correcting malocclusions during mixed dentition.
This presentation is intended to give the GP dentists as well as specialists some essential information regarding " white spot lesions" ,which can be considered as one of the most common side effect of orthodontic treatment with fixed appliances.
This document discusses fluorides in dentistry. It describes the sources of fluoride, mechanisms of how fluoride prevents tooth decay, and methods of fluoride delivery topically and systemically. It also addresses the indications for topical fluoride use, recommended dosages of fluoride tablets/drops, and potential toxicities like dental and skeletal fluorosis from inadequate or excessive fluoride intake. When used appropriately, fluoride is an effective cariostatic agent for improving dental health.
This document discusses various methods of delivering fluorides, including topical and systemic fluorides. It focuses on topical fluoride delivery methods. Topical fluorides are divided into professionally-applied and self-applied products. Professionally-applied products include neutral sodium fluoride, acidulated phosphate fluoride, and stannous fluoride solutions. Self-applied products include fluoride dentifrices, gels, and rinses. The document provides details on the preparation, application procedures, mechanisms of action, advantages, and disadvantages of each topical fluoride product type. It recommends amounts and methods for safe and effective professional application of topical fluorides.
This document discusses caries risk assessment in dentistry. It defines risk assessment as using factors to determine a patient's likelihood of developing dental diseases. Caries risk assessment can help predict who will develop caries, increase examination suspicion for high-risk patients, identify patients early in the disease process, and determine who will benefit from prevention. The treatment plan and decisions should be based on a careful caries diagnosis, risk assessment, and classification of the patient's treatment needs. Caries risk assessment tests saliva and plaque for bacteria levels, pH, and defense factors to predict future caries development and inform prevention.
Fluoride is a mineral that is naturally present in varying amounts in water sources. Studies from the early 20th century found correlations between fluoride levels in water and rates of dental caries as well as dental fluorosis. This led to further research demonstrating that optimal levels of fluoride in community water supplies could reduce rates of dental caries. Several large-scale studies in the 1940s-1960s provided strong evidence that water fluoridation at levels around 1 part per million can reduce dental caries by around 25% on average. Fluoride works both systemically during tooth development before eruption and topically on tooth surfaces after eruption to strengthen enamel and make it more resistant to decay.
In this lecture I explain in step-by-step fashion the basics of Indirect Pulp Capping Procedure. a photo guide is attached to the guide to aid in better understanding of the topic
This document discusses various behavioral management techniques for use with pediatric dental patients. It describes goals of building a relationship through communication between the dentist and patient. Techniques discussed include using voice control, nonverbal cues, the Tell-Show-Do approach, positive reinforcement, distraction, and determining whether parents should be present or absent during treatment. Effective communication is key to establishing authority while preventing uncooperative behavior and creating a positive dental experience for children.
History
Natural Sources Of Fluoride
Physiology and metabolism of fluoride
Fluoride in Dentistry
Control of dental caries
Fluoride toxicity
Dental fluorosis
Fluorosis indices
Water defluoridation
Conclusion
Role of fluoride in dentistry esspecially preventive and pediatric dentistry to prevent caries and induce remineralizaton of enamel.Fluoride as double edge sword less amount can cause caries excess can cause mottling of enamel or fluoride toxicity
The document discusses several theories on how fluoride reduces dental caries. The pre-eruptive theory states that fluoride taken during tooth formation can change tooth composition and morphology by replacing hydroxyl groups in tooth enamel with fluoride. The post-eruptive theory explains that fluoride in saliva and plaque reacts with tooth enamel to enhance remineralization and form calcium fluoride or fluorapatite crystals. Topically applied fluoride at high concentrations can also interfere with bacterial growth and metabolism. Fluoride reduces caries by increasing enamel resistance, promoting remineralization of early lesions, and interfering with cariogenic plaque bacteria.
This document discusses fluorides and their role in preventing dental caries. It begins with a brief history of fluoride research from the early 20th century and describes how fluoride strengthens tooth enamel and inhibits the cariogenic bacteria. It then discusses various methods of fluoride administration including water fluoridation, salt fluoridation, milk fluoridation and topical fluoride applications. Water fluoridation at 0.7-1.2 ppm is described as the most effective method for community-wide caries prevention, while topical fluorides provide localized protection when applied directly to the teeth. The document outlines the metabolism, mechanisms of action, and non-dental benefits of systemic fluoride intake.
Fluoride reduces dental caries through multiple mechanisms including:
1) Incorporation into tooth enamel and dentin during development and after eruption, making the tooth structure less soluble in acid.
2) Interacting with the bacterial enzymes and metabolic processes that produce acid in dental plaque, reducing acid production.
3) Promoting remineralization of enamel and dentin that have been demineralized by acid from plaque bacteria.
The document discusses fluoride in preventive dentistry. It provides information on the following:
- Fluoride content in the environment including soil, water, and atmosphere.
- Types of systemic and topical fluoride therapies including water fluoridation, supplements, and professionally-applied varnishes, gels, and foams.
- Details on commonly used topical fluoride agents like sodium fluoride, stannous fluoride, acidulated phosphate fluoride, and fluoride varnishes.
This document discusses and compares topical and systemic fluorides. It provides a history of fluoride use and research. Key points include: topical fluorides such as sodium fluoride, stannous fluoride, and acidulated phosphate fluoride have been used since the 1940s to reduce dental caries. Water, salt, and milk have been vehicles for systemic fluoride delivery. Topical fluorides provide a direct source of fluoride to the tooth surface while systemic fluorides incorporate fluoride into teeth and bone. Both methods have benefits and limitations.
This document provides an overview of fluoride toxicity and discusses acute and chronic fluoride toxicity. It describes the signs and symptoms of acute fluoride toxicity such as nausea, abdominal cramps, and vomiting. Chronic fluoride toxicity can result in dental and skeletal fluorosis from long-term ingestion of small amounts of fluoride. Dental fluorosis causes white or brown stains on teeth while skeletal fluorosis causes joint and bone pain. The document also discusses defluoridation methods like the Nalgonda technique, which uses alum, lime, and bleaching powder to remove fluoride from drinking water.
This document discusses topical protection of teeth, specifically focusing on fluoride. It begins by categorizing traditional measures for topical tooth protection such as operative dentistry, prophylactic odontomy, and fissure eradication. It then discusses various fluoride applications and delivery methods including pit and fissure sealants, topical fluoride applications, and remineralization techniques using compounds like amorphous calcium phosphate. The document delves into the history, sources, metabolism, and mechanisms of action of fluoride, as well as methods of delivery including dentifrices, mouth rinses, gels, and other products. It also covers the toxicity of fluoride in both acute and chronic forms.
Fluoride is effective at preventing dental caries through several mechanisms: it reduces demineralization by lowering bacterial acid production and enamel solubility; increases remineralization of incipient lesions; and interferes with plaque microorganisms. Topical fluoride treatments delivered professionally as gels, foams, varnishes or professionally-applied solutions provide a localized source of fluoride to tooth surfaces, while systemic fluoride from water or supplements provides lower levels of fluoride incorporated into developing teeth and bone.
1. Fluoride has been used extensively to prevent dental caries since the early 1900s. Both systemic and topical fluoride administration are effective ways to reduce caries risk.
2. Current recommendations include community water fluoridation at 0.7 ppm, fluoride toothpaste in rice-sized amounts for young children, and professionally applied topical fluoride treatments every 3-6 months for those at high risk.
3. New advancements like silver diamine fluoride show promise in arresting cavitated caries lesions and may provide an alternative to conventional restorative techniques.
This document discusses the mechanism of action of fluorides. It begins with background on the element fluorine. It then describes five main mechanisms by which fluoride prevents dental caries: 1) increasing enamel resistance by forming fluorapatite crystals during tooth development, 2) increasing the rate of post-eruptive enamel maturation, 3) promoting remineralization of early dental caries, 4) interfering with cariogenic oral bacteria like Streptococcus mutans, and 5) modifying tooth morphology during development to produce smaller occlusal fissures and grooves. The optimal level for these anti-caries effects is maintaining low levels of fluoride in the oral cavity. Higher fluoride levels during tooth development can lead to dental
Dental caries is the major dental disease affecting a large population. Cariostatic efficacy of the fluorides have increased the use of fluoride agents. This presentation will enlighten us about the use of fluorides in preventive dentistry.
HISTORY & MECHANISM OF ACTION SYSTEMIC FLUORIDES.pptxRUCHIKA BAGARIA
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.
- Topical fluoride applications like fluoride dentifrices, rinses, and varnishes can help inhibit tooth decay when used regularly. Fluoride dentifrices work best when used twice daily. Fluoride rinses and varnishes are also effective.
- Sustained release fluoride applications provide a regular slow release of fluoride intra-orally over a longer period to reduce tooth decay through remineralization. Materials like glass pellets and polymer beads have been developed for this purpose.
- Fluoride toxicity can occur from chronic overexposure, with risks of dental or skeletal fluorosis. Acute high doses of fluoride can also be lethal. Control of fluoride levels in drinking water is
This document provides an overview of fluorides and their role in dental health. It discusses the historical evolution of fluorides from their discovery in the early 1900s as the cause of mottled enamel. It describes how fluorides are naturally present in the environment and metabolism in our bodies, acting to strengthen tooth enamel and reduce cavities. The key mechanisms of action are increasing enamel resistance, promoting remineralization of early cavities, and interfering with cariogenic bacteria. While fluorides provide dental benefits when consumed in optimal amounts, both insufficient and excessive intake can impact health.
Fluoride is an element important for dental and bone health. It is found naturally in small amounts in foods and enters the body through drinking fluoridated water and using dental products containing fluoride. Fluoride is absorbed through the gastrointestinal tract and enters the bloodstream, then deposits in teeth and bones where it helps prevent cavities and fractures. While fluoride supports dental and bone health, too much fluoride intake can result in dental or skeletal fluorosis, characterized by discolored teeth or joint and bone problems. Maintaining the recommended dietary allowance of fluoride is important for optimal health benefits.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
3. Introduction
• Dental caries is the most common childhood disease.
• It is an important public health problem across the world. The world
health organization (WHO) emphasizes that the disease affects about
60–90% of school children.
• Fluoride was introduced into dentistry over 70 years ago, and it is now
recognized as the main factor responsible for the dramatic decline in
caries prevalence that has been observed worldwide.
4. Introduction
• Fluorine is derived from the latin word “fluore” meaning “to flow”.
• It is a member of the halogen family with atomic weight of 19 and
atomic number of 9.
• Is the most electronegative and reactive of all elements, hence it is
never found in its elemental form in nature.
• It is combined chemically in the form of fluorides.
5. Introduction
• Fluoride may occur in a wide variety of minerals in rock and soil
including fluorspar, cryolite, apatite, mica, topaz, tourmaline.
• Fluoride concentration in the soil increases with depth.
• Waters with high fluoride content are usually found at the foot of high
mountains and areas with geological deposits of marine origin.
6. Introduction
• All water contains fluorides in varying concentrations due to the presence of
fluoride in the earths crust.
• Water from lakes, rivers and artesian wells have a fluoride content below
0.5mg/l.
• Sea water contains fluoride levels of 0.8-1.4mg/l.
• Lake Nakuru in the rift valley in Kenya has the highest natural fluoride
concentration of 2800mg/l.
7. • Approximately 90% of the fluoride ingested each day is absorbed from the
alimentary tract with higher proportions from liquids than solids.
• Absorption across the oral cavity is limited and accounts for less than 1% of
the daily intake.
• Absorption from the stomach occurs readily and is inversely related to the ph
of the gastric contents.
• High concentrations of dietary calcium and other cat-ions form insoluble
complexes with fluoride ion thus reducing fluoride absorption from the
gastrointestinal tract.
8. Introduction
Dietary sources of fluoride include:
• Unprocessed foods -low (0.1-2.5 mg/kg).
• In plants - 2-20mg/g of dry weight.
• Leafy vegetables -11-26 mg on dry weight basis.
• Fish -20-40 ppm on dry weight basis
9. Introduction
• Approximately 99% of the body burden of fluoride is associated with the
calcified tissues.
• Approximately 55% will be retained by children and 36% by adults. The
remainder of the absorbed fluoride will be excreted in urine.
• The elimination of absorbed fluoride occurs almost exclusively via the
kidneys and about 10% of the daily intake of fluoride is not absorbed and is
excreted in the faeces.
10. Mechanism of Action of Fluoride
• The effect of fluoride in caries prevention can be considered
under two headings.
• Pre-eruptive effect
• Post – eruptive effect
11. Mechanism of Action of Fluoride
• Until recently the major caries-inhibitory effect of fluoride was
thought to be due to its incorporation in tooth minerals during the
development of the tooth (systemic) prior to eruption.
• There is now overwhelming evidence that the primary caries-
preventive mechanisms of action of fluoride are post-eruptive (topical)
effects for both children and adults.
12. Pre-eruptive Effect
• Improved crystallinity - Changes the crystalline structure of enamel
making it less soluble.
• Increased Crystal size
• Less acid solubility
• More rounded cusps and fissures
• Overall effect is small because discontinuation of fluorides leads to
loss of caries protection – constant servicing!!!
13. • Changes the crystalline
structure of enamel to make it
less soluble.
OLD CONCEPT
• That major inhibitory effect was
thought to be due to its
incorporation in tooth mineral
during the development of the
tooth prior to eruption
14. Post-Eruptive Effect
• Recent evidences shows that the main effect of fluoride in caries
prevention are the post-eruptive - through topical application.
• Fluoride incorporated developmentally into the normal tooth mineral
is insufficient to have a measurable effect on acid solubility.
• Only when fluoride is concentrated into a new crystal surface during
Re-mineralization, is it sufficient to alter solubility beneficially.
15. Post-Eruptive Effect
• Effect is seen when fluoride is present in plaque and saliva.
• There is now clear evidence that caries reduction is most
effective when a low concentration of fluoride is maintained
consistently within the oral environment.
16. Post-Eruptive Effect
• Permanent enamel is an acellular tissue composed chiefly of minerals
(calcium- deficient, carbonated hydroxyapatite (85% volume).
• The hydroxyapatite molecules are arranged in long and thin apatite
crystals that forms the enamel prism.
• The spaces between the crystals is occupied by water (12%vol) and
organic material (3% vol).
• It is in this space filled with the enamel fluid that the demineralization
and remineralization reactions take place.
17. Post-Eruptive Effect
• The dentine contains 47% apatite, 33% organic components and 20%
water.
• The organic matrix is composed mainly of collagen (90%), and other
non- collagenous components.
• The collagen forms the backbone of dentin and serves as a template
for the deposition of apatite crystallites within the collagen matrix.
18. Post-Eruptive Effect
• The small apatite crystals provides a large surface area for acid
interaction during acid attack.
• Thus making the dentine surface more susceptible to caries attack than
the enamel.
• For dentinal caries to occur, there must be an initial dissolution of the
mineral which in turn exposes the organic matrix to breakdown by
bacterial- derived enzymes as well as by host derived enzymes such as
matrix metalloproteinases present in dentin and saliva.
19. Post-Eruptive Effect
• The saliva under resting condition is a super saturated solution of calcium
and phosphate ions.
• Fluoride when present in the oral environment, reacts with the available
calcium ion to form CaF₂.
• The mineral of tooth tissue exists as a carbonated apatite which contains
calcium, phosphate, and hydroxyl ions, making it a hydroxyapatite
(Ca₁₀(PO4)₆(OH)₂). The carbonated portions weaken the structure and
render the tissue susceptible to attack.
20. Post-Eruptive Effect
• In the presence of an acid attack and with a pH below 5.5 (the critical pH
for hydroxyapatite demineralization), a net outward flow of calcium and
phosphate ions from the enamel surface into plaque and saliva occurs.
• As the pH returns to 7.0, remineralization occurs with a net inward flow of
ions into the enamel surface.
• Fluoride when present during remineralization, it is incorporated to form
fluorapatite (Ca₁₀(PO4)₆F₂). which is more stable and resistant to further
acid attacks
21. Post-Eruptive Effect
• This is now widely believed to
be the most important preventive
action of fluoride.
• A constant post-eruptive supply
of ionic fluoride is thought to be
the most effective.
22. Post-eruptive effect
• Fluoride prevents demineralization.
• Formation of fluorohydroxyapatite and inhibition of mineral loss from
enamel. (critical ph is 3.5)
• Fluoride enhances remineralization.
• Through formation of a fluoride reservoir and creation of supersaturated
solutions.
• Fluoride aids in post eruptive maturation of enamel.
• Fluoride reduces enamel solubility
23. Post-eruptive effect
• Fluoride inhibit plaque bacteria.
• By blocking the enzyme enolase, needed in the glycolytic
pathway of CHO metabolism
• Also reduces the accumulation of intracellular and extra-
cellular polysaccharides
• At low pH, fluoride combines with hydrogen ions and diffuses
into oral bacteria as hydrogen fluoride (HF) Inside the cell HF
dissociates, acidifying the cell and releasing fluoride ions that
inhibit glycolysis.
25. Topical Fluoride
• The term 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.
• Thus this term encompasses the use of fluoride rinses, dentifrices,
pastes, gels, and solutions that are applied in various manner.
26. Rationale for Topical Fluoride
• Topical fluorides hastens the process of fluoride acquisition by the
teeth mineral.
• Since immature and porous enamel acquires fluoride rapidly and the
enamel surface of newly erupted teeth undergoes rapid maturation, its
follows that the best time to apply topical fluorides is soon after
eruption.
27. Rationale for Topical Fluoride
• Also the initial carious lesion, characterized by a white spot, is porous
and accumulates fluoride at much higher concentrations than adjacent
sound enamel.
• Hence periodic applications of fluoride would enable vulnerable
enamel sites that are partially demineralized to accumulate fluoride.
28. Classification of Topical Fluoride
• Professionally applied
• Introduced by Bibby in 1942
• Dispensed by dental professionals in the dental office and usually involve the
use of high fluoride concentration products ranging from 5000-19000 ppm.
• which is equivalent to 5-9 mg F/ml
• Self applied
• Are low fluoride concentration products available for use at home.
• Fl conc. ranges from 200-1000ppm or 0.2-1 mgF/ml
• Include fluoride dentifrices, mouth rinses & gels
29. Indications for Professional Topical Fluorides
• High caries risk or caries active children i.e. those with past caries
experience or those who develop new carious lesion on smooth tooth
surfaces- severe ECC
• Children shortly after periods of tooth eruption, especially those who are
not carries free.
• Medication to reduce salivary flow or had undergone head and neck
radiation.
• After periodontal surgery when roots of teeth have been exposed.
• Patients with fixed or removable prosthesis and after placement or
replacement of restorations.
• Special health care need children.
30. • Professional topical fluorides used in dentistry include:
1. Sodium fluoride:
2. Stannous fluoride
3. Acidulated phosphate fluoride
31. Professionally Applied Fl
• The professionally fluoride may be in the form of:
• Varnish
• Gel
• Foam
• Solution
• Slow releasing device
• These can be applied using the Paint on Technique or the Tray
Technique.
32. Knutson’s Technique - NaF
• Named after Knutson JW in 1942. Because of his extensive work on topical
fluoride.
• This is a form of topical fluoride application with 2% Sodium Fluoride used
at a pH of 7.
• 2gm of NaF powder is dissolved in 100ml distilled water.
• Stored in a plastic bottle, as it may react with the silica in a glass bottle to
form Silicon-Fluoride thus; reducing the availability of free active fluoride
for anti-caries action.
33. Knutson’s Technique - NaF
• The four visit procedure is recommended for ages 3,7,11 and 13 yrs,
coinciding with the eruption of different groups of primary and
permanent teeth.
• Thus, most of the teeth will be treated soon after their eruption,
maximizing the protection afforded by topical application.
•
There are 4 appointments for each visit spaced with a weekly interval.
34. Technique
• Teeth cleaned with aqueous pumice slurry, dry with compressed air
and teeth isolated either by quadrant or by half mouth.
• 2% NaF solution is painted on the teeth so that all surfaces are
visibly wet and allow to air dry for 3-4 minutes.
• Repeat for each of the isolated segments until all teeth are treated.
• 2nd, 3rd and 4th NaF application is done, not preceded by a
prophylaxis, is scheduled at intervals of approximately one week.
35. Advantages
• It is relatively stable when kept in a plastic container;
• The taste is well accepted by patients;
• The solution is non-irritating to the gingiva;
• It does not cause discoloration of tooth structure;
Disadvantages
• One major disadvantage of the use of Knutson’s technique is that the
patient must make 4 visits to the dentist within a relatively short
time.
36. Muhler’s Technique(stannous Fluoride)
• It was so named because of the extensive done by Muhler et al in 1947.
• They observed that stannous fluoride solution greatly reduced the rate of acid
dissolution and is 3times more effective than NaF in preventing dissolution of Ca
and P0₃ ions from the enamel.
• Fluoride concentration of 19500ppm Stannous fluoride at 8% and 10%
concentrations is used in Muhler’s technique.
• A fresh solution of stannous fluoride is prepared for each patient as a result of the
unstable nature. It forms tin hydroxide soon after mixing and becomes cloudy.
37. Muhler’s Technique(stannous Fluoride)
• To prepare 8% stannous fluoride solution, the content of one capsule
which is 0.8 grams is dissolved in 10 ml of distilled water in a plastic
container.
Technique
• Thorough prophylaxis with pumice including the proximal surfaces.
• Isolation with cotton rolls and dry with compressed air.
• A quadrant or half of the mouth can be treated at a time.
38. • Apply freshly prepared 8% solution of SnF2 continuously to the teeth
with cotton applicators. So that the teeth are kept moist with the
solution for 4 minutes.
• A reapplication of the solution to a particular tooth is done every 15-30
seconds.
• Repeat applications are made every 6 months
Advantages
• Using an 8% stannous fluoride solution at 6 to 12 months intervals
conforms to the practicing dentist’s usual patient – recall system.
39. Muhler’s Technique(stannous Fluoride)
Disadvantages
• In aqueous solution the material is not stable
• 8% solution is quite an astringent and disagreeable in taste, its application
is unpleasant.
• The solution occasionally causes a reversible tissue irritation manifested by
gingival blanching.
• Causes pigmentation of teeth which has a characteristic light brown colour
especially hypocalcified areas and around margins of restorations.
40. Brudevold’s Technique - APF
• This follows the works done by Pameijer and Brudevold while comparing
the effectiveness of a solution of neutral NaF with a acidulated phosphate
fluoride (APF).
• They reported APF to be 50% more effective than neutral NaF as a
caries preventive agent.
• To prepare, 20 grams of sodium fluoride is disolved in 1L of 0.1 M
phosphoric acid and to this is added 50% hydrofluoric acid to adjust the ph
at 3.0 and fluoride ion concentration at 1.23%.
• The solution is also called Brudevold’s solution.
41. Brudevold’s Technique
• A gelling agent such as methylcellulose or hydroxyethyl cellulose is added to the
solution.
• The pH is to be adjusted between 4-5
Need for a gelling agent
• teeth must be kept wet with solution for 4 minutes
• APF solution is acidic and bitter in taste so repeated application necessitates
the use of suction.
• chair application by one dentist or auxiliary becomes difficult
• increased chairside time
• APF is recommended for application at 6 or 12 months interval
42. • APF gel may be applied in the same manner as topical solution as described
above.
• It can also be used by self application and children can be trained for this.
Using a variety of self re-usable or disposable trays in various sizes together
with sponge like tray liners are available.
Advantages
• It is stable when stored in plastic container
• No staining of teeth
• Gels can be self applied
• Requires only 2 applications in a year;
43. Brudevold’s Technique
Disadvantages
• Repeated exposure of porcelain or composite to APF can lead to loss
material, resulting in surface roughness and cosmetic changes
• It is acidic, sour and bitter in taste
• It cannot be stored in glass containers
44. Fluoride Varnishes
• A fluoride varnish is a professionally applied adherent material.
• It is formulated to hold fluoride in close contact with the tooth for
a period of time.
• It permits the application of high fluoride concentrations in small
amounts of material
• Varnishes typically contain high concentrations of fluoride and are for
professional application only.
45. Fluoride Varnishes
• When painted on the tooth surface, it act as fluoride depot from which
Fl ions are continuously released.
• It is also not quickly washed away by saliva.
• This allow the Fl ion to interact with the hydroxyapatite crystal over a
long period of time.
• Hence leads to deeper penetration and significant anti-caries effect.
46. Fluoride Varnishes
• It is applied sparingly with a cotton bud and a small pea-size amount is
sufficient for a full mouth application in children up to 6 years.
• Fluoride varnishes are particularly useful in children with special need.
• Also useful when fluoride is needed to target specific tooth surfaces
e.g. exposed surfaces of roots, incipient carious lesions or the margins
of restorations.
47. Fluoride Varnishes
• Fluoride varnishes are safe because the amount of varnish usually used is
0.3 – 0.5 ml which delivers only 3-6 mg fluoride.
• Patient should be instructed not to chew or brush for at least 1 hours after
varnish application.
• Many fluoride varnishes contain colophony which may cause a sensitivity
reaction.
• Hence, colophony-containing varnishes are contraindicated in unstable
asthmatics, atopic children, and those allergic to Elastoplast (contains
colophony)
49. Fluoride Varnishes
Technique
• Oral prophylaxis is done.
• Teeth are dried and isolated.
• First lower arch is taken up for application and then the upper arch -
saliva collects rapidly on the lower arch.
• Small amount of varnish is dispensed (0.3ml to 0.5ml, or 2 drops, for
the entire dentition) to the applicator dish.
• Varnish sets rapidly when they come in contact with saliva, hence no
drying is necessary
50. Fluoride Varnishes
• Patient is made to sit with the mouth open for 4 minutes before
spitting to allow the varnish set on teeth which is further enhanced by
the moist environment created by saliva.
• Patients should be clearly instructed not to rinse or drink anything
for an hour.
51. Slow Releasing Devices
• In the past, many dental materials, such as amalgam, composites,
cements, acrylics, and fissure sealants, have had fluoride added.
• But either the fluoride release was short term
• Or the properties of the materials were adversely affected.
• Long term fluoride release by glass ionomer cement has been debated, even
with its fluoride recharging ability.
• The objective of a slow-release fluoride device is to produce a
consistent level of fluoride intra-orally, over a long period of time (1-2
years) without the need for regular professional involvement or patient
compliance.
52. Slow Releasing Devices
• There are three systems of slow-release F devices:
• the copolymer membrane type - developed in the United States
• and the glass bead - developed in the United Kingdom.
• More recently, a third type, which consists in a mixture of sodium
fluoride (NaF) and hydroxyapatite has been developed.
• The devices are usually attached to the buccal surface of a posterior
tooth either by direct bonding, or by means of an orthodontic band or
plastic bracket.
53. Slow Releasing Devices
• Although, there is evidence from in vivo trials that slow release
fluoride devices can produce a sustained increase in salivary fluoride
levels (Toumba et al., 2009)
• To date there is insufficient evidence from randomised control trials to
determine the caries-inhibiting effect of slow-release fluoride devices
(chong et al., 2014).
54. A fluoride slow-release glass device attached to the
buccal surface of the upper right first permanent
molar tooth
PAEDIATRIC DENTISTRY 5TH EDITION.
Schematic cross-sectional view of the copolymer
device, which originally had 8 mm in length, 3 mm in
width, and 2 mm in tickness.
Adapted from PESSAN et al 2008
56. Fluoride Dentifrices
• The first clinical trial of a fluoride dentifrices was initiated by Bibby in
1942.
• The active agent was Sodium Fluoride which had been added to a
conventional dentifrices containing Di-calcium phosphate as the
abrasive.
• In 1955, the stannous fluoride dentifrice became the first dentifrice
recognized by FDA [Food and Drug Administration] as an effective
tooth decay preventive product which was later accepted by ADA
[American Dental Association].
57. Fluoride Dentifrices
• The various fluoride compounds used in dentifrices :
• Sodium fluoride
• Stannous fluoride
• Monofluorophosphate
• Amine fluoride
• Brushing with fluoride toothpaste increases the fluoride concentration in
saliva 100- to 1,000-fold.
• This concentration returns to baseline levels within 1 to 2 hours
58. • Fluoride toothpastes available contain fluoride concentration ranging between
1,000 to 1,500 ppm and 450-500ppm for children 3years or less.
AAPD recommendations
• Tooth brushing with fluoridated toothpaste significantly reduces dental caries
prevalence in the primary dentition.
• Children less than 3years of age should use a smear or rice-size amount of
fluoridated toothpaste. (reduce the risk of fluorosis)
• For children age 3-6 years, a pea-size fluoridated toothpaste is recommended.
• They should have supervised tooth-brushing done twice daily.
• Rinsing after brushing should be kept to a minimum or eliminated altogether.
59. Smear and pea-sized toothpaste sizes.
AAPD Best practice guidelines – fluoride therapy 2018
60. Mouth rinses
• Concentration of fluoride in home mouth rinses varies from 225ppm-
900ppm.
• It can be used daily or weekly
• The AAPD in its guidelines refers to randomized trials supporting the
use of 0.2% sodium fluoride mouth rinse (900ppm F) to reduce caries
as part of a preventive regimen.
61. Mouth rinses
• The EAPD stipulates that supervised rinsing is more efficacious than
unsupervised rinsing.
• The children using the fluoride rinse should be older than
6 years. (risk of swallowing)
• The rinse should be held in the mouth for 1 minute
and then expectorated.
• That there is no evidence to support the efficacy of fluoride rinse in
primary teeth.
• In permanent teeth the rinse is efficacious in preventing caries.
62. Mouth rinses
• Fluoride rinses should be at a different time to tooth brushing inorder
to increase the frequency of fluoride exposure.
• Tooth brushing and rinsing with fluoride has been shown
to be additive.
• All orthodontic patients should be use a daily fluoride rinse to
minimize the risk of demineralization and white spot lesions.
63. Other Fluoride Topical therapy -
Silver diamine fluoride
• SDF is a colourless solution with an alkaline pH (pH 8–10).
• Its main components are
• Silver – antimicrobial agent
• fluoride – aids remineralization
• and ammonia. – stabilizes the solution
• It offers a therapeutic and preventive effect in the management of
dental caries in paediatric patient.
64. SDF
• These components have the following synergistic activity
• a bactericidal action on cariogenic microorganisms,
• promotion of mineralization,
• inhibition of demineralization of tooth hard tissues, and
• decrease of the destruction of the organic portion of the dentin
65. SDF
• On application to a carious lesion, two compounds are formed:
calcium fluoride and fluoroapatite.
• Calcium fluoride is loosely bound to the teeth and it can be considered
a reservoir of fluoride that will be released if a pH drop occurs.
• Silver phosphate can also act as a reservoir of phosphate ions for the
next caries challenge
66. SDF
• The fluorhyapatite is formed when fluoride is incorporated into the
hydroxyapatite crystals.
• It helps remineralization and makes the tooth more resistant to further
demineralization.
• Also, high concentration of fluorides can inhibit the formation of
biofilm, since fluoride can influence the carbohydrate metabolism and
the sugar uptake of the microorganisms
67. SDF
• The silver ions (Ag+) exert a great antimicrobial effect, killing or
interfering in the microorganisms’ metabolic processes.
Drawback
• The only reported side effects of SDF are that caries lesions stain
black after treatment, and it will temporarily stain the skin and mucosa
with contact.
68. Systemic fluoride
• They are ingested and circulate through the blood stream.
• They are incorporated into the developing teeth and provide a low
concentration of fluoride over a long period of time.
• Ingested fluoride such as fluoridated water and dietary supplements, may
contribute to a topical effect on erupted teeth.
• Before it is swallowed, while in he oral cavity,
• as well as a topical effect due to increasing salivary and gingival
crevicular fluoride secretion
69. Systemic fluoride
• The different types of Systemic fluorides are:
• Water Fluoridation
• Community Water Fluoridation
• School Water Fluoridation
• Salt Fluoridation
• Milk Fluoridation
• Fluoride tablets/ drops/ lozenges
70. Systemic fluoride
• Water fluoridation is the controlled addition of fluoride to a public water
supply to an optimum level for the prevention of dental caries.
• It is socially equitable, in that it is available to all social groups and ages.
• One of the most important and successful public health intervention.
• Other fluoride supplements such as fluoride in milk and salt, fluoride tablet,
lozanges and drops are recommended for children who are not exposed to
fluoridated water
71. AAPD guidelines on dietary fluoride supplementation schedule
AGE FLUORIDE IN DRINKING
<0.3 ppm F 0.3 to 0.6 ppm F >0.6 ppm F
Birth to 6 months 0 0 0
6months to 3years 0.25mg 0 0
3 to 6 years 0.50mg 0.25mg 0
6 to at least 16 years 1.00mg 0.5mg 0
72. POTENTIAL HAZARDS OF FLUORIDE
• Fluoride is often called a double-edged sword.
• This is because inadequate ingestion of fluoride will not prevent dental
caries and an excessive intake of fluoride can lead to dental and
skeletal fluorosis.
73. Acute Toxicity
• Acute fluoride toxicity results from rapid excessive ingestion of
fluoride.
• The speed and severity of the response are dependent on the amount
of fluoride ingested and the weight and age of the child.
• Studies have found that a single ingestion of just 0.1-0.3 mg/kg.
• A child weighing 10 kilograms, therefore, can suffer symptoms of
acute toxicity by ingesting just 1 to 3 milligrams of fluoride in a single
sitting.
• 1 to 3 mgs of fluoride is found in just 1 to 3 grams of toothpaste (less
than 3% of the tube)
• Acute lethal dose is 15mg/kg body weight.
76. Chronic Toxicity
• Chronic fluoride toxicity results from long term ingestion of small amounts
of fluoride.
• The effect of chronic fluoride toxicity on enamel is dental fluorosis.
• Other problems such as skeletal fluorosis may also occur.
• Effect dosages duration:
• Dental fluorosis >2 times optimal until 5 years
• Skeletal fluorosis 10-25 mg/day 10-20 years.
77. Conclusion
• Fluoride has been contributing to the improvement of the dental health
of persons all over the world.
• Fluoride when used appropriately, is a safe and effective agent that
can be used to prevent and control dental caries.
• Practitioners should concentrate on recommending for their patients,
agents or methods that provide frequent low moderate fluoride
concentration rather than rely on infrequently applied high
concentrations of fluoride.
78. References
• Buzalafa, Pessan, Honório, Cate Mechanisms of Action of Fluoride for Caries Control.
Monogr Oral Sci. Basel, Karger, 2011, vol 22, pp 97–114
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