INTRODUCTION, METHOD OF ADMINISTRATION,WATER FLUORIDATION,SCHOOL WATER FLUORIDATION,SALT FLUORIDATION,MILK FLUORIDATION,FLUORIDE SUPPLEMENTS,DIETARY SUPPLEMENTS,PRENATAL FLUORIDE SUPPLEMENTS,RECENT STUDY

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Dr. TALAT NAZ
2ND
YEAR MDS

2. INTRODUCTION
 FLUORIDE – natural resistance and immunity
against dental decay
 SYSTEMIC – PRE EURPTIVE EFFECT
 TOPICAL – POST EURPTIVE EFFECT
 SYSTEMIC – MECHANISM
• Redering enamel more resistant to acid
dissolution
• Inhibition of bacterial enzyme systems- enzymatic
action
• By reducing tendency of the enamel surface to
absorb proteins
• Modification in the size & shape of teeth
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3. Methods of administration
of fluoride
SYSTEMIC
1. PUBLIC WATER FLUORIDTAION
2. SCHOOL WATER FLUORIDTAION
3. FLUORIDIZED SALT
4. FLUORIDIZED MILK
5. FLUORIDE SUPPLEMENTS (TABLETS & DROPS )

4. Water fluoridation
 Definition – upward adjustment of the
concentration of fluoride ion in public water
supply in such a way that the concentration of
Fluoride ion in the water may be consistently
maintained at 1 ppm to prevent dental caries
with minimum possibility of causing dental
fluorosis.
 WHO 1994- 0.5-1ppm
 Compounds used:fluorospar, NaF, silicofluorides,
etc.
 Equipment: saturator, dry feeder, solution feeder
 Water intake varies widely due to climate
changes
 Richard et al (1967) (temp ↓ ppm ↑)
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Temperature in °C Recommended ppm
18.3˂ 1.1- 1.3
18.9 – 26.6 0.8- 1.0
26.7˃ 0.5- 0.7

5. HISTORY OF WATER FLUORIDATION.
TIEL – CULEMBORG STUDY

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Study year place Ppm
F
result
Dean et al 1939 Galesburg,mon
mouth
1.7 dmft
weaver 1944 South& north
shields
1.4
0.4
41% dmft
Tan&
storvick
1964 Corvalis albarny 1 56% dmft
Murray 1969 Hartepool,york 1.5-2 64% dmft
WATER FLUORIDATION STUDIES

7. ADVANTAGES
 Population benefit
 Regular consumption
 Systemic and topical effect
 Least expensive
 Most effective
DISADVANTAGES
 Interferes with human rights
 Central water supply
Feasibility in India
Most effective, practical and economical public health
measure.

8. School water fluoridation
 1st
investigation-1954 –Virginia island, 2.3ppm,
 8 years later result (1962) - 21.9% caries reduction
 Optimum fluoridation of 5 – 6.3ppm (Horowitz et al
1978)
 180 days per year at school
 25 -40% reduction in DC
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9. ADVANTAGES
 Good results in caries
reduction
 Minimal equipment
 Cost effective approach
DISADVANTAGES
 Children receive benefit
until they go to school
 Not all children go to school
like in rural India
 Amount of water drunk
cannot be regulated

10. SALT FLUORIDATION

11. Salt fluoridation
 Introduced in Switzerland by WESPI in 1948 (medical
practioner – prevent goitre), has been on sale since
1955.
 Salt fluoridated –90 mgF/kg to 200-350mgF/kg in
columbia, spain & hungary- 20-25% dec in caries.
 Muhleman in 1967- to obtain the same F conc as
provided by water F, 300mg F/kg salt yields 1.5 mgF/5
gm.
 Toth from Hungary (1976), after 8 years of salt F at
250mgF/kg salt reported a 41% dec in DMFT in 2-6 yrs,
58% dec in 7-11 yrs & 36% dec in 12-14yrs age group.
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12. ADVANTAGES
 Safe
 No supervised water
distribution systems
 Lifelong daily compliance
 Small amounts
 Low cost
DISADVANTAGES
 Low consumption – during
early years of life
 Safety – Hypertension?
International efforts to
reduce salt intake

13. Milk fluoridation
 Ziegler 1955 (Swiss city of winterthur)bottles, 2.2mg of NaF added to
¼ litre of milk.
 Inamura (1959), from japan reported 36.3% dec in caries,(2.5mg
NaF , served daily in school meals)
 Rusoff et al (1962, USA)- 35% dec in caries with 3.5ppm F.
 Wirz (1964)- dec in caries from 14.8% to 31.5% in primary teeth.
 1971- Dr. edgar burrow ( BURROW DENTAL MILK FOUNDATION)
 STEPHEN ET AL – DAILY INGESTION OF 200 ml (7ppm). For 4 yrs, 38.8%
of caries reduction (1st
perm molar)
 Benoczy in 1983 from Hungary- 74% dec in caries in primary teeth.
 Compounds- calcium fluoride, NaF, disodium
monofluorophosphate, disodium silicofluoride
 first community based milk fluoridation – 1988, in Bulgaria.
 WHO 1994 - 0-1mgF/day
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14. ADVANTAGES
 Staple food
 Target children directly
 Less expensive than water
fluoridation
DISADVANTAGES
 Absorption – long
 Children who do not drink
milk / consumption declines
with age
Feasibility of milk fluoridation in India
Cannot afford milk
No centralized milk supply system
Variation of intake and quantity

15. Fluoride supplements
 With vitamins-parents, young children
 Should be in contact with teeth before swallow
 Once before bedtime is must-saliva less, no eating
 Moderate to high risk patient with deficient fluoride in
drinking water
 Tablets, drops and lozenges
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Lozenges oral rinse
Sodium fluoride tablets and drops

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Luride Chewable Tablets Luride drops
Fluor-A-Day Chewable Tablets

18. Dietary supplements
 Tablets
• Older children
• Chew swish and swallow
 Drops
• Young children
• Place directly on the
child’s teeth
• Exact prescription is must!
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• Prevent DC in both primary and permanent
dentition
• 40- 80% reduction, if supplements are
administered before 2 years of age
• NaF – compound of choice
• NOT RECOMMENDED–water fluoride
0.5ppm(FINN)

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PRIMARY TEETH - Caries reduction 50-80% (bef 2yr –
3-4yr) (Prichard 1969)
PERMANENT TEETH - 20-40% caries reduction
(Aasenden& peebles 1974)

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Prenatal fluoride supplements
Glenn study 1977-79- prenatal
• 1 -4mgF/day mother; 12th
week of
preg.
• Deciduous dentition – caries free
• Improved surface morphology
1966 FDA banned marketing of products
bearing claim that caries would be
prevented in their offspring of women
who used the products in their
pregnancy
AAPD 2011- DOES NOT SUPPORT .

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23. Factors to be considered
before determining
proper F dosage
 Concentration of fluoride in drinking water
 Total amount of bioavailable fluoride
 Age of the child
 Dosage forms commercially available
 Other fluoride product intake
 Oral hygiene status
 Medically compromised
 Parental motivation
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24. Fluoride dosage based on F content of drinking
water (ADA)
F content of
drinking water
2weeks-2yr 2-3yr 3-16yr
<0.3ppm o.25 mg 0.50 1mg
0.3-0.6ppm 0 0.25 0.50
>0.6ppm - - -
Dosage
1 tablet - 2.2mg (1mgF)
½ tablet- 1.1mg (0.5mgF)
¼ tablet -0.55mg (0.25mgF)
Dosage
1 tablet - 2.2mg (1mgF)
½ tablet- 1.1mg (0.5mgF)
¼ tablet -0.55mg (0.25mgF)
PRESCRITION
TABLETS:
7 YEAR OLD PATIENT HIGH RISK, FLUORIDE WATER LESS
THAN 0.3 ppm
RX – SODIUM FLUORIDE TABLETS
DISP: 120 CHEWABLE TABLETS
SIGN: chew 1 tablet daily after brushing at bedtime.
Swish and swallow. Refill 3 times(1 year supply)
DROPS
2 year old infant FLUORIDE WATER LESS THAN 0.3 ppm
RX – SODIUM FLUORIDE drops (0.125mgF/DROP)
DISP: 30ml
SIGN: place two drops on tongue or inside cheek at
bedtime

25. Recent studies
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26. Conclusion
Tremendous outpouring research on topical and
systemic effects of caries reduction. Dental health in
many countries has improved due to wide use of
fluorides.
“Reverses the increasing trend of dental decay”
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27. REFERENCES
TEXTBOOK OF FLUORIDES – AMRIT TIWARI

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