5. Fluoride incorporated
during tooth development
is insufficient to play a
significant role in caries
prevention.
The topical effect of
fluoride surrounding the
enamel is most important.
6. A variety of fluoride
compounds and different
delivery methods have been
used over since as early as
the 1940s.
7. The caries-preventive impact of a
certain modality depends on:
Type of fluoride compound
Concentration of fluoride
Rate of clearance from
plaque solution
Frequency of application
8.
9. Earliest form of professionally applied
topical fluoride (1940s).
The first preparation was 2% sodium
fluoride in an aqueous solution (NaF).
Applied 4 times at weekly intervals.
Targeted the ages of 3,7,10,13.
The solution was stable and had a bland
taste.
Patient recall was an issue.
10. The second preparation was 8% stannous
fluoride (SnF)
Applied every six months.
Solution was unstable, active for only 5-8 hours.
Poor taste
Caused staining and gingival irritation.
The third preparation was 1.23 acidulated
phosphate fluoride (APF).
Applied every six months
Needs to be kept in plastic containers
Acidic taste
11. No longer recommended, as better forms of
delivery are available
12. Developed in the 1960’s.
Usually it is 1.23% (12,300 ppm)
APF (Acidic).
Methyl-cellulose and hydroxy-ethyl
used as a “gelling agents”.
13. The acidity leads to dissolution of hydroxyapatite
and formation of Fluorapatite.
Rapid uptake of fluoride happens in the first four
minutes.
14. The acidity can cause etching of composite
restorations Neutral NaF 2% (9200 ppm)
alternative can be used.
Allows application to all teeth surfaces at once.
Systemic ingestion is not uncommon:
• High concentration of fluoride.
• Large amount of fluoride can be retained in mouth
following application.
• 78% of the dose swallowed if saliva ejector is not used.
• Reports of nausea and gastric irritation.
15. Permanent teeth:
Good evidence that gels can help prevent caries in
children (DMFS prevented fraction= 28%)
Primary teeth:
Low quality evidence that gels can help prevent caries in
(dmfs prevented fraction= 20%)
Adverse effects:
Poor reporting.
(Marinho et al., 2015)
16. Patient selection:
• Moderate or high caries risk
• 7 years or older
Preparation:
• Prophylaxis No evidence it is necessary.
• Select appropriate disposable plastic tray.
• Sit patient upright.
• Apply saliva ejector to reduce ingestion.
• Wipe teeth with gauze and air-dry.
•
17. Apply no more than
2–2.5 grams of gel
per tray (40% of the
tray's volume).
Upper and lower
trays could be
inserted separately
or together.
18. Keep the gel applied for 4
minutes.
Ask the patient to spit the
gel out for 1-2 minutes
afterwards.
Instruct the patient to not
rinse, eat, or drink for at
least 30 minutes.
19. Similar compound to that
used in gels (APF).
Similar application
procedure.
Requires only one fifth of
amount by weight,
potentially reducing
amount ingested.
20. Little research on their use.
Permanent teeth:
Enamel F uptake Equivalent to that of gels.
Bi-annual application reduced the incidence
of caries in smooth surfaces of 6s.
Application during orthodontic treatment
reduced the development of white spot
lesions.
Primary teeth:
Bi-annual application was effective in
reducing caries increment.
21. First developed in the 1960s. Since then it was used to
reduce the risk of dental caries, erosion, and sensitivity.
Adheres to tooth surfaces, which prolongs contact time
between fluoride and enamel (up to 48 hours).
Different commercial brands available with different
flavours and colours:
◦ 5% NaF - 2.26% F (22,600) Duraphat
◦ 1% Difluorosilane - 0.1% F Fluor Protector
◦ 5% NaF - Cavity Shield
22. Example: Duraphat varnish
2.26% w/w,
22,600 ppm F-
50mg/ml
10 ml tubes.
3 year shelf life, 3 months
after opening.
Costs 0.5 dinar per
application.
23. Permanent teeth
• Moderate evidence that varnish can help prevent caries (DMFS prevented
fraction= 48%)
Primary teeth
• Moderate evidence that varnish can help prevent caries (dmfs prevented
fraction= 33%)
No significant association with caries severity, exposure to fluorides,
prior prophylaxis, concentration, or frequency of application.
Not enough studies reporting on adverse effects.
(Marinho et al 2013)
24. One study reported that varnish is more acceptable than
foams, especially among 3 to 6 year olds (Hawkins et al.,
2004).
Insufficient evidence to determine whether varnishes are
more effective in caries prevention than gels (Marinho et al.,
2003).
Low-quality evidence that fissure sealants remains better than
fluoride varnish for preventing occlusal caries in permanent
molars (Ahovuo-Saloranta et al., 2016)
25.
26. Dry tooth surface before
application, ideally, tooth should
also be clean.
Use sparingly for local application
with a brush, can also use floss to
deliver interdentally.
Patient to avoid chewing for up to
4 hours.
Patients should not brush their
teeth for the rest of the day.
Fluoride varnish - Method of
application
27. Dose
Primary dentition: up to 0.25mls
Mixed dentition: up to 0.40mls
Permanent dentition: up to 0.75mls
Contraindications (as per manufacturer):
Hypersensitivity to colophony and/or any other constituents.
Ulcerative gingivitis.
Stomatitis.
Bronchial asthma.
28. Very high fluoride content.
Don’t use in combination with any other fluoride
applications.
Risk of toxic effects:
Acute fluoride poisoning (5 year old, 20 kg)
◦ only 0.9 ml needed
Lethal dose (5 year old, 20 kg)
◦ 13 ml needed
29. Very high fluoride content.
Don’t use in combination with any other fluoride
applications.
Risk of toxic effects:
Acute fluoride poisoning (5 year old, 20 kg)
◦ only 0.9 ml needed
Lethal dose (5 year old, 20 kg)
◦ 13 ml needed
30.
31. Marketed in North America.
APF and stannous fluoride mix.
F- concentrations are low compared to gels or varnish
(1,500 – 3,00 ppm)
Metallic taste and increased risk of ingestion.
32. No evidence for effectiveness.
Not recommended for use because other
established modalities are already available
33.
34. A device attached to the
sides of one or more
tooth.
Release F over several
years in the oral
environment.
Aim to provide F in the
oral cavity at low levels
for a long duration.
35. Co-polymer membrane:
• contains NaF in co-polymer matrix.
• kept in a SS retainer attached to orthodontic
band.
• Depending on the amount of F, these
devices can release between 0.02 and 1.0
mg F/day for up to 180 days.
36. Glass device:
Bead, kidney shaped (better retention), or
replaceable disk.
Attached to the buccal surface of the first
permanent molar using adhesive resins.
Contain 13.3% to 21.9% F.
Releases F for up to two years.
37. Only one good RCT to assess them
Good caries preventive impact in children that retained
the device over the course of the study.
Almost 50% of the participants lost their devices –
retention is an issue.
(Chong et al., 2014)
38.
39. Public Health England (PHE)
Scottish Intercollegiate Guidelines Network (SIGN)
American Academy of Pediatric Dentistry (AAPD)
European Academy of Paediatric Dentistry (EAPD)
40. Varnish and Gels are the methods supported by the strongest
evidence.
Application should be according to patient age, caries risk,
other sources of fluoride.
Example risk groups:
• Patients at high risk for caries on smooth tooth surfaces.
• Patients at high risk for caries on root surfaces.
• Orthodontic patients.
• Patients undergoing head and neck irradiation.
• Patients with decreased salivary flow.
• Children whose permanent molars should, but cannot,
be sealed.
41. Age Low risk High risk
Professional fluoride application
6 months - 3 years None Apply fluoride varnish to
teeth two or more
times a year
3-16 years Apply fluoride varnish to
teeth two times a year
Apply fluoride varnish to
teeth two or more
times a year
16+ years None Apply fluoride varnish to
teeth two times a year
