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FLOURIDESFLOURIDES

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INTRODUCTIONINTRODUCTION

y WHO has declared it as one of the 14 essential elements for

normal growth & development

y It has an atomic number of 9 & atomic weight of 19

y Fluorine means to flow in latin, it is a pale yellow green gas.

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HISTORIC REVIEWHISTORIC REVIEW

y 1901: Dr. Fredrick Mc Kay of Colorado USA discovered

permanent stains on teeth of patients and named it Colorado

Stains. Mc Kay named it as mottled enamel

y 1931: Shoe Leather Survey byTrendly H Dean.He was assigned

the job to continue Mc Kays work and find the geographical

distribution of mottled enamel.

y 1934: Trendly H Dean introduced Deans flourosis index

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SOURCES OF FLOURIDESOURCES OF FLOURIDE

y Fish products especially canned fish like salmon & sardines have

fluoride content of 40 mg/kg

y Banana & potatoes contain fluorides

y Rock salt contains 40 200 ppm of fluorides

y Tea leaves and instant tea contains 100 400ppm of fluoride

y Mineral water contains 1.5 7 ppm

y Breast milk

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ACTION OF FLUORIDES IN CARIESACTION OF FLUORIDES IN CARIES

REDUCTIONREDUCTION

y Increased enamel resistance / Reduction in enamel solubility

y Increased rate of post eruptive maturation

y

Remineralisation of incipient lesiony Fluoride as an inhibitor of demineralisation

y Interface with microorganisms

y Modification in tooth morphology

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y Increased enamel resistance:

Forms fluorapetite layer that reduces the solubility of enamel bypromoting the precipitation of hydroxyapetite and phosphate

y Increased rate of post eruptive maturation:

Newly erupted teeth have hypomineralised areas & fluorideincreases the rate of mineralisation or maturation.

Deposition of organic matter increases the resistance to caries

y Remineralisation of incipient lesion:

It is the deposition of minerals in previously damaged areas whichappear as white spots

Remineralising solutions contain fluorides with calcium &phosphate ions the sources of which are saliva

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y Interference with micro organisms:

In high concentrations fluoride is bacteriocidal & in low

concentrations it is bacteriostatic

Fluoride interacts with bacterial cell in ph dependent factor

y Modification in tooth morphology:

Diameter & cusp depth are smaller if fluoride are present, that

helps to keep the teeth self cleansing

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FLUORIDE DELIVERY METHODSFLUORIDE DELIVERY METHODS

y Topical

High concentration

Low concentration

y Systemic - Fluoridation

y Combination of both Fluoride rinses swished & swallowed

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TOPICAL FLUORIDESTOPICAL FLUORIDES

y It can be divided into:

Professionally applied

Self applied

y Professionally applied: Applied in dental office set up by a dentist. Ithas a high fluoride content of 5000 19000 ppm

y Self applied: They include mouthrinse, gels & dentifrices. It has low

fluoride content 200 1000 ppm

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FLUORIDES VEHICLESFLUORIDES VEHICLES

y Professional topical application of fluoride are available as Sodium

Fluoride, Stannous Fluoride & Acidulated Phosphate Fluoride

y Aqueous Solutions & Gelsy Thixotropic Solution

y Fluoridated prophylactic paste

y Foam

y Fluoride Varnish

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METHODS OFAPPLICATION OF TOPICALMETHODS OFAPPLICATION OF TOPICAL

FLUORIDEFLUORIDE

y Paint on technique

y Tray technique

y

Paint on technique: 2% Sodium Fluoride & APF gely Tray Technique: APF gels

y Knutsons Technique

y Swejda - Knutson

y Muhlers single application techniquey Mercer & Muhler

y Dubbing & Muhler

y Englader

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y Knutsons Technique:

After prophylaxis each tooth is wetted with solution which is

allowed to dry for 3 4 min, three further applications are done in

a weeks interval. Recommended age are 3,7, 11 & 13

SELFAPPLIED FLUORIDESELFAPPLIED FLUORIDE

y Dentifrices

y Gels

y Mouthrinses

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TOXICITY OF FLUORIDESTOXICITY OF FLUORIDES

y Acute

y Chronic

y Acute Toxicity: Rapid excessive ingestion of fluoride, it causesfluoride to combine with hydrogen in gastric juices to formhydrofluoric acid. CLD is 32 64 mgF / kg, STD is 8 16 mgF/kg

y Initial symptoms are

y Nausea, abdominal cramps, vomiting, diorrhea G I

y Hypotension, shock, weak pulse C V

y CNS depression

y Chronic Toxicity: Fluorosis

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SYSTEMIC FLUORIDESSYSTEMIC FLUORIDES

y Common methods of systemic supplements are:

Fluoride drops with or without vitamins

Fluoride tablets with or without vitamins

Lozenges

Oral rinses

y Compounds used are NaF & APF

y Concentration 0.125, 0.25, 0.50 mg tablets or drops

y Not more than 1 mg of fluoride should be ingested each day

y

Target population For infants & children upto 13 to 16 yrs

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COMMUNITY WATER FLUORIDATIONCOMMUNITY WATER FLUORIDATION

y Definition:

Controlled adjustment of conc. of fluoride in communal water

supply so as to achieve max caries reduction & a clinically

insignificant level of fluorosis

y Fluoride compounds in water fluoridation:

Fluorspar

Sodium fluoride

Silicofluorides

Sodium silicofluorides

Hydrofluosilicic acid

Ammonium Silicofluoride

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EQUIPMENTS FOR WATER FLUORIDATIONEQUIPMENTS FOR WATER FLUORIDATION

y The Saturator system

y The Dry feeder system

y The Solution feeder system

Principles:

y Saturator system: 4% saturated solution of NaF is produced &

injected at desired conc at water distribution source with the aid

of pump

y Dry feeder system: NaF or Silicofluoride in the form of powder is

introduced into dissolving basin with automatic mechanism toensure correct conc to amount of water

y Solution feeder: Volumetric pump permitting the addition of given

quantitiy of hydrofluosilicic acid to the amount of water treated

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DEFLUORIDATION OF WATERDEFLUORIDATION OF WATER

y NalgondaTechnique:

Involves addition of two chemicals sodium aluminate or lime,

bleaching powder & filter alum to flouride water.

y Steps:Rapid mix

Flocculation

Sedimentation

Filtration