Professionally applied topical fluorides
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Transcript of Professionally applied topical fluorides
Professionally applied topical fluorides
Dr. Shivashankar.K1st year M.D.S. Department of P.H.D.Saveetha Dental College.
Contents Introduction Definition Indications Contraindications Rationale Technique of application Products Sodium fluoride Stannous fluoride Acidulated Phosphate fluoride Fluoride varnish In-office mouth rinse Conclusion
Introduction
Definition 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.Richard. E. Stallard- A Textbook of Preventive Dentistry. 2nd edition.
Indications Patients who are at high risk for caries on smooth tooth
surfaces
Patients who are at high risk for caries on root surfaces
Special patient groups, such as: Orthodontic patients
Patients undergoing head and neck irradiation
Patients with decreased salivary flow
Children whose permanent molars should, but cannot, be
sealed
Contraindications
Patients with low caries risk who reside in communities with optimal fluoridation
Rationale for topical fluoride
Fluoride concentration of enamel is inversely related to the prevalence of dental caries (1940- Volker and Colleagues ).
Keen et al in 1973 showed the relationship between surface enamel fluoride content and caries prevalence.
Highest concentration of fluoride occurs at the outermost portion of the enamel surface(5 to 10 micron), and decreases towards the dentin (Brudevold et al 1975)
Technique of topical application
1. Paint on technique2. Tray technique
Products
Neutral sodium fluoride solution (NaF)
Stannous fluoride (SnF2)
Acidulated phosphate agents
Varnish
In office fluoride mouth rinses.
Sodium fluoride (2%)Preparation:
20 gms NaF dissolved in 1lt of distilled water
Plastic bottle
Knutson’s technique Cleaning and polishing
Isolated with cotton roll
Teeth dried
Paint on with applicator tip
Dry for 4 min
Avoid eating, drinking or rinsing for 30 min
Weekly intervals
Recommended ages 3,7,11 &13 years, 4 times weekly intervals
Mechanism of action Sodium fluoride reacts with hydroxyapatite crystals forming
CaF2
Fluoride concentration – 9000 ppm
Chocking off- initial rapid reaction followed by reduction in its
rate.
Thick layer of calcium fluoride interferes with further diffusion
Calcium fluoride reacts with hydroxyapatite forming fluoridated
hydroxyapatite.
Less susceptible to caries, stable product.
Plaque metabolism- anti- enzymatic action.
Advantages and disadvantages
ADVANTAGES:
1) Relatively stable, Needs Plastic Containers
2) Well acceptable taste, Non Irritating and no -discoloration
3) Suited for public health programmes
DISADVANTAGES:
4 visits relatively at short period of time .
1940- volker et al invitro study- solublity of enamel is reduced.
1941- Bibby had done 1st clinical study using a 0.1% aqueous NaF solution for 7-8 min. 1 year follow-up. 45% caries increment.
1942 - Knutson suggested technique which required 4 visits. 1948- Knutson and galagan 1% aqueous NaF. 4.9-5.8%
reduction. 1959- Sundvall- Hagland et al studied the effectiveness
of Knutson technique on caries incidence in the deciduous teeth. .5% reduction in caries increment.
STANNOUS FLUORIDE(STANNOUS FLUORIDE 8%)
PREPARATION………0.8gms in 10ml water
METHOD OF APPLICATION:
Cleaning and polishing
Isolated with cotton roll
Teeth dried
Paint on with applicator tip
Teeth kept moist for 4 minutes
Re-application done for every 15-30 seconds.
Mechanism of action Tin reacts with enamel forming stannous tri-fluorophosphate
which is more resistant.
If exposed to air stannous form of tin gets oxidized to stannic
form.
Main end-products:
Stannous hydroxy phosphate
Stannous- tri- fluorophosphate
Calcium tri fluorostannate
Calcium fluoride
Advantages and disadvantagesADVANTAGES:
Applications required only once per year
DISADVANTAGES:• Bitter metallic taste, disagreeable taste• Needs to be freshly prepared for each appointment• Not stable in solution • May cause reversible tissue irritation and staining at the
margins of restoration
1957- Muhler et al one application of SnF2 vs 4 application of
SnF2. 21% reduction in caries increment.
1957-1962 Muhler et al compared 1 application of SnF2 vs
4applications of NaF. 37% less caries increment which is 56%
lower than national average.
1974- Howink et al study among24 pairs of monozygotic twins.
Intervention was given to one group (1% fluoride) and other
group was control (no treatment). The intervention group
showed 37% fewer lesions compared to control group.
1960- Scott et al. Stannous fluoride forms a coating over
enamel. In-vitro electron microscope study.
1967- Stannous ions may reduce fluoride uptake.
Acidulated phosphate agentsMethod of preparation : 20gms..1litre of (0.1M phosphoric acid)
added 50% hydrofluoric acid
pH adjusted to 3 & F Conc. At 1.23%
Recommended Frequency
Twice a year
Application Cleaning and polishing
Isolated with cotton roll
Teeth dried
Paint on with applicator tip
Teeth kept moist for 4 minutes
Apply for every 30 seconds
1947- Bibby et al low pH high fluoride absorption.
1963- Brudevold Fluoride concentration in enamel increases
with decrease in pH
1961- Brudevoldt et al 66% reduction in caries lesion in
children. Bitewing radiograph.
1963- Brudevold et al . Neutral sodium fluoride vs acidulated
phosphate fluoride. Split mouth trial. APF is 50% more
effective than neutral sodium fluoride.
1968- Brudevold et al, Cartwright et al. bianual APF vs tap
water. 44-49% reduction in the new DMF
OTHER METHODS Wax or plastic trays- blotting paper soaked with APF solution
Gelling agent- methylcellulose or hydroxyethyl cellulose
added and pH adjusted to 4-5.
Trays- not sure of covering proximal surfaces
Gel- thixotrophic.
APF gel
Mouth trays should be tried in the patient's mouth
Upright and suction
Teeth should be air-dried, cleaning or prophylaxis
2–2.5 grams per tray or 40% of the tray's volume.
Upper and lower trays should be inserted separately.
Fluoride should be applied for 4 minutes, not 1 minute.
Expectorate for 1–2 minutes after tray removal.
Patient should not rinse, eat, or drink for at least 30 minutes after the
procedure.
1 minute gel applicationSilverstone
majority of fluoride uptake takes place in first 1 minute after application.
Reduces gel ingestion.
Prevent etching of porcelain or composite restoration
Dental Health Education by Christilina.B.DeBiase.
1967- Szwejda et al (1st gel study) no reduction after 1 year
1968- Brayan et al 45% reduction in DMF after single
application.
1970- Ingraham et al. APF gel vs APF solution. Gel is 50%
more effective than solution. Limitations: non-homogenous
groups.
1971- Horowitz and Doyle. APF solution is better than gel.
1100 children of age group 10-12 years
A study on APF by Horowitz and Doyle (1971) The result after 3 years.
1967- Averill et al. 2 years study among 483 children of 7-11
years.
control group- saline- 4.4
2% aqueous NaF- 3.9
4%Stannous Fluoride- 4.1
2% APF- 4.5
IN-OFFICE FLUORIDE MOUTH RINSES
Two-part fluoride rinses are being used more frequently
These rinses consist of two fluorides, APF and stannous
fluoride, which are mixed or used concurrently
Two-part rinses are marketed as a preventive agent that is
better tolerated than tray applications and reduces fluoride
ingestion.
Fluoride concentrations are much lower compared with APF
gel (1,500–3,000 ppm vs. 12,300 ppm).
Second, the risk of ingestion is greater because rinses can
be more easily swallowed.
FLUORIDE VARNISH The most common types of NaF varnish are Duraphat (2.2%
F) and Fluor Protector (0.1% F).
The advantage of varnish is its ability to adhere to tooth
surfaces, which prolongs contact time between fluoride and
enamel and improves fluoride uptake into the surface layers
of enamel.
Fluoride varnishDuraphat:
22600 ppm NaF
Caries reduction 30-40 % in permanent dentition
7-44% in primary dentition
Methods
No isolation as varnish sticks to cotton
0.5 ml equivalent to 11.3mgF, enough to cover full dentition
4 mins
Fluoride varnishFluorprotector: Clear polyurethane based products Contains silane fluoride 7000ppm 40% caries reduction The recommended dose of 0.5ml contains 3.1mg FMechanism of action
Fluoride + hydroxyapaptite =fluorapatite
Remove excess moisture from teeth with a cotton swab, cotton roll, or
air syringe.
0.5–1 ml of varnish
thin layer using a disposable brush, or cotton pellet.
The entire tooth surface must be treated
Avoid applying varnish to gingival tissues because of the risk of
contact allergies.
No drying is required after application
mouth can be closed immediately following treatment.
Patients can only have fluids or soft foods during the next four hours.
Patients should not brush their teeth for the rest of the day.
Note: Varnish is contraindicated for persons with a history of allergies or
asthma
1987- Shobha, Nandlal et al, A clinical study showed fluoride varnish
was more effective than APF
1995-Seppa and Co-worker reported the semiannual application of
NaF varnish and APF gel and observed no significant difference
between the two.
1982- Seppa et al, Duraphat(66% )found to be more effective than
Fluorprotector (49%).
Conclusion
References R. Hawkins, D. Locker and J. Noble; series editor E. J. Kay
prevention. Part 7: professionally applied topical fluorides for
caries prevention. British dental journal volume 195 no. 6
SEPTEMBER 27 2003 p 313-317
Ole fejerskov, brion A.Burt fluoride in dentistry, 2nd edition,.
J.J.Murray, et al. Fluorides in caries prevention (3rd edition ),
varghese publishing house.
Thank you