P.S.

M COLLEGE OF DENTAL SCIENCE & RESEARCH

AKKIKAVU, THRISSUR, KERALA – 680519
( Affiliated to Kerala University of Health Sciences )

Department of
PEDIATRIC AND PREVENTIVE DENTISTRY

Seminar on:
‘TOPICAL FLUORIDE’

Submitted by:
DIVYA ANIL S
FINAL YEAR- PART II
UNIVERSITY REG. NO: 170021258

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 P.S.M COLLEGE OF DENTAL SCIENCE & RESEARCH
AKKIKAVU, THRISSUR, KERALA – 680519
( Affiliated to Kerala University of Health Sciences )

Department of

PEDIATRIC AND PREVENTIVE DENTISTRY

CERTIFICATE
Certified that this is the bonafide seminar of DIVYA ANIL S .She has
satisfactorily completed the seminar on the topic "TOPICAL
FLUORIDE ” for FINAL YEAR- PART II BDS course during the
year 2022-2023.

University Reg No: 170021258 Professor & Head Of theDepartment

Date:

2
 ACKNOWLEDGEMENT

I am extremely thankful to almighty GOD who guided me in all aspects

for preparing this successful work.

I sincerely thank Dr.Thomas Manjooran (Professor and Head Of the

Department), Dr.Hemjith Vasudevan, Dr.Reshma Rajan,Dr.Anju S Raj,
Dr. Sangeetha for their guidance, motivation and encouragement given
throughout this work.

Special thanks to college library for providing all needed facilities. Let
me also convey my gratitude to my classmates and friends for providing
me all necessary help pertaining to this seminar and always encouraging
me to bring the best.

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 CONTENTS

SL NO. TOPICS PAGE NO.

1 INTRODUCTION 6

2 HISTORY 6
3 MECHANISM OF ACTION OF 8
FLUORIDE
4 FLUORIDE METABOLISM 10
5 FLUORIDE DELIVERY SYSTEM 12
6 SYSTEMIC FLUORIDE 13
7 TOPICAL FLUORIDE 13
8 FACTORS AFFECTING TOPICAL 14
FLUORIDE DEPOSITION IN TEETH
9 METHODS OF APPLICATION OF 15
TOPICAL FLUORIDE
10 INDICATIONS 17
11 CONTRAINDICATIONS 18
12 PROFESSIONALLY APPLIED 18
TOPICAL FLUORIDES
1. NEUTRAL SODIUM 18
FLUORIDE
2. STANNOUS FLUORIDE 22
3. ACIDULATED PHOSPHATE 26
FLUORIDE 29
4.FLUORIDE VARNISH
13 SELF APPLIED TOPICAL 30
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 FLUORIDE
1. FLUORIDE 31
DENTRIFICES
2. FLUORIDE FLOSS 32
3. FLUORIDE RINSE 34
14 RECENT ADVANCES IN TOPICAL 35
FLUORIDE
15 FLUORIDE TOXICITY 37
16 CONCLUSION 42
17 REFERENCE 43

INTRODUCTION
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Fluoride is the most electronegative element which never exist in free
state in nature but combine chemically with other elements as fluoride
compound. Fluorine word is derived from the Russian word 'flor’ which
comes from 'floris' meaning destruction in Greek & from Latin word
'fluor' that means to flow since it was used as flux.

It is highly reactive anion with an atomic weight of 19 & atomic number

of 9. Fluoride is one of the essential agents used preventive dentistry
effective against dental caries.

HISTORY
In 1901, Dr Frederick McKay of Colorado, USA discovered permanent
stain on the teeth of his patients which was referred to as "Colorado
brown stains. McKay named the stains as mottled enamel

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In 1916, Dr GV Black supported McKay work with histologic evidence
reporting it as an "an endemic imperfection of the enamel of the teeth."

In 1931, Mr. HV Churchill a spectrographic analysis of Bauxite city

water showed the presence of fluoride at the level of 13.5 ppm.

In 1933, Dr Trendley H Dean conducted Shoe Leather Survey.

In 1934, Dean' s index for fluorosis

 1 ppm - no stains
 2.5-3 ppm – dull chalky appearence
 4 ppm- discrete pitting

In 1939 Dr Trendley H Dean hypothesis showing the inverse

relationship between endemic dental fluorosis and dental caries.

In 1969, WHO recommended first time 1ppm fluoride in drinking water

for a practicable & effective public health measure.

"Dr. H Trendley Dean - Father of fluoride in dentistry"

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 MECHANISM OF ACTION
1. Increased enamel resistance or reduction in enamel solubility
2. Increased rate of post eruptive maturation
3. Remineralization of incipient lesions
4. Interference with plaque microorganisms
5. Modification in tooth morphology

INCREASED ENAMEL RESISTANCE/ REDUCTION IN

ENAMEL SOLUBILITY

The presence of fluoride reduces the solubility of enamel by promoting

the precipitation of hydroxyapatite & phosphate mineral.When
hydroxyapatite is exposed to low fluoride concentrations (about 1ppm) a

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layer of fluorapatite forms on the hydroxyapatite crystals.This thin layer
governs the rate of dissoluton.

INCREASED RATE OF POST ERUPTIVE

MATURATION

Fluoride increases the rate of mineralization of hypomineralized areas.

Organic material is also deposited into the enamel surface to further
increase its resistance to dental caries. Both mineral ions & organic
material are deposited from the saliva resulting in formation of a less
soluble tooth that is more resistant to acid attack & less prone to caries.

REMINERALIZATION OF INCIPIENT LESIONS

Fluoride enhances the remineralization process by accelerating the

growth of enamel crystals that have demineralised. Large amount of
Fluoride in calcium phosphate solutions will inhibit remineralization, by
formation of calcium fluoride,which prevent hydroxyapatite crystal
growth

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FLUORIDE AS AN INHIBITORS OF REMINERALIZATION

When fluoride is added to the demineralizing solution, the attack results

in a lesion with a completely different histologic appearance. Well
formed surface layer can be discerned with a mineral content
considerably higher than that of the underlying lesion body. Fluoride
also reduces the rate of demineralization

INTERFERENCE WITH MICRO-ORGANISMS

In high concentrations, fluoride is bactericidal. This is probably how

fluoride helps reduce plaque.In lower concentrations, it is bacteriostatic.
It helps control the growth of bacteria without destroying them. Fluoride
lodges in plaque & inhibits bacterial enzymes responsible for acid
metabolism.

MODIFICATION IN TOOTH MORPHOLOGY

If fluoride is ingested during tooth development, there is some evidence

to suggest the formation of a more caries resistant tooth i.e. reduction of
cusp height, decrease in fissure depth, increase in fissure width.

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 FLUORIDE METABOLISM

SOURCES OF FLUORIDE

Principle source of human fluoride is ingestion of water. It is also

derived from Plants, Marine animals & even dust particles.Tea contains
an average of 97 ppm .Certain types of fishes, dried mackerel & dried
salmon contain a large amount of fluoride that is 84.5 ppm-. Potatoes
contain 6.4 ppm of fluoride.

CHEMICAL FORMS OF FLUORIDE

 Fluorspar (CaF2)
 Fluorapatite (Ca(10PO4)6F2)
 Cryolite (Na3AIF6)

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ABSORPTION OF FLUORIDE

Readily absorbed into the body. Absorption occurs mainly in stomach.

Can also occur from lungs by inhalation of fluoride dust & gases. Rarely
through skin.

EXCRETION OF FLUORIDE

Through Urine (principal route of excretion 90-95%), Faeces (remaning

5-10%).Other routes are Saliva, Hair,Tears,Sweat. About half of the
ingested fluoride is excreted in the urine each day

STORAGE OF FLUORIDE

In hard tissues of body.

In saliva: most children have oral fluid fluoride levels ranging from
0.01-0.1 ppm

In plaque: concentration of fluoride in plaque is many times higher than

in saliva, especially in GCF where it is 10-20% more than plasma
concentration

In enamel, dentin & cementum: fluoride uptake increases with age,

considerably lower in enamel than dentin

In bone: Skeletons of older persons contain more fluoride than those of

younger ones In blood: approx. 1/3 of total blood fluoride is in plasma &
1/4 in red blood cells.
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 FLUORIDE DELIVERY SYSTEM

SYSTEMIC FLUORIDES

Systemic fluorides such as community water fluoridation & dietary

fluoride supplements are effective in reducing tooth decay.These
fluorides provide topical as well as systemic protection because fluoride
is present in the saliva.

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DIETARY FLUORIDE SUPPLEMENTATIONS

 Fluoridated Milk
 Fluoridated Salt
 Fluoride in Sugar
 Fluoride in Citrus beverages
 Fluoride drops
 Fluoride drops with vitamins
 Fluoride tablets & lozenges
 Fluoride tablets with vitamins
 Fluoride oral rinse supplements

TOPICAL FLUORIDES

The term "topically applied fluorides" is used to describe those delivery

systems which provide fluoride for a local chemical reaction to the
exposed surfaces of erupted dentition.

e.g. prophylactic pastse, solution, Thixotropic Gel, Foam, Varnish,

fluoride dentifrices & rinses

Topical fluorides are of 2 types:

➡Professional Applied Topical Application

➡Self-Applied Topical Application

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 FACTORS AFFECTING TOPICAL FLUORIDE
DEPOSITION IN TEETH

1. Tooth condition
2. Treatment formulation
3. Application procedure
4. Tooth condition

TOOTH CONDITION

Tooth age: The mature primary enamel acquires twice the fluoride
compared to the less porous mature permanent enamel.

Natural fluoride concentration: Enamel with a high natural fluoride

content will dissolve less & therefore will acquire slightly less fluoride.

Enamel defects: Enamel defects acquire larger amounts of fluoride than

sound enamel because of their greater porosity & surface.

Dentin/Cementum: acquires approx. 10 times of fluoride from a topical

application than enamel

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TREATMENT FORMULATION

Fluoride agent: Fluoride uptake by enamel from a particular agent is

dependent upon different pH' s, different fluoride concentration, and
result in the formation of different fluoride containing compounds.

pH: Lowering the pH of a fluoride treatment solution results in partial

dissolution of enamel crystal surfaces. The ionic calcium thus formed
reacts to form CaF2 & therefore, an increased total fluoride uptake.

Fluoride components: Thickening agents like hydroxyethylcellulose

increases the viscosity, but tends to decrease the rate of fluoride
diffusion. Humectants such as glycerol were found to reduce fluoride
uptake.

Abrasives :Abrasives used in prophylaxis pastes & dentifrices react with

fluoride thereby decreasing the amount available for reaction with
enamel.

APPLICATION PROCEDURE

Effect of time: As the duration of the fluoride treatment increases, the

amount of fluoride deposited in enamel also increases.

Temperature: An increase in temperature of the fluoride treatment

preparation increases the amount of fluoride deposited in enamel.

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Number of applications repeated application of conc. Solution & gels of
sodium fluoride increases enamel fluoride in incremental fashion.

Enamel pre-treatment: mild etching of enamel with acid & treatment

with polyvalent metal ions increases fluoride uptake by enamel.

METHODS OF APPLICATION OF TOPICAL

FLUORIDES

1. Paint –on technique

2. Tray technique

PAINT – ON TECHNIQUE

The patient is instructed to rinse the mouth & teeth are isolated using
cotton rolls. 1 min air drying will result in significantly more fluoride
uptake by the outer enamel treated with a professional topical fluoride
application. A 2% neutral sodium fluoride is used.The aqueous solution
of fluoride is continuously reapplied keeping the teeth isolated for 4
minutes.

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TRAY TECHNIQUE

During each appointment, a total of 4gm of acidulated phosphate

fluoride gel is applied to the teeth with the help of tray. Substantial oral
retention of fluoride both before and after expectoration. During this 4
min unwaxed dental floss which has been soaked in the fluoride
solution, is passed interproximally. The same procedure is then repeated
for each quadrant or the other half of the mouth depending upon the
method of isolation employed.After treatment the patient may
expectorate, but is instructed not to rinse, eat or drink for one-half hour.

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INDICATION FOR USE OF TOPICAL FLUORIDE IN
CHILDREN

 Caries active individuals

 Children shortly after periods of tooth eruption, especially those
who aren' t caries free.
 Those who take medication that reduce salivary flow or radiation
therapy.
 Post periodontal surgery when roots are exposed. Those receiving
radiation of head & Neck.

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  Patients with fixed or removable appliances of before cementation
of bands.
 After placement or replacement of restoration and before
cementation of stainless steel crown. Patients with eating disorders.
 Disable or alternatively abled children

CONTRAINDICATIONS

 Below 4 year of age

 Open wound case
 Gingival inflammation

PROFESSIONALLY APPLIED TOPICAL FLUORIDES

Professionally applied fluoride products are those medicaments typically

dispensed by dental professionals in the dental office and usually
involve the high fluoride concentration products, ranging from 5000 and
19000 ppm, which is equivalent to 5-19 mg F/ml.Professionally
administered topical fluoride agents (commonly used) are:

1. 2% Sodium Fluoride

2. 8% Stannous Fluoride

3.1.23% Acidulated phosphate fluoride

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 NEUTRAL SODIUM FLUORIDE

First Fluoride compound to be used.Developed by Knutson et al in 1947.

2% NaF is used pH: 7.Available fluoride is 9040 ppm.30% effective in
caries reduction.

Method of preparation

To prepare 2% NaF, dissolved 20 gm of NaF powder is dissolved in 1

liter of distilled water and stored in plastic bottles. Note- If stored in
glass containers, the Fluoride ion of solution react with silica of glass
forming silicon fluoride, thus reducing the avalability of free active
fluorides for anticaries action.

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Mechanism of action

When Sodium fluoride solution is applied on the tooth surface as topical

agent. It react with hydroxyapatite crystals in enamel to form calcium
fluoride gets formed, it interferes with the further diffusion of fluoride
from the topical fluoride solution to react with hydroxyapatite and block
further entry of fluoride is termed as "Chocking off effect". Fluoride
then slowly leaches from the calcium fluoride act as a reservoir for
fluoride release (reason why sodium fluoride is kept untouched on the
tooth for 4 min).

Ca10 (PO4)6(OH)2 + 20F ↔ 10 CaF2+6P04 − + 2 0H

CaF2+2Ca5 (PO4)3 OH ↔ 2Ca5 (PO4)3 F + Ca (OH)2

Technique- Knutson's & Feldman Technique (1948)

Clean & polish the teeth in only the first four application. Isolate upper
& opposing lower quadrant and dry teeth with cotton rolls.Dry the teeth
thoroughly. Apply the 2% NaF with cotton roll applicators & allow it to
dry on the teeth for 4 minutes.Instruct the patient to avoid eating,
drinking, for 30 minutes. Second, third and fourth applications are done
at week. Application is recommended at 3, 7, 11, 13 year of age.

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Advantages

 Chemically stable
 Acceptable taste because of neutral pH
 Non-irritating to gingival
 Does not discolor the teeth
 Cheap and inexpensive

Disadvantage

Four visits to the dentist within a relative short time interval.

STANNOUS FLUORIDE

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8% Stannous Fluoride is used at 2.1-2.3 pH.19360 ppm of available
fluoride.It 32% effective in caries reduction

Preparation

To prepare 8% stannous fluoride, 0.8 gm stannous fluoride content of

one capsule is dissolved in 10ml of distilled water and stored in plastic
container & then shaken. Note- Stannous Fluoride is always freshly
prepared and powder is always stored in air tight capsule as it is higly
unstable. Soon after they become cloudy due to the formation of tine
hydroxide.

Mechanism of Action

When Stannous Fluoride react with hydroxyapatite of the dental

enamel, the fluoride as well as the tin combine with it to form a
crystalline product know as stannous trifluorophosphate (Sn3F3 PO4).
This stannous trifluorophosphate is highly resistant to decay. When
stannous fluoride reacts with hydroxyapatite, 4 Stannous
trifluorophosphate end products are formed:

 Tin hydroxyphosphate
 Calcium trifluorostannate
 Calcium Fluoride

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Mechanism of action: SnF₂ low concentration

Ca5 (PO4)3 OH + 2SnF2 → CaF2+ Sn2 (OH)PO4 + Ca3 (PO4)2

Mechanism of action: SnF2 high concentration

Ca5(PO4)3OH+16SnF2 → CaF2+2Sn3F3PO4+
Sn2(OH)PO4+4CaF2(SnF3)2

2Ca5(PO4)3OH + CaF2 → 2Ca5(PO4)3F + Ca(OH)2

Technique- Muhler technique (1957)

Oral prophylaxis should be done.Isolate a quadrant and dry teeth with

cotton roll.Apply freshly prepared 8% stannous fluoride continuously to
the tooth with cotton applicators. Reapply the solution every 15-30
second for 4 minutes.Instruct the patient to avoid eating, drinking, for 30
minutes.Annual application done

Advantages

The rapid penetration of fluoride within 30 seconds. Highly insoluble

tin-fluoro phosphate complex form on enamel surface that is more
resistant to decay than enamel

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Disadvantages

 Highly unstable
 Has a metallic taste
 Cause gingival irritation
 Discoloration of teeth

ACIDULATED PHOSPHATE FLUORIDE (APF)

Acidulated phosphate fluoride is simply an acidified sodium fluoride

with phosphoric acid in order to gain more depth of fluoride penetration
when applied on the tooth.1.23% is used.12,300 ppm of available
fluoride.3.0 pH.28% effective in caries reduction was introduces in
1960's by Brudevold & his co-worker.It can be applied as a solution or
gel.

APF SOLUTION

Preparation

20 gm of NaF is dissolved in 1 liter of 0.1 M phosphoric acid & than

50% hydrofluoric acid is added to adjust the pH to 3.0 & fluoride
concentration to 1.23%. Mechanism of Reaction - When APF
solution/gel applied on the tooth it initially leads to dehydration and
shrinkage in volume of hydroxyapatite crystals and formation of
dicalcium phosphate dihydrate. The DCPD formed is highly reactive

26
with fluoride, leading to formation of Fluorapatite phosphate (FAP) the
amount and depth of fluoride deposited as FAP depend on the amount
and depth at which DCPD get formed. Since for the conversion of whole
of DPCD formed into FAP, continuous supply of fluoride is required,
APF has to be applied every 30 second for 4 minutes

Technique- Brudevold s technique(1963)

Do a thorough prophylaxis and isolate a quadrant with cotton rolls.APF

solution is continuously and repeatedly applied with cotton applicator.
Keep the teeth moist for 4 minutes.Pass the floss through each
interproximal embrasure to ensure wetting of these surface.Repeat the
procedure for remaining quadrant. Instruct the patient not to eat, drink or
rinse for 30 minutes. Semiannual application

Advantages

 Fluoride uptake is greater 50% more effective than NaF

 Stable, long shelf-life when stored in opaque plastic bottle
 Cheap, can be prepared easily.
 Easy to prepare

Disadvantages

 Teeth must be kept wet with the solution for 4 minutes.

 APF solution is acidic, sour & bitter in taste

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  Prolonged exposure of composite restoration results in loss of
material & surface roughening.

APF GEL

1.23% Fluoride of fluoride at 12300 ppm and PH: 4-5

Preparation

To prepare a gel, a gelling agent methylcellulose or hydroxyethyl

cellulose is to be added to the solution and the pH is adjusted between 4-
5.

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Technique

Do a thorough prophylaxis and dry the teeth. Fill the upper and lower
trey with APF gel. Insert the upper and lower tray simultaneously into
the mouth and have the patient bite down tightly for 4 minutes.Instruct
the patient not to eat, drink or rinse for 30 minutes.Semiannual
application. Thixotropic gel displays a high viscosity at low shear rates
& a very low viscosity at higher shear rates. The clinical importance of
this is that the gel thins out under biting forces & more easily penetrates
between the teeth.

Advantages

 Acceptable by the child to flavored taste.

 Easy to apply
 Reapplication not required
 Thixotropic property
 Can be self applied
 Caries reduction more than APF solution

Disadvantages

 Can cause irritation to inflamed gingival tissue & to open carious

lesion thus, it should be applied only after restoration of all carious
teeth

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 APF FOAM

0.92% Fluoride content.9200 ppm, PH: 4.5

Advantages

 It is less dense than gel and is able to flow better, allowing a free
movement of the fluoride ion on the tooth surface and
interproximal areas

Disadvantage

 Retention on the tooth surface is 43 less

FLUORIDE VARNISH
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First developed by Schmidt (1964).Fluoride varnishes are developed in
order to increase the retention of topical fluoride on to the enamel for a
longer period of time.

Commonly used-Duraphat/ duraflor 2.26% NaF,22600 ppm ,Fluor

Protector: 0.1%F , 7000 ppm,Carex 1.8%F,Bifluorid: NaF&CaF2(2.71%
NaF, 2.92% Ca Cavity shield Flouritop

Technique

Brushing /dry with gauze/cotton.Cotton tip applicator/syringe type

applicator 0.3-0.5 ml Fluoride. Application time 1-4 mins .Varnish sets
in contact with moisture.Not to eat for 2-4hrs.Avoid brushing that night.
Semiannual.25 yrs of clinical trials:25-45% caries reduction

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Advantages

 Form a water tight protective film insulating against thermal and

chemical influences
 Incipent caries lesion Handicapped children

Disadvantage

 Patient compliance is required

SELF-APPLIED TOPICAL APPLICATION

Self applied fluoride product are usually bought and dispensed by the
individual patient but at the recommendation of a dental personnel. Are
low fluoride concentration products ranging from 200-1000ppm or 0.2-1
mgF/ml.

E.g.-Dentifrices,Fluoride Floss,Fluoride Rinses

FLUORIDE DENTIFRICES

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Introduced by Bibby in 1945 & Muhler in 1955.It is a simplest way of
reducing caries. It combines the mechanical effects of tooth brushing
with fluoride benefit.500-1000 ppm of fluoride should be present
ideally.But 2-3 year old children usually ingest majority of the dentifrice
during brushing. 200 gm tube of tooth paste contain 140mg of free
fluoride.

RECOMMENDATION FOR THE USE OF

FLUORIDE TOOTH PASTE

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CHILD AGE TOOTH FLUORIDE RINSING
PASTE SIZE CONTENT

Eruption of first Smear or rice 1000 ppm twice Rinsing after

tooth to 6 years grain sixe daily brushing should
equivalent be kept to bare
minimum

2-6 years Pea size 1000 ppm twice

equivalent daily

6-12 years At least pea size At least 1000

equivalent ppm twice daily

13 and above At least pea size At least 1000

equivalent ppm twice daily

Low fluoride toothpaste(400-600 ppm) should be reserved for low caries

risk children.

*Shobha Tandon – Pediatric dentistry, third edition

Table: 33.13,page no:490

FLUORIDE FLOSS

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Dental floss is an essential part in the plaque control in the interproximal
enamel surface. If the interproximal surfaces receives the benefit of
additional fluoride dental flossing, this may increase its value as a caries
preventive aid.

Gillings (1973), utilizing sodium fluoride and stannous fluoride

successfully developed and patented several for- mulas of fluoridated
dental floss. Because of the unknown sample size and the lack of clinical
size and date, no defini- tive conclusions about this cariostatic effect
could be made.

FLUORIDE RINSES
35
Fluoride mouth rinses for school-based health programs or at home are
currently popular as a simple way to expose teeth to fluoride frequently.
The early trial with neutral sodium fluo- ride, acidulated phosphate
fluoride and stannous fluoride rinse proved to reduce caries by 20-50%.
Amount of fluoride in self-applied fluoride rinses are given in Table
33.14. Usually non-prescribed fluoride mouth rinses contain 0.05% NaF
(about 225 ppm). They should be swished vigorously once a day for 1
min and expecto- rated. When used in conjunction with a fluoride
toothpaste, it should be used at a different time to maintain intra-oral
levels of fluoride. Prescription fluoride rinses generally con- tain 0.2%
NaF (about 900 ppm). They are designed to be used under supervision,
once a week for 1 min.Precautions to be considered: Children under 5
years and some handicapped children may swallow the rinse rather than
spit it, hence mouth rinses are not recommended for them.

36
RECENT ADVANCES IN TOPICAL FLUORIDE

1. Ionotophoresis
2. Fluoride- Chlorhexidine Preparation
3. Fluoride containing Dental cement
4. Fluoride containing Amalgam
5. Fluoride containing Alginates
6. Fluoride impregnated Dental Floss
7. Fluoride chewing gums

IONTOPHORESIS

It is based on the theory that small electric current will help to drive
fluoride ion further into the dental enamel, producing the desired effect,
reduced enamel solubility, increased fluorapatite formation, reduced
dentine sensitivity and even sterilization of root canals.

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FLUORIDE CHLORHEXIDINE PREPARATION

Antiplaque and Anticaries activity

FLUORIDE CONTAINING DENTAL CEMENT

GIC NaF /SnF2 incorporated into ZOE Carboxylate cement

FLUORIDE CONTAINING AMALGAM

38
Enamel surface: decreased acid solubility

FLUORIDE CONTAINING ALGINATE

Zelgan & Kerr F in saliva :111ppm Anticaries activity for short duration

FLUORIDE IMPREGNATED DENTAL FLOSS

Gillings in 1973 Naf/SnF2.Decrease S. mutans count Number Decreased

caries/ gingivitis

FLUORIDE CHEWING GUMS

A high F concentration in saliva and a significant F up take in enamel

FLUORIDE TOXICITY

An excess accumulation of fluoride in the body can lead to

demineralization of bone & tooth enamel, to a toxic condition called
fluorosis. Bony changes, characterized by osteosclerosis, exostoses of

39
the spine usually are seen only after prolonged high intake of fluoride in
adults. These changes occur due to the fact that fluoride is not
biodegradable & it accumulates in the body & bones resulting in a toxic
or poisoning effect.

ACUTE TOXICITY

The amount of 35-70 mg F/kg body weight of soluble fluoride is

considered to be lethal.

Signs and Symptoms:

- Nausea, Vomiting, Abdominal pain - Increase salivation, Nasal

discharge - Weak thready pulse

- Fall in blood pressure - Depression of respiratory center

- Cardiac arrhythmia

-Coma and death

TREATMENT

For less than 5mg/kg Give calcium orally (milk) to relieve GI

symptoms. Observe for a few hours.

For more than 5mg/kg: Empty stomach by induced vomiting with

emetic. For patients with depressed gag reflex caused by age (<6 months
old), Down' s Syndrome, or severe mental retardation, induced vomiting

40
is contraindicated & endotracheal intubation should be performed before
gastric lavage. Give orally soluble calcium in any form (for e.g. Milk,
5% calcium gluconate, or calcium lactate solution). Admit to hospital &
observe for a few hours.

For more than 1.5 mg/kg: Admit to hospital Immediately.

Induce vomiting Begin cardaic monitoring & be prepared for cardiac

arrhythmia, Observe for peaking T-waves & prolonged Q-T intervals
Slowly administer intravenously 10ml of 10% calcium gluconate
solution. Additional doses may be given if clinical signs of tetany or Q-T
interval prolongation develops, electrolytes, especially calcium &
potassium, should be monitored using diuretics if necessary. Adequate
urine output should be maintained using diuretics if necessary,

CHRONIC TOXICITY

Chronic toxicity is due to long-term ingestion of a smaller amount of

fluoride which usually affects the hard tissues & kidney. The effect of
chronic fluoride toxicity on enamel is dental fluorosis.Dental fluorosis
occurs when dosage becomes 2 times greater than optimal. If dose
exceeds 10-25mg/day, skeletal fluorosis occurs.

41
 DENTAL FLUOROSIS

Dental fluorosis is caused by excessive intake of fluoride during tooth

development.Mild to moderate changes are seen where water fluoride
level is >3 ppm.Severe changes are seen where water fluoride level is
>4-8 ppm Clinical features- lusterless, opaque white patches in enamel
which may be mottled, striated or pitted. Mottled areas may become
stained yellow or brown. Hypoplastic areas in severe cases is lost,
Fluorosis occurs symmetrically in dental arches Management include
Bleaching, composite restoration, complete crown restoration

42
 SKELETAL FLUOROSIS

20-80 mg F/day for 10-20 year produce pathological skeletal fluorosis.

Pregnant, lactating mother and children are mostly affected.Calcium
fluoride is more toxic than sodium fluorosis. In the severest form spine
becomes rigid and joints stiffen, virtually immobilization the patient.

Fluoride Toxicity Dosage

 Certainly lethal dose =32-64 mg F/kg of body wt

 Safely Tolerated Dose = 8-16 mg F/kg of body wt
43
 CONCLUSION

The role of fluoride in preventive dentistry is very important as

it has a long history of effective decline in caries occurrence
when used wisely either systemically or topically.

The pediatric dentist in his responsibility as a preventive dentist

should have a thorough knowledge of this wonder magical
compound in order to provide a dacay free generation of the
future.

Professionally applied topical fluoride is a proven caries

prevention agent for individuals with moderate and high caries
risk. So its use in day to day practice should be augmented in
such patients

44
 REFERENCE

 TEXTBOOK OF PEDIATRIC DENTISTRY-

SHOBHA TANDON

 TEXT BOOK OF PEDIATRIC DENTISTRY-

NIKHIL MARWAH

 TEXTBOOK OF PUBLIC HEALTH DENTISTRY-

SOBEN PETER

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