Made by :

Ravneet kaur
4
th
year

Fluoride is the ionic form of the element
fluorine.

It is negatively charged and will not remain as
a free element.

Fluoride has a high affinity for calcium.
It is, therefore, very compatible with teeth and
bone.



promotes remineralization

inhibits demineralization
improves enamel crystallinity

reduces acid solubility
Fluorides role in remineralization

When bacteria metabolize carbohydrate and produce acid,
fluoride is released from dental plaque in response to lower
pH levels at the tooth interface.

To be more acid resistant and contain more fluoride and
less carbonate, the demineralized enamel crystal
structure takes up released plaque fluoride and salivary
fluoride along with calcium phosphate.

MECHANISMS OF ACTION


-Concentrates in plaque
-Disrupts enzyme systems

fluoride inhibits bacterial
metabolization of carbohydrates to
produce acid and affects the bacterial
production of adhesive polysaccharide.
Summary of Anti-Caries Activity of
Fluoride
1. Fluoride prevents
demineralization.

2. Fluoride enhances
remineralization.

3. Fluoride alters the action
of plaque bacteria.

4. Fluoride aids in post
eruptive maturation of
enamel.

5. Fluoride reduces
enamel solubility.

Remineralization Demineralization
Remineralization Demineralization
Fluoride Administration

TWO TYPES-:
SYSTEMIC
FLUORIDE
TOPICAL FLUORIDE

Systemic fluorides

-DIETARY FLUORIDE
-SALT FLUORIDE-FLUORIDE
IN SUGAR
-DIETARY FLUORIDE
SUPPLEMENTS
-WATER FLUORIDATION
-SCHOOL WATER
FLUORIDATION
-MILK FLUORIDATION.
-FLUORIDE DROPS
-DROPS WITH
VITAMINS
-TABLETS WITH
VITAMINS
-RINSES -
SOLUTIONS
FLUORIDE SUPPLEMENTS
AGE <0.3ppm 0.3-
0.6ppm
>0.6ppm
6m-3y 0.25 0 0
3-6y

0.5 0.25 0
6-16y 1.0 0.5 0
F in drinking water
F
Academy of Pediatric Dentistry current
recommendations
TEXT

-Caries active children

-In children shortly after the
Period of tooth eruption

-In patients with reduced salivary flow due to
medications

-Those receiving radiations of head and neck

-Patients with fixed and removable appliances

Professional
administration
Non-professional
fluoride
administration

-Solutions
-Gels
-Foams
-varnish
-Dentifrices
-Fluoride rinses
-Fluoride
impregnated
dental floss
-GELS

Professional application
Amount 2% NaF(9000ppm),
ph-7
8%SnF(19,000
ppm)
1.23% APF(12,300
ppm),Ph-3.0
Method of
preparation
Dissolve 20g of
NaF powder in 1
liter of distilled
water in a plastic
bottle
Contents of 1
capsule(0.8g) is
dissolved in 10 ml
of distilled water in
plastic container
and then shaken.
This solution is
prepared just
before each
application.
Dissolve 20g of
NaF in 1 liter of 0.1
M phosphoric acid
-to this add 50%
hydro fluoride acid
to adjust the Ph at
3.0 and F ion
concentration at
1.23%.
Technique of
application
Knutson technique
(1948)
Muhler technique
(1957)
Brudevold
technique(1963)
No. of applications
per year
4 applications per
year. 2
nd
,3
rd
& 4
th

applications are
done at weekly
interval
-Application are
recommended at
3,7,11,13 yr.
Once per year semiannual
ADVANTAGES -Chemically stable
-Acceptable taste
because of neutral
ph.
-Non-irritating to
gingiva
-Does not
discolour the teeth
-Cheap and
inexpensive
-Rapid penetration
-It forms a tin-
fluoro phosphate
complex on
enamel surface
that is more
resistant to decay
than enamel.
-It is cheap
-Has long shelf
life, when stored
in an opaque
plastic bottle.
-50% more
affective than NaF.
DISADVANTAGE
S
Patient has to make
4 visits to the
dentist within a
relatively short
time.
-Unstable and
should be prepared
fresh for patient.
-Causes gingival
irritation
-Produces
discoloration
-Causes staining on
margins of
restorations
Teeth must be kept
wet with solution
for 4 min
-This solution is
acidic, sour and
bitter in taste so
necessitates the use
of suction

gel varnish foam
Amount
1.23%APF, pH4-5 Bifluoride
12(2.71%NaF,2.92
%CaF2)
0,92%F pH 4.5
Method of
preparation
A gelling agent
methylcellulose is added to the
solution and the pH is
adjusted between 4-5
Commercially available Commercially
available
Technique
of
application
Do thorough prophylaxis and
dry the teeth.
-Fill the tray with APF gel
--insert the u/l tray into the
mouth simultaneously and
have the patient bite down
tightly, the clinical importance
of this is that the gel thins out
under the biting force and
more easily penetrate the teeth.
-Instruct the patient not to eat,
drink or rinse for 30 min.
Do thorough prophylaxis
and dry the teeth.
-drop the varnish onto the
brush
-paint the varnish thinly
first on the lower arch and
than on upper arch,
starting from the proximal
surfaces.
Instruct the patient
Not to rinse or drink
anything for that day
-not to eat solid for that
day
-not to brush that day
No.of
applications
semiannual semiannual semiannual
Advantages
-Acceptable taste.
-easy to apply.
-can be self applied.
-Thixotropic property
-caries reduction is
more as compared
APF solution
Forms a watertight
protective film
insulating against
thermal and chemical
influences
-it remains in
position for several
days
-it is less dense than
gel and is able to
flow better.
-the weight is less
than gel hence reduce
risk of ingestion and
systemic toxicity of
fluoride.
disadvantages
Can cause irritation
to the inflammed
gingiva and to open
carious lesion
-it should be applied
only after restoration
of all carious teeth.
Patients compliance
is required
Retention on tooth
surface is less as no
polymer are added
FLUORIDE VARNISH
White spots or other
incipiencies
All teeth i
Exposed roots
and root caries
Margins of
restorations
Erupting
teeth
Carious anterior teeth in
young children
Indications:
2.
3.
4.
5.
1.
6.
Applying Fluoride Varnish:
GELS
GEL-CAM
0.4% SnF2,
0,097% free F,
970 ppm F, 2-3mg
F/ dose.
PREVIDENT
1.1% NaF, 0.5%
free F, 5000 ppm,
10-25 mg F/ dose.
Indications:
1. Severe caries
2. Root caries
3. Prevention programs
Radiation caries
Application of gel
Other fluoride application by
professionals are:
1.Fluoride impregnated prophylaxis paste and cups
2.Iontophoresis
3. Dental materials containing fluorides
Carboxylate cement
Fluoride in amalgam
Fluoride containing varnish and sealant
Glass ionomers
Self application
dentifrices
They all contain between
1,000- 1,500 ppm fluoride
Formulated from either sodium
fluoride or sodium
mono-fluorophosphate and
none contains stannous fluoride
Advantages
Because fluoride dentifrices usually are used
regularly two or three times a day, they
provide a frequent source of fluoride in low
concentration that can inhibit demineralization
And enhance remineralization
Availability
Fluoride dentifrices are available and recommended
for the people of all ages whether they live in
fluoridated or non fluoridated areas
Precautions to be considered
o Pre-school age children should be supervised while
brushing to avoid ingestion of excessive amount of
toothpaste

oOnly a dab or pea size amount of dentifrice should be used
by 6 yr of age or below

oA ribbon of dentifrice that cover the bristle of an adult-
sized toothbrush contains about 1g of dentifrice.
Swallowing the amount of fluoride which is present in this
toothpaste should be avoided.
oAt least one brushing with fluoride should be done just
before bedtime, placing fluoride in the mouth prior to a
period if low salivary flow, thus fluoride availability.
F
S
P
T
F
S
P
T
F F
F
F
awake
asleep
High
salivary
flow
Low
salivary
flow
Brush
before
bedtime
Tooth-brushing should be
conducted just before bed-time
in order to take advantage of
night-time reduction of oral
clearance mechanisms. F
bioavailability will thus be
increased.

Age
Tooth brushing Recommendations (CDC, 2001)
< 4 year

~ fluoride toothpaste not recommended
4-6years

~ once daily with fluoridated and once with non fluoridated
toothpaste
6-12 years ~ brushing twice daily with fluoridated toothpaste and once
with a non-fluoridated toothpaste.
> 12 years ~ brushing three times with fluoride toothpaste.
recommendations on tooth brushing:
FLUORIDE IMPREGNATED IN DENTAL FLOSS
Dental floss is an essential part in the plaque control in
the interproximal enamel surface. If the interproximal
surfaces receive the benefit of additional fluoride dental
flossing ,this may increase its value as a caries
preventive aid.
fluoride rinses
Fluoride mouth rinses for school based health programs
or in home are currently popular as a simple way to
expose teeth to fluoride frequently. The early trial with
neutral sodium fluoride ,acidulated phosphate fluoride
and stannous fluoride rinse provide to reduce caries
by 20-50%.usually non-prescribed fluoride rinses
contains 0.05%NaF (225ppm).they should be swished
once daily for 1 min and expectorated. Prescription
fluoride rinses generally contains 0.2%NaF (about
900ppm).they are designed to be used supervision, once a
week for one minute.
HOME F RINSES
ACT
0.05% NaF, 0.023% free F,
230 ppm F, 2.3 mg F / dose
Daily Rinse:
PHOS-
FLOR

0.02% APF, 0.02% free F,
200 ppm F, 2 mg F / dose.
Weekly Rinse
PREVI-
DENT

0.2% NaF, 0.091% free F, 910
ppm F, 9.1 mg F / dose.
Indications:
1. High caries risk
2. Exposed roots
3. Prevention programs
Fluoride toxicity
Accumulated evidence from numerous
studies shows that the prolonged use of
fluoride at recommended levels does not
produce harmful physiological effects in
human.
Fluoride toxicity can be of two types:

Acute toxicity
Chronic
toxicity
Acute toxicity
Ingestion of an acute fatal dose of fluoride is
very rare. The amount of 35-70mg F/kg
body weight of soluble fluoride is
considered to be lethal
ACUTE TOXICITY
5 mg F / kg body weight
20 kg 6 year old, PTD=
100 mg F
10 kg 2 year old PTD
= 50 mg F
Symptoms:
1. Vomiting
2. Excess salivary and
mucous discharge
3. Cold wet skin
4. Convulsion at higher
dose
Probable toxic dose:
Counter Measures:
1. Emetics
2. 1% calcium
chloride
3. Calcium gluconate
4. milk
Ca
Ca
F
Ca
F
Ca
F
Ca
F
Ca
F
F
Divalent
cations like
Ca cause
precipitation
, of F and
prevent
absorption
in the
intestine.
Lethal and safely tolerated
dosage of fluoride for a 70 kg
adult
Certainly lethal dose
(CLD)
5-10g NaF
or
32-64mg F/kg
Safely tolerated dose(STD) CLD
1.25-2.5g NaF
or
8-16mg F/kg
CHRONIC TOXICITY
Chronic toxicity is due to long-term
ingestion of a smaller amount of fluoride
which usually affect the hard tissues and
kidney.
effects dosage Duration
Dental fluorosis 2 times optimal Until 5 yrs(excluding
3
rd
molar
Skeletal fluorosis 10-25 mg/day 10-20 yrs
Kidney damage 5-10 mg/day 6-12 months
Dental fluorosis
It is caused by excessive intake of fluoride
during tooth development.
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 several cases is lost.
Fluorosis occurs symmetrically in dental
arches.
moderate
severe
mild
pitting