FLUORID

GUIDED BY : DR. RAJ KUMAR JHA PRESENTED BY: RAJSHREE SHRESTHA

BDS 8TH BATCH
 CONTENTS

• Introduction
• Fluoride in environment
• Sources of fluoride
• Metabolism of fluoride
• Mechanism of action of fluoride
• Fluoride delivery methods
• Toxicity of fluorides
• De-fluoridation of water
• Conclusion
 INTRODUCTI
ON

• Dental caries is a major dental disease affecting a large

proportion of the inhabitants of the world. It impairs the quality
of life for many people causing pain and discomfort.
• The cariostatic efficacy of fluorides has been demonstrated and
recent decline in caries prevalence is primarily attributed to the
increase use of fluoride agents.
• Fluorine is a member of the halogen family with a relative
atomic weight of 19 and an atomic number of 9. The word
fluorine is derived from the latin term “ fluore” meaning “to
flow”.
 FLUORIDE IN ENVIRONMENT

• Fluorides enters atmosphere by volcanic action and by the

entrapment of soil and water particles due to action of wind on these
surfaces.

LITHOSPHERE
• There are more than 50 fluoride containing minerals, many of which
are silicates.
• Is widely distributed in the earth’s crust where it averages 300 ppm
and constitutes about 0.087% of its weight.

BIOSPHERE
• Normal level of fluoride in plants is about 2-20 mg of dry weight.
• Leafy vegetables contain about 11-26 mg fluoride on dry weight
basis.
• Dried fish contain 20-40 ppm of fluoride.

HYDROSPHERE
• Concentration of fluoride varies, water with high fluoride content
are found at the foot of high mountains and in areas with
geological deposits of marine origin.
• Fluoride content of water obtained from river, lakes are below 0.5
mg/kg.
• Sea water contains 1.2 to 1.4 mg/kg of fluoride.

ATMOSPHERE

Fluoride emissions are heaviest in the vicinity of industries.

In large cities, 1 cubic meter of an air contains 0.05 mg of fluoride
but high values have also been recorded.
SOURCES OF FLUORIDE
 METABOLISM OF FLUORIDE

• Metabolism is through absorption, distribution and elimination.

ABSORPTION
• Occurs mainly through stomach and also absorbed via lungs and
intestine.
• Main factors influencing absorption are\
i. Species variation
ii. Concentration of fluorides ingested
iii. Solubility and degree of ionization of the compounds
iv. Other dietary constituents

ABSORPTION FROM DENTAL PREPARATIONS

• Topical application, is almost completely absorbed when

swallowed.
• Sodium fluoride or stannous fluoride dentifrices bioavailability is
close to 100%.
• Fluoride varnish remains on the tooth surface for up to 12 hours
some may diffuse in saliva.

FLUORIDE IN BLOOD PLASMA

Fluoride in plasma exists in the form of :

•Ionic fluoride (inorganic or free fluoride )
•Non-ionic fluoride(bound fluoride)
Plasma fluoride levels expected in a healthy, long term resident of
community with a water fluoride level of 1ppm is approximately
1mM (0.019ppm).
PHARMACOKINETICS OF FLUORIDE

• By plotting the plasma concentration of fluoride as a function of

time on a semi logarithmic scale, three exponential phases can be
distinguished:

• An initial increase
• Followed by a rapid fall for about 1hour(distribution/alpha
phase)
• Thereafter a slower decline (elimination/beta phase)
DISTRIBUTION

FLUORIDE IN SOFT TISSUES

• Plasma fluoride concentration ratio falls between 0.4 and 0.9.
• Kidney has higher concentration than plasma.
• In CNS fluoride concentration is only 20% of plasma.
• Amount of fluoride in pulp is 100-650 ppm.

FLUORIDE IN BONE
• 99% of fluoride is found in calcified tissue in human body.
• Being reversibly bound to bone there are two phases of fluoride
removal form calcified tissue:
i. A rapid process of the order of weeks.
ii. Slow removal, taking years, due to osteoclastic resorption of
bone.

FLUORIDE IN SALIVA
There are two major sources:
•Secretion from salivary glands is about 0.007 to 0.05 ppm.
•Introduction into the mouth from food, water, and fluoride
preparations.

FLUORIDE IN ENAMEL
Amount of fluoride in outer enamel is 2,200- 3,200 ppm.

FLUORIDE IN DENTINE
Amount of fluoride in dentine is 200-300 ppm.
FLUORIDE IN CEMENTUM
• Amount of fluoride in cementum is 4,500 ppm.

FLUORIDE IN DENTAL PLAQUE

• Fluoride content in plaque ranges from 15-64 ppm.

DISTRIBUTION TO FOETUS
• Some state that placenta acts as complete barrier to fluoride others
state that it is only partial.
• Some also state that placenta only acts as a barrier when there is
sudden increase in the maternal plasma fluoride level.

EXCRETION OF FLUORIDES
• Fluoride is excreted in urine, lost through sweat, and excreted in
the faeces.
• It also occurs in traces in breast milk, saliva, hair and tears.
• About 10-25% of the daily intake of fluoride is not absorbed and
is excreted in the faeces.

RENAL CLEARANCE OF FLUORIDES

• Chief organ of excretion is kidney and mechanism involved is
simple passive diffusion.
• The renal clearance rate of fluoride ranges from 30-50 ml per
minute.
 MECHANISM OF ACTION OF FLUORIDE

• A number of proposed mechanism have been identified which work

simultaneously are as follows :

 Increase enamel resistance or reduction in enamel solubility.

 Increased rate of post eruptive maturation.
 Remineralization of incipient lesions.
 Interference with plaque microorganisms.
 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 and phosphate
mineral.
• Fluoride inhibits demineralization in several ways :

1) By reducing
bacterial acid
production and
acidurance.

2) By
reducing the
equilibrium
solubility of
apatite.

3)By fluoridation
of apatite crystal
surfaces
reducing the
dissolution rate .
 REMINERALIZATION OF INCIPIENT
LESIONS

• Newly erupted teeth often have hypomineralized areas that are prone
to dental caries.
• Post eruptive maturation involves deposition of minerals into
hypomineralized areas.
• Fluoride increases the rate of mineralization of those hypomineralized
areas.

INCREASED RATE OF POSTERUPTIVE

MATURATION

• Fluoride aids in reducing dental caries by enhancing

remineralization.
• Deposition of minerals into previously damaged areas of tooth
results in reduced enamel solubility.
• This increase in enamel resistance is achieved through growth of
larger crystals that are more resistant to acid attack.
• Most effective remineralizing solution contains fluoride in
combination with calcium and phosphate ions.
 INTERFERENCE WITH PLAQUE
MICROORGANISMS

• Fluoride inhibits bacterial enzymatic processes involved in

carbohydrate metabolism.
• Fluoride interferes with oral bacteria in two ways;

in lower
in higher concentra
concentra tion,
fluoride is
tions
fluoride is bacteriost
bactericida atic
l

INVITRO EFFECTS OF FLUORIDE ON ORAL BACTERIA

• Following are inhibited by fluoride :

1) Enolase;
maybe 2) Bacterial 3)
partially phospha- Potassium
inhibited by tases transport
0.5-1 ppm
MODIFICATION IN TOOTH MORPHOLOGY

• There is direct relationship between amount of fluoride ingested during

tooth development and the incidence of dental caries.
• The diameters and cusp depths of teeth are smaller if fluoride is present
during the tooth development.
• Such changes in morphology would tend to decrease the caries
susceptibility of teeth by making them self cleansing.
 FLUORIDE DELIVERY
METHODS
• Fluoride can be delivered either as;

A) TOPICAL FLUORIDES
Are directly placed on the
teeth. E.g. dentifrices.

B) SYSTEMIC FLUORIDES
They circulate through the
blood stream. E.g. Mouth
wash, fluoride tablets.
 TOPICAL FLUORIDES
Those delivery systems which provide for a local chemical reaction to
exposed surfaces of erupted dentition.

INDICATIONS FOR TOPICAL FLUORIDE USE;

 In caries active individuals.
 Children shortly after periods of tooth eruption, especially those who
are not caries free.
 Those who take medication that decreases salivary flow or have
received radiation.
 After periodontal surgery when roots have been exposed.
 Patients with prosthesis and after restorations.
 Patients with eating disorders or who are undergoing change.
 Mentally and physically challenged individuals.

Topical fluoride products can be divided in two broad categories.

1) Professionally 2) Self applied

applied products products

• These products are

dispensed by dental • Dispensed by the
professionals in the dental individual patient.
office.
• Includes fluoride
• Involves the use of high dentifrices, mouth rinses
fluoride concentration. and gels.

• Ranging from 5000 and • Typically are low fluoride

19000ppm. concentration products
ranging from 200-
1000ppm.
 FLUORIDE
VEHICLES

Aqueous gel Carex Durapat

Fluoridated
Foam
pastes

Fluoride varnish Fluorprotector

PROFESSIONALLY APPLIED TOPICAL FLUORIDE COMPOUNDS

1) Sodium
fluoride

2)
Stannous
fluoride

3)
Acidulated
phosphate
fluoride
 NEUTRAL SODIUM FLUORIDE

• Sodium fluoride (NaF) was the first fluoride compound to be

used for topical application.

• A minimum of four applications with a 2% sodium fluoride

solution gives a caries reduction of about 30%.

• Prepared by dissolving 20 grams of sodium fluoride powder in

one liter of distilled water in plastic bottle.

Method of Application of Neutral Sodium

Fluoride According To Knutson's Technique

Treatment is given in a series of four appointments.

• The teeth are first cleaned, isolated and dried.
• 2% sodium fluoride solution is painted one the teeth using cotton-
tipped applicator sticks. The solution is allowed to dry for 3-4 minutes.
• This procedure is repeated for each of the isolated segments until all
of the teeth are treated.
• A second , third and fourth fluoride application is scheduled at
intervals of approximately one week.
• The four visit is recommended for ages 3, 7, 11, and 13 years.
 MECHANISM OF ACTION OF SODIUM
FLUORIDE

Sodium fluoride solution reacts with hydroxyapatite crystals in enamel to

form calcium fluoride.

Calcium fluoride interferes with further diffusion of fluoride and this sudden
stop of entry of fluoride is CHOKING OFF EFFECT.

Fluoride then slowly leaches out acting as reservoir for fluoride release.

Calcium fluoride formed reacts with the hydroxyapatite crystals to form

fluoridated hydroxyapatite.

Hydroxyapatite increases the concentration of fluoride on enamel surface

which makes tooth resistant to caries attack.
 ADVANTAGES OF NEUTRAL
SODIUM FLUORIDE SOLUTION

• Relatively stable when kept in plastic container and there is no need

to prepare a fresh solution for each patient.
• The taste is well accepted.
• The solution is non- irritating to the gingiva.
• It does not cause discoloration of tooth structure.
• Once applied, the solution is allowed to dry for 3minutes, thus
clinician in public health can pursue a multiple chair procedure.

DISADVANTAGE OF NEUTRAL
SODIUM
FLUORIDE SOLUTION

• The patient must make four visits to the dentist within a relatively
short period of time.
 STANNOUS FLUORIDE

• It has been used at 8% and 10% concentrations in solutions equivalent

to 2 and 2.5% fluoride.

METHOD OF PREPARATION
• 8% stannous fluoride solution, the content of one capsule which is 0.8
grams is dissolved in 10ml of distilled water in a plastic container and
the solution is shaken briefly.

TECHNIQUE OF APPLICATION
(Muhler’s Technique)

Each tooth surface is cleaned with pumice or other dental cleaning agent for
5-10 seconds.

Dental floss is passed between the interproximal areas.

Teeth are isolated and dried with air.

Stannous fluoride is applied using the paint on technique and the solution is
kept for 4minutes. Repeat application are made every 6 months or more
frequency if the patient is susceptible to caries.
MECHANISM OF ACTION OF
STANNOUS FLUORIDE

When stannous fluoride is applied in low concentration, tin hydroxy

phosphate is formed which gets dissolved in oral fluids.

at very high concentration, calcium tri- fluoro stannate gets formed

along with tin tri-fluorophosphate.

Tin-tri-fluorophosphate is responsible for making the tooth structure

more stable and less susceptible to decay.

Calcium fluoride so formed further reacts with hydroxyapatite.

 ADVANTAGES OF STANNOUS
FLUORIDE

• Using an 8% stannous fluoride solution at 6 to 12 months intervals

conforms to the practicing dentist’s usual patient- recall system.

• Administration difficulties, particularly in public health programs,

created by the need to arrange four appointments are avoided.

DISADVANTAGES OF STANNOUS
FLUORIDE

• In aqueous solution the material is not stable.

• Its application is unpleasant.
• Solution occasionally causes a reversible tissue irritation.
• Causes pigmentation of teeth .
 ACIDULATED PHOSPHATE
FLUORIDE (APF)

• Introduced by Brudevold and his co-workers in 1960’s.

METHOD OF PREPARATION OF ACIDULATED PHOSPHATE FLUORIDE

• Prepared by dissolving 20 grams of sodium fluoride in 1 liter of 0.1 M

phosphoric acid and to this is added 50% hydrofluoric acid to adjust the
ph at 3.0 and fluoride ion concentration at 1.23%. It is called
Brudevold’s solution.

TECHNIQUE OF
APPLICATION

Oral prophylaxis

Teeth to be treated is completely isolated and thoroughly dried with air.

A minimum amount of fluoride gel that will permit complete coverage of

the tooth surfaces should be dispensed.

It is reapplied every 10-30 seconds so as to keep the fluoride solution

throughout the four minute period.

Patient is instructed not to eat, drink or rinse his mouth for at least
30minutes.
 MECHANISM OF ACTION OF
ACIDULATED PHOSPHATE
FLUORIDE

When APF is applied on the teeth , it initially leads to dehydration

and shrinkage in the volume of hydroxyapatite crystals which
further on hydrolysis forms dicalcium phosphate dihydrate
(DCPD).

DCPD is highly reactive with fluoride ion and starts forming

immediately when APF is applied.

Fluoride penetrates into the crystals more deeply through the

openings produced by shrinkage and leads to formation of
fluorapatite.
 ADVANTAGES OF
ACIDULATED PHOSPHATE
FLUORIDE

• Requires only two application in a year.

• Gel preparation can be self applied.
• It has ability to deposit fluoride in enamel to deeper depth than
neutral sodium fluoride or stannous fluoride.
• APF is stable and need not be freshly prepared for each patient.

DISADVANTAGES OF ACIDULATED
PHOSPHATE FLUORIDE

• Practical difficulties like the teeth should be kept wet for 4minutes
and repeated applications.
• It has unpleasant taste.
• It cannot be stored in glass containers.
Characteristics of professionally applied topical
fluorides

Characteristics Sodium Stannous fluoride APF

fluoride

Percentage 2% 8% 1.23%

Fluoride concentration 9,200 19,500 12,30

(ppm) 0

pH Neutral 2.4-2.8 3.0

Frequency of 4 at weekly Biannually biann

application intervals ually
3,7,11,&13
years

Adverse effects No Tooth pigmentation No

gingival irritation

Caries reduction 30% 32% 28%

 Self applied topical fluorides

• Depending upon the manner of usage, these preparation expose

about 0.5-3.4 mg fluoride.
• It includes:

1) FLUORIDE
DENTIFRICES

2) GELS

3) RINSES
 DENTIFRICES

• It plays role that is more significant for caries prevention since it

requires active participation by the patient.

• FLUORIDE COMPOUNDS IN DENTIFRICES:

Sodium fluoride dentifrices
Stannous fluoride
Monofluorophosphate
Amine fluoride dentifrices
 FLUORIDE MOUTH RINSES

• First described by Bibby et al in 1946.

• Preparation of sodium fluoride mouth rinse:

Home use:
 By dissolving 200mg sodium fluoride tablet in 5 teaspoons of fresh
clean water.
In schools:
 Authorities can buy packets of sodium fluoride powder (2g powder
in each packet) and dissolve this powder in 100ml of water to
make a 0.2% solution.

MECHANISM OF ACTION OF FLUORIDE

MOUTH RINSES

• Fluoride changes the enamel structure of teeth from

hydroxyapatite to fluorapatite.
• It may act by inhibition of bacterial metabolism and plaque acid
formation.
 FLUORIDE GELS

• It include neutral sodium fluoride and acidulated phosphate fluoride.

• The gels are either applied in trays or brushed on the teeth.
• Gels can be applied once a day or more.
• Patients brush their teeth for 1 minute with gel or if trays are used
several drops are placed in each tray and held in contact with the teeth
for 5 minutes.
• Home fluoride gels are not recommended for children of 6 years and
younger.

LIMITATIONS OF FLUORIDE GELS

• They violate the principle of delivering low concentration of fluoride at

regular intervals.
• They present a toxicity hazard as relatively large amounts of fluoride are
given in uncontrolled manner.
 SYSTEMIC FLUORIDES

• Provides a low concentration of fluoride to the teeth over a long

period of time.
• Circulates through the blood stream and is incorporated into
developing teeth.
• Different types of systemic fluorides are;

Community water
fluoridation Salt fluoridation

Fluoride
Milk fluoridation tablets/drops/lozen
ges
 COMMUNITY WATER
FLUORIDATION

• Most common form of systemic fluoride administration.

• Optimal level of fluoride in water for protection against dental
caries is approximately 1 part per million (ppm).

LIMITATIONS OF COMMUNITY WATER

FLUORIDATION

• Crucial requirement for community water fluoridation is a well

established, centralized piped water distribution system which is
lacking in most developing countries.
• Introduction of water fluoridation program requires the support
of the top health authorities and of the government.

Fluoride concentration in the water can be

estimated by :
1. Fluoride electrode coupled with standard pH meter.
2. Scot-Sanchis method
FLUORIDE COMPOUNDS USED IN
WATER FLUORIDATION

Sodium
Fluorspar
fluoride

Sodium silico
Silico fluorides
fluoride

Hydro fluor Ammonium

silicic acid silico fluoride

TYPE OF EQUIPMENT FOR WATER

FLUORIDATION

• The types of fluoridation equipment commonly

used for fluoridation of water supplies are:

1. The saturator system

2. The dry feeder system
3. The solution feeder system
 Types of equipment used in water fluoridation

System Procedure Factors Recommenda

limiting usage tion

Saturato 4% saturated Need to clean Suitable for

r system solution of NaF is gravel bed medium-sized
produced and used for towns
injected at the filtration. requiring <3.8
desired million lit/day.
concentration in the
water distribution
source with aid of a
pump.
Dry NaF or silicofluoride Care in Suitable for
feeder in the form of handling medium-sized
powder is fluoride, towns
introduced into a obstruction of requiring 3.8-
dissolving basin. pipes, and 19million
compacting of lit/day.
fluoride while
storage.

Solution Volumetric pump The Suitable for

feeder permitting the equipment medium sized
addition of a given must be and large
quantity of resistant to towns with a
hydrofluosilicic acid attack by capacity of
in proportion to the hydrofluosilicic >7.6 million
amount of water acid, lit/day.
treated. necessitating
construction in
polyvinyl
chlorides or
another
plastic.
 SCHOOL WATER FLUORIDATION
PROGRAMS

• Where community water is not feasible, school water fluoridation is a

suitable alternative because of dental caries in children.
• The recommended level is 4.5-6.3 ppm of fluoride in the school water
supply.

ADVANTAGES
• Effective public health measure.
• Target population- school children.
• Quite economical.

LIMITATIONS
• Need for co-operation from school authorities.
• Intermittent fluoride exposure.
 SALT WATER FLUORIDATION

• It is a controlled addition of fluoride, during manufacture of salt for

human consumption.
• Ideal fluoride concentration in salt is 200,250,350mg of fluoride per kg
salt.

PRODUCTION OF FLUORIDATED SALT

• Batch processing
• Continuous processing

ADVANTAGES
• It does not require a community water supply.
• It permits individuals to accept or reject it.
• Non-fluoridated salt, like non-iodized salt, can be made available to
the population.

LIMITATIONS
• There may be large variation in salt intake in different groups of
people.
• If there are multiple drinking water sources which have fluoride
concentration.
• Requires refined salt produced with modern technology and a high
level of technical expertise.
 MILK FLUORIDATION

• Addition of a measured quantity of fluoride to bottled or packaged milk.

RATIONAL OF MILK FLUORIDATION

• Milk is often available to children that can provide a convenient and cost
effective vehicle.
• Process is relatively simple and bioavailability of fluoride is not reduced by
milk.
• It has been demonstrated that effectiveness of fluoridated milk in
preventing dental disease.
 TOXICITY OF FLUORIDES

• Fluoride is often called as a double edge sword because

inadequate ingestion of fluoride is associated with dental
caries and excessive intake can lead to dental and skeletal
fluorosis.
• Acute toxicity results from rapid excessive ingestion of fluoride
at one time.
• Other symptoms of fluoride toxicity include:
o Abdominal cramps
o Vomiting
o Diarrhea
o Increased salivation
o Dehydration and thirst

Chronic fluoride toxicity

• Results from long term ingestion of small amounts of
fluoride.
• Effect on enamel is dental fluorosis.
• Other problems such as skeletal fluorosis may occur.

Certainly lethal dose (CLD)

• 32 to 64 mg of fluoride/ kg body weight

Safely tolerated dose (STD)

• 8-16 mg of fluoride /kg body weight

MANAGEMENT OF ACUTE FLUORIDE TOXICITY
Less than 5mg/kg • Give calcium orally (milk) to
relieve gastrointestinal
symptoms. Observe for few
hours.
• Induce vomiting (not
necessary)
More than 5mg/kg but less than • Empty the stomach by
15mg/kg body weight inducing vomiting with emetic.
For patients with depressed
gag reflex induced vomiting is
contraindicated and
endotracheal intubation
should be performed before
gastric lavage.
• Give orally soluble calcium in
any form (milk, 5% calcium
gluconate, or calcium lactate
solution)
• Admit to hospital & observe
for few hours.

More than 15mg/kg • Admit to hospital immediately.

• Induce vomiting.
• Begin cardiac monitoring.
• Slowly administer
intravenously 10ml of 10%
calcium gluconate solution.
Additional doses maybe given
if clinical signs of tetany
develops. calcium and
potassium, should be
monitored.
• Adequate urine output should
be maintained using diuretics
if necessary.
• General supportive measures
for shock.
 DENTAL FLUOROSIS

• Is caused by excessive intake of fluoride during tooth

development.

CLINICAL FEATURES
• Lusterless, opaque white patches in enamel which may become
mottled, striated or pitted.
• Mottled areas may becomes stained yellow or brown.
• Hypoplastic areas may also be present to such an extent in
severe cases that normal tooth form is lost.

SKELETAL FLUOROSIS
Occurs from ingestion of very high amounts of
fluorides for long periods of time.

SYMPTOMS
• Severe pain in the back bones, joints, hips and
stiffness.
• Outward bending of legs and hands is seen in
advanced stages. (KNOCK-KNEE SYNDROME)
• Fluoride may lead to blocking and calcification of
blood vessels causing cardiac problems.
• In its severest form, crippling fluorosis, spine
becomes rigid and the joints stiffen, immobilizing
the patient.
 DE-FLUORIDATION OF WATER

• Process of removing excess fluoride form drinking water in order

to reduce the prevalence and severity of dental fluorosis.
• There are five established de-fluoridation methods:
1. Bone charcoal
2. Contact precipitation
3. Activated alumina
4. Clay
5. Nalgonda technique
 NALGONDA TECHNIQUE OF
DEFLUORIDATION

• The process comprises addition in sequence of sodium aluminate,

lime and bleaching powder to fluoride water followed by
flocculation, sedimentation, and filtration.
 MECHANISM

The unit holds 22 liters of water, which is filled into the upper chamber.

 RAPID MIX:
• Coagulant is rapidly and uniformly dispersed throughout a single or
multiple phase system.
• Rapidly mixed for a period of 30 to 60 seconds with a speed of 10 to
20 rpm.
• This helps in formation of microflocs and results in proper utilization
of chemical coagulants.

 FLOCCULATION:

• In this second stage, formation of settleable particles from destabilized

colloidal sized particles is achieved.
• By prolonged mixing for a period of 10-15 minutes with a speed of 2-4
rpm.
 SEDIMENTATION

• It is the separation from water by gravitational setting of suspended

particles that are heavier than water.
• Factors influencing sedimentation are:
a) Size, shape, density, and nature of the particles.
b) Viscosity, density and temperature of water.
c) Surface over flow rate.
d) Velocity of flow
e) Effective depth of settling zone.

 FILTRATION

• Process of separating suspended and colloidal impurities from

water by passage through a porous media.
• Treated water will be available for drinking and cooking with desired
level of fluoride 1ppm or less.
 Salient Features Of Nalgonda
Technique

• No regeneration of media.
• No handling of caustic acids and alkalis
• Only readily available chemicals used in conventional municipal
water treatment are required.
• Adaptable for domestic use.
• Simplicity of design, construction, operation and maintenance.
• Highly efficient removal of fluoride to desirable levels.
• Little wastage of water.
• Needs minimum of mechanical and electrical equipment.

Indications For Adopting Nalgonda Technique

• Absence of acceptable, alternate low fluoride source within

transportable distance.
• Total dissolved solids are below 1500 mg/l.
• Raw water fluoride ranging from 1.5 mg to 20mg F/L.
 CONCLUSION

When used appropriately fluoride is a safe and effective agent that can be
used to prevent and control dental caries. Fluoride has contributed to
improved dental health of people all over the world. Fluoride is needed
regularly throughout life to protect teeth against tooth decay. However,
since fluoride is considered to be a double-edged sword, it must be used
judiciously so that dental caries is prevented and the deleterious effects
of dental and skeletal fluorosis avoided.
 REFERENC
E

• Essentials of public health dentistry, Soben Peter (7 th edition)