Dr. Huda Y K

Fluoride has been proven to play a significant role in preventing and controlling the caries disease. So we will talk about: Description of fluoride, how It works, its dangers, and side effects.

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.

Fluoride is a natural mineral in soil and water. The fluoride concentration (Units of Measure) is commonly expressed as parts per million (ppm). which is equivalent to 1mg fluoride per kilogram or liter of water. Thus, 1ppm fluoride in the water supply corresponds to 1mg fluoride per liter of water.

Fluoride is absorbed via the gastrointestinal tract and accumulated in the bones. The normal daily intake of fluoride is rather low and estimated to be 1–3 mg per day in adults. Intake of high amounts of fluoride can be toxic, however although very rarely lethal.

The probably toxic dose (PTD) sufficient to produce severe poisoning (including death, in some individuals) in humans is estimated to be around 5mg F − /kg body weight.

There are two types of toxicity Acute Toxicity Chronic Toxicity

The symptoms of acute toxicity Occur rapidly, with diffuse abdominal pain, diarrhea, vomiting, excess saliva, and thirst. The immediate treatment when a toxic dose is suspected is: 1.To induce vomiting. 2.Milk should be swallowed to reduce fluoride absorption. 3.Then, without delay the person should be referred to medical/toxicological attendance.

The dentist F.S. McKay from Colorado discovered in 1901 that many of his patients had permanent stains on their teeth. He termed it “Colorado stain” or “stain mottled enamel”. In the beginning of the 1930s they found that fluoride was the reason for mottled enamel And the term “dental fluorosis” was introduced.

Dental Fluorosis(Chronic Toxicity) Dental fluorosis can affect both dentitions. There is a linear dose–response relationship between fluoride ingestion and dental fluorosis. There is only a RISK of developing DENTAL FLUOROSIS when the dentitions are developing. The first 3 years of life seem to be most critical

A mild case of dental fluorosis (the white streaks on the subject's upper right central incisor) Specks / Streaks 11 Dental fluorosis is a developmental disturbance of dental enamel caused by the consumption of excess fluoride during tooth development

Sever Dental Flourosis. (Case 1) 12

Severe Dental Flourosis. (Case 2) 13

Fluoride in Saliva and Plaque When fluoride is constantly present, mutans Streptococci produce less acid Regular use of fluoride toothpaste or other vehicles for fluoride provides elevated fluoride concentrations in saliva as well as in plaque

Mechanisms of Action Systemic (Pre-eruptive fluoride exposure ) – Improves enamel crystallinity(increased the size of the apatite crystals) – Reduces acid solubility Topical (post-eruptive fluoride exposure) – Inhibits demineralization – Promotes remineralization (Fluorapatite ) – mutans Streptococci produce less acid The main beneficial effect of fluorides on caries is posteruptive.

Fluoride cannot completely prevent caries, but it can effectively DELAY ITS PROGRESSION, and even keep lesions at an inactivated or a subclinical level. So the use of fluoride should ideally be combined with other preventive approaches

Water Fluoridation Fluoridated Milk and Salt The strength of the community-based methods is that they have a broad reach in the population, are less expensive than most of the individually applied methods

Water Fluoridation In general, it was established that fluoride in the water supply at a level of 1ppm versus no fluoride reduced the number of decayed, missing, and filled teeth by 50%. The preventive effect of fluoride on caries was related to a pre-eruptive action Water is an efficient vehicle for delivering a low concentration of fluoride to saliva and plaque At High Frequency. A concentration in the range of 0.6–1.1ppm F, was considered as optimal to balance reduction of dental caries and occurrence of dental fluorosis.

Fluoridated Milk and Salt The advantage of milk or salt (250ppm ) fluoridation is that individuals may choose to use it or not, which is not possible with water fluoridation. According to the WHO, fluoridated milk and fluoridated salt may be considered as cost-effective alternatives to water fluoridation in communities or countries in which other preventive measures are not feasible.

Professionally Applied Fluorides 1.Fluoride Varnishes 2.Fluoride Solutions 3.Fluoride Gels Self-Applied Fluorides 1.Fluoride Toothpaste 2.Fluoride Mouth Rinses 3.Fluoride Tablets and Chewing Gums

Professionally Applied Fluorides Topically fluoride application by a Dentist, Dental Hygienist or any other Dental Auxiliary has become an established Caries- Preventive Procedure in the Dental History. The three agents currently used as professionally applied fluorides are:- 1.Neutral Sodium Fluoride (NaF) 2.Acidulated Phosphate Fluoride (APF) 3.Stannous Fluoride (SnF2) The fluoride may be applied using the Paint on Technique (flouride varnishes) or the Tray Technique (F gel or solution).

Professionally Applied Fluorides Fluoride Varnishes In order to be effective in decay prevention the varnish should be reapplied at least twice yearly.

Professionally Applied Fluorides Tray Technique (solution or gel) They should be applied for 5 minutes, remove the trays and thoroughly expectorate (spit out) the residual fluoride. Very Important – do not rinse mouth, drink or eat for at least 30 minutes after fluoride use.

Self Applied Topical Fluorides Self applied fluorides products are usually bought and dispended by the individual patient but at the recommendation of a dental professional. These fluoride products are of low concentration The self applied fluoride usually are:- 1.F luoride Dentifrices 2.Fluoride tablets and gums 3.Fluoride rinse

Self Applied Topical Fluorides F luoride Dentifrices The amount of fluoride toothpaste (≤1100ppm F – at least to age 3 years) should be very limited corresponding to a pea or less per day Children age 6 years and over are advised to brush their teeth with toothpaste containing 1450–1500 ppm F – 2500–5000ppm fluoride are available upon prescription in some countries and intended for caries- active individuals over 16 years of age and for patients with special needs A small amount of water to remove the waste toothpaste slurry is recommended

Other Remineralization Agents Carbonate hydroxylapatite nanoparticles CPP-ACP(casein phosphopeptide amorphous calcium phosphate) is a milk derivative. – can be added to sugar-free chewing gums,lozenges, mouth rinses, and filling materials – but is most readily available as a topical self-applied paste Both enhance calcium and phosphate delivery to the teeth