1. Topical Fluoride Mayra Aguilar and Kathy Cronin

2. What is fluoride? Comes from the element fluorine Exist only as a fluoride compound Fluorine is a part of minerals in rocks and soil. A small amount of soluble fluoride is present in all water sources. Fluoride is also present in all foods and beverages, to some extent.

3. Benefits of Fluoride Prevents and reverses the early signs of decay Makes the tooth structure stronger and more resistant to acids formed from bacteria Remineralizes areas in which acid attacks have already begun.

4. Topical Fluoride Topical fluorides are applied directly to the tooth enamel It strengthens teeth and makes them more resistant to decay Topical fluorides include toothpastes, mouth rinses, and fluoride treatments in the dental office

5. Types of Professionally Applied Fluoride Varnish Gel Foam

6. Fluoride Varnish 5% NaF (pH 7.0) = 22,600ppm Fluoride Easier to apply in younger children Takes less time Less patient discomfort Greatest patient acceptability Fast drying Reduce sensitivity Up to 24 weeks

7. Fluoride Gels Acidulated phosphate fluoride (APF)(pH 3.5) = 12,300 ppm Fluoride or 2.0% NaF (pH 7.0) = 9040 ppm Fluoride Higher patient acceptability compared to foam 4 Minute Application Time

8. Fluoride Foams APF (pH 3.5) = 12,300 ppm Fluoride or 2.0% NaF (pH 7.0)= 9040 ppm Fluoride 4 minute application time Bad taste, less patient acceptability Requires 1/5 the quantity by weight to cover the same arch compared to gel

9. Who Benefits from Topical Fluoride? All people benefit from topical fluoride applications People who are moderate to high caries risk benefit most

10. Caries Risk Categories Low risk all ages – No incipient or cavitated primary or secondary carious lesions during the last 3 years and no factors that increase caries risk*

11. Caries Risk Categories Moderate risk (0-6 years old) – No incipient or cavitated primary or secondary carious lesions during the last 3 years but the presence factors that increase caries risk*

12. Caries Risk Categories Moderate risk (older than 6 years old) – 1 or 2 incipient or cavitated primary or secondary carious lesions during the last 3 years but the presence factors that increase caries risk*

13. Caries Risk Categories High risk (0-6 years old) – Any incipient or cavitated primary or secondary carious lesions during last 3 years – Multiple factors that increase caries risk* – Low socioeconomic status – Suboptimal fluoride exposure – Xerostomia

14. Caries Risk Categories High risk (older than 6 years old) – 3 or more incipient or cavitated primary or secondary carious lesions during last 3 years – Multiple factors that increase caries risk* – Low socioeconomic status – Suboptimal fluoride exposure – Xerostomia

15. Some Factors that Increase Caries Risk include High titers of cariogenic bacteria Poor oral hygiene Prolonged nursing or bottle use Poor family dental health Irregular dental care Presence of exposed root surfaces Physical or mental disability Alcohol / drug abuse, eating disorders

16. Clinical Recommendations for Application Intervals Low caries risk (all ages) – May not benefit from additional topical fluoride – Fluoridated water and fluoride toothpaste may be enough Moderate risk (0-6 years) – Varnish application every 6 months Moderate risk (6 and older) – Varnish or (1.23% APF) gel every 6 months

17. Clinical Recommendations for Application Intervals High Risk (0-6 years old) – Varnish every 3 months or 6 months High Risk (6 and older) – Varnish or (1.23% APF) gel every 3 or 6 months

18. Our Recommendations: Fluoride Varnish for All Ages! Easy to apply Better patient tolerability Faster to apply Applied directly to each tooth Fluoride compound is less acidic Dries fast so young kids don’t ingest excess fluoride Great for dentin hypersensitivity

19. References Adair, S.M., Bowen, W.H., Burt, B.A., Kumar, J.V., Levy, S.M., and Pendrys, D.G., et.al. (2001). Recommendations for using fluoride to prevent and control dental caries in the United States. Morbidity and Mortality Weekly Report 50 (RR14) 1-42. American Dental Association. (2005). An alternative technique for applying fluoride varnish. Retrieved November 23, 2008, from www.ada.org/goto/jada American Dental Association. (2007). Fluoride treatments in the dental office. Retrieved November 23, 2008, from http://jada.ada.orghttp://jada.ada.org American Dental Association Council on Scientific Affairs. (2007). Professionally applied topical fluoride: evidence-based clinical recommendations. Journal of Dental Education, 71(3), 393-402. Retrieved November 20, 2008, from http://www.jdentaled.org/cgi/content/full/71/3/393 Benton-Franklin Health District. (2008). Fluoride. Retrieved November 20, 2008, from http://www.bfhd.wa.gov Jiang, H., Tai, B., Du, M., and Peng, B (2005). Effect of professional application of APF foam on caries reduction in permanent first molars in 6-7-year-old children:24 month clinical trial. Journal of Dentistry, 33 469-473. Marinho, V. C. C., Higgins, J. P. T., Sheiham A., & Logan, S. (2004). One topical fluoride (toothpaste, or mouthrinse, or gels, or varnish) versus another for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews, Issue 1. Art.No.: CD002780. Ritter, A. V., Dias, W, Miguez, P, Caplan, D. J, & Swift Jr., E. J (2006). Treating cervical dentin hypersensitivity with fluoride varnish: A randomized clinical study. The Journal of the American Dental Association, 137 1013-1020 Weintraub, J.A., Ramos-Gomez, F., Jue, B., Shain, S., Hoover, C.I., Featherstone, J.D.B., Gainsky, S.A. (2006). Fluoride varnish efficacy in preventing early childhood caries. Journal of Dental Research, 85(2), 172-176. Retrieved November 23, 2008, from http://jdr.iadrjournals.org/cgi/content/full/85/2/172?maxtoshow=&HITS=10&RESULTSFORMAT=&author1= Ramos-Gomez&fulltext=Fluoride&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT

20. References Topical fluoride application uploan.wikimedia.org Application of topical fluoride (baby) www.communityhealth.dhhs.state.nc.uswww.communityhealth.dhhs.state.nc.us Application of topical fluoride (tooth and paint brush) www.communityhealth.dhhs.state.nc.uswww.communityhealth.dhhs.state.nc.us Fluoridex bottles www.discusdental.com colg_fluorofoam_hero.jpg www.colgateprofessional.com Duraphat decs.nhgl.med.navy.mil