4 Topical Fluoride

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FLOURIDE DELIVERY METHODS:

1.Topical fluorides

2.Systemic fluorides



TOPICAL FLUORIDES:

Definition: 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.

INDICATIONS

1.Caries active individuals

2.Children shortly after periods of tooth eruption,

especially those who aren‟t caries free. 3.Those who take medication that reduce salivary flow or

radiation therapy.

4.Post periodontal surgery when roots are exposed.



Professionally applied topical fluorides:

It was introduced by Bibby in 1942.

Involve the use of high fluoride concentration products

ranging from 5000-19,000ppm, which is equivalent to 5-

19 mgF/ml.

Self applied products:

Include fluoride dentifrices, mouth rinses & gels

Are low fluoride concentration products ranging from

200-1000ppm or 0.2-1 mgF/ml.

Topical fluorides are divided into two categories:



PROFESSIONALLY APPLIED

TOPICAL FLUORIDES:

1.FLUORIDE VEHICLES:

Aqueous solutions & gels

The gel adheres to teeth &

eliminates the continuous wetting

of enamel surfaces required

when solutions are used.

Thixotropic solutions are notgels, but have a high viscosity

under storage conditions &

become fluid under conditions of

high stress



FLUORIDATED

PROPHYLACTIC PASTES:

If prophylaxis pastescontaining fluoride are used,

the lost fluoride is

replenished & there is a

significant gain in theconcentration of fluoride.



FOAM:

Developed to minimise the risk of fluoride over dosage

as well as to maintain the efficacy of topical fluoridetreatment.

Advantages :

Its lighter than a conventional gel & therefore only a

small amount of agent is needed for topical application

The surfactant has cleansing action by lowering surface

tension, this facilitates the penetration of material into

interproximal surfaces.

It doesn‟t require suctioning so it offers advantages for

home use



FLUORIDE VARNISH:

Increasing the time of contact between enamel surface & opical

fluoride agents favours the deposition of fluorapatite &

fluorhydroxyapatite.

DURAPHAT:

It s a viscous yellow material, containing 22,600 ppm fluoride as

sodium fluoride in a neutral colophonium base.

FLUORPROTECTOR:

Its a clear polyurethane based product containing 7000 ppm

fluoride from difluorosilane.

Its dispensed in iml ampules each ampule containing 6.21mgof

fluoride.

CAREX:

It has low fluoride concentration than duraphat & has equal efficacy to

that of duraphat as caries preventive agent.



FLOURIDE APPLICATION FLOURIDE VARNISH



TOPICAL FLUORIDES USED IN PREVENTIVE

DENTISTRY:

1.SODIUM FLUORIDE:

2.STANNOUS FLUORIDE

3.ACIDULATED PHOSPHATE FLUORIDE

4.AMINE FLUORIDE

NEUTRAL SODIUM FLUORIDE

A minimum of four applications with a 2% sodium fluoride

solution gives a caries reduction of 30%.

METHOD OF PREPARATION:

It is prepared by dissolving 20 gms of NaF powder in 1L of

distilled water in a plastic bottle



KNUTSONS TECHNIQUE:

At the initial appointment teeth are cleaned with pumice slurry &

then isolated with cotton rolls & dried with compressed air.

Using cotton-tipped applicator sticks ,the 2% NaF is painted on

air dried teeth so that all tooth surfaces are visibly wet. The

solution is allowed to dry for 3-4 min.

This procedure is repeated for each of the isolated segments

until all the teeth are treated.

A 2nd, 3rd and 4th fluoride application, each not preceded by a

prophylaxis, is scheduled at intervals of approximately one week;

The four-visit procedure is recommended for ages 3, 7, 11 and 13

years, coinciding with the eruption of different groups of primary

and permanent teeth.



Advantages of neutral sodium fluoride solution :

It is relatively stable when kept in a plastic container;

The taste is well accepted by patients; The solution is non-irritating to the gingiva;

It does not cause discoloration of tooth structure;

The series of treatments must be repeated only 4 times in the

general age range of 3 to 13, rather than at annual or semiannual

intervals.

Disadvantage of neutral sodium fluoride solution :

The major disadvantage of the use of sodium fluoride is that the patient

must make 4 visits to the dentist within a relatively short period of

time.

STANNOUS FLUORIDE : (SnF2) :

Stannous fluoride has been used at 8% and 10% concentrations







ACIDULATED PHOSPHATE FLUORIDE (APF) :

Method of preparation of acidulated phosphate fluoride :

An aqueous solution is acidulated phosphate fluoride is

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 ionconcentration at 1.23%. It is also called as Brudevold‟s

solution

For the preparation of acidulated phosphate fluoride gel, a

gelling agent methylcellulose or hydroxyethyl cellulose is

added to the solution.



Technique of application :

Acidulated phosphate fluoride is recommended for application at 6 or 12

months intervals.

Oral prophylaxis is done;

The teeth to be treated are completely isolated and thoroughly dried

with air;

Clinical application of APF gels should be done using trays that fit the

patient‟s upper and lower dental arches. A disposable foam-lined tray

is preferred; To reduce ingestion of fluoride, a minimum amount of fluoride gel that

will permit complete coverage of the tooth surfaces should be

dispensed;

After the trays have been properly positioned saliva ejector is used to

evacuate the stimulated saliva and excess fluoride;

It is reapplied every 15-30 seconds so as to keep the teeth moist withthe fluoride solution throughout the 4 minute period;

The patient is instructed to eat, drink or rinse his mouth for atleast 30

minutes.



FLUORIDETRAYS



Advantages of acidulated phosphate

fluoride

Requires only 2 application in a year; The gel preparation can be self applied and

thus the cost of application also gets

reduced;

It has the ability to deposit fluoride inenamel to a deeper depth;

Disadvantages of acidulated

phosphate fluoride : Practical difficulties like the teeth should be

kept wet for for 4 minutes;

It is acidic, sour and bitter in taste;

It cannot be stored in glass containers.



SELF-APPLIED TOPICAL FLUORIDES

It includes:

Dentifrices

Mouth rinses

Gels

DENTIFRICES:

The active agent was NaF which had been added to aconventional dentifrice containing dicalcium phosphate

as the abrasive.



FLUORIDE MOUTH

RINSES:

Mouth rinsing is a practicaland effective means for self-

application of fluoride.

Persons excluded from the

practice are :

1. Children under 6 years of

age;

2. Those of any age who

cannot rinse because oforal-facial musculature

problems or other

handicap.



Method of use :

1. Rinse daily with 1 teaspoonful (5 ml) after brushingbefore bed;

2. Swish between teeth with lips tightly closed for 60

seconds; expectorate.

Flouride rinses can be used as daily mouth rinse bycommunity and fortnightly in schools.

Advantages :

30-40% average reduction in dental caries incidence.

Disadvantages :

Requires community participation.



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4 Topical Fluoride