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 arent caries
free.
3.Those who take medication that reduce
salivary flow or radiation therapy.
4.Post periodontal surgery when roots are
exposed.


1. Patients with fixed or removable prosthesis
and after placement or replacement of
restorations.
2. Patients with an eating disorder or who are
undergoing a change in lifestyle which may
affect eating or Oral Hygiene Habits
conductive to good oral health.
3. Mentally or physically challenged individuals.
Rationale for using topical fluoride
agents
to speed the rate and increase the concentration of fluoride
acquisition in surface enamel.

Since immature and porous enamel acquires fluoride rapidly
and since the enamel surface of newly erupted teeth
undergoes rapid maturation, it follows that the best time to
apply topical fluorides is soon after eruption.
Also, the initial caries lesion, characterized by a white spot, is
porous and accumulates fluoride at much higher
concentrations than adjacent sound enamel.

This implies that periodic applications of fluoride would
enable vulnerable enamel sites that are partially
demineralized to accumulate fluoride.


Topical fluorides

Methods of Enhancing Fluoride
Fixation in Enamel

Increase in Frequency of Application and Time of Exposure
increasing the number of applications and lengthening the
time interval between the applications of a APF solution
increases fluoride uptake (Richardson 1976.)


Pretreatment of Enamel Surfaces
0.05 M phosphoric acid increase enamel surface
area, greatly enhances the uptake and retention of
fluoride (Aasenden et al, 1968].
Use of complexing agents
McCann 1969 fluoride complexes with enamel and elevated
fluoride level were associated with higher aluminium
concentration.

Pretreatment of enemel with .05 and 1.o M aluminium nitrate
greately elevated level of f by factor of 6 times than did APF
treatment.

TOPICAL
FLUORIDES
Professionally
applied topical
fluorides
Self applied
products


Professionally applied topical fluorides:

introduced by Bibby(1942).

Involve the use of high fluoride concentration products
ranging from 5000-19,000ppm,(5-19 mgF/ml).






Professional
applied fluorides
Neutral
Sodium
Fluoride (NaF)
Stannous
Fluoride
(SnF2)
Acidulated
Phosphate
Fluoride (APF)
Self applied products:

fluoride dentifrices
mouth rinses
gels.

Are low fluoride concentration products
ranging from 200-1000ppm (0.2-1 mgF/ml).


PROFESSIONALLY APPLIED
TOPICAL FLUORIDES:

FLUORIDE VEHICLES:
Aqueous sol. and gels
Thixotropic solution
Fluoridated prophylactic paste
Foam
varnish


Aqueous solutions & gels

The gel adheres to teeth & eliminates the continuous
wetting of enamel surfaces required when solutions are
used.

When trays are used for applying gels, two or four
quad can be treated simultaneously.





amount used is less so hazard of accidental ingestion
less.

Thixotropic solutions
They are not gels, but have a high viscosity under storage
conditions & become fluid under conditions of high
stress.
More stable at low pH and do not run off the tray readily.


FLUORIDATED PROPHYLACTIC PASTES:

Allows both cleaning and the fluoride application in one
step.

First indicated by Bibby1946 ( paste containing 1 %
NaF)


The first marketed F containing prophylaxis
paste contained stannous fluoride and
ziriconium silicate.
FOAM:

Developed to minimize the risk of fluoride over dosage and to
maintain the efficacy of topical fluoride treatment.

Advantages :

Its lighter than a conventional gel ; small amount of agent is
needed .[4 gm of gel/mouth while less than 1 gm of foam/mouth.

The surfactant has cleansing action and facilitates the
penetration into interproximal surfaces.

APF foam do not require suctioning so it offers advantages for
home use, young children ,disabled.
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.

Solutions
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
of tin and F WITHIN
30 SEC.
-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.
DISADVANTAGES Patient has to make 4
visits to the dentist
within a relatively
short time.
-Unstable and should
be prepared fresh for
patient.
- Metallic taste
- 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
Neutral Sodium Fluoride (NaF)

A minimum of four applications of with 2% Sodium Fluoride solution (9040 ppm)
pH 7 reduces caries by about 30%.





allowed to dry for 3-4 minutes
2% NaF solution is painted on the air dried teeth so that all surfaces are visibly wet
teeth isolated either by quadrant or by half mouth
dry with compressed air
Teeth cleaned with aqueous pumice slurry
[ Knutsons and feldman Technique 1948 ]:
2nd, 3rd and 4th NaF application, each not preceded by a prophylaxis, is scheduled at intervals of
approximately one week.
repeated for each of the isolated segments until all teeth are treated
Instruct the patient to avoid eating drinking for 30 minutes.
Mechanism of action of sodium
fluoride

When NaF is applied topically :
Ca
10
(P0
4
)
6
(OH)
2
+ 20 F
-
10CaF
2
+ 6 P0 + 20H
-





Further
CaF
2
+ 2Ca
5
(P0
4
)
3
OH 2Ca
5
(P0
4
)
3
F + Ca (OH)
2


Chocking Off Effect
Stannous Fluoride
(SnF2)


Stannous Fluoride has been used at 8% and 10% concentrations in solutions
equivalent to 2 and 2.5% fluoride. Although 10% solutions used for adults and 8%
for children there is no any clinical difference between the two. However 8%
Stannous Fluoride is preferred.



Procedure for application of Stannous Flouride
[ Muhlers 1957 Technique ]
Repeat applications every 6 months or more frequently if patients is susceptible to caries.
Instruct not to eat /drink 30 min.
Fresh 8%SnF2 is applied using the paint on technique and teeth kept moist for 4 min.
Te isolate a quadrant and dry the teeth
Thorough oral prophylaxis
Mechanism of Action
SnF2 Low concn tin Hydroxyphosphate oral fluids dissolve it
forms gets
metallic taste application


SnF2 high concentration

Calcium tri-fluoro-stannate Tin tri-fluoro-phosphate

Tin tri-fluoro-phosphate makes tooth surface more stable & less suspectibility to decay

Calcium fluoride is also formed both at high and low concn which reacts with hydroxyapatite and
results in formation of fluorohydroxyapatite.

Pediatric dentistry- STEWART
Essentials of preventive and community
dentistry- SHOBAN PETER
Pediatric dentistry: STEPHEN WEI
Fluorides in caries prevention- J.J. MURRAY