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Fluoride Action Topical References

Fluoride Action Topical References

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In 1999 Dental journals and the CDC reported fluoride acted topically. ADA stated that fact in a 2000 cover story. La Salud, Cuba stopped fluoridation. Decay rates went down.
In 1999 Dental journals and the CDC reported fluoride acted topically. ADA stated that fact in a 2000 cover story. La Salud, Cuba stopped fluoridation. Decay rates went down.

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Published by: Case Against Fluoride on Apr 23, 2012
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CommunityDentOralEpidemio/1999
Feb~27(1):62-71
Are-examinationofthepre-eruptiveandpost-eruptivemechanismoftheanti-carieseffectsoffluoride:isthereanyanti-cariesbenefitfromswallowingfluoride?
LimebackHFacultyofDentistry,UniversityofToronto,Ontario,Canada.hlimeback@dental.utoronto.caThebeliefthatfluoridatedwaterreducescariesincidencebyhalfstemsfromyearsoffluoridationstudieswherethecariesratesofpeopleinvariousfluoridatedandnon-fluoridatedcommunitieswerecompared.Bytheirnature,thewaterfluoridationtrialswerenotabletodistinguishbetweenthetopicaleffectsofthefluorideinthewaterandthesystemiceffectsofthefluoridethatisinevitablyswallowedandincorporatedintodevelopingteeth.Someattemptshavebeenmadetoestimatethecontributionofsystemicfluoridetothecontrolofdentalcariesbutresearchersarediscoveringthatthetopicaleffects'offluoridearelikelytomaskanybenefitsthatingestingfluoridemighthave.Inthisupdatedreviewofthepre-eruptivevs.post-eruptivebenefitsoffluorideinthepreventionofdentalcaries,are-examinationoftheliterature,whichisoftencitedtosupportthenotionthatswallowingfluoride,eitherinwaterorinpillform,wasdoneinrecognitionofthemountingevidenceforthetopicalmechanismasbeingtheprimarymechanismforthepreventionofdentalcaries.Maximumbenefitsfromexposingnewlyeruptedteethtotopicalfluorideintheoralcavitymayhavebeenseriouslyunder-estimated.Thishasobviousimplicationsfortheuseofsystemicfluoridestopreventdentalcariesandforceseveryoneworkinginthefieldtoexaminemorecloselytherisksandbenefitsoffluorideinallitsdeliveryforms.
CommunityDentistryandOralEpidemiology
1999Feb~27(1):62-71
J-3h
 
c-.
CDC
,...
...
__
........
--
,
October22,1999/Vol.48/No.41
~FluoridationofDrinkingWater~toPreventDentalCaries941ProgressTowardPoliomyelitisEradication~Nepal,1996-1999944Update:WestNileVirusEncephalitis.....NewYork,199995SNoticetoReaders
,MORBIDITYANDMORTALITY
WEEKLYREPOR·T
AchievementsinPublicHealth,190~1999
FluoridationofDrinkingWatertoPreventDentalCaries
Fluoridationofcommunitydrinkingwaterisamajorfactorresponsibleforthedeclineindentalcaries(toothdecay)duringthesecondhalfofthe20thcentury.Thehistoryofwaterfluoridationisaclassicexampleofclinicalobservationleadingtoepidemiologicinvestigationandcommunity-basedpublichealthintervention.Althoughotherfluoride-containingproductsareavailable,waterfluoridationremainsthemostequitableandcost-effectivemethodofdeliveringfluoridetoallmembersof,mostcommunities,regardlessofage,educatlonalattainment,orincomelevel.
BiologicMechanism
'P~~
?
36.
Fluoride'scaries-preventivepropertiesinitiallywereattributedtochangesinenamelduringtoothdevelopmentbecauseoftheassociationbetweenfluorideandcosmeticchangesinenamelandabeliefthatfluorideincorporatedintoenamelduring_/toothdevelopmentwouldresultinamoreacid-resistantmineral.However,laboratory
.If
andepidemiologicresearchsuggeststhatfluoridepreventsdentalcariespredomI-natelyaftereruptionofthetoothintothemouth,anditsactionsprimarilyaretopicalforbothadultsandchildren(1).Thesemechanismsinclude1)inhibitionofdemIner-alization,2)enhancementofremineralization,and3)inhibitionofbacterialactivityIndentalplaque(1).Enamelanddentinarecomposedofmineralcrystals(prim~rilycalciumandphosphate)embeddedinanorganicprotein/lipidmatrix.Dentalmineralisdissolvedreadilybyacidproducedbycariogenicbacteria'whentheymetabolizefermentablecarbohydrates.Fluoride.presentinsolutionatlowlevels,whichbecomesconcen-tratedindentalplaque,cansubstantiallyinhibit-dissolutionoftoothmineralbyacid.FluorideenhancesremlnerallzationbyadsorbingtothetoothsurfaceandattractingcalciumIonspresentinsaliva.Fluoridealsoactstobringt,hecalciumandphosphateionstogetherandisIncludedinthechemicalreactionthat,takesplace,producinga.crystalsurfacethatismuchlesssolubleinacidthantheoriginaltoothmineral(1).,,/'Fluoride'fromtopicalsourcessuchas,fh,ioridateddrinkingwateristakenupby"cariogenicbacteriawhentheyproduceacid.,Onceinsidethecells"fluorideinterfereswithenzymeactivityofthebacteriaandthecontrolofint(8cellularpH.Thisreduces'bacterialacidproduction,whichdirectlyreducesthedissolutionrateoftoothmineral
(19).''.
References
",1.FeatherstoneJD.Preventionandreversalofdentalcaries:roleoflowlevelfluoride.Com-munityDent
Oral
Epidemiol
1999;27:31-40.,19.
Sheiiis
RP,
D~c~orth
RM.
Studiesonthecariostaticmechanismsoffluoride.IntDen'tJ
1994;44(3
suppl
1):263-73.
U.S.DEPARTMENTOF,HEALTH
&
HUMANSERVICES
Reported
by
DivisionofOralHealthNationalCenterforChronicDiseasePreventionandHealthPromotion,CDC
3-3d
 
C0VER
THEJOURNALOF'THEAMERICANDENTALASSOCIATION
STORV
THESCIENCEANDPRACTICEOFCARIESPREVENTION
.JOHND.B.FEATHERSTONE.M.SC••PH.D.
ABSTRAeT
Backgroundand
Overview.
Dentalcariesisabacteriallybaseddisease.Whenitprogresses,acidproducedbybacterialactionondietaryfermentablecarbohy-dratesdiffusesintothetoothanddis-solvesthecarbonatedhydroxyapatite
min-
eral-aprocesscalleddemineralization.Pathologicalfactorsincludingacidogenicbacteria(mutansstreptococciandlacto-bacilli),salivarydysfunction,anddietarycarbohydratesarerelatedtocariespro-gression.Protectivefactors-whichincludesalivarycalcium,phosphateandproteins,salivaryflow,fluorideinsaliva,andantibacterialcomponentsoragents-canbalance,preventorreversedentalcaries.
HOWFLUORIDECOMBATSTHECARIESPROCESS
P
Sig
Theabilityoffluoridetopre-ventandarrestcarieshasbeenresearchedextensively.FhlO-ridehasthreeprincipaltopicalmechanismsofaction:-inhibitingbacterialmetabo-./lismafterdiffusingintothe~bacteriaasthehydrogenfluo-ride,orHF,moleculewhenthe'plaqueisacidified;-inhibitingdemineralizationwhenfluorideispresentatthecrystalsurfacesduringanacidchallenge;-enhancingremineralizationandtherebyformingalow-solubilityveneersimilartotheacid-resistantmineralfluorap-atite,orFAP,ontheremineral-izedcrystals.Inhibitingbacterialmetabolism.
f'
s
1l?Insummary,fluoridefromtopicalsourcesisconvertedpar-
tiully
toHFbytheacidthatthebacteriaproduceanddiffusesintothecell,therebyinhibiting('ssentialenzymeactivity.
JADA,Vol.131,July2000887
Conclusions.Cariesprogressionorreversalisdeterminedbythebalancebetweenprotectiveandpathologicalfac-tors.Fluoride,thekeyagentinbattlingcaries,worksprimarilyviatopicalmech-anisms:inhibitionofdemineralization,enhancementofremineralizationandinhibitionofbacterialenzymes.ClinicalImplications.Fluorideindrink-ingwaterandinfluoride-containingproductsreducescariesviathesetopicalmechanisms.Antibacterialtherapymustbeusedtocombatahighbacterialchal-lenge.Forpracticalcariesmanagementandpreventionorreversalofdentalcaries,thesumofthepreventivefactorsmustoutweighthepathologicalfactors.Inhibitingdemineraliza-tion.
pgc?O_
Onlywhenfluorideisconcentratedintoanewcrys-talsurfaceduringremineraliza-tionisitsufficienttobeneficial-lyalterenamelsolubility.Thefluorideincorporateddevei"OP-'mentally-thatis,systemicallyintothenormaltoothmineral-isinsufficienttohaveameasur-ableeffeCtonacid
solubility.t-"
pea'll
Insummary,fluoridepresentinthewaterphaseatlowlevelsamongtheenamelordentincrystalsadsorbstothesecrystalsurfacesandcanmarkedlyinhibitdissolutionoftoothmin-eralbyacid.
2136
Fluoridethatactsinthiswaycomesfromtheplaquefluidviatopicalsourcessuchasdrinkingwaterand./fluorideproducts.Fluoride
Jt:.
incorporatedduringtootll.<developmentisinsufficienttoplayasignificantrole
fn
cariesprotection.Fluorideisneededregularlythroughoutlifetopro-tectteeth'againstcaries.Enhancingremineraliza-tion.
P~!?~
Theclinicaleffectsoffluoride!therefore,canbeoptimizedbyusingdeliverymethodsthatbringfluoridetothesurfaceofthetoothandintotheplaqueratherthanincorporatingfluo-rideintothetoothmineral
cEXs
talsduringtoothdevelopment.Thesetopicaldeliverymethodsareequallyapplicabletoadultsandchildrenandincludefluo-rideinbeveragesandfoods,dentalproductsanddrinkingwater.
pg93
-Themechanismsofactionoffluoridedescribedinthisarticleapplyprimarilytofluoridefromtopicalsources;systemicallyincorporatedfluo-ridehasonlyaminorroleinprotectingagainstdentalcarieThisconclusionissupportednoonl;lb;llaboratorydataasdescribedpreviously,butalsobyepidemiologicstudies.s.
t
3.-3e

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