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 Introduction


Occurrence in nature: Widely distributed in the earth’s crust, 17th most abundant(0.06 to 0.09%)

Reactivity: It is the most electronegative of all the elements, which makes it extremely reactive. It combines with almost every element and also reacts with organic radicals. It is rarely found in the free state in nature.

Form of occurrence: Fluorine occurs as minerals as fluorspar(CaF2), cryolite(Na3AlF6) or fluorosilicates(Na2SiF6). In biological mineralized tissue, such as bones and teeth, it occurs as fluoridated hydroxyapatite(Ca10(PO4)(OH)2-X FX), where X is much smaller than 2. So, only some of the hydroxyls of the apatite lattice are replaced by fluoride ions, yet this change profoundly alters the resistance of enamel to demineralization.

Sources of fluoride: Water, Drinks(carbonated beverages, fruit juices), Tea leaves, Cereals, Meat, Fish, Infant formula

• Infant formula: o Variable amounts of fluoride, the amount depending primarily on fluoride content of water used as diluent. o It has been shown that fluoride intake during infancy may be an overriding factor in the development of enamel fluorosis of the permanent teeth.

 Fluoride metabolism:

F- in diet/supplements of GA agents

F- from inhalation

F- from metabolism

Absorption in GIT

Fluoride in plasma

Mineralized tissues urine(50% of ingested dose)

Soft tissues

Excretion in

Fluoride source may be inorganic or organic. Depending upon the physical and chemical properties of compound and its solubility, varying amounts of ingested fluoride dose will be absorbed and enter the systemic circulation. NaF is rapidly and almost completely absorbed. There is detectable rise in the plasma F- conc. only a few minutes after the dose is swallowed.

CaF2, MgF2 and AlF3 are less completely absorbed. The plasma peak usually occurs within 30 min(independent of amount of Fingested) , if dentifrice is ingested on a fasting stomach. But when the dentifrice is swallowed 15mins after a meal, the peak does not occur until after 1 hour.

The height of plasma peak is proportional to – -Fluoride ingested (directly proportional ) -Rate of absorption (directly proportional ) -Body weight of the subject (indirectly proportional ) Ingestion of fluoride with food retards its absorption. On a fasting stomach, degree of absorption of NaF is almost 100%. If taken with milk, it decreases to 70%. Absorption is only 60%, when F- is taken with calcium rich breakfast.(Reason---Fbinds with Ca++ and other food constituents and so fecal excretion of Fincreases). Clinical significance: If toothbrushing occurs soon after a meal, F- absorption will be inhibited to some extent, and high plasma F- peaks will not occur. This might be important for small children, who tend to retain and ingest more of toothpaste applied to the brush. (a thorough rinsing after toothbrushing will minimize the ingestion of F- following toothbrushing with fluoridated toothpaste.)  Absorption of fluoride • By passive diffusion

019ppm) • Diurnal changes in levels in subjects living in an area with a high fluoride conc. • The plasma fluoride level in a healthy. So. F. there is no ‘normal’ physiologic concentration. in drinking water particularly in adults.  Pharmacokinetics of fluoride . long term resident of a community with water fluoridation(1ppm) is approx 1µM(0.in diet HF is formed in stomach Readily passes through biologic membranes  Fluoride in plasma • 2 forms: o Ionic/free/inorganic o Non-ionic/bound • Fluoride levels in plasma are not homeostatically regulated but instead they rise and fall according to the pattern of fluoride intake.• From both stomach and intestine • Rate of absorption is related to gastric acidity. fasting.

the pharmacokinetic analysis shows 3 phases i. Higher the plasma concentration of fluoride. . Initial increase(represents mainly absorption): upto 1 hr Rapid fall/ α phase(represents mainly distribution to soft tissues and bone initially and then followed by resting skeletal muscle and adipose tissue): for about 1 hr iii.After single fluoride dose. faster the elimination. ii. Slower decline/ β phase(represents elimination) The plasma half-life for fluoride in human adults typically ranges from 4 to10 hrs.

in short term. the fluoride is mobilized from bone to plasma when person moves from highly fluoridated area to low water fluoride level area. So. The apatite has capacity to bind and integrate fluoride ion into its crystal lattice • The selective affinity of fluoride for mineralized tissues is.lungs liver than for less perfused tissues as resting skeletal muscle. In the long term. Distribution in mineralized tissues: • Approx.than that of plasma. 99% of all fluoride in human body is found in mineralized tissues. • During the growth phase of skeleton. skin and adipose tissues • Kidney tubules have higher conc of F.into CNS(which has only 20% that of plasma). . Distribution: Distribution in soft tissues: • More rapid in highly perfused tissues such as heart. due to uptake on the surface of bone crystallites by the processes of isoionic and heteroionic exchange. • Fluoride is not irreversibly bound to bone. a relatively high portion of an ingested fluoride dose will be deposited in skeleton( more as compared to an adult). it is actually incorporated into the crystal lattice structure in the form of fluorapatite or fluorhydroxyapatite. • Blood brain barrier is effective in restricting passage of F.

• There is direct relationship between the serum fluoride concentrations of mother and fetus. urinary pH(As the tubular fluid becomes more acidic.sweat. • Other routes.Distribution to the fetus: • The placenta is not a barrier to pssage of fluoride to fetus.  Excretion • Major route. in short term. The apatite has capacity to bind and integrate fluoride ion into its crystal lattice • The selective affinity of fluoride for mineralized tissues is. • From the fetal blood.  Fluoride in teeth and bone • Approx.via Kidneys. feces(10% of ingested dose). fluoride is readily taken by mineralizing fetal bones and teeth. 99% of all fluoride in human body is found in mineralized tissues. Renal clearance of fluoride dependent on GFR rate(more GFR.breast milk(limited transfer). more fluoride excretion). more of ionic fluoride is converted into HF which gets diffused out of tubules ). due to uptake on the surface of bone crystallites by the processes of isoionic and .

its rate of growth. a relatively high portion of an ingested fluoride dose will be deposited in skeleton( more as compared to an adult). the fluoride is mobilized from bone to plasma when person moves from highly fluoridated area to low water fluoride level area. vascularity. • The distribution and concentration in surfaces changes differentially with age. • During the growth phase of skeleton. However.4. fluoride at low pH eg. fluoride in blood.saliva and tissue fluid will be present in fully ionized form as F-.heteroionic exchange. • Concentrations in mineralized tissues are variable due to o Level of fluoride intake o Duration of exposure o Factors as stage of tissue development. o As pKa of HF is 3.binding to organic components is possible. although F. • In all mineralized tissues. In . surface area and reactivity of mineral crystallites. In the long term. • Fluoride is not irreversibly bound to bone. porosity and degree of mineralization. it is actually incorporated into the crystal lattice structure in the form of fluorapatite or fluorhydroxyapatite. • Mechanism of fluoride uptake o Body fluoride mainly as inorganic fluoride. So. fluoride levels tend to be greatest at surface since this region is the closest to tissue fluid supplying fluoride.

2) will exist almost totally in undissociated form ie. HF.the stomach(pH of approx. o Fluoride  Superficially adsorbed on crystal surfaces or loosely entrapped in hydration shells of mineral crystallites  Incorporated into interior of mineral crystallites .

inhibiting glycolysis and suppressing Streptococcus mutans.replaces OH. acquisition of fluoride by exchange or absorption will also be important.  Action of fluoride Action of fluoride depends on the conditions of its use. At low conc. Phosphate(PO43-) and hydroxyl (OH-) from tooth mineral will enter solution F. a process known as ‘ accretion’. Fluoride loss from bones and teeth: Loosely and even some of firmly bound fluoride may be lost as crystals are destroyed.together with CO32. But even during periods of active crystal growth.ion F. there is an uptake of fluoride by hydroxyapatite.o When fluoride is applied to a tooth surface in a highly concentrated form(often at low pH).ion F.may replace PO43- Most of fluoride within mineral crystallites is acquired during the period of crystal growth.replaces CO32. dissolution of apatite mineral. Professional fluoride ie high fluoride conc. affects (at least temporarily)bacterial metabolism. eg systemic fluoride provided by water fluoridation or supplements or topical fluoride from dentifrices and mouthrinses. .

Reported that children on water containing 0. using .  Hypotheses regarding fluoride’s anticaries mechanism of action 1. Fluoride also promotes and accelerates remineralization of calcium-depleted tooth structure. Alteration of tooth morphology Alteration of tooth morphology: Researcher Forrest (1956) and Ockere(1949) Wallenius(1959) Finding Commented on ‘well rounded cusps and shallow fissures’of teeth from fluoridated areas in Great Britain and South Africa. Action on the hydroxyapatite of enamel a) Decresing its solubility b) Improving its crystallinity c) Remineralizing calcium-depleted mineral 2.5ppm F. Action on the enamel surface a) Desorbing proteins and/or bacteria b) Lowering the free surface energy 4. Action on bacteria of dental plaque a) Inhibiting enzymes b) Suppressing cariogenic flora 3.0ppm F were 1.7% wider than those receiving <0. but presented no statistical data.5-1.rendering it less soluble and improving its crystallinity.

This change is suggested to affect the synthesis of protein and this reduction in amount of matrix protein further reduces the thickness of enamel and thus change in shape of fissure. it can greatly increase lattice stability. There is a consensus that occlusal surfaces are more rounded under the influence of fluoride. it is suggested that fluoride changes the ultrastructure of ameloblats.ion in lattice. When F. The results on tooth size are contradictory. Large vacuoles appear in RER (organelle associated with protein synthesis). and Reported that teeth in fluoride area were larger than in lowfluoride control area and had shallower fissures(more significant difference in mandibular molars) and obtuse inter-cuspal angels. Effect of fluoride on crystallinity and reactivity of mineral: Fluoride in interior of crystal lattice: The incorporation of fluoride can significantly alter the properties of mineralized tissues since the inclusion of any extraneous element in a crystalline lattice will alters its reactivity. The difference was Simpson Castaldi(1969) more significant in mandibular teeth in boys. Kruger showed the reduced uptake of proline by ameloblasts.plaster casts of teeth from 419 children. . presumably by attracting the protons of adjacent apatite hydroxyl ions thereby increasing degree of hydrogen bonding in so called ‘ hydroxyl column’. but the effect is generally considered to be too small to be of much practical importance. Possible mechanism of morphological effects of fluoride: Depending upon the experiments by Kruger(1968).replaces OH. In 1970.

So. the fluoridated apatite lattices are more crystalline.9% .1958 Reported that 2 enamel layers with fluoride containing 460 ppm and 1080 ppm differed in solubility by only 1. It was suggested that fluoride is producing crystal with apatite which is less soluble Issac et al. 1939 Rate of dissolution of powdered enamel decreases if it was exposed to fluoride solution prior to action of acidic buffers on powdered enamel. It can affect fluid. fluoride ion is better aligned within the plane formed by calcium ions and there is more electrostatic attraction between calcium ions and F. Studies on solubility hypothesis: Volker.crystal equilibria which involves interaction between the ions at crystal surfaces and those in solutions. compared with hydroxyl . Superficially located fluoride: Superficially located may have relatively little effect on behavior of crystallite lattice.ions as compared to Ca2+ with OH-.In addition. more stable and therefore less soluble in acid.

Acc to a study by Oliveby A(1990). Plaque appears to be able to retain and concentrate fluoride.Mechanism of topical fluorides by action on demineralization/remineralization: • Enhancement of remineralization • Inhibition of demineralization The plaque fluid containing plaque bacteria is in contact with enamel surface and saliva/GCF. Plaque fluid transports organic acids as well as fluoride. Dental plaque is normally richer in fluoride than the fluids to which it is exposed. the children living in high fluoride . calcium. The balance between these factors(fluoride and pH being most important) determines demineralization or remineralization of the tooth. phosphate and other ions to enamel surface.  Fluoride in saliva: • The conc of salivary fluoride from major salivary glands is about 2/3 of the plasma fluoride concentration and seems to be independent of flow rate • The conc of fluoride in whole saliva is related to o Dietary fluid intake o Dental fluoride preparations • The salivary fluoride levels depend upon the fluoride levels in water levels.

there is 100. toothpaste or any other fluoride vehicles. and salva becomes less important as a source of plaque fluoride.3 µM/L ).9µM/L) as compared to low fluoride areas(0.or even 1000.areas(1. • The ductal saliva is normally not an important source of fluoride in plaque or plaque fluid. This high conc of F in saliva falls rapidly. both the volume of fluid in the mouth and conc of fluoride decrease. • Fluoride in plaque: . Following topical application of fluoride in the form of mouthrinses. and within the next 3-6 hrs. giving a high salivary fluoride concentration. A diurnal variation in salivary fluoride conc was also seen in high fluoridated area.1ppm fluoride in water and 0. the saliva F conc is reduced to a few ppm within an hour. • Clearance of salivary fluoride varies considerably because of large variations in o Salivary flow rates o Volume of fluoride distribution in oral cavity o Individual variation in anatomy and the number of teeth • Fluoride from saliva to plaque: Transfer of F from saliva to plaque may occur during or immediately after mouthrinsing(0r similar procedures): a 10 mL volume of rinsing solution is diluted in only 1-2 mL of saliva. When the mouthrinse is spat out.2ppm )had higher F levels in saliva(0. Depending on the conc and type of fluoride agent.fold increase in salivary fluoride concentration of fluoride agent. returns to the baseline level.

o Free form fluoride in plaque  Using mouthrinses/ dentifrices containing fluoride Fluoride Calcium in plaque becomes supersaturated CaF2 formed Ca+ + F- . the plaque F levels are much higher than salivary F conc. low pH being associated with low fluoride concentrations. saliva and crevicular fluid. o pH of plaque appears to be an important factor. o 5-10ppm F wet weight in dental plaque o Due to slower elimination of ion from the plaque and also due to release of F from CaF2 present in plaque.o Exists in ionic and bound forms o Sources of plaque fluoride: diet. o Fluoride in plaque has a large variation at various sites in the mouth eg maxillary incisor site has a much higher conc of fluoride than the other sites.

Fluoride can be associated with calcium counterions. mainly calcium(oral environment is rich in calcium). This probably makes tooth-paste a particularly appropriate fluoride vehicle. Bacterial surfaces have a net negative charge due to abundant phosphate and carboxyl groups. which is subsequently covered by plaque. This fluoride is replenished regularly and this reservoir is scarcely depleted. Example is when paste is applied directly to tooth enamel. . • Enamel and dentin not covered by plaque may also take up fluoride. Ca+ and F. When pH approaches pK of acidic groups. • Fluoride in crevicular fluid: o Low in fluoride o F conc is closely related to plasma fluoride concentration o Not an important source of fluoride for plaque • Fluoride and dental enamel Large amounts of fluoride may be acquired by enamel as calcium fluoride when exposed to fluoride toothpaste during tooth brushing. So. which is slowly released.this source is probably less important than fluoride deposited beneath plaque.are released. The acidic groups on the surface of bacteria will acquire counterions. the CaF2 in outer enamel acts as reservoir and releases Ca and F during caries challenges. The pH changes in plaque covering this fluoride rich enamel contributes to its rapid mobilization and transfer of fluoride to plaque fluid.

whereas the cellmembranes contain phosphate groups). because fluoride penetrates more easily as HF. pretreatment with calcium ions increases fluoride retention(calcium attracted to acidic groups on the surfaces of the tissues. and retention of fluoride is based on interaction with calcium counterions.is acquired during topical application(although soft tissue fluoride is not a major source) o This uptake is pH dependent. Connective tissue has sulfate. o Some of fluoride in soft tissues is associated with calcium.and carboxyl groups. . HF is dissociated after the absorption and may not necessarily be easily released.• Fluoride reservoirs in or on the oral soft tissue: F.

 Indications: 1) Caries-active individuals defined as those with past caries experience or those who develop new carious lesions on smooth tooth surfaces 2) Children shortly after periods of tooth eruption. . A pumice prophylaxis is not an essential prerequisite to this treatment. every 3-6 months). Professional topical fluoride treatments should be based on caries-risk assessment. Appropriate precautionary measures should be taken to prevent swallowing of any professionally-applied topical fluoride. those with high caries risk should receive greater frequency of professional fluoride applications (ie. especially when the roots of teeth have been exposed. have diseases that decrease salivary flow or have received radiation to head and neck. 3) Individuals who are on salivary flow-reducting medications. Professionally applied fluorides: Accoring to AAPD. 5) Patients with fixed or removable prostheses and after placement or replacement of restorations. 4) Patients after periodontal surgery. Children at moderate caries risk should receive a professional fluoride treatment at least every 6 months. especially those who are not caries-free.

maintained during 4 minute application of agent. o o Place patient in upright position Use minimal amount of gel(no more than 2. • If solutions are used. sufficient to cover the teeth but not to exude from the tray.6) Individuals with an eating disorder or who are undergoing a change in lifestyle which may affect eating and oral hygiene habits conducive to good oral health.  Precautions: Topical fluoride agents contain relatively higher concentrations of fluoride. o o o o Use custom-fitted or stock trays with absorptive liners Warn patient not to swallow gel Use suction. the teeth should be carefully isolated with cotton rolls or gauze swabs and only enough solution applied to wet the surfaces of the teeth and keep them wet. • If gels are to be used.5ml per tray). Remove excessive gel from teeth and gingival with gauze on removal of the tray . 7) Mentally and physically challenged individuals. certain precautions need to be taken to prevent the patient from inadvertently ingesting these agents.

o Instruct patient to expectorate thoroughly after treatment  Fluoride solutions General featuresCharacteristic Fluoride(%age) Fluoride(ppm) Frequency application Stability NaF 2% 9.7. applications for 7-8 min were made 3 times a year at 3-4 monthly intervals.200 of 4 at SnF2 8% 19.23% 12. After prophylaxis and drying of teeth.1% aqueous NaF solution.500 weekly 1 or 2/year APF 1.11 and 13 Stable Unstable Disagreeable Yes Occasional. . the first clinical study to use fluoride solution was done by Bibby using 0. the caries increment in experimental quadrant was 45% lower than that found in the opposing control quadrant(Bibby 1943). Transient 32% Stable in plastic container Acidic No No 28% Taste Bland Tooth pigmentation No Gingival pigmentation No Effectiveness(average) 29%  Neutral sodium fluoride solution • In 1941. One year later.300 1 or 2/year intervals at ages 3.

The results after 3 years are as follows: quadrant No. of New DF DF s new DF DF in s s Total new in DF DF s Difference in DF surfaces(% caries-free teeth(1945 surface surface teeth(1942 ) ) previou surface ) .7. Knutson used a different technique which required four visits within a month. • In 1948. This technique was recommended by USA Public Health Service(USPHS) in public health programs Although this regimen is not convenient for private practitioners who tend to recall their patients for check-ups at 6-12 month intervals. Knutson concluded that maximum reduction in caries was achieved from 4 treatments at weekly intervals and suggested that the series of applications should be carried out at the ages of 3. Gagalan and Knutson showed that 1% NaF solution was equally effective.this would minimize the amount of time that teeth were at risk to caries attack before preventive treatments were given. • A number of studies using NaF solution reported reduction in caries. 2% aqueous NaF solution was applied for 3 min.10 and 13 years to coincide the eruption of teeth(Knutson. • In 1942.Knutson and Armstrong began a study involving children aged 7-15 years.• In 1942. After prophylaxis and drying. 1948).

with little difference observed in effectiveness.1950 cariogenic diet was superior to 10ppm of sodium fluoride in reducing caries Muhler.8 d  Stannous fluoride solution: • General features: o Both 8% and 10% sol of SnF2 have been tested. Dudding and Muhler described a method for applying SnF2 solution to teeth.1947 enamel solubility.Treated Untreate 1870 1888 214 338 teeth 287 464 teeth 216 284 503 748 32. Boyd and Stannous fluoride was 3 times more effective than sodium van Huysen.month intervals In vitro Studies: Studied in/by Conclusion Muhler and van Tin fluoride was the most effective fluoride salt in reducing Huysen . making the saliva ejector essential  Treatments recommended at 6.  Thorough prophylaxis  Teeth are kept wet for 4 mins. Muhler and 10ppm stannous fluoride in drinking water given to rats fed on Day.1950 fluoride in preventing dissolution of calcium and phosphorus . o In 1962.

1960 Brudevold.1962 conducted a 5 year study(1957-62) to compare 8%Sn F2(single annual application) and 2%NaF(4 annual applications) and every 3 years. 35% less than increment in NaF group. 1967 from enamel by dilute acids. Gish and Howell. Stannous ions form a coating on enamel surface Coating by stannous ions has no protective action against the carious process and may actually reduce fluoride uptake Clinical studies: Muhler. caries increment in SnF2 group was approx. . After 5 years.Scott.

• Causes brown discoloration of teeth particularly in hypocalcified areas and round margins of restorations. thus must be prepared freshly for each treatment.(1961) Mercer and muhler (1961) Burgess et al. it has to be freshly prepared for each treatment. .(1959) Jordan et al.(1974) Study period 1 2 1 1 2 1 1 1 2 9 Reduction surfaces(%) 28 38 24 51 29 23 none none none 37 in DMF General features: • Undergo rapid hydrolysis and oxidation.(1965) Horowitz and lucye (1966) Houwink et al.(1962) Harris(1963) Torell(1965) Wellock et al. The problem seems to be worse in patients with poor oral hygiene • Can cause reversible gingival irritation in patients with poor gingival health • As it is unstable in aqueous solution.Author Compton et al.(1959) Law et al.

by Forsyth Dental Center as acidified sodium fluoride solution. • In 1947 Bibby reported that as ph of the solution was lowered fluoride was absorbed into enamel more effectively.1M phosphoric acid and contains a fluoride concentration of 1.23% • Acidic taste due to acidic pH. based on premise that greater fluoride is taken by enamel under acidic conditions. .buffered with 0.• Disagreeable taste. • Stored and is stable in plastic container because it may etch the glass if stored in glass container.  Acidulated phosphate fluoride: • Introduced in 1963. • Brudevold et al 1963 studied the effect of prolonged exposure of enamel to sodium fluoride in acid sodium fast solutions. • Repeated or prolonged exposures of porcelain or composite restorations to APF can result in surface roughening and possible cosmetic changes. • They concluded that the fluoride concentration in enamel increased with decrease in ph of solution. As SnF2 is very reactive. • APF has pH of 3. But flavoring can be done. so flavoring to mask the taste is contraindicated.0.

23% available fluoride in 0.8 are applied in a similar manner to SnF2 sol. After 2 years. there was a high fluoride conc. .Cartwright. o Parmeijer.1M phosphoric acid at pH 2. compared the effectiveness of neutral NaF solution with an APF solution. Tossy and Below(1967) carried out the clinical trial of APF gels on seven years old children. They observed no reduction in caries increment after 1 year.• Mellberg(1966) reported that after a 10 min exposure of a cut tooth section to APF sol.Maitland and Brudevold. • Clinical studies o APF sol. Lindahl and Bawden. In the inner layers of enamel. In this study. o Szwejda.92 new surfaces were found.1965.1968).in a study of 77 children aged 4-10 years. children in the study group had approx. it was concluded that APF was 50% more effective than neutral NaF as a caries preventive agent. Brudevold and Hunt(1963). 45 new DMF surfaces were recorded whereas on the left side(NaF). o Further studies have reported reductions of 44-49% in new DMF teeth in children given annual or bi-annual applications of APF solution compared with control groups receiving treatment with tap water only(Wellock. The first clinical trial was started in 1961 by Wellock and Brudevild(1963). 66% fewer carious surfaces than children in control group. used on opposite sides of the mouth. on the right side(APF). containing 1.

Caries reductions by fluoride varnishes have been similar to those reported for fluoride solutions and gels (DeBruyn and Arends.first published trial of APF gels on 7year old children. The varnishes adhere to the tooth surface for longer periods and prevent the immediate loss of fluoride after application.3 Advantages: • Safe to use: Because the amount of varnish usually used is 0. 1990). • Application: . The varnishes were originally developed to prolong the contact time between fluoride and enamel3.  Fluoride varnishes: Duraphat was the first fluoride varnish introduced in 1960s.3-0. 1987. Ripa. thus acting as slow-releasing reservoirs of fluoride.5mL. 1989. • Szwejda. which delivers only 3-6mg fluoride. APF gels: • Available as thixotropic gels ie. Tossy and Below(1967). • Gelling agent used is usually methylcellulose or hydroxyethyl cellulose. they convert to a solution and flow more easily under pressure • Gentle pressure should be maintained on the tray to force gel approximally. Seppa.

Usually biannual applications of varnish are the most widely recommended.clean teeth.7% fluoride) Acidic Leaves a clear Hardens into a yellowish transparent film on the brown coating in presence of teeth Efficacy saliva 30-40%(Permanent teeth) 7-44%(Primary teeth) 1-17% Other varnishes: DuraFlor: Another name for Duraphat Carex: • 1. Instructions to patients: Not to eat or brush for at least 4 hrs after varnish application. The comparison between Duraphat and Fluorprotector is as under: Properties Duraphat Introduced in 1960s General consistency Viscous resinous lacquer Fluoride content pH Application 5%wt sodium Fluorprotector 1970s Polyurethane-based difluorosilane lacquer fluoride 5 wt% (2.8% fluoride • Efficacy similar to Duraphat .26% fluoride) Neutral Applied to dry. (0.

(Englander H. et al 1967. • Disadvantage: o Relatively high cost of fabricating individual trays for each patient o Dependence on the patient’s cooperation. first tested in supervised school programs.4% stannous fluoride gel(1.000 ppmF) has been used as an alternative. Many of these stannous gels have been accepted by ADA Council on Dental Therapeutics.1971). fissures and interproximal spaces. reduced decay in a nonfluoridated community by about 75% and in fluoridated community by about 30% after 2 yrs.  Fluoride mouthrinses: • 20-50% effective in reducing caries . Self applied fluorides o Self applied topical fluoride gels: • 0.05% gel(5.G. • 0. • This procedure.000ppm F) daily self application for 5 min is effective means of caries reduction • Custom fitted maxillary and mandibular trays (Toplicators) are fashioned by vacuum drawing heat-treated sheets of polyvinyl over plaster models of the teeth. Intermittent biting pressure on plastic trays tends to pump the gel into pits.

 Fluoride dentifrices: • Sodium monofluorophosphate (MFP) was first tested as a therapeutic agent in dentifrices in early 1960s.2% sodium fluoride(900ppm F) for 1 min.daily: o More effective • Available as over-the. • 0. Numerous clinical trials of dentrices containing 0. The label states that use is restricted to persons 6 yrs old and older.• The rinse should be swished between the teeth for 1 min and then expectorated.76% or 0.8% MFP have since been conducted by different groups in various countries showing approx. 25% effectiveness in caries reduction.05% sodium fluoride(230ppm F) for 1 min. • Advantages: o Safe o Effective o Relatively inexpensive o Easy to learn o Requires little time o Can be supervised by non dental personnel in school settings.biweekly use • 0.counter product. • Toothpastes containing 1000 ppm fluoride .

3 4.84 0.22% NaF 5.28 0.5 3 1. 1 yr Muhler and 2 yr Radike(Adults) Jordan and 2 yr Peterson Muhler Kyes et (Adults) Bixler Muhler Muhler Muhler and 2 yr 8 mo 3 yr 2 yr al.006 0.0001 0. 1 yr Muhler et al.3 2 2 11-17 9-15 1-2 1 * * 0.6 of Reduction in Level carious surface per increment(%) 49 36 34 13 21 63* 0.48 0.) pH Duration(yr ) Age(yr) Statistically significant reductions in carious surfaces saved % redn P Brudevold 0.013 0. carious surfaces saved year 1.87 0.22% NaF+ 4.0001 statistical of significance Muhler et al.01 * and Chilton Peterson 1.66 11-12 7-14 - - - Investigators Duration of Trial No. 3 yr 0.01 0.005 NS 0.85.5% soluble and Williamson Slack et al.41 8 45 22 NS 0.0062 .46 0.Investigators Active ingredient(% conc.8 0.18 1.85. orthophosphate * Zacherl 0.

Finn Jamison Slack Martin and 2 yr and 2 yr 1.2 No placebo 46 true No placebo true - .

CONTENTS  Introduction to fluorides  Sources of fluoride  Metabolism  Absorption  Distribution  Excretion  Mechanism of action  Professionally applied fluorides o Solutions  Sodium fluoride  Stannous fluoride  APF o Gels o Foams  Self applied fluorides o Gels .

o Mouthrinses o Dentifrices .

131.References  Fluorides in caries prevention.the disease and its clinical management. ADR 1994 8: 190  JADA.By Fejerskov  B. Seppä and G. 132. L.Murray  Fluorides in dentistry. July 2000  JADA. 32:83-92  Journal Of Minimum Intervention In Dentistry. Øgaard. 2009. Vol.Fejerskov  Dental caries. Professional Topical Fluoride Applications-. September 2001  Caries research 1998. 2 (4) 225 . Vol. Rolla.Clinical Efficacy and Mechanism of Action.

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