 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.• From both stomach and intestine • Rate of absorption is related to gastric acidity. in drinking water particularly in adults. there is no ‘normal’ physiologic concentration.  Pharmacokinetics of fluoride . long term resident of a community with water fluoridation(1ppm) is approx 1µM(0. • The plasma fluoride level in a healthy. fasting.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. F. So.

Higher the plasma concentration of fluoride. the pharmacokinetic analysis shows 3 phases i. Slower decline/ β phase(represents elimination) The plasma half-life for fluoride in human adults typically ranges from 4 to10 hrs. . faster the elimination.After single fluoride dose. ii. 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.

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

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

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

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

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

Action on bacteria of dental plaque a) Inhibiting enzymes b) Suppressing cariogenic flora 3. Fluoride also promotes and accelerates remineralization of calcium-depleted tooth structure. but presented no statistical data. Action on the hydroxyapatite of enamel a) Decresing its solubility b) Improving its crystallinity c) Remineralizing calcium-depleted mineral 2.5ppm F.rendering it less soluble and improving its crystallinity. using . Action on the enamel surface a) Desorbing proteins and/or bacteria b) Lowering the free surface energy 4. Reported that children on water containing 0.7% wider than those receiving <0.0ppm F were 1. 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.  Hypotheses regarding fluoride’s anticaries mechanism of action 1.5-1.

it can greatly increase lattice stability. presumably by attracting the protons of adjacent apatite hydroxyl ions thereby increasing degree of hydrogen bonding in so called ‘ hydroxyl column’. . The results on tooth size are contradictory. but the effect is generally considered to be too small to be of much practical importance.plaster casts of teeth from 419 children. The difference was Simpson Castaldi(1969) more significant in mandibular teeth in boys. When F. it is suggested that fluoride changes the ultrastructure of ameloblats. 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. There is a consensus that occlusal surfaces are more rounded under the influence of fluoride.ion in lattice. Possible mechanism of morphological effects of fluoride: Depending upon the experiments by Kruger(1968). 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. In 1970. 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. Kruger showed the reduced uptake of proline by ameloblasts.replaces OH. Large vacuoles appear in RER (organelle associated with protein synthesis).

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

Plaque fluid transports organic acids as well as fluoride. Dental plaque is normally richer in fluoride than the fluids to which it is exposed.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 appears to be able to retain and concentrate fluoride. phosphate and other ions to enamel surface. The balance between these factors(fluoride and pH being most important) determines demineralization or remineralization of the tooth. calcium. Acc to a study by Oliveby A(1990).  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. the children living in high fluoride .

3 µM/L ).areas(1. returns to the baseline level.or even 1000. and salva becomes less important as a source of plaque fluoride. This high conc of F in saliva falls rapidly.fold increase in salivary fluoride concentration of fluoride agent. • The ductal saliva is normally not an important source of fluoride in plaque or plaque fluid. there is 100. • Fluoride in plaque: . and within the next 3-6 hrs. toothpaste or any other fluoride vehicles. Following topical application of fluoride in the form of mouthrinses. Depending on the conc and type of fluoride agent. the saliva F conc is reduced to a few ppm within an hour. both the volume of fluid in the mouth and conc of fluoride decrease. • 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(0.9µM/L) as compared to low fluoride areas(0. A diurnal variation in salivary fluoride conc was also seen in high fluoridated area. giving a high salivary fluoride concentration.1ppm fluoride in water and 0.

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. o pH of plaque appears to be an important factor.o Exists in ionic and bound forms o Sources of plaque fluoride: diet. 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. low pH being associated with low fluoride concentrations. 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. saliva and crevicular fluid.

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

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

especially those who are not caries-free. 5) Patients with fixed or removable prostheses and after placement or replacement of restorations. every 3-6 months). Professionally applied fluorides: Accoring to AAPD. Children at moderate caries risk should receive a professional fluoride treatment at least every 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. A pumice prophylaxis is not an essential prerequisite to this treatment. 4) Patients after periodontal surgery. have diseases that decrease salivary flow or have received radiation to head and neck. especially when the roots of teeth have been exposed.  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. those with high caries risk should receive greater frequency of professional fluoride applications (ie. 3) Individuals who are on salivary flow-reducting medications.

sufficient to cover the teeth but not to exude from the tray. • If solutions are used.  Precautions: Topical fluoride agents contain relatively higher concentrations of fluoride. 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. o o Place patient in upright position Use minimal amount of gel(no more than 2. certain precautions need to be taken to prevent the patient from inadvertently ingesting these agents. maintained during 4 minute application of agent. 7) Mentally and physically challenged individuals. • If gels are to be used. o o o o Use custom-fitted or stock trays with absorptive liners Warn patient not to swallow gel Use suction.5ml per 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. Remove excessive gel from teeth and gingival with gauze on removal of the tray .

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. the first clinical study to use fluoride solution was done by Bibby using 0.1% aqueous NaF solution.7.o Instruct patient to expectorate thoroughly after treatment  Fluoride solutions General featuresCharacteristic Fluoride(%age) Fluoride(ppm) Frequency application Stability NaF 2% 9.300 1 or 2/year intervals at ages 3. After prophylaxis and drying of teeth.11 and 13 Stable Unstable Disagreeable Yes Occasional. . applications for 7-8 min were made 3 times a year at 3-4 monthly intervals.200 of 4 at SnF2 8% 19. One year later.23% 12.500 weekly 1 or 2/year APF 1. the caries increment in experimental quadrant was 45% lower than that found in the opposing control quadrant(Bibby 1943).

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 ) .Knutson and Armstrong began a study involving children aged 7-15 years. 1948). 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. 2% aqueous NaF solution was applied for 3 min. After prophylaxis and drying. 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.10 and 13 years to coincide the eruption of teeth(Knutson.this would minimize the amount of time that teeth were at risk to caries attack before preventive treatments were given. • In 1942. Knutson used a different technique which required four visits within a month. • A number of studies using NaF solution reported reduction in caries.7. Gagalan and Knutson showed that 1% NaF solution was equally effective. The results after 3 years are as follows: quadrant No.• In 1942. • In 1948.

with little difference observed in effectiveness.Treated Untreate 1870 1888 214 338 teeth 287 464 teeth 216 284 503 748 32.1947 enamel solubility. Dudding and Muhler described a method for applying SnF2 solution to teeth. making the saliva ejector essential  Treatments recommended at 6. o In 1962.1950 cariogenic diet was superior to 10ppm of sodium fluoride in reducing caries Muhler.  Thorough prophylaxis  Teeth are kept wet for 4 mins. Muhler and 10ppm stannous fluoride in drinking water given to rats fed on Day.month intervals In vitro Studies: Studied in/by Conclusion Muhler and van Tin fluoride was the most effective fluoride salt in reducing Huysen .1950 fluoride in preventing dissolution of calcium and phosphorus . Boyd and Stannous fluoride was 3 times more effective than sodium van Huysen.8 d  Stannous fluoride solution: • General features: o Both 8% and 10% sol of SnF2 have been tested.

. 1967 from enamel by dilute acids. After 5 years.Scott. Gish and Howell. 35% less than increment in NaF group. 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. 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.

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. .(1959) Jordan et al.(1959) Law 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. • Causes brown discoloration of teeth particularly in hypocalcified areas and round margins of restorations.(1962) Harris(1963) Torell(1965) Wellock et al.Author Compton et al.(1965) Horowitz and lucye (1966) Houwink et al. thus must be prepared freshly for each treatment. it has to be freshly prepared for each treatment.(1961) Mercer and muhler (1961) Burgess et al.

• They concluded that the fluoride concentration in enamel increased with decrease in ph of solution. so flavoring to mask the taste is contraindicated. based on premise that greater fluoride is taken by enamel under acidic conditions. . But flavoring can be done. by Forsyth Dental Center as acidified sodium fluoride solution.• Disagreeable taste.  Acidulated phosphate fluoride: • Introduced in 1963. • Repeated or prolonged exposures of porcelain or composite restorations to APF can result in surface roughening and possible cosmetic changes. • Stored and is stable in plastic container because it may etch the glass if stored in glass container.1M phosphoric acid and contains a fluoride concentration of 1.0. As SnF2 is very reactive.buffered with 0. • Brudevold et al 1963 studied the effect of prolonged exposure of enamel to sodium fluoride in acid sodium fast solutions.23% • Acidic taste due to acidic pH. • In 1947 Bibby reported that as ph of the solution was lowered fluoride was absorbed into enamel more effectively. • APF has pH of 3.

Tossy and Below(1967) carried out the clinical trial of APF gels on seven years old children. • Clinical studies o APF sol. 66% fewer carious surfaces than children in control group.8 are applied in a similar manner to SnF2 sol.Cartwright. Lindahl and Bawden. 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. containing 1. The first clinical trial was started in 1961 by Wellock and Brudevild(1963).Maitland and Brudevold. In this study.92 new surfaces were found. compared the effectiveness of neutral NaF solution with an APF solution. on the right side(APF).• Mellberg(1966) reported that after a 10 min exposure of a cut tooth section to APF sol. o Parmeijer. .23% available fluoride in 0.1968). They observed no reduction in caries increment after 1 year. children in the study group had approx. o Szwejda. After 2 years. there was a high fluoride conc. it was concluded that APF was 50% more effective than neutral NaF as a caries preventive agent. In the inner layers of enamel.1965. Brudevold and Hunt(1963). used on opposite sides of the mouth.1M phosphoric acid at pH 2. 45 new DMF surfaces were recorded whereas on the left side(NaF).in a study of 77 children aged 4-10 years.

Caries reductions by fluoride varnishes have been similar to those reported for fluoride solutions and gels (DeBruyn and Arends. 1990). • 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. APF gels: • Available as thixotropic gels ie.3-0. which delivers only 3-6mg fluoride. • Szwejda. thus acting as slow-releasing reservoirs of fluoride. • Application: . 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 0.5mL. 1987. Seppa. Tossy and Below(1967). The varnishes were originally developed to prolong the contact time between fluoride and enamel3. 1989. Ripa.  Fluoride varnishes: Duraphat was the first fluoride varnish introduced in 1960s.first published trial of APF gels on 7year old children.

26% fluoride) Neutral Applied to dry. 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 .Usually biannual applications of varnish are the most widely recommended.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. (0.clean teeth. Instructions to patients: Not to eat or brush for at least 4 hrs after varnish application.

(Englander H. • 0.4% stannous fluoride gel(1.000 ppmF) has been used as an alternative. first tested in supervised school programs. Self applied fluorides o Self applied topical fluoride gels: • 0.000ppm 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.G. • This procedure. • Disadvantage: o Relatively high cost of fabricating individual trays for each patient o Dependence on the patient’s cooperation.1971).05% gel(5. fissures and interproximal spaces. Intermittent biting pressure on plastic trays tends to pump the gel into pits. Many of these stannous gels have been accepted by ADA Council on Dental Therapeutics. et al 1967.  Fluoride mouthrinses: • 20-50% effective in reducing caries . reduced decay in a nonfluoridated community by about 75% and in fluoridated community by about 30% after 2 yrs.

Numerous clinical trials of dentrices containing 0.76% or 0.  Fluoride dentifrices: • Sodium monofluorophosphate (MFP) was first tested as a therapeutic agent in dentifrices in early 1960s. • 0.counter product.2% sodium fluoride(900ppm F) for 1 min. The label states that use is restricted to persons 6 yrs old and older.8% MFP have since been conducted by different groups in various countries showing approx.05% sodium fluoride(230ppm F) for 1 min. • Toothpastes containing 1000 ppm fluoride . • 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. 25% effectiveness in caries reduction.daily: o More effective • Available as over-the.biweekly use • 0.• The rinse should be swished between the teeth for 1 min and then expectorated.

0001 0. 3 yr 0.46 0.01 0.005 NS 0.87 0.28 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* 0.5% soluble and Williamson Slack et al.48 0.18 1.41 8 45 22 NS 0.006 0.5 3 1.013 0.22% NaF+ 4.66 11-12 7-14 - - - Investigators Duration of Trial No.0001 statistical of significance Muhler et al.22% NaF 5.01 * and Chilton Peterson 1.3 4.8 0. carious surfaces saved year 1. orthophosphate * Zacherl 0. 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.84 0.) pH Duration(yr ) Age(yr) Statistically significant reductions in carious surfaces saved % redn P Brudevold 0.85.0062 .Investigators Active ingredient(% conc.85.

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 .

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