SYSTEMIC FLUORIDES

Lesson Plan

 Subject: Public Health Dentistry

 Topic: Systemic Fluorides
 Name of teacher: Dr. Rekha P. Shenoy
 Date: 12.03.2022
 Duration: 60 minutes
 Time: 08.30 am to 09.30 am
 TL Method: Interactive lecture
 Media: LCD, PowerPoint
Sl. No. Specific Learning Objective Content Duration

1. Students should be able to 1. Introduction 05 minutes

explain the rationale behind
the use of systemic fluorides.

2. Students should be able to 1. Salt fluoridation 15 minutes

describe in brief the history,
advantages and
disadvantages of salt
fluoridation.
Sl. No. Specific Learning Objective Content Duration

3. Students should be able to 1. Milk fluoridation 15 minutes

describe in brief the history,
advantages and
disadvantages of milk
fluoridation.

4. Students should be able to 1. Fluoride supplements 15 minutes

describe in brief the history,
advantages and 2. Summary
disadvantages of fluoride 3. Conclusion
supplement use.
Index:

 Introduction

 Salt fluoridation

 Milk fluoridation

 Fluoride (F) supplements

 Summary

 Conclusion
 Introduction

Means of administering Fluorides / Modalities of Fluoride (F) delivery

 Topical

 Systemic

 Community water fluoridation (0.7 - 1.2 ppm)

 School water fluoridation (4 - 4.5 times the optimal level)
 Salt fluoridation
 Milk fluoridation
 Fluoride (F) supplements
Salt Fluoridation
 History

 1946 -- Wespi initiated the 1st salt fluoridation experiment in

Switzerland

 1st done in Zurich

 Studies done with concentrations of 90 mg F / kg salt &

200 - 350 mg / kg salt

 Optimal concentration = 200 – 250 mg F / kg salt

 Reduction in Dental Caries

 Similar to that seen with optimally fluoridated water

AGENTS USED ARE

 NaF

 KF
 Advantages

1. Economic
 costs are lower than those for water fluoridation

 F required is lesser than that for water fluoridation

2. Unlike daily intake of F tablets or drops,

 no attention has to be paid to lifelong daily compliance
3. Freedom of choice

4. Acceptable

5. Safe -- toxic level of salt is reached before that of F

6. Simple, easy to implement, wide coverage

 Disadvantages

1. Consumption is lowest when F is most needed

2. Large individual variations in salt intake

3. Varying suboptimal F levels in water will require different

concentrations in salt

4. Need for control of fluoridated salt in processed food

Salt Fluoridation System
Milk Fluoridation
 History

 potential for milk as a vehicle for fluoridation – in

Switzerland by Zeigler in 1953; 1st done at Winterthur in 1955
 Rationale

 Milk is nutritious -- most complete single food item

 a convenient & cost-efficient vehicle

 targeted at communities in greatest need

 Reduction in Dental Caries

 43% reduction in DMFS after 5 years

 Advantages

 Selectively offered to children during their developmental

years

 Freedom of choice

 Risk of overdose is small

 Both systemic & topical effects

 Disadvantages

 Individuals vary in how much milk they consume

 Lactose intolerance?

 Daily affordability of milk?

 Production of Fluoridated Milk

 To calculate appropriate F-concentration, it is necessary to

consider the volume of milk consumed by a child

 5 ppm in 250 ml of milk

 Agents used are NaF, CaF2 & Disodium MFP

Fluoride Supplements
 History

o 1st recommended by Erharde to promote better dental health

among children & pregnant women

o Used since the 1940s

 Dietary Supplements

1. F drops

2. F tablets

3. F lozenges

4. Liquids, F-vitamin preparations

The correct amount of F is based on the age of the child & the
existing F levels in water.
 Fluor-A-Day Chewable Tablet

0.25mg

1mg
0.5mg
 Lozi Flur Cherry Flavor
Fluoritab Liquid
Lozenge

0.25 mg/drop
1 mg
 F drops: infants, by mouth / added to food

 F tablets: chewed, swished & swallowed by older children;

in infants – crushed in food or dissolved in water

 F lozenges: sucked by older children; in infants – crushed in

food or dissolved in water

 F-vitamin preparations: combined supplement

 WHO Recommendations

Fluoride Content of Drinking Water

Ages
0 - 0.3 ppm 0.3 - 0.7 ppm > 0.7 ppm

6 mo – 2 yrs. 0.25 mg F 0 0

2 – 4 yrs. 0.5 mg F 0.25 mg F 0

4 – 16 yrs. 1.0 mg F 0.5 mg F 0

 Advantages

1. Used in areas where other systemic methods of F

administration are not possible

2. Effective
 40 - 80% reduction in caries experience

3. Both systemic & topical effects

4. Freedom of choice
 Disadvantages

1. Cannot be used as an alternative to water or salt fluoridation

but is effective in controlled situations

2. Expensive

3. Long term patient compliance

4. Inadvertent use
 increased risk of fluorosis
 greater chances of toxicity
 Summary

 The use of Systemic fluorides (in water, salt, milk and as

supplements) in caries prevention is widespread

 Selection of the type of Systemic fluoride to be used in a particular

situation depends on various factors such as its cost-effectiveness,
indications and contra-indications of use
 Conclusion

 Fluoride has played a vital role in caries reduction across the world

 Systemic fluorides have proven effectiveness in caries prevention

and are, therefore, of great importance if used in specific situations
 Assignment

 Classify the different modalities of Fluoride delivery and write a note on

milk fluoridation. (2+3=5)

 Milk fluoridation. (3/5)

 Salt fluoridation. (3/5)

 Fluoride supplements. (3)

 Reference

 Soben Peter. Essentials of Public Health Dentistry. 7th edition. 2022.