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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.


Professionally applied topical fluorides:

It was introduced by Bibby in 1942.

Involve the use of high fluoride concentration products
ranging from 5000-19,000ppm, which is equivalent to 5-
19 mgF/ml.

Self applied products:

Include fluoride dentifrices, mouth rinses & gels

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





Topical fluorides are divided into two categories:
PROFESSIONALLY APPLIED
TOPICAL FLUORIDES:

1.FLUORIDE VEHICLES:

Aqueous solutions & gels

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

Thixotropic solutions are not
gels, but have a high viscosity
under storage conditions &
become fluid under conditions of
high stress


FLUORIDATED
PROPHYLACTIC PASTES:

If prophylaxis pastes
containing fluoride are used,
the lost fluoride is
replenished & there is a
significant gain in the
concentration of fluoride.


FOAM:

Developed to minimise the risk of fluoride over dosage
as well as to maintain the efficacy of topical fluoride
treatment.

Advantages :

Its lighter than a conventional gel & therefore only a
small amount of agent is needed for topical application
The surfactant has cleansing action by lowering surface
tension, this facilitates the penetration of material into
interproximal surfaces.
It doesnt require suctioning so it offers advantages for
home use
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.
FLOURIDE APPLICATION

FLOURIDE VARNISH

TOPICAL FLUORIDES USED IN PREVENTIVE
DENTISTRY:

1.SODIUM FLUORIDE:
2.STANNOUS FLUORIDE
3.ACIDULATED PHOSPHATE FLUORIDE
4.AMINE FLUORIDE

NEUTRAL SODIUM FLUORIDE

A minimum of four applications with a 2% sodium fluoride
solution gives a caries reduction of 30%.

METHOD OF PREPARATION:

It is prepared by dissolving 20 gms of NaF powder in 1L of
distilled water in a plastic bottle
KNUTSONS TECHNIQUE:

At the initial appointment teeth are cleaned with pumice slurry &
then isolated with cotton rolls & dried with compressed air.

Using cotton-tipped applicator sticks ,the 2% NaF is painted on
air dried teeth so that all tooth surfaces are visibly wet. The
solution is allowed to dry for 3-4 min.

This procedure is repeated for each of the isolated segments
until all the teeth are treated.




A 2
nd
, 3
rd
and 4
th
fluoride application, each not preceded by a
prophylaxis, is scheduled at intervals of approximately one week;

The four-visit procedure is recommended for ages 3, 7, 11 and 13
years, coinciding with the eruption of different groups of primary
and permanent teeth.

Advantages of neutral sodium fluoride solution :

It is relatively stable when kept in a plastic container;
The taste is well accepted by patients;
The solution is non-irritating to the gingiva;
It does not cause discoloration of tooth structure;
The series of treatments must be repeated only 4 times in the
general age range of 3 to 13, rather than at annual or semiannual
intervals.

Disadvantage of neutral sodium fluoride solution :

The major disadvantage of the use of sodium fluoride is that the patient
must make 4 visits to the dentist within a relatively short period of
time.

STANNOUS FLUORIDE : (SnF2) :

Stannous fluoride has been used at 8% and 10% concentrations
Method of preparation of stannous fluoride solution :

Solutions of stannous fluoride are not stable. Soon after mixing
they become cloudy due to the formation of tin hydroxide.

A fresh solution of stannous fluoride be prepared for each patient.

To prepare 8% stannous fluoride solution, the content of one
capsule which is 0.8 grams (0 No. of gelation capsule) is dissolved
in 10 ml of distilled water in a plastic container.

Technique of application (Muhlers technique) :

1. Each tooth surface is cleaned with pumice or other dental
cleaning agent for 5 to 10 seconds;
2. Unwaxed dental floss is passed between the interproximal areas;
3. Teeth are isolated and dried with air;
4. Stannous fluoride is applied using the paint-on technique and the
solution is kept for 4 minutes. Repeat applications are made
every 6 months or more frequently if the patient is susceptible to
caries.

Advantages of stannous fluoride :

Using an 8% stannous fluoride solution at 6 to 12 months
intervals conforms to the practicing dentists usual patient
recall system;
Administrative difficulties are avoided.

Disadvantages of stannous fluoride :

1. In aqueous solution the material is not stable;
2. 8% solution is quite astringent and disagreeable in taste, its
application is unpleasant;
3. The solution occasionally causes a reversible tissue irritation
manifested by gingival blanching;
4. Causes pigmentation of teeth which has a characteristic light
brown colour



ACIDULATED PHOSPHATE FLUORIDE (APF) :

Method of preparation of acidulated phosphate fluoride :

An aqueous solution is acidulated phosphate fluoride is
prepared by dissolving 20 grams of sodium fluoride in 1 liter
of 0.1 M phosphoric acid and to this is added 50%
hydrofluoric acid to adjust the pH at 3.0 and fluoride ion
concentration at 1.23%. It is also called as Brudevolds
solution

For the preparation of acidulated phosphate fluoride gel, a
gelling agent methylcellulose or hydroxyethyl cellulose is
added to the solution.


Technique of application :

Acidulated phosphate fluoride is recommended for application at 6 or 12
months intervals.
Oral prophylaxis is done;
The teeth to be treated are completely isolated and thoroughly dried
with air;
Clinical application of APF gels should be done using trays that fit the
patients upper and lower dental arches. A disposable foam-lined tray
is preferred;
To reduce ingestion of fluoride, a minimum amount of fluoride gel that
will permit complete coverage of the tooth surfaces should be
dispensed;
After the trays have been properly positioned saliva ejector is used to
evacuate the stimulated saliva and excess fluoride;
It is reapplied every 15-30 seconds so as to keep the teeth moist with
the fluoride solution throughout the 4 minute period;
The patient is instructed to eat, drink or rinse his mouth for atleast 30
minutes.

FLUORIDE
TRAYS
Advantages of acidulated phosphate
fluoride

Requires only 2 application in a year;
The gel preparation can be self applied and
thus the cost of application also gets
reduced;
It has the ability to deposit fluoride in
enamel to a deeper depth;

Disadvantages of acidulated
phosphate fluoride :
Practical difficulties like the teeth should be
kept wet for for 4 minutes;
It is acidic, sour and bitter in taste;
It cannot be stored in glass containers.
SELF-APPLIED TOPICAL FLUORIDES

It includes:

Dentifrices

Mouth rinses

Gels

DENTIFRICES:

The active agent was NaF which had been added to a
conventional dentifrice containing dicalcium phosphate
as the abrasive.


FLUORIDE MOUTH
RINSES:

Mouth rinsing is a practical
and effective means for self-
application of fluoride.
Persons excluded from the
practice are :

1. Children under 6 years of
age;
2. Those of any age who
cannot rinse because of
oral-facial musculature
problems or other
handicap.

Method of use :

1. Rinse daily with 1 teaspoonful (5 ml) after brushing
before bed;
2. Swish between teeth with lips tightly closed for 60
seconds; expectorate.

Flouride rinses can be used as daily mouth rinse by
community and fortnightly in schools.

Advantages :
30-40% average reduction in dental caries incidence.

Disadvantages :
Requires community participation.