Fluoride Treatment

By Dr.Ruth Tessema
• Fluoride
• Effects of Fluoride on tooth
• Types of Fluoride
• Forms of Fluoride
• Mode of Application of Fluoride
• Benefits of Fluoride
• Fluorosis
• Fluoride toxicity and Management
Fluoride
• Natural element with ionic form: fluorine.
• Mineral found in bone and teeth. Also found naturally in water, soil,
plants, and rocks.
Beneficial Effects of Fluoride On Tooth
• alters the ameloblast
• makes fissures more shallow
• stabilizes the matrix of the hydroxyapatite molecule within enamel,
making it more resistant to acid dissolution
• interferes with glycolysis, slowing down bacterial acid production
• has direct anti-bacterial effect
• its principal anti-caries action is to alter the balance of
remineralisation v. demineralization in favor of remineralisation.
Fluoride gives greatest protection to smooth surfaces
 The caries balance.
Pathological and protective factors which shift the caries balance between de- and
remineralization (modified from Featherstone 2000)
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 Fluoride

Topical
Systemic

Professiona Self applied

l Water fluoridation
Salt Fluoridation
Milk fluoridation
Fluoride tablets
Professionally Applied Topical Fluorides
• 1, Sodium Fluoride(NaF) solution
• 2, Stannous Fluoride solution
• 3, Acidulated Phosphate Fluoride solution
• 4, Varnish
1, Sodium Fluoride(2% NaF,
9040 ppm, pH 7)
Advantages
I. Chemically stable solution.
II. Acceptable taste, non irritating to the gingiva and does not discolor
teeth.
III. Inexpensive.
Disadvantage
Patient had to make four visits to the pediatric dental surgeon within a
relatively short time.
2, Stannous Fluoride Solution
(8% SnF2, 19360 ppm)
Advantages
I. Rapid penetration of fluoride to the deeper layer of enamel.
Disadvantages
I. Unstable in aqueous solution and should be prepared fresh for each patient.
II. It is highly acidic in nature (pH 2.1-2.3)
III. It has metallic taste which is unacceptable to most
of the children and patient.
IV. It may cause gingival irritation particularly to
dehydrated and diseased gingival tissues.
3, Acidulated Phosphate Fluoride(APF)
Advantages
I. APF solution is cheap.
II. It is stable in solution or gel form and have long shelf life.
Disadvantages
I. Teeth must be kept wet with the solution for 4
minutes.
II. APF solution is acidic in nature and bitter in taste.
4. Fluoride Varnish
• Protective coating that is painted on teeth to prevent cavities.

• It is indicated in:
• For moderate to high caries risk patients
• As a primary preventive measure
• As a treatment for hypersensitive tooth
• To decrease post operative sensitivity (ex. After periodontal scaling)
• Used as a cavity liner
Advantages of Fluoride Varnish
• Easy to use and fast to apply
• Can be swabbed directly on the teeth in less than 3 minutes and sits
within a minute of contact with saliva.
• Safe and posses less risk of an adverse reaction
Disadvantages of Fluoride Varnish

• Yellow discoloration of teeth which gradually fades.

• Undesirable taste in the mouth after the application.
Self Applied Topical Fluorides
• 1, Dentifrices
• 2, Mouth Washes
• 3, Fluoride Gels
1, Dentifrices

• Aid in cleansing and polishing of tooth surfaces

• Mixture of abrasive or polishing agents, detergent, binders, flavoring
agents, and substances necessary to facilitate their preparation.
• Used in paste form or powder form but powder form are more
abrasive.
Tooth paste

• A ‘smear’ or ‘rice-size’ amount of fluoridated tooth-paste

(approximately 0.1 mg fluoride) should be used for children less
than three years of age.
• A ‘pea-size’ amount of fluoridated toothpaste (approximately 0.25
mg fluoride) is appropriate for children aged three to six.
To maximize the beneficial effect of fluoride in the toothpaste,
rinsing after brushing should be kept to a minimum or eliminated
altogether.

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 ‘Smear’ – under 3 yrs. ‘Pea-sized’ – 3 to 6 yrs.

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2. Fluoride Mouth Washes/Rinses

• Sodium Fluoride rinses are usually formulated at concentrations of

either 0.2% for weekly use or 0.05% for daily use.
3. Fluoride Gels
• The gels are applied by brushing or in trays.

Disadvantages
. Present with toxicity hazard as relatively large amount of fluoride are
given in uncontrolled manner.
Water Fluoridation

• the most effective means of reducing caries,

• remains the most cost-effective,
• cost-saving, convenient, and reliable method of providing the
benefits of fluoride to the general population

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Dietary Fluoride Supplements

a. Fluoridated salt
b. Fluoridated milk
c. Fluoride in sugars
d. Fluoride in beverages
e. Fluoride drops with vitamins
f. Fluoride oral rinse supplements

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Fluoride Tablets
6 months – 3 years 0.25mg tablet
3 – 6 years 0.5 mg
> 6 years 1.0mg

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Fluorosis

• Disease caused by deposition of fluorides in the hard and soft tissues

of the body.
• Usually characterized by discoloration of teeth and crippling
disorders.
• Population living in high fluoride zone are bound to get dental
discoloration which may be seen even in deciduous teeth.
Dental fluorosis treatment
• Tooth Whitening: for mild fluorosis case
• Composite Bonding: For severe cases of fluorosis
• Porcelain Veneers: For esthetic purpose

• ***As a Prevention nutritional interventions like highly intake of

vitamin C and Calcium helps reduce fluorosis.
Prescribing Fluoride
The simple rule of thumb to prescribing fluoride is:
• select only ONE systemic method
• select ANY NUMBER of topical methods

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Fluoride Dose and Caries Reduction
The magnitude of the caries reduction is entirely dependent on the
dose of the fluoride
The higher the dose of fluoride in toothpaste, the greater the
reduction in caries.
Children at high caries risk should have at least 1000ppm fluoride
in toothpaste
Spit out after brushing but don’t rinse with water.

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Caries Risk Assessment and Fluoride Dose
The dose of fluoride toothpaste to prescribe depends on the caries
risk of the child.
a child with a low caries risk = up to 600ppm fluoride
a child with a high caries risk = 1000ppm fluoride

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 Fluoride delivering system, Fluoride
concentration and Application

1. Water fluoridation - Optimal 1ppm - Continuously

2. Fluoride tablets - 0.25-1mg - Daily
3. Fluoride drops -1000-2000ppm -Daily
4. Rinsing solution (dental) -250-1000ppm- Daily
5. Fluoridated toothpaste -500-1500ppm -Twice daily
6. Milk fluoridation -7.5ppm -At school
7. Salt fluoridation- 250-350ppm- Continuously
8. Concentrated solutions -10,000ppm -Biannually
9. Concentrated gels -4000-12,300ppm -Biannually
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The Diagnosis and Management of Acute
Fluoride Overdose
As little as 1mg/kg can cause toxicity.
Symptoms include:
• nausea and vomiting
• stomach pain
• diarrhea
• hyper salivation.

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Overdose of 5mg/kg could be fatal.
Symptoms include:
• convulsions
• respiratory and cardiac failure
• coma.

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To manage overdose:
Find out if any other poisons have been consumed.
Give milk as a chelating agent (although the evidence for this is
unclear).
Establish dose (sometimes the dose can be unreliable since it is
based on the communication between the dentist and the
overwrought parent and so it is wisest to err on the side of caution
If in any doubt, send to hospital.

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Overdose management is dependent on
amount of fluoride ingested
Under 5mg/kg
Give milk.
5–15mg/kg
Give an emetic (Ipecac syrup):
• 10mL for under 18 months old
• 15mL for older children
>15mg/kg
Admit urgently to a pediatric intensive care unit.

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How to Apply Fluoride Clinically?
Sodium Fluoride Solution (2% NaF,
9040 ppm, pH 7)
I. Clean and polish the teeth during first visit.
II. Isolate the teeth with cotton or rubber dam.
III. Dry the teeth with air syringe thoroughly

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• IV. Apply 2 percent sodium fluoride on cleaned isolated and dried
teeth with the help of cotton rolls applicator and allow drying for 4
minutes.
• Second, third and fourth application of fluoride done at weekly
interval and application is recommended at 3, 7,11 and 13 years of
age.
• V. Sodium fluoride 2 percent applied once in each visit.
• VI. Advice the patient to avoid eating or drinking for 30 minutes
after application

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Stannous Fluoride Solution
(8% SnF2, 19360 ppm)
I. A through oral prophylaxis and polishing of
teeth should be completed prior to the fluoride
application.
II. Isolate one quadrant with cotton rolls and dry the
teeth with air syringe.
III. Prepare 8 percent SnF2 solution in distilled water immediately at
the time of application.

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IV. Apply this freshly prepared solution with the help of
cotton applicator to the isolated tooth every 15-30
second.
So that the teeth are kept moist with the
solution for 4 minutes.
V. Advice the patient not to eat or drink for 30 minutes
after application.
VI. Once a year topical application of SnF2, 8 percent
is recommended.
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Acidulated Phosphate Fluoride Solution
I. A through oral prophylaxis should be completed prior to APF
application.
II. Isolate the quadrant selected for application and apply APF
solution continuously and repeatedly with the help of cotton
applicator.
III. Keep the teeth moist for 4 minutes.

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IV. Pass the APF solution dipped floss through each
interproximal embrasure to ensure wetting of these
surfaces.
V. Repeat the same procedure for the remaining
quadrant.
VI. Advice the patient not to eat or drink for half an
hour.

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Fluoride gels

• To reduce the chances of ingestion of fluoride

1. Patient should be seated in the upright position.
2. Oral prophylaxis and polishing of teeth should be completed before
application of fluoride.

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3. Rubber dam should be placed.
4. Use soft tray .
5. Only 2.5 ml of fluoride gel is placed in each stock tray (not more
than that)
6. Always use salivary ejector during and following treatment.
7. Remove excess gel from teeth with gauze following tray removal.
8. Patient is advised to expectorate repeatedly and thoroughly
following treatment

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References
Fluorides in dentistry 2nd edn, Ole Fejerskov
Fluorides in caries prevention 3rd edn, J.J Murray
http://www.gov.sk.ca/
http://www.aap.org/oralhealth/cme/
Thank you!