Fluoride

Fluorides in Dentistry
 Fluoride

Fluoride ion is the most potent

and practicable preventive
agent against dental caries
Occurrence of fluoride in
enviroment

soil fluoride -1
Fluoride represents the 17 most abundant element of earth crust
In rocks , soil fluoride found in combined from as fluoride , apatite,
mica, cryolite
Volconic roks as well as deposits of marine origin contain significant
amount of fluoride
fluoride in water-2

Sea water contain 0.8-1.4ppm-1

Rivers & lakes contain >0.5ppm-2
Nile water contain 0.2-0.5ppmf-3
Tap water contain 0.01-0.1ppmf-4
Deep wells contain up to 29.5ppmf in arizona &up to 40 ppm f in -4
boreholes in kenya
fluoride in air-3

Air contains 0.05-1.9microqram of

F/m 3 (in non industrial areas)
Fluoride intake by man

There are four sources from them a human can

obtain fluoride
solid foods-1
water &drinks-2
inhalation-3
fluoride –containing drugs -4
Fluoride ingestion from food

Canned fish 40mg/kg(ppm)

Chicken meat 1.0<ppm
Meat of cattle 0.2-1.0ppm
Meat fish 2-5ppm
Vegetables &fruits 0.1-0.4ppm
 fluoride intake from drinks
Human milk >0.02

Cows milk 0.02-0.05

Fresh fruit juices 0.1-0.3
Tea 0.5-1.5

) tea leaves contain 400mg/kg(

 Daily intake of fluoride from drinks
1-3mg f/day in fluoridated area
1or less mg f/day in non fluoridated area
– Depends on
temperature-1
concentration-2
age of person-3
Plant

Tea have high level of fluoride several

hundred ppm
ppm in normal value of fluoride 2-20
in plant
Animal

Same level
Chicken have high level than meat
as chicken easy fish bone
Factor affecting of absorption of fluoride

concentration of fluoride -1 •
solubility and degree of ionization-2 •
empty of stomach (presence of food -3 •
will decrease of absorption
ABSORPTION OF FLUORIDE IN MILK
IS REDUCE DURING FIRST HOUR
BUT AFTER THIS THE ABSORPTION
INCREASE AND FOR LONGER TIME
 FLUORIDE ADMINISTRATION
These can be administered systemically or applied topically
for preventive effect
A. Systemic.
1. Water fluoridation.
Community Water Fluoridation
School water fluoridation.

2. Dietary supplements.
a. Fluoride tablets and drops.
b. Fluoridized salts.
c. Fluoride vitamins preparation.
d. Fluoridized milk and fruit juices
B. Topical.
1. Those applied by professional.
a. Topical solutions and gels.
b. Fluoride containing varnishes.
c. Fluoride prophylaxis paste.
d. Restorative materials containing fluoride.
e. Fluoride containing devices (Slow Release).
2. Self applied fluoride agents.
Fluoride dentifrice
Fluoride mouth rinses
1. Community Water Fluoridation
 In 2008, 64.3% of the population served by public water systems
received optimally fluoridated water. Public water fluoridation practice
varies by city and state. Water fluoridation was recognized by the Centers
for Disease Control and Prevention (CDC) as one of the 10 greatest
public health achievements of the 20th century.
The 1984 WHO [World Health Organization] guidelines suggested that
in areas with a warm climate, the optimal fluoride concentration in
drinking water should remain below 1 mg/liter (1 ppm or part per
million), while in cooler climates it could go up to 1.2 mg/liter. [A range
of 0.7-1.2 ppm]. The differentiation derives from the fact that
perspiration is more in hot weather and consequently water intake is
more.
1. School Water Fluoridation
It’s most applicable in rural schools, where fluoridation of community
water is not feasible. Reduction in dental caries was found to be about
40%.
Disadvantages
• The children do not receive the benefits until they begin school
[belated exposure]
• Children consume the fluoridated water only when the school is in
session [abbreviated exposure].
To compensate for this belated and abbreviated exposure, the school
water is usually fluoridated at 4.5 times the optimum concentration
recommended for that place .

Recommended dosage schedule for children by

AAPD
Age Fluoride Ion Level in Drinking Water
(ppm)*
 To compensate for this belated and abbreviated exposure, the school
water is usually fluoridated at 4.5 times the optimum concentration
recommended for that place .

Recommended dosage schedule for children by

AAPD
Age Fluoride Ion Level in Drinking Water
(ppm)*
<0.3 ppm 0.3-0.6 ppm >0.6 ppm
Birth-6 None None None
months
6 months-3 0.25 None None
3-6 years
years 0.50
mg/day** 0.25 None
6-16 years 1.0
mg/day 0.50
mg/day None
mg/day
* 1.0 ppm — 1 mg/liter mg/day
** 2.2 mg sodium fluoride contains 1 mg fluoride
ion.

Dosage:
Fluoride Varnish application
Fluoride varnishes are not intended to
adhere permanently to a tooth,
but should remain in contact with the
surface for several hours.

Tooth brushing or wiping and drying with

cotton wool rolls or cotton gauze is
sufficient to clean the teeth before varnish
application; a prophylaxis is not
essential
White spots are areas of demineralization
and considered early decay—Indication for
.fluoride varnish applications
Knee to Knee Position
Child is examined in a knee-to-knee
.position with parent
Clean and Dry Teeth
It is critical to dry the teeth with a gauze
before applying the varnish
The high concentration of fluoride in
varnishes requires that only a small
amount should be applied:
 Primary dentition − up to 0.25 ml
 Mixed dentition − up to 0.4 ml
 Permanent dentition − up to 0.75 ml
A quantity of varnish covering an area of 5
to 7 mm should be placed on the surface of
.a dispensing pad
Apply Varnish with small brush
The varnish is applied with a
microapplicator, or a fine brush, to the
sites where caries is most likely to initiate;
the pits and fissures and approximal
surfaces.
Complete the lower arch before
application to teeth in the upper arch
Apply varnish to
-Anterior teeth
-Posterior teeth
-Use of the gauze to keep the teeth dry as
.the varnish is applied
The varnish hardens in response to
moisture.
Once the varnish is on the tooth, it will harden when
exposed to saliva and moisture.
Because the varnish sets under moisture, the patient can
have water immediately following the procedure unlike
recommendations for the other topical fluorides.
Post application instructions for
parents

-Varnish will set on contact with saliva.

-Child can eat or drink right after

application

-Not to brush the teeth or chew hard

food for at least 30 minutes after varnish
application; only soft foods and liquids
should be consumed for the first four
.hours after application
Frequency of application

-All children, aged 3 years and over, and

adolescents should receive applications of
fluoride varnish twice yearly.
- All those giving greater concern, for
example those with active caries, special
needs or those wearing orthodontic
appliances, should receive more frequent
application .
-Adults giving cause for concern should also
receive fluoride varnish two to four times a
year.
Type of fluoride toxicity
1- acute fluoride toxicity

chronic fluoride toxicity-2

chronic toxicity of bone-
skeletal fluorosis*
crippling fluorosis*
chronic toxicity of teeth (dental fluorosis)-
++
+-
Signs &symptoms of acute f
toxicity
the early manifestation are due to local-
action on alimentary canal
nausea -1
vomiting-2
diarrhea-3
the symptoms due to absorption-
general&local signs of muscle tetany-4
painful abdominal cramping-5
severe spasm in limbs-6
Finally

coma-7
convulsion-8
cardiac arrhythmias-9
death occurs within 2-4 hours-10
Certain lethal dose (CLD) for 70 kg adult is 5-10
gram
depend on concentration and weight======
and age
Treatment of acute fluoride toxicity
rapid measures to stimulate vomiting-1
immediate administration of antidote to prevent absorption such as lime-2
water Ca(OH)2 antacids containing aluminum or magnesium hydroxide or
milk
admit to hospital-3
less than 5 g/kg --induce vomiting-give milk-
more than 5 g/kg –go to hospital –give Ca gluconate orally Ca lactate-
++++--- more than 15 g/kg- •
Iv ca gluconate •
Cardiac monitoring •
General supportive of treatment •
Dose

endemic skeletal fluorosis 2-8 mg of-1

fluoride daily for long period
crippling fluorosis 20-80 mg of -2
fluoride daily over period of 10-20 years