anchal ppt
TRANSCRIPT
TOPICAL FLUORIDE
Presented by-
Dr. ANCHAL CHANDAK
B.D.S ( FINAL YEAR)
CONTENTS
Introduction History Fluoride delivery methods Factor affecting topical fluoride deposition Mechanism of action Method of application Advantages Disadvantages conclusion
INTRODUCTION
fluoride is the ionic form of the element fluorine.
It is the member of the halogen family and it is the most electronegative and reactive of all the elements .
The word flourine is derivd from the latin term “fluore”meaning to flow .
HISTORY OF TOPICAL FLUORIDE
In early 1940’s it was demonstrated that extracted teeth when exposed to dilute solution of fluoride on for few seconds were found to have completely bound fluoride on the enamel surface which subsequently was less soluble than the original enamel surface .
These two fact brought forth the idea of topical application of fluoride solution of dental caries prevention .
In 1941 began the era of topical fluoride when the first clinical study of sodium fluoride was carried out by Bibby using a 0.1% sodium fluoride solution.
In early 1950’s stannous fluoride occupied a central role in the saga of preventive dentistry.
After the discovery sodium fluoride a wide variety of other fluoride compounds were tried like potassium, lead ,
silicon, tin and zirconium.All yielded some cariostatic benefit but stannous fluoride was
found to be 3 time more effective than sodium fluoride
FLUORIDE DELIVERY METHODS
Fluoride can be derived as
A.Topical fluoridesB.Systemic fluorides
Topical fluorides Systemic fluorides These are placed
directly on the teeth. Some preparation
provide high or low concentration of fluoride over a short period of time
These circulate through the bloodstream and are incorporated into the developing teeth.
They provide a low concentration of fluoride over along period of time.
INDICATIONS
Caries active individuals. Children shortly after a period of tooth eruption. Patient with eating disorder or who are undergoing
a change in lifestyle which may affect eating or oral hygiene habits conductive to good oral health.
Mentally and physically challenged individuals. Patient with fixed or removable prosthesis and after
placement or replacement of restorations. Patient with reduce salivary flow due to
medications Patient reciving radiation of head and neck
Factors affecting topical fluoride deposition
Tooth condition
Treatment formulation
Application procedure
TOPICAL FLUORIDES PRODUCTS ARE DIVIDED INTO TWO CATEGORIES
PROFESSIONALLY APPLIED SELF APPLIED
1.Sodium fluoride Toothbrushing dentrifices
2. Stannous fluoride Toothbrushing solutions
3.Acidulated phosphate fluoride
Mouthrinses
4.Fluoride varnishes5.Fluoride gel
SODIUM FLUORIDE – 2 %
METHOD OF PREPERATION:- 9040ppm at pH 7
Sodium fluoride solution can be prepared by dissolving 20 gms of of sodium fluoride powder in 1 litre of distilled water in a plastic bottle.
KNUTSON TECHNIQUE
RECOMMENDED AGES
Full series of four treatment is recommended at ages 3,7,11and13 YEARS
MECHANISM OF ACTION OF NaF
NaF + Hydroxyapatite crystal Calcium Fluoride
CHOCKING OFF
Calcium Fluoride + Hydroxyapatite crystal
Fluoridated Hydroxyapatite
Advantages :- Accepted taste Stable if stored in plastic bottle Non-irritating to gingiva Does not discolor the teeth Inexpensive
Disadvantages : Four visits relatively at short period of time which
is difficult from the patient and parent’s point of veiw
STANNOUS FLUORIDE
It has been used in 8 % and 10% concentrations.
Method of preparation; 19360 ppm at PH 2.1-2.3
A solution of stannous fluoride are not stable . Soon after mixing they become cloudy due to formation of tin hydroxide .
A fresh solution of stannous fluoride be prepared for each patient.
Muhler's technique
Do a thorough prophylaxis Isolate a quadrant with cotton roll and dry the
teeth Apply the freshly prepared 8% stannous
fluoride continuously to the teeth with cotton applicators
Reapply the solution every 15-30 sec ,so that the teeth are kept moist for 4 min.
Instruct the patient not to eat, drink, rinse for 30 sec
Application is recommended once a year
Mechanism Of Action OF STANNOUS FLUORIDE
SnF2+hydroxyapatite Stannous
Tri-Fluorophosphate
Other end products:-1. Tin hydroxyphosphate2. Calcium-tri fluorostannate3. Calcium fluoride
Advantages:- Application required only once per year Rapid penetration of tin and fluoride within 30
sec.
Disadvantages :- Has to be prepared freshly each time before
use Metallic taste Causes gingival irritation Discoloration of teeth Staining of margins of restoration
ACIDULATED PHOSPHATE FLUORIDE- 1.23%
Method Of Preperation [Brudevolds Solution ] :-
By dissolving 20 gms of sodium fluoride in 1 litre of 0.1 M Phosphoric acid.
To this 50% hydrofluoride acid added to adjust the pH at 3.0 and fluoride conc. At 1.23 %.
APF GEL :- A gelling agent methylcellulose is to be added
to the solution and the pH is to be adjusted between 4-5.
MECHANISM OF ACTION OF APF
APF Gel applied on
tooth
Dehydration and shrinkage in volume of
hydroxyapatite crystalsOn Further
hydrolysis intermediate
product dicalcium phosphate dihydrate
(DCPD)highly reactive with
fluoride
Fluoride penetrate
deeply into crystals
through the openings
produced by shrinkage and
leads to formation of fluoroapatite
Advantages-1. Required only 2 applications in a year.2. The gel preparations can be self applied and
thus, cost of application also get reduced.3. It has the ability to deposit fluoride in
enamel to deeper depth.disadvantages-4. Practical difficulties like the teeth should be
kept wet for 4min.5. It is acidic sour and bitter in taste.6. It can be stored in glass container only.
FLUORIDE VARNISHES
Fluoride varnishes are developed in order to increase the retention of topical fluoride on to the enamel for a longer period of time.
Thus, providing an improved cariostatic action.
TECHNIQUE OF FLUORIDE VARNISHES
After prophylaxis teeth are dried but not isolated cotton rolls since, varnish sticks to cotton.
Total of 0.3-0.5 ml of varnish is required to cover full dentition.
Application is first done on lower arch then upper, using single tufted small brush, starting with proximal surfaces.
Patient is asked to sit with mouth open for 4min to let duraphat set on teeth.
Duraphat
This fluoride varnish contains sodium fluoride.
Made by alcoholic solution of natural varnishes
It sets very faster rapidly in the presence of moisture when applied .
It remains on to the applied tooth surface for upto the next 12 hours after application.
Fluoroprotector
It contain 2% difluorosilane. The varnish form is made by
polyurethane lacquer which is dissolved in chloroform .
Sets faster than duraphat
Method Of Application
Oral prophylaxis
Dried the tooth surface
Applied varnish over all the surfaces
Pt. is instructed not to close the mouth and to remain wide open for 4 minutes
Pt is instructed not to eat drink or rinse for 1 hour
SELF APPLIED FLUORIDE
Fluoride dentifrices Fluoride mouth rinses Fluoride gels
FLUORIDE DENTIFRICES
1. High Potency Fluoride Dentifrices (>1000ppm)2. Low Potency Fluoride Dentifrices (< 1000ppm)
Fluoride dentifrices for children are currently widely available in market.
They contain 500ppm
A pea size amount of toothpaste is appropriate for children 2-5 yrs of age
Recommendation for use of fluoride toothpaste
Child age :
Below 4 years: not recommended 4-6 years: once daily by fluoridated
toothpaste 6-12 years: brushing twice daily with
fluoridated toothpaste and once with non fluoridated
Above 12 years: brushing three times with fluoridated toothpaste.
FLUORIDE MOUTH RINSES
They used as an adjunct to fluoride dentifrices for caries control and prevention .
They provide 35% reduction in dental caries
Commonly used fluoride mouth rinses are:-1. 0.2% Sodium Fluoride – 900 ppm (Weekly ) 2. 0.05% Sodium Fluoride – 225 ppm (Daily )3. 0.01% Acidulated Sodium Fluoride At Ph 4 –
45ppm 4. Stannous Fluoride Mouth Rinses
FLUORIDE GELS
Fluoride gel product include neutral sodium fluoride and APF with a fluoride concentration of 5000ppm and stannous fluoride with a concentration of 1000ppm.
The gels are either applied in trays or brushes on teeth.
Self applied once a day or more, while professionally applied given twice a year.
Home fluoride gels are not recommended to children before 2years and younger.
CONCLUSION
Fluoridation is universally accepted by the dentist as being useful in preventing tooth decay.
They can be useful in areas where fluoride concentration is low in water supply.
It helps in maintaining a good oral health.
REFERENCE
1. Essential Of Preventive And Community Dentistry; 11th edition ; Soben Peter.
2. Topical fluoride- Amit Tiwari.3. Textbook of pediatric dentistry; 3rd edition;
Nikhil Marwah.
4. Textbook of pediatric dentistry: 2nd edition; Shobha Tandon