Fluoride is a mineral that is best known for its role in making teeth more resistant to decay. Fluoride is found naturally in varying amounts in water, reaching streams and rivers from rocks and soil. Cavities used to be a fact of life but as a result of fluorides, tooth decay has been reduced dramatically. It also helps repair the tooth in the early stages of decay.
Gels and foams are used for individuals who are at high risk for caries, orthodontic patients, patients undergoing head and neck radiation, patients with decreased salivary flow and children whose permanent molars should, but cannot, be sealed.
The gel or foam is applied by the use of a mouth tray. The tray is held in the mouth by biting. Application generally takes about four minutes and patients should not rinse, eat, smoke or drink for at least 30 minutes after application.
Some gels are made for home application and are used in a manner similar to toothpaste. The concentration of fluoride in these gels is much lower than professional products. Most widely operator administered fluoride in gel form is APF gel (Acidulated phosphate fluoride).
A gelling agent methylcellulose or hydroxyethyl cellulose is to be added to the solution and the pH is to be adjusted between 4-5.
Twice a year
When APF is applied to the tooth it forms an intermediate product called DCPD (Dicalcium phosphate dihydrate). This DCPD is highly reactive with fluoride and penetrates into the crystals more deeply and leads to the formation of fluorappitite.
Stannous Fluoride concentrate is an excellent home care product for the control of plaque and root caries.
Provide stannous ion: Stannous ion inhibit or disrupt plaque colonies.
Provides fluoride ion: Fluoride ions have multiple benefits.
Great tasting: Easy to apply with a brush. Comes in 3 flavours: Red Berry, Cinnamon, Peppermint.
For those patients that need home fluoride but cannot tolerate the acidic stannous type gels. Comes in convenient 4.3 oz. bottles. 24 bottles per case. Sodium Fluoride concentrate is 1.1%.
Neutral formulation: Ideal for patients with porcelain or composite restorations. Provides high concentration of fluoride ions.
A highly effective tooth desensitizing gel for home use. Excellent for hypersensitivity, gingival recession and localised pain. Available in 6 bottles containing 2-oz. of medication.
Gel-Kam Gel is a 0.4% stable stannous fluoride gel that is an effective decay-preventive home-use gel of significant value when used as directed. With regular use it relieves sensitivity in normal teeth. However, clinical effectiveness against plaque, gingivitis or other periodontal indications has not been proven.
Fluoride varnish has practical advantages over gels in ease of application, a non-offensive taste and smaller amounts of applications are required. Varnish is intended for the same group of patients as the gels and foams. The varnish is applied with a brush and sets within seconds. A varnish is better over the gel since it is sticky in nature and stays longer as compared to the gel.
Two most commonly used varnish
A colourless, polyurethane lacquer. The fluoride compound is diflurosilane ethyl diflorohydroxy silane. Fluoride available is 7000ppm.
It is a sodium fluoride in varnish form containing 22.6mgF/ml suspended in alcoholic solution of natural organic varnishes. The active fluoride available is 22,600ppm.
Since the fluoride concentration in varnishes is higher they are better preventatives compared to mouth rinses.
The most common fluoride compound used in mouth rinse is sodium fluoride. Over-the-counter solutions of 0.05% sodium fluoride (225 ppm fluoride) for daily rinsing are available for use. Fluoride at this concentration is not strong enough for people at high risk for caries.
Prescription mouth rinses are more effective for those at high risk for caries, but are usually contraindicated for children, especially in areas with fluoridated drinking water. However, in areas without fluoridated drinking water, these rinses are sometimes prescribed for children.
Most commonly administered fluoride mouth rinses are sodium fluoride and stannous fluoride.
This solution is prepared by dissolving 20 gms of sodium fluoride in 1 liter of distilled water and is stored in a plastic bottle.
Recommended at age interval of 3,7,11,13 yrs.
Once a year
The other end products are
Systemic fluorides are those that are ingested into the body and become incorporated into forming tooth structures.
Systemic fluorides such as community water fluoridation and dietary fluoride supplements are effective in reducing tooth decay. These fluorides provide topical as well as systemic protection because fluoride is present in the saliva.
Water fluoridation is the most effective way to prevent tooth decay in the community irrespective of race, class, gender, age or educational level. It is the least expensive way of ensuring that the greatest number of people achieve the maximum gain in protection against tooth decay. A reduction of the disease burden is likely to be seen within two years of the programme being instituted.
The fluoride level in water is a major factor in determining the dosage for children between 6 months and 16 years of age.
| Age | Fluoride ion concentration in drinking water | ||
|---|---|---|---|
| 0.3 | 0.3-0.6 | 0.6 | |
| Birth-6 months | None | None | None |
| 6 mon-3 yrs | 0.25 mg/day | None | None |
| 3-6 yrs | 0.50 mg/day | 0.25 mg/day | None |
| 6-16 yrs | 1.0 mg/day | 0.50 mg/day | None |
(acc. to ADA, AAPD, AAP)
Dietary fluoride supplements (tablets, drops or lozenges) are available only by prescription.
| Name/Strength | Form | Child Dosage | Max child dosage |
|---|---|---|---|
| Sod. fluoride, drops-2mg/ml fluoride | Drops |
1/2 dropperful= 0.25mg
1 dropperful= 0.5mg
2 dropperful= 1mg
|
Prescribe no more than 200ml per household |
| Sodium fluoride | Drops |
2 drops= 0.25mg
4 drpos= 0.5mg 8drops= 1mg |
Prescribe no more than 30ml per household |
| Sodium fluoride, drops- 2.5mg/ml fluoride | Drops |
2 drops= 0.25mg
4 drpos= 0.5mg 8 drops= 1mg |
Prescribe no more than 30ml per household |
| Sodium fluoride, drops- 5mg/ml fluoride | Drops |
1 drops= 0.25mg
2 drops= 0.5mg 4 drops= 1mg |
Prescribe no more than 23ml per household |
| Sodium fluoride, rinse 0.2mg/ml fluoride | Rinses | 1mg fluoride / teaspoonful (0.2mg fluoride/ml) swished for 1 min then swallowed | Prescribe no more than 500ml per household |
| Sodium fluoride tablets and lozenges- 0.25mg fluoride | tablets and lozenges | 1 tablet or lozenge per day taken with water or juice and dissolved in mouth or chewed | Prescribe no more than 480 tablets or lozenges per household |
| Sodium fluoride tablets and lozenges- 0.5mg fluoride | tablets and lozenges | 1 tablet or lozenge per day taken with water or juice and dissolved in mouth or chewed | Prescribe no more than 240 tablets or lozenges per household |
| Sodium fluoride tablets and lozenges- 1mg fluoride | tablets and lozenges | 1 tablet or lozenge per day taken with water or juice and dissolved in mouth or chewed | Prescribe no more than 120 tablets or lozenges per household |
