Topical and systemic fluorides including sodium fluoride, stannous fluoride and APF in detail. It comes as long question in BDS final year(CCS University)

1. Chinkita Chaudhary
(BDS-Final Year)
ITS Dental College, Greater Noida
TOPICAL AND SYSTEMIC
FLUORIDES

2. FLUORIDES CAN BE DELIVERED
AS :-
FLUORIDES
TOPICAL
FLUORDES
SYSTEMIC
FLUORIDES

3. TOPICAL FLUORIDE
 Topical fluorides are placed directly on
the teeth
 Local chemical reaction to exposed
surfaces of the erupted dentition.

4. TOPICAL FLUORIDES
Professionally applied
products
Dispensed in dental offices
High fluoride concentration
Self applied
products
Dispensed at home by
individual but at
recommendation
Low fluoride concentration

5. INDICATIONS
 Caries – Active individuals
 Children after tooth eruption who are
not caries free
 Individuals with decreased salivary flow
 When roots are exposed after
periodontal surgery
 Patients with prosthesis (fixed or
removal)
 Mentally and physically compromised

6. 1.PROFESSIONALLY APPLIED
TOPICAL FLUORIDES
 Bibby in 1942 was first to demonstrate that
the repeated application of sodium or
potassium fluoride to the teeth of children
significantly reduced their caries prevalence.
 RATIONALE:- Speed the rate and increase
the concentration of fluoride acquisition
above the level, which occurs naturally.
 Best time to apply topical fluoride is soon
after eruption, since immature and porous
enamel acquires fluoride rapidly

7. FLUORIDE VARNISH
Durph
at
• First fluoride
varnish
22,600ppm
F as NaF in
colophonium
base
Fluop
r-
otecto
r
• Base-
polyurethan
e
• 7000 ppm F
as silane
fluoride
Carex
• It contains
lower fluoride
concentration
than durphant,
but efficacy
equivalent to
that of durphant

8. TECHNIQUE OF VARNISH
APPLICATION
Prophylaxis and dry the
teeth do not isolate with
cotton
Application of varnish with small
brush first on lower arch starting
with proximal surface.
It is than sit to let dry for 4
minutes before spitting
Patient is asked not to rinse
or drink for one hour

9. TOPICAL FLUORIDE COMPOUNDS
USED IN PREVENTIVE
DENTISTRY
AGETNTS
CURRENTLY IN
USE
SODIUM
FLUORIDE(NaF)
ACIDULATED
PHOSPHATE
GEL (APF)
STANNOUS
FLUORIDE(SnF₂)

10. SODIUM FLUORIDE(NaF)
METHODS OF
PREPARATION OF 2%
NaF
MECHANISM OF
ACTION
 Dissolve 20 gm of NaF
powder in 1 liter(1000ml)
in plastic bottle
 Silica of glass container
react with fluoride ion
forming silicon fluoride
which reduces free active
fluorides.
 9,040 ppm
 pH-7
 NaF + Ha -> Caf₂
 Thick layer of calcium
fluoride interferes with
further diffusion of F
from the topical agent
(NaF). This is known as
“choking off effect”
 CaF₂ reacts with
hydroxyapatite forming
fluoridated
hydroxyapatite on the
enamel surface

11. METHOD OF APPLICATION(knutsons
technique)

12. ADVANTAGES DISADVANTAGES
 Relatively stable
when kept in plastic
container
 Taste is well
accepted
 Non irritating to
gingiva
 Does not cause
discoloration
 Patient must make
four visits to the
dentist within a
relatively short
period of time.

13. STANNOUS FLUORIDE :-
METHOD OF
PREPARATION
MECHANISM OF
ACTION
 It is prepared fresh
before each application
 8% Snf₂ (19,360 ppm)
 pH 2.4- 2.8
 0.8 g of capsule is
dissolved in 10ml of
distilled water.
 SnF + HA  CaF +
SnHA+ calcium
trifluorostanate
+stannous
triflurophosphate
 Tin-tri-
fluorophosphate is
resposible for making
the tooth structure
more stable

14. TECHNIQUE OF
APPLICATION:-
ADVANTAGES
DISADVANTAGES
 Metallic taste
 It is highly unstable
 Causes reversible
tissue irritation.
 Administrative
difficulties are
avoided

15. ACIDULATED PHOSPHATE
FLUORIDE
 Used as 2 forms (1) Solution (2) Gel form
 1.23% F (12,300 ppm)
 pH -3, pH-4 (gel)
 METHOD OF PREPARATION :- Dissolve 20g of NaF
in 0.1M of phosphoric acid and add 50% of
hydrofluoride to adjust the pH(3), known as
Brudevold’s solution
 MECHANISM OF ACTION:- Dehydration and
shrinkage of HA crystals and forms DCPD. This DCDP
reacts with fluoride ions and forms Fluorapatite.

16. BRUDEVOLD’S TECHNIQUE
ADVANTAGES DISADVANTAGES
 Requires 2
application in a year
 APF is stable and
need not to be freshly
prepared
 fluoride can reach to
 It is acidic sour and
bitter in taste
 Cannot be stored in
glass containers
 Practical difficulties
PROPHYLAXI
S
PROPHYLAXIS
ISOLATE THE
QUADRANTS WITH
COTTON ROLLS
APLLY THE
SOLUTION WITH
COTTON
APPLICATOR
CONTINIOUSLY
AND REPEATEDLY
KEEP THE TEETH
MOIST FOR 4
MINUTES
ASK THE PATIENT
NOT TO EAT,
DRINK OR RINSE
FOR ONE HOUR
APPLY ONCE IN 6
MOTHS

17. TECHNIQUE( FOR GEL)

18. 2.SELF-APPLIED TOPICAL
FLUORIDES
 It includes dentifrices, gels and rinses
 Intended for daily use
 Expose dentition to about 0.5-3.4 mg fluoride each
time they are used
SELF APPLIED
TOPICAL
FLUORIDE
DENTIFRICES
FLUORIDE
MOUTHRINSES
FLUORIDE
GELS

19. SYSTEMIC FLUORIDE
 They circulate through the bloodstream
 Provides low concentration of fluoride to
teeth over a long period of time
 Incorporates in developing teeth
Systemic
fluoride
Salt
fluoridation
Community
Water
fluoridation
Milk
fluoridation
Fluoride
tablets/drops/l
ozenges

20. COMMUNITY WATER
FLUORIDATION
 Addition of fluoride to public water supplies
 Optimal level- 1ppm (protection against caries) –reduces
caries up to 50%
 Cold climate - 1.2 ppm
 Hot climate - 0.8 ppm
 Defined as the upward adjustment of the concentration of
fluoride in communal water supply as to achieve maximum
caries reduction and a clinically insignificant level of
fluorosis.
 OPTIMAL WATER FLUORIDE CONCENTRATION:-
Galagan &Vermillion (1957) developed an empiric
formula for estimating the amount of daily fluoride intake
based on body weight & climatic conditions as follows:

21. Controlled Water Fluoridation
Studies
 ppmF=0.34 ⁄ E
E= 0.038 ⁺ 0.0062 XT
‘E’ is estimated daily water intake by children
‘T’ is mean maximum daily air temp.
1.Grand-Rapids-muskegon study
2.Newburgh-Kingston study
3.evanston-Oak Park Study
4.Tiel-Culemborg fluoridation Study

22. Methodology of estimation of fluoride
concentration in drinking water
 It includes :
 SAMPLE COLLECTION:-500ml of water is collected
and 2 CC of 6N HCl is added to inhibit microbial
growth
 METHODS OF ESTIMATION :-
Fluoride electrode
coupled with standard
pH meter
Scot-Sanchis method

23. Choice of equipment and chemicals
for water fluoridation
Fluoride compounds used in
water fluoridation.
Types of equipment for
water fluoridation.
 Fluorspar
 Sodium fluoride
 Silicofluorides
 Sodium Silicofluoride
 Hydrofluosili
 Ammonium Silicofluoride
 The saturator system
 Dry feeder
 The solution –feeder
system

24.  1.SATURATOR SYSTEM
Principle: A 4% saturated solution of NaF is
produced and injected at desired concentration at
the water distribution source with the aid to pump.
• 2.DRY FEEDER:-
Principle:- Sodium fluoride or Silicofluoride in the form of
powder is introduced into a dissolving basin with the aid of
an automatic mechanism to ensure maintenance of the
correct supply of fluoride according to the amount of
water to be delivered.
• 3.Solution feeder:-
Principle:-Volumetric pump permitting the addition of a
given quantity of hydrofluorosilic acid in proportion to the
amount of water treated.

25. TECHNICAL CONSIDERATIONS FOR
WATER FLUORIDATION.
 To avoid problems such as obstruction of pipes and
the hazard of toxic dusts, it is appropriate to use a
liquid fluosilicic acid rather than fluoride in powder
form.
 MAINTAINANCE AND CONTROL
 CONTROL AT THE WATER TREATMENT PLANTS
 CONTROL OF THE QUALITY ANALYSIS
 FLUORIDATION CAN BE CONSIDERED ONLY IF :-
1. Water supply reaching a reasonable no. of homes
2. People drink this water
3. Supply of a suitable F chemical is assured
4. there is sufficient money available

26. SCHOOL WATER FLUORIDATION
PROGRAMS
 Suitable alternative because children would consume
it during school days
 Concentration of fluoride is more due to less intake of
water
 Recommended level- 4.5 -6.3 ppm
 ADVANTAGES :- Effective public health measure
Target population- school children
Quite economical
 DISADVANTAGES:- Need co-operation from school
authorities
Limited pre-eruptive benefits
to primary teeth

27. SALT FLUORIDATION
 Controlled addition of F, pottasium or sodium F
 Introduced by Wepsi in 1948 in Switzerland
 Level of fluoride can be kept at 200,250 and 350 mg
of F per kg salt
 PRODUCTION : BATCH PROCESSING
CONTINUOUS PROCESSING
ADVANTAGES:- Permits individuals to accept or reject
it
Does not require community water
supply
DISADVANTAGES: There can be large variations in
salt intake .
It can be decreased by

28. MILK FLUORIDATION AND
FLUORIDE
TABLETS/LOSANGES/DROPS