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FLOURIDESFLOURIDES
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INTRODUCTIONINTRODUCTION
y WHO has declared it as one of the 14 essential elements for
normal growth & development
y It has an atomic number of 9 & atomic weight of 19
y Fluorine means to flow in latin, it is a pale yellow green gas.
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HISTORIC REVIEWHISTORIC REVIEW
y 1901: Dr. Fredrick Mc Kay of Colorado USA discovered
permanent stains on teeth of patients and named it Colorado
Stains. Mc Kay named it as mottled enamel
y 1931: Shoe Leather Survey byTrendly H Dean.He was assigned
the job to continue Mc Kays work and find the geographical
distribution of mottled enamel.
y 1934: Trendly H Dean introduced Deans flourosis index
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SOURCES OF FLOURIDESOURCES OF FLOURIDE
y Fish products especially canned fish like salmon & sardines have
fluoride content of 40 mg/kg
y Banana & potatoes contain fluorides
y Rock salt contains 40 200 ppm of fluorides
y Tea leaves and instant tea contains 100 400ppm of fluoride
y Mineral water contains 1.5 7 ppm
y Breast milk
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ACTION OF FLUORIDES IN CARIESACTION OF FLUORIDES IN CARIES
REDUCTIONREDUCTION
y Increased enamel resistance / Reduction in enamel solubility
y Increased rate of post eruptive maturation
y
Remineralisation of incipient lesiony Fluoride as an inhibitor of demineralisation
y Interface with microorganisms
y Modification in tooth morphology
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y Increased enamel resistance:
Forms fluorapetite layer that reduces the solubility of enamel bypromoting the precipitation of hydroxyapetite and phosphate
y Increased rate of post eruptive maturation:
Newly erupted teeth have hypomineralised areas & fluorideincreases the rate of mineralisation or maturation.
Deposition of organic matter increases the resistance to caries
y Remineralisation of incipient lesion:
It is the deposition of minerals in previously damaged areas whichappear as white spots
Remineralising solutions contain fluorides with calcium &phosphate ions the sources of which are saliva
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y Interference with micro organisms:
In high concentrations fluoride is bacteriocidal & in low
concentrations it is bacteriostatic
Fluoride interacts with bacterial cell in ph dependent factor
y Modification in tooth morphology:
Diameter & cusp depth are smaller if fluoride are present, that
helps to keep the teeth self cleansing
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FLUORIDE DELIVERY METHODSFLUORIDE DELIVERY METHODS
y Topical
High concentration
Low concentration
y Systemic - Fluoridation
y Combination of both Fluoride rinses swished & swallowed
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TOPICAL FLUORIDESTOPICAL FLUORIDES
y It can be divided into:
Professionally applied
Self applied
y Professionally applied: Applied in dental office set up by a dentist. Ithas a high fluoride content of 5000 19000 ppm
y Self applied: They include mouthrinse, gels & dentifrices. It has low
fluoride content 200 1000 ppm
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FLUORIDES VEHICLESFLUORIDES VEHICLES
y Professional topical application of fluoride are available as Sodium
Fluoride, Stannous Fluoride & Acidulated Phosphate Fluoride
y Aqueous Solutions & Gelsy Thixotropic Solution
y Fluoridated prophylactic paste
y Foam
y Fluoride Varnish
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METHODS OFAPPLICATION OF TOPICALMETHODS OFAPPLICATION OF TOPICAL
FLUORIDEFLUORIDE
y Paint on technique
y Tray technique
y
Paint on technique: 2% Sodium Fluoride & APF gely Tray Technique: APF gels
y Knutsons Technique
y Swejda - Knutson
y Muhlers single application techniquey Mercer & Muhler
y Dubbing & Muhler
y Englader
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y Knutsons Technique:
After prophylaxis each tooth is wetted with solution which is
allowed to dry for 3 4 min, three further applications are done in
a weeks interval. Recommended age are 3,7, 11 & 13
SELFAPPLIED FLUORIDESELFAPPLIED FLUORIDE
y Dentifrices
y Gels
y Mouthrinses
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TOXICITY OF FLUORIDESTOXICITY OF FLUORIDES
y Acute
y Chronic
y Acute Toxicity: Rapid excessive ingestion of fluoride, it causesfluoride to combine with hydrogen in gastric juices to formhydrofluoric acid. CLD is 32 64 mgF / kg, STD is 8 16 mgF/kg
y Initial symptoms are
y Nausea, abdominal cramps, vomiting, diorrhea G I
y Hypotension, shock, weak pulse C V
y CNS depression
y Chronic Toxicity: Fluorosis
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SYSTEMIC FLUORIDESSYSTEMIC FLUORIDES
y Common methods of systemic supplements are:
Fluoride drops with or without vitamins
Fluoride tablets with or without vitamins
Lozenges
Oral rinses
y Compounds used are NaF & APF
y Concentration 0.125, 0.25, 0.50 mg tablets or drops
y Not more than 1 mg of fluoride should be ingested each day
y
Target population For infants & children upto 13 to 16 yrs
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COMMUNITY WATER FLUORIDATIONCOMMUNITY WATER FLUORIDATION
y Definition:
Controlled adjustment of conc. of fluoride in communal water
supply so as to achieve max caries reduction & a clinically
insignificant level of fluorosis
y Fluoride compounds in water fluoridation:
Fluorspar
Sodium fluoride
Silicofluorides
Sodium silicofluorides
Hydrofluosilicic acid
Ammonium Silicofluoride
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EQUIPMENTS FOR WATER FLUORIDATIONEQUIPMENTS FOR WATER FLUORIDATION
y The Saturator system
y The Dry feeder system
y The Solution feeder system
Principles:
y Saturator system: 4% saturated solution of NaF is produced &
injected at desired conc at water distribution source with the aid
of pump
y Dry feeder system: NaF or Silicofluoride in the form of powder is
introduced into dissolving basin with automatic mechanism toensure correct conc to amount of water
y Solution feeder: Volumetric pump permitting the addition of given
quantitiy of hydrofluosilicic acid to the amount of water treated
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DEFLUORIDATION OF WATERDEFLUORIDATION OF WATER
y NalgondaTechnique:
Involves addition of two chemicals sodium aluminate or lime,
bleaching powder & filter alum to flouride water.
y Steps:Rapid mix
Flocculation
Sedimentation
Filtration