GOOD MORNING

TOPICAL FLUORIDE DELIVERY

METHODS
ANAND MATHEW JOHNY
III BDS
CONTENTS

 INTRODUCTION

 DIFFERENT METHODS OF DELIVERY

 PROFESSIONALLY APPLIED TOPICAL FLUORIDES

 SELF APPLIED TOPICAL FLUORIDE

 CONCLUSION
 INTRODUCTION

Through scientific research and technological advances and a better understanding

of the disease process, dentistry has now emerged from a purely reparable art towards a
preventive-oriented science. The Cariostatic efficacy of fluoride has been convincingly
demonstrated and a recent decline in caries prevalence is primarily attributed to the
increased use of fluoride agents. Methods of fluoride delivery include:

 TOPICAL FLUORIDES

 SYSTEMIC FLUORIDES
 TOPICALLY APPLIED FLUORIDES:
This term, by definition, is used to describe those delivery systems which
provide fluoride for a local chemical reaction to exposed surfaces of the erupted
dentition.
INDICATIONS
1. Caries 5. Patients with fixed or removable prostheses and

2. Children shortly after periods of tooth eruption, after placement or replacement of restorations.

especially those who are not caries-free. 6. Patients with eating disorders or who are
undergoing a change in lifestyle which may affect
3. Those under medications to reduce salivary flow
eating or oral hygiene habits conducive to good
or have received radiation to head and neck.
oral health.
4. After periodontal surgery when roots of teeth 7. Mentally and Physically challenged individuals.
have been exposed.
 FLUORIDE DELIVERY METHODS

 PROFFESSIONALLY APPLIED SELF APPLIED PRODUCTS

PRODUCTS
Products are usually bought and
Those medicaments typically applied by a
dispensed by the individual patient but
dental professional and usually involve the
at the recommendation of dental
use of fluoride concentration ranging from
personnel. These involve products with
5000 to 19,000 ppm, equivalent to 5 – 19
fluoride concentrations ranging from
mg F/ml.
200 to 1000 ppm or 0.2 to 1.0 mg F/ml
 PROFESSIONALLY APPLIED TOPICAL
FLUORIDES

 SODIUM FLUORIDE (NaF)

 ACIDULATED PHOSPHATE FLUORIDE (APF)
 STANNOUS FLUORIDE (SnF2)
 AMINE FLUORIDE
NEUTRAL SODIUM FLUORIDE

 1st fluoride compound to be used for topical application.

 Minimum 4 applications with 2% sodium  30% caries reduction.

 PREPARATION:
- 20 grams NaF in 1 L of distilled water
- Stored in a plastic bottle (Not in a glass container as NaF may react with Silica)
 METHOD OF APPLICATION:

2% NaF painted
Tooth Cleaned Left to dry for Once for
over teeth with
& Air dried 3- 4 mins 3-4 weeks
cotton tips

 MECHANISM OF ACTION
 NaF reacts with hydroxyapatite crystals to form CaF2
 CaF2 causes a “Choking effect” i.e.; CaF2 acts as a fluoride reserve and
leaches it slowly.
CaF2 also reacts with hydroxyapatite crystals to form fluoridated
hydroxyapatite, thus leaving more fluoride reserve on enamel and making it
caries resistant.
 ADVANTAGE DISADVANTAGE

Chemically stable Continuous application for 4 minutes

Acceptable taste Multiple visits

Non-irritating to gingiva Follow-up difficult

Does not discolor teeth

Cheap and inexpensive

 STANNOUS FLUORIDE

 Used at 8% and 10% concentrations equivalent to 2 and 2.5% fluoride

 8% is most commonly used

 PREPARATION:
One capsule (0.8 gm) of stannous fluoride capsule is dissolved in 10mL of
distilled water and solution is shaken briefly.
It is recommended to use freshly prepared SnF2, because it becomes cloudy
and when aged becomes less effective.
 METHOD OF APPLICATION (Muhler’s technique)

Tooth Cleaned 2% SnF2

Left to dry for 4
painted over Biannually
& Air dried minutes
teeth with
cotton tips
 MECHANISM OF ACTION
Calcium tri-fluoro stannate, tin-tri-fluorophosphate and calcium fluoride are formed.
Calcium fluoride makes the tooth structure more stable and less susceptible to
decay.
 ADVANTAGE DISADVANTAGE

6 to 12 month intervals convenient for

Need to be freshly prepared
normal patient recall system

Avoid frequent visits Low ph

Metallic taste due to stannous

hydroxylphosphate

Cause discoloration

Gingival irritation

Causes staining on restoration margins

ACIDULATED PHOSPHATE FLUORIDE

 METHOD OF PREPARATION:
20g of NaF is dissolved in 0.1 M phosphoric acid and to this 50%
Hydrofluoride acid is added to adjust the pH at 3.0 and F concentration at
1.23%.
Gelling agent like Methylcellulose or Hydroxyethyl cellulose is added
and pH adjusted to 4-5.
 METHOD OF APPLICATION:
After prophylaxis, the lingual and buccal sides are isolated with cotton rolls.
The patient is positioned upright and provides a saliva ejector.
A disposable foam-lined tray is filled one-third with APF and placed on the
arch.
Squeeze the gel to different surfaces and let the tray remain in the mouth for
4 minutes.
The patient is asked to expectorate after the tray is removed.
patiavoidsvoid drinking and eating for the next 30 minutes.
 MECHANISM OF ACTION:
Initial dehydration with shrinkage of hydroxyapatite crystals
Hydrolysis and formation of intermediate product Dicalcium phosphate
dihydrate (DCPD).
DCPD is highly reactive with fluoride to form Fluoroapetite
The amount and depth of fluoride deposition are dependent on the amount
and depth at which DCPD gets formed. This is why the tray is left on for 4
minutes, to keep the tooth surface wet.
 ADVANTAGE DISADVANTAGE

Has Acceptable taste Teeth have to be kept wet for 4 minutes

No Staining Solution is Acidic

No Gingival irritation

Stable with long shelf life

Cheap
AMINE FLUORIDE

 Organic fluoride compounds were found to be more effective in reducing

enamel solubility.

 Properties that enhance their potential as a cariostatic agent.

 Surface active compounds and holds fluorides for a longer time against the
tooth.

 Have antibacterial properties – reduced plaque formation and antiglycolytic

activity
SELF APPLIED TOPICAL FLUORIDES

 DENTIFRICES
 FLUORIDE MOUTH RINSES
 FLUORIDE GELS
 DENTIFRICES

 It has been demonstrated that subjects who brush twice per day or more with either
1000ppm fluoride, 1500ppm, or 2500ppm fluoride, have significantly fewer caries
than subjects using the same formulations who brush once per day or less.

 Fluoride dentifrices may play a more significant caries prevention role since it
requires active participation by the patient to have any effect.
 SODIUM FLUORIDE
DENTIFRICES
Formulated with
calcium pyrophosphate  AMINE FLUORIDE
abrasive system. DENTIFRICES
Insoluble
metaphosphate
abrasive and
polishing agent
 STANNOUS FLUORIDE
DENTIFRICES

 MONOFLUOROPHOSPHATE
FLUORIDE MOUTHRINSES
 Most commonly used: Sodium Fluoride mouth rinses.
Other fluoride mouth rinses include stannous fluoride,
amine fluoride, and ammonium fluoride

 Formulated at either 0.2% (900 ppm F) for weekly use

or 0.05% (225 ppm F) for daily use.

 They are to be forcefully swishing 10ml of liquid around

the mouth for 60 seconds before expectorating it.
FLUORIDE GELS

 Include neutral sodium fluoride and acidulated phosphate with a fluoride

concentration of 5000ppm and stannous fluoride concentration of 1000 ppm.
 Applied in trays or brushed for teeth

 Used once or twice daily, either brushed for

a minute or using a tray for 5 minutes.

 Not To Be Swallowed and must be rinsed

off after application

CONCLUSION

When used appropriately, fluoride is a safe and effective agent that

can be used to prevent and control dental caries. Fluoride has contributed
profoundly to the improved dental health of people all over the world.
Fluoride is needed regularly throughout life to protect teeth against tooth
decay. However, since fluoride is considered to be a double-edged sword, it
must be used judiciously so that dental caries is prevented and the deleterious
effects of dental and skeletal fluorosis avoided
SOURCES

 Essentials of PUBLIC HEALTH DENTISTRY - 7th Edition – Soben Peter.

 Textbook of Pediatric Dentistry – 4th Edition – Nikhil Marwah.

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