Topical fluoride Definition : Those delivery systems which provide fluoride for exposed surface of erupted dentition.

Factor affecting uptake of topical fluoride : 1) Condition of tooth a)Tooth age : inverse relation between enamel fluoride uptake & age of tooth. e.g. unerupted permanent enamel(8)>permanent enamel(1). b)Natural fluoride concentration : fluoroapatite hydroxyapatite so enamel with high acquire less fluoride. lesssolublethan natural fluoride local chemical reaction to

c)Enamel defects : open caries , incipient caries ,microcrackes, more fluoride than sound enamel. d)Dentin / Cementum : 10 times more acquire fluoride than enamel. 2 Formulation of agent

hypomineralizedareas require

a)Fluoride agent : fluoride uptake from any agent depend on concentration of fluoride,pH & type of fluoride. b)PH : low pH dissolution of enamel crystals more fluoride uptake. fluoride

c)Fluoride concentration : increase fluoride concentration, increase uptake by sound enamel. d)Formulation components : Thickening agent : reduce rate of fluoride diffusion,reduce fluoride Humectants : reduce uptake of fluoride. Abrasives : reduce uptake of fluoride.

uptake.

Application procedure

a)Pre application prophylaxis : through cleaning of teeth to obtain maximum topical fluoride uptake. b)Effect of time : increase duration of fluoride treatment, increase uptake. fluoride

c)Temperature :increase temperature, increase fluoride uptake. d)Number of application : repeated application of fluoride gel & solution, increase fluoride uptake. e)Enamel pretreatment : mild etching of enamel with acid, increase uptake by enamel. f)Impervious coating : applied over treated enamel so prevent outward diffusion of fluoride into saliva. Indication : 1) Caries active children 2) Children shortly after period of tooth eruption 3) Those receiving radiation of head and neck 4) Patient with fixed or removable appliances 5) Disabled children 6) Patient with eating disorders 7) After placement of replacement of restoration and before stainless steel crown Two methods : 1)Professional application 2)Home application 1)Professional application : This is done by dental professionals in dental office and involve high fluoride concentration from 5000 to 19000 ppm. Procedure : Patient position : upright Use tray with absorptive liners Limit the amount of agent Use suction during and after treatment Have the patient expectorate thoroughly after trays are removed cementation of fluoride

Fluoride solution Amount 2% NaF Ph 7 Method of preparation 20 g NaF powder + 1 liter distilled water in Technique of application Knutson and Feldman technique ( 1948) Clean and polish the teeth in only 1st of four applications. Isolate upper and opposing lower quadrant with cotton rolls. Dry the teeth thoroughly. Apply 2% NaF with cotton rolls applicators and allow it to dry for 4 mins. It is applied once because of formation of CaF2 which interferes with the diffusion of F.(Choking phenomenon) Instruct the patient not to eat or drink for 30 mins. No. of applications per year 2nd ,3rd and 4th at weekly interval and recommended at 3 , 7 , 11 and 13 year Advantages Chemically stable Acceptable taste because of neutral pH. Non irritating to gingiva Does not discolor the teeth Cheap and inexpensive bottle

Disadvantages four visits of patient to the dentist within time. Amount 8% SnF2 Method of preparation O No gelatin capsules are filled with powdered SnF2. To prepare 8%SnF2,Dissolve such 1 capsule in 10 ml distilled water and shaken. Technique of application Muhler technique - Do prophylaxis.

Isolate and dry the teeth with cotton rolls. Apply continuously freshly prepared 8% SnF2 Reapply it for every 15-30 sec so teeth are kept Instruct the patient not to eat or drink for 30 mins. No. of applications per year once per year Advantages Rapid penetration of tin and fluoride in 30 sec Highly insoluble tin fluoro phosphate complex which resistant to decay. Disadvantages Unstable in aqueous solution and should be freshly. Metallic taste. Irritation to gingival tissues. Discoloration of teeth. Staining of margins of restoration. Fluoride solution Amount 1.23% F APF pH 3.0 Method of preparation 20 g NaF + 1 liter 0.1 M phosphoric acid. To this add 50% hydro fluoride acid to adjust Ph 3.0 and F conc. 1.23% Technique of application Brudevold technique Prophylaxis and isolate quadrant with cotton rolls. Continuous & repeated application of APF with cotton applicators Moist the teeth for 4 mins. Pass the floss through each interproximal embrasures to ensure wetting of it. Repeat the procedure for remaining quadrants. prepared is more with cotton applicator. moist with it for 4 mins.

Instruct the patient not to eat, drink or rinse for 30 mins. No. of application per year Semiannual Advantages Greater fluoride uptake Cheap Easily prepared Stable Long shelf life

Disadvantages Teeth must be kept wet with solution for 4 mins. Acidic , sour and bitter in taste so necessary to use suction Fluoride gel Amount 1.23% F APF pH 4-5 Method of preparation F solution + methylcellulose or hydroxyethyl cellulose (gelling agent) Technique of application Prophylaxis and dry the teeth. Fill the U/L tray with APF gel. Insert it in patients mouth and have easily penetrates between the

the patient tight bite for 4 mins. So it teeth.

Instruct the patient not to eat, drink or rinse for 30 mins. No. of application per year Semiannual Advantages Self applied Thixotropic property More caries reduction compare to APF solution Easy application Acceptable by the child due to flavored taste

Disadvantages Irritation to inflammed gingival tissue and to open carious lesion so should be applied after restoration of carious lesion Fluoride varnish Amount Bifluoride 12 (2.71%NaF,2.92% CaF2) Method of preparation Commercially available Technique of application Prophylaxis and dry the teeth Drop the varnish onto brush or foam pellet. Paint the varnish thinly first on lower proximal surfaces.

arch then on upper arch starting from

Instructions to patient Not to rinse or drink anything for that day Not to eat solid for that day. Not to brush that day. Take liquid & semisolids till next morning. No. of application per year Semiannual application Advantage Forms watertight protective film insulating against influences. With correct application, varnish remains for several fluoride acts on treated surface. Disadvantage patient compliance is required. Fluoride foam Amount 0.92% F Ph 4.5 Method of preparation Commercially available No. of applications per year Semiannual application Advantages less dense and better flow than gel, allowing a free fluoride ion on the tooth surface and interproximal areas. Reduction in risk of ingestion and systemic toxicity of movement of thermal and chemical

days so

fluoride.

Disadvantage Retention on to tooth surface is less as no added. Other fluoride application (by the professional) 1.Fluoride Impregnated Prophylaxis Paste and Cup

polymers are

The temperature of enamel surface is raised during a prophylaxis because of the friction between the prophylaxis cup and the tooth. High temperature enhances the uptake from fluoride containing prophylaxis paste or solutions. 2.Iontophoresis Small electric current will help to drive fluoride into dental enamel,reduce enamel solubility,increased fluorapatite formation,reduce dentin sensitivity and even sterilization of root canal. 3.Dental Material Containing Fluoride Carboxylate cements For cementation of crown and orthodontic bands. Fluoride in amalgam also shows reduction in enamel acid solubility. Fluoride containing sealers and varnish (Expoxylite 9070 polyurethane with 10% sodium monoflurophosphate) Glass ionomer cements (Fluoride leaching property) 2.Self applied topical fluoride : include fluoride dentrifices,gels,rinses. Intended for daily use Fluoride dentifrices : Advantage : Because of regular use of 2-3 times/day , provide frequent source of fluoride in low concentration that inhibit demineralization and enhance remineralization. Precautions : Preschool age children :Avoid ingestion of excessive amount of paste. <= 6 years of age of child : use pea size amount of dentifrice. Swallowing of fluoride should be avoided. One brushing with fluoride toothpaste is done just before bedtime.

Use of fluoride tooth paste Child age <4 year 4 to 6 year fluoridated tooth paste 6 to 12 year fluoridated tooth paste and Recommendations not recommended Brushing once daily with non

Brushing twice daily with once with non fluoridated tooth paste

>12 year fluoride tooth paste Fluoride gels :

Brushing 3 times with

Contain neutral NaF and APF with fluoride concentration of 1000 ppm and SnF 0f 1000 ppm. Applied in tray or brushed on teeth once in a day. Precaution : not to swallow the gel. Limitations : Toxicity hazard as given in uncontrolled manner. Tedious to use on daily basis over longer period of time.

Fluoride impregnated dental floss : Useful in plaque control as well as in caries prevention in the interproximal areas. Fluoride rinses : Simple way to expose teeth to fluoride frequently. NaF,APF,SnF rinse proved to reduce caries by 20 to 50%. Amount of fluoride in self applied fluoride rinse Program Agent Frequency Fluoride conc fluoride Volume used Amount of

Home 2.3 mg

0.O5NaF

Daily

0.023%

10 ml

0.044%APF 2.0 mg 0.01%SnF 2.4 mg

Daily

0.02%

10 ml

Daily

0.024%

10

ml

School 9.0 mg

0.2%NaF

Weekly

0.09%

10 ml

Precautions : children < 5 years and handicapped children may Sustained fluoride release : Regular release of fluoride over longer period of time More effective in reducing caries by remineralization of incipient lesion Developed as cements, acrylics and resins. CONCLUSION

swallow.

TOPICAL FLUORIDE IS PREFFERD OVER SYSTEMIC FLUORIDE BECAUESE IT HAS DIRECT EFFECT ON ORAL MICROFLORA AND DIRECT EFFECT ON PLAQUE. REFERENCE SHOBHA TANDON SOBEN PETER MACDONALD