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Topical Fluoride

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jackie lee

on 3 April 2014

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Transcript of Topical Fluoride

Topical Fluoride
An educational short program for our viewers
Christina Dodok
Nancy Duran
Ashley Galea-Andrews
Jackie Lee
Alyssa Perez
Brittany Pires
Maria Seher

So What is Fluoride?

The Pros and Cons

Types of Fluoride
Fluoride and Cavities
The main goal of fluoride
is to prevent demineralization
and encourage remineralization (Walsh,2010)

An imbalance of the two
leads to tooth decay.
Children vs Adults
Neutral Sodium Fluoride (NaF)
Stannous Fluoride (SnF2)
This type of fluoride is not recommended for children under 12 years old due to sensitivity
1.23% Acidulated Phosphate Fluoride (APF)
This type of fluoride is not recommended for children under 6 years old
Requires a prescription
Also available as a dentifrice to increase client compliance
How Do I Get Myself Some Fluoride?
Now.. going live to our real life
dental setting! Maria is confused
on the many different types of
fluoride products available...
Brush on Gels &
Tray Technique
Fluoride Rinse
Fluoride Varnish
Fluoride in Drinking Water
Fluoridated Toothpaste
Fluoride Cost
Make sure child could demonstrate they are capable of spitting
Children under the age of 2 who drink non- or under-fluoridated water are at higher risk of developing dental caries
Maximum benefits are obtained during childhood until tooth eruption is complete

Protect from caries
Acute Toxicity
Chronic Toxicity
Effects range from as simple as a stomach ache, to as serious as death
The severity of acute fluoride toxicity is determined by route of administration, age and weight, and rate of absorption
Acute toxicities affects three major body systems:
Gastrointestinal, Neurologic, and Cardiovascular
For Example...
In 1974, a 3 year-old boy went in for a routine dental appointment, and the dental hygienist gave him a fluoride gel treatment. The boy drank water with the fluoride gel still in his mouth and ingested 45 cubic centimeters of 2% stannous fluoride. The boy later complained of stomach aches and his mother rushed him to the hospital. After a long wait, and many lapses in and out of a coma, the boy died of cardiac arrest.

Chronic means affects which happen after a long period of time.
Caries Reduction
42.5% average reduction in caries incidences in
school-aged children

30% average reduction in caries incidences in general
(Wilkins, p 534, 2013)
Fluoride Metabolism
(Wilkins, 2013)
Form of hypomineralization
Results from excess ingestion of fluoride while the tooth is developing
Teeth exposed to optimum levels of fluoride will appear smooth, and creamy white
No health problems are involved
Fluoride and Tooth Development
(Wilkins, pg 518, 2013)
Dental/Skeletal Fluorosis
(Wilkins, BOX 35-5 of pg 537, 2013)
Fluoride Safety

Certainly Lethal Dose
Safely Tolerated Dose
Study was done which showed
brushing once a day with a fluoridated
tooth paste showed a 21%
reduction in decay
The FDA has approved varnishes as a hypersensitivity agent but it has also been used as a caries prevention (Bird, 2012)
The reduction in caries with varnish has gone up from 18% to 77%
Osteosclerosis can be a side effect of long term fluoride consumption.
Stiff and painful joints is an early sign of skeletal fluorosis.
Skeletal Fluorosis is more of a concern in countries such as China and India

Each tooth is rated a score of 0-5. This system was first used in 1942 for NHANES and only the maxillary anterior teeth are assessed. The final judgment is based on the two most effected teeth. There has been an modified version which is used in the NHANES survey.

0- normal : no fluorosis
1- very mild
2- mild
3- moderate
4- severe
5- questionable


Professional: Most clients receive topical application following their scaling;
stain removal and oral hygiene care instruction following their routine maintenance appointment.

At home:
Usually custom trays are made to fit the mouth perfectly and completely cover the teeth that are being treated. The gels used are available by prescription and comes in neutral sodium or acidulated phosphate.
It is recommended to use the gel once a day, after brushing the teeth before bedtime.
Sodium fluoride

Sodium monoflurophosphate

Stannous fluoride.

Fluoride mouth rinses are a practical and effective way for self-applying fluoride
Most widely used fluoride product

Low-potency/ high frequency
High-potency/low frequency

B r e a k i n g news!

Our special
guests are back with a brand new topic!

Stay tuned for this
40 minute Principles class presentation.
Benefits: newly erupted teeth, smooth surfaces and pits and fissures
Necessary for optimal oral health
for all ages - Especially for high risk individuals to prevent and control dental caries
Naturally occurring element
found in food, water, and minerals

Systematic or
Protect your teeth with fluoride!
Vital to the development of healthy teeth and bones
Three stages to fluoride in tooth development:

Pre-eruptive - mineralization stage
Pre-eruptive - maturation stage
Gastrointestinal tract
Blood stream
Distributed and Retained
Blood plasma
Tissue and organs
Concentration highest at tissue fluid supplying fluoride
Kidneys: Urine
It is the 13th most abundant element on earth
It is also synthesized in laboratories and added to drinking water and various products such as toothpastes and mouth rinses (Nordqvist, 2013).
Remineralization is a process where the damaged minerals of the tooth are repaired
Higher concentrations of fluoride demotes the growth of bacteria
(Wilkins, Pg. 522, 2013)
According to Wilkins, saliva and biofilm contains fluoride to aid in remineralization when needed
Fluoride inhibits plaque bacteria from causing decay
Neutral sodium fluorides were approved by the FDA in 1994 for its use as a cavity liner and for treatment of hypersensitive teeth.

Widely used as a standard of practice as a cavity preventive agent. Clinical studies have recommended applications of 3 to 6 months.
Gel & foam 1.1%-2%, vanish 5%
Gel ~0.4%
Fluoride gel used once daily or as directed by the dentist. It is brushed on the teeth after brushing with toothpaste.
Gel, Foam
Special Precautions & Warnings:

Pregnancy and breast-feeding: Safe when taken in doses below the tolerable upper intake level (UL) of 10 mg per day
Children should demonstrate they can spit before applying topical fluoride

(Wilkins, p 537, 2013)
According to the National Health and Nutrition Examination Survey, 1999-2004, 40.6% of children aged 12-15 had some form of dental fluorosis.
Did you know?
(Voight, 2012)
Dean's Fluorosis Index
Initial goal is to reduce the amount of fluoride available for absorption from the GI tract
Induce vomiting: administer enemic
Fluoride-binding liquid orally: ie. Milk, milk of magnesia, or lime water
Ontario Poison Control
Monitor client
(Darby & Walsh, 2012)
Educate both client and health care professional
Caution (age, weight, health status)
FDA approved topical fluoride applications
Proper home care instructions/products
(Wilkins, pg.534, 2013)
An advantage of this type of fluoride is it does not stain teeth or irritate soft tissue
(Pg 537, Wilkins, 2013)

(Darby & Walsh, 2009 )
There are many different methods of applying topical
fluoride to the teeth:
Self-applied without prescription
Self-applied with prescription
Professionally applied prescription products.

5000ppm: age 6 + up
(Walsh, 2010)
0.4% in glycerin base; 1000ppm, used separate from tooth brushing and is available over the counter.
(Wilkins, 2010)
(Wilkins, 2010)
Fluoride Dentifrices:

average reduction of caries among adults is 27%
Community water fluoridation: $0.77-$4.00
Fluoride Varnish: $24-$51
Fluoride Rinse: $2.24

(ODHA, 2014)

Topical Fluoride Gel in Office: $18.73
Home- custom combined: $58.49 + lab fee
Home- custom mandibular arch: $40.95 + lab fee
Home-custom maxillary arch: $ 40.95 + lab fee

(Wilkins, 2010)
Post-op Instructions...
(Wilkins, 2010)
Most low-potency rinses can be purchased over the counter where as high potency is only available with prescription.
(Darby & Walsh, 2013)
5% Sodium Fluoride
When painted onto the teeth seep into the enamel matrix and releases calcium and phosphate
Documented to have the least amount of toxicity cases
There are also toothpastes available
for children that have 250-550ppm.
Fluoride in enamel
(Wilkins, 2013)
(Wilkins, 2013)
Fluoride in dentin
(Wilkins, 2013)
The enzyme enolase is inhibited- this enzyme is needed by bacteria to break down carbohydrates.
(Wilkins, pg. 521 Figure 35-2, 2013)
(Walsh, 2010)
GI: nausea, diarrhea, and abdominal pain
More serious = Neurologic and Cardiovascular areas:
Paresthesia, CNS depression and coma
Hypotension, shock and possibly cardiac failure
(O'Grady, 1979)
The most common chronic toxicity of fluoride is dental fluorosis (Walsh, 2010)
(Wilkins, pg 519, 2013)
(Wilkins, 2013)
(Wilkins, BOX 35-5 of pg 537, 2013)
follow the instructions. Increased amounts does not mean better results!
Post-op Instructions...
(Walsh, 2010)
American Dental Association. (2013). Topical Fluoride for Caries Prevention. ADA Center for Evidence-Based Dentistry.
Retrieved from http://ebd.ada.org/contentdocs/Topical_fluoride_for_caries_prevention_2013_update_- _full_manuscript.pdf
Azarpazhooh, A. & Main, P. (2012). Dimensions of Dental Hygiene: Fluoride Varnish. The Journal of Professional
Excellence. Retrieved from http://www.dimensionsofdentalhygiene.com/ddhright.aspx?id=6124
Darby, M. & Walsh, M. (2010). Implementation. Dental Hygienie Theory and Practice. St.
Louis, Missouri: Saunders Elsevier.
Darby, M. (2012). Strategies for Oral Health Promotion and Disease Prevention and Control. Mosby’s Comprehensive
Review of Dental Hygiene (7th ed.). St. Louis, Missouri: Elsevier.
Dentsply. (2013). Nupro Safety Data Sheet. Dentsply. Retrieved from Http://www.professional.dentsply.com/content/
dam/dentsply/pim/manufacturer/Preventiv e/Fluorides/Topical_Gel_Oral_Solution/NUPRO_Neutral_Sodium_Fluoride_NaF_Oral_

O’Grady, Daniel. (1979). “$750,000 Given In Child’s Death in Fluoride Case: Boy, 3, Was In
City Clinic For Routine Cleaning”. New York Times. Retrieved from http://fluoridealert.org/articles/kennerly/.
Rothen, M. & Heacox, G. (2007). Dimensions of Dental Hygiene: Topical Fluoride. The Journal
of Professional Excellence. Retrieved from http://www.dimensionsofdentalhygiene.com/print.aspx?id=1052
Voigt, K. (2011). Oral Health Programs in the Community. Community Oral Health Practise for
the Dental Hygienist (3e). St. Louis, Missouri: Saunders
WebMD. (2014). “Sodium fluoride rinse”. Drugs & Medications. Retrieved from
WebMD. (2014). “Stannous fluoride dent”. Drugs & Medications. Retrieved from
Wilkins,E. (2013). Implementation: Prevention. Clinical Practice of the Dental Hygienist (11
ed.).Philadelphia, USA: Lippincott Williams & Wilkins.
Larsen, C., Daronch, M., & Moursi, A. (2012). Dimensions of Dental Hygiene: Smile Insurance.
The Journal of Professional Excellence. Retrieved from http://www.dimensionsofdentalhygiene.com/print.aspx?id=13978
Nordqvist, C. (2013, February 28). "What Is Fluoride? What Does Fluoride Do?." Medical News
Today. Retrieved from http://www.medicalnewstoday.com/articles/154164.
ODHA. (2014). Suggested Fee Guide for Dental Hygienists. ODHA. Retrieved from http://
References CONT'D
References CONT'D
Images retrieved March 30, 2014 from:
Name 4 methods of applying fluoride...
Dean's Fluorosis Index rates each tooth from a score of _ to _
Acute toxicity from fluoride affects these three body systems...
Which type of fluoride requires a prescription?
Your 7-year old client has just finished their treatment and he wants more "yummy orange goo". You had used orange-flavoured fluoride. Name three liquids you could give them to help reduce absorption.
# 1
# 2
# 3
# 4
# 5
Which topical fluoride application method has been documented to have the least toxicity cases?
# 6
Thank you!
Full transcript