CONTENT: 1. Introduction 2. Fluoride Delivery Systems 3. Topical Fluorides

1. TOPICAL
FLUORIDES
IN DENTISTRY

2. CONTENTS
• METHODS OF FLUORIDE DELIVERY
• TOPICAL FLUORIDES
• REFERENCE

3. TOPICAL FLUORIDES SYSTEMIC FLUORIDES
Professionally Applied Self-Applied
 Neutral Sodium Fluoride[NaF]
 Stannous Fluoride[SnF2]
 Acidulated Phosphate Fluoride[APF]
 Amine Fluoride
 Dentifrices
 Mouthrinses
 Gels
I. Water Fluoridation:
a) Community Water Fluoridation
b) School Water Fluoridation
II. Salt Fluoridation.
III. Milk Fluoridation.
IV. Fluoride Tablets/drops/lorenges.

4. TOPICAL FLUORIDES
• The term ‘Topically Applied Fluorides’ is used for the systems containing relatively large
concentration of fluoride that are applied topically or locally, to the erupted tooth surface
to prevent the formation of Dental caries.
• It includes measures for professional application such as – Solutions, Gels, and Varnishes
as well as for unsupervised home such as – Fluoride dentifrices and rinses.

5. INDICATIONS
•Patients with
past experience
of caries.
•Children
shortly after
period of tooth
eruption.
•Patients with
dental
prosthesis.
Medically
compromised
patients
Patients
receiving
Radiation
Therapy to
Head and Neck
Mentally and
physically
challenged

6. Advantages
• THESE DON’T CAUSE
FLUOROSIS
• CARIOSTATIC FOR ALL AGE
GROUP
Disadvantages
• PER CAPITA COST IS
HIGH COMPARED TO
WATER FLUORIDATON

7. TOPICAL FLUORIDE PRODUCTS CAN BE DIVIDED INTO
TWO BROAD CATEGORIES
PROFESSIONALLY APPLIED PRODUCTS
SELF APPLIED PRODUCTS

8. PROFESSIONALLY APPLIED PRODUCTS
 Neutral Sodium Fluoride[NaF]
 Stannous Fluoride[SnF2]
 Acidulated Phosphate Fluoride[APF]
 Amine Fluoride

9. SELF APPLIED PRODUCTS
 Dentifrices
 Mouthrinses
 Gels

10. Neutral Sodium Fluorides
• It was the 1st fluoride compound to be used topical application.
• Concentration of NaF solution – 2%.
• pH of NaF is – 7% PPM - 9200
• Caries reduction – 30%.
Method of preparation:
• 20 grams of NaF powder is dissolved in 1 liter of distilled water in a
plastic bottle.
• Glass bottle should not be used to avoid formation of SILICON
FLUORIDE

11. KNUTSONS TECHNIQUE OF APPLICATION OF NEUTRAL NaF:
• Done is series of 4 appointments at intervals of approximately one week.
• Recommended for ages coinciding with eruption of different group of primary and
permanent teeth – 3 [Deciduous Teeth]
7 [Permanent 1st Molar]
11 [Premolars]
13 [2nd Molar]
• Oral prophylaxis is done before the 1st appointment and
then isolated with cotton.
• 2% NaF solution is applied and allowed to dry for 4 mins.

12. MECHANISM OF ACTION OF NaF:
NaF + Ca10(PO4)6(OH)2
CaF2
Leaching of Fluoride
from CaF2
CaF2 + Hydroxyapetite
crystals
Fluoridated
Hydroxyapetite
CHOKING OFF EFFECT:
Sudden stop of entry of fluoride due
to formation of thick layer of CaF2 .

13. ADVANTAGES
DISADVANTAGES
• Taste well accepted by patient.
• Non-irritating to gingiva.
• Fresh solution is not needed for
each patient.
• Weekly visits can be
inconvenient for some patient.

14. Stannous Fluoride(SnF2)
• Concentration – 8% and 10%, Equivalent to 2% and 2.5% Fluoride.
• pH – Acidic
• PPM – 19300
• Caries Reduction – 32%
Method of preparation:
• 0.8 grams Stannous Fluoride is
dissolved in 10ml of distilled water.
• Fresh solution of Stannous Fluoride for
each patient should be prepared.

15. MUHLER’S TECHNIQUE OF APPLICATION OF SnF2:
• Each tooth is cleaned and isolated.
• SnF2 is applied using paint-on technique and kept for 4mins.
• If patient is susceptible to caries then it is applied every 6 months.
Mechanism of action:
After application 4
end products form
Tin
TriFluoroPhosphate
Tin
Hydroxyphosphate
Ca-TriFluoroStannate
CaF2

16. ADVANTAGES
DISADVANTAGES
• Metallic taste
• Need for fresh
preparation.
• Gingival
irritation.
• No need for four
applications.
• Stains incipient
caries/
demineralized
lesion

17. ACIDULATED PHOSPHATE FLUORIDE(APF):
• Introduced in 1960, by Brudevold and his co-workers at the Forsyth Dental
Center, Boston, Massachusetts.
Method of preparation:
• 20grams of Sodium Fluoride is dissolved in 1 liter of 0.1M Phosphoric acid
• 50% Hydrofluoric acid is added to this to adjust the pH at 3 and Fluoride ion
concentration at 1.23%.
• For APF Gel, methylcellulose/hydroxyethyl cellulose is added to the solution
and pH 4-5.

18. TECHNIQUE OF APPLICATION:
• Paint-on-Technique used for Aqueous solution of APF.
• Tray-technique for gel preparation.
• Semiannually/annually recommended.
• After oral prophylaxis, teeth are isolated.
• APF gel is applied using Tray and minimum amount of fluoride gel is dispensed (<5ml) so as
to cover the complete tooth surfaces.
• Reapplied very 15-30 seconds throughout the entire 4mins period to keep the teeth moist
with fluoride solution.
• Patient is instructed not to eat, drink or rinse his mouth
for atleast 30mins.

19. Mechanism of action:
DEHYDRATION and SHRINKAGE in volumn
of HAP crystals
On hydrolysis forms intermediate product
DICALCIUM PHOSPHATE
DIHYDRATE(DCPD)
This is highly reactive to Fluoride ion
Formation of FLUORAPETITE and CaF2

20. • Can be self applied
• Need not be prepare for each
patient.
ADVANTAGES
• Acidic in nature and can cause
corrosion of Ceramic and porcelain
restoration.
• Bitter in taste
• Cannot be stored in glass container.
DISADVANTAGES

21. DENTIFRICES:
• 1ST clinical trial – BIBBY, 1942.
• In 1955, Stannous Fluoride Dentifrices became the 1st
dentifrices recognized by FDA.
• ADA, In 1964 – accepted the 1st Fluoride dentifrice.
Fluoride Compounds in Dentifrices:
• NaF Dentifrices [Fluoride ion conc. – 650 ppm]
• SnF2 Dentifrices [not used]
• Monofluorophosphate Dentifrices [800 ppm]
• Amine Fluoride dentifrices

22. Fluoride Mouthrinses:
• 1st described by BIBBY et al in 1946.
• Council of Dental Therapeutics of the American Dental
Association in 1975 accepted NaF and APF mouthrinses as
effective caries preventive agents.
Sodium Fluoride Mouthrinses:
• Concentration – 0.2% (900 PPM F) – For weekly use
- 0.05% (225 PPM F) – For daily use
• 10ml of liquid is forcefully swished around the mouth
for 60 seconds and then expectorated.

23. Fluoride Gels:
• Concentration – 5000 PPM in APF
- 1000 PPM in Stannous Fluoride.
• Applied by – Trays – Several drops are placed in tray and
held in contact o teeth for 5mins.
- Brushing – For 1min with gel.
• Posses a Health Hazard for children and are not
recommended for children below 6 years of age.
Disadvantage:
• Large amount of fluoride is given in an uncontrolled
manner.
• High concentration of fluoride deposit CaF2 on tooth
surface, thus discouraging the formation of
Hydroxyapetite.

24. CONCLUSION:
• Topical Fluorides are universally accepted by the dentists as an effective method for
prevention of dental caries.
• The primary caries-preventive effects of fluoride result from its topical contact with enamel
and through its antibacterial actions.
• Therapeutic use of fluoride for children should focus on regimens that maximize topical
contact, preferably in lower-dose, higher-frequency approaches.
• Topical Fluorides should be used in areas where Central Water Fluoridation is not done or the
water contains low- concentration of Fluoride
• As Fluoride is considered “Double-edged sword” , it should be used judiciously.

25. SUMMARY
• The WHO Oral Health Programme continues to emphasize the importance of public health
approaches to the effective use of fluorides for the prevention of dental caries in the 21st
century.
• Topical Fluorides can be applied at home and also by the professionals by variety of
methods.
• Choice of topical Fluoride depends on the age, education , oral health habits of the
patient.

26. REFERENCE:
ESSENTIALS OF PUBLIC HEALTH DENTISTRY – SOBEN PETER 7TH EDITION