Topical application of fluoride.pptx

By Dr hiba Hussain Aouda

1. ( (Topical application of fluoride Done by : DR. Hiba Hussain Aouda

2. contents Introduction Definition Classification of topical fluoride Self applied fluoride: toothpaste Mouth rinse Gel Professional applied fluoride: Varnish SDF/SDI Fluoride containing restorative materials

3. Introduction ● Dental caries  is a major dental disease that impairs the quality of life for many people causing pain and discomfort. ● Fluorides have been proved to be the single most effective weapon in our still limited arsenal of anti caries agents. ● Fluoride play a role of a caries preventive agent throughout the life of a tooth. ● Fluoride ( F- ) can have both beneficial and detrimental effects on the dentition .

4. Definitions: Topical Fluoride therapy refers to, “The use of systems containing relatively large concentrations of fluoride that are applied locally, or topically, to erupted tooth surfaces to prevent the formation of dental caries Topically applied fluorides is used to describe those delivery systems which provide fluoride for a local chemical reaction to exposed surfaces of the erupted dentition. Topical fluoride is “A fluoride applied directly to the teeth, especially of children, in a dental caries prevention program. ’’

5. Indication: Children with   active caries Newly erupted teeth In patients with reduced salivary flow due to medications Those receiving radiation of head and neck region Patients with fixed or removable appliances , (e.g. before cementation of bands) After placement or replacement of restorations and before cementation of stainless steel crowns Disabled children

6. Classification of topical fluoride

7. Classification of topical fluoride application Self applied : Fluoridated toothpaste Mouth rinse Gel Professional applied: Varnishes SDF /SDI . Restorative Materials containing Fluoride

8. Self applied : Fluoride products are usually bought and dispensed by the individual patients but at the recommendation of a dental personnel . These products include – fluoride dentifrices mouth rinses, gels. Usually use the low fluoride concentration products ranging from 200 to 1500 ppm or 0.2 – 1.5mg F/m

9. 1. Fluoridated toothpaste Toothpastes contain fluoride as sodium monofluorophosphate (SMFP), sodium fluoride, stannous fluoride or amine fluoride . Adult Twice daily →1,000–1,500 ppm children → 250–500 ppm

10. 2.Fluoride Mouth rinse NaF 0.05 % (225ppm) daily use 0.2 % (900ppm) weekly use SnF2 100,200,300 ppm. 10 ml swishing for 1 min . children below the age of 6 years should not use fluoride mouth rinse .

11. 3.Topical fluoride gels and foams There are also self-applied gel formulations of sodium fluoride (1.1% [5,000 ppm] sodium fluoride) stannous fluoride (0.15% [1,000 ppm] fluoride) available by prescription for home use.

12. Neutral sodium fluoride gels ( NaF ) are preferable to acidulated gels (APF) in people with porcelain and composite restorations.  

13. PROFESSIONALLY APPLIED- Fluoride products Are those medicaments typically dispensed by Dental professionals in the Dental office and usually involve the use of high concentration products ranging from 5000 and 19000ppm which is equivalent to 5-19 mgF /ml.

14. PROFESSIONALLY APPLIED- Fluoride product s These exert an anti caries effect by increasing the concentration of fluoride in the outermost surface of the enamel. Sodium fluoride preparation. Stannous fluoride preparation. Acidulated phosphate fluoride preperation . Fluoride varnish. Silver diamine fluoride liquid (SDF ). Fluoride containing restorative materials.

15. Fluoride Varnish Fluoride varnish is a topical fluoride treatment that has been shown to be effective in preventing dental caries, particularly in children and adolescents . Indication : 1. moderate- high caries risk patients. 2. For hypersensitive teeth. 3.Decrease post operative sensitivity ( after periodontal scaling). 4.As cavity liner.

16. Fluoride varnishes Usually applied with at least two applications / year . Types: Duraphat : 22.6 mg F/ml. Fluorprotector : pH lower than Duraphat and it is available in box with 20 vials each vial contains 0.4 ml of solution. Duraflour : 22.6 mg/ml. Cavity shield.

17. Method of application Oral prophylaxis is done Teeth are dried but not isolated with cotton rolls as varnish sticks to cotton. Paint fluoride using disposable brush on all tooth Surfaces. Varnish sets rapidly when they come in contact with saliva, no drying is necessary. After application ,patient asked to sit with mouth open for 4 minute.

18. Silver diamine fluoride liquid (SDF). ( SDF ) is a  cariostatic agent  used in the nonsurgical management of caries. It was designed to combine the  antimicrobial properties   of silver and the remineralizing effect of fluoride in one   treatment . Numerous studies have shown subsequently the effectiveness of SDF in caries arrest . Formulation : 25 % silver (antimicrobial) 8 % ammonia (solvent) 5 % fluoride ( remineralization ) 62% water.

19. Indication of SDF 1)Extreme caries risk ( xerostomia ) 2)Behavior or medical management challenges 3) More lesions than treatable at 1 visit 4) Patients without access to care 5) Patients looking for minimally invasive treatment options

20. Contraindication and limitation 1 ) Possible concerns with silver allergy. 2) May sting ulcerated gingiva (use petroleum jelly to protect gingiva when needed) 3) Do not use if there is exposed pulp in lesion (can cause sensitivity and “tingling” feeling ).

21. Advantage of SDF 1 . Applied every 6 or 12 months. 2.Arrests caries in addition to prevent caries 3.Decreases dentinal sensitivity. 4.Expected caries prevention is about 25-70%. 5. Minimally invasive option very helpful during pandemic situations like in COVID-19.

22. Disadvantage of SDF Dark staining of demineralized tooth surfaces

23. Selection of Teeth for the Application of SDF Absence of clinical signs related to inflamed pulp or history of spontaneous pain. Carious lesions that are not infringing on to the pulp. When possible, prescribe radiographs to assess the proximity of pulp to caries lesions. Carious lesions on any surface that are accessible with a brush during SDF application Before placement of restoration and as a cariostatic means .

24. Method of application of SDF Isolate using cotton roll, dry angle and/or bite block. Dry teeth with air/water syringe Dip micro brush in SDF and apply for 60 seconds . With careful application using a micro brush, the intraoral and extra oral soft tissue exposure can be prevented. For a single complete appointment, not more than one drop of SDF should be used. One drop is sufficient to treat 5 to 6 teeth. Let solution air dry for 60 sec.(not with air/water syringe or solution will spread to other areas). Wipe with gauze or apply fluoride varnish (to mask taste of SDF and does not wash away with saliva or contact mucosa ) Application frequency: The studies that had three times / year applications showed higher arrest rates.

25.   Silver modified atraumatic restorative treatment (SMART) : ( A) Before SDF application; (B) After SDF application; (C) After GIC application

26. SDI (SDF/Potassium iodine ) Next generation SDF. The major drawback of SDF application is the dark staining of both teeth and restorative materials. Hence , its use on adult dentition is limited. Improving the esthetic outcome by stain reduction would greatly enhance the opportunity for SDF’s universal use.

27. KEY FEATURES Clinically tested & proven for decades Esthetically pleasing for the patient - reducing staining Approved for Caries Arrest Non-invasive – suitable for MID Patented Technology Immediate dentinal hypersensitivity relief in adults Increased bond strengths when used with auto cure GIC.

28. INDICATIONS of SDI : Anti-cavity / Anti-caries. Prevents, fights and/or protect against cavities or caries. Effective decay preventive fluoride. Helps reverse the tooth decay process earliest stage before it can become a cavity. Helps to reduce sensitivity in cervical hypersensitivity teeth in adults. Step 1 is indicated for children 3 years old to adults Step 2 is indicated for adults only

29. The silver fluoride and potassium iodide action blocks the microscopic tubules that make up dentin. A low solubility precipitate is formed that gives instant relief. It acts by preventing the flow of fluid that produces sensitivity

30. Treatment Protocol SDF/KI is suitable for application to any asymptomatic carious lesion in both deciduous and permanent teeth. If used in conjunction with a self-cure GIC (providing the correct treatment protocol is followed), it will arrest caries and assist with the remineralization of the lesion to become a caries resistant base under the restoration . Applied correctly, it will neither stain surrounding tooth structures or the restoration

31. Pre-treating tooth surfaces with SDF/KI is a great way to enhance bonding of glass ionomers to dentine. SDF/KI two step patented procedure minimises the risk of staining. By applying the potassium iodide solution over the silver fluoride, a silver iodide creamy white precipitate is formed and washed off.

32. Caries Access Accessing caries is required, especially proximally, for the correct application of SDF/KI . local anaesthetic is usually unnecessary . Occlusal caries requires minimal tooth removal. Proximal caries may require using an ultra conservative “ tunnel preparation” for permanent teeth or for deciduous teeth, a small proximal slot preparation.

33. Surface Preparation Prepare the surface by first removing any loose grossly carious dentin, followed by a 15 second etch with 37% phosphoric acid. Rinse and dry the preparation .

34. Clinical Steps to SDF/KI Isolate the preparation Etch the preparation for 15 seconds, wash and dry Take the SDF (grey) vial and break the seal with the hard end of the brush applicator Apply the SDF with the brush over the caries Immediately following this, similarly apply the KI (green) vial over the SDF A white precipitate will appear Continue applying the KI solution until the white precipitate completely disappears Wash away the reactant with water and dry the preparation.

35. GIC and Composite Placement A self-cure GIC restoration is indicated immediately after SDF/KI treatment. If the restoration encroaches upon undermined cusps in the tooth or has a large load bearing area, a GIC and composite resin “co-cure” sandwich restoration is indicated.

36. The difference between two glass ionomer cement restorations, one treated with SDF and the other treated with SDF/KI. The tooth was stored in water for 6 weeks exposed to direct sunlight . SDF SDF/KI

37. SDI Riva Star Aqua - Bottle Kit Riva Star Aqua from SDI is a highly effecctive next generation water based silver fluoride tooth pain desensitising solution that is also effective in arresting carious lesions. containing 38% Silver Fluoride . Indications Desensitising cervical tooth hypersensitivity

38. Benefits of aqua Riva star: Clinical match to SDF. Immediate sensitivity relief . Reduce staining. Two years desensitizing effect . No tissue burn risk. No gingival barrier required. Improved smell .

39. 3.Fluoride containing restorative materials Fluoride added to dental restorative materials, luting cements and cavity varnishes in order to impart a cariostatic property and to reduce enamel solubility at the margins of restoration. There is also accepted concept of application of topical fluoride to the occlusal surfaces immediately after placing pit and fissure sealants .

40. 3.Fluoride containing restorative materials Include :- Glass ionomer cements. Resin modified glass ionomer cements. Polyacid modified resin composites ( compomers ). Resin composites. Fissure sealants . Dental amalgam .