TOPICAL FLUORIDE IN PAEDIATRIC DENTISTRY

TOPICAL FLUORIDE RELATED TO PAEDIATRIC DENTISTRY

1. FLUORIDE TOPICAL FLUORIDE PRESENTED BY DR. MAYURI SOPAN MUNDHE JR1 PAEDIATRIC AND PREVENTIVE DENTISTRY FODS, KGMU, LUCKNOW PART TWO 30/07/2024

2. TOPICAL FLUOIRIDE Topical fluorides are those fluoride containing agents which are applied to the tooth surface in regular intervals in order to prevent the development of caries.

3. TOPICAL FLUORIDE PROFESSIONALLY APPLIED SELF APPLIED H igh fluoride concentration products that is from 5000 to 19,000 ppm Fluoride  Low fluoride concentration 200 to 1000 ppm

4. Indications For Topical Fluorides Caries active individual Newly erupting teeth Exposed root and root caries WSL Teeth in the area of radiation Margins of restoration Patients with fixed or removable prosthesis. Patients with an eating disorder. Mentally or physically challenged individuals.

5. FLUORIDE VEHICLES  AQUEOUS SOLUTIONS AND GELS The gel adheres to teeth & eliminates the continuous wetting of enamel surfaces. Thixotropic solutions are not gels but have a high viscosity under storage conditions & become fluid under conditions of high stress.

6. Methods of Fluoride application Hodgson ( 2005) has suggested an alternative technique utilizing a 5 ml plastic syringe More efficient application of the varnish. Which can be useful in uncooperative pediatric patients.

7. SOME PROFESSIONALLY APPLIED TOPICAL FLUORIDES

8. Fluoride varnish is a non-aqueous form of topical fluoride and was developed in the 1960s to promote a longer retention of the fluoride agent on tooth surfaces. The most commonly used varnish Duraphat ( NaF varnish containing 2.26%F)  Fluorprotector (Silane fluoride with 0.7% F) FLUORIDE VARNISH

9. Demonstration of fluoride varnish technique. (a) Areas of demineralized enamel on the primary incisors. (b) Teeth are dried with gauze square. (c) Varnish is applied to the tooth surface with a small brush. (d) After application. Azarpazhooh A, Main PA. Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic review. J Can Dent Assoc. 2008 Feb;74(1):73-9. PMID: 18298889.

10. It is a 5% NaF formulation in a viscous colophonium base.  1 mL of the varnish contains 50 mg of NaF It is available as a 10ml tube. Caries reduction - 30-40% in permanent, 7-44% in primary The resinous base is an alcoholic suspension which when applied to the tooth surface, evaporates, leaving a layer of fluoride rich varnish attached to the tooth surface. PRICE: 1200-1300 Rs for 10 ml DURAPHAT:

11. TRIALS ON DURAPHAT The first clinical trial to see the efficacy of Duraphat was carried out by Heuser and Schmidt in 1968. One application of Duraphat done on 224, 11-14 year old children showed; a 30 percent DMFT reduction after a period of 15 months. Majority of clinical trials conducted to see the efficacy of Duraphat during 1970's have reported the effectiveness between 10-45 % dmfs reduction 43% dmfs reduction after 3 years; Hetaer and Irmisch (1973) 40% dmfs reduction after 3 years; Maiwald , H.J. (1974) 36.6% dmfs reduction after 2 years; Murray et al (1977) 44% dmfs reduction after 2 years; Holm (1979) Fluorides and dental caries : a compendium Ved Prakash Jalili ,  Amrit Tewari

12. ₹ 4495 7gm Bottle Fluor Protector I s a clear polyurethane product containing fluoride, in the form of difluorosilane . (7000 ppm) Has a lower pH and less viscosity than duraphat thus spreads easily and readily flows into complex surface structures. It is suitable for treating children, adolescents and adults.

13.    First fluoride varnish manufactured in India. It contains 50 mg Sodium Fluoride per ml equivalent to 22.6 mg of fluoride in slow release form. Fluoritop may offer a better alternative to existing topical fluoride agents as a caries preventive agent in our country FLUORITOP 10 for 600Rs

14. 5500 Rs for 35 dose 1700 Rs for 10 ml 1350 Rs for 5 dose 1050 Rs for 5 dose

15. SOME OTHER VARNISHES WHICH ARE NOT AVAILABLE IN THE INDIAN MARKET

16. American Dental Association Council on Scientific Affairs. Professionally applied topical fluoride: evidence-based clinical recommendations. J Am Dent Assoc. 2006 Aug; 137

17. WHAT AAPD RECOMMENDS?

18.  Bibby and his associates evaluated a paste containing 1 % ( NaF ) in a small group of children and reported caries reductions of from 25% to 43% depending on the number of treatments. If prophylaxis pastes containing fluoride are used, the lost fluoride is replenished and there is small but significant, net gain in the concentration of fluoride (Stearns - 1973) PROPHYLACTIC PASTES CONTAINING FLUORIDE

19. Fluoride In Dentistry - 2nd Edition. By Ole Fejerskov , Jan Ekstrand , Brian A Burt. FLUORIDE FOAM To minimize the risk of fluoride overdose and to maintain the efficacy of topical fluoride treatment. In a study report Wei et al (1988) stated that topical application of APF foam significantly increased the fluoride concentration in the outer 5mm enamel; similar to that of an APF gel

20. Silver Diamine Fluoride  Stebbins (1891) - First used silver in dentistry - Silver Nitrate  Percy Howe - added Ammonia to Silver Nitrate making it more stable and effective as antimicrobial. SDF - 1969 Osaka University in Japan : Ammine was added to AgF to produce SDF It is hypothesized to halt the caries process and simultaneously prevent the formation of new caries.  38% SDF contains 44,800 ppm F & 2,53,870 ppm Ag

21. MECHANISM OF ACTION OF SDF Effect on cariogenic bacteria Effect on mineral content of tooth Effect on exposed dentinal tubule Effect on organic content of dentin Zhao IS, Gao SS, Hiraishi N, Burrow MF, Duangthip D, Mei ML, Lo EC, Chu CH. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J. 2018 Apr;68(2):67-76. English. doi : 10.1111/idj.12320. Epub 2017 May 21.

22. ₹ 2592 ₹ 1649

23. DRAWBACKS OF SDF The lesions will be stained black. cavitations still lodge food particles; restoration is needed.

24. SELF APPLIED TOPICAL FLUORIDES

25. Dentrifices Containing Fluoride  The frequently used concentration of fluoride in toothpaste is 1000-1100 ppm . Concern with this delivery method is ingestion of fluoridated toothpastes which can produce serious toxic effects. Appropriate adult supervision is essential for children . Fluoride compounds in dentrifices : Sodium Fluoride Stannous Fluoride Monoflurophosphate Amine Fluoride

26. Over the counter toothpaste should contain at least 1000 ppm F and less than 1500 ppm F. Toothbrushing at least twice daily with an age appropriate amount of over the counter fluoride containing toothpaste to prevent caries prevention. WHAT AAPD RECOMMENDS? HOW MUCH TOOTHPASTE??? Smear or rice sized amount(0.1mg F) of fluoridated toothpaste for children less than three years of age. Using no more than a pea sized amount(0.25mg F) of fluoridated toothpaste is appropriate for children aged three to six. American Academy of Pediatric Dentistry. Fluoride therapy. The Reference Manual of Pediatric Dentistry. Chicago,  Il .: American Academy of Pediatric Dentistry; 2023:352-8.

27. 500 ppm Fluoride 140 Rs for 75 gms 485ppm F/ 1000 ppm F 95 Rs for 100 gms 1450 ppm F 500 for 50 ml 500 ppm 1450ppm

28. PRESCRIPTION STRENGTH TOOTHPASTE

29. CONTRAINDICATIONS: Fluoridated mouth rinse should not be given To children under 6 years, as they cannot control muscles of swallowing. Children living in fluoridated area or receiving fluoride supplements. Fluoridated mouth rinses should not substitute fluoridated dentifrices, rinses is usually supplement to toothpaste. FLUORIDE MOUTH RINSES First described by Bibby et al in 1946 In 1977 ADA accepted Neutral Sodium Fluoride and Acidulated Phosphate Fluoride mouth rinses as effective caries preventive agents.

30.  Chewing gums- effective vehicle for delivery of fluoride. Peak concentration of fluoride: 15-25ppm for 0.25mg 25-40ppm for 0.5 mg dose Most of the release occurs during first 5 minutes, after which the fluoride concentration decreased rapidly. FLUORIDE CHEWING GUMS

31. Effects of a Stannous Fluoride-Impregnated Dental Floss on in vivo Salivary Fluoride Levels Casey C Flatt, RDH, Donna Warren-Morris, RDH, Med Journal of Dental Hygiene, Vol. 82, No FLOSS CONTAINING FLUORIDE In an in-vivo pilot study to determine the concentration of fluoride retained intra-orally in saliva after flossing with dental floss impregnated with stannous fluoride (SnF2). It was concluded that fluoride can be released from flossing with the tested SnF2-impregnated dental floss elevating salivary fluoride levels for at least 30 minutes.

32. RECENT ADVANCES IN PROFESSIONALLY APPLIED TOPICAL FLUORIDE 1) INTRAORAL FLUORIDE RELEASING DEVICE A re developed to release fluoride at a predetermined rate when placed in an oral aqueous environment. Mainly two types of slow-release F devices:  Copolymer membrane type - developed in the United States Glass bead - developed in the United Kingdom.

33. Copolymer Membrane Device This system was designed as a membrane-controlled reservoir-type and has an inner core of hydroxyethyl methacrylate (HEMA) / methyl methacrylate (MMA) copolymer (50:50 mixture), containing a precise amount of sodium fluoride ( NaF ). Depending on the amount of F in the inner core, the rate of F release of these devices can be between 0.02 and 1.0 mg F/day for up to 180 days.

34. GLASS DEVICE The original device was dome shape, with a diameter of 4 mm and about 2 mm thick , being usually attached to the buccal surface of the first permanent molar using adhesive resins Preliminary studies were conducted to evaluate the best F concentration to be used in the glass devices, with F concentrations ranging from 13.3% to 21.9% (Curzon MEJ,2004). It was found that devices containing 13.3% F showed a higher rate of F release compared to devices containing higher F concentrations (18.3% and 21.9%)

35. FLUORIDE CONTAINING ALGINATE It contains 1.9% &1.5% F. Helps increase F concentration in saliva- 111 ppm. Limited used- Because not every patient requires impression. FLUORIDE CONTAINING DENTAL CEMENTS Fluorides were added to different dental cements to enhance their anticaries properties. Silicate Zinc Phosphate GIC Carboxylate ZOE Giomer

36. TOOTH CRÈME Perfect for patients at moderate or high risk of dental caries. Cleans and whitens teeth with low abrasion. Contains 0.21% sodium fluoride (950 ppm fluoride ion), tri-calcium phosphate. RECENT INNOVATIONS IN SELF APPLIED TOPICAL FLUORIDES

37.  Contains 10 % of the Recaldent molecule by weight. CPP-ACP adheres intra-orally to plaque pellicle, hydroxyapatite as well as soft tissues. It supplies bioavailable calcium and phosphate into saliva and plaque fluid enabling it to drive remineralisation. It is widely recommended for the prevention of early dental caries and remineralization of white spot lesions. TOOTH MOUSSE

38. REFRENCES Keratibumrungpong K, Trairatvorakul C, Jirakran K, Govitvattana N. A Comparison of the Fluoride 'Paint- On' vs Tray Application Techniques for Enamel Remineralisation. Int Dent J. 2024 Apr 12:S0020-6539(24)00085-6. doi : 10.1016/j.identj.2024.03.003. Epub ahead of print. PMID: 38614880. Azarpazhooh A, Main PA. Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic review. J Can Dent Assoc. 2008 Feb;74(1):73-9. PMID: 18298889. American Dental Association Council on Scientific Affairs. Professionally applied topical fluoride: evidence-based clinical recommendations. J Am Dent Assoc. 2006 Aug; 137 American Academy of Pediatric Dentistry. Fluoride therapy. The Reference Manual of Pediatric Dentistry. Chicago,  Il .: American Academy of Pediatric Dentistry; 2023:352-8. Effects of a Stannous Fluoride-Impregnated Dental Floss on in vivo Salivary Fluoride Levels Casey C Flatt, RDH, Donna Warren-Morris, RDH, Med Journal of Dental Hygiene, Vol. 82, No Fluorides and dental caries : a compendium Ved Prakash Jalili ,  Amrit Tewari

39. THANK YOU!!