PEDAGOGY LESSON PLAN TOPIC: SYSTEMIC FLUORIDATION AND TOPICAL FLUORIDE. - PowerPoint Presentation

1. PEDAGOGYLESSON PLANTOPIC: SYSTEMIC FLUORIDATION AND TOPICAL FLUORIDE.TARGET GROUP: IV BDS UNDER-GRADUATE STUDENTS.DURATION: 1 HOURAUDIO VISUAL AIDS USED: POWERPOINT PRESENTATION, PROJECTOR.DATE: 05/12/2022.PRESENTER: DR. Nikhil Bomble.

2. LEARNING OBJECTIVESTo understand what is systemic fluoridationTo understand what are topical fluoridesTo understand the importance of fluoride delivery methods

3. Introduction ClassificationTopical fluoridesSystemic fluorideReferencesCONTENTS

4. Introduction

5. Fluoride can be applied topically or it can be ingested systemically. The following slides illustrates the methods by which fluoride can be administered to a patient in dentistry. The importance of fluorides is now well known and if you are regularly visiting your dentist then he must be appraising you of this and must be suggesting the various methods of fluoride applications to you. Sometimes it is applied by the dentist and also the patient is suggested to use fluoridated tooth pastes. INTRODUCTION

6. CLASSIFICATIONFluoride delivery methodsTopical Systemic Professional applicationSelf applicationFluoridegelsWater fluoridationDietary fluoridationFluoridefoamsFluoridevarnishesFluoridesolutionsFluoridedentifricesFluoridemouth rinsesMilk Salt Sugar Fluoride supplementsSchool-Water fluoridationCommunity-Water fluoridation

7. The delivery system which provide fluoride for a local chemical reaction to exposed surfaces of the erupted dentition.It is the directly applied to the erupted teeth.High conc. over short period and low conc. over long period.Two methods are usedProfessionally appliedSelf applied TOPICAL FLUORIDES

8. Individuals with active and past caries experience.Shortly after tooth eruption.Individuals on drug therapy that reduce salivary flow.Radiation therapy individuals of head and neck.After periodontal surgery.Fixed \removable prosthesis.Mentally & physically challenged individuals.Indications of topical fluoride use

9. Speed the rate & increase the conc. of fluoride in post-eruptive teeth rather than only drinking water containing fluoride.Immature & porous enamel (white spots) acquires fluoride rapidly than mature enamel.Enamel of newly erupted teeth undergoes rapid maturation and is the best time to apply topical fluorides.Partially demineralized sites accumulate more fluoride, which implies periodic application. Rationale

10. IndicationsUsually those patients who have high caries risk eg-xerostomic patient.Children with newly erupting teeth and have high caries index.Person having incipient lesions. As the incipient lesions can be remineralized by fluoride. PROFESSIONALLY APPLIED

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12. Bought and dispensed by individual but by the recommendation of a dentist.Dentifrices & mouth rinses.Fluoride conc. of 200-1000ppm (0.2-1mg/ml).Self applied

13. Sodium fluoride(NaF).Acidulated phosphate fluoride(APF).Stannous fluoride(SnF2).TOPICAL FLUORIDES

14. Aqueous solutions and gels.Fluoridated prophylactic paste.Foam.Fluoride varnish. Duraphat Fluorprotector CarexFluoride vehicles

15. SOLUTIONSGELSThin flowThick flowRx- One quadrant at a timeRx= 2- 4 quadrants at a time Time consumingTime savingMore material usedLess material used (< 0.5ml)More chances of accidental ingestion Less chances of accidental ingestionAqueous solutions and gels.

16. Surface enamel contains higher levels of fluorides than internal layers.A prophylactic paste can remove the fluoride rich layer.Hence a fluoride containing prophylactic paste must be used replenish the fluoride layer.Fluoridated prophylactic paste.

17. Minimize risk of fluoride over dosage.Lighter than conventional gel so small amount of agent required for application.Gel= 4gm/mouth & foam= 1gm/mouth.Surfactant in the foam has cleansing action by lowering the surface tension.Facilitates penetration of material into interproximal surfaces.Does not need suction.Can be used at home, young children, disabled children. Foam

18. First developed in Europe in 1964 by Schmidt.Fluoride varnishDuraphatFluorprotectorCarex NaFDifluorosilane-22,600ppm7000ppm1800ppmReduces caries by 30-40% in permanent dentition1-17%.Same as duraphatForm of bottleForm of ampule containing 6.21mg fluoride.Bottle

19. Oral prophylaxisDry the teeth0.3-0.5 ml Application with tufted small brush beginning on lower arch proximal surface and then upper arch.Setting time 4 minutes (ask patient to sit with open mouth)1 hour not to not to drink, or rinse the mouthOnly semisolids to be consumed after 1 hour till next morning (at-least 18 hours contact of fluoride and enamel should be maintained)Technique of varnish application

20. A minimum of four application with 2% NaF solution gives a caries reduction of about 30%20 grams of NaF powder in 1000ml of distilled water gives a 2% of neutral NaF preparationTechnique of application given by Knutson consist of four series of appointments scheduled at interval of approximately one week, which are recommended at age of 3,7,11 and 13 years.Sodium fluoride

21. AdvantagesThere is no need to prepare fresh solution for each patient.The taste is well accepted by patient and solution is non-irritating to gingiva.Clinician in public health programmers can pursue a multiple-chair procedure.DisadvantagesMajor disadvantage is that the patient must make 4 visits to the dentist within a relatively short time.SODIUM FLUORIDE(NaF)

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23. Muhler recommended fresh preparation of stannous fluoride solutions before application as stannous fluoride is not a stable compound.0.8 gram of gelatin capsule in 10ml of distilled water solution gives 8% of stannous fluoride.Every six monthly recommended.Stannous fluoride

24. DisadvantagesUnstable so every time it is prepared fresh for each patientThe solution has a metallic tasteIt may cause gingival irritation particularly in diseased gingival tissueProduce discoloration of teethCauses staining on the margins of restorationsSTANNOUS FLUORIDE

25. Brudevold prepared APF20 grams of NaF in 1 liter of 0.1 M phosphoric acid and to this is added 50% hydrofluoric acid to adjust the ph at 3.0 and fluoride ion concentration at 1.23%. it is called as Brudevold’s solution.ACIDULATED PHOSPHATE FLUORIDE

26. AdvantagesFluoride uptake following the application of APF solution is greatly accelerated where as that following NaF is much slower.APF solution is cheap, can be prepared easily.It is stable with a long shelf life, when stored in an opaque plastic bottle.Requires only 2 applications in a year and is thus suited for most dental office routinesACIDULATED PHOSPHATE FLUORIDE

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28. DISADVANTAGESTeeth must be kept wet with the solution for 4 min.APF solution is acidic, sour & bitter in taste so necessitates the use of suction.It cannot be stored in glass containers. ACIDULATED PHOSPHATE FLUORIDE

29. It is process of adjusting the amount of fluoride in community water supply to an optimum level for prevention of dental caries.Sodium fluoride was the first compound used in a controlled fluoridation programs. Now most commonly used are sodium silicofluoride and hydrofluorsilic acid.SYSTEMIC FLUORIDES - COMMUNITY WATER FLUORIDATION

30. Concentration 0.7-1.2ppm=depending upon community mean maximum daily temperatureCold climate= 1.2ppmSummer season or temperate climate= o.7ppmRecent recommendation (WHO 1994)= 0.5-1.0ppmRecommended Level of Fluoride In Water Report of a WHO committee on oral health status and fluoride use | 1994

31. Water fluoridation has pre-eruptive & post eruptive effect.Fluoridated drinking water not only acts systemically during tooth formation to make dental enamel more resistance to dental decay, but also has topical effect through the release in saliva after ingestion.Fluoride in saliva through the systemic mode remains elevated for an extended period provides protection against demineralization and facilitates remineralisation.Fluoridation of community water is the least expensive and most effective way to provide fluoride to large group of people.Benefits of Water Fluoridation

32. Water fluoridation…First began in Grand Rapids, U. S. A., in 1945 Studies on water fluoridation (city) ControlGrand Rapids (Michigan)NewburgBrantford (Ontario-Canada)Evanston (Illinois)Teil (Netherlands)MuskegonKingstonSarniaOak-ParkCulemberg

33. It is adjustment of fluoride conc. Of a school’s water supply for caries prevention.Children spent annually 20-25% of time in school so to compensate for this part time exposure to fluoride is currently recommended.Level for school water fluoridation is 4-5ppm.There is approximately 40% reduction in caries reported after 12 years.School Water Fluoridation

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35. Milk FluoridationMilk is essential component of human diet throughout life, both as a source of micro and macro nutrient.Fluoridated milk can be produced in number of different ways     Liquid pasteurized & sterilizedPowder    DIETARY FLUORIDATION

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37. Compounds used to fluoride milkSodium fluorideCalcium fluorideDisodium monofluorophosphateDisodium silicofluorideRecommendation of WHO expert committee (1994) in ranging from 0-1.0mgF/day according to the age of child.  Report of a WHO committee on oral health status and fluoride use | 1994

38. Disadvantages Milk Fluoridation: It provides only a limited exposure to children, as consumption of milk tends to decline with increase in age.Absorption is slow as compared to water fluoridation. 

39. These were first introduced in 1940’s and were intended as a substitute for fluoridated water for children in non-fluoridated areas.Fluoride Compounds UsedSodium fluoride (NaF)Acidulated phosphate fluoride (APF)ConcentrationAvailable in à 0.125mg drops                      0.25mg drops                       0.50mg drops                       0.25mg tablets/lozenges                      Dietary Fluoride Supplements 

40. 0.50mg tablets/lozenges                       1.0mg tablets/lozenges                       1mg/5ml – oral rinse supplementThese are administered in following forms;Fluoride DropsFluoride Drops With VitaminsFluoride TabletsFluoride Sustained ReleaseFluoride Tablet With VitaminsFluoride Rinse & Solutions

41. INDICATIONS FOR USEIn areas where there are no central water supplies, low conc. Of well water and where parental motivation is highWhere there is no community water fluoridationAreas where water fluoridation or salt fluoridation schemes cannot be implemented.

42. DISADVANTAGES:Accidental ingestion of fluoride supplements can cause stomach upset.Not more then 1.2-2.2mg NaF tablets should be dispensed at one time.

43. The addition of fluoride to table salt is a feasible way to deliver systemic fluoride, particularly in countries that lack a wide spread municipal water system.It has been sold in Switzerland for many years. France and few new countries in western hemisphere have introduced salt fluoridation in recent years.Salt as a vehicle for fluoride in the 1940’s.Salt Fluoridation

44. Initially supplementation was 90mgF/kg of salt.Recent recommended range is 200-250mgF/kg.Commonly used salts are potassium fluoride (250mg/kg) and sodium fluoride (225mg/kg).

45. Initial conc. of 90mg F/kg was raised to 250mg F/kg in Switzerland.In Hungaria (1982-83) the salt was fluoridated at 350mg F/kg which brought the DMF score down from 10.3 to 3.3 in 12-14 yr old children.Canton of Glarus started salt fluoridation in 1975-76 containing 250mg F/kg.

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47. AdvantagesNo supervised water workers nor water distribution system are necessary.It has low cost ie. Less expensive.DisadvantagesIts consumption is lowest when need for fluoride’s is greatest i.e. in early years of life.High salt intake causes hypertension

48. Peter S. Essentials of preventive and community dentistry. Arya publication 4th edition: 236-81.Fejerskov O, Ekstrand J, Burt B A. Fluorides in dentistry. Munksgaard publication 2nd edition: 347-55.Fluorides and oral health. Report of a WHO committee on oral health status and fluoride use 1994; 846.References

49. THANK YOU“You don’t have to brush all your teeth, just the ones you want to keep”.