MJDF/MFDS Fluoride Patricia Thomson - PowerPoint Presentation

Slide1

MJDF/MFDS Fluoride

Patricia Thomson

2020

Action

Fluoride is an active chemical treatment for carious lesions. The mode of action is to enhance the

remineralisation

of initial caries defects and inhibit the further demineralization that leads to caries initiation or progression.

It shifts the

demin-remin

balance from net demineralization to net

remineralisation

in caries prone individuals

Only 10% of the UK’s populations have the optimum level of fluoride in their public water supply to achieve optimum levels for dental health.

Toothpaste

98% of toothpaste in retail outlets has fluoride. Reduces caries in primary dentition by up to 37% and permanent by 24%.

Effectiveness is concentration dependent. Over the range 1000-2500 ppm F there is further 8% improvement in efficacy for every 1000 ppm F

Dosage

DOH and British Society for the Study of Community Dentistry recommend:

0-3

yrs

smear of paste with no less than 1000 ppm F

3-6

yrs

pea sized amount of 1350-1450 ppm F

SDCEP :

3-6 years pea-sized amount not less than 1000ppm. Consider 1350-1500 ppm.

7+ 1350-1500ppm

Higher strength fluoride toothpastes

These are

Duraphat

®

2800 (0.619%-2800 ppm) and 5000 (1.1%-5000ppm)

2800 used on caries prone individuals 10-16 years old, and 5000 for16 and over years of age

Indicated for patients with fixed appliances, high caries risk adolescents, adults with special needs, and all adults who are medically compromised such as with reduced salivary flow, polypharmacy, stroke, dementia etc.

Fluoride mouthrinse

Not recommended under 6 years.

2 formulations:

0.05% for daily application, 250ml once per day, rinse for 1 min then spit out

0.2% for weekly application

Cochrane found they reduce caries in the permanent dentition by 26%. Can be used for ortho patients. Recommend use at different time of day from brushing.

Other delivery systems

Fluoride Gel

Cochrane concluded that professional application of F gel in trays for 5 mins, x4/year reduces caries by up to 28% in permanent dentition. Concentration is 12,300 ppm. High level of coop needed.

Fluoride Varnish 

Sodium Fluoride varnish 5% up to x4 per year from 2 years

2-5 years 0.25ml

6+ years 0.4ml

Advise soft food for rest of day and do not brush for rest of day

1ml contains 50mg

NaF

= 22.8mg Fluoride ion. 5%

NaF

=22,600 ppm F

-

Fluoride Varnish

F varnish x3/year reduces caries in 1

y

and 2

y

dentition by 33% and 46% respectively

2.26%F

Duraphat

® or 1.23% acidulated phosphate fluoride solution (APF)

An extremely effective and easy method. 22,600 ppm F. Especially effective for root surface caries.

Caution: allergy to sticking plaster (colophony) and presence of asthma

Fluoride tablets and drops

They are swallowed, so there is a risk of fluorosis. Not commonly used in many countries, but may still be used for high caries risk individuals and the medically compromised. Suck for topical effect and different time of day from toothbrushing. Dependent on compliance. Minimal effect systemically

Doses for different water fluoride content regions and varying ages available from SDCEP prescribing guidelines, Clinical Dentistry by I Chestnut and J Gibson, SIGN guidelines 47- preventing dental caries in children at high caries risk, and elsewhere. They still ask these in exams. In this area it is 1mg F (2.2mg

NaF

) /day for 6+ years 

2.2mgNaF= 1mg Fluoride ion