Preventive dentistry
Self - Applied fluoride
A relatively low cone. of F applied by the individuals them selves
1- Dentifrices. 2- Mouth rinses. 3- Fluoridated gels.
It can be used once or twice daily
Fluoridated dentifrices:
it consist from:
1. Polishing /abrasive agent.
2.binding/ thickening agents
3. Detergent, surfactant.
4. Humectants .
5. flavoring agents.
6. Sweeteners and coloring agents .
7. Antibacterial agents.
8.Anti caries agents .
9. Anti-calculus agents.
10. Desensitizing agents
The active agent was sodium flouride, and the abrasive was dicalicium phosphate.
Functions of Fluoridated dentifrices
1. Physical functions: a. Reduce cariogenicity of plaque by rinsing or flushing action that remove fermentable materials .
b. Disrupts the delicate balance of environmental conditions necessary for acid formation of thicker cariogenic plaque.
c. Fluoride deposit in the residual plaque to inhibit acid formation and enamel dissolution.
2.Chemical functions: Based on the potential anti caries mechanism of fluoride reactions through deposition of fluoride into the outer enamel surface and plaque
Types of fluoride used in dentifrices; Sodium fluoride (NaF), Stannous fluoride (SnF2), Sodium monofluorophosphat (MPF) Amine fluoride. Combination of NaF and MPF.
The concentration of fluoride range 525 - 1450 ppm., With increase the time of storage, conc. of fluoride decrease with the time of storage i.e. 6 months or more.
The type of fluoride used should be compatible with the constituents of the dentifrices especially the abrasive system.
Following brushing there will be retention of F in the oral fluid and dental plaque which will act as reservoir for F ions. These ions will be released gradually in the saliva and there by maintains a degree of protections against caries.
Increase frequency of brushing will increase benefits of fluoride. Studies showed that caries reduction by using fluoridated tooth is 25-30%.
Guide line followed for using tooth paste
l - Children under 5 years:
A brush full of 1000 ppm F paste may contain I mg F ions. Child may swallow paste accidentally as he can not control muscles of swallowing.
Thus brushing twice a day with 1000 ppm F tooth paste the child may swallow about 0.5 mg FI day. The child may be at risk to be effected by dental fluorosis especially if he is living in fluoridated area or taking F supplements
Recommendations:
? -A small pea sized amount of tooth paste used.
? -Brushing under supervision.
? -Use low concentration of F dentifrice.
2- Children above 5 year and adults:
For children, instruction should be given not to swallow tooth paste and a high F concentration can be applied.
fluoridate Mouth rinses:
Rinses can be used in home or school programs.
Fluoridate mouth rinse can be used in the following cases:
1- Primary preventive programs for children and adults.
2- In subjects with high risk to dental caries.
3 - Patients with rampant caries.
4- Patients with hypo salivation or Xerostomia.
5- Patient with sensitive teeth as cases of abrasion, attrition and erosion.
6- Patients with periodontits and presence of root caries.
7- Patients with orthodontic appliances
Types of fluoridated agents
1- Sodium fluoride NaF.
0.2 % (900 ppm F) for weekly use
.0.05% (225 ppm F) for daily use.
It is the main type used in neutral or acidified forms in a water vehicle.
2- Stannous fluoride
100, 200, 300 ppm
A 10 ml of rinse is used by forcefully swishing of liquid around the mouth for one minute then expectorate. Fluoridated mouth rinse should Not be used for children under 6 years of age as they can nor control muscle of swallowing. Also it is not preferable to be given for children living in F area or receiving F supplements. Studies reported caries reduction about 30%.
Note: F mouth rinse is not a substitute to F dentifrices it is usually used as a supplement to tooth paste.
Other types are also used Amine fluoride or Ammonium fluride
Fluoridated gel:
It is used in home programs.
Types:
- NaF or APF (5000ppm).
- SnF2 (0.4%).
---These can be applied using special tray or directly applied by tooth brush. Used for 1- 5 minutes, then expectorate.
-Patients advised not to rinse by water and not to eat or drink for at least 30 minutes.
Indications.
1- Patients with rampant caries.
2- Patients with Xerostomia,
3 - Sensitive teeth.
4- Root caries.
It can be used for 4 weeks course then when the onset of the disease is stopped we can switch back to mouth rinse. It is not recommended for children under 6 years.
Note: It is used in combination with dentifrices, and not preferable to be used in combination with mouth rinses.