Fluoride and Oral Health (I)

Dr. Raghad Hashim Assistant Professor 2011

HISTORICAL ASPECTS

Dr. Frederick S. McKay H.V. Churchill Dr. H. Dean

Fluoridation - 1945

The first communities were fluoridated in 1945. Research in the communities began before
fluoridation was started to obtain baseline information, and it continued over the years with detailed examinations and reports.

Fluoride

a halogen; the 13th most common element the most electronegative element; highly reactive a seeker of mineralised tissues sea water: [F] = 0.8 to 1.4 ppm unfertilised soils: [F] = 300+ ppm unfluoridated water supplies:[F] = 0.3ppm water fluoridation [F] = 0.7 to 1.2 ppm

FLUORIDE METABOLISM Absorption Distribution & Retention Excretion

FLUORIDE AND TOOTH DEVELOPMENT PRE-ERUPTIVE: MINERALIZATION STAGE PRE-ERUPTIVE: MATURATION STAGE

DEMINERALIZATION and REMINERALIZATION

DEMINERALIZATION A. Initiation

Demineralization means breakdown of the tooth structure with a loss of mineral content, primarily calcium and phosphorus. Breakdown is caused by organic acids produced by acidogenic bacteria after the metabolism of ingested fermentable carbohydrates.

DEMINERALIZATION B. Progression The acids produced in the dental biofilm pass through the micro channels between the enamel rods. Demineralization occurs in the subsurface layer. Eventually the area can be detected on clinical examination when the spot may become chalky or discolored by food or tobacco.

REMINERALIZATION A. Process of Remineralization Remineralization is the recovery of the demineralization process. Saliva acts to buffer (neutralize) the acid, and the calcium and phosphorous ions are restored to the crystal structure. With the addition of fluoride, the dental carious process is arrested. When early remineralization occurs, the white spot will "harden" and the area may be hypermineralized compared with the enamel around it.

REMINERALIZATION B. Role of Fluoride Fluoride inhibits demineralization and enhances remineralization.

The fluoride in the biofilm may be acquired

directly from fluoridated water, dentifrice, and other topical sources, brought by the saliva from the same sources, or from an exchange with the demineralizing tooth surface under the biofilm.

The fluoride ion and the early enamel lesion

Enamel
Plaque acids Dentine

FCa2+ PO43-

There are three basic effects of fluoride to prevent dental caries: A. Inhibit demineralization. B. Enhance remineralization of incipient lesions. C. Inhibit bacterial activity.

But wait you have to remember that.

Adjusted water fluoridation:

What dose that mean ???????

FLUORIDATION
Fluoridation is the adjustment of the fluoride ion content of a domestic municipal water supply to the optimum physiologic concentration that will provide maximum protection against dental caries and enhance the appearance of the teeth with a minimum possibility of producing objectionable enamel fluorosis. Fluoridation has been established as the most efficient, effective, reliable, and inexpensive means for improving and maintaining oral health.

PRIMARY TEETH

With fluoridation from birth, the caries incidence

is reduced up to 50% in the primary teeth.

TOOTH LOSS

Tooth loss is much greater in both primary and

permanent teeth without fluoride, because of increased dental caries, which progresses more rapidly.

PERMANENT TEETH A. Overall Benefits

Continuous use of fluoridated water from birth can

result in as many as 40% to 65% fewer carious lesions.

The effects are similar to those found in

communities with optimum levels of natural fluoride in the water.

B. Distribution Anterior teeth, particularly maxillary, receive more protection from fluoride than do posterior teeth. The anterior teeth are contacted by the drinking water as it passes into the mouth. C. Progression Not only are the numbers of carious lesions reduced, but the caries rate is slowed.

ADULTS

When a person resides in a fluoride area

throughout life, benefits continue. In Colorado Springs, adults aged 20 to 44 years who had used water with natural fluoride showed 60% less caries experience than did adults in fluoride-deficient Boulder, Colorado. In Boulder, adults also had had three to four times as many permanent teeth extracted.

ROOT CARIES

Root caries experience of lifelong residents of a

community with fluoridated water is in direct proportion to the fluoride concentration in the water compared with the experience of residents of a fluoride-free community.

The incidence of root caries is approximately

50% less in lifelong residents of a fluoridated community.

The ideal preventive intervention

works does not rely on changes in behaviour is safe reduces health inequalities makes cost-effective use of scarce public resources

SCHOOL FLUORIDATION

FLUORIDES IN FOODS
Food Salt Halo effect Milk Bottled water

So, do you think that salt fluoridation is superior to water fluoridation ? Why ?????

DIETARY FLUORIDE SUPPLEMENTS

DETERMINE THE NEED

A. Tablets and Lozenges B. Mouth rinse C. Drops

AVAILABLE FORMS OF SUPPLEMENTS

Whenever possible, a supplement that has a topical effect (is chewed, swished, and then swallowed).
Available as a pill, chewable tablet, lozenge, drop, or mouth rinse for swallowing after rinsing. Prescribed on an individual patient basis for daily use at home, or may be administered to school classroom groups as part of a total public health program.

Types of fluoride drops available:

0.125 mg F/drop. 0.25 mg F/drop. 0.5 mg F/drop.

This form can be used for very young children.

Recommended daily fluoride supplementation ( mg F) Concentration of fluoride in water (ppm) Age 6 months to 3 yrs 3 to 6 yrs > 6 yrs < 0.3

0.25 0.5 1.0

For maximum benefit should be continued from birth to

13 years, and the tablets sucked slowly.

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PRESCRIPTION

Prescription for breast-fed infant

The concentration of fluoride in breast milk is very low,

even when the mother uses fluoridated community water.

Infant who are totally breast-fed after 6 months need a

daily fluoride supplement of 0.25 mg.

In a fluoridated community, an infant who receives other

sources of liquid, such as drinking water or supplemental formula feedings made with fluoridated water, does not need the prescription.

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