Professional Documents
Culture Documents
Dr G. kayalvizhi
Contents
Introduction water fluoridation School water fluoridation Salt fluoridation Milk fluoridation Fluoride tablets and drops Prenatal supplementation Defluoridation Conclusion references
Water fluoridation
Definition upward adjustment of the concentration of fluoride ion in public water supply in such a way that the concentration of f ion in the water may be consistently maintained at 1 ppm.
Galagon and vermillion 1957 based on body wt & climatic conditions = ppm F (conc.) = 0.34/E Where E = -0.038+0.0062 x temperature of the area in 0F
Types of equipment
equipment principle Factors limiting utilisation recommenda tion
Saturator system
Dry feeder
Solution feeder
Equipmentpolyvinyl chloride
Saturator system
Volumetric feeder
Solution feeder
Venturi fluoridator
Method of estimation of fluoride concentration in drinking water fluoride electrode coupled with ph meter (orion, radiometer) Scot- sanchis method Zirconium alizarin reagent
Tan& storvick
Murray Murray & Atkinson Backer dirkis Whittle & downer
1964
1969 1971 1974
Corvalis albarny 1
Hartepool,york London Holland & new zealand Birmingham salford F/NO N-f 1.5-2 0.2
56% dmft
64% dmft 93% dmft Prox& gingival caries 54% dmft
1979
Weidman 1963
up to 4ppm- no radiographic evidence
Feasibility in India
Most effective, practical and economical public health measure Shortcoming central pipe water supply system (30%)
Advantages
Effective public health measure
Disadvantages
Limited pre eruptive contact (5-6yr) Intermittent exposure of F to children (5-6hrs 4.5ppm over dosage
Salt fluoridation
Introduced in Switzerland 1955 Salt fluoridated 90 mgF/kg (canton of Zurich) 250mgF/kg (canton of vaud 1970) Belgium, France, Germany, Spain, Hungary Clinical trials Wespi et al 1955 20-25% Muhlemann 1967- 300mgF/kg - 1.5mgF/5gm of salt Toth 1976 250mgF/kg salt - 41% (2-6yr) - 8yr - 58%(7-11yr) - 36% (12-14yr)
Advantages of salt fluoridation Safe Supplement Consumer free choice No supervised water distribution systems Lifelong daily compliance Small amounts Low cost Disadvantages Low consumption Safety - Hypertension ? No problem of acute toxicity
Limitations
Limited to domestic salt Variation in salt intake Difficulty in controlling the distribution of various conc Requires refined salt produced with modern technology Technical expertise Multiple sources of water
Feasibility in India
Effectively controlled supply Individual monitoring not required (5-8gms of salt/day) Freely available Cariostatic effectiveness and excretion Does not alter its color
Milk fluoridation
Ziegler 1955 (Swiss city of winterthur) 0.03 ppm F (Erickson 1971) Compounds NaF- conc. aqueous solution disodiummonofluorophosphate reacts ca disodiumsilicofluoride pasteurized milk Manufacture fl added to milk in appropriate quantity Fluoridated milk- pasteurized / sterilised (liquid) - powder WHO 1994 - 0-1mgF/day (age+water F)
Studies Inamura 1956 (Japan) 36.3% - (2.5mg NaF ) Rusoff et al 1962 (U.S.A) 35% (3.5ppm F) Benoczy 1984 longitudinal study (3-9yr old) 3yr 200ml milk +0.4mg F (3-5yyr old) 0.75mgF (6-9yr old) Primary teeth Ziegler 1964 14 31% (1ppm) Benoczy 1983 74% Effectiveness of milk F bioavailability is not reduced promotes remineralisation (low level of ionised F)
Stamm 1972 4 criticisms of milk fluoridation as public health measure 1) low socioeconomic 2) less benefit 3) cost 4) slow absorption
fluoride supplements
1940 , pre eruptive effect Common dietary supplementsFluoride drops vitamins Fluoride tablets - vitamins Lozenges Oral rinse supplements
Commercially available
NaF tablets fluoroday tymafluor, luride (U.K) Vitamins Drops 0.125,0.25,0.50mg
dosage
2.2mg (1mgF) 1.1mg (0.5mgF) 0.55mg (0.25mgF) APF tablets/ KF/CaF
Luride drops
Lozenges
oral rinse
o.25 mg
0.50
1mg
0.3-0.7ppm
0.25
0.50
>0.7ppm
Precautions
Stomach upset Risk of mild fluorosis
Hoskova 1968 93% (prenatally) 82% - 54% (birth) 56% (kailis et al) Since birth 6-8yr -40% (Prichard 1969) - 3 yr 78% (hennon 1971) After 3yr 0-38%
Placental transfer of F ?
1) Fluorosis in primary teeth - thylstrup (3-21ppm) 2) Prenatal fluoride metabolism
Defluoridation
Deflouridation - scientific means to improve the quality of water with high fluoride conc by adjusting the optimum level in drinking water Methods Adsorption and ion exchange methods
Adsorb F + exchange negative ions activated alumina, fluidized activated alumina, activated bauxite, zeolite, tricalcium phosphate,super phosphate, activated bone char, magnesite
Precipitation method - High ph co-precipitation of several elements + fl ions - Alum, alum + lime, lime softening, CaCl
Methods based on membrane separation Reverse osmosis expensive 30% of raw water is lost
Defluoron 1
Sulphonated saw dust impregnated with 2% alum. High attritional losses (bhakuni 1964, 1970)
Carbion
Good durability , bulk density 680g/lt
Pilot plant gangapur - Rajasthan (4.8ppm) 8:1 Carbion & defluoron 1, alum
Defluoron 2 (1968)
Sulphonated coal +alum cycles, 2-4yrs life regeneration and maintenance of plant skilled operation
NEERI ,Nagpur - 1960 Nawlakhe 1974 Nalgonda technique 1975 (Andhra Pradesh)
Domestic treatment
container 20- 50lt
CHEMICAL TANK OUTLET INLET CHEMICAL DOSING SYSTEM HAND PUMP PERFORATED SHEET GRAVEL
VALVE 1 VALVE 2 GRAVEL LAND BACK WASHLINE MASONARY M.S. STAND DRAIN
Activated alumina
References
Fluorides in dentistry Fejerskov Fluorides Amrit tewari Salt fluoridation - Adv dent res 1995 Dcna 1999 Essentials of preventive and community dentistry soben peter J of Indian dental association 1986 JDR 1992 clinical uses of Fluorides- stephen wei j dent child 1981