Mechanism Of Action of Fluoride in dental

caries.

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 Mechanism of action of
fluoride
• Florine is the most electronegative element and
therefore highly reactive. It does not occur in the
elemental state (F2) in nature but is widespread in
nature, occurring in fresh water, vegitables, blood,
milk and organic compounds.
• Since fluoride can affect both the inorganic tooth
structure & the bacterial metaboloims in plaque,
several mechanism of action have been proposed.

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• Reduced enamel, solubility, improved
crystallinity, promotion of reminerlization,
lower free surface energy, desorption of
protein and bacteria, reduced cariogenic
flora & inhibition of bacterial enzymes
systems.
• Many of these mechanisms probably work
simultaneously depending on the
cnsentration and form of fluoride but the
exact contribution of any one of the total
careis reduction is unknown.

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 Systemic Effect of
Fluoride
• The main in organic constituent of tooth and bone is
hydroxy apatite (HAP)
• Hydroxy apatite on addition of fluorine results in the
formation of flour apatite (FAP) or fluoridated hydroxy
apatite becaue not all the hydroxyl groups are replaced
by fluorides.
• A pure fluorapatite crystal would contain 38,000 ppm F
but enamel form a fluoridated area contain only 500 to
2000 ppm.
• And this leads to speculation on several possible
mechanims of action of systemically ingested fluoride
improved crystalinity, the void theory, FAP V/s HAP
solubility in acid & iproved tooth morphology.
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• Improved crystallinity :-
This theory is explained by x-ray
diffraction method - Fluoride increases the
crystal size and less produces, less strain in
crystal lattice. This takes place through
conversion of amorphous calcium phosphate
into crystalline hydroxy phosphate.

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• Void theory :- void in the crystals
decreases the stability and increases
chemical reactivity. If fluoride fills
these void in the hydroxy apetite
crystals it will attain stable from with
formation of more and stronger hydrogen
bonds. Greater stability will leads to
lower solubility and hence greater
resistance to dissolution in acids.

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• Acid Solubility (FAP V/s HAP) The simplest
explanation for the decreased solubility of fluoridated
enamel is that fluorapatite (with a solubility product
constant of 10-60 ) is less soluble than hydroxyapatite
(whose solubility product is constant between 10-55 and
10-60 ) 46 However, the amount of fluoride in surface
enamel from the teeth of persons living in a fluoridated
area is only 500 to 2000 ppm F-. This is but a fraction
of the theoretie amount of fluoride in fluorapatite
(38000 ppm F in enamel). Obviously little of the enamel
is composed of fluorapatite.
However the actual difference in the amount dissolving
is usually so small that it is not likely to be factor in
cariostasis.

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• Tooth Morphology:-
Quantitative studies on the influence of fluoride
in the morphology of human teeth showed that
person living in a high fluoride areas shows
smaller cusp height and less convexity
According to Wallensus, tooth in a high fluoride
area were 1.7% wider then control.

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 Topical Effect Of
Fluoride
• Topical effect of fluoride may be due to either low or high
concentration of fluoride and frequent or sporadic
exposure.
• Bacterial Metabolism & fluoride:-
Once the teeth erupt into oral cavity, the systemic effects
of fluoride on enamel ceases fluoride is relieved to have an
effect on the glycolates pathway of oral micro organism.

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• Enzyme Inhibition

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• Fluoride has enolase inhibition effect and it also
inhibits glucose transport, enolase is a metallo
enzyme that requires adjavalent cation for tis
activity., fluoride due to its increased reactivity
forms a complex with this cation. Thus inhibiting
the enzyme. It also inhibits non-metallo enzyme
like phosphatage thus leading to reduce acid
production.
• Suppression of flora :- Stanous fluoride is a
potent suppressor of the bacterial growth
because it oxidizes the thiol group present in
bacteria thus inhibiting bacterial matabolism.

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• Antibacterial action:- The concentration of
fluoride above 2 ppm in solution progressively
decrease the transport of uptake of glucose into
Cells of streptococci and also reduces ATP
synthesis.
Action of fluoride on tooth surface
• Fluoride incorporation in enamel – Incorporation
of fluoride into enamel through out development
is not a principal mechanism of cario static's
effect. It is believed that pre eruptive exposure
to fluoride may produce teeth more resistance to
caries by making pits and fissures shallower.
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• Pre-eruptive in corporation – fluoride gets
incorporated in the fluid filled sac, which
surrounds the developing tooth. It then
enters the developing enamel. Highest
concentration of fluoride is seen in enamle
crown located at or near the tooth
surface.
• Post eruptive incorporation – fluoride
continuous to enter the enamel surface,
causing crystal to change from
predominatly carbonated apatite and
hydroxy apatite to flour apatite (FAP) and
flour hydroxy apatite (FHAP) crystals.
These fluoride rich crystals are less acid
soluble then the original enamel
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apatite.
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 Remenerilization of Acid Dissolved enamel
Minerals of tooth enamel are continuously in
exchange with the minerals of saliva and thus the
balance is maintained. This Equilibrium can get
disturbed with the organic acid produced by the
metabolism of fermentable carbohydrates by the
microorganism. This leads to drop in PH. of the
plaque on the enamel surface and in the sub surface.
Minerals, particularly calcium and phosphate leave
the dissolved enamel in their ionic form an entrace
the plaque fluid. This process is called
deminerilization this get reverrse with the factor
like fluoride and is terms reminerilization.

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 Specific Plaque
Hypothesis
• The use of topical fluoride as a cure for infection
has been termed the specific plaque hypothesis by
hoesche. The primary assumption in this theory is
that dental caries results from a specific
pathogen, S. mutans. Thus the elimination or
reduction of this pathogen with provide a lasting
cariostatic effect. Thus the specific palque
hypothesis explains a persistant anticaries action
of topical fluorides that is not seen with water
fluoridation or fluoride dentifrices.

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• References:
• Shobha Tondon
Text book of pedodontics

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