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Fluoride therapy is a method of dental cleaning using fluoride, which is designed to prevent tooth decay and dental caries which result in cavities. Using this technique, fluoride is most commonly administered through non-consumable products including topical gels, toothpaste, and mouth rinse. Fluoride is often used as a topical dental treatment, however fluoride is not safe to randomly consume.

Benefits of fluoride therapy

Fluoride therapy is commonly practiced and generally agreed upon as being useful in the modern dental field. Fluoride combats the formation of tooth decay primarily in three ways:

  • Fluoride promotes the remineralization of a tooth. Fluoride has been found to enhance the tooth remineralization process. Fluoride found in saliva will adsorb onto the surface of a tooth where demineralization has occurred. The presence of this fluoride in turn attracts other minerals (such as calcium), thus resulting in the formation of new tooth mineral.

  • Fluoride can make a tooth more resistant to the formation of tooth decay. The new tooth mineral that is created by the remineralization process in the presence of fluoride is actually a "harder" mineral compound than existed when the tooth initially formed. Teeth are generally composed of hydroxyapatite and carbonated hydroxyapatite. Fluorapatite is created during the remineralization process when fluoride is present and is more resistant to dissolution by acids (demineralization).

  • Fluoride can inhibit oral bacteria's ability to create acids. Fluoride decreases the rate at which the bacteria that live in dental plaque can produce acid by disrupting the bacteria and its ability to metabolize sugars. The less sugar the bacteria can consume, the less acidic waste which will be produced and participate in the demineralization process.

There are many different types of fluoride therapies, which include at home therapies and professionally applied topical fluorides (PATF). At home therapies can be further divided into over-the-counter (OTC) and prescription strengths. The fluoride therapies whether OTC or PATF are categorized by application – dentifrices, mouthrinses, gels/ foams, varnishes, dietary fluoridate supplements, and water fluoridation.

Fluoride, while beneficial to adults, is more important in children whose teeth are developing. As teeth are developing within their jaw bones, enamel is being laid down. Systemic ingestion of fluoride results in a greater component of fluoroapatite in the mineral structure of the enamel.

Dentifrices

OTC toothpaste

Most dentifrices today contain 0.1% (1000 ppm) fluoride, usually in the form of sodium monofluorophosphate (MFP); 100 g of toothpaste containing 0.76 g MFP (equivalent to 0.1 g fluoride). Toothpaste containing 1,500 ppm fluoride has been reported to be slightly more efficacious in reducing dental caries in the U.S.
  • Use:
    • For children: Use of a pea-sized amount (approximately 0.25 g) of fluoride toothpaste <2 times per day by children aged <6 years. Parents of children aged <2 years are to seek advice from a dentist or physician before introducing their child to fluoride toothpaste.
    • For adults: Use as directed.
  • Contraindications - Fluoride toothpaste may cause or exacerbate perioral dermatitis in some patients.

Prescription Strength Dentifrices

  • 1.1% (4,950 ppm) sodium fluoride toothpaste – e.g. PreviDent 5000 Plus or booster
    • Self applied topical neutral fluoride dentifrice containing 1.1% (w/w) sodium fluoride for use as a dental caries preventive in adults and pediatric patients
    • Indication and usage – As a dental caries preventive; for once daily self-applied topical use. It is well established that 1.1% sodium fluoride is safe and extraordinarily effective as a caries preventive when applied frequently with mouthpiece applicators. Toothpaste with 1.1% sodium fluoride in a squeeze-tube is easily applied onto a toothbrush. This prescription dental cream should be used once daily in place of your regular toothpaste unless otherwise instructed by your dental professional.
    • Contraindications - Do not use in pediatric patients under age 6 years unless recommended by a dentist or physician.

Mouthrinses

OTC mouthrinse

The most common fluoride compound used in mouthrinse is sodium fluoride.
  • Over-the-counter solutions of 0.05% sodium fluoride (225 ppm fluoride) for daily rinsing are available for use by persons aged >6 years.
  • Indications: incipient decay and low risk pts
  • Use: Fluoride mouthrinse is a concentrated solution intended for daily or weekly use as directed by manufacturer.
  • Contraindications: : not strong enough for high caries risk pts
  • E.g. ACT, Fluorigard

Prescription Mouthrinses

APF 200ppm F - 0.2 mg/ml acidulated pH 4 F
  • Indication: additional protection if necessary for children where no F in water, useful during orthodontic tx or for moderate risk pts.
  • Use: 5 ml/day: if swallowed = 1 mg F/day
  • Contraindications: not strong enough for high caries risk patients, not to be swallowed by children where >3.0 ppm F in drinking water or who use supplements or a toothpaste with F.

NaF 900 ppm F - 0.2 mg/ml neutral = 0.2%

  • Indication: additional protection if necessary for children where no F in water, useful during orthodontic tx or for moderate risk pts.
  • Use: 5 ml/day: if swallowed = 1 mg F/day
  • Contraindications: not strong enough for high caries risk patients, not to be swallowed by children where >3.0 ppm F in
  • E.g. - PreviDent Dental Rinse 0.2% neutral sodium fluoride (Rx)

0.63% stannous fluoride (1512 ppm)

  • Indication: moderate to high risk patients, reduce sensitivity and protect root surface. For children over 12 years of age.
  • Contraindications: children < 12 years
  • E.g. – Gel-Kam Oral Care Rinse (Rx)

Gels/Foams

General indications:
  • Patients who are high risk for caries on smooth surfaces
  • Patients who are at high risk for caries on root surfaces
  • Special patient groups:
    • Ortho patients
    • Patients undergoing head and neck radiation
    • Patients with decreased salivary flow
  • Children whose permanent molars should, but cannot be sealed
  • Not recommended in children with low caries risk in optimally fluoridated areas.

General application of fluoride gels and foams

  • Mouth trays should be tried in the patient’s mouth, as it may be necessary to modify or adapt trays.
  • Patient should be seated upright and suction should be used during the procedure.
  • Teeth should be air dried before gel application. For caries prevention, cleaning or prophylaxis unnecessary prior to professionally applied topical fluorides (PATF).
  • Enough gel or foam should be used to completely cover the teeth, but should be no more than 2-2.5 grams per tray or 40% of the tray’s volume.
  • Upper and lower trays should be inserted separately.
  • Fluoride should be applied for 4 minutes.
  • Patient should expectorate for 1-2 minutes after tray removal.
  • Patient should not rinse, eat or drink for at least 30 minutes after application.

PATF products include:

  • Gel of APF (1.23% ppm fluoride) = 12.3 mg/ml F
    • Indications: high risk caries, current activity
    • Use: four minute application with foam tray
    • Contraindications: don’t use frequently if glass based restorations present (porcelain or resins), sour taste, young children at risk for swallowing product
  • Gel or foam of sodium fluoride (0.9% ppm fluoride)
    • Indications: high risk caries, current activity, especially with an erosive component
    • Use: four minute application with foam tray
    • Contraindications: slightly lower F uptake than APF, young children at risk for swallowing product

Home Use products include:

  • Gel of sodium fluoride – 1.1% (4,950ppm) fluoride – e.g. Fluorishield, Phos-Flur Gel, PreviDent brush-on gel
  • Stannous fluoride - 0.4% (960 ppm) fluoride – e.g. Gel-Kam Gel
  • Use once a day for cavity prevention
  • Use twice a day for sensitivity relief

Varnish

Fluoride varnish has practical advantages (e.g., ease of application, a non-offensive taste, and use of smaller amounts of fluoride than required for gel applications).

General indications:

  • Patients who are moderate to high risk for caries on smooth surfaces
  • Patients who are at high risk for caries on root surfaces
  • Special patient groups:
    • Institutionalized patients
    • Ortho patients
    • Patients undergoing head and neck radiation
    • Patients with decreased salivary flow
  • Children whose permanent molars should, but cannot be sealed
  • No published evidence indicates that professionally applied fluoride varnish is a risk factor for enamel fluorosis,

General Contraindications:

  • Treatment of cavitated lesions
  • Low risk, caries free patients, living in fluoridated communities

Use: High-concentration fluoride varnish is painted directly onto the teeth

General application of fluoride varnishes

  • Remove excess moisture from teeth with gauze or air.
  • Apply varnish as a thin layer using disposable brush
  • The entire tooth surface must be treated, but do not place large amounts on tooth surfaces.
  • Avoid applying varnish to gingival tissue because of risk of allergy.
  • No drying is necessary after application because varnish sets in a few seconds.
  • No rinsing, eating or drinking for at least 30 minutes after application.

Products

Dietary Fluoride Supplements

Dietary fluoride supplements in the form of tablets, lozenges, or liquids (including fluoride-vitamin preparations)
  • Supplements are provided as sodium fluoride. One milligram of fluoride is attained from 2.2 mg of sodium fluoride
    • Indications: The use of fluoride supplements is indicated for children in non-fluoridated areas.
    • Contraindications: if the water is already optimally fluoridated

Water fluoridation

Fluoridation is the adjustment of fluoride in a water supply to an optimal concentration of between 0.7 to 1.2 ppm. In non-fluoridated communities, adding fluoride to school water supplies (at higher than optimal levels) results in significant cavitiy reduction.
  • Indications: Every community, and is especially beneficial for individuals living in poorer communities, who have a high burden of dental caries and less access to dental care and alternative fluoride resources.
  • Most cost effective community-based approach to dental care in the United States in terms of cost per saved tooth surface. Water fluoridation has the benefit of reaching the whole population with relatively minimal effort.
  • Contraindications: Virtually none except the possible fluorosis risk if levels are too high.

Grand Rapids, Michigan, was the first city in the United States to add fluoride to the drink water, doing so in 1945.

Fluoride Conversion Chart

APF (10)(%)(1000) ppm
1.1% 10,000
1.23% 12,300
NaF (4.5)(%)(1000) ppm
0.05% 225
0.20% 900
0.44% 1,980
1.0 % 4,500
1.1% 4,950
2.0% 9,000
5.0% 22,500
SnF2 (2.4)(%)(1000) ppm
0.40% 960
0.63% 1,512

References

  • CDC. Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States.
  • Fluoride History History of fluoride therapy including early patents

 

This article is licensed under the GNU Free Documentation License. It uses material from the "Fluoride therapy".

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