Fluoride DiscussionPlease discuss the questions regarding fluoride.1. A patient comes into the dental hygiene clinic and refuses fluoride treatment. How would you explain and encourage the benefits of fluoride to this patient?2. Explain the clinical procedures of a topical (tray) and fluoride varnish application on a patient.
Fluoride
Jordan Anderson, RDH, MDH
Objectives
? Identify fluoride as a method of preventing dental caries
? Describe the importance of the proper level of fluoride in a water
system
? List three types of fluoride used for professional applications.
? List the types of self-applies fluorides
? Compare percentages of fluoride in self applied and topical
professional applications.
? Designate the recommended amount of fluoride in sub optimally
fluoridated communities and with patients who are susceptible to
caries.
Key Terms
? PPM- parts per million, measure designate the amount of fluoride used
for optimum level in fluoridated, dentifrice, and other fluoride
containing preparations.
? Fluoride- a salt of hydrofluoric acid, the ionized form of fluoride that
occurs in many tissues and is stored primarily in bones and teeth
? Systemically- by way of the circulation to developing teeth (preeruptive
exposure)
? Topically- directly to the exposed surfaces of erupted teeth (posteruptive
exposure)
? Fluoridation- the adjustment of natural fluoride ion content in a water
supply that will maximize caries prevention and limit enamel fluorosis
Key Terms
? Xerostomia- dryness of the mouth due to a diminished quality of
saliva
? Rampant Caries- widespread formation of chalky white areas and
incipient lesions that may increase in size over a short time
? Fluorosis- form of enamel hypomineralization due to excessive
ingestion of fluoride during the development and mineralization
of the teeth; depending on length and exposure and ppm of
fluoride; the fluorised area may appear as a white spot or as
severe brown staining with pitting (over 2 ppm)
Historical Aspects
? Early 20th century Dr. Frederick McKay observed people in
Colorado Springs, CO. They had mottled enamel (dental
fluorosis) and less dental caries. He associated this with
drinking water.
? 1930’s- Dr. H Trendley Dean and US Public Health Service
concluded that the optimum level of fluoride for dental
caries prevention is 1 ppm in moderate climates.
? 1945- the first communities were fluoridated
Fluoride Level
? In 2011, US Dept of Health and Human Services updated
recommendation for the optimal concentration of water
fluoridation to 0.7 ppm for all communities.
? The decision based on fact that Americans have access to
many more sources of fluoride today than they did when
water fluoridation was introduced.
Effects/Benefits of Fluoridation
? Appearance of teeth (optimum- white/opaque less caries;
slightly over optimum- mild fluorosis)
? Reduction in dental caries in primary/permanent teeth
? Slow progression of dental caries
? Less tooth loss
? Desentization
? Remineralization of Demineralized areas
School Fluoridation
? Adding 1 ppm of fluoride to school water supply because of
intermittent use of school water and time there
? Has been phased out in several states.
Professional Topical Fluoride
Indications
? Based on caries risk assessment for the individual patient
? Low caries risk: use professional judgement, application may
not provide additional benefit.
? Moderate caries risk: ( presence of at least one risk factor)
application at 6 month intervals or more frequent.
? High caries risk: (multiple risk factors, xerostomia or
suboptimal fluoride exposure) application at 6 month or 3
month intervals
Professional Topical Fluoride
Applications
? Ages 6 or younger, fluoride varnish is the only topical
application recommended.
? Also come in gels or foams delivered in trays for all ages and
levels of caries risk except ages 6 and under
Types of Professionally Applied
Fluoride
? 2 % sodium fluoride (NaF) gel or foam in trays
? 1.23 acidulated phosphate fluoride as a gel or foam in trays
? 5% sodium fluoride as a varnish brushed on teeth
Clinical Procedures of topical
tray fluoride
? Determine need and type of fluoride for patient
? Patient should be seating upright, head tilting forward and no
swallowing. Procedure lasts 4 minutes
? Choose appropriate size of tray for full coverage
? Fill tray 1/3 full of gel or foam
? Dry Teeth
? Insert trays with suction in between
? Don’t leave patient unattended
? Remove tray after 4 minutes ask patient to expectorate and not drink,
eat or rinse for 30 minutes
Procedure for Varnish
Application
? Determine need based on caries risk
? Explain procedure and prepare patient
? Lightly Dry teeth
? Apply varnish in a thin layer
? Instruct patient there will be a thin covering and to leave on
at least 4-6 hours after
Self- Applied Fluorides
? Tray technique
? Mouthrinses
? Brush on gel and dentifrices
Tray Technique-Home
Application
? Indicated for patient with xerostomia, rampant caries
? Custom tray is made for the patient
? Instruction is provided for the use of this tray and gel used
Fluoride Mouthrinses for home
application
? Indicated for adolescent and pre-teen, patients with
demineralization, and prevention of caries
? Children under 6 years of age and those of any age that
cannot rinse because of oral and/or facial musculature
problem should not use a fluoride rinse
? Mouthrinses is a practical and effective means for selfapplication of fluoride for individual at moderate or high risk
Fluoride home applying
gel/dentifrice
? SnF, NaF, APF Na monofluorophoshate, and amine fl
? Fluoride dentifrice are available as gels or pastes
? Approved by ADA as an integral part of a complete
preventive program and is a basic caries prevention
intervention for all patients.
Patient Instructions
? Select accepted ADA Fluoride –containing toothpaste
? Place a small amt of dentifrice on toothbrush
? Spread dentifrice over teeth with light brushing
? Proceed with correct brushing technique
? Keep dentifrice out of reach of children
? Rinse minimally with water after brushing to retain fluoride
Recommended amounts of
dentifrice per age
Age
Amount of Dentifrice
Instruction
Child (less than 2 yo)
“Smear”- less than ½ size
of small pea
Twice daily brushing with
minimal amt of dentifrice
swallowed
Older Child (3-5 yo)
Small pea size
Twice daily brushing
spreading over filaments
explaining not to swallow
large amounts.
Adults
½ inch or less
Twice daily brushing
References
? Wilkins, E. (2013) Clinical Practice of the Dental Hygienist.
11th edition. P. 517-541

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