fluoride

Question 1

Mechanism of fluoride action

Answer 1

When sodium fluoride is applied on the tooth
surface it reacts with hydroxil apatite crystals
rapidly to form calcium fluoride.

a thick layer of calcium fluoride gets
formed it interferes with the further diffusion of fluoride from aqueous solution to react with hydroxil apatite.

Question 2

The calcium fluoride reacts with hydroxil apatite to form

Answer 2

fluoridated hydroxil apatite.

Question 3

Why professionally applied fluoride agents are recommended for public health programs ?

Answer 3

1. For areas with relatively homogenous high-risk
   prevalence, fluoride-deficient drinking water and lack of fluoride toothpaste
2. In special risk groups such as the mentally handicapped or elderly people with reduced salivary
   flow, exposed root surfaces and heavily restored dentitions; and in people with senile dementia.

Question 4

professionally applied fluoride indications

Answer 4

Patients who are at high risk for caries (smooth surface , root surfaces )
White spots
Active decay

• Special patient groups, such as:
-Orthodontic patients

-Patients with decreased salivary flow
( Xerostomia)

Children whose permanent molars should, but can not be sealed.

And areas whithout fluoridated water

Question 5

Professionally Applied Fluorides
Types and materials

Answer 5

• Professional Topical fluoride therapy
– Sodium Fluoride
– Stannous Fluoride
– Acidulated Phosphate Fluoride
– Fluoride Varnish
• Self applied fluoride agents
– Fluoride Dentifrice
– Fluoride Mouth Wash
– Fluoride Impregnated Dental Floss
– Fluoride Chewing Gum
• Alternative fluoride agents
– Intraoral Controlled Release Device for Fluoride
– Fluoride Containing Alginates
– Fluoride Restorative Materials

Question 6

forms of fluoride delivery

Answer 6

1. Gels
2. Foams
3. Mouth rinse (mouthwash)
4. Varnish

Question 7

Sodium fluoride Method of Preparation

Answer 7

To prepare 2% NaF –20 gms of NaF is dissolved in 1 liter
distilled water in a plastic container

Question 8

Sodium fluoride technique of application

Answer 8

 Polishing
 Isolation
 2% NaF applied
 Allowed to dry 3 – 4 min
 Patient is advised to avoid rinsing, drinking and eating for
next half an hour

Question 9

Sodium fluoride advantages and disadvantages

Answer 9

Advantages
 Chemically stable
 Acceptable taste
 Non-irritant to gingiva
 Does not discolor teeth
 Inexpensive

Disadvantages
 4 visits within a short time
 30% Caries reduction

Question 10

Standouts fluoride Method of Preparation

Answer 10

To prepare 8% SnF – 0.8 gms is dissolved in 10 ml of
distilled water in a plastic container and shaken.

Question 11

Standouts fluoride Technique of application

Answer 11

(Muhler Tech)
 Polishing
 Teeth are isolated with cotton rolls
 SnF is applied with cotton
tipped applicators
 Patients are allowed to expectorate
after cotton rolls are removed
A six monthly interval treatment schedule is advised.
 Solution is applied continuously keepingthe
teeth moist for 4 min
 Instructed not to eat, drink or rinse for 30min

Question 12

Standouts fluoride No. of application and disadvantages

Answer 12

6 mts or 12 mts

Disadvantages :
Unstable
 Metallictaste
 May cause gingivalirritation
 Causes brown pigmentation of teethparticularly
in hypocalcified area
 Causes staining on margins ofrestorations

Question 13

Acidulated phosphate fluoride (solution) Method of preparation

Answer 13

 20 gms of NaF is dissolved in 1 litter of 0.1 phosphoric acid
 To this 50% hydro fluoride acid is added to adjust the pH at
3 & fluoride conc. at 1.23%

Question 14

Paint on technique

Answer 14

For pt. who can not tolerate tray
application

may used for gels and
foams

• Seat the pt. upright
• Isolate the teeth on one side of
mouth by inserting cotton rolls
when needed, use cotton roll
holder
• Insert saliva ejector on the
opposite side where application
take place ,dry teeth with air
syringe

• Quickly apply fluoride
with cotton-tipped
applicator to moisten
all teeth
• Wait for 1 to 4 min.
• Ensure tooth surface
remain wet with
product by applying
continuously

• Remove saliva ejector,
cotton rolls
• Gently proceed suction
on all teeth surfaces or
wipe the teeth with
gauze to remove the
residual product
• Ask pt. to expectorate
• Instruct pt. to not eat ,
drink, or brush teeth at
least 30 min.

Question 15

Acidulated phosphate fluoride no. Of application, advantages and disadvantages

Answer 15

 1 or 2 per year
Advantages :
 Stable
 Cheap
 50% more effective than NaF
Disadvantages :
 Teeth must be kept wet for 4 min
 Acidic, sour and bitter to taste

Question 16

Acidulated phosphate fluoride (gel)
Method of preparation and recommended application time

Answer 16

 A gelling agent methylcellulose or hydrox-ethyl
cellulose is to be added to the solution and pH is
adjusted between 4 – 5

recommended application time is 4 minutes

Question 17

Do not use acidulated phosphate fluoride on pt. with …. Because ??

Answer 17

porcelain and composite restoration

changes in translucency – which can
affect aesthetics – roughened surfaces can accumulate stains and
organic debris

Question 18

Tray technique

Answer 18

• Allow simultaneous application to
both max. and mand. Teeth
• The most appr. For gel and foams
• Seat the pt. in up right position
• Chose comfortable tray cover
patient dentition
• Place the fluoride gel or foams
without over loading, the biting
process will cause the product to
flow sufficiently to cover the tooth
surface

• Isolate the mand. Teeth using
cotton rolls, then dry with air
syringe
• Insert the mand. Tray
,pressing it against occlusal
,facial ,and lingual surface to
force the product to flow
• Insert the max. tray ,using the
same technique

• Carefully place saliva
ejector between the trays
• Instruct the pt. to close the
mouth and bite gently on
the trays
• Leave the trays in place for
about 1 to 4 minutes

• To remove the trays, tilt the chin
downward, this allow excess
product to flow forward and
facilitate removal
• Ask pt. to expectorate, then suction
any residual fluoride by saliva
ejector
• Instruct the pt. to not eat ,drink
,rinse ,or brush teeth at least for 30
min.

Question 19

acidulated phosphate fluoride advantages and disadvantages

Answer 19

Advantages

 Requires only 2 application in a year;
 The gel preparation can be self applied and thus the cost of application also gets
reduced;
 It has the ability to deposit fluoride in enamel to a deeper depth;

Disadvantage
 Practical difficulties like the teeth should be
kept wet for for 4 minutes;
 It is acidic, sour and bitter in taste;
 It cannot be stored in glass containers.

Question 20

Semi slow release and slow release such as

Answer 20

fluoride varnishes, glassionomer
cements.
• Examples of fluoride varnishes are:
Duraphat ,Fluor Protector and Bifluorid

Question 21

Fluoride varnish is

Answer 21

Protective coating that is painted on child’s teeth to prevent cavities , can also be painted on teeth that already have cavities

Question 22

It is recommended that the initial varnish application be repeated…

Answer 22

3 times within 7-10 days in patient with caries risk

Question 23

Fluoride varnish advantages and disadvantages

Answer 23

Advantages :
 Forms a water tight protective film insulating against
thermal and chemical influences
 Varnish remains on tooth for several days
Disadvantages :
 Pt co-operation is required
Yellow discolouration
Undesirable taste
 Expensive Advantages :
 Forms a water tight protective film insulating against
thermal and chemical influences
 Varnish remains on tooth for several days
Disadvantages :
 Pt co-operation is required
 Expensive

Question 24

Fluoride varnish indications

Answer 24

1- for moderate, high risk
2- as a primary preventive measure
3- as a treatment for hypersensitive teeth
4- to decrease post- operative sensitivity
5- used as a cavity liner

Question 25

Advantages of Fluoride varnish over professionally used fluoride

Answer 25

1- easy to use , fast to apply
2- swabbed directly on the teeth less than 3 minutes and sits within a minute
3- less risk
4- dose not require the use of dental equipment or instruments

Question 26

Advantages of DuraFlor Halo

Answer 26

1- no discolouration
2- no bad taste
3- more acceptable by children
4- no cross contamination

Question 27

Silver diamine fluoride SDF
Indications
Disadvantages
application

Answer 27

Indication : uncooperative children with fear or disabilities

Disadvantages :
Black staining :
temporary(soft tissue), due to shedding
Permanent (teeth) in only demineralised area

Application
1- clean the teeth (removal of debris)
2- changes of the cavity
3- one drop (3-4min )
4- cotton pellet to absorb any excess to prevent discolouration on soft tissue