ROLE OF FLUORIDE

-FLOURIDE is; the umbrella that protect the tooth from the acidic environment . The ionic form of fluorine, the 13th most abundant element in the earth's Crust. Negatively charged and combines with positive ions (e.g., calcium or sodium) to form stable compounds (e.g., calcium .fluoride or sodium fluoride) Released naturally in both water and air. Its compounds also are produced by some industrial processes that use the mineral apatite, a mixture of calcium phosphate compounds. In humans, associated with calcified tissues (i.e., bones and teeth) because of its high affinity for calcium.

So where ever calcium is there, its bind to the fluoride and make
stabilization into CAF2. HOW FLUORIDE PREVENTS CARIES? We have different theories; -One of them says that its happens POST-ERUPTIVE : Promoting remineralization and inhibiting demineralization of early carious lesions. Inhibition of glycolysis, the process by which cariogenic bacteria metabolize fermentable carbohydrates. -And anther says thats happen PRE-ERUPTIVE:

do Some reduction in enamel solubility in acid by pre-eruptive incorporation of fluoride into the hydroxyapatite crystal,, so formation of fluorapatite rather than hydroxyapatite.

FACTS ABOUT FLUORIDE

Fluoride is more readily taken up by demineralized enamel than by sound enamel; what happens that when we apply fluoride on the surface of the tooth, the fluoride binds to the surface of the tooth, so if the tooth dont have demineralization the precipitation of that fluoride happens in form of calcium fluoride CAF2-. -then; when there is acidic environment it will attack the CAF2 particle which located on the surface of the tooth and promote breaking down of calcium phosphate bond. -so the fluoride is free now into the oral environment, it will uptaken by demineralized enamel ,, so remineralization happens. -the saturated fluoride increased around the environment of the tooth, so it promote remineralization to happens, the remaining fluoride thats not used during the process it will stay in form of calcium phosphate on the surface of the tooth to by readily available when the acidic attack happens again . -Cycles of demineralization and remineralization continue throughout the lifetime of the tooth.

-Fluoride also inhibits dental caries by affecting the activity of cariogenic bacteria, so we can consider it bacteriostatic in addition to is effect in remineralization.

-Fluoride works primarily after teeth have erupted; in the first 6 month after the eruption, the tooth vulnerable to acidic attack, because it's not reach to its optimal maturation, in this duration the up taken of fluoride is very imp. Bcz it will do complete maturation of the tooth, and make the tooth more resistant to dental caries. -Thus, adults also benefit from fluoride, rather than only children, as was previously assumed, here we dont depend on that theory of pre-eruptive or first response of maturation, we depend on the presence of fluoride around the teeth, Regardless of demineralization or acidic attack presence or not. - the adult eats sweats, their diet is more cariogenic than children, especially those travel to study after high school, we prescribe a fluoridated mouth wash to usen every day in order to increase their ability to prevent dental caries.

GUIDELINES FOR FLUORIDE USE

The recommendations include an optimally adjusted concentration of fluoride in community drinking water to: -maximize caries prevention -limit enamel fluorosis

Why we prefer fluoride in drinking water, and its the best method in prevention of dental caries? -bcz; its continues used, its readily available for everybody.

but in Jordan the water is fluoridated but not drinkable ,,, most of us drink pure water "filtered or ozone treated water" which is not have fluoride in it, there is some company" like masafi","Nestleh" and "Al-sabeel" they contain some minerals and they added 0.3 ppm fluoride but they dont add more fluoride because it became more expensive.

So,,,, all of us not getting enough fluoride because optimal water fluoridation is 0.7ppm. Why we need optimal water fluoridation?? in order to make balance between preventing dental caries and not having dental fluorosis. -This concentration ranges from 0.7 ppm to 1.2 ppm.

-depending on the average maximum daily air temperature of the area; in high temp. areas 0.7 fluoridation

in cold temp. areas 1.2 fluoridation/ because the consumption of water is less. -Depending on the average of max daily temp. in the area, we can determined the concentration of fluoride we need. -In children and infant less than 16 YO,, sometimes we need to give them supplements In order to compensate, bcz we live in an area dont have enough fluoride. -These supplements categorized by the American Academy of Pediatric Dentistry (AAPD) and they said that they depends on how much water fluoridation and the age of the child.

-Less than 0.3 they definitely need fluoride tablets to be taken from age 6 month ups to 16 yr.

 -When the age increase,, the pre- eruptive effect is less, but what we depend on by using tablets fluoridation to get actually topical effect, when the tablet taken orally or when the child swallowing the water, that topical effect is what we want. -Between 3 to 6 years,, they only need fluoride between 0.3 to 0.6 ppm if we give them fluoride during this period more than this we afraid to get over dose of fluoride /fluorosis/. -Over 0.6,,, dont need supplement at all.

-If some individual come to your clinic- 6 years of age- what are the Qs u ask in order to know if he need supplements or not? Where he living?,, which water he drink of?

-If he 6 years, living in Irbid and drink from bottle water which is not has brand name, and his mother cooking from tap water which has filter machine connected to it, would u recommend supplements? -the child does not getting any fluoride in home either from drinking or cooking water,, do we have other sources of fluoride??,,, yes; toothpaste with 1200 ppm concentration small amount for brushing the teeth which should happens twice a day, other sources like milk, salt, but all these supplement not reach to 0.7 ppm ,, so in those individuals we recommend mouthwash weekly and professional fluoride application every 6 month,,,. - if this child come back to u after a while and he doing well but there is some areas with demineralization on the surface of the tooth,, do u recommend something else?? Varnish on the area of demineralization,,, every time any individual come into the clinic, u should assist the caries risk for him, where he is living, what things he is eating, what sources of fluoride are available for him, is there any increase in caries risk or not.

-If the same pts when he reach 10 yrs of age came to u, he dont have any white lesions, he is going to undergo orthodontic Fluoridated community treatment,, his risk become very high,, what do u recommend?,, drinking water and daily mouth rinse,, professional fluoride application every 3 month fluoride in order to prevent demineralization,,, I would watch for white toothpaste are the spot lesion around the brackets,, and if I found anything ,, apply most common varnish. sources of fluoride Water method of prevention;

-In some areas where fluoridating a community's drinking water is not feasible (e.g., rural areas), - the alternative is fluoridating a school's public water supply system.

-What do u consider it?,, primary community level of prevention. -To give the child tablets of fluoride to put it in his water,, primary level of prevention, provided by professional. Bottled Water;

-Although some bottled waters marketed contain an optimal concentration of fluoride (approximately 1.0 ppm), -Most contain <0.3 ppm fluoride.

-Few bottled water brands have labels listing the fluoride concentration. Fluoride Toothpaste;

-Brushing with fluoride toothpaste also increases the fluoride concentration in saliva 100- to 1,000-fold. -this concentration returns to baseline levels within 1-2 hours.

Let say I have a child (-3 yrs)with high risk of dental caries he is not getting enough fluoride from any other source, would that be okay to use the adult toothpaste with a very little amount in order to brush his teeth once a day?? yes.

Fluoride Mouthrinse; -Is a concentrated solution intended for daily or weekly use.

-The fluoride from mouth rinse, is retained in dental plaque and saliva to help prevent dental caries. Daily Fluoride Mouthrinse;

-The most common is sodium fluoride.

-Over-the-counter solutions of 0.05% sodium fluoride (230 ppm fluoride) for daily rinsing are available for use by persons aged >6 years. Weekly Fluoride Mouthrinse;

-Solutions of 0.20% sodium fluoride (920 ppm fluoride) are used in supervised, school-based weekly rinsing programs. -To maximize the topical effect of fluoride, tablets and lozenges are intended to be chewed or sucked for 1--2 minutes before being swallowed. The end.

Done by; asmaa almawas