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Mechanism Of Action of Fluoride in

dental caries.

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Mechanism of action of systemic
fluoride
 Improved crystallinity:- 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.
 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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 The acid solubility : 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.
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The fluorapatie is more insoluble than
hydroxyapatite but the actual difference
in the amounts dissolving is usually so
small that it is not likely to be a factor in
cariostasis.
Affects morphology:-
 Shallow fissures (more in mandible)
 More obtuse inter cuspal angles
 Mesio – distal dimension – 2 %
decreased.
 Reduced buccal convexity
Reduced uptake of matrix protein by
Ameloblast
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Reduced Thickness Shallow shaped


Mechanism of action of topical
fluoride
Once the teeth erupt into the oral cavity, the
systemic effect of fluoride on enamel cease.
Fluoride is believe to have an effect on the
glycolyte pathway of oral microorganism.
Enzyme inhibitions:- 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
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Polysaccharide Synthesis:-
Both intracellular and extracellular
polysaccharide synthesis can occur in
bacterial metabolism. The intracellular
synthesis by S. mitis is reduced if the
organism is exposed to 10 PPM or more of
fluoride. This effect is not due to enzyme
inhibition of the polysaccharide-
synthesizing steps, however, but to
impaired uptake of glucose. Although the
enzymes in volved in the transportation of
glucose across the membrane are not
sensitive to fluoride, the inhibition of
enolase will reduce the
production of intracellular PEP
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(which is necessary for transport). Thus the
production of intracellular polysaccharides is
inhibited by the same membrane transport
mechanism responsible for reduced acid
production.
Action of topical fluoride on tooth surface :
The action of fluoride at the enamel surface
may be twofold : (1) the desorption of
proteins and bacteria, and (2) the lowering of
the free surface energy. The current concept
of protein adsorption to hydroxyapatite was
formulated by Bernardi et al. 3 The crystals of
hydroxyapatite that form enamel have both a
positive and a negative receptor site.

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Such a material is termed amphoteric. Acidic
protein groups may be bound at calcium sites
on the crystal surface whereas basic protein
side groups will be bound at phosphate sites on
the crystal. Fluoride is a most efficient inhibitor
of binding of acidic proteins to hydroxyapatite.
This inhibition is attributed to a competition for
positive calcium sites on the crystal surface.
Whether a concentration of 1 ppm will have an
appreciable effect in this regard is doubtful, but
the higher concentrations found in topical
applications may well have.
The high concentration of topical fluorides may
also affect the wettability of the enamel
surface.
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Thus higher concentrations of fluoride
may be effective in desorbing protein by
a competitive inhibition for calcium sites
and may also affect the wettability of
dental enamel. A lowered free surface
energy or less wettable surface would
imply a cleaner surface with less plaque
adherence.

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 Growth of Crystals:

 Carbonate

Attack & Block More soluble


growth of crystals

• Fluoride reduced carbonates and favours growth.


• Fluoride accumulate in early lesions.
• After dissolution by acids, fluoride favors
reminerilization.
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 Supressing Flora:- Stanous fluoride is
a potent suppressor of the bacterial
growth because it oxidizes the thiol
group present in bacteria thus
inhibiting bacterial matabolism.
 Anti bacterial 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.
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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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The Mechanism by which fluoride Acts to
prevents dental caries are not fully
understood certain hypothesis are given as
follows:-
1. Affects morphology - (more self
cleansing)
2. Growth of crystals - remineralization
3. Enzyme inhibition - Decereased
bacterial
acids production

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1. Affects morphology:-
 Shallow fissures (more in mandible)
 More obtuse inter cuspal angles
 Mesio – distal dimension – 2 % decreased.
 Reduced buccal convexity
Reduced uptake of matrix protein by
Ameloblast

Reduced Thickness Shallow shaped


of Enamel fissures

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2. Growth of Crystals:

Carbonate

Attack & Block More soluble


growth of crystals

• Fluoride reduced carbonates and favours growth.


• Fluoride accumulate in early lesions.
• After dissolution by acids, fluoride favors
reminerilization.
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The action of Fluoride on the Enamel
surface can be divided into the following:-

 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.
 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.

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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 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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3. Enzyme Inhibition:-

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 Phosphatase liberated from dental plaque,
desquamated epithelial cells or bacteria
precipitate calcium phosphate by hydrolyzing
organic phosphate in saliva thus increasing
the concentration of free phosphate ions.
 Esterase may initiate calcification by
hydrolyzing fatty esters into free fatty acids.
 Fatty acids forms soaps with calcium and
magnesium that latter converted in to the less
ca.p salts .
 Seeding agent induce small foci of
calcification that enlarge and coalesce to form
calcified mass.
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