e not recommended for adults, especially pregnant women, for reducing dental caries. • The concentration of fluoride that reaches the fetus is generally lower than that in the maternal blood. • Infants exposed will have higher plasma, skeletal and developing enamel fluoride levels.
Fluoride and dental caries• Fluoride Supplements (Infants and Children) – Fluoride supplementation at birth gives some protection against caries to the deciduous teeth. – No fluoride supplements must be given to infants less than 6 months of age ( exception of infants consuming milk)
Fluoride and dental caries• Fluoride Rinses – 3 years is necessary to achieve the maximum benefit from a rinse program. – Effective in children with a higher caries baseline than low caries baseline. The lower the incidence of caries, the more limited the effect of each preventive measure.
Fluoride and dental caries• Sustained Release Delivery Systems – Advantages: lower required dosage, reduced toxicity, release constant level of fluoride, better use of fluoride and better patient compliance. – Clinical studies showed exposure to low levels of fluoride is more effective in decreasing the incidence of caries.
Fluoride and dental caries – Useful in children who tend to get caries easily, xerostomia, adults with rampant root or coronal caries.
Fluoride and dental caries• Fluoridated Milk – Milk is used as an instrument for fluoride administration. – Fluoridated milk was found to be as effective as fluoridated water in reducing dental caries.
Fluoride and dental caries• Fluoridated Salt – Use salt as a vehicle for fluoride in the diet. – Salt is about 2/3 as effective as the water.
Mechanisms of anticaries action of fluoride1. Increase in the enamel’s resistance to acid solubility − Enamel formed has more perfect and larger crystals, less soluble in acid, and less likely to develop caries. Fluoride favors formation of fluorapatite, a more acid – resistant apatite than hydroxyapatite.
Mechanisms of anticaries action of fluoride2. Remineralization − Greater concentration of fluoride released from the dissolved enamel or already present on the plaque, the more will remineralization be favored and carious process be slowed. − Use of topical fluoride raises the fluoride level of tooth surface and underlying tissues to a level expected to protect against caries.
Mechanisms of anticaries action of fluoride3. Antibacterial effects of fluoride − Inhibition of enzymes essential to cell metabolism and growth. − Lower the surface energy of the tooth. − Can strip off bacteria from hydroxyapatite. Fluoride can bind more effectively to positively charged areas on the apatite crystal than can the bacteria.
Dental benefits• Fluorosis of the deciduous teeth is rarely seen and is not a problem.• First 2 to 3 years of life are the most critical period for the development of mottled enamel on the permanent anterior teeth and for this reason only. – 0.25 mg/day is prescribed from birth until 2 years of age.
Dental benefits – 0.5 mg/day from 2 to 3 years of age. – 1.0 mg/day from 3 until 13 years of age.• Use of fluoridated water or fluoride supplements as early as 1 year of age enhance the formation of the relatively caries – resistant fluorapatite in the enamel surface.