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DEPARTMENT OF PEDODONTICS
AND
PREVENTIVE DENTISTRY

Seminar on

SYSTEMIC FLUORIDE

DATE OF PRESENTATION: 23 Oct, 2024

PRESENTED BY: Anurag Patil (Final yr)

GUIDED BY: Dr. Sandhyarani ma’am

STAFF SIGN
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• INTRODUCTION
• HISTORY OF FLUORIDE
• MECHANISM OF FLOURIDE
INCORPORATION
• TYPES OF SYSTEMIC FLOURIDE
• WATER FLOURIDATION
• SCHOOL WATER FLOURIDATION
• SALT FLOURIDATIONMILK
FLOURIDATION
• FLOURIDE SUPPLEMENTS
• CONCLUSION
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FLUORIDE

• Fluoride has been described as an essential

nutrient in the Federal Register of United States
Food and Drug Administration (1973) and World
Health Organization (WHO)
• The term fluoride is derived from a Latin word
Fluore, which means to flow.
• Its atomic weight is 19 and atomic number is 9.
Fluoride is never encountered in nature in the
elemental form,
• As it is the most electronegative and reactive of all
elements, and - thus it is found in salt form.

INTRODUCTION
• Systemic fluorides provides a low concentration of
fluoride to the teeth over a long period of time.
• It circulates through the blood stream and is
incorporated into developing teeth.
• After teeth erupt, fluoride contacts teeth directly
through salivary secretions
• Most systemic fluorides have a topical effect but
their primary effect is systemic.
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SHOE LEATHER SURVEY

• Given by:- Clinton T Messner
• The study of relationship between fluoride concentration
in drinking water, mottled enamel and dental caries
• He sent a questionnaire to the secretary of every local and
state dental society in the country and asked if mottled
enamel existed in their areas,if so, how extensive and also
enquired about the water source.
• Out of 1197 questionnaires, 632 replies were received.
Dean reported that 97 localities in the country where
mottling had occurred.
• His aim was to find out the minimal threshold of fluoride-
The level at which fluorine began to blemish the teeth. He
showed conclusively that the severity of mottling
increased with increasing fluoride concentrations in the
drinking water
• He gave the following observations:
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• Water concentration was 4 ppm or more-signs of discrete

pitting
• Water concentration was 3 ppm or more-mottling was
widespread.
• Water concentration was 2-3 ppm-teeth had dull chalky
appearance
• Water concentration was ≤1 ppm-no mottling of any
esthetic significance

METABOLISM OF FLUORIDE
• Absorption
• Fluoride is primarily absorbed in the stomach through
passive diffusion, with absorption inversely related to
pH.
• Higher gastric acid levels increase absorption,
leading to higher plasma peaks.
• Transportation:
• Fluoride exists in two form: lonic (Free fluoride) and
Non-ionic fluoride
• In plasma, fluoride exists mainly as ionic fluoride,
with a half-life of about 10 hours. It is not bound to
plasma proteins, resulting in similar compositions
between plasma and interstitial fluid.

MECHANISM OF SYSTEMIC FLUORIDE

• Improved crystallinity
• void theory
• Acid solubility
• Enzyme Inhibition
• Suppressing the flora
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• Antibacterial action
• Lowering free surface energy
• Desorption of protein and bacteria
• Alteration in tooth morphology

TYPES OF SYSTEMIC FLUORIDES

• WATER FLUORIDATION
• COMMUNITY WATER FLUORIDATION
• SCHOOL WATER FLUORIDATION
• SALT FLUORIDATION
• MILK FLUORIDATION
• FLUORIDES SUPPLEMENTS

WATER FLUORIDATION
• It can also be defined as "the upward adjustment of the
concentration of fluoride in public water supply in such a
way that the concentration of fluoride ion in the water
may be consistently maintained at 1 parts per
million(ppm) by weight to prevent dental caries with
minimal possibility of causing dental fluorosis
• Water fluoridation is an effective and inexpensive means
of obtaining the fluoride necessary to prevent tooth decay.
• Studies show that water fluoridation continues to be
effective in reducing tooth decay by 20% to 40% in
children and adults.

FLUORIDE COMPOUNDS USED IN WATER FLUORIDATION

• FluorsparSodium
• fluorideSilicofluorides
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• Sodium silicofluoride
• Hydrofluosilicic acid
• Ammonium silicofluoride

OPTIMUM FLUORIDE LEVEL

• optimum recommended fluoride levels varies with climate
because the average consumption of water increases in
warmer climates
• In cold climates the recommended fluoride level-1.2 ppm.
In extremely hot climate-0.7 ppm.
• In moderate climates-1 ppm.
• The optimum fluoride concentration can be calculated by
following equation:
• ppm fluoride (concentration) = 0.34/e
• Where e-0.038+0.0062 x temperature of the area in
degree farenhite.

PRE REQUIRMENTS
• Presence of caries in the community/public.
• Level of fluoride concentrations in their drinking water.
• Centralized water supply to the community.
• Community acceptance/approval.
• Installation and maintenance cost.

ADVANTAGES
• Large number of people are benefited.
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• Consumption is regular
• Fluoridated drinking water not only acts systemically
• During tooth formation to make dental enamel more
resistant to dental decay, but also has topical effect
through the release in saliva after ingestion.
• Fluoridation of community water is the least expensive
way to provide fluoride to a large group of people.

DISADVANTAGES
• Interfere with human rights.
• Other modes are not considered.
• Common source of water supply may not be present.

SCHOOL WATER FLUORIDATION

• School water fluoridation is one of the possible areas to be
explored.
• This programme helps in limiting caries in school children
who are the prime concern.
• It is the suitable alternative where water fluoridation is not
feasible.
• The amount of fluoride added in school drinking water
should be greater than normal because children have to
stay in the school for a short period of time and to
compensate for holidays and vacations.

The current recommended regimen for school water

fluoridation is adding 4.5 times more fluoride.
There has been around 25 to 40% decrease in dental caries
with this program.
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Simple fluoridators particularly that employ the venturi system

are most suitable because they require almost no maintenance
and can be utilized effectively in small instalments of small or
medium sized schools

ADVANTAGES
• Good results in reducing caries.
• Minimal equipment requirement.
• Not expensive

DISADVANTAGES
• Children do not receive the benefit until they go to school.
• Not all children go to the school go the school in poor
countries and towns and villages.
Amount of water drunk can't be regulated.

SALT FLUORIDATION
• Salt fluoridation is a controlled addition of fluoride, usually
sodium or potassium fluoride, during the manufacture of
salt for human consumption.
• First fluoridated salt was introduced by Wespi in
Switzerland 1948.It has been on sale in Switzerland since
1955.
• Experiments have been conducted with concentration of
fluoride in salt ranging from 90 mg of fluoride per kg. Salt
to 200-350 mg/kg.

ADVANTAGES
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• Fluoridated salt is safe.

• Theoretically fluoridated salt prevents dental caries by
both systemic as well topical action.
• It does not require community water supply as in case of
water fluoridation.
• It permits individual to accept it or reject it.
• Low cost
• Fluoridated salt and iodized salt can be made available to
the population.

DISADVANTAGES
• No precise control over indicated consumption, since salt
intake varies greatly among people.
• International efforts to reduce sodium uptake.
• Less sodium (Na+) intake to help control hypertension

LIMITATIONS
• There may be large variations in salt intake in different
groups of people. Fluoridated salt consumption is lowest
when the need for fluorides is greatest in early years of
life
• .The amount of fluoridated salt ingested may decrease
with increasing consumption of processed food. If the
processors do not use fluoridated salt.
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• Difficulties arise when there are multiple drinking water

sources which have a naturally optimal or excessive
fluoride concentration.
• It requires refined salt produced with modern technology
and a high level of technical expertise.
• The current view data high salt intake may contribute to
hypertension

MILK FLUORIDATION
• Milk fluoridation is the addition of a measured quantity of
fluoride to bottled or packaged milk to be drunk by
children
• .It was introduced by Zeigler, a Pediatrician, who started
the first project with fluoridated milk in swiss city of
Winterthur in 1953.
• In 1971, Dr. Edgar borrow established the borrow
foundation (formally the borrow dental milk foundation) in
England, with the aim of promoting the use of milk as a
vehicle for fluoride for the benefit of children's oral health.
• The first community based milk fluoridation scheme was
introduced in 1988, in Bulgaria, under the international
milk fluoridation program

COMPOUNDS USED FOR FLUORIDATION

• Calcium fluoride
• Sodium fluoride
• Disodium Monofluorophosphate
• Disodium Silicofluoride

FLUORIDE SUPPLEMENTS
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• Fluoride supplements are available in different forms such

as fluoride tablets drops, lozenges.
• Fluoride tablets, drops and lozenges are not available over
the counter but prescribed by the dentist or Paediatrician
to individual patients or as a part of school or home based
preventive dentistry program.

BENEFITS
• The use of dietary fluoride supplements from birth to age
13 or 16 years provides caries reduction from 16-65%.
• Supplements provide systemic and topical benefits for
primary and permanent teeth.

PRECAUTIONS
• Accidental ingestion of fluoride supplements can cause
stomach upset.
• No more than 120, 2.2 mg sodium fluoride tablet should
be dispensed at one time.
• There is no risk of dental fluorosis if the proper regime is
followed
• .However, fluoride supplements when ingested prior to
tooth eruption are a risk factor for dental fluorosis.

Conclusion
• When used appropriately, fluoride is safe and effective
agent that can be used to prevent dental caries . It has
systemic as well as topical effect .systemic fluoride
provides a low concentration of fluoride to the teeth over a
long period of time. It is easy to administer through
various medium like water ,milk ,salt . However, excessive
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intake can lead to fluorosis, a condition that affects the

appearance of teeth. Therefore, while systemic fluoride is
beneficial, its use should be carefully monitored to ensure
it remains at safe, optimal levels for maximum health
benefits.

Reference
Textbook of Pediatric Dentistry – 5th Edition -Nikhil Marwah
Essential of Public Health Dentistry – 7th Edition – Soben Peter