Lec 10 Prevention

Lec.
9+10 Prevention Fifth Grade

Fluoride supplements
Fluoride supplements were originally designed to provide the systemic fluoride that a child would
not consume living in a non-fluoridated area. Fluoride supplements should only be prescribed by
dentists where there is clear evidence for high risk of caries and non-compliance with using other
fluoridated products. Also for disabled children and those with chronic diseases.
Tablets, drops and/or lozenges:
This is effective method in reducing or prevention of dental caries.
Fluoride tablets were introduced in the late 1940s to try to mimic the ‘systemic’ fluoride delivery
from water fluoridation, and most used sodium fluoride. Fluoride tablets became the method of
choice for fluoride supplementation, it can be chewed and swallowed. The American Dental
Association (ADA) Recommended Fluoride Supplementation Schedule as follow:
Age Fluoride supplement dosage according to fluoride in the drinking
water (parts per million)
<0.3 0.3–0.6 >0.6
Birth to 6 months None None None
6 months to 3 years 0.25 mg/day None None
3 to 6 years 0.5 mg/day 0.25 mg/day None
6 to 16 years 1.0 mg/day 0.5 mg/day None
 Studies recommended the prescription of F tablets at 3 years of age by giving 0.5 mg/day
till 13-15 years.
 It is better to be given daily once or twice a day.
 Studies reported that tablets taken during first 7 years of life provide caries reduction of 39%
to 80%.
 NaF 2.2 mg=1mgF, 1.1 mg=0.5mgF.
 Tablets should not be given with milk.
 More caries reduction in child’s primary teeth when pregnant women (0.4 ppm F in maternal
blood) and breast feeding taken 1mg F daily.
Fluoridated drops are available in:
 0.125mg
 0.25mg
1
 0.5mg
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 10 drops=1mg/l=1ppm.
Fluoridated salt
The idea of adding fluoride to table salt originated in Switzerland following the success of adding
iodine to help prevent goiter in 1955.
Salt is usually fluoridated at 250 ppm (which is 250 mg F/kg salt, or 0.25mg/gm salt). Fluoridated
salt in form of KF and NaF. Table salt in the kitchen can contribute 1 to 4g of the daily salt intake.
Thus, a person could potentially ingest 1 mg of fluoride a day at a salt intake of 4 grams a day.
Some restrictions remain in effect in Europe, however, in that fluoridated salt cannot be added to
commercial products or to food at restaurants. In a theoretical basis, fluoridated salt should provide
some protection against caries because it increases salivary fluoride levels when the meals
prepared with fluoridated salt are ingested. Consumption of fluoridated salt is lowered during early
life when the need for fluoride is the maximum. Salt fluoridation needs community education and
promotion.
Limitations
Children, adults and elderly with hypertension.
Advantages
o Low cost.
o Effective in caries reduction for primary and permanent teeth.
Fluoridated milk
It is the addition of a measured quantity of fluoride to bottled milk or packaged milk to be drunk
by child. The bioavailability of F in milk is in similarity to water. Human and bovine milk contain
very low concentration of fluoride 0.03 ppm. However, it appears that the majority of fluoride is
available in milk up to a concentration of about 5 ppm. F milk can be used in home and school
programs with caries reduction of 70%.
Disadvantages:
1. High cost
2. Some people dislike milk. Fluoride fruit juices are an alternative method of fluoride delivery
that may be appropriate for warm climates.
A high concentration of fluoride is needed for two reasons: (1) the children did not drink the
beverage throughout the day and (2) calcium in the milk complexes with fluoride, which would
reduce its availability for topical benefits.
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Community water Fluoridation
Communal water fluoridation defined as the upward adjustment of the natural fluoride level in a
community's water supply to prevent dental caries. It is a population-based method of primary
prevention that uses piped water systems to deliver low-dose fluoride over frequent intervals.
Fluoridation is a public health measure, the benefits to all individuals consuming drinking water
that is optimally fluoridated without regard to socioeconomic status, not expensive, effective in
caries reduction of permanent teeth more than primary teeth.
Fluoridated water is used in the manufacturing of beverages and foods that are consumed in non-
fluoridated areas. This, in part, explains why it is so difficult to show a difference in caries
prevalence rates between fluoridated and non- fluoridated communities. In determining fluorosis
risk, total intake of fluoride from all sources should be considered. Excess fluoride intake is
common and can lead to side effects that have to be taken into account.
While the disadvantages are political and/or emotional objections to water additives, allergic
toxicity and possibility of mild to moderate fluorosis if other sources of fluoride are ingested.
According to World Health Organization (WHO), there is evidence that ingestion of fluoride at
recommended levels presents no danger to humans.
Chemicals used in fluoridation are sodium fluoride (NaF), sodium fluorosilicate (Na2SiF6), (most
widely used because of low cost), hydrofluorosilicic acid (H 2SiF6), Ammonium silicofluoride
(NH)2SiF6. The process of adding fluoride to drinking water supplies to the level recommended
to achieve the maximum dental therapeutic benefits is technically simple, uncomplicated, and
similar to the processes used when dealing with chlorine and other water treatment chemicals.
These chemicals are certified as to their purity and safety when used appropriately.
Sodium fluoride (granular or powder) and sodium fluorosilicate (granular) are used in distribution
systems that use “dry” compounds, whereas fluorosilicic acid, a liquid, is used in solution or “wet”
systems. Sodium fluoride was the first compound used in controlled water fluoridation programs
Sodium fluorosilicate is substantially less expensive than sodium fluoride.
For fluoridation to be properly implemented, a number of factors should be considered. Of prime
importance is the compatibility of the fluoride additive to be used with the existing water treatment
and distribution system.
Variation in the adjusted water fluoride levels has occurred in water plants where the operators
were not properly trained and/or operator turnover was high. Most of the variances in fluoride
concentrations that have occurred were due to poor monitoring at water treatment facilities,
resulting in fluoride levels below the recommended level referred as hypofluoridation.
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Hyperfluoridation occurs when an excess amount of fluoride is added to the drinking water over
several days, usually secondary to an-overfeed from malfunctioning equipment and/or
maintenance errors.
There are alternative methods to provide fluoride systemically as school water fluoridation,
fluoridated salts; milk, juice; drops and lozenges.
School water fluoridation

This method was first applied in USA, 1954. This type of water fluoridation used when there is no
communal water supply. The optimal level of fluoride equal to 4.5 times that a community due to:
1. Children spent a part of their time in school.
2. Children enter the school at 6- year of age.
Advantage of school water fluoridation
a. Cost is low.
b. Technically feasible.
c. No effort is needed.
d. Effective in caries reduction (40%).
Home water fluoridation is effective in caries prevention; the level of fluoride is similar to
communal water fluoridation.
Does water fluoridation simply delay dental decay?
Fluoride incorporation in the primary dentition and in the alveolar bone, which must be resorbed
prior to the eruption of the permanent teeth is believed to be the cause of this generalized delay in
tooth eruption. It is possible to estimate the effects on dental decay rates of a delay of tooth eruption
of 1.0 year (20%) or 1.5 years (33.3%).
Studies showed that fluoridated water could reduce coronal caries in adults and reduce root caries.
These benefits are topical and likely cumulative
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9+10 Prevention Fifth Grade

School water fluoridation

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