|
Fluorides: Questions and answers.
Even more information can be found on the ADA website: Fluoridation Facts
Stannous fluoride, sodium fluoride, and acidulated phosphate fluoride (APF) appear to be equally effective at preventing cavities. However, they differ in terms of application frequency, taste, cost, stability, gingival tissue acceptance, and staining tendency.
Many stannous fluoride products have a bitter taste and some have been shown to cause tooth staining. Stannous fluoride may occasionally contribute to gingival irritation. On the basis of available research, stannous fluoride appears to be the most effective type from a bacteriostatic standpoint.
Sodium fluoride has an acceptable taste and does not cause staining or gingival irritation. Its primary drawback is that it requires more office applications than APF. Neutral pH sodium fluoride preparations may be, on the basis of preliminary research findings, the treatment of choice for patients with extensive porcelain or composite restorations. Some investigators have cautioned against using low pH fluorides which may etch restorative surfaces.
Acidulated phosphate fluoride (APF) is usually applied biannually making it more convenient than sodium fluoride office topicals. APF is stable in plastic containers and is usually flavored for an acceptable taste. Use of a thixotropic APF gel can help preclude inadvertent ingestion.
Suggested Source: Ripa, L.W. Professionally (Operator) Applied Topical Fluoride Therapy: A Critique. Clinical Preventive Dentistry, 4: 3, 1982.
Are sequential two-part fluoride rinses (APF/Stannous Fluoride) as effective as APF gel office treatments?
Based on the absence of any clinical studies to demonstrate the effectiveness of two-part rinse systems, office APF gels continue to be the preferred treatment regimen. The American Dental Association has not accepted two-part rinses as being effective. Concerns have also been raised regarding the potential of these rinses to be easily ingested. When a child uses the combined rinse as directed, about eleven times the amount of fluoride contained in a 0.2% NaF weekly rinse is taken into the mouth. This amount could be inadvertently swallowed and cause nausea, headaches, and cramps.
Suggested Source: Horowitz, H.S. and Horowitz, A.M. Letter to the Editor. Consultants' Response. Journal Public Health Dent. 41 (1): 6,1981.
What is the preferred fluoride gel/applicator tray system that your dentist should use?
The preferred system is one that provides optimum therapeutic effectiveness while being convenient for the operator and acceptable to the patient. To achieve these three goals, the features of both the applicator tray and the fluoride gel should be considered.
The applicator tray should provide: 1) complete coverage of all tooth surfaces (including the cervical area (where the tooth's crown and the root meet)); 2) anatomical contours to force the gel into the critical interproximal areas (between teeth); 3) a positive seal and adequate distal dam to preclude salivary dilution of the gel and keep the gel from being ingested; 4) soft edges which do not cause discomfort by impinging on gingival tissues; 5) adequate size selection to accommodate all patients; 6) non-flimsy construction to preclude gel overflow and ingestion; and 7) easy detection of post-treatment fluoride (soft spongy tray interiors absorb and use more gel and are difficult to inspect for the amount of fluoride deposited on teeth vs. the fluoride remaining in the absorbent liner).
There are important features to be aware of regarding fluoride gel selection. For maximum effectiveness, the gel should be thixotropic and have a low pH. Thixotropic gels "cling" to the tooth surfaces better and provide good interproximal coverage. Another advantage of thixotropic gels is that they are less apt to escape from the tray and be ingested. There are wide variations in the taste of fluoride gels. Some brands achieve their pleasant taste by using a higher than scientifically proven pH . . . or even a neutral pH. A pH below 4.5 would appear to be needed for optimal protection.
Suggested Source: McCall, D.R., et al. Fluoride Ingestion Following APF Gel Application. Br. Dent. J. 155: 333. Nov. 1983.
Do fluoride-containing prophylaxis pastes provide adequate topical therapy?
No. They should not be considered as a sole means of fluoride delivery. The prophylaxis procedure removes the fluoride-rich outer layer of enamel. The fluoride in the prophylaxis paste may be taken up by the enamel but its duration is relatively brief. A topical fluoride application is required to provide meaningful caries inhibition.
Suggested Source: Accepted Dental Therapeutics, ed. 39. Chicago, American Dental Association, 1982, pp 360-362.
Is a professionally-administered prophylaxis necessary prior to the topical fluoride application?
The theory that organic surface integuments act as a barrier to fluoride uptake and should be removed via professional prophylaxis prior to topical applications has recently been challenged by dental researchers. More than a dozen laboratory and clinical studies have shown that preliminary cleaning (either professionally or by selfbrushing) did not produce superior therapeutic results.
The prophylaxis step should still be considered beneficial as an adjunct in the prevention and treatment of gingivitis and periodontal disease and also for cosmetic purposes (stain removal). However, its use should be based on the individual patient's gingival and oral hygiene status-and not as a prerequisite for optimal topical fluoride efficacy.
Suggested Source: Ripa, L.W. Need for Prior Toothbrushing When Performing a Professional Topical Fluoride Application: Review and Recommendations for Change. JADA 109 (2): 281-285.
Can topical fluoride applications produce tooth mottling (pitting and discoloration)?
Tooth mottling is caused by excessive systemic use of fluorides during the period of tooth development, not by topical use. Like any nutrient, fluoride is beneficial in the proper amounts but harmful in excessive amounts. Some areas do not have fluoridated water. Other areas have naturally fluoridated water. Geographic locations in which the water supply is not naturally fluoridated have no more than the recommended level of fluoride (which is 0.7 to 1.2ppm depending on climate) added to the water. To determine if your tap water is fluoridated, check with your local water district. Ingestion of water having a fluoride concentration of two or three times greater than the recommended level can produce white flecks and chalky opaque areas. Consumption of water having a fluoride concentration of four times the recommended level can cause brown, pitted and corroded areas. Using evacuation during a topical treatment plus using quality gels and applicator trays can preclude inadvertent swallowing, which could produce undesirable systemic effects.
Suggested Source: Whitford, G.M. Fluorides: Metabolism, Mechanisms of Action and Safety. Dent. Hygiene 57 (5): 1629, May 1983.
How much fluoride dentifrice (toothpaste) should be placed on a child's toothbrush?
Preschoolers should have only the tips of their brush wetted with a fluoride-containing toothpaste (no more than a pea-sized dot). Most fluoride dentifrices contain 1,000 ppm of fluoride. Younger children can ingest up to .30 mg of fluoride during a single brushing. Consistent ingestion of large quantities during tooth development may result in mild enamel fluorosis. Parents should monitor their child's brushing and instruct them not to swallow.
Suggested Source: Barnhart, W.E. et al. Dentifrice Usage and Ingestion Among Four Age Groups. J. Dent. Res. 53:1317-1325, 1974.
|
