The fluorine in the prevention

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1 –

2 – Routes of Administration

3 – Methods of Implementation

4 – fluoride varnishes and gels

5 – Fluoride toothpaste

6 – Mouthwashes

7 – Fluoride Dental Floss

8 – Prophylaxis Paste

9 – Chewing gum with Fluor

10 – How to select the methods applied

11 – Bibliography

  

1 – Introduction

The fluorine was discovered by Scheele Marggraf (1771) as Hydrofluoric acid but due to the high affinity of this element combined with others, was not isolated until 1886 by Moisen, the presence of biological materials Fluor was first observed in 1803 by Morichini in fossil elephant teeth. Berzelius in 1823 detected levels of fluoride in water.

In this sense, Madeiros (1998) states that the fluorine is the most electronegative of all chemical elements, fluorine is not found in its elemental form, will always be combined with fluoretos observed, the most common being cryolite and apatite.

* General Considerations:

Prophylaxis of dental caries by fluorine results from a series of observations:

-In geographic areas where the drinking water contains significant amounts of fluoride, a significant part of the subjects show and opaque white spots on the enamel, which characterize the dental fluorosis.

-Individuals with dental fluorosis have yet fewer cavities than others, particularly compared with those who drink water without fluoride.

* Mechanism of Action:

The exact mechanism of action of fluorine is not entirely known, as a consequence, several hypotheses have been issued in work underlying the preventive activity against caries fluorine.

This could in principle establish four main groups:

-Action on hydroxyapatite:

* Decreases the solubility

* Increases the crystallinity.

* Promotes remineralization.

-Action on bacteria plaque:

* Enzyme inhibitor

* Reduces cariogenic flora (direct antibacterial).

-Action on the enamel surface:

* Inhibits the binding of proteins and bacteria.

* Reduces the surface free energy.

-Action on the size and structure of the tooth:

* Morphology of the crown.

* Delayed eruption.

Other investigators have described two basic categories of macanismo anticariogena action of fluorine, which correspond:

* A Physico-Chemical Aspects of enamel on one side.

* The study of microbiology and biochemistry of plaque.

In this sense, Pinkham (1991) states that although not fully understood the mechanism, the preventive nature of fluoride may be due to increased resistance of tooth structure to the solution of acids, promoting remineralization and decrease cariogenic potential of plaque.

2 – Routes of Administration

Fluoride can reach the tooth estrutura through two ways:

* In that fluorides are ingested and conveyed through the bloodstream mainly deposited on the bone and to a lesser extent in the teeth. The maximum benefit of this contribution is obtained in the pre-eruptive phase both mineralization and in that of postmineralizacion. The systemic administration of fluoride is the contribution of continuous, low dose of the same, being therefore toxicity hazards practically nonexistent.

* Systemic:

* Via Topica:

It involves the direct application of fluoride on the tooth surface, so its use is posteruptivo and may start at 6 months of age and continued throughout life. Logically most useful would focus on periods of increased susceptibility to caries (childhood and early teens) or adults with high caries activity.

The first technique proved effective topical fluoride that involved the use of a neutral solution of sodium fluoride to 2% (Knutson, 1948).

The search for more effective agents led to the introduction of stannous fluoride solution 8%, according Gish et al, (1962). However, Andlaw (1994) states that stannous fluoride is unstable in solution and produces a brown spot on hipomineralizado or demineralized enamel. The acidulated phosphate fluoride today is used for topical applications.

3 – Methods of Implementation

Systemic a.Via:

-Fluoridation of public drinking water: It is by far, the most effective of all known methods for the prevention of caries. Fluoridation is the process of adding a naturally occurring element, fluorine, water consumption for the purpose of reducing tooth decay. The compounds used are sodium fluoride, sodium silico fluoride and hexafluorsilicico acid. The appropriate dose ranges from 0.1-0.2 parts per million, being variable depending on weather conditions.

According Pinkham (1991) Water fluoridation is the foundation of any program of prevention of tooth decay, not only for efficiency, but also better reason for its cost / effectiveness.

-Water fluoridation in the schools: In this case the water should be fluoridated to a level several times higher than it would be recommendable for that area, because children would drink this water over a small number of hours a day. Now if the institution houses children under 6 years must be assured that they do not receive fluoride by any other means, at the risk of being contributing overdose.

Table-Fluor Water: Bottled water is another Fluor contribution formula, the dose being highly variable as a function of the natural source.

-Food Supplements with Fluor: Another alternative is to incorporate fluorine in certain foods such as salt, milk, flour or cereals. Its dosage ranges from 200-250 mg. In the seventies, according to Maier (1971), it was considered that there was insufficient evidence or the exact amount of fluoride to be incorporated in the milk, salt and bread

-Fluoride dietary supplements: There are other ways of administering fluoride systemically, such as drops, tablets and / or vitamin preparations that can be an alternative or supplement to the ingestion of fluoride from water and can be used individually or communal in schools. Dietary supplements can be prescribed fluoride from birth to 13 years to children living in areas where the water contains 0.7 ppm of fluoride or less. The major drawback of these methods is that they require a high degree of motivation to perform the supply is continuously and correctly for years. The method of administering these supplements, based on age, in young children were used in fluoride drops or vitamin preparations, placing them directly on the tongue or mixing with water or juice, or the child’s own food. It should be noted that these preparations should not be mixed with milk, since it retards their absorption. In children with ability to chew the tablets can be used, they must be chewed and mixed with saliva for one minute and then are ingested, so get a topical effect and a systemic effect.

According to Driscoll (1974) cited by Pinkham, fluoride supplements have the potential to be as effective in preventing fluorada.Claro like water, the effectiveness depends on the degree of responsibility of parents in the administration.

The advantage of this method over the water fluoridation is that it allows specific doses of fluoride. (Andlaw, 1994).

A serious drawback that limits the use of fluoride tablets and drops in dental practice is the need for intelligent cooperation with the child’s parents, as these should be highly motivated to fluoride administered daily for several years, and have to be careful and responsible in order to store the tablets in a safe place, out of reach of children.

b.Via Topica:

The most common forms of presentation available for topical fluoride application are:

-Varnishes.

-Gels.

-Toothpaste.

-Containing mouthwashes.

Silk-fluoride toothpaste.

-Prophy paste.

-Chewing with Fluor.

4 – fluoride varnishes and gels

a.Metodo:

-Application of fluoride gels: cells were performed by the professional, these cells must be adjusted appropriately to avoid both arches out and ingestion of fluoride. Also the patient must be built and the bucket slightly bent; continuous aspiration, not overly filled buckets and removing excess by expectoration after placement time (4minutes) and recommend no intake of food and drink within 30 minutes seq. Other authors, justify the application of the solution with brush or cotton.

According Andlaw (1994), the indirect method of the application technique of fluoride from buckets, must precede the proper brushing the child’s teeth, and then an analysis on the appropriate selection of the bucket, testing it in the mouth the patient. The same author, determines that it is necessary to supply the required amount of gel directly into the bowl, and this should be kept out of reach of children, because the ingestion of small amounts (eg., 1.6 ml of a child 5 years of age) can cause digestive symptom.

-Application of fluoride varnishes: After cleaning, drying and isolation by rollers, the varnish is applied on the tooth surfaces using cotton swabs, brushes, single use catheters or syringes with blunt cannula. Other authors, reinforce the idea that the results achieved with fluoride varnishes have been inconclusive in preventing caries.

According Andlaw (1994), the technique of direct local application of fluoride must begin with a rigorous and evaluated brushing tooth surfaces, thereby eliminating food waste before applying fluoride.

Fluor b.Compuestos:

Fluorinated agents most commonly used are the acidulated fluorophosphate (APF) and sodium fluoride (NaF). The APF is the most widely used compound, contains fluoride concentration of 1.2% which equates to 12,300 ppm The NaF has a concentration of 0.9% which represents a rate of 9,040 ppm fluoride and appeared as an alternative to APF to the possibility that this altered composite restorations and surfaces crowns or porcelain veneers. According Pinkham (1991), using the 0.5% acidulated fluorophosphate.

c.Dosificacion:

The frequency recomendadaes two annual applications, considering that each application is a contribution of approximately 5ml, composite, containing about 62 mg in the case of fluorine and 45 mg F APF gels in NaF.

5 – Fluoride toothpaste

The application of fluoride from toothpastes is widely practiced and certainly, the most popular topical. The most used compounds are sodium monofluorophosphate, sodium fluoride or fluorides of amines, with a concentration of 0.1% (1000 ppm F). It is generally recommended the application of 1 gr. From toothpaste for brushing that equals 1 mg of F.

The results show reductions of about 15-30% in the number of tooth surfaces that become carious through periods of 2-3 years. (Murray and Rugg-Gunn, 1982), cited by Andlaw.

According Pinkham (1991), parents should put the paste on the brush and invariably supervise the brushing session, so that the child spit out the foam and saliva.

They expressed concerns about the ingestion of toothpastes by young children or not expectorate efficiently rinse after brushing. (Hargreaves and., 1982).

6 – Mouthwashes

The use of fluoride mouthwashes swish SELF is a formula very commonly used fluoride both individually and in groups. Scandinavian and American authors presented positive and effective preventive potential in planning prevention programs in communities with high prevalence of caries, but did not extend its use across the board.

a. Method: There are two methods that can be recommended, the high power / low frequency and low power / high frequency. The former practice once a week and are often used in school programs, the latter are a daily rinse and use is more prevalent in individual programs. The child enters your mouth 5 ml of mouthwash if in preschoolers (not recommended for children under 6 years) or 10 ml for older children. Rinsing is performed for 60 seconds and then expectorated avoid eating or drinking for 30 minutes after.

b. Fluorine compounds: The 0.2% sodium fluoride containing 904 ppm of F with a concentration of 0.09% is equivalent to 0.90 mg of fluoride per liter, is commonly employed in the preparation weekly rinses. For the technique is employed 0.05% sodium fluoride, containing 0.02% F (226 ppm F) which represents F 0.23 mg per ml of mouthwash. Also, may be employed at 0.044% acidulated fluorophosphate.

c. Dosage: The rinse is performed once a day using low concentration mouthwashes or once a week with high concentration mouthwashes. The amount used in each crop is 10 ml, which represents F 2.3 mg 9 mg daily or weekly.

As with the administration of fluoride tablets, one disadvantage of using mouthwash is that it must keep the interests of children and parents, and that these should be enough to motivate the patient rinse with a conscience.

7 – Fluoride Dental Floss

Its characteristics lie not only in the mechanical effect of removing plaque in interproximal spaces by reducing the risk of decay, but also helps the process of remineralization of that specific area. Some dental flosses are added 0.165 mg of sodium fluoride for every 50 meters of silk, so that the amount of fluoride released is usually around 1000 ppm

8 – Prophylaxis Paste

It incorporates several fluoride prophylaxis pastes, sodium fluoride, stannous APF hexafluorozirconate sodium monofluorophosphate and stannous (Andlaw, 1994). There are no contraindications to use fluoride toothpaste applied to the teeth before applying a solution , gel or varnish.

9 – Chewing gum with Fluor

Chewing gum by chewing stimulates the saliva and buffer system

helps to maintain a certain level of fluoride in saliva and in contact with the enamel. However, other authors determined that there are no controlled clinical trials to support this indication.

10 – How to select the methods applied

Water fluoridation is not only the most effective method currently known to prevent tooth decay but also the most useful in terms of cost (Horowitz and Heifetz, 1979).

If water fluoridation is not feasible and should be chosen among other methods, the decision should be based in part on the relative effectiveness in the cost of alternative systems. The methods recommended to use fluoride in dental practice are local applications of solution or gel, and employment homey toothpaste or mouthwash tablets. It may suggest using fluoride toothpastes all patients, but we must decide which of the other methods will be selected for each person. One obvious factor affecting this decision is the patient’s age and the concentration of fluoride in the local water supply, but another danger to consider is the degree of danger of caries in children and in adults, this will can classify patients with “high risk”, is one with a high rate of caries, or a medical condition or prior history of rheumatic fever, which may be complicated by bacteremia resulting from an infection or a mental subnormality treatment prevents dental, or “low risk” are those patients with low caries index without any medical condition to complicate your situation.

As such Murray (1991) had previously determined the current concepts of the effective dose of Fluor: No certainly effective dose of fluoride in its various applications. However, the American Dental Association editorial a few years ago most effective doses of fluoride application. Bear in mind that are different parameters which decide the effective dose, ie including the individual’s age, status of caries and fluoride concentration in drinking water. Today you see a problem that occurs fluorosis distance, that is, individuals who live in non-fluoridated areas used fluoride pastes, gels in the visit to the professional or home fluoride tablets and fluoride receiving food produced in areas Fluorinated not as soft drinks. This causes fluorosis produzacan phenomena.

All methods must be properly prescribed by professionals with knowledge of the area of Health Promotion, to assist in improving the oral health of the population. (Madeiros, 1998).

11 – Bibliography

– Andlaw, R. (1.994). Handbook of Pediatric Dentistry. Mexico City, Mexico. Editorial Interamericana.

– GISH, C. Muhler, J. HOWELL, C. (1,962). A new approach to the topical application of fluorides for the reduction of dental decay in children: results at the end of 5 years. Journal of Dentistry for Children 29.

– KNUTSON, J. (1,948). Sodium Fluoride Solutions: technique for application to the Teeth. Journal of the American Dental Association 36.

– MURRAY JJ, Rugg-Gunn (1982). Fluorides in Caries Prevention. Second edition. Wriggt Bristol.

– HARGREAVES J A, INGRAM, WAGG. (1,982). A gravimetric study of the ingestion of toothpaste by children. Caries Research 6.

– H S. HOROWITZ (1.970). The current status of topical fluorides in preventive dentistry. Journal of the American Dental Association 81.

– Pinkham, J. (1.994). Pediatric Dentistry. Editorial Interamericana.

– Driscoll, M (1974). Use of fluoride. Panamericana Editorial.

– Medeiros (1998). The truth about fluoride. (Online document) available at

– Murray J. (1.976). Flururos in preventing caries. Editorial Bristol.

– KOSTIW V. (1.993). Employment security in consultation Fluor dental hygiene. Odont Arch.

– BASCONES, A. (1998). Treaty of Dentistry. Advances Medico-Dental Publishing.

– Mc DONALD, R E & AVERY. Dentistry for the child and adolescente.St. Louis. C. V Mosby Co. 1994.

– ALVES, A C, Medeiros, U V. Intensive fluoride varnish program in Brazilian schoolchildren. J. Dent. Res Vol 75.

– ANDERSON. (1998). Ocean Medical Dictionary Mosby.Cuarta edition. Barcelona, Spain. Editorial Oceano Group.

– MAIER, FRANZ. (1.971). Fluoridation of drinking water. Mexico City, Mexico. Editorial Limusa-Wiley.

During the visit to the dentist is fundamental explanation to patients about the benefits of fluoride in the prevention, through brushing and flossing, the decreased intake of sugars.