Fluoride therapy

Last updated

Fluoride therapy
Sodium fluoride tablets.jpg
Sodium fluoride tablets. Fluoride tablets are the least preferred fluoride therapy (topical therapies are more effective).
Clinical data
Trade names OrthoWash, PerioMed, others
AHFS/Drugs.com Monograph
License data
Routes of
administration 		By mouth
ATC code
Legal status
Legal status
Identifiers
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEBI
Chemical and physical data
Formula FNa
Molar mass 41.98817244 g·mol−1
3D model (JSmol)
  • [F-].[Na+]
  • InChI=InChI=1S/FH.Na/h1H;/q;+1/p-1
  • Key:PUZPDOWCWNUUKD-UHFFFAOYSA-M

Fluoride therapy is the use of fluoride for medical purposes. [2] Fluoride supplements are recommended to prevent tooth decay in children older than six months in areas where the drinking water is low in fluoride. [3] It is typically used as a liquid, pill, or paste by mouth. [4] Fluoride has also been used to treat a number of bone diseases. [5]

Contents

Relatively high ingestion of fluoride by babies and children may result in white marks on the teeth known as fluorosis. [4] Excessive ingestion by babies and children can result in severe dental fluorosis, indicated by a brown or yellow coloring, weakening and brittleness of the teeth, or in severe cases, acute toxicity. Fluoride therapy typically uses the sodium fluoride form, though stannous fluoride may also be used. [4] [5] Fluoride decreases breakdown of teeth by acids, promotes remineralisation, and decreases the activity of bacteria. [5] Fluoride works primarily through direct contact with teeth. [3] [5]

Fluoride came into use to prevent tooth decay in the 1940s. [6] Fluoride is on the World Health Organization's List of Essential Medicines. [7] In 2020, it was the 265th most commonly prescribed medication in the United States, with more than 1 million prescriptions. [8] [9]

Medical uses

Dental caries

Fluoride therapy has a beneficial effect on the prevention of dental caries. [10] Fluoride toothpaste, with concentrations of 1000 ppm and above, reduces the risk of dental caries in school-aged children and adolescents. [10] As primary teeth are being developed, the ingestion of fluoride causes the teeth to form stronger and more resistant to cavities, although this increases the risk of dental fluorosis. [10] [11] [12] Water and milk fluoridation are two forms of systemic fluoride therapy that are effective at preventing dental cavities. [13]

Osteoporosis

Fluoride supplementation has been studied for the treatment of postmenopausal osteoporosis, for which it does not appear to be effective. Even though sodium fluoride increases bone density, it does not decrease the risk of fractures. [14] [15]

Side effects

Fluorosis

The use of fluoride toothpaste (with concentrations of 1000 ppm and above) and fluoride supplements in children below the age of six years, especially within the first three years of life, is associated with a greater risk of dental fluorosis. [10] The use of fluoride supplements during the last six months of pregnancy has no significant impact on the incidence of fluorosis in children. [16] Optimal water fluoridation for the prevention of dental caries increases the prevalence of dental fluorosis by 4 to 5%. [13] The observed effects are mild to moderate, usually of minimal aesthetic concern. [13]

Other risks

Water fluoridation is not linked to the development of osteoporosis or cancer. [13]

Overdose

Consumption of large amounts of fluoride can lead to fluoride poisoning and death. The lethal dose for most adult humans is estimated at 5 to 10 grams, equivalent to 32 to 64 mg elemental fluoride per kg of body weight. [17] [18] [19] Ingestion of fluoride can produce gastrointestinal discomfort at doses as low as 0.2 mg/kg, 20 times lower than lethal doses. [20] Chronic intake and topical exposure may cause dental fluorosis, and excess systematic exposure can lead to skeletal fluorosis. The American Dental Association (ADA) recommends infants primarily consume human milk to reduce fluoride intake and prevent infants developing fluorosis. [21]

In 1974, a three-year-old child swallowed 45 milliliters of 2% fluoride solution, triple the fatal amount, and died. The fluoride was administered during his first visit to the dentist, and the dental office was later found liable for the death. [22]

Mechanism

Strictly speaking, fluoride therapy repairs rather than prevents damage to the teeth, causing the mineral fluorapatite to be incorporated into damaged tooth enamel. Fluorapatite is not a natural component of human teeth, although it is found in the teeth of sharks. The main mineral found in natural tooth enamel is hydroxyapatite rather than the fluorapatite created in the presence of fluoride. Even without fluoride, teeth experience alternating increases and decreases in mineral content, depending upon how acidic or alkaline the mouth is, and depending upon the concentration of other substances in the mouth, such as phosphate and calcium.

Fluoride reduces the decay of tooth enamel by the formation of fluorapatite and its incorporation into the dental enamel. The fluoride ions reduce the rate of tooth enamel demineralization and increase the rate of remineralization of teeth at the early stages of cavities. Fluoride exerts these effects by the demineralization and remineralization cycle. [23] The remineralization cycle, critical to decay prevention, occurs when fluoride is present in the oral cavity. After fluoride is swallowed it has a minimal effect. [10] [24] [25]

Fluoride ions are involved in three principal reactions of remineralization: [24]

  1. Iso-ionic exchange of F− for OH− in apatite: Ca10(PO4)6(OH)2 + 2F− → Ca10(PO4)6F2 + 2OH−
  2. Crystal growth of fluorapatite from a supersaturated solution: 10 Ca2+ + 6PO43− + 2F− → Ca10(PO4)6F2
  3. Apatite dissolution with CaF2 formation: Ca10(PO4)6(OH)2 + 20F− → 10 CaF2 + 6PO43− + 2OH−

Iso-ionic exchange by the replacement of F− for OH¯ in apatite and crystal growth of fluorapatite from supersaturated solutions are able to occur during exposure to low levels of fluoride (0.01–10 ppm F) over long periods of time. Reaction of apatite dissolution with CaF2 formation occurs in higher levels of fluoride (100–10,000 ppm F) and the addition of CaF2 or a CaF2 containing compound. [24]

Fluoride's effect on oral microflora and the significance of this effect on fluoride's overall effectiveness against cavities does not currently have a consensus. [23] [24] Many studies on bacterial cells in laboratories have shown the fluoride has many effects on them as an antimicrobial agent. The antimicrobial effects require concentrations of fluoride at least 10 ppm F, which only occurs briefly in the mouth with oral fluoride-containing products. [23] A study looked at fluoride's effects on oral microflora and concluded that fluoride may not solely interact as an antimicrobial agent, acting additionally to reduce bacterial adhesion to teeth, along with the primary action of decreasing demineralization. Further investigation will need to be done to verify these claims. [26]

Fluoride can be delivered by many chemical methods (sodium fluoride, stannous fluoride, amine fluoride, monofluorophosphate, and more). The anti-caries performance differences between them have been shown to have less effect than variations in behavior shown by individuals in brushing, using fluoride products and post use behavior. Often the chemical form of fluoride is driven by compatibility with the other elements mixed with, price, and such. [23]

All fluoridation methods provide low concentrations of fluoride ions in saliva, thus exerting a topical effect on the plaque fluid. [27] Fluoride does not prevent cavities but rather controls the rate at which they develop, and so repeated exposure throughout the day is essential for its effective function. [23] The more constant the supply the more beneficial fluoride will be in cavity prevention. [23] [24]

Delivery

Fluoride conversion chart
APF (10)(%)(1000)ppm
1.0%10,000
1.23%12,300
NaF (4.5)(%)(1000)ppm
0.05%225
0.20%900
0.44%1,980
1.0%4,500
1.1%4,950
2.0%9,000
5.0%22,500
SnF2 (2.4)(%)(1000)ppm
0.40%960
0.63%1,512

Water fluoridation

Water fluoridation is the controlled addition of fluoride to a public water supply in order to reduce tooth decay. [28] Its use in the U.S. began in the 1940s, following studies of children in a region where water is naturally fluoridated. In 1945, Grand Rapids, Michigan became the first city in the world to fluoridate its drinking water. The Grand Rapids water fluoridation study was originally sponsored by the U.S. Surgeon General, but was taken over by the NIDR shortly after the institute's inception in 1948. [29] Fluoridation is now used for about two-thirds of the U.S. population on public water systems [30] and for about 5.7% of people worldwide. [31] Although the best available evidence shows no association with adverse effects other than fluorosis, most of which is mild, [13] water fluoridation has been contentious [31] and opposition to water fluoridation exists despite its support by public health organizations. [32] Water fluoridation is the most cost-effective way to induce fluoride, with an estimated cost between US$0.50 and $3.00 per person per year, depending on the size of the community involved. [33] A dollar spent on fluoridating water is estimated to save $7–42 on dental treatment. [33]

Toothpaste

Most toothpastes contains between 0.22% (1,000  ppm) and 0.312% (1,450 ppm) fluoride, usually in the form of sodium fluoride, stannous fluoride, or sodium monofluorophosphate (MFP). Frequent use of toothpaste with 1,100 ppm fluoride content enhances the remineralization of enamel and inhibits the demineralization of enamel and root surfaces. [34] Most toothpastes with fluoride contain mild abrasives in order to remove heavier debris and light surface staining. [35] These abrasives include calcium carbonate, silica gels, magnesium carbonates and phosphate salts. [35]

Fluoride is available in three forms during toothbrushing. First, it is available as a free ionic fluoride which can react with the tooth structure, interfere with the metabolism of bacteria in plaque, or absorb to the oral mucosa. [36] Second, it is available as profluoride compounds which can precipitate in the mouth during toothbrushing and release ionic fluoride. [36] Lastly, fluoride in toothpaste can exist as unavailable fluoride compounds which do not release fluoride ions. This is due to the fluoride ions being swallowed or expelled when spitting. [36]

High-fluoride content toothpaste generally contains 1.1% (5,000 ppm) sodium fluoride toothpaste. This type of toothpaste is used in the same manner as regular toothpaste. The application of high-fluoride content toothpaste in adults twice daily improves the surface hardness of untreated root decay when compared to toothpaste with regular fluoride content. [37] [38]

Fluoridated toothpaste is also available in the form of 0.454% stannous fluoride (SnF2 with fluoride concentration 1,100 ppm). When combined with the stannous ion (Sn2+), fluoride in toothpaste appears to have a wide range of benefits to oral health. Toothpastes containing stannous fluoride have been shown to be more effective than other fluoride toothpastes for reducing dental decay, [39] dental erosion, [40] [41] [42] [43] gingivitis, [44] [45] [46] [47] [48] tooth hypersensitivity, [49] dental plaque, [45] [48] calculus (tartar) [50] and stains. [50] A systematic review revealed stabilised stannous fluoride-containing toothpastes caused a reduction of plaque, gingivitis and staining in clinical trials, with a significant reduction in calculus and halitosis compared to other toothpastes. [51]

Anti-sensitivity toothpastes with fluoride are also available for those who have sensitive teeth. Some anti-sensitivity toothpastes with fluoride on the market contain the ingredients called strontium chloride or potassium nitrate which help to alleviate tooth sensitivity. [35]

Mouth rinses

Fluoride mouth rinses can be professionally applied by a dental professional or used at home. The most common fluoride compound used in mouth rinse is neutral sodium fluoride. Fluoride mouth rinses range from 0.05% to 0.2% (225–1,000 ppm) in concentration. [52] The fluoride rinse with a 0.05% fluoride content is used for daily rinsing, while the rinse with 0.2% fluoride content is used for weekly rinsing and in school-based weekly rinsing programs. [53] Fluoride at these concentrations is not strong enough for people at high risk for tooth decay. Regular use of a daily (230 ppm) or weekly (900 ppm) fluoride mouth rinse under supervision results into a reduction of tooth decay in children's permanent teeth. [54] After a fluoride mouthrinse treatment, the fluoride in the mouthrinse is retained in the saliva which helps prevent tooth decay. [53]

Fluoride mouth rinses are recommended for use in conjunction with other fluoride therapies, but is usually contraindicated for children under six years old as they may swallow the rinse and increase their risk of dental fluorosis. [53] [54] In areas without fluoridated drinking water, these rinses are recommended for children.

Many brands of topical fluoride exist. [55] They are not recommended if a person is drinking water that already contains sufficient fluoride. [55]

Gels/foams

There are several types of professionally applied fluoride gels and foams on the market. The types of professionally applied fluoride gels include 2.0% neutral sodium fluoride and 1.23% acidulated phosphate fluoride. [53] Acidulated phosphate fluoride (APF) gel or foam comprises a sodium fluoride solution, paste, or powder that has been acidulated with hydrofluoric acid to pH 3 to 4, buffered with a phosphate, and mixed with a gel or foam vehicle such as carboxymethyl cellulose. 1.23% acidulated phosphate fluoride gel or foam is used for patients without tooth-colored restorations, while 2.0% neutral sodium fluoride is used for patients with composites, porcelain, titanium, sealants or sensitivity. [56]

Professionally applied fluoride gel or foam is applied through the use of a foam mouth tray which is held in the mouth by gently biting down. The application usually lasts for approximately four minutes, and patients should not rinse, eat, smoke, or drink for 30 minutes after application. The reason for this is to allow the teeth to absorb the fluoride into the tooth structure when it is at its highest concentration, without being interrupted. This aids in the repair of microscopic dental decay. [57] There is no clinical evidence on the effectiveness of one-minute fluoride gel/foam applications. [58] A specific benefit when using foam is that less product is required during application, which results in a lower fluoride dose and lessens the risk of accidental ingestion. [58] Additionally, more research regarding the efficacy of fluoride foam is needed as the evidence for its effectiveness is not as strong compared to those of fluoride gels and varnish. [58]

Some gels are made for home application with the use of a custom tray. A model of a person's teeth can be made by a dental professional, who then uses that to make trays, similar to a sport guard tray, which is put over their teeth. The patient can then use this to hold a fluoride treatment against their teeth overnight or several minutes during the day. The concentration of fluoride in these gels is much lower than in professional products. [53] The self-applied sodium fluoride gel/foam typically contains 0.5% fluoride and stannous fluoride gel/foam contains 0.15%. [53]

Head and neck radiation treatment may destroy the cells of the salivary gland which can result in dry mouth. Patients with reduced salivary flow are at an increased risk of tooth decay. The home application of 1.1% fluoride gel with a custom tray is recommended for patients undergoing or are finished with head and neck radiation treatment and patients with decreased salivary flow. [59]

More research is required regarding the efficacy of fluoride gels in treating initial dental decay lesions. [60]

Varnish

Fluoride varnish has practical advantages over gels in ease of application and use of smaller volume of fluoride than required for gel applications. The principle of fluoride varnish is to apply fluoride salt in a very high concentration (approximately 50,000 ppm) onto the surface of the teeth. [36] Fluoride varnish is a resin-based application that is designed to stay on the surface of the teeth for several hours. As this varnish rests on the tooth's surface, saliva dissolves the fluoride salt, which in turn allows fluoride ions to be released and absorbed by the teeth and soft tissues. [36] Later, the fluoride is re-released into the oral cavity from these reservoirs which acts as protection for the teeth against cavities. [36] Currently, there is also no published evidence that indicates that professionally applied fluoride varnish is a risk factor for enamel fluorosis. The varnish is applied with a brush and sets within seconds.

Fluoride varnish has shown to be effective in reducing initial dental decay lesions in both primary and permanent dentition. [60] Application of fluoride varnish every six months is effective in preventing dental decay in primary and permanent teeth of children and adolescents. [58]

Slow-release devices

Devices that slowly release fluoride can be implanted on the surface of a tooth, typically on the side of a molar where it is not visible and does not interfere with eating. The two main types are copolymer membrane and glass bead. These devices are effective in raising fluoride concentrations and in preventing cavities, but they have problems with retention rates, that is, the devices fall off too often. [61] A 2018 Cochrane review found insufficient evidence to determine the effect of slow-release fluoride glass beads in caries-inhibiting when compared to other types of fluoride therapy. [62]

Lozenges

Fluoridated lozenges may contain about 1 mg fluoride each, and are meant to be held in the mouth and sucked. The dissolved lozenge is swallowed slowly, so the use of lozenges is both a topical and a systemic therapy. A 1955 study comparing the effects of fluoride lozenges and fluoride pills provided clear evidence early that fluoride acts topically. [24] [63]

Medical supplements

Medical fluoride supplements in the form of tablets, lozenges, or liquids (including fluoride-vitamin preparations) are used primarily for children in areas without fluoridated drinking water. The evidence supporting the effectiveness of this treatment for primary teeth is weak. The supplements prevent cavities in permanent teeth. A significant side effect is mild to moderate dental fluorosis. [10] A Cochrane review also found no evidence that daily fluoride supplementation in pregnant women was effective in preventing tooth decay or causing fluorosis in their children. [64]

Related Research Articles

<span class="mw-page-title-main">Mouthwash</span> Liquid rinse for oral hygiene

Mouthwash, mouth rinse, oral rinse, or mouth bath is a liquid which is held in the mouth passively or swirled around the mouth by contraction of the perioral muscles and/or movement of the head, and may be gargled, where the head is tilted back and the liquid bubbled at the back of the mouth.

<span class="mw-page-title-main">Toothpaste</span> Substance to clean and maintain teeth

Toothpaste is a paste or gel dentifrice used with a toothbrush to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it is an abrasive that aids in removing dental plaque and food from the teeth, assists in suppressing halitosis, and delivers active ingredients to help prevent tooth decay and gum disease (gingivitis). Owing to differences in composition and fluoride content, not all toothpastes are equally effective in maintaining oral health. The decline of tooth decay during the 20th century has been attributed to the introduction and regular use of fluoride-containing toothpastes worldwide. Large amounts of swallowed toothpaste can be poisonous. Common colors for toothpaste include white and blue.

Fluoride is an inorganic, monatomic anion of fluorine, with the chemical formula F−
, whose salts are typically white or colorless. Fluoride salts typically have distinctive bitter tastes, and are odorless. Its salts and minerals are important chemical reagents and industrial chemicals, mainly used in the production of hydrogen fluoride for fluorocarbons. Fluoride is classified as a weak base since it only partially associates in solution, but concentrated fluoride is corrosive and can attack the skin.

<span class="mw-page-title-main">Tooth decay</span> Deformation of teeth due to acids produced by bacteria

Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors from yellow to black. Symptoms may include pain and difficulty with eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation.

<span class="mw-page-title-main">Water fluoridation</span> Addition of fluoride to a water supply to reduce tooth decay

Water fluoridation is the controlled adjustment of fluoride to a public water supply solely to reduce tooth decay. Fluoridated water contains fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride. Fluoridated water operates on tooth surfaces: in the mouth, it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities. Typically a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $1.26 per person-year. Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits. In 2011, the World Health Organization suggested a level of fluoride from 0.5 to 1.5 mg/L, depending on climate, local environment, and other sources of fluoride. Bottled water typically has unknown fluoride levels.

<span class="mw-page-title-main">Fluorine deficiency</span> Medical condition

Fluoride or fluorine deficiency is a disorder which may cause increased dental caries and possibly osteoporosis, due to a lack of fluoride in diet. Common dietary sources of fluoride include tea, grape juice, wine, raisins, some seafood, coffee, and tap water that has been fluoridated. The extent to which the condition truly exists, and its relationship to fluoride poisoning has given rise to some controversy. Fluorine is not considered to be an essential nutrient, but the importance of fluorides for preventing tooth decay is well-recognized, despite the effect is predominantly topical. Prior to 1981, the effect of fluorides was thought to be largely systemic and preeruptive, requiring ingestion. Fluoride is considered essential in the development and maintenance of teeth by the American Dental Hygienists' Association. Fluoride incorporates into the teeth to form and harden teeth enamels. This makes the teeth more acid resistant, as well as more resistant to cavity forming bacteria. Caries-inhibiting effects of fluoride were first noticed 1902, when fluoride in high concentrations was found to stain teeth and prevent tooth decay.

<span class="mw-page-title-main">Dental abrasion</span> Medical condition

Abrasion is the non-carious, mechanical wear of tooth from interaction with objects other than tooth-tooth contact. It most commonly affects the premolars and canines, usually along the cervical margins. Based on clinical surveys, studies have shown that abrasion is the most common but not the sole aetiological factor for development of non-carious cervical lesions (NCCL) and is most frequently caused by incorrect toothbrushing technique.

<span class="mw-page-title-main">Dental erosion</span> Medical condition

Acid erosion is a type of tooth wear. It is defined as the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin. Dental erosion is the most common chronic condition of children ages 5–17, although it is only relatively recently that it has been recognised as a dental health problem. There is generally widespread ignorance of the damaging effects of acid erosion; this is particularly the case with erosion due to consumption of fruit juices because they tend to be considered as healthy. Acid erosion begins initially in the enamel, causing it to become thin, and can progress into dentin, giving the tooth a dull yellow appearance and leading to dentin hypersensitivity.

<span class="mw-page-title-main">Dental fluorosis</span> Medical condition

Dental fluorosis is a common disorder, characterized by hypomineralization of tooth enamel caused by ingestion of excessive fluoride during enamel formation.

<span class="mw-page-title-main">Early childhood caries</span> Dental disease of young children

Early childhood caries (ECC), formerly known as nursing bottle caries, baby bottle tooth decay, night bottle mouth and night bottle caries, is a disease that affects teeth in children aged between birth and 71 months. ECC is characterized by the presence of 1 or more decayed, missing, or filled tooth surfaces in any primary tooth. ECC has been shown to be a very common, transmissible bacterial infection, usually passed from the primary caregiver to the child. The main bacteria responsible for dental caries are Streptococcus mutans and Lactobacillus. There is also evidence that supports that those who are in lower socioeconomic populations are at greater risk of developing ECC.

<span class="mw-page-title-main">H. Trendley Dean</span> American dentist (1893–1962)

Henry Trendley Dean was the first director of the United States National Institute of Dental Research and a pioneer investigator of water fluoridation in the prevention of tooth decay.

<span class="mw-page-title-main">Tin(II) fluoride</span> Chemical compound

Tin(II) fluoride, commonly referred to commercially as stannous fluoride (from Latin stannum, 'tin'), is a chemical compound with the formula SnF2. It is a colourless solid used as an ingredient in toothpastes.

<span class="mw-page-title-main">Tooth brushing</span> Act of scrubbing teeth with a toothbrush

Tooth brushing is the act of scrubbing teeth with a toothbrush equipped with toothpaste. Interdental cleaning can be useful with tooth brushing, and together these two activities are the primary means of cleaning teeth, one of the main aspects of oral hygiene. The recommended amount of time for tooth brushing is two minutes.

Olaflur is a fluoride-containing substance that is an ingredient of toothpastes and solutions for the prevention of dental caries. It has been in use since 1966. Especially in combination with dectaflur, it is also used in the form of gels for the treatment of early stages of caries, sensitive teeth, and by dentists for the refluoridation of damaged tooth enamel.

<span class="mw-page-title-main">Dental public health</span>

Dental Public Health (DPH) is a para-clinical specialty of dentistry that deals with the prevention of oral disease and promotion of oral health. Dental public health is involved in the assessment of key dental health needs and coming up with effective solutions to improve the dental health of populations rather than individuals.

<span class="mw-page-title-main">Oral hygiene</span> Cleaning the mouth by brushing the teeth and cleaning in between the teeth

Oral hygiene is the practice of keeping one's oral cavity clean and free of disease and other problems by regular brushing of the teeth and adopting good hygiene habits. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. The most common types of dental disease are tooth decay and gum diseases, including gingivitis, and periodontitis.

<span class="mw-page-title-main">Fluoride varnish</span> Highly concentrated form of fluoride

Fluoride varnish is a highly concentrated form of fluoride which is applied to the tooth's surface, by a dentist, dental hygienist or other health care professional, as a type of topical fluoride therapy. It is not a permanent varnish but due to its adherent nature it is able to stay in contact with the tooth surface for several hours. It may be applied to the enamel, dentine or cementum of the tooth and can be used to help prevent decay, remineralise the tooth surface and to treat dentine hypersensitivity. There are more than 30 fluoride-containing varnish products on the market today, and they have varying compositions and delivery systems. These compositional differences lead to widely variable pharmacokinetics, the effects of which remain largely untested clinically.

<span class="mw-page-title-main">Water fluoridation by country</span>

Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay, and is handled differently by country. Fluoridated water has fluoride at a level that is proven effective for preventing cavities; this can occur naturally or by adding fluoride. Fluoridated water operates on tooth surfaces: in the mouth it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities. Typically a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $1.26 per person-year. Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits. In 2011 the World Health Organization suggested a level of fluoride from 0.5 to 1.5 mg/L, depending on climate, local environment, and other sources of fluoride. Bottled water typically has unknown fluoride levels.

<span class="mw-page-title-main">Remineralisation of teeth</span>

Tooth remineralization is the natural repair process for non-cavitated tooth lesions, in which calcium, phosphate and sometimes fluoride ions are deposited into crystal voids in demineralised enamel. Remineralization can contribute towards restoring strength and function within tooth structure.

Topical fluorides are fluoride-containing drugs indicated in prevention and treatment of dental caries, particularly in children's primary dentitions. The dental-protecting property of topical fluoride can be attributed to multiple mechanisms of action, including the promotion of remineralization of decalcified enamel, the inhibition of the cariogenic microbial metabolism in dental plaque and the increase of tooth resistance to acid dissolution. Topical fluoride is available in a variety of dose forms, for example, toothpaste, mouth rinses, varnish and silver diamine solution. These dosage forms possess different absorption mechanisms and consist of different active ingredients. Common active ingredients include sodium fluoride, stannous fluoride, silver diamine fluoride. These ingredients account for different pharmacokinetic profiles, thereby having varied dosing regimes and therapeutic effects. A minority of individuals may experience certain adverse effects, including dermatological irritation, hypersensitivity reactions, neurotoxicity and dental fluorosis. In severe cases, fluoride overdose may lead to acute toxicity. While topical fluoride is effective in preventing dental caries, it should be used with caution in specific situations to avoid undesired side effects.

References

  1. ↑ Mosby's Review Questions for the National Board Dental Hygiene Examination. Elsevier Health Sciences. 2013. p. 231. ISBN   978-0-323-22631-8. Archived from the original on 18 September 2017.
  2. ↑ Weiner ER (2008). Applications of Environmental Aquatic Chemistry: A Practical Guide (2nd ed.). CRC Press. p. 389. ISBN   978-1-4200-0837-1. Archived from the original on 18 September 2017.
  3. 1 2 World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. pp. 501–502. hdl:10665/44053. ISBN   978-9-2415-4765-9.
  4. 1 2 3 British National Formulary (BNF) 69 (69th ed.). British Medical Association. 2015. pp. 699–700. ISBN   978-0-85711-156-2.
  5. 1 2 3 4 "Fluorides". The American Society of Health-System Pharmacists. Archived from the original on 3 June 2016. Retrieved 8 January 2017.
  6. ↑ Murray JJ, Nunn JH, Steele JG (2003). The Prevention of Oral Disease. OUP Oxford. p. 53. ISBN   978-0-19-263279-1. Archived from the original on 18 September 2017.
  7. ↑ World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl: 10665/345533 . WHO/MHP/HPS/EML/2021.02.
  8. ↑ "The Top 300 of 2020". ClinCalc. Retrieved 7 October 2022.
  9. ↑ "Sodium Fluoride - Drug Usage Statistics". ClinCalc. Retrieved 7 October 2022.
  10. 1 2 3 4 5 6 Ismail AI, Hasson H (November 2008). "Fluoride supplements, dental caries and fluorosis: a systematic review". Journal of the American Dental Association. 139 (11): 1457–68. doi: 10.14219/jada.archive.2008.0071 . PMID   18978383.
  11. ↑ "Fluoridation Facts". ADA.org. American Dental Association. Archived from the original on 30 November 2016. Retrieved 8 December 2016.
  12. ↑ Aoba T, Fejerskov O (March 2002). "Dental fluorosis: chemistry and biology". Critical Reviews in Oral Biology and Medicine. 13 (2): 155–70. doi:10.1177/154411130201300206. PMID   12097358.
  13. 1 2 3 4 5 National Health and Medical Research Council (Australia) (2007). A systematic review of the efficacy and safety of fluoridation (PDF) (Report). Archived from the original (PDF) on 13 January 2012. Retrieved 24 February 2009.
    Summary: Yeung CA (2008). "A systematic review of the efficacy and safety of fluoridation". Evidence-Based Dentistry. 9 (2): 39–43. doi: 10.1038/sj.ebd.6400578 . PMID   18584000.
  14. ↑ Haguenauer D, Welch V, Shea B, Tugwell P, Wells G (2000). "Fluoride for treating postmenopausal osteoporosis". The Cochrane Database of Systematic Reviews. 2010 (4): CD002825. doi:10.1002/14651858.CD002825. PMC   8453489 . PMID   11034769.
  15. ↑ Vestergaard P, Jorgensen NR, Schwarz P, Mosekilde L (March 2008). "Effects of treatment with fluoride on bone mineral density and fracture risk--a meta-analysis". Osteoporosis International. 19 (3): 257–68. doi:10.1007/s00198-007-0437-6. PMID   17701094. S2CID   25890845.
  16. ↑ Takahashi R, Ota E, Hoshi K, Naito T, Toyoshima Y, Yuasa H, et al. (October 2017). "Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children". The Cochrane Database of Systematic Reviews. 2017 (10): CD011850. doi:10.1002/14651858.CD011850.pub2. PMC   6485723 . PMID   29059464.
  17. ↑ Gosselin RE, Smith RP, Hodge HC (1984). Clinical toxicology of commercial products. Baltimore (MD): Williams & Wilkins. pp. III–185–93. ISBN   978-0-683-03632-9.
  18. ↑ Baselt RC (2008). Disposition of toxic drugs and chemicals in man. Foster City (CA): Biomedical Publications. pp. 636–40. ISBN   978-0-9626523-7-0.
  19. ↑ IPCS (2002). Environmental health criteria 227 (Fluoride). Geneva: International Programme on Chemical Safety, World Health Organization. p. 100. ISBN   978-92-4-157227-9.
  20. ↑ Gessner BD, Beller M, Middaugh JP, Whitford GM (January 1994). "Acute fluoride poisoning from a public water system". The New England Journal of Medicine. 330 (2): 95–9. doi: 10.1056/NEJM199401133300203 . PMID   8259189.
  21. ↑ "Interim Guidance on Fluoride Intake for Infants and Young Children" (PDF). American Dental Association. 8 November 2006. Archived from the original (PDF) on 25 December 2014.
  22. ↑ McFadden RD (20 January 1979). "$750,000 Given in Child's Death in Fluoride Case: Boy, 3, Was in City Clinic for Routine Cleaning" (PDF). The New York Times.
  23. 1 2 3 4 5 6 ten Cate JM (February 2013). "Contemporary perspective on the use of fluoride products in caries prevention". British Dental Journal. 214 (4): 161–7. doi: 10.1038/sj.bdj.2013.162 . PMID   23429124.
  24. 1 2 3 4 5 6 Rošin-Grget K, Peroš K, Sutej I, Bašić K (November 2013). "The cariostatic mechanisms of fluoride". Acta Medica Academica. 42 (2): 179–88. doi: 10.5644/ama2006-124.85 . PMID   24308397.
  25. ↑ Featherstone JD (February 1999). "Prevention and reversal of dental caries: role of low level fluoride". Community Dentistry and Oral Epidemiology. 27 (1): 31–40. doi:10.1111/j.1600-0528.1999.tb01989.x. PMID   10086924.
  26. ↑ Loskill P, Zeitz C, Grandthyll S, Thewes N, Müller F, Bischoff M, et al. (May 2013). "Reduced adhesion of oral bacteria on hydroxyapatite by fluoride treatment". Langmuir. 29 (18): 5528–33. doi:10.1021/la4008558. PMID   23556545.
  27. ↑ "A-Z Topics: Fluoride and Fluoridation" (PDF). American Dental Association (ADA). Archived from the original (PDF) on 8 March 2014.
  28. ↑ Centers for Disease Control and Prevention (August 2001). "Recommendations for using fluoride to prevent and control dental caries in the United States. Centers for Disease Control and Prevention". MMWR. Recommendations and Reports. 50 (RR-14): 1–42. PMID   11521913. Archived from the original on 8 February 2007.
  29. ↑ "The Story of Fluoridation". National Institute of Dental and Craniofacial Research. July 2018. Retrieved 3 March 2018.
  30. ↑ Ripa LW (1993). "A half-century of community water fluoridation in the United States: review and commentary". Journal of Public Health Dentistry. 53 (1): 17–44. doi:10.1111/j.1752-7325.1993.tb02666.x. PMID   8474047.
  31. 1 2 Cheng KK, Chalmers I, Sheldon TA (October 2007). "Adding fluoride to water supplies". BMJ. 335 (7622): 699–702. doi:10.1136/bmj.39318.562951.BE. PMC   2001050 . PMID   17916854.
  32. ↑ Armfield JM (December 2007). "When public action undermines public health: a critical examination of antifluoridationist literature". Australia and New Zealand Health Policy. 4 (1): 25. doi: 10.1186/1743-8462-4-25 . PMC   2222595 . PMID   18067684.
  33. 1 2 "How much does community water fluoridation cost?". Wisconsin Dental Association - Oral & Dentistry Advocates | WDA. Archived from the original on 5 August 2018. Retrieved 4 August 2018.
  34. ↑ Nóbrega DF, Fernández CE, Del Bel Cury AA, Tenuta LM, Cury JA (2016). "Frequency of Fluoride Dentifrice Use and Caries Lesions Inhibition and Repair". Caries Research. 50 (2): 133–40. doi:10.1159/000444223. PMID   26992247. S2CID   11785219.
  35. 1 2 3 "Learn more about toothpastes". American Dental Association (ADA). Archived from the original on 2 December 2016. Retrieved 30 November 2016.
  36. 1 2 3 4 5 6 Carey CM (June 2014). "Focus on fluorides: update on the use of fluoride for the prevention of dental caries". The Journal of Evidence-Based Dental Practice. 14 (Suppl): 95–102. doi:10.1016/j.jebdp.2014.02.004. PMC   4058575 . PMID   24929594.
  37. ↑ Srinivasan M, Schimmel M, Riesen M, Ilgner A, Wicht MJ, Warncke M, et al. (August 2014). "High-fluoride toothpaste: a multicenter randomized controlled trial in adults". Community Dentistry and Oral Epidemiology. 42 (4): 333–40. doi:10.1111/cdoe.12090. PMC   4282025 . PMID   24354454.
  38. ↑ Yeung CA (March 2014). "Some beneficial effect on root caries from use of higher concentration fluoride toothpaste (5000 ppm F)". Evidence-Based Dentistry. 15 (1): 8–9. doi: 10.1038/sj.ebd.6400981 . PMID   24763166. S2CID   6575644.
  39. ↑ Stookey GK, Mau MS, Isaacs RL, Gonzalez-Gierbolini C, Bartizek RD, Biesbrock AR (2004). "The relative anticaries effectiveness of three fluoride-containing dentifrices in Puerto Rico". Caries Research. 38 (6): 542–50. doi: 10.1159/000080584 . PMID   15528909. S2CID   489634.
  40. ↑ West NX, He T, Macdonald EL, Seong J, Hellin N, Barker ML, Eversole SL (March 2017). "Erosion protection benefits of stabilized SnF2 dentifrice versus an arginine-sodium monofluorophosphate dentifrice: results from in vitro and in situ clinical studies". Clinical Oral Investigations. 21 (2): 533–540. doi:10.1007/s00784-016-1905-1. PMC   5318474 . PMID   27477786.
  41. ↑ Ganss C, Lussi A, Grunau O, Klimek J, Schlueter N (2011). "Conventional and anti-erosion fluoride toothpastes: effect on enamel erosion and erosion-abrasion". Caries Research. 45 (6): 581–9. doi:10.1159/000334318. PMID   22156703. S2CID   45156274.
  42. ↑ West NX, He T, Hellin N, Claydon N, Seong J, Macdonald E, et al. (August 2019). "Randomized in situ clinical trial evaluating erosion protection efficacy of a 0.454% stannous fluoride dentifrice". International Journal of Dental Hygiene. 17 (3): 261–267. doi:10.1111/idh.12379. PMC   6850309 . PMID   30556372.
  43. ↑ Zhao X, He T, He Y, Chen H (June 2020). "Efficacy of a Stannous-containing Dentifrice for Protecting Against Combined Erosive and Abrasive Tooth Wear In Situ". Oral Health & Preventive Dentistry. 18 (1): 619–624. doi:10.3290/j.ohpd.a44926. PMID   32700515.
  44. ↑ Parkinson CR, Milleman KR, Milleman JL (March 2020). "Gingivitis efficacy of a 0.454% w/w stannous fluoride dentifrice: a 24-week randomized controlled trial". BMC Oral Health. 20 (1): 89. doi: 10.1186/s12903-020-01079-6 . PMC   7098169 . PMID   32216778.
  45. 1 2 Hu D, Li X, Liu H, Mateo LR, Sabharwal A, Xu G, et al. (April 2019). "Evaluation of a stabilized stannous fluoride dentifrice on dental plaque and gingivitis in a randomized controlled trial with 6-month follow-up". Journal of the American Dental Association. 150 (4S): S32–S37. doi:10.1016/j.adaj.2019.01.005. PMID   30797257. S2CID   73488958.
  46. ↑ Mankodi S, Bartizek RD, Winston JL, Biesbrock AR, McClanahan SF, He T (January 2005). "Anti-gingivitis efficacy of a stabilized 0.454% stannous fluoride/sodium hexametaphosphate dentifrice". Journal of Clinical Periodontology. 32 (1): 75–80. doi: 10.1111/j.1600-051X.2004.00639.x . PMID   15642062.
  47. ↑ Archila L, Bartizek RD, Winston JL, Biesbrock AR, McClanahan SF, He T (December 2004). "The comparative efficacy of stabilized stannous fluoride/sodium hexametaphosphate dentifrice and sodium fluoride/triclosan/copolymer dentifrice for the control of gingivitis: a 6-month randomized clinical study". Journal of Periodontology. 75 (12): 1592–9. doi:10.1902/jop.2004.75.12.1592. PMID   15732859.
  48. 1 2 Selwitz RH (March 2009). "Twice daily toothbrushing with a stabilized stannous fluoride/sodium hexametaphosphate dentifrice may reduce gingivitis, gingival bleeding, and dental plaque". The Journal of Evidence-Based Dental Practice. 9 (1): 28–9. doi:10.1016/j.jebdp.2008.12.007. PMID   19269614.
  49. ↑ West NX, Seong J, Davies M (April 2015). "Management of dentine hypersensitivity: efficacy of professionally and self-administered agents". Journal of Clinical Periodontology. 42 (Suppl 16): S256-302. doi: 10.1111/jcpe.12336 . PMID   25495777.
  50. 1 2 Clark-Perry D, Levin L (December 2020). "Comparison of new formulas of stannous fluoride toothpastes with other commercially available fluoridated toothpastes: A systematic review and meta-analysis of randomised controlled trials". International Dental Journal. 70 (6): 418–426. doi:10.1111/idj.12588. PMC   9379195 . PMID   32621315. S2CID   220336087.
  51. ↑ Johannsen A, Emilson CG, Johannsen G, Konradsson K, Lingström P, Ramberg P (December 2019). "Effects of stabilized stannous fluoride dentifrice on dental calculus, dental plaque, gingivitis, halitosis and stain: A systematic review". Heliyon. 5 (12): e02850. doi:10.1016/j.heliyon.2019.e02850. PMC   6909063 . PMID   31872105.
  52. ↑ Twetman S, Keller MK (2016). "Fluoride Rinses, Gels and Foams: An Update of Controlled Clinical Trials". Caries Research. 50 (1): 38–44. doi: 10.1159/000439180 . PMID   27101002. Archived from the original on 21 December 2016.
  53. 1 2 3 4 5 6 Centers for Disease Control and Prevention (17 August 2001). "Recommendations for using fluoride to prevent and control dental caries in the United States". Archived from the original on 8 February 2007. Retrieved 30 November 2016.
  54. 1 2 Marinho VC, Chong LY, Worthington HV, Walsh T (July 2016). "Fluoride mouthrinses for preventing dental caries in children and adolescents". The Cochrane Database of Systematic Reviews. 7 (11): CD002284. doi:10.1002/14651858.cd002284.pub2. PMC   6457869 . PMID   27472005.
  55. 1 2 "Perio Med Uses, Side Effects & Warnings - Drugs.com". Drugs.com. Retrieved 4 August 2018.
  56. ↑ Darby ML, Walsh MM (2015). Dental Hygiene Theory and Practice (4th ed.). St. Louis: Saunders/Elsevier. pp. 580–597. ISBN   978-1-4557-4548-7.
  57. ↑ "For the dental patient: fluoride treatments in the dental office: extra protection for your teeth". Journal of the American Dental Association. 138 (3): 420. March 2007. doi:10.14219/jada.archive.2007.0175. PMID   17332048. Archived from the original on 11 December 2016.
  58. 1 2 3 4 American Dental Association Council on Scientific Affairs (August 2006). "Professionally applied topical fluoride: evidence-based clinical recommendations" (PDF). Journal of the American Dental Association. 137 (8): 1151–9. doi:10.14219/jada.archive.2006.0356. PMID   16873333. Archived (PDF) from the original on 4 November 2016.
  59. ↑ Hancock PJ, Epstein JB, Sadler GR (October 2003). "Oral and dental management related to radiation therapy for head and neck cancer". Journal. 69 (9): 585–90. PMID   14653934.
  60. 1 2 Lenzi TL, Montagner AF, Soares FZ, de Oliveira Rocha R (February 2016). "Are topical fluorides effective for treating incipient carious lesions?: A systematic review and meta-analysis". Journal of the American Dental Association. 147 (2): 84–91.e1. doi:10.1016/j.adaj.2015.06.018. PMID   26562737.
  61. ↑ Pessan JP, Al-Ibrahim NS, Buzalaf MA, Toumba KJ (2008). "Slow-release fluoride devices: a literature review". Journal of Applied Oral Science. 16 (4): 238–46. doi:10.1590/S1678-77572008000400003. PMC   4327531 . PMID   19089254.
  62. ↑ Chong LY, Clarkson JE, Dobbyn-Ross L, Bhakta S (March 2018). "Slow-release fluoride devices for the control of dental decay". The Cochrane Database of Systematic Reviews. 3 (4): CD005101. doi:10.1002/14651858.cd005101.pub4. PMC   6494221 . PMID   29495063.
  63. ↑ Bibby BG, Wilkins E, Witol E (February 1955). "A preliminary study of the effects of fluoride lozenges and pills on dental caries". Oral Surgery, Oral Medicine, and Oral Pathology. 8 (2): 213–6. doi:10.1016/0030-4220(55)90195-x. PMID   13236309.
  64. ↑ Takahashi R, Ota E, Hoshi K, Naito T, Toyoshima Y, Yuasa H, et al. (October 2017). "Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children". The Cochrane Database of Systematic Reviews. 2017 (10): CD011850. doi: 10.1002/14651858.CD011850.pub2 . PMC   6485723 . PMID   29059464.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.