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PubMed1990

An evaluation of the use of professional (operator-applied) topical fluorides.

Application of fluoride solutions, gels, varnishes, and prophylaxis pastes is reviewed as well as the sequential APF/SnF2 office-rinse method. The most widely-used technique is with 1.23% APF gel (12,300 ppm F) in trays. Clinical results from this method are similar to those achieved with an APF solution of the same fluoride concentration. A professional APF gel/tray application need not be preceded by a prophylaxis, should last four min, and should not be followed by a water rinse for 30 min. Fluoride varnishes are newer topical fluoride agents, but their relative efficacy, compared with other proven caries-inhibitory methods, remains to be fully determined. In general, fluoride prophylaxis pastes have not been shown to inhibit caries; however, their use is justified by the ability of some to replenish fluoride lost from the abrasive action of the paste on tooth enamel. The sequential office-rinse method has not been tested in randomized clinical trials, and its use cannot be recommended.

Evaluation Studies as Topic↗
PubMed1988

Applicability of acid-etching techniques for fluoride determination on enamel after topical fluoride treatment.

A common technique for fluoride gradient determination of enamel is based on acid-etching of thin enamel layers. The dissolution of CaF2-like material in two different acid-etching solutions was compared with the dissolution of pure CaF2. The results showed that the CaF2-like material deposited on enamel after a topical treatment with 2% NaF dissolved almost completely in the 1 M HClO4 and 1.6 N HCl/70% glycerol solutions. The dissolution of pure CaF2 in the same solutions was low. Even after 30 min, less than 9% of the CaF2 had dissolved. It was concluded that acid-etching techniques for fluoride determination could be used on enamel treated topically with fluoride. The study also indicated that CaF2-like material may have chemical properties different from pure CaF2.

Acid Etching, Dental↗
PubMed1993

Evaluation of the use of topical fluoride gel.

Professionally applied topical fluoride should be used judiciously and is indicated only in patients with moderate or high caries activity. While the anti-caries effectiveness of acidulated phosphate fluoride gels has been clinically documented, the 2% neutral NaF gel has not been adequately tested, and further clinical verification is needed. Daily use of a self-applied fluoride gel is recommended for patients undergoing orthodontic treatment or to those affected with xerostomia as a result of disease or head and neck radiation therapy. The dental profession and the public should be well informed on the proper use of clinically proven products to achieve optimum effectiveness and minimize the risk of fluoride ingestion.

Acidulated Phosphate Fluoride↗
PubMed1978

Cost analysis of 3 years of topical fluoride application.

The article gives additional information about the 3-year study of caries reduction after topical application of 4% NaF-PO4 in Ljubljana, Yugoslavia. The caries reduction obtained was about 20% after topical fluoride application once a year (Group 2) and about 30% after topical fluoride application twice a year (Group 3). Data on costs of treatment and dentist's working time required are given. The costs of repair and topical fluoride application during the 3-year experimental period were in Group 2 72% and in Group 3 158% higher than in the Control Group. The dentist's working time for repair and topical fluoride application during the experimental period was in Group 2 33% and in Group 3 80% higher than in the Control Group. It seems to be of special interest that the dentist's working time spent for total tooth repair per child at the beginning of the study was 3.3-4.9 times higher than the working time for repair in the years during the study.

Child↗
PubMed1994

Current status of professionally applied topical fluorides.

The literature was reviewed to establish the current effectiveness of professionally applied topical fluorides in the prevention of dental caries and to determine the risk of chronic and acute fluoride ingestion from their use. Use of professionally applied topical fluorides by moderate to high risk children and adults is supported by existing research. Although many of the studies are dated, there is sufficient evidence to support their continued use. Professionally applied topical fluorides are not a risk factor for dental fluorosis, though they have been implicated in acute reactions. The precautions needed to minimize fluoride intake are discussed.

Adult↗
PubMed2003

Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents.

BACKGROUND: Topical fluoride therapy (TFT) in the form of varnish, gel, mouthrinse or toothpaste has been used extensively as a caries-preventive intervention for over three decades. OBJECTIVES: To determine the effectiveness and safety of fluoride varnishes, gels, mouthrinses, and toothpastes in the prevention of dental caries in children and to examine factors potentially modifying their effect. SEARCH STRATEGY: We searched the Cochrane Oral Health Group's Trials Register (May 2000), CENTRAL (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). DATA COLLECTION AND ANALYSIS: Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects metaregression analyses. MAIN RESULTS: There were 144 studies included. For the 133 that contributed data for meta-analysis (involving 65,169 children) the D(M)FS pooled prevented fraction estimate was 26% (95% CI, 24% to 29%; p < 0.0001). There was substantial heterogeneity, confirmed statistically (p < 0.0001), but the direction of effect was consistent. The effect of topical fluoride varied according to type of control group used, type of TFT used, mode/setting of TFT use, initial caries levels and intensity of TFT application, but was not influenced by exposure to water fluoridation or other fluoride sources. D(M)FS PF was on average 14% (95% CI, 5% to 23%; p = 0.002) higher in non-placebo controlled trials, 14% (95% CI, 2% to 26%; p = 0.25) higher in fluoride varnish trials compared with all others, and 10% (95% CI, -17% to -3%; p = 0.003) lower in trials of unsupervised home use compared with self applied supervised and operator-applied. There was a 0.7% increase in the PF per unit increase in baseline caries (95% CI, 0.2% to 1.2%; p = 0.004). REVIEWER'S CONCLUSIONS: The benefits of topical fluorides have been firmly established on a sizeable body of evidence from randomized controlled trials. While the formal examination of sources of heterogeneity between studies has been important in the overall conclusions reached, these should be interpreted with caution. We were unable to reach definite conclusions about any adverse effects that might result from the use of topical fluorides, because data reported in the trials are scarce.

Adolescent↗
PubMed1998

[Clinical considerations apropos of topical fluorides in the control of dental caries].

Studies on the caries reducing effect of topical fluorides have provided a great understanding of their therapeutic role in caries control. It is believed that topically applied fluorides interfere with dental tissue demineralisation and reduce the rate of caries progression. According to this assumption, topical fluorides are recommended to both children and adults as a measure to control coronal as well as root caries. In the present review, some aspects of caries development and arrest are considered and the reasoning behind topical fluoride application is discussed. Guidelines concerning self-applied and professionally applied topical fluorides regimes according to the patient's caries risk and caries activity are presented.

Adult↗
PubMed2005

The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances: a systematic review.

INTRODUCTION: Decalcification is a significant problem during fixed orthodontic treatment. Topical Fluorides can reduce or eliminate the problem, but the relative effectiveness of different treatments or combinations of topical fluoride preparations is unknown. This systematic review was undertaken to determine the effectiveness of topical fluoride preparations in preventing decalcification during fixed orthodontic treatment. METHODS: A wide search of published and unpublished material in any language was undertaken by using general and specialist databases; key dental journals were searched by hand. Predefined inclusion criteria based on objective outcome measures of decalcification, duration of treatment, presence of a comparison group, and study design were applied to determine study selection. Included studies were double extracted onto pre-designed data extraction sheets. RESULTS AND CONCLUSIONS: By screening titles and abstracts, we identified 143 articles; after the inclusion criteria were applied, 7 reports (of 6 studies) remained. Differences in the methodologies and reporting made statistical analysis impossible. However, the use of topical fluorides in addition to fluoride toothpaste reduced the incidence of decalcification in populations with both fluoridated and non-fluoridated water supplies. Different preparations and formats appear to decrease decalcification, but there was no evidence that any 1 method was superior. There was some evidence that the potency of fluoride preparations might be important.

Cariostatic Agents↗
PubMed1985

Diffusion of fluoride from alginate compared with other topical fluoride agents.

A two-chamber diffusion cell has been employed to monitor the diffusion of fluoride (F) from F-containing agents. The F which diffused from fluoridated alginate-base formula, F-containing gel (Gelution) and varnish (Duraphat) was determined within the first 6 or 20 min in unstirred conditions. A comparative analysis of the data showed that the alginate-base formula was efficient in releasing F. The results also indicate that the diffused F was not directly related to the total F content in the products or the bulkiness of the test specimens. It is obvious that the physicochemical properties of the products play a determining role in the release of F.

Acidulated Phosphate Fluoride↗
PubMed1997

Effects of daily topical fluoride gels on resin composite degradation and wear.

OBJECTIVES: This in vitro study compares the effects of professional and consumer-applied topical fluorides on the weight, wear resistance and surface appearance of a resin composite containing barium boroaluminosilicate glass filler particles. METHODS: Prior to wear studies with a pin and disc apparatus, specimens were immersed for 6 min 10 times in water, three consumer-applied topical fluorides (1.1% NaF, 0.4% SnF2, or 0.5% APF gel) or a professionally applied topical fluoride (1.23% APF gel). Specimens were weighed before and after each immersion. Following wear studies, the specimen surfaces were visually evaluated using scanning electron microscopy. Weight changes were analyzed for significant differences using one-way ANOVA and Duncan's multiple range test (p = 0.01). Values of wear parameters were ranked and tested for significance using one-way ANOVA with least squares mean contrast (p = 0.05). RESULTS: Significant differences were found in the weight loss of specimens treated with different fluoride agents: 1.23% APF = 0.5% APF > 0.4% SnF2 > 1.1% NaF = water (p < or = 0.0001). Significant differences in initial wear depth (S(i)) occurred in the following samples: 1.23% APF > 1.1% NaF = 0.5% APF (p = 0.04). Scanning electron micrographs showed variable wear tracks on the specimen surfaces. The specimen surfaces outside the wear track were smooth for those treated with water or with NaF; the surfaces outside the wear track of specimens treated with APF showed extensive loss of filler particles. SIGNIFICANCE: Topical APF agents caused extensive loss of filler from the resin composite specimens whereas 1.1% NaF caused the least damage. Although significant differences in surface wear resistance were detected, clinical studies are needed to determine the effect of topical fluorides on the properties of this resin composite.

Acidulated Phosphate Fluoride↗
PubMed1990

Evaluation of topical fluoride preparations.

For practical reasons, evaluation of topical fluoride products must depend upon clinical and laboratory assessments. While not always a good predictor of clinical efficacy by itself, fluoride uptake is the most commonly used laboratory test. A consideration of the relationship between possible anticaries mechanisms of fluoride, different product types, and the meaning of various kinds of fluoride uptake data suggests that both the amount of fluoride taken up by early lesions and the amount of ambient fluoride present at a cariogenic site may play key roles in determining the efficacy of a product. While formulations applied annually or semi-annually probably depend on fluoride deposition, those used daily might not. There are no clear data supporting the superiority of one fluoride compound over another, even for infrequently used products, although there are significant differences among them in fluoride uptake by enamel. This suggests that fluoride uptake in vivo at a cariogenic site might actually be different from that suggested by in vitro data, or that larger differences are required for a clinical effect to be observable. Clinical data support the conclusion that a large increase in the fluoride concentration of a product will somewhat increase its anticaries effectiveness, although the increase will not be linearly related to concentration. There also are no obvious differences in clinical effectiveness caused by the addition of gelling agents to topical solutions. Fluoride varnishes are clinically effective but have not been shown to be superior to topical solutions or gels.(ABSTRACT TRUNCATED AT 250 WORDS)

Dentifrices↗
PubMed1994

Professional topical fluoride applications--clinical efficacy and mechanism of action.

All currently used topical fluoride agents deposit soluble fluoride as calcium fluoride on enamel or in lesions. Calcium fluoride serves as a source of fluoride for the formation of fluorapatite. The latter phase is formed when pH drops in plaque, not during topical application. The potential for calcium fluoride formation should probably be increased in topical fluoride agents. In countries with low caries prevalence, the clinical recommendations for topical fluoride need to be reconsidered. Toothpaste is the basic fluoride regimen recommended for everybody. The need for additional fluoride supplementation depends on caries activity. There is no distinct difference in the caries-preventive effects of concentrated fluoride solutions, gels, or varnishes. Thus, the choice of method depends on costs, convenience, patient acceptance, and safety. The use of fluoride varnishes has proven to be a feasible and safe method of fluoride application. With fluoride varnishes, the amounts of fluoride exposure can be better controlled, and less chair-time is required compared with conventional solutions and gels. No dose-response effect to concentrated fluoride agents is apparent, and the benefit of frequent application is not clearly established. In individuals with the most severe cariogenic challenge, combinations of fluoride and antimicrobials may give better clinical effects than fluoride alone.

Calcium Fluoride↗
PubMed1989

Rheological properties of topical fluoride gels.

The rheological properties of several commercial topical fluoride gels were studied. For that purpose, we investigated hysteresis loops under standard conditions, equilibrium values, apparent viscosities as a function of shear rate, rate of thixotropic recovery, and the influence of temperature. The rheological equilibrium values, treated by the Power Law and the Cross Equation, show very important differences. Five gels show pseudoplastic behavior; seven have thixotropic properties. For the risks of fluoride gel toxicity to be lowered, high pseudoplasticity seems most desirable for the first group; for the thixotropic gels, a combination of yield value (very high viscosity at rest), the presence of a static yield value (very fast decrease in viscosity at very low shear rates), and both fast and high thixotropic recovery after destruction seems ideal. Positive and negative, as well as practically no, influence on rheological properties can be noted when the temperature changes.

Fluorides, Topical↗
PubMedDate not supplied

Effects of professionally applied topical fluorides on surface hardness of composite-based restoratives.

This study investigated the effects of professionally applied topical fluorides on the surface hardness of a composite (Spectrum TPH), a compomer (DyractAP) and a giomer (Reactmer). Thirty specimens of each material were fabricated and stored in distilled water at 37 degrees C for one week. These specimens were then randomly divided into five groups of six and treated for 36 hours at 37 degrees C with one of the following: distilled water (control), 1.23% acidulated phosphate fluoride (APF) foam, 0.9% neutral foam, 1.23% APF gel and 0.4% stannous fluoride gel. The treated specimens were subsequently subjected to microhardness testing (load = 500 gf; dwell time = 15 seconds). Results were analyzed using ANOVA/Scheffe's test (p<0.05). The effects of topical fluoride application on surface hardness was material dependent. For all materials, treatment with APF gel and foam significantly reduced surface hardness when compared to the control. KHN values after exposure to APF gel were consistently the lowest and ranged from 4.53 to 15.97. Control KHN values were higher, ranging from 32.88 to 47.47. The surface hardness of the compomer was also significantly reduced after exposure to neutral foam. Therefore, the use of professionally applied topical fluorides, especially APF gel and foam, may be detrimental to the long-term durability of composite-based restoratives.

Acidulated Phosphate Fluoride↗
PubMed1997

A survey of general dentists in Ontario, Part II: Knowledge and use of topical fluoride and dental prophylaxis practices.

A mail questionnaire was used to assess variations in the knowledge and practices of Ontario dentists with respect to topical fluoride and prophylaxis procedures. The questionnaire was answered by 1,276 general dentists. A high percentage (72 to 83 per cent) of respondents identified six months as the optimal time interval at which both procedures should be repeated for all patients under 19 years of age. Relatively few dentists (< 10 per cent) indicated that there should be no specific time interval for re-treatment (i.e. that it should be individually selected). The respondents' preventive knowledge was found to be deficient in two areas: few dentists (16 per cent) knew that it is not necessary to provide a prophylaxis prior to topical fluoride application to achieve maximum caries protection; and most dentists overestimated the speed of caries progress from outer enamel to the dentinoenamel junction (DEJ) in both primary (83 per cent) and permanent (82 per cent) approximal tooth surfaces. In bivariate analysis, three variables were found to be consistently and significantly related to optimal time intervals selected for both topical fluoride application and prophylaxis procedures: year of graduation from dental school; level of hygienist employment; and percentage of patients with private insurance. Multivariate analysis also identified three significant variables: year of graduation from dental school; level of dental hygienist employment; and practice business. Continuing education courses are suggested as a means of updating dentists' knowledge regarding preventive services. Studies are needed to determine the extent to which recent recommendations regarding the professional application of topical fluorides have been followed.

Adolescent↗
PubMed2003

Prevention. Part 7: professionally applied topical fluorides for caries prevention.

This paper reviews the use of professionally applied topical fluorides (PATF) in caries prevention. PATFs are indicated for children and adults with one or more decayed smooth surfaces and/or those who are at high caries risk. Frequency of administration depends on the patient's caries risk, and is usually every 6 months. The effectiveness of fluoride varnish and gel applications has been well established in caries prevention trials involving permanent teeth. Although both types are effective, varnish may be preferred because it is easier to apply, reduces the risk of fluoride over-ingestion, and has greater patient acceptance. Fluoride foams are similar products to gels, but have not been tested clinically. The use of in-office two-part rinses is not recommended because they have not been proven effective. A cleaning, or prophylaxis, is not necessary before the application of topical fluoride for caries prevention. In conclusion, when used appropriately, PATFs are a safe, effective means of reducing caries risk among high-risk populations.

Acidulated Phosphate Fluoride↗