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PubMed2001

Current concept on the anticaries fluoride mechanism of the action.

The paper discusses a possible new concept of the role of fluoride and its mechanism of action in caries prevention. In the past fluoride inhibition of caries was ascribed to reduced solubility due to incorporation of fluoride (F) into the enamel minerals (firmly bound fluoride or fluorapatite). Based on the new findings, it appears that fluoride, either released into or present in the fluid phase bathing the hard tissue, is more important for the reduction of caries development and progression. There is convincing evidence that fluoride has a major effect on demineralization and remineralization of dental hard tissue and that it interferes with acid production from cariogenic bacteria. The provision of dissolved fluoride is the key to successful therapy. The source of this fluoride could either be fluorapatite or calcium fluoride (CaF2) (like) precipitates, which are formed on the enamel and in the plaque after application of topical fluoride. The precipitates of calcium fluoride do not dissolve quickly as was initially believed. Calcium fluoride coating at neutral pH by pellicle proteins and phosphate is the main reason for this. The dissolution of the fluoride from calcium fluoride is pH dependent. At lower pH, the coating is lost and an increased dissolution rate of calcium fluoride occurs. The CaF2, therefore, act as an efficient source of free fluoride ions during the cariogenic challenge. These are subsequently incorporated into the enamel as hydroxyfluorapatite or fluorapatite.

Calcium Fluoride↗
PubMed1988

Fluoride acquisition on and in human enamel during topical application in vitro.

Fluoride acquisition during topical fluoride treatment was studied after different time intervals, at different concentrations and at different pH. The effects of pretreating the enamel with Ca++, and of pre-etching were also tested. Four experimental groups of repeated measures design were established. Chemical assessments were made of the amounts of fluoride formed on (as alkali soluble fluoride, i.e., calcium fluoride) and in enamel (as firmly bound fluoride). The depositions on enamel were also demonstrated by SEM. The amounts of alkali soluble fluoride on enamel increased with time, concentration, pH-decrease and calcium availability. The time of exposure seemed to be the major factor. The amounts of fluoride deposited on enamel outranged by far (greater than 70%) the amounts of fluoride acquired in the enamel. The formation of alkali soluble fluoride on enamel is probably limited by the availability of calcium ions. It is suggested that the fluoride on enamel may protect the enamel surface and serve as a reservoir of fluoride.

Calcium↗
PubMed2003

A prospective, randomized trial for the prevention of mucositis in patients undergoing hematopoietic stem cell transplantation.

Oral mucositis is a complication common to many cancer therapies and produces considerable pain and morbidity. The present study reports a double-blind, prospective, randomized clinical trial testing the efficacy of a calcium phosphate mouth rinse (Caphosol) with fluoride treatments vs a standard regimen of fluoride rinsing and placebo tray treatments in 95 patients undergoing hematopoietic stem cell transplantation (HSCT). The days and severity of mucositis were prospectively evaluated. There were statistically significant decreases in days of mucositis (3.72 vs 7.22 P=0.001), duration of pain (2.86 vs 7.67, P=0.0001), dose of morphine (34.54 mg vs 122.78 mg), days of morphine (1.26 vs 4.02, P=0.0001) and days to the onset of engraftment ANC (absolute neurotrophil count)>200 mm(3) (11.12 vs 12.56) in the Caphosol and fluoride treatment group vs fluoride-rinse group, respectively. Caphosol, a neutral, supersaturated, Ca(2+)/PO(4)(3-) mouth rinse, used in combination with topical fluoride treatments, is superior to fluoride rinse alone in reducing the frequency, intensity and duration of oral mucositis in patients undergoing HSCT.

Analysis of Variance↗
PubMed1988

Degradation of surface enamel and formation of precipitates after topical applications of sodium fluoride solutions in vitro.

After topical treatment of enamel pieces cut from bovine incisors, the chemical composition of the solution phases and of the topmost layers of enamel were determined by special techniques of elemental and surface analysis. Fluoride seems to degrade surface enamel when applied in acidic and neutral solutions. Calcium remains immobile on the enamel surfaces, whereas phosphate goes into solution. When treated with acidic solutions (0.05-0.5 mol/l fluoride), a calcium-fluoride-rich phase is precipitated on the enamel surfaces.

Animals↗
PubMed1989

Fluoride uptake into demineralized primary enamel from fluoride-impregnated dental floss in vitro.

Fluoridated mouthrinses are not advised for preschool children who may swallow much of the agent. An alternate method of delivering topical fluoride to the interproximal tooth surfaces in these young patients may be fluoridated dental floss. The purpose of this study was to determine the fluoride levels of demineralized primary enamel both before and after the use of a commercially available dental floss impregnated with commercially available fluoride-containing products. The results showed that demineralized primary tooth surfaces treated with fluoride-impregnated dental floss exhibited significantly higher fluoride levels than those surfaces treated by immersion in a fluoridated mouthrinse or deionized water.

Dental Devices, Home Care↗
PubMed2002

Dentistry between pathology and cosmetics.

In ancient and medieval times, the prevalence of caries and periodontal disease varied. There were no treatments for dental hard tissue, but dental cosmetics played an important role. In the late 19th century, caries levels reached a maximum in Europe and North America after refined sugar became a cheap staple food. Toothlessness became frequent even in young adults. Caries prevention, effective on a public health scale, began with the introduction of water fluoridation in the 1940s. By 1985, dental academia had acknowledged that substantial declines could also be obtained in entire populations through topical fluorides, mainly in toothpastes. While decreasing caries prevalence is irrefutable in affluent countries, the specific reasons of the decline are still a matter of debate. In countries where caries has declined substantially, activities of dentists are shifting towards cosmetic dentistry. However, caries continues to be a problem for the lower socioeconomic strata, even in affluent countries, and is a serious problem in developing countries. Thus, water fluoridation is still important, and salt fluoridation should be considered where water fluoridation is not feasible. Both measures are extremely cheap to implement. Controlled fluoridation has a great potential for developing countries and low social strata of affluent countries. Its reduced effectiveness in high socioeconomic strata of affluent countries, due to the widespread usage of fluoride in toothpastes and other oral care products, should not detract from the public health value of fluoridation.

Dental Caries↗
PubMed1992

Comparison of fluoride profiles by SIMS with mineral density of subsurface enamel lesions treated intra-orally with a fluoride-releasing device.

A variety of intra-oral model systems has evolved which allows for the study of remineralization of coronal and/or root-surface lesions following application of topical fluoride (F) agents. The problem of interpretation of the results has led to a variety of analytical methods (i.e., microhardness, F biopsy, microradiography, and polarizing light microscopy), each of which provides important but limited information related to the overall understanding of remineralization. Microhardness measures change in mineral content which is more precisely localized by microradiography and polarized light microscopy. F biopsy allows for assessment of the F uptake of lesions, but does not suggest the chemical state of the F. Previous work has demonstrated that patterns of mineral deposition during remineralization do not necessarily parallel the F uptake profiles, and fluoridated apatites cannot be distinguished from non-specifically-adsorbed F (Clark et al., 1988). Because artificial lesions demonstrate variations in depth and mineral content, complementary analytical methods that demonstrate profiles of both F content and mineral density curves on the same section are needed so that the process of remineralization can be more clearly understood. This study used secondary ion mass spectrometry (SIMS) for F profiles and quantitative microradiography for assessment of mineral deposition on the same section. These state-of-the-art methods demonstrate the precision with which information about remineralization can be obtained. Subsurface lesions in human enamel specimens were developed by immersion in 0.1 M lactate buffer with 1% CMC at a pH of 4.5 for 48 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The future of water fluoridation and other systemic fluorides.

School and community water fluoridation, salt fluoridation, and use of dietary fluoride supplements have abundant scientific support as effective caries-preventive methods. Because caries has declined greatly in many developed countries from use of topical fluorides, the absolute caries reduction will be considerably smaller when systemic fluoride methods are implemented now than it was 20 to 40 years ago. For countries with most of the population living in cities with communal water supplies, community fluoridation is the most logical approach from the standpoints of cost-effectiveness and total caries-preventive impact. In countries with a mostly rural population without central water supplies, salt fluoridation is more practical. Dietary fluoride supplements can be recommended only for regions where neither water fluoridation nor salt fluoridation is possible, or as a temporary measure. Although divergent views exist concerning the relative caries-preventive effects of pre-eruptive and post-eruptive fluoride administration, the effectiveness of systemic fluoride methods for preventing dental caries remains unchallenged. Persuasive scientific and public health arguments exist to justify implementing and sustaining their use. The future of these methods will be influenced by the findings of new clinical and epidemiological research. Social, political, economic, and educational factors will be of equal, if not greater, importance. Perceptions of the current severity of dental caries as a health problem and of risks associated with preventing the problem may affect the future uses of systemic fluorides more than will recommendations of scientists.

Fluoridation↗
PubMed1991

Bond strength of light-cure fluoride-releasing base-liners as orthodontic bracket adhesives.

Fluoride-releasing bracket adhesives are desirable for their ability to minimize the potential for subsurface enamel demineralization adjacent to a bonded bracket. Self-applications with topical fluoride rinses, pastes, and gels have been documented to minimize and eliminate subsurface caries adjacent to bonded brackets. However, the success of these mediums are limited by patient compliance. A urethane with fluoride (TimeLine) and a glass ionomer with methyl methacrylate (Vitrabond), both of which are light cured and exhibit sustained fluoride ion release, were compared with a non-fluoride-releasing light-cured bracket adhesive (Transbond). Premolar brackets with mesh pads (A-Company) were positioned on the buccal surface of the premolars and placed in a PVC ring with polymethyl methacrylate. Two groups of 10 samples each of the tested material were prepared and immersed in distilled water immediately after in vitro bonding. Samples of each material were evaluated for enamel shear strength (Instron) at 24 hours and at 30 days. Bond strengths to enamel at 24 hours measured in megapascals (MPa) were 5.98 for TimeLine, 11.58 for Vitrabond, and 11.35 for Transbond. Bond strength to enamel at 30 days was found to be significantly less for TimeLine and Vitrabond: 3.05 for TimeLine, 5.39 for Vitrabond, and 10.80 for Transbond. The two fluoride-releasing, light-cured materials tested have low bond strengths after 30 days and are not acceptable as orthodontic bracket bonding agents. However, for patients with high caries risk, these materials may be placed around already bonded brackets.

Acid Etching, Dental↗
PubMed1981

Caries prevalence and therapy in the deciduous dentition from 3 to 8 years. A longitudinal study.

The onset and prevalence of caries in primary teeth and the rate of failure in conservative caries therapy were followed up for six years in a group of children who were three years old at the start of the study in 1974. All children were offered a basic preventive program which included counselling their parents on dietary habits, oral hygiene and the use of fluoride tablets. During the annual clinical examinations bite-wing radiographs were taken in cases with established molar contacts. Operative care was delivered when necessary, combined with topical fluoride applications. At the age of three years the onset of caries was registered in 26 percent of the children. The corresponding percentages at the ages of 4, 5, 6, 7 and 8 years were 26, 18, 3 and 2, respectively. Consequently, 17 percent were still caries-free at the end of the six-year period. Proximal caries was most often observed on the distal surfaces of the first primary molars, followed by the mesial surfaces of the second primary molars. The overall frequency of class II amalgam restorations requiring replacement was 16 per cent. The highest percentage of failures was noted in lower first primary molars.

Age Factors↗
PubMed2005

Salt fluoridation in Central and Eastern Europe.

For decades Central European countries have been interested in preventive dentistry. Water fluoridation played a major role in the former German Democratic and Czechoslovak Republics and a minor one in Poland. These schemes were abandoned after 1989. Extensive research on all aspects of salt fluoridation was conducted in Hungary from 1966 to 1984 but attempts to introduce it in the country have had little success. Salt fluoridation was implemented in the Czech and the Slovak Republics in the mid-nineties. The market share of the fluoridated domestic salt appears to have reached 35% in the Czech Republic; it became eventually part of a preventive strategy comprising school-based dental health education including topical fluoride. Another four countries have been considering salt fluoridation but schemes did not materialize. Antifluoridation activities occasionally impeded caries prevention, and for years some respected dentists declared their position against fluorides. Caries prevalence in 12-year-old children is by 1 to 3 DMFT higher than in Western Europe. For many years to come, modern fluoride-containing toothpastes and dentifrices may not be affordable for the lower socio-economic strata of the populations in Central and Eastern Europe. It is concluded that salt fluoridation, which is by far the cheapest means of lowering caries prevalence, could markedly improve the oral health situation even if the economical situation is slow to improve.

Cariostatic Agents↗
PubMed1979

SnF2 treatment of enamel, hydroxyapatite or brushite at 37 degrees C and 50 degrees C: an infra-red investigation.

The effect of 4% SnF2 on brushite, hydroxyapatite and powdered bovine enamel applied for short, 15 or 30 minute, periods was investigated using infra-red spectroscopy. It was found that brushite was converted into a fluoridated hydroxyapatite, a reaction which was both time and temperature dependent. The reactions of hydroxyapatite and powdered enamel with SnF2 were similar. There was a drop in the OH- peak intesities. X-ray diffraction analysis of these samples showed that F- ions occupied mainly OH positions in the hydroxyapatite lattice structure. In all reactions an increase in temperature from 37 degrees C to 50 degrees C increased the reaction speed by at least a factor 2. The most probable result of in vivi SnF2 application on sound enamel is the formation of a fluoridated hydroxyapatite together wity stannous complexes and amorphous CaF2. In demineralized areas some of the brushite is converted into a fluoridated hydroxyapatite as is some of the remaining hydroxyapatite. In the more protected area of an enamel lesion these reactions may well continue for some time after the topical fluoride application; Sn2F3PO4 may also therefore be formed.

Animals↗
PubMed1990

Fluoride in caries prevention: is the effect pre- or post-eruptive?

A longitudinal study of children from ages 7 to 18 showed that, if enamel lesions were included, the overall number was the same in fluoridated and non-fluoridated areas. However, a significant reducing effect of pre-eruptive fluoride could be seen in the number of dentinal lesions in a fluoridated area, provided that fluoride was also consumed post-eruptively for a considerable period of time. A precise estimation of both pre- and post-eruptive effects was obtained when teeth were classified according to their eruption time as related to the onset of water fluoridation. About 66% of the greatest reduction in pit and fissure caries came from pre-eruptive fluoride, while in smooth surfaces, this effect was reduced to 25%. In approximal surfaces, the reduction was due half to pre- and half to post-eruptive fluoride. Post-eruptive fluoride became more important with decreasing severity of caries attack. Thus, assuming a continuing decline in dental caries, the majority of such populations will benefit most from the use of topical fluorides. However, in high-risk groups, supplementation of pre-eruptive fluoride can still be of major importance.

Child↗
PubMed1997

Caries development in fluoridated and non-fluoridated deciduous and permanent enamel in situ examined by microradiography and confocal laser scanning microscopy.

The aim of the study was to compare initial caries development in fluoridated and non-fluoridated deciduous and permanent enamel in situ. Enamel slabs were mounted in removable appliances and worn for 4 wks. Significantly larger lesions developed in deciduous than in permanent enamel when no topical fluorides were used. Fluoride mouthrinsing partly prevented lesion development in deciduous and completely in permanent enamel. Initial enamel caries not detected by microradiography can be visualized by CLSM (confocal laser scanning microscopy).

Dental Caries↗