Topical fluoride: a status report.
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Fissure sealant is an important tool in the prevention of dental caries. This study evaluated the effect of treating the enamel with topical fluoride gel prior to acid etching on sealant retention clinically (Part I) and in vitro (Part II). In part I a split mouth design using contralateral first permanent molars was conducted. Seventy (35 pairs) molars were sealed. Fissure sealant was applied on one side of the mouth (control group) and the contralateral tooth received acidulated phosphate fluoride gel (test group) prior to acid etching. The sealant was evaluated after 6 and 12 months and scored as intact, partially lost or completely missing. In part II, the shear bond strength between sealant and buccal enamel of extracted permanent molars without or with topical fluoride treatment was evaluated. Results showed no statistically significant differences between the test and control groups either clinically or in vitro. It is concluded that topical fluoride application prior to acid etching does not have a deleterious effect on sealant retention. However, further investigations should be conducted using different types of fluoride before altering the traditional practices.
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The effect of 1.23% acidulated phosphate fluoride, 0.40% stannous fluoride gels, and 2.00% citric acid solution on 150.00 overglazed and 150 autoglazed porcelain surfaces was measured using a profilometer. Application of 1.23% acidulated phosphate fluoride for periods of 16 and 32 minutes caused etching in both groups, but the autoglazed group was significantly more effected. In both groups increase in application time did not affect the amount of etching. No etching was detected in either group after the application of 0.40% stannous fluoride for 6 and 12 hours and 2.00% citric acid for 4 and 8 hours.
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A survey of 2,800 general dentists from six licensing regions was conducted to determine the current rate of pit and fissure sealants and topical fluoride use. The response rate was 56 percent. Seventy percent of general dentists used sealants on newly erupted secondary teeth and 20 percent of general dentists had never used sealants. Sixty-five percent of general dentists used topical fluorides on pedodontic patients at six-months intervals and 25 percent used them at one-year intervals. Dentists with more frequent use of sealants tended to be recent graduates who used new procedures, spent more practice time in pedodontics, came from the central region, had a hygienist in their practice, and belonged to the Academy of General Dentistry. Dentists with more frequent use of topical fluorides tended to perform frequent recall examinations. Those who performed frequent recall examinations were more likely to come from Florida and the Southeast, to believe caries spread rapidly, to be recent graduates, and to have a greater percentage of patients with insurance.
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Pharmacokinetic studies have revealed quantitative information about the bioavailability, rate of absorption, distribution, and clearance of fluoride following the use of fluoride-containing dentifrices, gels, varnishes, and solutions. It is concluded that following the use of topical fluoride products, variable amounts of fluoride are swallowed and absorbed into the systemic circulation--amounts which may be sufficient to produce acute or chronic side-effects. Pharmacokinetic data should, therefore, form part of the basis for the optimal and safe use of fluoride products. In addition, there is a need for future research to determine the kinetics of fluoride in the oral fluids after the application of topical fluoride agents and to determine the associated changes in the composition of the mineral components of the oral fluids.
Of the five types of topical fluoride gel products available in the United States, two have not been clinically tested in randomized double blind clinical trials. For those tested, the averaged results of clinical trials involving schoolchildren in fluoride-deficient communities indicate a caries reduction of approximately 26 percent from either a professional or self-administered program. A similar relative reduction can be expected from programs conducted in fluoridated communities, but the absolute caries inhibition is less. Twice-a-year professional applications are more effective than once-a-year applications, and self-applications using trays are more effective than applying the gel on a toothbrush. For subjects beyond school age, there are few clinical studies of either self-applied or professionally applied gels; however, current epidemiological evidence does not indicate a need for public health caries preventive programs for healthy employed adults. For medically compromised patients, especially those exhibiting rampant caries associated with radiation-induced xerostomia, a variety of topical gel procedures appear to be effective in limiting caries.
It is now well-accepted that the primary anti-caries activity of fluoride (F) is via topical action. The retention of F in the mouth after topical fluoride treatment is considered to be an important factor in the clinical efficacy of F. The purpose of this study was to evaluate F levels in ductal saliva, whole saliva, and pooled plaque after treatment with topical F agents intended for home use. Ten consenting adults, mean (SD) age 31.0 (8.2) years, participated in all aspects of the study. Two days before each test, subjects received a professional tooth cleaning and subsequently abstained from all oral hygiene procedures to permit plaque to accumulate, and from the use of F-containing dental products. Treatments consisted of a placebo dentifrice (PD), fluoride dentifrice (FD; 0.24% NaF), fluoride rinse (FR; 0.05% NaF), and fluoride gel (FG; 1.1% NaF). Unstimulated whole saliva and pooled plaque were sampled at multiple points over a 24-hour period. In a separate experimental series, stimulated parotid saliva was sampled over a two-hour period after treatment. Fluoride levels generally followed the same pattern in whole saliva and pooled plaque samples, with FG > FR > FD > PD. Night-time F application resulted in prolonged F retention in whole saliva but not in plaque. Fluoride levels in parotid saliva were only slightly higher after F treatment and returned to baseline levels within two h. The results of this study indicate that the method of F delivery, the F concentration of the agent, and the time of application (daytime vs. night-time) are important factors influencing F levels in the mouth.(ABSTRACT TRUNCATED AT 250 WORDS)
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Subjects undergoing orthodontic treatment were asked to brush their teeth twice a day for 6 weeks with stannous fluoride gel or acidulated phosphate-fluoride gel. A reduction in salivary Streptococcus mutans levels was evident in subjects who brushed with the stannous fluoride.
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Tooth sections were treated in vitro for 4 min with APF, SnF2, or received no treatment. Each treatment group then received washes of KOH, (24 h), an inorganic solution (24 h), or DDH2O (2 min) and were placed into dialyzed 15% w/v gel (pH 4.3) containing 0.15 mM hydroxyapatite, but no fluoride (less than 0.02 ppm F). Adjacent nontreated sound enamel acted as the control. Lesion microdissection, after 2 weeks exposure to the acidified gel, revealed an inverse relationship between lesion body fluoride concentration and lesion depth. The lesion depth was smallest, and the lesion body fluoride concentration was greatest in both fluoride-treated groups after a 2-min DDH2O wash, a 24-hour inorganic wash, and a 24-hour KOH wash, respectively. These data support the theory that the progress of carious lesions is related to the fluoride concentration in the lesion and that the fluoride concentration in the lesion is related to the acquired fluoride concentration in sound enamel.