Effect of prior toothcleaning on bi-annual professional acidulated phosphate fluoride topical fluoride gel-tray treatments. Results after three years.
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In recent years, an increase in the prevalence of dental fluorosis, mostly of the very mild to mild category, has been seen in the United States. This paper therefore discusses the safety of dental fluoride products, primarily with respect to the risk of dental fluorosis due to chronic ingestion of these products by pre-school children. No change is indicated in the optimal fluoride level (0.7 to 1.2 ppm) for water fluoridation. A reduction in the dosage of fluoride supplements is recommended for children aged from three to six years (14.5 to 22 kg body weight) residing in communities with less than 0.7 ppm F. Physicians, pharmacists, and dentists need to be better educated in correctly prescribing fluoride supplements; such prescriptions should be based on the fluoride concentration of the domestic water supply and the child's weight/height/age. No change is recommended in the concentration of fluoride used in dentifrices and mouthrinses. The US Food and Drug Administration should require more explicit labeling of fluoride products with regard to avoidance of ingestion, use of small amounts, and need for supervised use by pre-school children. The efficacy of water fluoridation, fluoride supplements, and topical fluoride agents has been amply documented elsewhere.
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The in vitro, in vivo and clinical research on topical fluoride varnishes in surveyed. The probable mechanisms of action for fluoride varnishes is discussed and this effect demonstrated from the results of in vitro and in vivo research. Findings from clinical studies are summarized and selected results are used to estimate expected preventive effects from the treatment. The practical advantages and limitations of fluoride varnishes are also reviewed and indications for the future used of these preventive agents are considered.
The circulatory uptake and urinary excretion of topical fluoride were investigated by applying a sodium fluoride solution containing 18F for six min to healthy gingiva of four adult dogs. Blood and urine samples were taken a regular intervals. Maximal fluoride in blood represented 0.02-0.05% of the applied dose and occurred four min after completion of the application. By 6.0 h, 0.02-0.06% of the applied dose had been excreted in urine. Preliminary data showed that this represented about 8.8% of the fluoride absorbed through the gingiva.
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Fluoride therapy continues to be the best defense in the battle against dental caries. The decision to utilize topical fluorides is no longer age dependent. Changing disease patterns require dentists to critically evaluate the caries risk of each patient and develop a fluoride treatment plan based upon the needs of the individual patient. A variety of professional and self-applied fluoride products are available and new fluoride delivery systems have recently entered the market. A critical review of literature, combined with an understanding of the advantages and disadvantages of each topical fluoride system will assist the dentist in selecting the product best suited for each patient.
Inadvertent ingestion of fluoride from topical procedures poses the risk of dental fluorosis in age-susceptible users. This risk can be minimized for mouthrinsing by restricting it to those above the age-susceptible limit. Operators administering topical fluoride treatments can take practical precautions that have been shown to reduce the amount of fluoride retained and, thus, reduce ingestion. Clinical and epidemiological studies have failed to establish that dentifrice ingestion by young children constitutes a serious fluorosis risk. Discussion of risk must consider the effect of perceived risks upon the public.
Topical fluorides are frequently prescribed to orthodontic patients to minimize development of initial carious lesions around brackets and bands. However, various topical fluorides are reported to cause surface changes and weight loss of dental materials composed of ceramic elements. Little is known of the effects of these fluorides on ceramic brackets. The purpose of this study was to determine the effects of topical fluorides (0.4% stannous fluoride, 0.5% acidulated phosphate fluoride, and 1.1% sodium fluoride) as compared with water, on the weight and on the surface of the wings and slots of aluminum oxide ceramic brackets. The brackets (n = 10 each treatment agent) were weighed before 6-minute immersions in the treatment agent, rinsed, dried, and reweighed for a total of 10 immersions. The surface appearance of the wings and the slots of the brackets (n = 5 each treatment group) were evaluated with scanning electron microscopy. No statistically significant changes in weight were found among the groups. Surface changes were not observed in either the slots nor the wings of ceramic brackets. Therefore it was concluded that the commercially available topical fluorides when applied as per the regimen in this study to the aluminum oxide ceramic brackets did not cause surface damage or significant weight loss as compared with controls (water).
The purpose of this study was to compare the oral fluoride (F) retention following acidulated phosphate fluoride (APF) foam and gel applications in children. Fifty-nine children were divided into two groups, 6-9 years old and 10-13 years old. They each received a randomly assigned sequence of topical F foam and gel applications in two consecutive visits, using either sponge-lined or unlined trays. Approximately 0.6-0.8 g of APF foam, or 3-4 g of APF gel was used in each of the 4-min F applications. The amounts of F applied, recovered from the mouth, and retained were calculated for each treatment. The retention of an average of 1.26 mg F after an APF foam application was significantly less than 2.53 mg F for the APF gel. The sponge-lined trays also reduced significantly the F retention, compared with unlined trays. However, there was no significant difference in the amount of F retained between the two different age groups. The amount of F retained was reduced significantly from 3.65 mg F in the first appointment, to 1.24 mg F in the second appointment when unlined trays were used.
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The topical application of sodium fluoride to abraded rat skin produced several morphological and biochemical effects. Related to the degranulation of dermal mast cells, skin histamine concentration was increased, fluorides were absorbed into the skin, and deposited mainly kin mitochondria. Dermal histamine binding was decreased for both H1 and H2 receptors with reduced binding sites, but epidermal adenyl cyclase was activated by fluorides. The response of the rat skin to fluorides involves a sequence of changes by which the potentiation of an inflammatory response also involves alterations in specific histamine receptors and a histamine-specific adenyl cyclase system.
This study describes salivary fluoride levels after topical fluoride gel application on overdenture abutments. Fluoride levels were evaluated separately for the subjects with normal unstimulated salivary flow rate (n = 16) and for those with a low flow rate (n = 8). One drop of fluoride gel (Karigel-N, Lorvic) was placed in two abutment depressions of the duplicated overdenture, after which unstimulated whole saliva was collected for 30 minutes. Samples for fluoride analysis were taken at 5-minute intervals. Two additional samples were taken at 45 and 60 minutes. Fluoride concentration at the abutment-denture interface (remaining fluoride concentration) was measured at the end of the study. Salivary fluoride concentrations decreased gradually in both groups of subjects, but after 1 hour they remained at a higher level in subjects with low flow rates. Subjects' salivary flow rates correlated negatively with remaining fluoride concentration at the denture-tissue interface. Consequently, mean remaining fluoride concentration was significantly higher in subjects with low flow rate than in their normal counterparts.
A variety of topical fluorides is now used clinically for the prevention and control of dental caries. It is essential for the dental profession to be fully aware of the relative retention rates of fluoride in saliva and thus its contact with the teeth. These may vary following the use of the different categories and concentrations of agents available and with different methods of use. It is also important to be aware of the amounts of fluoride ion ingested following use of the more concentrated forms and of the resultant elevation in total blood fluoride levels. These parameters were investigated in a series of experiments involving human volunteer subjects using a variety of topical fluoride materials commercially available in Australia. Fluoride mouthrinses appeared to provide the highest salivary retention rates per dose of all forms of topical fluoride. Ingestion rates from concentrated gels were acceptable when effective evacuation methods were applied. The use of custom-made trays resulted in a reduction in amounts of fluoride ion ingested, though simple self-application by toothbrush of smaller quantities proved to be an effective alternative in terms of amount of fluoride ion retained in saliva per amount applied and ingested. None of the concentrated gels used resulted in elevations in total blood fluoride levels which were of concern in adults. It is acknowledged that salivary retention rates of fluoride ion do not necessarily reflect the caries inhibitory effects of topical fluorides. However, these data provide some indication of possible advantages of some products and methods of application over others.
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