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Endogenous fluoridation for preventing dental caries .

Prof. d-r R.Kabaktchieva. Endogenous fluoridation for preventing dental caries . . Purpose of fluoride prevention . Purpose of fluoride prevention is to build resistant tooth structure for better oral health.

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Endogenous fluoridation for preventing dental caries .

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  1. Prof. d-r R.Kabaktchieva Endogenousfluoridationforpreventingdentalcaries.

  2. Purpose of fluoride prevention • Purpose of fluoride prevention is to build resistant tooth structure for better oral health. • Fluoride prevention is aimed at:     - Prevention of dental caries;     - Slowing the progression of dental caries.

  3. Forms of endogenous fluoride prevantion Endogenous fluoride prevention is carried out by using various ways of supplying fluoride: - Drinking waterfluoridation, - Use of natural fluoride       mineral water - Tablets containing fluoride - Milk fluoridation, - Salt fluoridattion and others.

  4. Communitywaterfluoridation(alsoreferredtoasfluoridation) • Fluoridation, isdefinedastheupwardadjustmentofthenaturalfluoridelevelin a community'swatersupplyto a leveloptimalfordentalhealth. • Itis a population-basedmethodofprimarypreventionthatusespipedwatersystemstodeliverlowdosesoffluorideoverfrequentintervals.

  5. Fluoridationis oneofthetoptenpublichealthachievementsofthetwentiethcentury. • Fluoridationcontributedto a dramaticdeclineindentalcariesfrom the 1950s tothe 1980s, andcontinuestoeffectivelyreduceandpreventtoothdecaytodaywhenmultiplesourcesoffluoride, suchasfluoridetoothpaste, arereadilyavailable.

  6. Continuedmonitoringoffluorideexposurefromallsources, especiallyfromsourcessuchasfluoride-containingdentifrices, isimportanttoachievetheappropriatebalancebetweenmaximumcaries-preventivebenefitandminimalriskoffluorosis. • Fluoridationhasbeenshowntobeaneffectiveinterventionandsoundpublicpolicy.

  7. TheAmericanDentalAssociation (ADA) officiallydefineswaterfluoridationastheadjustmentofthenaturalfluorideconcentrationoffluoride-deficientwatersuppliestotherecommendedlevelforoptimaldentalhealth.

  8. Theoptimalfluoridationlevelvariesbygeographicallocationaccordingtothetemperatureandis a valuethatrangesfrom0.7 ppm F to 1.2 ppm F.

  9. Partspermillion (ppm) andmilligrams/liter (mg/l) areessentiallyequivalent, andthetermsareusedinterchangeably. • Onepartpermillionisthesameconcentrationas 1 mg/l. • Somedocumentsrefertoconcentrationsusedinwaterfluoridationaspartspermillion; othersusemilligramsperliter.

  10. FluorideisthethirteenthmostabundantelementonEarth. • Thisnaturallyoccurringsubstanceisfoundinwater, soil, plants, and, eveninair. • Certainfoods, suchasteaandfish, containsignificantamountsoffluoride.

  11. TheWorldHealthOrganization (WHO) identifyfluorideas a nutrientimportantforhealth. • Fluoridationcanbethoughtas a formofnutritionalsupplementationinwhichfluorideisaddedtothedrinkingwater.

  12. Fluoridationisanidealpublichealthintervention because it : • (1) benefitspeopleofallages; • (2) issociallyequitableanddoesnotexcludeanygroup; • (3) impartscontinuousprotectionwithnocomplianceorconsciouseffortrequiredbyconsumers, otherthandrinkingoptimallyfluoridatedwater; • (4) works withoutrequiringindividualsto access care • (5) doesnotrequirethecostlyservicesofhealthprofessionals; • (8) isremarkablycosteffective.

  13. MechanismsofActionofFluoride Fluoride works in 3 waystoreduceandpreventtoothdecay • (1) systemically,bybeingingestedandincorporatedintotheenamelstructureduringtoothdevelopment; • (2) topically,bypromotingremineralizationandinhibitingdemineralizationoftoothsurfacesaftereruption; • (3) topically, byinhibitingglycolysisinmicroorganisms, therebyhinderingtheabilityofbacteriatometabolizecarbohydratesandproduceacid.

  14. Thegreatesteffectonreducingandpreventingdecayistopical; • however, bothsystemicandtopicalmechanismsareimportant.

  15. Systemicfluorideisingested, ortakenintothebodyduringconsumptionoffoodsorbeverages. • Systemicfluoridecanbeincorporateddirectlyintothehydroxyapatitecrystallinestructureofthedevelopingtooth, thesmallerfluorideionsreplacinghydroxylionsinthecrystallinestructureofthetoothandproducing a less-solubleapatitecrystal.

  16. Todayitisacceptedthatthesystemiceffectoncariespreventionisthelessereffect;Todayitisacceptedthatthesystemiceffectoncariespreventionisthelessereffect; • however, thereiscurrentevidencethatsystemicexposuretofluorideduringtoothformationreducestoothdecay.

  17. Topicalfluorideconcentratesintheplaqueandsaliva, therebyenablingittocomeintofrequentcontactwiththesurfacesoftheteeth. • Itseffectsareposteruptiveandcanbenefitpeopleofallages . • Thedecayprocessinvolvesbothdemineralizationandremineralizaitonandcanmoveineitherdirection.

  18. CyclesofdemineralizationandremineralizationcontinuethroughoutthelifetimeofthetoothCyclesofdemineralizationandremineralizationcontinuethroughoutthelifetimeofthetooth

  19. Fluoride, especiallythatheldinplaque, isanessentialnutrientintheremineralizationofteeth. • Cariogenicbacteriaresidingindentalplaquemetabolizesugarsandothercarbohydrates, producingacidthatbeginstodissolve, ordemineralize, thetooth'senamelcrystalsurface. • Calcium, phosphate, andcarbonatearelostfromtheenamelandcanbecapturedintheadjacentplaque. • TheloweredpHcausedbytheacidalsoreleasesfluoridecontainedintheplaque.

  20. Thenthefluoridefromtheplaqueandavailablesalivaaretakenupbythedemineralizedenamelalongwithcalcium, phospate, andcarbonate; • Тhisresultsinremineralizationastheionsre-formintoanimprovedenamelcrystalstructurethatcontainsmorefluorideandlesscarbonate, andismoreresistanttoacid • Fluoridealsoinhibitstheprocessthatbacteriausetometabolizecarbohydrates, thusreducingbacterialacidproductionandreducingdissolutionoftoothenamel.

  21. Therefore, on a regularbasis, waterfluoridationreplenishessmallquantitiesoffluoridetotheplaqueandsaliva, whichcontributestogoodoralhealth.

  22. Systemicfluoridesalsoprovide a topicaleffectbecausesalivacontainssomefluoridefromingestion, iscontinuallyavailableatthetoothsurface, andbecomesconcentratedindentalplaquewhereitinhibitsacid-producingcariogenicbacteriafromdemineralizingtoothenamel. • Fluorideconcentrationintheplaqueis 50 to 100 timeshigherthaninthewholesaliva.

  23. Insummary Fluoridationhasbeenfoundtoreducedentaldecaythroughthreemechanisms: • (1) bysystemicingestionoffluoride, whichisincorporatedintothedevelopingtoothstructureandconvertshydroxyapatiteintofluorapatite, thusreducingthesolubilityoftoothenamelinacidandmakingitmoreresistanttodecay;

  24. (2) bytopicalactionoffluorideintheplaqueandsaliva, whichenhancesremineralizationoftoothenamelthathasbeendemineralizedbyacidsproducedbydecay-causingbacteria, • (3) bytopicalinteractionwithbacteriaintheplaque, whichreducetheacidproductionbydental-plaqueorganisms.

  25. EnamelFluorosis • Fluoridationhasrisksaswellasbenefits. • Fluorideinwatercancause a dentalconditionknownasenamelfluorosis or fluorosis. • Themildandverymildformsoffluorosismaybesominimallyapparentthatindividualsmaynotevenrealize that theirteethareaffected, • The moderateandsevereformsoffluorosisresultinstainedandpittedteeththatarecosmeticallyobjectionable.

  26. Fluoridationinvolvesfinding theappropriatebalancebetweenthebenefitsofcariespreventionandimprovedoralhealth, andthepotentialforcosmeticconditionsassociatedwithverymildandmildfluorosis.

  27. Enamelfluorosisresultsfromhypomineralizationinenamelsurfaces ofteeththathavebeenexposedtofluorideingestedduringenamelformation. • Enamelfluorosiscanpresentin a numberofways, fromwhitestriaetothemostsevereformthatcouldbeclassifiedas a developmentaldefectoftheenamel.

  28. Thedegreeoffluorosisdependsonthetotaldoseoffluoridefromallsources, aswellasonthetiminganddurationoffluorideexposure. • Enamelfluorosisoccursinchildrenwhoconsumefluoridewhentheirteetharedeveloping; • Fluorosiscannotoccuronceenamelformationiscompleteandtheteethhaveerupted, regardlessofintake; therefore, olderchildrenandadultsarenotatriskforenamelfluorosis.

  29. Standardof 2.0 ppm F wassettoprotectchildrenfrommoderate/severeenamelfluorosis.

  30. Questionable, verymild, andmildstagesoffluorosisoftenresultfromveryyoungchildrenswallowingtoomuchfluoride-containingtoothpasteorfrominappropriatesupplementationwithprescriptionfluorideproductssuchas • (1) physiciansordentistsindependentlyprescribingfluoridesupplements; • (2) physiciansordentistsprescribingfluoridesupplementswithoutcheckingthefluoridecontentofthechild'swatersupply. • Ineithercase, a childgets a "double" doseoffluorideon a dailybasis.

  31. Monitoringtotalfluorideintakeiscomplicated, consideringtheavailabilityofmultiplesourcesoffluoride. • Also, fluoridefromtablets/dropsisingestedandabsorbedatonetimeofday, asopposedtofluorideinwaterinwhichtheingestionandabsorptionoflow-dosefluorideisdistributedthroughouttheday.

  32. Thesefactorshavebeenconsideredintheestablishmentoffluoridedosageschedules, whichwereadjusteddownwardinthe 1990s, particularlyforchildreninthefirst 6 monthsoflife. • TheDietaryFluorideSupplement Schedule approvedbytheAmericanDentalAssociation,theAmericanAcademyofPediatrics,andtheAmericanAcademyofPediatricDentistryshouldbefollowedwhenfluoridesupplementsareprescribed

  33. DietaryFluorideSupplement Schedule, 1994

  34. Recommendationstoreducetheriskforenamelfluorosis. • Allpersonsshouldknowwhetherthefluorideconcentrationintheirprimarysourceofdrinkingwateris: - belowoptimal (lessthan 0.7 ppm F), - optimal (0.7-1.2 ppm F), - aboveoptimal (greaterthan 1.2 ppm F). Thisknowledgeisthebasisforallindividualand professional decisionsregardinguseofotherfluoridemodalities (e.g., fluoridetoothpaste, mouthrinses, orsupplements).

  35. Theriskofdevelopingverymildfluorosisversusthebenefitofdecreaseddentalcariesandattendanttreatmentcostsshouldbecommunicatedtopatientswho express concern. • Severefluorosisdoesnotoccurfromfluoridatedwateralone, andmostfrequentlyoccurswhenthereistoomuchnaturallyoccurringfluorideinwater.

  36. OptimalFluorideLevels • Тhehighertheaveragetemperaturein a community, thelowertherecommendedwaterfluoridelevel. ForeverygeographiclocationintheUnitedStates, a specificoptimalfluorideconcentrationisrecommendedforthedrinkingsupply, withoptimallevelsrangingfrom 0.7 to 1.2 ppm F • Inaddition, optimalfluorideconcentrationswererecommendedat a timebeforetherewereotherregularsourcesoffluorideexposure, suchasdiscretionaryfluoridetoothpaste, mouthrinses, ordietarysupplements.

  37. OtherFluorideVehicles • Saltfluoridationresultsinsmallamountsoffluoridebeingreleasedfromplasmathroughouttheday. • Toachievedental-cariesreductionsatlevelscomparabletowaterfluoridation, theleveloffluoridesupplementationofrefinedsaltshouldbeatleast 200 mg F/kgassodiumfluorideorpotassiumfluoride.

  38. Saltfluoridationrequirescentralizedsaltproduction, aswellasmonitoring. • CountriesusingsaltfluoridationincludeSwitzerland, France, CostaRica, Jamaica, Germany, Mexico, Colombia, Ecuador, Venezuela, andUraguay

  39. Milkfluoridation • Theadditionof 5 mgoffluorideto 1 literofmilk, hasbeenintroducedas a vehicleofschool-basedfluoridedeliveryinsomecountries (Bulgaria, Chile, China, theRussianFederation, andtheUnitedKingdom). • Additionalstudiesarerequiredtoadequatelyassessmilkfluoridationas a viablecaries-preventionstrategy. • Accordingtothe WHO report, "Thedistributionoffluoridatedmilkcanbemorecomplicatedthanthatoffluoridesupplements (tabletsordrops).“

  40. Fluoridemouthrinses • School-basedweeklyfluoriderinseprograms, use 0.2% sodiumfluorideinpreventingcoronalcariesinschoolchildrenwhoareatriskfordentalcaries. • TheNationalPreventiveDentistryDemonstration Project examinedpreventiveeffortsfrom 1976-1981 intencitiesintheUnitedStatesandreported fluoridemouthrinseprogramshadlittleeffectinreducingcaries, especiallyamongchildrenfromfluoridatedcommunities.

  41. END

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