SYSTEMIC FLUORIDES

BY HAWWA THASNEEM IVTH YEAR PART 1

INTRODUCTION

• Provides low concentration of F to teeth over a long period of time

• Circulates through the blood stream and is incorporated into developing teeth

• After eruption, F contacts teeth directly through salivary secretions

• Most of them have topical effect

TYPES

COMMUNITY WATER

FLUORIDATION

SALT FLUORIDATION

MILK FLOURIDATION

FLUORIDE TABLETS/DROPS

/ LOZENGES

COMMUNITY WATER FLUORIDATION

COMMUNITY WATER FLUORIDATION

• Most common form of systemic fluoride administration

• 1ppm• controlled or adjustment of the

concentration of F in a communal water supply so as to achieve maximum caries reduction and a clinically insignificant level of fluorosis

• 50% to 70% reduction in caries without damage to teeth or other structures

• Practicable and effective public health measure

CONTROLLED WATER FLUORIDATION STUDIES

Grand Rapids – Muskegon study Newburgh – Kingston study The Brantford- Sarnia- Stratford

fluoridation caries study Evanston – Oak Park study Tiel- Culemborg fluoridation study

OPTIMAL WATER FLUORIDE CONCENTRATION

• Empiric formula by GALAGAN & VERMILLION

ppm F = 0.34/E where E = - 0.038+0.0062x T

METHODOLOGY OF ESTIMATION OF FLUORIDE CONCENTRATION IN DRINKING WATER

SAMPLE COLLECTION

• 500 ml of water collected in a dry polythene container • 2 CC of 6N HCL added• Stored at 4C • Estimated by 1) F electrode coupled with standard pH meter 2) Scot Sanchis method

F electrode coupled standard pH meter

• Most recent and universally accepted• 2 pH meters used Orion 901 microprocessor ion

analyzer and Orion 407• Specific ion meter• Conc. of F calculated by: a) Typical calibration curve b) by applying electrode potential equation c) Direct ppm reading

Scot Sanchis method

• Based on the reaction btw F & the red zirconium alizarin lake

• F forms colorless complex ion – liberates alizarin sulphuric acid

• F inc – color changes from yellow to red• Comparing the color with the standard

LIMITATIONS

• Lack of centralized water supply system

• Require support of health authorities and government

F compounds used

• Fluorospar• NaF• Silico fluorides• NaSiF• Hydroflurosilicic acid• Ammonium silico F

EQIUPMENTS

• SATURATOR SYSTEM• DRY FEEDER SYSTEM• SOLUTION FEEDER SYSTEM

SATURATOR SYSTEM

• Principle:4% saturated solution of NaF is produced and

injected at the desired concentration at th e water distribution source with the aid of a pump

• high hard water level used• Suitable for small towns

DRY FEEDER SYSTEM

• Principle:NaF in the form of powder is introduced into a

dissolving basin with the aid of an automatic mechanism to ensure maintanence of the correct supply of F according to the amount of water to be delivered

• Handling of F, obstruction of pipes• Medium sized town

SOLUTION FEEDER SYSTEM

• Principle:• Volumetric pump permitting the addition of a

given quantity of hydrofluorosilicic acid in proportion to the amount of water treated

• Construction using polyvinyl chloride• medium sized and large town

TECHNICAL CONSIDERATIONS

• Maintenance and control• Control at water treatment plants• Control of the quality of analysis• Control of the quality of water in

network• Control of the quality of the F used

DEFLUORIDATION

DEFLUORIDATION

• It is the process of removing excess naturally occurring F from drinking water in order to reduce the prevalence and severity of dental fluorosis

• Based on ion exchange or adsorption• Based on addition of chemicals to water

ION EXCHANGE RESINS

• Carbion

• Defluoron 1

• Defluoron 2

NALGONDA TECHNIQUE

• Was developed by National Environmental Research Institute at Nagpur in 1974 and reported by Bulusu in 1988

• This process comprises of addition in sequence of sodium aluminate, lime and bleaching powder to F water followed by flocculation, sedimentation & filtration

• Useful both as domestic and community water supplies

MECHANISM

• RAPID MIX

• FLOCCULATION

• SEDIMENTATION

• FILTRATION

SALIENT FEATURES

• No regeneration of media required• no handling of acids and alkalis• Only readily available chemicals used• Adaptable for domestic use• Simplicity of design, construction, operation• Highly efficient• Little wastage of water• Minimum mechanical and electrical equipment

INDICATIONS

Absence of acceptable low F source within transportable distance

Desalination necessary when total solids exceed 1500mg/L

Raw water F ranging from 1.5mg to 20mg F /l

SALT FLUORIDATION

SALT FLUORIDATION

• It is the controlled addition of F, usually Na or K F, during the manufacture of salt for human consumption

• Alternative method of prevention caries on a large scale

• Introduced by Wespi in 1948, Switzerland

• IDEAL: 200, 250 and 350 mg of F per kg of salt

• PRODUCTION: batch processing continous processing

ADVANTAGES

• Does not require community water supply

• Permits individuals to accept or reject

• Non F salt can be made available

LIMITATIONS

• large variation in salt intake• Amount of intake decreased • Difficult when water sources are fluoridated• Requires modern technology• hypertension

MILK FLUORIDATION

• Addition of measured quantity of fluoride to bottled or packaged milk to be drunk by children

• Started by Ziegler, in 1953

PLANNING A MILK FLUORIDATION PROGRAMME

• Dental health status• Other fluoride source• Urine analysis• Milk distribution• Fluoridating the milk

FLUORIDE TABLETS/DROPS/LOZENGES

• May be prescribed to induvidual persons, or may be part of school or home based public health programme

• Prescribed by pediatrician or the dentist

F COMPOUNDS USED

• NaF• Acidulated phosphate F• KF• CaF• 0.25mg, 0.5mg, 1.0mg• Drops• Tablets and lozenges

indications

• No central water supply

• As interim measure

• Water or salt F schemes not implemented

• nomads

TOXICITY OF FLUORIDES

• Double edged sword• Inadequate ….. Caries• Excessive…… dental & skeletal fluorosis• industrial accidents• Acute• Chronic

ACUTE TOXICITY OF F

• Results from rapid excessive ingestion of F at one time

• Severity depends on the amount of F ingested, wieght and age of the individual

• Most frequent is Nausea

SYMPTOMS

ABDOMINAL CRAMPS

VOMITINGINCREASED SALIVATION

CHRONIC FLUORIDE TOXICITY

• Results from long term ingestion of small amount of F

• Dental F > 2 times optimal

• Skeletal F 10- 25 mg/day

DENTAL FLUOROSIS

• Is caused by excessive intake of F during tooth development

• 2/3times- White flecks or chalky opaque areas• 4times- brown pitted corroded appearance• Mottled enamel• Hypoplastic areas

SKELETAL FLUOROSIS

• Occurs from ingestion of F for long periods of time

• First in Madras

• Water F levels over 8 ppm

Symptoms

JOINT PAIN

KNOCK KNEE

CARDIAC PROBLEMS

PREGNANT MOTHER AND FOETUS

BIBLIOGRAPHY

Essentials of preventive & community dentistry - Soben Peter

THANK YOU