Teeth have a built-in defense system to help protect them from cavities and tooth decay and this defensive layer is called as enamel. But People with certain conditions may be at increased risk of tooth decay and would therefore benefit from additional fluoride treatment.
Fluoride helps prevent tooth decay by making the tooth more resistant to acid attacks from plaque bacteria and sugars in the mouth. It also reverses early decay.
Fluoride also helps speed remineralization as well as disrupts acid production in already erupted teeth of both children and adults.
Topical Fluoride Therapy:- Topical fluorides are applied directly to the tooth enamel.
1. Tooth paste
Fluoride toothpastes are more effective at preventing tooth decay at higher fluoride concentrations. If needed for therapeutic reasons, toothpastes containing more than 1,500 ppm F (e.g., 2,800 ppm F) are available but may be obtained only with a prescription. Children under 2 years should not use fluoride toothpaste, recommends the American Dental Association. After his/her second birthday, parents can introduce fluoride toothpaste to your child. In the early years only small amount of toothpaste should be used. A pea-sized amount is plenty for brushing all of his/her small teeth. Parents should monitor any child less than 6 years while he/she is using fluoride toothpaste.
2. Mouth rinses
Fluoride mouth rinse use is valuable because fluoride has been shown to be safe, inexpensive and extremely effective in preventing tooth decay in school age children of age 5. When acid from plaque bacteria begin taking minerals out of the tooth enamel, fluoride can put minerals back in, and therefore prevent tooth decay! Weekly mouth rinsing with fluoride provides topical fluoride; provided the child does not swallow it. This type of topical fluoride can prevent tooth decay by 20-40%.The Food and Drug Administration (FDA) has approved the 0.2% weekly sodium fluoride mouth rinse as a safe and effective means of preventing tooth decay. There are no known adverse effects associated with this procedure
3. Fluoride Gel
Fluoride gel is a prescribed high-concentrated topical agent (1-2%) intended either for professional applications in plastic/disposal trays 2-4 times per year or self-applied with aid of a toothbrush once or twice per week. The formulations are based on sodium fluoride, acidulated phosphate fluoride or amine fluoride. The gels are flavored but contain no abrasive cleaning agents or preservative. Fluoride gels are safe when used according to instructions. Fluoride gels are however not recommended for children younger than six years; Professional or self-applied fluoride gels should be considered as a topical fluoride option to increase fluoride exposure to individuals older than six years and assessed with increased caries risk.
Fluoride varnish is a concentrated topical fluoride usually containing 5% sodium fluoride (NaF) in a resin or synthetic base. Varnish when applied onto the teeth, provides a highly concentrated dose of fluoride and maintains prolonged contact to inhibit caries. For high-caries patients/children or communities,5% NaF varnish application 2-4 times in a year and for low caries communities based on the children’s histories of caries, 2-4 applications in a year is recommended by most of the dentists.
Systemic Fluoride Therapy:- Systemic fluorides are those that are swallowed.
1. Water fluoridation
Water fluoridation is the process of adding fluoride to the water supply so the level approximately 0.7 ppm, or 0.7 milligrams of fluoride per liter of water; this is the optimal level for preventing tooth decay. Naturally occurring fluoride concentrations in surface waters depend on location but are generally low and usually do not exceed 0.3 ppm. Because community water fluoridation benefits everyone in the community, regardless of age and socioeconomic status, water fluoridation provides protection against tooth decay in populations with limited access to prevention services.
2. Salt fluoridation
Fluoridated salt is increasingly common – both intentionally fluoridated and naturally fluoridated. In countries unable to fluoridate their water, fluoridating salt ensures that people will have maximum dental protection. Intentionally fluoridated salt usually contains about 250 ppm fluoride, which results in a daily intake of 2.5 mg of fluoride per day for people consuming 10 grams of salt.
3. Milk fluoridation
The addition of fluoride to milk and milk-based products is called milk fluoridation. Fluoridation of milk can be recommended as caries preventive measure where the fluoride concentration in drinking water is suboptimal, caries experience in children is significant, and there is an existing school milk program in most of the schools. The program should aim to provide fluoridated milk for at least 200 days per year and should commence before the children are 4 years of age.
4. Dietary fluoride supplements
Dietary fluoride supplements in the form of tablets, lozenges, or liquids (including fluoride-vitamin preparations) have been used. Most supplements contain sodium fluoride as the active ingredient. Tablets and lozenges are manufactured with 1.0, 0.5, or 0.25 mg fluoride. To maximize the topical effect of fluoride, tablets and lozenges are intended to be chewed or sucked for 1–2 minutes before being swallowed. For infants, supplements are available as a liquid and used with a dropper.