Dental caries is a multi factorial, bacterial, chronic infection that affects millions of people in the world and has become a public health problem. Also referred to as tooth decay, this disease is one of the most common disorders throughout the world, second only to the common cold. Dental caries is the most common chronic childhood disease in the United States and is 5 to 7 times more common than asthma. According to the World Oral Health Report in 2003, dental caries affect 60-80% of school children and a vast majority of adults. If left untreated, dental caries can result in cavities forming and, eventually, tooth loss. Although the prevalence and severity of dental caries has decreased over the years, this disease can be controlled better with proper fluoride exposure.
Fluoride dentifrices have been shown in numerous clinical trials to be effective anticaries agents and have been recognized as a major cause of the remarkable decline in caries prevalence in many developed countries. Dentifrices have been widely adopted around the world as the principle means of delivering topical fluoride and obtaining caries preventive benefits. Although there is documented literature on the use of topical fluorides, the issue needs to be further researched based on the recent documeanted literature and guidelines regarding use of topical fluorides. Hence, the present review was conducted with the aim to review the available literature on the use and effectiveness of different topical fluorides used in dentistry.
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Chapter 7: HOME APPLIED / SELF APPLIED:
Probably the most widespread and significant vehicle used for fluoride has been toothpastes. Introduced in the late 1960s and early 1970s, their rapid increase in market share was remarkable. The consensus view from developed countries was that the introduction of fluoride toothpaste was the single factor most responsible for the massive reduction in dental caries seen in many countries during the 1970s and 1980s.
Toothpaste has an important functions in maintaining oral health. It helps the consumers in the removal of plaque and debris by its detergent action. Polishing the tooth surface with toothpaste helps prevent the accumulation of microorganisms and debris. In modern life, toothpastes are used by individuals on a daily basis and hence can be a source of various therapeutic agents including F.29 Toothpastes containing F were first available commercially in the 1970s and are the major source of F in some communities where fluoridated drinking water is not available. F is added into toothpastes mostly as sodium fluoride (NaF), sodium monofluorophosphate (MFP), amine fluoride, and stannous fluoride15. The active ingredient in this toothpaste is sodium fluoride. This agent can be recommended for children 6 years and older and adolescents who are at high risk of caries and who are able to expectorate after brushing. Dentists may also prescribe this agent for adolescents who are undergoing orthodontic treatment, as they are at increased risk of caries during this time. The other ingredients of toothpaste may also affect the availability of F in the oral cavity. Tooth brushing with fluoridated toothpaste is close to an ideal public health method in that its use is convenient, inexpensive, culturally approved and widespread [Burt, 1998].
This is especially true in the case of calcium containing abrasives due to their potential to inactivate the F. Similarly, F will react with silica to form fluorosilicates if a sufficient amount of detergent is not present. The use of fluoridated toothpastes has been demonstrated to have a caries reduction efficacy 25% greater than that for non-fluoridated tooth pastes. However, the benefits and therapeutic efficacy of using fluoridated tooth pastes may be affected by multiple factors such as the concentration of F, the amount of toothpaste used, and individual variations including the duration and frequency of brushing and rinsing behavior. The main concern with this delivery method is inappropriate handling, particularly by children. The ingestion of fluoridated toothpastes can produce serious toxic effects and appropriate adult supervision is essential for children using toothpaste. Toothpastes are available in a wide range of F concentrations.
Toothpaste is a paste or gel dentifrice that is composed of water, abrasives, humectants, detergents, flavoring agents, antibacterial agents, and most important fluoride. Abrasives, which include calcium carbonate, dehydrated silica gels, hydrated aluminum oxides, magnesium carbonate, phosphate salts and silicates, are incorporated to remove food debris, plaque, and surface stains from teeth (Marinho, 2003). Another toothpaste ingredient is humectants, which include glycerol, xylitol, and sorbitol. Humectants are agents that prevent water loss in toothpaste and reduce the tendency of toothpaste to dry into a powder. Additionally, detergents in the toothpaste create a foaming action that helps with even toothpaste distribution, which improves cleansing power. These include sodium lauryl sulfate and sodium N-Lauryl sarcosinate. In order to encourage the use of toothpaste, flavoring agents, such as saccharin, are included in toothpaste for taste. These flavoring agents come in a variety of colors and flavors. Even though these flavoring agents are sweeteners, they do not promote tooth decay (Marinho, 2003). Understandably, antibacterial agents, such as Triclosan and zinc chloride, are also common ingredients in toothpaste. Their role is to prevent buildup of hardened plaque, also referred to as tartar. In addition these antibacterial agents can help reduce bad breath and gingivitis, a mild inflammation of gum tissue. Besides these ingredients, some toothpaste can consist of potassium nitrate or strontium chloride which helps in reducing tooth sensitivity.
Fluoride toothpaste has consistently been proven to provide a caries-preventive effect for individuals of all ages. In the United States, the fluoride concentration of over-the-counter toothpaste ranges from 1000 to 1100 ppm. In some other countries, toothpastes containing 1500 ppm of fluoride are available. A 1-inch (1-g) strip of toothpaste translates to 1 or 1.5 mg of fluoride, respectively. A pea-sized amount of toothpaste is approximately one-quarter of an inch. Therefore, a pea-sized amount of toothpaste containing 1000/1100 ppm of fluoride would have approximately 0.25 mg of fluoride, and the same amount of toothpaste containing 1500 ppm of fluoride would have approximately 0.38 mg of fluoride. Parents should supervise children younger than 8 years to ensure the proper amount of toothpaste and effective brushing technique. Children younger than 6 years are more likely to ingest some or all of the toothpaste used. Ingestion of excessive amounts of fluoride can increase the risk of fluorosis. This excess can be minimized by limiting the amount of toothpaste used and by storing toothpaste where young children cannot access it without parental help. Use of fluoride toothpaste should begin with the eruption of the first tooth. When fluoride toothpaste is used for children younger than 3 years, it is recommended that the amount be limited to a smear or grain of rice size (about one-half of a pea). Once the child has turned 3 years of age, a pea-sized amount of toothpaste should be used. Young children should not be given water to rinse after brushing because their instinct is to swallow. Expectorating without rinsing will both reduce the amount of fluoride swallowed and leave some fluoride in the saliva, where it is available for uptake by the dental plaque. Parents should be strongly advised to supervise their child's use of fluoride toothpaste to avoid overuse or ingestion. High-concentration toothpaste (5000 ppm) is available by prescription only.[.].
Toothpaste tubes containing fluoride are now labeled and contain approximately 0.5 mg fluoride per gram of toothpaste. Some tubes suggest covering the bristles with toothpaste. A 'peasized' portion weighs approximately 0.75 g and contains about 0.4 mg of fluoride; a 'full cover' portion weighs approximately 2.25 g and contains about 1.0 mg of fluoride. Thus, brushing twice a day would deliver 0.8 to 2.0 mg of fluoride, depending on which regimen is used. If swallowed, the amount of fluoride could be excessive and could contribute to the development of fluorosis.
The duration of tooth brushing should exceed one minute on each occasion and children should be encouraged to spit out excess toothpaste and avoid rinsing with water. There is no firm evidence to suggest the ideal timing of tooth brushing but a common recommendation is that children's teeth should be brushed last thing at night before bedtime and on at least one other occasion. Eating directly after brushing should be avoided. Children's teeth can be brushed with either manual or powered toothbrushes with a soft small head.There are three categories of fluoride from toothpaste during tooth brushing: free ionic fluoride which has the ability to react with tooth structure, interfere with microbial metabolism, absorb to the oral mucosa, and has anticaries efficacy; profluoride compounds that are delivered or precipitate in the oral cavity during brushing, release ionic fluoride over time, and contribute to anticaries efficacy; and unavailable fluoride compounds that do not release fluoride ions, are either spat out or swallowed, and have no anticaries efficacy.
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