Preventive Sheet #7 By Mutahar Hanash

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Preventive Sheet #7 By Mutahar Hanash

Post by Sura on 27/3/2012, 3:16 am

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Re: Preventive Sheet #7 By Mutahar Hanash

Post by Shadi Jarrar on 9/4/2012, 11:05 pm

Last time we took about water fluoridation, water fluoridation in the systemic method for fluoride administration.
We will continue to talk about fluoride supplement in the form of tablets and drops and the guidelines how to use them and other methods of systemic fluoride (salt and milk).
When we talked about fluoride supplement, we have seen the value of the water fluoridation its effective in terms of preventing caries but sometimes water fluoridation is not possible means we need another way actually to supply the fluoride and alternative is to give fluoride in tablets or drops. And whenever u give any medication u want to be careful that u have to follow the principle of doing no harm so when we took about systemic fluoride we have a gain to keep in mind that we minimize any risk associated with fluoride.
Objective:
Make sure to obtain maximum caries preventing effect with a low risk of un acceptable enamel mottled. So that the balance we have to keep and the objective of what we doing when we prescribe fluoride supplement.
 There are arguments on whether to give or not to give supplements
Anything done in the clinic is based on evidence  evidence based dentistry.
 Studies looked at the value of fluoride tablets and found that it’s valuable in terms of decreasing the levels of caries and it’s comparable with water fluoridation (1ppm).
 Fluoride tablets are the same as fluoridated water in terms of efficacy .In this study, children above 3 years receiving 1mg F/Day had comparable results to those taking 1ppm of fluoride.
Effects on primary teeth:
Series of studies (20-30 studies) done worldwide found that is a reduction in caries by 50-80%. Taking the supplements earlier had caries effects. That’s because the effect is cumulative; the longer you use it the more the effect it has on the teeth.




Effects on permanent teeth:
Very good reduction in caries was seen (40-80%) and again the earlier it is used the better the effect its go to be (since it is cumulative).
Parental Fluoride:
Pregnant women taking fluoride tablets. This is incorporated into the baby while it’s forming the primary teeth. It goes through the placenta to reach the baby.
There was no effect in terms of decreasing caries since it doesn’t pass through the placenta barrier effectively.
There is no justification for the idea of giving pregnant women prenatal fluoride in the hope to reduce future caries.
Form of supplements:
a) Drops:
Usually given to every young children that can’t chew.
b) Tablets
c) Lozenges
The newest form used where fluoride is sucked slowly in the mouth.
Formulation of fluoride:
i. Calcium Fluoride:
• No topical as the others
• Not seen much
ii. Sodium Fluoride:
• Mostly seen and used, one component of toothpaste.
• Best result
iii. Acidulated Phosphofluoride(APF)
• NOT greater than NaF but more expensive.
iv. Fluoride combined with vitamins
• Usually it is done for children Naf receiving a lot of vitamins so as to reduce the number of medications taken.
• Combining vitamins with fluoride had no effect on fluoride’s efficacy.

Those that criticize the usage of fluoride supplements have 3 reasons for their criticism as follows:
1. The clinical trials:
This includes problems in methodology as follows:
A. Small number of participants: In any kind of trial the larger the number of participants the stronger the evidence would be and the statistically more powerful the test will be.
B. No control group: there should be a test group (taking fluoride supplements) and a control group (not taking fluoride supplements) and see the different between both groups.
C. No randomization: selecting people randomly for a test. These trials were done without randomization.
D. Long Time ago (1950s and 1960’s) different era where toothpastes were different, diet and dentistry were different as well and so it is difficult to make a conclusion from a study done a half a century ago and these days.
2. Compliance:
Those giving the supplements must be very compliance and follow the instructions and give it every day and so it is difficult.
The idea of compliance is very important; for a patient to be given fluoride supplements it means they have caries problems and s they are not able to follow the basic instructions of oral hygiene instructions and have a good diet and are at low risk for caries their compliance is not a problem.
High risk individual with bad oral hygiene have low compliance so telling them instructions to take supplements will probably not be followed.
 The patients are not following your instructions from the beginning so the problem is that even that even if you’re giving then a supplement prescription they aren’t taking them.
3. Fluorosis:
30-45% of individuals taking supplements develop fluorosis; the problem with fluorosis basically is esthetics. We are more worried with fluorosis happening more posteriorly. The greatest risk of fluorosis occurs at the time period between 18 months and 3 years.

Animal experiments showed:
Giving fluoride supplements in the same amount as fluoridated water once a day has a greater risk of developing fluorosis than those splitting the dosage throughout the day. Since giving it once a day will develop a peak directory of fluoride that will harm the ameloblasts unlike the fluoridated water that is taken throughout the day.
Do we or we not give fluoride supplements??!!
You should follow the most recent published guidelines and assess caries risk ….. So those don’t have risk or at low risk then don’t give them supplements so as not face a risk of fluorosis.


1) The British society of pediatric guidelines :

These assessed supplement intake depending on 2 THINGS:
1. Age
2. Amount of fluoride in water







2) European Association:
Lozenge is preferred




Other Methods of fluoridation:
A) Salt
 Present in Switzerland and Hungary
 Fluoride present at 250 ppm
 Its not very easy to measure the effectiveness since there is a variation in salt intake.
 A study was done showing that less caries were seen with fluoridated salt.
Conclusion:
Caries preventive effect of fluoridated salt is substantial and who recommended that if fluoridated water is not feasible then fluoride supplements can be used as an alternative.
B) Milk:
 Present in Switzerland, Japan, Germany, Austria.
 Caries were less
 The problem is that fluoride likes to bind positive ions but in terms of milk it’s not a major problem it is still effective but its topical effect is less than others.
 The problem again in that not everyone drinks the same amount of milk.
 Still we are waiting on more research when it comes to fluoridated milk.
 Supplements
• Are not a public health measure (remember that water fluoridation is)
• Aren’t feasible
• Used in children with high caries
 You should consider fluoride toxicity and so you must take good care of the dosage. It has to do with the child’s age and what other sources of fluoride the child is taking; consider how much fluoride is in water.

As a general RULE:
You should have ONE systemic method of fluoride.

General Instructions:
Losenges are preferred since they stay in the mouth for a longer time.
If the patients are taking tablets then tell the patient not to swallow it directly and to keep on moving it from one place to another in the mouth.
Avoid peek of ingestion of fluoride levels. So tell them to take it at a time separated from tooth brushing. So it is better not to give it at night it’s better to be given during the day.


Done By:
Mutahar Hanash
Lec_#_7.
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Shadi Jarrar
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عدد المساهمات : 997
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تاريخ التسجيل : 2009-08-28
العمر : 26
الموقع : Amman-Jordan

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