A Report on Fluoride: Types, Application, Regulations, and Toxicity

This report provides a comprehensive overview of fluoride in dentistry, covering its uses, types, and regulations. It details how fluoride, a naturally occurring mineral, strengthens tooth enamel and prevents cavities through remineralization. Different forms of fluoride application, including mouth rinses, toothpaste, varnishes, foams, gels, and supplements, are discussed. The report highlights the importance of adhering to prescribing regulations for topical fluoride varnish to avoid potential disadvantages such as dental fluorosis and other health issues associated with long-term, high-dose consumption. It also addresses fluoride toxicity, its symptoms, and precautions, along with providing an information sheet for patients on topical fluoride application, including pre- and post-application instructions and addressing common concerns. References to relevant studies and guidelines are included to support the information presented.

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Assignment 1
Student ID
Course Name
11 Feb 2019
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Contents
An introduction to fluoride.............................................................................................3
What fluoride is?.......................................................................................................3
The types..................................................................................................................3
How it works?............................................................................................................3
Disadvantages..........................................................................................................3
Prescribing regulations for topical Fluoride Varnish and fluoride toxicity.....................4
Dosage......................................................................................................................4
Overdose...................................................................................................................4
Toxicity......................................................................................................................5
Information sheet on topical fluoride application for patients.......................................6
General information on fluoride application..............................................................6
Pre and post application instruction..........................................................................6
Address common concern........................................................................................7
References...................................................................................................................8
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An introduction to fluoride
What fluoride is?
Fluoride is a naturally occurring mineral, which is also present in bone and teeth.
Particularly for Dentistry, fluoride is commonly used for strengthening the enamel of
teeth. It helps in preventing cavity and in re-mineralization of tooth enamel.
The types
Fluoride can be directly applied to the teeth true mouth ringers and fluoridated
toothpaste. In certain cases, dentist also apply fluoride in the form of varnish, foam,
and gel. Fluoride supplements are also available in the form of tablets, and liquid
which must be used with reference to prescription made by physician or dentist
(Chang et al. 2017).
How it works?
The action of bacteria produces acid that rinse off the minerals in tooth enamel and
thereby causes cavities. Fluoride helps in re-mineralization of tooth enamel and
reverse the early signs of tooth decay. Thus, it also helps in rebuilding the weakened
tooth enamel as well as preserve prevent the growth of harmful bacteria (Byeon,
Lee, and Bae 2016).
Disadvantages
The disadvantages associated with Fluoride happens when consumed in high doses.
Although it does not cause any harmful symptoms, but leaves white spot on teeth
which is known as dental fluorosis. The situation is known to be more harmful for
children under aged under 8, especially when their permanent teeth are yet to come.
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The long-term usage of fluoride cause health problems such as kidney disease,
bone fluorosis, low IQ in children, and bone cancer.
Prescribing regulations for topical Fluoride Varnish and fluoride toxicity
The application of topical fluoride should always be included within the broad
package of preventive care. This broad package must also include the dental advice
related to maximizing the usage of toothbrush, dietary control, and other related
interventions. For varnishing purpose, only the products which are licensed for usage
for the control of caries dental caries, are applicable.
Dosage
Fluoride varnish are approved under FDA 510k compliance as Class II medical
devices that can be used for cavity liner or as tooth desensitizer. The indication of
application is for the use of adults and all children under the scope of medical
concern by dentist. The provisions include dry mouth, active dental caries, and are
there dental predisposing factors which requires special needs.
The topical application is indicated for young adults and children, only twice yearly.
Whereas for adults the indicated use is three to four times a year with reference to
dentist concern. According to the prescribing regulations in UK, varnishing products
having a concentration of fluoride 2.2%, which is 22,600 ppm. However, in lower risk
categories of dental caries, the topical fluoride which have concentration of 1.23%
are recommended for use (Gao et al. 2016).
Overdose
The common source of overdose include accidentally overdosing during the topical
vanish process or the prescribed dose my dentist is too high then normal
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requirement. According to the report of Cury et al. (2016), the overdose of fluoride
topical application can occur in following cases:
 Fluoride topical application to the patient who is consuming drinking water
containing more than 0.7 ppm fluoride concentration.
 Contraindication in cases where patient is consuming diet with high salt.
 Children swallowing topical fluoride after the application.
According to Macpherson (2018), overdose complications of fluoride is rare
nowadays, However, the frequency of topical application can be responsible for
developing harmful effects on bone and teeth, which is more pronounced in small
children. Overdose complications includes:
 White spots or specks on mature teeth.
 Appearance of pitting are staining on teeth.
 Symptom arising related to Bone homeostasis problem.
 Appearance of dense bones which in general are not strong.
Toxicity
The main source of toxicity can arise with overdose of fluoride topical application,
which can result into (Yokoyama et al. 2016):
 Nausea with or without vomiting.
 Continuous provoking of diarrhea.
 Feeling of tiredness and lethargy in performing routine activities.
 Uneasiness feeling along with excessive sweating.
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In addition to this, toxicity related to topical application of fluoride is also found in
cases such as:
 Patient having gum disease that can cause irritation with the application of
topical fluoride varnish.
 In case of pregnant woman.
 If the patient is breast-feeding.
Information sheet on topical fluoride application for patients
General information on fluoride application
Fluoride varnish is one of the most recommended treatment aims to prevent tooth
decay. The application must be practiced by a dentist, hygienist, trained extended
duty dental nurse, who are certified by the state dental council.
Pre and post application instruction
Prior to the application it is important to perform the risk assessment which include,
extra-oral assessment such as abnormalities which may includes swelling, spot, and
inflammation inside mouth or infection on lips. The intra-oral assessment include
upper and lower surface of tongue, any sign of decay or infection (Kim et al. 2016).
Fluoride varnish is applied only on top and side line of teeth using a small brush. In
any form of allergic reaction, the products should be removed immediately using
tooth brushing and rinsing protocol.
After application, there is no restriction on eating and drinking. Patient should not
have hard and excessively chewable food as well as hot item and liquids after
fluoride varnish. It is also recommended not to brush or floss the teeth for next 6 to 8
hours and patient should split while rinsing the teeth. Also it is advised for not taking
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any fluoride supplement for the next two days after the application, which then can
be continued as directed (Neidell, Shearer, and Lamster, 2016).
Address common concern
The common concern including the purpose, benefits, procedure, possible side
effects, and answer to any query must be advice to patient before starting the
application procedure. Fluoride application can make teeth look yellow or dull in most
of the cases. However, the color of teeth will recover to normal after brushing off the
fluoride varnish. They are normally sticky in nature and hardened when comes in
contact with saliva. It is important to note that the toxicity issue arises only in case
where excess of fluoride concentration is applied. Any further complication must be
reported be concerned dentist (Yokoyama et al. 2016).
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References
Byeon, S. M., Lee, M. H., & Bae, T. S. (2016). The effect of different fluoride
application methods on the remineralization of initial carious lesions. Restorative
dentistry & endodontics, 41(2), 121-129.
Chang, C. T., Liu, S. P., Muo, C. H., Tsai, C. H., & Huang, Y. F. (2017). Dental
Prophylaxis and Osteoradionecrosis: A Population-Based Study. Journal of dental
research, 96(5), 531-538.
Cury, J. A., de Oliveira, B. H., Dos Santos, A. P. P., & Tenuta, L. M. A. (2016). Are
fluoride releasing dental materials clinically effective on caries control?. Dental
Materials, 32(3), 323-333.
Gao, S. S., Zhang, S., Mei, M. L., Lo, E. C. M., & Chu, C. H. (2016). Caries
remineralisation and arresting effect in children by professionally applied fluoride
treatment–a systematic review. BMC Oral Health, 16(1), 12.
Kim, K. H., Ha, M. O., Hong, N. H., & Cho, M. J. (2016). Effect of fluoride application
after dental prophylaxis by the type of dental floss. Journal of Korean society of
Dental Hygiene, 16(1), 77-83.
Macpherson, L. (2018). A systems approach using the functional resonance analysis
method to support fluoride varnish application for children attending general dental
practice. Applied Ergonomics, 68, 294-303.
Neidell, M., Shearer, B., & Lamster, I. B. (2016). Cost-effectiveness analysis of
dental sealants versus fluoride varnish in a school-based setting. Caries
research, 50(Suppl. 1), 78-82.
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Assignment Name Student ID
Yokoyama, Y., Kakudate, N., Sumida, F., Matsumoto, Y., Gilbert, G. H., & Gordan,
V. V. (2016). Evidence‐practice gap for in‐office fluoride application in a dental
practice‐based research network. Journal of public health dentistry, 76(2), 91-97.
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