Dietary balance: Fluoride

Dietary balance: Fluoride:

EDUCATIONAL OBJECTIVES

At the end of this course, the student should be able to:

• Distinguishing between different fluoride pathways
• Mastering the benefits of using fluoride
• Know the methods of administering fluoride
• Know the side effects of excessive fluoride intake

Plan

1- Introduction

2- history

3- Mode of action of fluoride

3-1 Effect of fluoride in the pre-eruptive phase

3-2 Effect of fluoride in the post-eruptive phase

4- Methods of administering fluoride

4- 1 Fluorine in systemic applications

4-2 Fluoride in topical applications

A- Self-application

B- Professional topical applications

5- Risks of excessive fluoride intake: fluorosis

6-Recommendations

7-Conclusion

8- bibliographies

Introduction

Fluorine is part of the family of trace elements, it is the first element of halogens in the classification of Mendeleev (..), It is also a chemical element with symbol F, atomic number 9 and atomic mass 18.998 u. (Futura science. Fluorine ).

• Historical

In November 1906, Henri Moisson was the first to win the Nobel Prize in Chemistry who isolated and studied fluorine, using an electric furnace, which opened the way to very high temperature syntheses .

• Mode of action of fluoride

3-1 Effect of fluoride in the pre-eruptive phase

It intervenes during the formation and mineralization of dental germs by acting on the cellular metabolism of ameloblasts and odontoblasts.

3-2 Effect of fluoride in the post-eruptive phase

It provides effective prevention against dental caries by promoting remineralization and slowing down the metabolism of bacteria responsible for caries.

• Methods of administering fluoride

4-1- Fluorine in systemic applications 

This involves providing fluoride by fluoridation of several possible types:

– Water fluoridation : The optimal [ ] is between 0.7 and 1.2 ppm depending on climatic conditions.

– Fluoride salt : After 2 years, the average dose of fluoride absorbed through fluoride salt during meals is estimated at 0.25 mg/day.

– Fluoridated milk :Constitutes a less effective alternative to water fluoridation.

– Other foods :It has been proposed to add fluoride to sugar and flour; sea fish contain (1-3 mg/100 g) fluoride and tea.

– Fluoride supplements : come in the form of tablets, lozenges or drops, administered systemically in areas where the tap water was poorly or not at all fluoridated ( inf a 0.3mg/L). Indicated in children with high RCI.

Dietary balance: Fluoride

4-2 – Fluoride in topical applications 

A-Self-application

• Toothpaste :

According to EAPO, the patient should use a toothpaste with a fluoride content appropriate to their age:

-6 months to 2 years: 500 ppm toothpaste / no systemic fluoride regardless of the RCI

-2 to 6 years: 1000ppm toothpaste; if low RCI no systemic fluoride; if high RCI systemic fluoride 0.25mg/day

– over 6 years: toothpaste at 1450 ppm, if RCI low no systemic fluoride; if RCI high systemic fluoride 0.50mg/day

• Fluoride mouthwashes

Are intended only for children with a high RCI, i.e. from 6 years old. The main BDBs are based on sodium fluorides (0.05% for daily use and 0.2% for weekly use)

• Fluorinated chwingum 

Fluoride content: 0.113 mg/gum. The fluoride intake is uncertain but it stimulates salivary secretion which fuels the self-cleaning of teeth.

• Fluoride gels

Have a fluoride content of 0.5 %. They are indicated in cases of high RCI and in prevention of ORN in patients irradiated in the oropharyngeal sphere.

B – Professional topical applications

• Fluoride varnishes : NaF 2.3% in alcoholic solution is the active agent of the varnish. The varnishes adhere to the enamel surface for more than 12 hours and thus allow better penetration of the product.
•  Fluoride solutions : There are three types: 2% sodium fluoride, 8 or 10% stannous fluoride, and acidulated fluorophosphate , applied with a brush to clean, dry teeth.
• Fluoride gels : the compound used is APF, used in gutters for 4 min. It is recommended not to drink or eat for 2 hours after applying the gel.

This operation should be carried out twice a year. It is indicated in cases of high RCI.

• Fluoridation gutters :

They are indicated: For caries prophylaxis: 1 to 2 sessions/ year. For imperfect amelogenesis , MIH: until the sensitivity disappears .

• Risks of excessive fluoride intake : fluorosis

It is due to an overdose of fluoride, over several months or years, occurring during the period of tooth mineralization. The complete development of enamel crystals is disrupted by the excess fluoride leading to porous fluorotic tissue .

• If the damage is significant, the porous enamel is likely to incorporate any colored exogenous element and cause discoloration of the teeth (ranging from a simple white spot to a brown or brown layer).
• The severity of the alterations is multifactorial and depends on the dose ingested, the time of exposure (enamel formation phase), the duration of impregnation and interindividual variability.
• Accumulation and lack of awareness of the various sources of fluoride intake are the cause of most cases of dental fluorosis.
• In most cases, the impact is mainly aesthetic. It is therefore necessary to be particularly vigilant for children aged 0-4 years, the period of mineralization of the crowns of the incisors, especially since at this age and up to around the age of 6, a significant quantity of toothpaste is ingested involuntarily.
• The WHO has set a dose of fluoride not to be exceeded to avoid any risk of fluorosis of 0.05 mg per day per kg of body weight in children, all intakes combined without exceeding 1 mg per day.

Dietary balance: Fluoride

Recommendations

According to EAPO, the patient should use a toothpaste with a fluoride content appropriate to their age:

-6 months to 2 years: 500 ppm toothpaste

-2 to 6 years: 1000ppm toothpaste;

– over 6 years old: toothpaste at 1450 ppm

-Any prescription for supplementation must be preceded by a fluoride intake assessment. When the water content is greater than 0.3 mg/L, no tablets or drops are administered.

-When the family uses table salt, neither drops nor tablets are used.

A supplement can begin as soon as the first molars appear at a rate of 0.05 mg of fluoride/day/kg of weight.

CONCLUSION

Since the discovery of the carioprotective role of fluoride, its use has significantly improved dental health. Combined with hygiene measures, its appropriate intake has proven to be highly effective. However, the current multiplicity of sources of fluoride intake should not lead to indiscriminate intake.

Bibliographies

1- Marysette Folliguet : Prevention of dental caries in children under 3 years of age, 2006.

2- French Society of Pediatric Odontology. Recommendations on the prescription of fluorides from birth to adolescence, 2007.

3- AFSSAPS Update Use of fluoride in the prevention of dental caries before the age of 18 October 2008

4- Amélie Brun. Fluoride supplementation in children aged 0 to 6 years: survey on the practices of a sample of general practitioners in the departments of Paris and Essonne. Human medicine and pathology. 2014. ffdumas-01114677

5- Chahrazed SELLAF, Fatima Zohra SENOUCI BEREKSI & Fadia HADJ SLIMANE final year dissertation: DESCRIPTIVE STUDY OF STRUCTURAL ENAMEL DEFECTS IN SCHOOL CHILDREN AGED 6 TO 15 YEARS; 2017.

Dietary balance: Fluoride