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SYSTEMIC FLUORIDES
BY
HAWWA THASNEEM
IVTH YEAR PART 1
• Provides low concentration of F to teeth over
a long period of time
• Circulates through the blood stream and is
incorporated into developing teeth
• After eruption, F contacts teeth directly
through salivary secretions
• Most of them have topical effect
COMMUNITY
WATER
FLUORIDATION
SALT
FLUORIDATION
MILK
FLOURIDATION
FLUORIDE
TABLETS/DROPS/
LOZENGES
COMMUNITY WATER FLUORIDATION
• Most common form of systemic fluoride
administration
• 1ppm
• controlled or adjustment of the concentration of F in
a communal water supply so as to achieve maximum
caries reduction and a clinically insignificant level of
fluorosis
• 50% to 70% reduction in caries without
damage to teeth or other structures
• Practicable and effective public health
measure
Grand Rapids – Muskegon study
Newburgh – Kingston study
The Brantford- Sarnia- Stratford fluoridation caries study
Evanston – Oak Park study
Tiel- Culemborg fluoridation study
• Empiric formula by GALAGAN & VERMILLION
ppm F = 0.34/E
where E = - 0.038+0.0062x T
METHODOLOGY OF ESTIMATION OF
FLUORIDE CONCENTRATION IN
DRINKING WATER
• 500 ml of water collected in a
dry polythene container
• 2 CC of 6N HCL added
• Stored at 4C
• Estimated by
1) F electrode coupled with
standard pH meter
2) Scot Sanchis method
• Most recent and universally accepted
• 2 pH meters used Orion 901 microprocessor ion
analyzer and Orion 407
• Specific ion meter
• Conc. of F calculated by:
a) Typical calibration curve
b) by applying electrode
potential equation
c) Direct ppm reading
• Based on the reaction btw F & the red
zirconium alizarin lake
• F forms colorless complex ion – liberates
alizarin sulphuric acid
• F inc – color changes from yellow to red
• Comparing the color with the standard
• Lack of centralized water
supply system
• Require support of health
authorities and government
• Fluorospar
• NaF
• Silico fluorides
• NaSiF
• Hydroflurosilicic acid
• Ammonium silico F
• SATURATOR SYSTEM
• DRY FEEDER SYSTEM
• SOLUTION FEEDER SYSTEM
• Principle:
4% saturated solution of NaF is produced and
injected at the desired concentration at th e
water distribution source with the aid of a
pump
• high hard water level used
• Suitable for small towns
• Principle:
NaF in the form of powder is introduced into a
dissolving basin with the aid of an automatic
mechanism to ensure maintanence of the
correct supply of F according to the amount of
water to be delivered
• Handling of F, obstruction of pipes
• Medium sized town
• Principle:
• Volumetric pump permitting the addition of a
given quantity of hydrofluorosilicic acid in
proportion to the amount of water treated
• Construction using polyvinyl chloride
• medium sized and large town
• Maintenance and control
• Control at water treatment plants
• Control of the quality of analysis
• Control of the quality of water in network
• Control of the quality of the F used
DEFLUORIDATION
• It is the process of removing excess naturally
occurring F from drinking water in order to
reduce the prevalence and severity of dental
fluorosis
• Based on ion exchange or adsorption
• Based on addition of chemicals to water
• Carbion
• Defluoron 1
• Defluoron 2
• Was developed by National Environmental
Research Institute at Nagpur in 1974 and
reported by Bulusu in 1988
• This process comprises of addition in
sequence of sodium aluminate, lime and
bleaching powder to F water followed by
flocculation, sedimentation & filtration
• Useful both as domestic and community water
supplies
MECHANISM
SALIENT FEATURES
• No regeneration of media required
• no handling of acids and alkalis
• Only readily available chemicals used
• Adaptable for domestic use
• Simplicity of design, construction, operation
• Highly efficient
• Little wastage of water
• Minimum mechanical and electrical equipment
INDICATIONS
Absence of acceptable low F source within
transportable distance
Desalination necessary when total solids
exceed 1500mg/L
 Raw water F ranging from 1.5mg to 20mg F /l
SALT FLUORIDATION
• It is the controlled addition of F, usually Na or
K F, during the manufacture of salt for human
consumption
• Alternative method of prevention caries on a
large scale
• Introduced by Wespi in 1948,
Switzerland
• IDEAL: 200, 250 and 350 mg of F per kg of salt
• PRODUCTION:
batch processing
continous processing
ADVANTAGES
• Does not require community water supply
• Permits individuals to accept or reject
• Non F salt can be made available
LIMITATIONS
• large variation in salt intake
• Amount of intake decreased
• Difficult when water sources are fluoridated
• Requires modern technology
• hypertension
MILK FLUORIDATION
• Addition of measured quantity
of fluoride to bottled or
packaged milk to be drunk
by children
• Started by Ziegler, in 1953
• Dental health status
• Other fluoride source
• Urine analysis
• Milk distribution
• Fluoridating the milk
• May be prescribed to induvidual persons, or
may be part of school or home based public
health programme
• Prescribed by pediatrician or the dentist
• NaF
• Acidulated phosphate F
• KF
• CaF
• 0.25mg, 0.5mg, 1.0mg
• Drops
• Tablets and lozenges
indications
• No central water supply
• As interim measure
• Water or salt F schemes not implemented
• nomads
TOXICITY OF FLUORIDES
• Double edged sword
• Inadequate ….. Caries
• Excessive…… dental & skeletal fluorosis
• industrial accidents
• Acute
• Chronic
• Results from rapid excessive ingestion of F at
one time
• Severity depends on the amount of F ingested,
wieght and age of the individual
• Most frequent is Nausea
ABDOMINAL
CRAMPS
VOMITING
INCREASED SALIVATION
• Results from long term ingestion of small
amount of F
• Dental F > 2 times optimal
• Skeletal F 10- 25 mg/day
DENTAL FLUOROSIS
• Is caused by excessive intake of F during tooth
development
• 2/3times- White flecks or chalky opaque areas
• 4times- brown pitted corroded appearance
• Mottled enamel
• Hypoplastic areas
• Occurs from ingestion of F for long periods of
time
• First in Madras
• Water F levels over 8 ppm
Symptoms
JOINT PAIN
KNOCK KNEE
CARDIAC PROBLEMS
PREGNANT
MOTHER AND
FOETUS
BIBLIOGRAPHY
Essentials of preventive & community
dentistry
- Soben Peter
THANK YOU

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SYSTEMIC FLUORIDES

  • 2. • Provides low concentration of F to teeth over a long period of time • Circulates through the blood stream and is incorporated into developing teeth • After eruption, F contacts teeth directly through salivary secretions • Most of them have topical effect
  • 5. • Most common form of systemic fluoride administration • 1ppm • controlled or adjustment of the concentration of F in a communal water supply so as to achieve maximum caries reduction and a clinically insignificant level of fluorosis • 50% to 70% reduction in caries without damage to teeth or other structures • Practicable and effective public health measure
  • 6. Grand Rapids – Muskegon study Newburgh – Kingston study The Brantford- Sarnia- Stratford fluoridation caries study Evanston – Oak Park study Tiel- Culemborg fluoridation study
  • 7. • Empiric formula by GALAGAN & VERMILLION ppm F = 0.34/E where E = - 0.038+0.0062x T
  • 8. METHODOLOGY OF ESTIMATION OF FLUORIDE CONCENTRATION IN DRINKING WATER
  • 9. • 500 ml of water collected in a dry polythene container • 2 CC of 6N HCL added • Stored at 4C • Estimated by 1) F electrode coupled with standard pH meter 2) Scot Sanchis method
  • 10. • Most recent and universally accepted • 2 pH meters used Orion 901 microprocessor ion analyzer and Orion 407 • Specific ion meter • Conc. of F calculated by: a) Typical calibration curve b) by applying electrode potential equation c) Direct ppm reading
  • 11. • Based on the reaction btw F & the red zirconium alizarin lake • F forms colorless complex ion – liberates alizarin sulphuric acid • F inc – color changes from yellow to red • Comparing the color with the standard
  • 12. • Lack of centralized water supply system • Require support of health authorities and government
  • 13. • Fluorospar • NaF • Silico fluorides • NaSiF • Hydroflurosilicic acid • Ammonium silico F
  • 14. • SATURATOR SYSTEM • DRY FEEDER SYSTEM • SOLUTION FEEDER SYSTEM
  • 15. • Principle: 4% saturated solution of NaF is produced and injected at the desired concentration at th e water distribution source with the aid of a pump • high hard water level used • Suitable for small towns
  • 16.
  • 17. • Principle: NaF in the form of powder is introduced into a dissolving basin with the aid of an automatic mechanism to ensure maintanence of the correct supply of F according to the amount of water to be delivered • Handling of F, obstruction of pipes • Medium sized town
  • 18.
  • 19. • Principle: • Volumetric pump permitting the addition of a given quantity of hydrofluorosilicic acid in proportion to the amount of water treated • Construction using polyvinyl chloride • medium sized and large town
  • 20.
  • 21. • Maintenance and control • Control at water treatment plants • Control of the quality of analysis • Control of the quality of water in network • Control of the quality of the F used
  • 22.
  • 23. DEFLUORIDATION • It is the process of removing excess naturally occurring F from drinking water in order to reduce the prevalence and severity of dental fluorosis • Based on ion exchange or adsorption • Based on addition of chemicals to water
  • 24. • Carbion • Defluoron 1 • Defluoron 2
  • 25. • Was developed by National Environmental Research Institute at Nagpur in 1974 and reported by Bulusu in 1988 • This process comprises of addition in sequence of sodium aluminate, lime and bleaching powder to F water followed by flocculation, sedimentation & filtration • Useful both as domestic and community water supplies
  • 27.
  • 28. SALIENT FEATURES • No regeneration of media required • no handling of acids and alkalis • Only readily available chemicals used • Adaptable for domestic use • Simplicity of design, construction, operation • Highly efficient • Little wastage of water • Minimum mechanical and electrical equipment
  • 29. INDICATIONS Absence of acceptable low F source within transportable distance Desalination necessary when total solids exceed 1500mg/L  Raw water F ranging from 1.5mg to 20mg F /l
  • 30.
  • 31. SALT FLUORIDATION • It is the controlled addition of F, usually Na or K F, during the manufacture of salt for human consumption • Alternative method of prevention caries on a large scale • Introduced by Wespi in 1948, Switzerland
  • 32. • IDEAL: 200, 250 and 350 mg of F per kg of salt • PRODUCTION: batch processing continous processing
  • 33. ADVANTAGES • Does not require community water supply • Permits individuals to accept or reject • Non F salt can be made available
  • 34. LIMITATIONS • large variation in salt intake • Amount of intake decreased • Difficult when water sources are fluoridated • Requires modern technology • hypertension
  • 36. • Addition of measured quantity of fluoride to bottled or packaged milk to be drunk by children • Started by Ziegler, in 1953
  • 37. • Dental health status • Other fluoride source • Urine analysis • Milk distribution • Fluoridating the milk
  • 38. • May be prescribed to induvidual persons, or may be part of school or home based public health programme • Prescribed by pediatrician or the dentist
  • 39. • NaF • Acidulated phosphate F • KF • CaF • 0.25mg, 0.5mg, 1.0mg • Drops • Tablets and lozenges
  • 40. indications • No central water supply • As interim measure • Water or salt F schemes not implemented • nomads
  • 42. • Double edged sword • Inadequate ….. Caries • Excessive…… dental & skeletal fluorosis • industrial accidents • Acute • Chronic
  • 43. • Results from rapid excessive ingestion of F at one time • Severity depends on the amount of F ingested, wieght and age of the individual • Most frequent is Nausea
  • 45. • Results from long term ingestion of small amount of F • Dental F > 2 times optimal • Skeletal F 10- 25 mg/day
  • 46. DENTAL FLUOROSIS • Is caused by excessive intake of F during tooth development • 2/3times- White flecks or chalky opaque areas • 4times- brown pitted corroded appearance • Mottled enamel • Hypoplastic areas
  • 47.
  • 48. • Occurs from ingestion of F for long periods of time • First in Madras • Water F levels over 8 ppm
  • 49. Symptoms JOINT PAIN KNOCK KNEE CARDIAC PROBLEMS PREGNANT MOTHER AND FOETUS
  • 50. BIBLIOGRAPHY Essentials of preventive & community dentistry - Soben Peter