Fluoride and Orthodontics

1. 1 Fluoride Fluoride and and orthodontics orthodontics prepared by prepared by Dr. Mohammed Alruby Dr. Mohammed Alruby يماظع كيلع الله لضف نكاو يماظع كيلع الله لضف نكاو Fluoride Fluoride and and O Orthodontics rthodontics Dr. Mohammed Alruby Dr. Mohammed Alruby

2. 2 Fluoride is: natural mineral that helps build strong teeth and prevent cavities Fluoride treatment; is typically professional treatment containing high concentration of fluoride that dentist or hygienist will apply to a person’s teeth to improve health and reduce the risk of cavities Benefits of fluoride treatment: 1-Slow or reverse the development of cavities by harming bacteria that cause cavities. 2-Join into tooth structure when tooth develop to strengthen the enamel surface 3-Helps body, better use mineral such as Ca and phosphate, the teeth reabsorb these mineral to repair weak tooth enamel Side effect of fluoride: 1-Tooth discoloration 2-Allergies or irritation 3-Toxic effect: if person apply it incorrectly or at high doses: nausea, diarrhea, excessive sweating Common source of dietary fluoride: Tea, water, sea food, fish eaten with their bones Grape juice, food cooked in water. Optimal fluoride intake: Birth to 3 years: ---- 0.1 to 1.5 mg 4 years of age: ------1 to 2,5mg 7 years of age: ------ 1.5 to 2.5mg Adolescent and adult: --- 1.5 to 4mg History: 1802: Sir James Crichton Browne, the 1st hint of possible connection of fluoride and dental health 1901: Fredrek Mckay: present in permanent stains on teeth known as mottled enamel 1902: J.M Eager: stains on teeth 1916: Green Vardmin Black: support the Mckay work with histologic evidence, reported as endemic imperfection of enamel Fluoride application procedures: 1-Fluoride prophylaxis pastes: The use of cleaning and polishing pastes (pumic, zircate) and other comparable abrasive pastes before cementing orthodontic bands may lead to removal of significant amount of surface enamel which has more resistant layer and provide a significant amount of fluoride to support enamel surface. 2-Topical fluoride solution: The most commonly used topical solutions are; Sodium fluoride –2% neutral Acidulated sodium fluoride at PH3 and 1.2 fluoride 8% --10% stannous fluoride. Fluoride Fluoride and and O Orthodontics rthodontics Dr. Mohammed Alruby Dr. Mohammed Alruby

3. 3 3-Fluoride gel: Are available in; sodium fluoride, acidulated sodium fluoride, stannous fluoride 4-Fluoride mouth rinse 5-Fluoride tablets: Fluoride administration as pills or tablets (0.5 ---1mg/day) according to age show caries reduction in permanent teeth of 20 --- 40% when started at 6 –9 years of age 6-Fluoride dentifrices: There are large number of dentifrices in market as, sodium fluoride, stannous fluoride, amine fluoride Sodium monofluorophosphate The regular use of fluoride dentifrices should be recommended to all patients undergoing orthodontic treatment in addition to other forms of fluoride administration 7-Fluoride cements: Silicate cements restoration slowly release fluorides and protect surrounding enamel from secondary caries 8-Fluoride varnish: Topical application of fluoride predisposes to the formation of readily soluble Ca fluoride crystals on the enamel surface 9-Other methods: as elastic containing 10% sodium fluoride. Some studies: 1-Good oral hygiene was the only factor that reduce the incidence of demineralization 2-Fluoride and tooth movements: heavy force application and fluoride intake increase the rate of tooth movement. Age negatively correlated to orthodontic tooth movement. 3-Fluoride containing varnishes are very effective in tooth preventing and inhibiting demineralization since they have high fluoride concertation. N: B: fluorine is a member of the halogen family with atomic weight 19 and atomic number 9 In soil: fluoride concentration increase with depth In water: sea water: 0.8 ------ 1.4mg/L Lakes, rivers: below 0.5mg/L In air: widely distributed in the atmosphere Gaseous industrial waste In food: unprocessed food; 0.1 ----- 2.5mg/kg In plant 2 -----20mg/ of dry weight Leafy vegetables: 11 ----26mg on dry weight Fishes: 20 -----40 ppm on dry weight Absorption of fluoride; After ingestion of fluoride, such as drinking of glass --------- majority absorbed at stomach and small intestines ---------- to blood stream causing short term increase in level within 20 –30 minutes -------- this concentration declines rapidly within 3 –6 hours. Fluoride Fluoride and and O Orthodontics rthodontics Dr. Mohammed Alruby Dr. Mohammed Alruby

4. 4 Excretion of fluoride: Excreted in urine and feces and lost through sweat The principle route in through urine Kidney is the main way of fluoride excretion with average fluoride intake 3 –9mg/ Day Fluoride storage: 1-In enamel: during the initial stage of enamel formation, the fluoride concentration is much higher than it is upon completion. 2-In dentine and cementum: fluoride concentration is higher than that of enamel because of greater porosity Fluoride concentration of cementum is higher than that of any dental tissues 3-Fluoride in bone: the distribution of fluoride within the bone is not uniform, it is highest in the area of most active growth. 4-Fluoride in saliva: is slightly less than those found in plasma, ranging from 0.01 – to 0.05ppm 5-Fluoride in milk: human breast milk provides less than 0.01mg/day 6-Fluoride in blood: ¾ of total fluoride is in plasma and ¼ in RBCs Regulation of plasma fluoride is due to large volume of extracellular body fluid Mechanism of action of fluoride in caries reduction: 1-Increased enamel resistance / reduce enamel solubility. 2-Increased rate of post-eruptive maturation. 3-Remineralization of incipient lesion 4-Fluoride is as inhibitor of demineralization 5-Modify tooth morphology 6-Interfere with plaque micro-organism (high concentration-------bactericidal) (low concentration -------bacteriostatic) Mode of action of fluoride: 1-Ionic exchange; to form Ca fluro-aptite which is more acid resistance 2-Enzymatic inhibition: it inhibits the breakdown of carbohydrate 3-Direct bacterial inhibition 4-Precipitation of Ca from saliva, so it assists remineralization 5- Decrease plaque accumulation on tooth surface by decrease its surface energy. Fluoride release orthodontic material: = orthodontic adhesive: glass ionomer, composite = orthodontic band cements = elastomeric: power chain, elastic ligature tie Removable appliance: acrylic resin 1-Orthodontic bracket adhesives: Glass ionomer such as: ketac-cem and photac- fill containing up to 23% fl in form NaFl, CaFL, AlFl, fluoride release does not alter the composition of the material = Tweetman et al concluded that glass ionomer adhesive has cryostatic effect which is responsible for decrease or absence of white spots ** pattern of fluoride release: Fluoride Fluoride and and O Orthodontics rthodontics Dr. Mohammed Alruby Dr. Mohammed Alruby

5. 5 Fluoride is leached in the first one or two days in high concentration (burst effect) which start to decrease gradually to attain stable level of release Some brands such as Fluoever continued to release fluoride up to 85 weeks Fluoride releasing increased the enamel micro-hardness and surface mineral content, this may be due to formation of Ca fluoride which assist mineralization ** fluoride and salivary PH: Ogaard among others proved that there is inverse relation between the release of fluoride and salivary PH. When PH is more acidic fluoride release start to increase and vice versa.so fluoride releasing adhesives can be described as reservoir of fluoride from which fluoride is leached on demand N: B: enamel demineralization is evaluated through: Photographic technique; = micro-hardness Clinical scoring: = electrodenstometry 2-Orthodontic band luting cement: Glass ionomer are the main fluoride releasing band cementation material Kocaderli and Cigar: recommended the use of lutter material because it form a band with the tooth surface and band material, it is able to bleach fluoride which is an anti-cariogenic agent to minimize the development of carious lesion under orthodontic bands 3-Fluoride release elastomeric material: An another idea of fluoride application is the incorporation of fluoride into elastomeric such as: O ties or power chain (PC) Willshire: reported release significant amount of fluoride compared with control one = initial burst of fluoride during 1st and 2nd day, by the end of second week 88% of total fluoride had been leached from elastomeric = O ties elastic should replace monthly Wilson and Gregory: after placement of O tie elastic, the percentage of streptococcus Mutans decreased significantly Wilson and Love reported that, the enamel micro-hardness significantly increase with fluoride release 4-Fluoride releasing removable appliance: To develop a fluoride, release removable appliance by: using fluoride acrylic resin or insert fluoride releasing device within the plane of acrylic resin, this device may be glass ionomer Alcam et al, both methods can be useful for prolonged release of low concentration of fluoride without any systematic effect. Thank you Fluoride Fluoride and and O Orthodontics rthodontics Dr. Mohammed Alruby Dr. Mohammed Alruby