1. SYSTEMIC FLUORIDES
BY
HAWWA THASNEEM
IVTH YEAR PART 1

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

3. COMMUNITY
WATER
FLUORIDATION
SALT
FLUORIDATION
MILK
FLOURIDATION
FLUORIDE
TABLETS/DROPS/
LOZENGES

4. COMMUNITY WATER FLUORIDATION

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

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

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

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

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

26. MECHANISM

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

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

35. MILK FLUORIDATION

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

41. TOXICITY OF FLUORIDES

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

44. ABDOMINAL
CRAMPS
VOMITING
INCREASED SALIVATION

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

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

51. THANK YOU