Fluoride

BACKGROUND:

Although community water fluoridation (CWF) results in a range of potential contaminant exposures, little attention has been given to many of the possible impacts. A central argument for CWF is its cost-effectiveness. The U.S. Government states that $1 spent on CWF saves $38 in dental treatment costs.

OBJECTIVE:

To examine the reported cost-effectiveness of CWF.

METHODS:

Methods and underlying data from the primary U.S. economic evaluation of CWF are analyzed and corrected calculations are described. Other recent economic evaluations are also examined.

RESULTS:

Recent economic evaluations of CWF contain defective estimations of both costs and benefits. Incorrect handling of dental treatment costs and flawed estimates of effectiveness lead to overestimated benefits. The real-world costs to water treatment plants and communities are not reflected.

CONCLUSIONS:

Minimal correction reduced the savings to $3 per person per year (PPPY) for a best-case scenario, but this savings is eliminated by the estimated cost of treating dental fluorosis.

Mouthwashes are medicated solutions used for gargling and rinsing the mouth. Many oral conditions require the use of a mouthwash, which can vary from oral malodour to periodontal disease to treatment of secondary infections like oral mucositis. A mouthwash may be recommended as an antimicrobial, a topical anti-inflammatory agent, a topical analgesic or for caries prevention. Many different mouthwashes are available now a day. Selection of an appropriate mouthwash depends on patient’s oral condition, disease risk and efficiency and safety of mouthwash. The main objective of this review is to help the oral health care professionals to make the correct selection of mouthwash while dealing with different conditions of oral cavity.

Pharmaceutical products for oral hygiene encompass several different formulations including toothpastes and pills. In these products, fluorides can be added in several different forms, such as sodium fluoride, sodium monofluorophosphate, tin fluoride, or in the form of different amines. This paper describes the potentiometric method with flow injection and continuous analysis for determination of hydrolysis of sodium monofluorophosphate and fluoride in the samples of toothpastes and pills. The measurements were performed in a home-made cell under appropriate flow conditions (2.86 mL min–1, 0.2 mL samples, 10–6 M sodium fluoride and Ac-buffer pH=5.5). Na2FPO3 complete hydrolyzed at a concentration of 1×10–4 mol L–1 by addition of 1.0 mL 6.0 M HCl in the measurements with the FIA. Measurements carried out with CA shows that even after addition of 4.0 mL 6.0 M HCl does not come to a complete hydrolysis Na2FPO3. Obtained results show that in measurements performed with FIA errors ranged from 2.21 to 9.60 %, while errors are around 30% in the measurements with CA.

BACKGROUND:
This study evaluated the fluoride release and uptake of five common dental restoratives mainly glass ionomer formulations, including a conventional glass ionomer, a relatively new caries stabilization glass ionomer and resin-modified glass ionomer (Fuji II, Fuji VII and Fuji II LC); one compomer (F2000); and one fluoride releasing composite resin (tetric ceram).

MATERIALS AND METHODS:
A total of 12 cylindrical specimens for each of the five materials were prepared following manufacturer’s instructions for manipulation and immersed independently in 25 ml of artificial saliva and stored as five groups Group I-V. Each group was further divided into three sub Groups A, B, C. The saliva was changed every day in all the specimens. No treatment was carried out for the specimens in subgroup A. The specimens were immersed in 2% sodium fluoride for 1 min before changing saliva in sub group B and the specimens were treated by brushing with a fluoridated dentifrice for 2 min before changing saliva in sub Group C. The fluoride release was evaluated on the 1(st), 7(th) and 28(th) day using a fluoride ion specific electrode.

RESULTS:
The results demonstrated that the conventional glass ionomer and the recently introduced caries stabilizing glass ionomer showed similar patterns and quantity of fluoride release, which was significantly higher than the resin-modified glass ionomer, the compomer and the composite resin. The resin-modified glass ionomer showed higher fluoride release than the compomer and the composite resin. All the formulations of glass ionomers showed fluoride uptake from the neutral sodium fluoride and the fluoridated dentifrice, by releasing increased amounts of fluoride after treatment, in comparison with the untreated group. However, the compomer and the composite resin showed no fluoride uptake.

CONCLUSION:
The fluoride released by the glass ionomer cements (GICs) was found to be highest during the first 24 h and decreased significantly over the 1(st) week with lower levels obtained on the 7(th) and 28(th) day, thus demonstrating the phenomenon of “initial burst.” The composite resin and compomer used in this study did not show this phenomenon of the initial burst. The resin-modified GICs released more fluoride than the compomer, and the composite resin.

The conclusions of this updated review remain the same as those when it was first published. There is moderate quality evidence of a large caries-inhibiting effect of fluoride gel in the permanent dentition. Information concerning the caries-preventive effect of fluoride gel on the primary dentition, which also shows a large effect, is based on low quality evidence from only three placebo-controlled trials. There is little information on adverse effects or on acceptability of treatment. Future trials should include assessment of potential adverse effects.

Author: Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV.
Year: 2015
Abstract / Excerpt: "We found some low quality evidence to suggest that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste for preventing caries in the permanent teeth of children, and that there are no associated adverse-effects from such toothpastes. The effect estimate should be interpreted with caution due to high risk of bias and the fact that it results from two studies that were carried out by the same authors in the same population. The remaining evidence we found is of low to very low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children, or adults."

"Background. The authors assessed the association between enamel fluorosis and dental caries to determine if there is any beneficial effect of enamel fluorosis in U.S. schoolchildren.  Methods. The authors used data from a National Institute of Dental Research survey of the oral health of U.S. children conducted in 1986 and 1987 to determine the prevalence of caries and mean decayed, missing or filled surfaces on permanent maxillary right first molars in children 7 to 17 years of age who had a history of a single residence. (To date, this is the only national oral health data set in the United States with detailed information on fluoride exposures.) They examined the association between enamel fluorosis and caries using logistic regression analysis, controlling for potential confounders in communities with water at or above optimal fluoridation levels and in communities with nonfluoridated or suboptimally fluoridated water. Results. Permanent maxillary right first molars with fluorosis consistently had lower levels of caries experience than did normal molars. Adjusted odds ratios for caries prevalence in molars with fluorosis were 0.71 (95 percent confidence interval [CI], 0.56–0.89) in communities with nonfluoridated or suboptimally fluoridated water and 0.89 (95 percent CI, 0.74–1.06) in communities with water at or above optimal fluoridation levels. Conclusion. This study’s findings suggest that molars with fluorosis are more resistant to caries than are molars without fluorosis. Clinical Implications. The results highlight the need for those considering policies regarding reduction in fluoride exposure to take into consideration the caries-preventive benefits associated with milder forms of enamel fluorosis."

The overconsumption of toothpaste has negative consequences, particularly for children. This study’s objectives were to describe misleading marketing strategies used in selling children’s fluoridated toothpaste and identify warning label characteristics. Two researchers independently coded the packaging from 26 over-the-counter toothpastes that are specifically marketed for children. Aggressive marketing strategies targeting children were identified: every toothpaste in this sample displayed at least 1 children’s animated character, 50% had at least 1 picture of a food item, 92.3% stated they were flavored and 26.9% depicted a full swirl of toothpaste, directly contradicting dentist recommendations for young children. Further, on most toothpaste tubes, warnings regarding fluoride overconsumption for young children were only listed on the back and in very small font. Misleading marketing strategies are regularly used in selling children’s toothpaste as if it is a food product, while warnings regarding overconsumption among youth are minimized. Dental hygienists are in an important position to help parents of young children implement safe oral care practices.

BACKGROUND:
Fluoride is delivered to the teeth systemically or topically to aid in the prevention of dental caries. Systemic fluoride from ingested sources is in blood serum and can be deposited only in teeth that are forming in children. Topical fluoride is from sources such as community water, processed foods, beverages, toothpastes, mouthrinses, gels, foams, and varnishes. The United States Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA) have proposed changes in their long standing recommendations for the amount of fluoride in community drinking water in response to concerns about an increasing incidence of dental fluorosis in children. Current research is focused on the development of strategies to improve fluoride efficacy. The purpose of this update is to inform the reader about new research and policies related to the use of fluoride for the prevention of dental caries.

METHODS:
Reviews of the current research and recent evidence based systematic reviews on the topics of fluoride are presented. Topics discussed include: updates on community water fluoridation research and policies; available fluoride in dentifrices; fluoride varnish compositions, use, and recommendations; and other fluoride containing dental products. This update provides insights into current research and discusses proposed policy changes for the use of fluoride for the prevention of dental caries.

CONCLUSIONS:
The dental profession is adjusting their recommendations for fluoride use based on current observations of the halo effect and subsequent outcomes. The research community is focused on improving the efficacy of fluoride therapies thus reducing dental caries and lowering the amount of fluoride required for efficacy.

A double-blind randomized clinical trial was performed in 6- to 7-yr-old schoolchildren to evaluate, in a 30-mo period, whether the caries increment on the distal surface of the second primary molars adjacent to permanent first molars sealed with fluoride release compounds would be lower with respect to those adjacent to permanent first molars sealed with a nonfluoridated sealant. In sum, 2,776 subjects were enrolled and randomly divided into 3 groups receiving sealants on sound first molars: high-viscosity glass ionomer cement (GIC group); resin-based sealant with fluoride (fluoride-RB group); and a resin-based sealant without fluoride (RB group). Caries (D1 – D3 level) was recorded on the distal surface of the second primary molar, considered the unit of analysis including only sound surfaces at the baseline. At baseline, no differences in caries prevalence were recorded in the 3 groups regarding the considered surfaces. At follow-up, the prevalence of an affected unit of analysis was statistically lower (p = .03) in the GIC and fluoride-RB groups (p = .04). In the GIC group, fewer new caries were observed in the unit of analysis respect to the other 2 groups. Incidence rate ratios (IRRs) were 0.70 (95% confidence interval: 0.50, 0.86; p < .01) for GIC vs. RB and 0.79 (95% confidence interval: 0.67, 0.89; p = .005) for fluoride-RB vs. RB [Corrected]. Caries incidence was significantly associated with low socioeconomic status (IRR = 1.18; 95% confidence interval: 1.10, 1.42; p = .05). Dental sealant high-viscosity GIC and fluoride-RB demonstrated protection against dental caries, and there was evidence that these materials afforded additional protection for the tooth nearest to the sealed tooth (clinical trial registration NCT01588210).