Synonyms in the broader sense

fluoride therapy

introduction

In dentistry, the fluoridation of the teeth is performed as a prophylactic measure. Numerous scientific studies have shown that fluoride helps with caries prophylaxis.
In dentistry, only low doses of fluorides are used, which are completely harmless to health. Thus, the content of fluoride in toothpaste is limited to 1500ppm (parts per million). In children's toothpaste, it is reduced to 250 to 500ppm, as children swallow a large portion of the toothpaste and in combination with fluoride tablets could ingest too high a dose of fluoride systemically.

How does fluoride work?

Acid attacks on the enamel of the teeth occur daily. The enamel is demineralized by demineralization, ie calcium is dissolved out of the enamel.
On the other hand, calcium is also reinjected from the saliva, this process is called remineralization. As long as demineralization and remineralization balance each other out, no decay will occur. Only when the remineralization can no longer replace the loss of calcium, it comes to tooth decay.

Fluorides help to remineralize saliva and thus help prevent the spread of decay. The beginning of a decalcification due to acid attacks does not occur on the surface of the enamel, but immediately below it.
As long as the surface is not destroyed, remineralization can prevent the onset of a carious defect. However, if a destruction of the surface has already taken place, the process can no longer be stopped by remineralization. This promotion of remineralization is one of the most important effects of fluorides.

The second effect of fluorides is the hardening of the enamel by incorporation of fluorine ions in the enamel. The fluorine content in the apatite of the enamel is increased, which improves the crystal structure and reduces the solubility. Both cause a higher resistance to acid attack. The so hardened enamel can not be so easily attacked by acid. Fluorides have a preventative and a repairing effect.

  • Rebuild tooth enamel
  • How is tooth decay?

What are the side effects?

If fluorides are used in a therapeutic dose, no side effects occur. It is different, however, if you use them in too high a dose, then a fluoride poisoning can occur. Especially in children, the effects on the teeth are very noticeable. The permanent teeth can get discolored, which is called fluorosis.

In the case of excessive intake in childhood, brown spots on the teeth are usually recognizable. In addition, a fluoride-damaged tooth is no longer as resilient as an undamaged tooth. Excessive fluoridation occurs, for example, when the drinking water is fluoridated, a fluoride-containing toothpaste is used and additionally fluoride tablets are administered. You should therefore, if possible, through the food or jelly feed this substance in order to be able to dispense with tablets.
If overdosage with fluoride is external, whitish patches may appear on the teeth.

In adults, there are no side effects on the teeth, however, symptoms of intoxication such as bowel irritation, vomiting or diarrhea may occur. If these symptoms occur, you should definitely consult a doctor. Once you have ingested too much fluoride, a glass of milk can help. The calcium contained therein binds the excess fluoride. For exact quantities, please consult the pediatrician or dentist.

fluorosis

Fluorosis of the teeth is a more or less pronounced discoloration of the permanent teeth, less of the deciduous teeth. The color scale ranges from slightly yellowish to brownish. Also, corrosions may be present. These are not damages in the sense of caries, but irreversible aesthetic changes that can only be remedied by a prosthetic restoration.

The cause is an excessive daily dosage of more than 2 mg fluoride during the growth phase of the teeth as long as they have not broken through. The crucial period is the phase of tooth development in which the tooth germs are still supplied with blood. For teeth that are already in the oral cavity, very high levels of fluoride may not cause such changes.

What are fluorides?

Fluorides are fluorine salts consisting of a compound of fluorine with inorganic or organic elements such as:

  • sodium
  • calcium
  • Tin or
  • Amin

arise. The formation of salt results in completely different properties in contrast to pure fluorine gas. Only these innocuous fluorine compounds are used in prophylactic use in dentistry. The harmlessness of salts from two highly toxic individual substances can best be demonstrated by using common salt. It consists of the very poisonous chlorine and the also very poisonous sodium. Together, sodium chloride is produced, which is the salt we consume daily and which is even vital.

Forms of fluoridation

Systemic fluoridation

In systemic fluoridation, fluoride is delivered to the body by uptake via the gastrointestinal tract. This is done either by food or artificially by tablet intake, fluoridated table salt or even by mineral waters.
The fluoride is absorbed into the bloodstream and thus also reaches the salivary glands and the oral cavity. Fluoridation with tablets must be co-ordinated in children after age. It should be remembered that children brush teeth when they want larger amounts of toothpaste arbitrarily because of the good taste or involuntarily swallowed.

Local fluoridation

In contrast to the systemic application, in which the fluoride enters the oral cavity only in a highly diluted concentration, the fluoride is applied directly to the teeth during local application.
The local application is carried out by toothpaste, gel, rinsing solutions or paints applied by the dentist. Toothpaste should contain fluoride in any case. Most pastes contain inorganic sodium fluoride or sodium monofluorophosphate, they are tasteless and work well with the other ingredients of the toothpaste. Especially in America, toothpaste containing tin fluoride is also available. As an organic compound in toothpastes, amine fluoride is used.

Another indication of fluorides is the local treatment of sensitive tooth necks.
Usually the tooth neck is protected by the enamel and the gums. Especially due to the periodontosis but also due to incorrect brushing, the gums retract and thus exposes the neck of the tooth.

Now, through the fine dentinal tubules, thermal and chemical stimuli can be passed on to the pulp and cause pain.
Domestic application of fluoride gel to the painful cervix or the application of fluororesis by the dentist seals the open dentinal tubules, thus eliminating the painfulness.

Trinkwasserfluoridierung

The simplest and cheapest supply of fluoride supply is the enrichment of fluoride in drinking water. It has already been carried out in America (USA) but also in Europe. Thus, the city of Basel in Switzerland and Karl Marx City in the former GDR introduced the fluoridation of drinking water.
The success was demonstrated in a significant decrease in caries.

In the Federal Republic, however, there will be no drinking water fluoridation, as this is considered compulsory medication, and it would therefore be necessary to provide for each household two separate water pipes, so you can choose between fluoride-free and fluoride-enriched water.

Fluoridation of the deciduous teeth

The fluoridation of the deciduous teeth is a controversial topic. Adolescent dentistry is constantly improving and there is no doubt that fluoride plays an essential role in it. The scientists are still not sure what makes more sense:

  • the systemic application: so the fluoride intake with certain foods or tablets during the maturity phase of the teeth or
  • local fluoridation: lifelong use of fluoride-containing toothpastes or salt.

However, the combination of Flouride with other preventive measures has the best effect:

It should be dispensed with the constant pacifier and bottle nipple, the drinks should be as sugar-free as possible.

A healthy diet also plays an important role. Between meals, sufficiently long breaks should be kept.

The oral hygiene of the parents also plays an important role - on the one hand, the parents are a good role model for the child, on the other hand, it has been scientifically proven that the children whose mothers got tooth decay, have an increased risk of having tooth decay themselves.

It should not be forgotten that bacteria are responsible for caries development. Therefore, parents should not take the pacifier of their baby in the mouth!

Which fluoridation agents are there?

For the fluoridation of teeth there are many different agents and products on the market. First of all, fluoridated toothpaste should be used during daily brushing. In virtually every commercially available toothpaste, unless specially marked, there is a prescribed amount of fluoride with 1000 to 1500 ppm (= parts per million).
Furthermore, there are more fluoridated toothpastes or gels that should be used once a week, eg elmex gelée (available in the pharmacy). In addition to toothpastes, there are fluoride mouthwashes for daily use. Furthermore, it is advisable to use fluoridated table salt for cooking. There are also fluoride tablets that can be used for fluoridation.

What is a fluoridation track?

A fluoridation bar is an individual plastic bar which serves as a type of carrier for fluoride-containing gel. It is made by laboratory fit for the upper or lower jaw and should be worn once a week for about 5 - 10 minutes. Ingestion of the gel should be avoided. During production, the dentist first makes impressions of the jaws and sends them to a laboratory. There, plaster models of the jaw are created and created on it by means of a plastic a tailor-made rail.

It serves for additional fluoridation of the teeth and thus a reduction of the caries risk. The splint allows a more even distribution throughout the dental arch compared to brushing the fluoride gel on the teeth. Furthermore, the contact time of the fluoride gel is increased. Since the fluoride gels used contain a dose of approximately 12500 ppm fluoride, use is contraindicated in smaller children. Frequent ingestion of the gel may lead to fluoride overdose.

Fluoridation in special cases

Fluoridation of the teeth in childhood

The German Academy for Pediatric and Adolescent Medicine recommends that the baby should be given combined fluoride and vitamin D tablets for the first few months.
Following the breakthrough of the first deciduous tooth, systemic fluoridation continues: until the 36th month of life, 0.25 mg / day of fluoride is delivered to the body in the form of tablets or drops.

It is combined with vitamin D until the age of 12 months. After the 36th month of life can be dispensed with the systemic fluoridation, if it is ensured that the teeth are cleaned (at least) twice a day without the toothpaste is essentially swallowed. In addition, fluoride-containing cooking salt can be used.
If the conditions are not met, it is recommended to continue fluoridation after consultation with the dentist.

In contrast to these recommendations, the DGZMK (the German Society of Dentistry, Oral Medicine) considers the use of a fluoridated toothpaste to be more useful from the point of breakthrough of the first deciduous tooth. The Opinion is based on the results of the study, which show that local fluoride intake is more effective, and includes the following points:

  • Fluoridation is not required during the first 6 months of life.

  • With the appearance of the first deciduous teeth, the care should be performed once a day with a pea-sized amount of fluoridated toothpaste. Care should be taken that no large quantities are swallowed.

  • From the 24th month, teeth are brushed twice a day. On the one hand, this should develop good habits of brushing and on the other hand increase caries prophylaxis.

  • The parents should supervise the toddlers brushing their teeth and perhaps brush their teeth.

  • From school age, the teeth are brushed with a toothpaste with a fluorine content of 1-1.5 mg.
  • It should also be used fluoridated table salt.
  • The fluoride tablets can be given to children if no fluoride paste or fluoride-containing salt can be used.

Of course, parents often have their thoughts on how to properly perform their child's dental care. Especially as the children often swallow the dentifrice, which are cosmetics in the strict sense and are not subject to food law controls. The paediatricians also recommend to refrain from using additional salt in the baby food. Therefore, no local fluoridation can take place in this way.

Because of this much different information, it is recommended that the first visit to the dentist be at the age of one year. Then the dentist can perform the so-called fluoride anamnesis and ask what measures are being taken by the parents. It is asked about nutrition, because the parents often do not know which foods are fluoride-containing (eg black tea). Then the dentist can decide together with the parents, which measures are carried out.

Many parents underestimate the important role of the deciduous dentition and think, "It's just the milk teeth, it's the permanent ones coming anyway" - that's a wrong way of thinking!

The deciduous teeth have an important placeholder function. If a tooth is prematurely lost due to decay, the remaining teeth can move into the gap and narrow the space for the adjacent permanent tooth. This can result in a crooked permanent dentition and a costly orthodontic treatment. In addition, inflamed deciduous tooth roots can endanger the health of permanent teeth.

The intact milk teeth are a prerequisite for proper nutrition, language learning and emotional development. One should not forget that at the age of 6 breaks the first permanent tooth. The so-called 6-year molar is very often filled at a young age or carious, because the brushing and fluoridation were neglected.

Sometimes it is too late for prophylaxis - many parents are wondering if they can do anything else. The deciduous teeth are - as well as the "adult teeth" supplied with plastic or metallic fillings.

Fluoridation of teeth in pregnancy

Fluoridation of the teeth is also very important during pregnancy.
Especially for women, who often vomit during pregnancy, fluorides are an essential part of the dental care dar. Since many expectant mother even brushing the teeth due to the Würgereizes already difficult, is advised to a fluoride-containing mouthwash. This can be rinsed several times a day to harden the enamel.

Just after vomiting, this is a good alternative. Proper brushing shortly afterwards would damage the enamel, as the tooth surface is softened by stomach acid and then wears off more quickly when brushing. Because of damage to the adolescent you need not worry. Fluorides are safe for the child with normal intake.

Fluoridation of teeth after bleaching

Bleaching is a method to whiten teeth. It uses strong chemicals that attack the enamel. The hardness of the enamel decreases in this treatment, but can increase again by fluoridation. Even during the treatment, the application of a fluoride gel is very helpful. Hypersensitivity reactions can be reduced and the treatment made more pleasant.

Furthermore, the surface roughened by the whitening tooth surface is smoother again by this measure. Fluoride helps remineralise the enamel. This means that minerals are stored back into the teeth and the tooth becomes more resistant. Second, some studies indicate that the application of fluoridation after bleaching slows the recurrence of discoloration. Some manufacturers also recommend a daily two-minute application of fluoride gel after a bleaching session for about a week to regenerate the affected enamel.

Cost of fluoridation

The teeth should be fluoridated weekly.
There are jellies of different brands, which are used for it. The best known is Elmex jelly. A small tube of 25g costs about 5 €. Under certain circumstances, you can get a large pack on prescription, so that only the prescription fee is due in the pharmacy. If you have your teeth fluoridated by the dentist, this usually happens as part of a professional tooth cleaning. The costs vary from doctor to doctor and start at around 60 €.

Summary

Fluorides are an indispensable component of caries prophylaxis. They can be used in different dosage forms. They harden the enamel and promote remineralization. In dentistry, they are used in harmless concentrations.
The fluorosis occurs only with overdose during the development of the teeth, it is harmless to health but aesthetically disturbing.


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