Home
Welcome
About Dr. Comisi
Your First Visit
Continuing Care
Dental Treatments
Emergencies
Office Location
Financial Considerations Dental Insurance
Related Links
Fluoride Facts
Dental Benefit FAQ's
Contact Us

Comprehensive General Dental Care in Ithaca, NY for the Adult and Child. Including: Preventive, Restorative (Including Cosmetic Restorations), Prosthetic (fixed, removable, and implants), Endodontic (root canals), Tooth Whitening, Occlusal Rehabilitation, Limited Orthodontics and Periodontal Care.

Fluorides: Questions and answers.

At what age should professionally-applied topical fluorides first be administered?

More than just a patient's age should be considered in determining the treatment regimen. A fluoride history should be taken on each patient and the decision based on: age; caries (tooth decay); level of water fluoridation; and additional fluoride exposure.

For most children, topical fluorides can be applied beginning at age three. In active and rampant caries groups, some clinicians have recommended topical applications as soon as the teeth erupt. Due to the porosity of newly erupted teeth, the primary dentition receives even greater anticariogenic benefits from fluoride than does the permanent dentition.

When topical applications are begun at an early age, precautions should be taken. These include: close monitoring of the amount of fluoride used; adequate evacuation during treatment to prevent ingestion; and thorough expectoration following treatment.

Suggest Source: Ripa, L.W. A Personalized Regimen of Multiple Fluoride Therapy for Child Patients. NY State Dent. J., 54 (2): 59-64,1994.

In addition to office fluoride application, what other therapies should be used?

Studies have shown that multiple fluoride therapies produce superior results. The most beneficial regimen uses a systemic mechanism (water fluoridation or dietary supplementation) and as many topical approaches as needed to control caries.

Twice-a-year office topical applications provide infrequent high concentrations of fluoride. Dentrifices (toothpastes), mouth rinses and home fluoride gels offer frequent low concentration which is needed to enhance the remineralization process of the tooth enamel.

Suggest Source: Horowitz, H.S., Alternative Methods of Delivering Fluorides. Dent. Hygiene 57 (5): 37-43, May 1983.

What is remineralization and how does it work?

The process of tooth decay causes demineralization or loss of minerals. With the aid of fluorides, minerals can be incorporated back into the lesion through remineralization. Both the demineralization and remineralization processes are continuously ongoing within the tooth. When remineralization overcomes the demineralization process, caries (decay) can actually be reversed and the lesion repaired. The remineralization process also significantly increases the size of the enamel crystals. These larger crystals are more resistant to acid attack than even natural enamel.

These processes are occurring in the tooth subsurface. Unfortunately, dental professionals are unable to detect early subsurface lesions even on the best of radiographs. It is usually not until the lesion has spread into the dentin, the second layer of tooth structure past the outermost enamel, that it becomes radiographically detectable. At the point where a lesion becomes barely detectable, scientists estimate that it has been developing for approximately 36 months.

Therefore, individuals that were once considered "caries-free" should now be recognized and treated with fluorides which will help reverse the undetectable subsurface destruction. Research has shown that low level fluorides (such as contained in dentifrices (toothpastes), rinses, and home fluoride gels) are more effective than high fluoride concentrations from the standpoint of enhancing the remineralization process.

Suggested Source: Silverstone, L.M. Caries and Remineralization. Dent. Hygiene 57 (5): 30-36, May 1983.

Should dental professionals recommend fluoride therapy for adults?

Though there have been few studies which specifically focus on adults, systemic and topical fluorides can provide significant benefits. It has been assumed that children are in greater need of fluorides because of their higher caries rate ... but adults are not caries-free. Adults with undetectable subsurface or "white spot" lesions can benefit from the increased remineralization potential of continuous low fluoride levels. Also, the growing incidence of adult root caries could be reduced through utilization of office and home fluoride regimens.

Suggest Source: Swango, P.A. The Use of Topical Fluorides to Prevent Dental Caries in Adults: A Review of the Literature. JADA 107 (3): 447-450, Sept. 1983.

Can fluorides benefit xerostomic (dry mouth) patients?

When salivary flow is absent or minimal, caries destruction is rapid and rampant. Patients experiencing drug or radiation-induced xerostomia (dry mouth) should be treated with professionally-applied fluorides, home fluorides, and a strict program of oral hygiene.

A complete health history must be taken to consider previous conditions and drug exposures. Temporary dry mouth commonly occurs as a side effect of many drugs including: antihistamines, diuretics, antihypertensives, anticholinergic, antidepressants, antipsychotics, and decongestants.

Salivary gland dysfunction can be caused by radiation exposure of the head and neck. This permanent xerostomic condition represents a lifelong high caries risk requiring the frequency of exposure provided by daily home fluorides and in some cases, artificial saliva preparations.

Suggested Source: Accepted Dental Therapeutics, ed. 39. Chicago, American Dental Association, 1982, pp 52-55.

Does fluoride possess anti-plaque properties?

In addition to decreasing enamel solubility and enhancing the remineralization process, fluoride has been shown to affect the metabolism and quantity of plaque bacteria. Both high and low concentrations of fluoride could be useful as an adjunct to traditional mechanical plaque control therapy. Most of the research in this area has used stannous fluoride which has demonstrated the ability to metabolically disrupt plaque bacteria-specifically, Streptococcus mutans.

Suggested Source: Perry, D.E., et al. Stannous Fluoride Adjunct to Root Planing-Clinical and Antimicrobial Effects. IADR Abst. 702, Dallas, March 1984.

What are the differences between the types of fluorides used?

Stannous fluoride, sodium fluoride, and acidulated phosphate fluoride (APF) appear to be equally effective at preventing cavities. However, they differ in terms of application frequency, taste, cost, stability, gingival tissue acceptance, and staining tendency.

Many stannous fluoride products have a bitter taste and some have been shown to cause tooth staining. Stannous fluoride may occasionally contribute to gingival irritation. On the basis of available research, stannous fluoride appears to be the most effective type from a bacteriostatic standpoint.

Sodium fluoride has an acceptable taste and does not cause staining or gingival irritation. Its primary drawback is that it requires more office applications than APF. Neutral pH sodium fluoride preparations may be, on the basis of preliminary research findings, the treatment of choice for patients with extensive porcelain or composite restorations. Some investigators have cautioned against using low pH fluorides which may etch restorative surfaces.

Acidulated phosphate fluoride (APF) is usually applied biannually making it more convenient than sodium fluoride office topicals. APF is stable in plastic containers and is usually flavored for an acceptable taste. Use of a thixotropic APF gel can help preclude inadvertent ingestion.

Suggested Source: Ripa, L.W. Professionally (Operator) Applied Topical Fluoride Therapy: A Critique. Clinical Preventive Dentistry, 4: 3, 1982.

Which is more effective-daily or weekly fluoride rinses?

Daily rinses (0.05% sodium fluoride) and weekly rinses (0.2% sodium fluoride) have been shown to be equally effective. Daily rinses are available over-the-counter and weekly rinses require a prescription or office dispensing. The benefits to the primary dentition (baby teeth) from fluoride rinsing are less than those generally obtained for the permanent dentition (permanent adult teeth).

The decision of which to use (daily or weekly rinses) can be facilitated by a co-therapy approach with each patient. Some patients may find that incorporating a rinse as a daily habit works best for them. Also, missing a single dose of a daily rinse is less critical than missing a weekly rinse. However, other patients might perceive a prescription product as being more important and follow the regimen seriously.

An important consideration in selecting fluoride rinse products is their ethanol (alcohol) content. The Committee on Drugs of the American Academy of Pediatrics has recommended that no ethanol be used in medicinal products intended for use by children.

Suggested Source: Driscoll, W.S., et al. Caries-Preventive Effects of Daily and Weekly Fluoride Mouthrinsing in a Fluoridated Community: Final Results After 30 Months. JADA 105 (6): 1010-1013, Dec. 1982.

Are sequential two-part fluoride rinses (APF/Stannous Fluoride) as effective as APF gel office treatments?

Based on the absence of any clinical studies to demonstrate the effectiveness of two-part rinse systems, office APF gels continue to be the preferred treatment regimen. The American Dental Association has not accepted two-part rinses as being effective. Concerns have also been raised regarding the potential of these rinses to be easily ingested. When a child uses the combined rinse as directed, about eleven times the amount of fluoride contained in a 0.2% NaF weekly rinse is taken into the mouth. This amount could be inadvertently swallowed and cause nausea, headaches, and cramps.

Suggested Source: Horowitz, H.S. and Horowitz, A.M. Letter to the Editor. Consultants' Response. Journal Public Health Dent. 41 (1): 6,1981.

What is the preferred fluoride gel/applicator tray system that your dentist should use?

The preferred system is one that provides optimum therapeutic effectiveness while being convenient for the operator and acceptable to the patient. To achieve these three goals, the features of both the applicator tray and the fluoride gel should be considered.

The applicator tray should provide: 1) complete coverage of all tooth surfaces (including the cervical area (where the tooth's crown and the root meet)); 2) anatomical contours to force the gel into the critical interproximal areas (between teeth); 3) a positive seal and adequate distal dam to preclude salivary dilution of the gel and keep the gel from being ingested; 4) soft edges which do not cause discomfort by impinging on gingival tissues; 5) adequate size selection to accommodate all patients; 6) non-flimsy construction to preclude gel overflow and ingestion; and 7) easy detection of post-treatment fluoride (soft spongy tray interiors absorb and use more gel and are difficult to inspect for the amount of fluoride deposited on teeth vs. the fluoride remaining in the absorbent liner).

There are important features to be aware of regarding fluoride gel selection. For maximum effectiveness, the gel should be thixotropic and have a low pH. Thixotropic gels "cling" to the tooth surfaces better and provide good interproximal coverage. Another advantage of thixotropic gels is that they are less apt to escape from the tray and be ingested. There are wide variations in the taste of fluoride gels. Some brands achieve their pleasant taste by using a higher than scientifically proven pH . . . or even a neutral pH. A pH below 4.5 would appear to be needed for optimal protection.

Suggested Source: McCall, D.R., et al. Fluoride Ingestion Following APF Gel Application. Br. Dent. J. 155: 333. Nov. 1983.

Do fluoride-containing prophylaxis pastes provide adequate topical therapy?

No. They should not be considered as a sole means of fluoride delivery. The prophylaxis procedure removes the fluoride-rich outer layer of enamel. The fluoride in the prophylaxis paste may be taken up by the enamel but its duration is relatively brief. A topical fluoride application is required to provide meaningful caries inhibition.

Suggested Source: Accepted Dental Therapeutics, ed. 39. Chicago, American Dental Association, 1982, pp 360-362.

Is a professionally-administered prophylaxis necessary prior to the topical fluoride application?

The theory that organic surface integuments act as a barrier to fluoride uptake and should be removed via professional prophylaxis prior to topical applications has recently been challenged by dental researchers. More than a dozen laboratory and clinical studies have shown that preliminary cleaning (either professionally or by selfbrushing) did not produce superior therapeutic results.

The prophylaxis step should still be considered beneficial as an adjunct in the prevention and treatment of gingivitis and periodontal disease and also for cosmetic purposes (stain removal). However, its use should be based on the individual patient's gingival and oral hygiene status-and not as a prerequisite for optimal topical fluoride efficacy.

Suggested Source: Ripa, L.W. Need for Prior Toothbrushing When Performing a Professional Topical Fluoride Application: Review and Recommendations for Change. JADA 109 (2): 281-285.

Can topical fluoride applications produce tooth mottling (pitting and discoloration)?

Tooth mottling is caused by excessive systemic use of fluorides during the period of tooth development, not by topical use. Like any nutrient, fluoride is beneficial in the proper amounts but harmful in excessive amounts. Some areas do not have fluoridated water. Other areas have naturally fluoridated water. Geographic locations in which the water supply is not naturally fluoridated have no more than the recommended level of fluoride (which is 0.7 to 1.2ppm depending on climate) added to the water. To determine if your tap water is fluoridated, check with your local water district. Ingestion of water having a fluoride concentration of two or three times greater than the recommended level can produce white flecks and chalky opaque areas. Consumption of water having a fluoride concentration of four times the recommended level can cause brown, pitted and corroded areas. Using evacuation during a topical treatment plus using quality gels and applicator trays can preclude inadvertent swallowing, which could produce undesirable systemic effects.

Suggested Source: Whitford, G.M. Fluorides: Metabolism, Mechanisms of Action and Safety. Dent. Hygiene 57 (5): 1629, May 1983.

How much fluoride dentifrice (toothpaste) should be placed on a child's toothbrush?

Preschoolers should have only the tips of their brush wetted with a fluoride-containing toothpaste (no more than a pea-sized dot). Most fluoride dentifrices contain 1,000 ppm of fluoride. Younger children can ingest up to .30 mg of fluoride during a single brushing. Consistent ingestion of large quantities during tooth development may result in mild enamel fluorosis. Parents should monitor their child's brushing and instruct them not to swallow.

Suggested Source: Barnhart, W.E. et al. Dentifrice Usage and Ingestion Among Four Age Groups. J. Dent. Res. 53:1317-1325, 1974.