Fluoride: What’s New, What’s Not, and What Dental Patients Should Know?

The effects of fluoride on oral-systemic health

Oral health affects a person’s quality of life and overall health. Good oral health reduces the risk of things like:

• Periodontal disease
• Tooth wear
• Tooth loss
• Cancer of the mouth and throat
• Pain in the face and mouth
• Mouth sores and infection
• Other disorders and diseases that can limit the ability to chew, bite, speak, smile and psychosocial well-being

Patients are at increased risk for oral disease with tobacco and alcohol use, as well as unhealthy diets. Chronic diseases such as cancer, cardiovascular disease, diabetes and chronic respiratory diseases can also increase the risk of oral disease. This also happens with poor oral hygiene.

Dental products that can help

Many products are available that can help rebuild areas exposed to decay, such as foams, rinses, and gels. Fluoride varnish is a dental treatment that can help prevent tooth decay, slow it, or prevent it from getting worse. It is made with fluoride, a mineral that can strengthen tooth enamel. Fluoride varnish treatment usually comes as a preparation of saline or saline in a quick-drying resin or alcohol solution.

Each manufacturer varies in how they distribute this fluoride concentration. Although 5% is the standard concentration of sodium fluoride, others contain only 1%-2.5%. Some come in a polyurethane base, while others come in a shellac base. Keep in mind that fluoride varnish treatments cannot completely prevent tooth decay. Fluoride varnish treatments can help prevent tooth decay, remineralize teeth, eliminate sensitivity, and destroy bacteria that can cause periodontal disease. These benefits—along with brushing with the right amount of fluoride toothpaste, regular flossing, regular dental care, and a healthy diet—are all part of maintaining oral health.

Adult patients can also benefit from fluoride varnish treatments, perhaps even more so than children. If patients exhibit the following characteristics, they may be good candidates for fluoride varnish treatment:

• Have sensitive teeth
• You have periodontal disease
• You have frequent tooth decay
• They have exposed tooth roots and receding gums that leave them vulnerable to tooth decay
• Do not brush or floss frequently
• Have a dry mouth
• Drink soda or other acidic drinks frequently
• You have multiple fillings or crowns
• You have teeth with developmental defects or deep pits and grooves
• Have braces or retainers that can trap the plate in or around them

Silver fluoride diamine

Silver diamine fluoride (SDF) has caught everyone’s attention lately. Here’s what you need to know about incorporating it into your dental practice.

Marketed as Advantage Arrest by Elevate Oral Care, 38% SDF is approved by the Food and Drug Administration (FDA) to reduce dental hypersensitivity. It has also been shown to reduce bacteria and matrix metalloproteinases (MMPs), which are responsible for dentin degradation, and is believed to inhibit carious lesions.¹⁴

SDF will only stain defects in tooth structure such as carious lesions and restorative margins. Healthy tooth structure will not be stained. SDF is also economical as one drop can be used for many teeth.

SDF will stain the caries structure dark brown or black. Care must be taken on other tooth surfaces and near the margins of composite restorations or crowns. Explain the risks of tooth structure discoloration to patients prior to SDF application. If a restoration is stained, the stain should shine through, but may remain stained around the margins.

Educating yourself about the risks and benefits before using SDF will help make the application process smooth.¹⁴

Patients who may benefit from fluoride treatments

Some patients have conditions that put them at increased risk of tooth decay, so additional fluoride treatments and toothpastes with higher levels of fluoride may be beneficial:

• Dry mouth conditions caused by diseases or drugs. Lack of saliva makes it harder to wash away food particles and neutralize acids, putting teeth at risk of demineralization. When patients do not have enough saliva, they may have difficulty washing away food particles and neutralizing acids, which increases the risk of tooth demineralization.
• Gum recession it can expose teeth and roots to bacteria, increasing the chance of tooth decay. Gingival recession is common and increases as patients age and may also contribute to dental hypersensitivity. About one-third of the 78 million US adults age 60 and older are at risk of tooth decay.¹⁵ Since dental hypersensitivity is more common in this demographic, treatment of hypersensitivity is imperative. In addition, since fluoride varnishes are known to treat hypersensitivity, it is often used in cases of receding gums.
• Periodontal disease is a condition where the gums and the tissues surrounding them are infected. Plaque buildup below and along the gum line can lead to gum disease. There are two types of periodontal disease. Gingivitis it is a milder form that good oral hygiene can reverse. With gingivitis, the gums are swollen, red and may bleed easily. Periodontitis is a more serious type of gum disease that damages the bone and soft tissues that support the teeth. Infected gums form pockets and pull away from the teeth. As plaque begins to spread, the body’s immune system (as well as help from dental professionals) can help fight the bacteria. This process, along with bacterial toxins, can break down the connective tissue and bone that hold the teeth in place. If left untreated, the gums, bone and tissue can be damaged, leading to loose teeth and the need for extractions.
• History of frequent cavities.If your patient has a cavity every year or every two years, they may benefit from extra fluoride. The ADA’s Council on Scientific Affairs assembled a group of scientists in 2005 to produce scientific evidence to evaluate and support how effective fluoride is in preventing tooth decay. In the same year, the Journal of the American Dental Association published the recommendations of scientists who supported fluoride varnish treatments for people at higher risk for tooth decay.¹⁶ If your patients eat a lot of sugary foods, snack frequently, or have a family history of tooth decay, they are at greater risk of tooth decay and could benefit from periodic fluoride varnish treatments.
• Dental work (such as crowns, bridges or braces). Some dental treatments put teeth at risk of decay where the crown meets the underlying tooth structure or around the arms of orthodontic appliances. Braces, retainers, bridges, crowns or other dental work can increase the risk of tooth decay.
• Deep pits and groovesin the teeth are prone to dental caries.
• Fluoride varnishes are approved through the ADA for dental hypersensitivity.¹⁷ Sensitivity occurs when fluids cause pain and nerve pressure due to open dental tubules. Fluoride varnish forms a layer of calcium that blocks the flow of fluid by clogging the tubules.

Since varnish can remain on the surface of the teeth for several hours, it has an advantage over rinses, gels, pastes and foams. Varnish treatments are ideal for patients who are sensitive to dental products such as whitening treatments. If sensitivity occurs after dental procedures such as scaling and root planing, fluoride varnish can help reduce hypersensitivity.^18,19

Side effects of fluoride treatments

When used properly, most experts claim that fluoride treatments do not have many side effects, or if they do, they are usually mild and rare. Due to the adhesion and color of the varnishes, there may be a slight, but temporary, change in the color of the teeth. However, as eating and brushing occurs, the enamel slowly wears away and the yellowish color fades. Patients should avoid drinking hot liquids such as coffee, tea or hot soup and avoid drinking alcohol, chewing gum or brushing and flossing for six hours. This will allow the fluoride to sink into the tooth structure.

Possible side effects (although rare) of fluoride varnish may include:

• White spots on teeth
• Vomiting, nausea or abdominal pain
• Allergic rashes
• Sores in the mouth

Patients may experience more serious side effects, such as gastrointestinal bleeding or bone problems. These are extremely rare, however, and usually only occur when patients are exposed to higher doses of fluoride over a long period of time. Despite these rare side effects, fluoride is supported by many public health agencies for its oral health benefits.²⁰

Patient education is key

Topical fluoride varnish application should be part of the dental professional’s entire preventive care routine that includes education on maximizing the benefits of tooth brushing, professional interventions, and nutritional control. Explain to patients that fluoride varnish treatments use a stronger concentration of fluoride than is found in everyday toothpastes, mouthwashes, and over-the-counter products.

The fluoride varnish treatment usually takes a few minutes and is applied with a brush or cotton swab. The varnish is left on the teeth for several hours, allowing it to release fluoride in the cervical and interdental areas where fluoride is most needed. If patients continue to experience tooth sensitivity, advise them to come in every six months for reapplication.^21,22

With all the information about fluoride, it is important that patients understand why we recommend it for their dental care. Take the time to answer their questions and place brochures and flyers in your reception area to help them understand why fluoride is an important part of dentistry.

Editor’s Note: This article first appeared on Clinical Insights newsletter, a publication of Endeavor Business Media Dental Group. Read more articles and Sign up.

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