Fluoride (???)

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Fluoride(???)

• ??? ???
• ??????????
• 07-3121101?7008, 7020
• hosech_at_kmu.edu.tw

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????

• ??????
• ??????
• ??????
• ??????
• ????
• Murray JJ Appropriate use of fluoride for human
  health. WHO, Geneva, 1996

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FluorideFluorine
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???(Fluoride)

• Fluoride geochemistry
• ??????
• ????????
• ??????17?(0.06)

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? Nitrogen N ??? nitrum ?? 1772
? Oxygen O ??? oxy-genos ???? 1774
? Fluorine F ??? flurre ?? 1886
? Neon Ne ??? neos ?? 1898
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In minerals

• Fluospar (fluorite) CaF2/??
• Cryolite (greenland spare, icetone)
• Na3AlF6/???
• Fluorapatite Ca5(PO4)3F/????

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In foods

• China tea(???)
• Chicken(??)
• Fish(??)
• Taro(?)

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Metabolism of fluoride

• By oral
• ?
• Hydrofluoride acid (HF)
• (Passive diffusion)
• ?
• Fluoride in blood (plasma)
• ?
• Ionic form, No ionic form
• ?
• Soft tissue Bones, teeth
• ?
• Sweat , Saliva , Breast milk Digestive
  juice, Urine ,stool

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Organic fluoride(Inhalation anesthesia)

• Halothane
• Methoxyflurane
• Enflurane
• ?
• Excreted unchanged in expired air

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Toxicology of fluoride

1. Gastrointestinal
2. Blood chemistry
3. Cardiovascular system
4. Neurological

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Gastrointestinal

• Nausea, Vomiting
• Diarrhea, Cramps
• Abdominal pain

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Blood chemistry

• Acidosis
• Hypocalcemia
• Hypomagnesemia

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Cardiovascular system

• Week pulse
• Hypotension
• Pallor, shock
• Cardiac irregularities
• Ultimately failure

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Neurological

• Paresthesia , Paresis
• Tetany , Coma
• CNS depression

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Danger

• The acute lethal dose is about 50mg/kg.
• The average 5 years old child (B.W. 20kg) 3mg/kg
  early symptoms

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Treatment

• Immediate treatment
• Induced vomiting
• Protection of stomach
• Maintenance of blood calcium

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Chronic toxic dose
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Table 3-9 Toxic effects of fluoride in the human Table 3-9 Toxic effects of fluoride in the human Table 3-9 Toxic effects of fluoride in the human
Concentration or dose of F Medium Effects
2 ppm or more Water Mottled enamel
5 ppm Water No osteosclerosis
8 ppm Water 10 osteosclerosis
20-80 mg/day or more Water or air Crippling fluorosis
50 ppm Food or Water Thyroid changes
100 ppm Food or Water Growth retardation
More than 125 ppm Food or Water Kidney changes
2.5-5.0 g Acute dose Death
Date from Smith and Hodge.107 Date from Smith and Hodge.107 Date from Smith and Hodge.107
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Dental fluorosis
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Skeletal fluorosis
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Dental benefits of fluoride

• Prophylaxis of dental caries
• Treatment of sensitive dentine
• Treatment of various bone disease

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Table 11-1 Hypotheses regarding fluorides anticaries mechanism of action
Fluoride acts on the hydroxyapatite of the enamel per se Decreasing its solubility Improving its crystallinity Remineralizing calcium-depleted mineral
Action on the bacteria of dental plaque Inhibiting enzymes Suppressing cariogenic flora
Action on the enamel surface Desorbing proteins and/or bacteria Lowering the free surface energy
Alteration of tooth morphology
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?????????

• ?????? (1-2 mg/l)
• ?????? (10 mg/l)
• ?????? (100250 mg/l)
• ???? (1000 mg/l)

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• HF

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Systemic
Topic

• Toothpaste
• Mouth rinses
• Painting solution
• Varnishes
• Sucking tablets
• Chewing gum

• Drinking water
• Tablet salt
• Milk
• Tablets
• Drops

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Table3. DIFFERENT WAYS TO DELIVER FLUORIDE Table3. DIFFERENT WAYS TO DELIVER FLUORIDE Table3. DIFFERENT WAYS TO DELIVER FLUORIDE
F Concentration Frequency of Application
Water fluoridation Optimal 1 ppm Continuously
Fluoride toothpaste 5001500 ppm Twice daily
Fluoride tablets 0.251 mg/tablet Daily
Fluoride drops 10002000 ppm Daily
Rinsing solutions 2501000 ppm Daily
Salt fluoridation 250350 ppm Continuously
Milk fluoridation 7.5 ppm At school
Concentrated solutions 10,000 ppm Biannual
Concentrated gels 400012,300 ppm Biannual
Lacquers 100022,600 ppm Biannual
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• Name Johnny Jones .
  
• Address 128 Peaks Street Age 5 .
  
• Buchanan, Virginia .
• Rx Sodium Fluoride Tablets, 2.2 mg (1.0 mg F)
• Dispense 120 tablets
• Sig. One tablet each day chew and swish for one
  minute before swallowing or allow to dissolve in
  mouth.
• Signed Robert L. Smith,
  D.D.S.

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Effectiveness of Various Modes of Administering Fluorides in Improving Dental Health Effectiveness of Various Modes of Administering Fluorides in Improving Dental Health Effectiveness of Various Modes of Administering Fluorides in Improving Dental Health Effectiveness of Various Modes of Administering Fluorides in Improving Dental Health
Mode Concentration of Dose Reduction in Dental Caries Remarks
Community water fluoridation 1 ppm (1 mg/liter) 55-70 Continues into adult life
School water fluoridation 4.5 ppm (4.5 mg/liter) About 40 Only for school age children
Topical application 2 NaF solution 8 stannous fluoride 1.23 acidulated phosphate fluoride, or gel 30-40 For children of all ages
Mouth rinse Home or school rinsing daily Supervised school rinsing weekly 0.05 NaF 0.2 NaF 20-50 Probably more effective under supervision
Tablets 2.2 mg NaF? 20-40 Effective in supervised school distribution chew, swish, and swallow
Drops 2-2.2 mg NaF total of 4-12 drops Probably same as tablets Latitude in partial doses
Dentifrices 0.4 stannous fluoride, 0.22 NaF, 0.76 Na monofluorophosphate 15-30 Adults and children may be used in fluoridated areas
Dosage in a temperate climate. ? No vitamin fluoride mixtures have been accepted by the ADA Council on Dental Therapeutics because they lack flexibility in altering fluoride dosage. Dosage in a temperate climate. ? No vitamin fluoride mixtures have been accepted by the ADA Council on Dental Therapeutics because they lack flexibility in altering fluoride dosage. Dosage in a temperate climate. ? No vitamin fluoride mixtures have been accepted by the ADA Council on Dental Therapeutics because they lack flexibility in altering fluoride dosage. Dosage in a temperate climate. ? No vitamin fluoride mixtures have been accepted by the ADA Council on Dental Therapeutics because they lack flexibility in altering fluoride dosage.
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Determine F in compound

• NaF
  1/2.2
• SnF2 x molecular wgt, ratio
  1/4.1
• Na2P03F
  1/7.6

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Example

• 2 NaF contains 0.91 F
• 2 x 1/2.2 9952 ppm
• 0.9 F x 10 9.1 mg F/ml
• 5 ml of 2 NaF
• 5 ml x 9.1 mg F/ml 45.5 mg F

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Magnitude of increase between asymptomatic and
lethal dose levels of four well-know substances
Morphine Sulfate (mg) Salicylate (g) Digoxin (mg) Fluoride (mg)
Asymptomatic 0.3 0.1 0.1 0.1
Therapeutic 1.63.0 0.33.6 1.0 1.0
Toxic 3060 713 1.2 264
Lethal 200400 3040 2.5 2500
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