Fluorides

Fluorides are widely used in caries prevention, for which they have been highly effective. Systemic administration of fluorides for caries prevention is available via drink ing water (1 mg/ L), tablets (0.25-1 mg), drops (0.125-0.5 mg), topical application by mouthwashes (200-1,000 mg/L), gels for home use (900 mg/kg) and professional use (9,000-19,000 mg/kg), and dentifrices (1,000 mg/kg). In contrast to the efficacy of fluorides in preventing carious lesions, these formulations have relatively poor antibacterial properties (Table 42.1).The weak therapeutic benefit of fluorides on gingivitis is due to a modest inhibition of glycolysis in plaque bacteria. Sodium fluoride, monofluorophosphate, and stannous fluoride are the compounds used in topically applied agents.

A few well-controlled clinical studies suggested a potential plaque-inhibiting effect for dentifrices containing stannous fluoride. However, these results were most likely due to the stannous ion rather than to fluoride; the positive charge of the stannous ion may interfere with bacterial membrane function, bacterial adhesion, and glucose uptake, thereby inhibiting the formation of plaque.

Mild tooth staining has been observed after use of stannous fluoride products. The ADA Council on Dental Therapeutics endorses fluorides for their caries-inhibiting effect but not for plaque inhibition.

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