MASTERING TOPICAL FLUORIDES: FROM THEORY TO CLINICAL PRACTICE

Added: 2026-05-15

[00:14:45]Hello.

[00:14:47]Hello.

[00:17:16]Good afternoon everyone. On behalf of the department of pediatric and preventive dentistry, Dashmesh Institute of Research and Dental Sciences Farit.

[00:17:24]We warmly welcome you all to today's webinar titled Mastering Topicals from theory to Clinical Practice. It is truly a pleasure to have such an enthusiastic gathering of faculty members, post-graduate students, and the delegates joining us today for this academic session. Fun fact, fluoride is the only naturally occurring mineral that has been officially recognized as one of the 10 great public health achievements of 20th century. Today, we dive deep into making the most of it at the chairside. Before we officially commence the program, I invite you all to watch a short video presentation highlighting our esteemed institution.

[00:19:02]Before we officially commence the program, Thank you. I now take the privilege of inviting our respected Dr. Mino Bola, professor and head department of pediatric and preventive dentistry to deliver the welcome address.

[00:21:19]>> Good afternoon everyone. It gives me an immense pleasure to welcome you all to this academic webinar on mastering topical fluorides from theory to clinical practice. I extend my heartfelt gratitude to our honorable director sir Dr. Gurak Singh our rever joint director Sardar Swarjit Singhil and our honorable principal sir Dr. MK Sunnil for their constant support, encouragement and guidance in organizing this webinar. To all our participants, thank you for joining us today. I hope this session offers you insights that will help you in day-to-day patient care.

[00:22:03]Thank you so much ma'am for your inspiring words. Now I would like to request our respected principal sir Dr. MK Sunil to kindly address the gathering and share a few words.

[00:22:16]>> Yeah. Good afternoon everyone.

[00:22:21]Uh respected uh our director sir Dr. Dr. Gurus Singh sir, our joint director Swarjit Gil sir and members of the committee and my dear fac students and faculty members who be joined this webinar. It's a gives a immense pleasure to welcome you all on this today's webinar.

[00:22:47]We have a a renowned speaker Dr. Dr. Narabjit K professor and head of the department department of aeronautics governmental college I'm sir it's a I welcome you ma'am on this august gathering and accepting our invitation for this webinar and today's webinars the topic is on the mesmerizing the topical fluorides from theory to clinical practice I think uh uh everyone Everyone will agree with this particular topic. Now it is more and you know that the fluoride contents in the regular water and everything is more and where I think the lot of studies has been even now is going on particularly on the deflitation techniques and etc. So I think definitely this particular topic will show and will give more of enriched knowledge about the students and the faculty of delegates who have been participating in this webinar. I welcome you on this August gathering madam and I welcome our uh uh madam Dr. Minola who is the head of the department of pedodontics who helped who has made put in a lot of effort in organizing this webinar. I welcome all the faculty members of all the department and other people and other delegates who have been enrolled for this webinar. I once again welcome all the faculty members and the students who joined this webinar. Thank you. Thank you.

[00:24:27]>> Thank you so much sir for your motivating and encouraging words. Before we formally commence the webinar, I kindly request all the participants to keep their microphones muted throughout the session. The question and answer session will be held at the end of the webinar. Participants are requested to post their questions in the chat box and all questions will be addressed during the discussion session thereafter. I also request everyone to refrain from using the raise hand feature during the webinar session. I now once again invite Dr. Mino ma'am to introduce our esteemed guest speaker for today.

[00:25:00]>> It's my proud privilege to introduce today's distinguished guest speaker Dr. Chit Kh professor and head of department of pediatric and preventive dentistry at Punjab Government Dental College and Hospital Amritser. Dr. Navjit K has completed both her graduation and postgraduation from Punjab Government Dental College Amritser and joined the Punjab Dental Education Services in 2008.

[00:25:29]She has authored numerous publications in both national and international journals and she is also a life member of ISPD. Her significant contributions to pediatric and preventive dentistry along with her commitment to teaching has motivated and influenced countless students and professionals. Dr. Nabjit, we are truly grateful for your presence and look forward to your valuable insights.

[00:26:03]Thank you Dr. Mu.

[00:26:05]Am I audible?

[00:26:09]>> Hello.

[00:26:09]>> Yes ma'am. You are audible.

[00:26:11]>> Okay. A very good afternoon to respected principal sir all the management uh uh respected elders Dr. Mu and my dear students. I feel uh privileged to be here as a guest speaker in your institute. Thank you for giving me this chance. So uh now we will start with the webinar. Dr. Mu, we can start.

[00:26:36]>> Yes ma'am. Sure ma'am.

[00:26:58]put off.

[00:27:05]So today's topic of webinar is mastering topical fluorides from theory to clinical practice. What fluoride is?

[00:27:15]Fluoride is the ionic form of the element florine, a hogen in the uh group 17 in the periodic table. So the role of fluoride in dentistry, fluoride is regarded as the most effective antiarogenic agent in dentistry and it forms the foundation of modern preventive dental practice. Its clinical importance lies in its ability to influence the dynamic process of demineralization and remmininalization thereby preventing the initiation and progression of dental carries. So here I would like to mention what demininalization and what remmininalization is. Demineralization is the loss of the minerals from the tooth leading to the initially white spot lesions that later on further progress and give to the cavitation and remmineralization is re-uptake of the essential minerals so as to reverse the process of demineralization and it is highly helpful to I mean prevent the tooth from getting cavitated.

[00:28:23]Then mechanism of action of fluoride remmininalization. Fluoride enhances the precipitation of calcium and phosphate ions into partially demininalized enamel crystals promoting remmininalization.

[00:28:37]It facilitates the formation of fluoridated hydroxy appatite that is fluorepatite which is more stable, less soluble, more resistant to acidic dissolution. This mechanism is especially effective in reversing the incipient enamel lesions that are widespread less takes approximately 2 years to get cavitated lesion. So we have a grace period during which with the help of different remininalizing agents we can reverse that white spot lesion.

[00:29:15]So then comes it inhibition of demineralization during kerogenic acidic attacks. Fluoride absorbs onto the enamel crystal surface and it reduces enamel solubility resulting in decreased mineral loss reduced progression of carious lesions and preservation of tooth structure.

[00:29:37]Then it it it has it is also having antibacterial action. Fluoride exerts antimicrobial activity by inhibiting the bacterial enzymes particularly anise enzyme is inhibited which is important in the process of glycolysis in kerogenic bacteria such as streptocous mutants and lactobacillus. So it ultimately reduces acid production plaque kerogenicity and bacterial metabolism.

[00:30:06]Then effect on the tooth development like systemic fluoride incorporation during adontogenesis that is during the tooth formation it results in the formation of enamel crystals with greater structural integrity and acid resistance newly erupted teeth exhibit enhanced resistance to dental carries. So coming to the clinical role of right preventive dentistry in preventive dentistry it leads to the primary prevention of dental carries. It arrests early enamel lesions. Then there is reduction in carries prevalence and incidence. In our specialty that is pediatric dentistry.

[00:30:47]It is essential for caris prevention in high-risk children. It is widely used in school dental health programs. It is important during the post eruptive enamel maturation. Coming to the restorative dentistry for ride releasing restorative materials like glassore cements they provide sustained antiarogenic effects. It also helps in the reduction of secondary or recurrent carries as a part of community dentistry. Fluoride helps like in community water fluoridation. It is considered one of the most successful and cost effective public health measure for the car's prevalence worldwide.

[00:31:27]Then the today's topic of discussion is mastering topical full rights from theory to clinical. That means the knowledge regarding the topical full rights which we have how to be implemented in the clinical practice.

[00:31:40]The highlights of today's discussion are evidence-based topical fluite use in clinical practice, types and applications in practice and safety and patient compliance.

[00:31:50]Clinical applications of fluoride can be either topical or systemic. Topical means they are applied on the surfaces in any form that could be professionally applied which will release higher concentration of flide that is 9,000 to 22,600 ppm. ppm is parts per million. Then it can be self applied in the low concentrations 200 to,500 ppm. Coming to the systemic fluoridation, water fluoridation is mainly used. Then comes cool fluoridation, salt fluoridation and milk fluoridation. The table is given along with side in which the consumption or the fluoride uh I mean recommendation as per age and the fluoride content of that area is given.

[00:32:41]Then topical fluoride versus systemic fluorides. Topical fluorides are applied topically after the eruption of the tooth that is posterive systemic fluorides are applied through systemic roots during the development of dentition. Normally high concentration of fluorides are used in topical fluidation. In systemic lower concentration of fluorides are used.

[00:33:03]Topical effects are seen only for shorter durations. Effects are there throughout life. Topical doesn't lead to dental fluosis. Systemic fluorides can lead to dental ferosis. Patient cooperation and compliance are absolutely necessary for topical fluidation. Patient cooperation and compliances are not required. Expensive topical fluoride. Yes, they are comparatively expensive. Then the systemic fluorides are cost effective and cheaper. Normally topical fluorides are applied professionally or sometimes they can be used by the patients like tentifises mouth rinses. Systemic fluoride self application is not uh possible. Then indications of topical fluoride therapy as seen in the pictures. Number one high risk carries.

[00:33:52]Then newly updated permanent teeth, incipient non-cavitated carious lesions, special health care need patients, then incipient carious lesions, widespot lesions, orthodontic patients with widespot lesions and zerostomia patients. So I feel there are I mean junior students also attending the seminar. Zerostoia is a condition in which the salivory flow is decreased. So when salivory flow is decreased it automatically leads or makes the patient prone to carious attack. So and in those cases topical fluide therapy is highly beneficial.

[00:34:28]Then the objectives of professionally applied fluoride therapy.

[00:34:32]It uh I mean it will uh lead to the prevention of dental carries. It helps in the enhancement of remininalization, reduction of enamel demineralization and remmininalization of the incipient carious lesion. As I already told that we have a grace period of approximately 2 years for an incipient carious lesion to develop to full cavitated lesion. We can take the help of these professionally topical applied fluide therapy to reverse that lesion. Then the indications for topical light therapy are patients with high carries activity, children and adolescent with newly erupted teeth, orthodontic patients, neostomia patients, individuals with poor oral hygiene, root uh root carry susceptibility, patients with special health care needs, patients undergoing radiation therapy. However, there are certain contra indications too like low carries risk patients history of fluoride hypersensitivity, young children with poor swelling reflects acute ulcerative gingivitis or stomatitis and patients with fluorosis or endemic exposure.

[00:35:41]Then the available forms of topical fluorides are in the form of solutions uh in which they have sodium fluorides, tennis fluoride or APF. Then method of application is usually with a cotton applicator or paint on technique, gel, foam, APF. It is usually applicated applied with a tray. Then varnish with which are painted with a micro brush and antifes toothpaste which can p which can be used by the patient at home and the mouth rinses.

[00:36:12]Commonly professionally applied fluoride agents are sodium fluoride, acidated phosphate fluoride, stannis fluoride, fluoride varnishes and silver diamide.

[00:36:24]Sodium fluoride therapy. Sodium fluoride is widely accepted following the work of Nutson. Common professional concentration of sodium fluoride use this 2% sodium fluoride which contains approximately 92 parts per million fluoride. It gives a neutral pH. K's reduction in first year was seen to be 45% and in second year it was 36%.

[00:36:49]So sodium fluoride is usually valued for its safety, stability, neutral pH and for its proven antiarogenic efficacy.

[00:37:00]Nuts and technique is the most recommended technique in which 2% sodium fluoride solution is applied topically.

[00:37:08]Usually four applications are done at weekly intervals. The recommended frequency is 3, 7, 11 and 13 and this particular pattern has the basis that it is initiated around at the age of 3 years when primary dentition is completed. Then at 7 years of age after the eruption of permanent first mers and incizers to help those teeth then at the age of 11 year with usually when the mixed dentition is there and at 13 years eruption of the all permanent teeth. The rational for this particular protocol is to coincide with the eruption periods of the susceptible teeth allowing maximum post eruptive enamel maturation and pride uptake. So the technique is uh usually done as oral profileaxis means scaling and polishing has been done earlier uh before this application. Then teeth are isolated and dried. Then 2% sodium fluoride solution is applied using cotton applicators or trays and it is maintained for 4 minutes. Then patient is instructed to avoid eating, drinking, rinsing immediately after the application for 30 minutes.

[00:38:23]Method of preparation of sodium fluoride. It is prepared by dissolving 20 gram of sodium fluoride powder in one liter of distilled water in a plastic bottle. It is essential to mention here that it should be stored in the plastic bottles because if stored in glass containers the fluoride ions of solution can react with the silica of glass forming uh SF2 thus reducing the availability of free active fluoride for the anticaries action. So the mechanism is application of 2% sodium fluoride which will release fluoride ions. Then it will lead to the formation calcium fluoride plus hydroxy appatite will form fluor appetite that is a fluoride reservoir with increased acid resistance leading to remmininalization and reduced enamel solubility along with that giving antibacterial effect because of the uh I mean uh decrease in the process of glycolysis and decreased acid production that also then eventually leads to the prevention and rest of the dental carries. Then talking of effect is like when sodium fluoride is applied topically it reacts with the hydroxy appetite crystals to form calcium fluoride the dominant product of the reaction. Talking of effect occurs because once a thick layer of calcium fluoride is formed then it will interfere with the further diffusion of fluoride form from the topical fluoride solution to react with hydroxy appetite. That is why it is left to dry for 4 minutes.

[00:40:03]Calcium fluoride reacts with hydroxy appetite to form fluoridated hydroxy appetite which increases the concentrations of surface fluoride. It makes the tooth structure more stable and less susceptible to dissolution by acids. It interferes with plaque metabolism through anti-enzyatic action.

[00:40:22]It also helps in reminalization of the initial decalcified areas. So talking of effect refers to the phenomena in which excessive surface precipitation of calcium fluoride or fluor appetite blocks further penetration of the fluoride ions into the deeper enamel layers.

[00:40:42]Then the advantages of nuts and regime are it is scientifically proven to be reduced I mean to in the case reduction it is safe and economical neutral pH that is non-erritating to the oral mucosa suitable for children compatible with restorative materials but there are certain limitations too that means that requires multiple appointments we need patient compliance patient has to be recalled for four times then time consuming also superseded today by fluide varnishes and APF gels in many clinical setting. The Nutson regime laid the foundation for the modern professionally applied fluoride therapy and it remains a landmark protocol in preventive dentistry for systematic carries prevention.

[00:41:28]Coming to the another topical fluoride that is stannis fluoride. Stannis fluoride is a topical fluoridating agent that is used for caris prevention and control of enamel demineralization.

[00:41:41]It is one of the earliest and most biologically active fluoride compounds used in dentistry.

[00:41:48]So its single annual application reported 32% carries reduction.

[00:41:55]Muller's technique is a method in which uh we apply stannis fluoride. Uh the method of preparation of stannis fluoride is it has to be freshly prepared before each time because stannis form of tin gets oxidized to stenic form thus making the stannis flide inactive for anticaris action. So it has no shelf life for convenient preparations. Gellation capsules are filled with 0.8 g powder powdered stanniside and are stored in airtight plastic containers. Just before application, the content of one capsule is dissolved in 10 ml of distilled water in a plastic container and the solution thus prepared is shaken briefly. Then the solution is applied immediately to the teeth. 10 ml of the solution should be sufficient to treat the whole mouth of the single patient. If any solution left is left then it should be discarded and it should not be reused.

[00:42:52]Method of application of stannispulite.

[00:42:54]Again thoropril axis should be done that involves scaling and polishing and the teeth are isolated with cotton rolls and dried preferably with the compressed air. Either quadrant or half of the mouth can be treated at one time.

[00:43:09]Quadrant to be treated should be kept free of saliva and if possible a saliva ejector should be used. Freshly prepared 8% solution of stenosis is applied to the teeth with cotton applicators. Teeth are kept moist with a solution for 4 minutes. A reapplication of solution to a particular tooth is done every 15 to 30 seconds. The recommended frequency of 8% stannis fluoride application is once per year.

[00:43:40]So here I would like to mention to specifically to the interns if they are attending this webinar that you should learn these values. Stannis will write percentage the recommended frequency once per year, twice per year, nuts and technique four applications because these are the I mean um important points that you should be keeping in your mind while preparing this topic as these are the usually asked multiplechoice questions. Coming to the mechanism of action of stenosis fluoride, it reacts with hydroxy appetite in addition to fluoride. The tin of stenosis fluoride also reacts with enamel and a new crystalline product gets formed that is stannis trifluosphate.

[00:44:26]Rapid penetration of tin and fluoride in 30 seconds occurs. Therefore reapplication after 15 to 30 seconds is needed. In addition to stannis triluro phosphate three more additional products are formed. Stannis hydroxy phosphate calcium fluoride and calcium trilostenate.

[00:44:46]The advantages are strong anticarious agent this broad antimicrobial spectrum desensitizing action better enamel uptic than sodium fluoride. Disadvantages it causes extrinsic staining brown or black discolorations. Then metallic taste due to stydoxify phosphate unstable in acquisation have to be prepared fresh every time. short shelf life. It may irritate oral mucosa. In some cases, it can cause staining on the margins of the restorations. So the clinical uses are for carries prevention for hypersensitivity treatments, root carries management and high risk carries patients, high carries risk patients.

[00:45:26]It's available in toothpaste most common gel that is professionally applied and varnish less common due to the stability issues. Then coming to the third type that is acidilated phosphate fluoride.

[00:45:40]It is APF is one of the most commonly used professional topical fluoride preparation used for caris prevention especially in children and high-risk patients. APF solution or gel usually contains 20 gram of sodium fluoride and fluoride usually 1.23% giving 12,300 ppm of fluide. Students you must learn these values this how many ppm are released by which type of fluoride the hydrofuloric acid plus phosphoric acid buffer system giving pH acidic pH that is 3 to 3.5 flavoring agents that could be any artificial fruit flavors plus thickening agent like methile cellulose in the gel form is used the acidic pH is the key for enhancing enamel uptake APF gel and solution. Uh comparing them both, gel is relatively costly. Solution comparatively cheap. Gels are readily available. Solution can be prepared easily. The advantages of you being used as self application. Solution has to be applied topically by dentist or the auxiliary staff. Then method of preparation contains 1.23% 23% of fluoride in 0.1 m phosphoric acid at a pH of 3 and is stable with long shelf life when stored in opaque plastic bottles. It's prepared by dissolving 20 g of sodium fluoride in one liter of 0.1 m phosphoric acid. To this is added 50% of hydrofluoride acid to adjust the pH at 3 and fluoride concentration at 1.23%.

[00:47:22]For the preparation of APF gel, a jelling agent methile cellulose or hydroxyethile cellulose is to be added to the solution and the pH is to be adjusted between four to five. Method of application again after oral profile accessis the teeth are isolated with cotton rolls dried and APF solution is continuously and repeatedly applied with cotton applicators and teeth are kept moist for 4 minutes. Floss may be drawn through each intropoximal embraasure to ensure wetting of these surfaces. The recommended frequency of APF topical applications is semiannually.

[00:48:01]APF gel may be applied in the same manner as topical solution but APF gel can be used by self application procedure. A variety of self-reusable disposable trays in various sizes together with sponge-like trays or liners are available.

[00:48:20]Method of application of gel form. The quadrants are isolated on both buckle and lingual side with cotton rolls. For application of gel, position the patient upright and provide saliva ejector.

[00:48:33]Place enough gel to fill one/ird of the trough area of the tray so that it is sufficient to cover the dental arches.

[00:48:41]Place loaded tray over the arch and squeeze over buckle and lingual surfaces forcing the gel between them and allow the tray to remain in the mouth for 4 minutes. Then instruct the patient toectorate immediately and avoid eating and drinking for next 30 minutes. The recommended frequency of APF topical application is semiannual.

[00:49:05]So mechan mechanism of action is when APF is applied to the teeth, it initially leads to dehydration and shrinkage in the volume of hydroxy appetite crystals which on hydrarolysis form dalium dalium phosphate dihydrate.

[00:49:21]This DCPD which is highly reactive with fluoride starts forming immediately when APF is applied and fluorides penetrate into the crystals more deeply through these openings produced by the shrinkage and leads to the formation of fluorapetite. Fluorapetite as I already told is more I mean resistant to carries and acid attack. The amount and depth of fluoride deposited as FAP fluorapitate would be dependent on the amount and depth at which the DCPD gets formed.

[00:49:55]Since for the conversion of the whole DCPD so formed into FAP deeper penetrations and continuous supply of fluide is required. So APF has to be applied every 30 seconds and the teeth is to be kept wet for 4 minutes continuously.

[00:50:14]Advantages it has adaptable taste, no staining, no gingal irritation, stable with long shelf life, comparatively cheap. Disadvantages teeth have to be kept wet for 4 minutes continuously. Solution is acidic.

[00:50:29]Then uh here is a table uh in brief which is showing the comparison of the three types of these sodium fluoride, status fluoride and APF. The percentage used is 2% 8% and uh 1.23%.

[00:50:44]Fluoride uh uh concentration released is 9200 ppm by sodium fluoride, stennis fluoride and uh APF. Then frequency of application uh sodium fluoride has to be applied four times at 3 71 11 and 13 stannis perideite bionoli and APF bionoli. PH it has neutral acidic acidic and there are no adverse effect tooth pigmentation in case of stannis flide and there is no pigmentation in case of APF carries reduction is 30% by sodium fluoride 32% by stiside and 28% by APF.

[00:51:23]Then coming to the fluoride varnishes.

[00:51:26]According to the American Academy of Pediatric Dentistry, fluoride varnish is a highly concentrated topical fluoride agent designed to be painted uh onto the tooth surfaces which sets upon contact with saliva. It acts as a slowreleasing reservoir of fluoride.

[00:51:46]uh it acts as a slowreleasing reservoir of fluoride to enhance enamel remineralization, inhibit demineralization and reduce bacterial metabolism. The two most commonly used varnishes are durafet uh and floor protector. Composition of durafet is a sodium fluoride in varnish form containing 22.6 mg of fluoride per ml that is 2.26% 26% suspended in an alcoholic solution of natural organic wishes. It is available in bottles of 30 ml suspension containing 50 mg of sodium fluoride per mg. The active fluoride available is 22,600 parts per million. Then floor protector is a colorless fluine in a polyurethane.

[00:52:38]The fluoride content in floor protector is 0.7% by weight and active fluoride available is 7,000 parts per million.

[00:52:47]The review by Marino at all showed that the clinical efficacy of flide varnish showed decrease in carries uh by 35% for primary teeth and by 45% in permanent teeth. In terms of efficacy of varnish, according to sepa at all, durafet is more effective as compared to floor protector. Green at all uh proved that I mean he concluded that durafet and floor protector are equivalent in their efficacy. According to Levi at all, durafet is comparatively a bit less than floor protector.

[00:53:24]So here is the technique of varnish application after profilis teeth are dried but not isolated with cotton rolls. So here it should be noted that in the last I mean where we were using all the solutions we were uh I mean giving the isolation with the cotton rolls. The point to be noted here clinically is that these are not to be isolated with the cotton rolls. A total of 0.3 to 0.5 ml of varnish equivalent to 6.9 to 11.5 mg fluide is required to cover the full dentition.

[00:53:58]The application is done first on the lower arch and then on the upper arch with the help of single tufted small brush. After application, the patient is made to sit with mouth open for four minutes before spitting to let the derafit varnish set on the teeth which is further enhanced by the moist environment created by the saliva. The patient should be clearly instructed not to rinse or drink anything at all for 1 hour and not to eat anything solid but take liquids and semi-olid only till the next morning.

[00:54:34]So then coming to the silver damine fluoride SDF SDF is a colorless topical liquid solution composed of 38% silver damine fluoride that is widely utilized in pediatric dentistry as non-invasive painless alternative to traditional cavity drilling. It contains approximately 24 to 28% silver acting as a powerful antimicrobial agent and 5 to 6% fluoride promoting enamel and dentin remmineralization providing about 44,800 ppm of fluoride ions to effectively arrest the active dental gains. It targets tooth decay by three distinct mechanisms. First of all, it has an antimicrobial action that is silver ions destroy the cell walls of the path pathogenic bacteria to stop active infections. Reminalization high concentration of right ions rebuilt uh uh rebuild and harden compromised enamel uh and dented. In an enzyme inhibition, the compound blocks the specific enzymes and that break down the tooth structural collagen.

[00:55:50]Paint on technique of STF clinical steps. Isolate the tooth with cotton god or cotton rolls or goch. Remove gross debris and dry lesions gently. Proh protect adjacent gingiva and lips with petroleum jelly. Uh because if it touches those areas it can cause staining. Then dispense one drop of SDF into the tapping dish. Then dip micro brush in SDF and apply to the lesion paint on technique. Allow to contact for for 1 to 3 minutes. Then excess material should be blotted off. Then advise the patient not to eat or drink for 30 minutes. It can be reapplied at the periodic intervals commonly 6 months.

[00:56:31]The advantages of SDF it is a noninvasive and painless technique. No drilling or local anesthesia is required. Rapid application technique.

[00:56:40]It is highly effective in arresting.

[00:56:42]Cost effective and easy to use. It is useful in very young or medically compromised children. Then reduces bacterial load and dentinal sensitivity.

[00:56:51]It is ideal for outreach and public health programs. However, certain disadvantages like it can cause permanent black staining of the carious lesions. It has a metallic or bitter taste. Temporarily gingiva or mucosa irritation if improperly applied does not restore tooth form or function.

[00:57:11]Aesthetic corner I mean we have to do some kind of filling after application of it. If cavitated lesion has to be stopped from further progress you can paint on SDF but restorative part has to be done additionally. So it is not restoring the tooth form for a function.

[00:57:27]Anesthetic concern in case of anterior teeth requires periodic reapplications and follow-ups contraindicated in silver allergy and ulcerative ging gingial conditions.

[00:57:40]So a systematic review by far at all in 2026 concluded that uh compared with sodium fluoride 38% silver diamond fluoride increases the likelihood of arresting early childhood carries lesions while producing similar effects on DMFS.

[00:58:03]Clinical selection should be uh should balance apply topical fluorides self- apply topical fluorides are the fluoride containing preparations that are used by the individuals at home under professional guidance to enhance enamel resistance and prevent dental carries through regular lowd do exposure. The common forms are fite toothpaste that could be I mean containing sodium fluoride, sodium monoflloro phosphate and sty flide. Flide mouth rinses with the daily uses having a concentration of 0.05% sodium fluoride and weekly use 0.2% sodium flide. Fluoride gels and pastes that can be used at home but under specific supervision.

[00:58:51]Then fluoridated antifricesis. Commonly fluoride compounds in dentifesis is sodium fite, sodium monoflloro phosphate or stannisite. The fluoride concentration in your toothpaste usually is 900 to,00 ppm of fite. The toothpaste any toothpaste colgate closeup any toothpaste you go and check it would be having 900 to 1,00 or,00 ppm of life.

[00:59:19]And in case of pediatric patients the the prescription like kidodent or colgate kit they usually have a fluide concentration of 400 to 500 ppm. Then the ad recommendations for fluoridated antifricesis.

[00:59:36]Uh the use of fluoridated antifricesis is recommended as per the age group less than 3 years of age. Recommended amount of rye toothpaste is smear or grain of rice sized amount and the recommendation is to brush twice daily under parental supervision. For the age group of 3 to 6 years, a p-sized amount is prescribed and it should be supervised brushing to minimize swelling. Then more than 6 years of age is a regular amount and encourage spitting after brushing with the proper rinsing. So carries reduction by different types of applications of topical fluorides are uh with the fluoride varnish using 5% sodium fluoride the caris reduction in primary teeth is 37% and in permanent is 43 to 47%.

[01:00:29]Fluoride gels using 1.23% 23% APF uh have shown the reduction to be 20 to 21% uh in primary teeth and 28 to 38% in case of permanent teeth for right mouth rinse program 0.05 daily or 0.2 2 uh% daily uh leads to 27% of carries reduction for right toothpaste containing 900 to 1100 ppm in case of pediatrics it would be 400 to 500 ppm and the carries reduction with fluoridated toothpaste is 24 to 44% in case of primary teeth and in case of permanent teeth it would be uh it has been I mean calculated as 24 to 44%.

[01:01:14]SDF silver diamin fluoride 38% solution has shown to be much effective leading to 66 to 81% reduction or arresting of active carious lesion in case of primary teeth and 25% to 71% of root carries.

[01:01:33]Coming to the fite toxicity. Flight toxicity refers to the harmful effects caused by the excessive ingestion of fulite over a short or long period. It could be acute and chronic. Acute occurs due to sudden ingestion of large amount of flite commonly in children. Usually uh small children Johan they usually ingest a longer I mean larger amount of light toothpaste in to the taste we just have it more and forite toxicity can occur leading to nausea vomiting abdominal pain diarrhea excessive salivation muscle spasm and in severe cases it can lead to respiratory or cardiac failure. So the management is to induce vomiting if conscious and administrate milk or calcium preparation and provide immediate care. Usually toxicity then you being into the dental course should be knowing toothpaste then immediate treatment is to give milk or to induce vomiting.

[01:02:44]Coming to the chronic fulrite toxicity it results from prolonged exposure to high fluoride levels usually through drinking water. can lead to dental fluorosis and skeletal fluorosis. So coming to the conclusion, topical fluorides remain one of the most scientifically validated and clinically effective measures for the prevention and control of dental carries.

[01:03:06]Appropriate selection of fluoride agents, correct application techniques, risk based patient assessment and adherence to the preventive protocols significantly enhance therapeutic outcomes while minimizing the adverse effects.

[01:03:22]Ultimately, the integration of topical fluorides into routine clinical practice represents a cornerstone of preventive dentistry, contributing to the long-term oral health promotion and minimally invasive patient care.

[01:03:39]Thank you.

[01:03:44]Thank you so much ma'am for such an insightful and enlightening lecture. It was truly a valuable learning experience for all of us. Uh now we have received some wonderful questions from our participants in the chat and we'd love to take up a few of them. So uh the first question comes from one of our participants who would like to know that is there an age or clinical situation in uh where topical fluoride application is no longer beneficial like we could we should disc consider discontinuing it.

[01:04:16]So ideally uh if we say there is no age related contraindication regarding the non-uses of topical fluorides they are usually effective in all age groups in podiatric population usually newly erupted either primary or permanent dentition is there which need fluite topical fluorides. If we talk about the old age groups, there is usually recession root carries. So the need for right for reminalization of those new appearing I mean lesions otherwise medically compromised patients could be on any kind of drug therapy. So reduced saliva could be there. So ideally if we talk there is no specific age for that fluide application topically is contraindicated but however yes depending upon certain situations like in case where there is some kind of oral mucosal I mean ulceration is there or the patient is not fit I mean there are some other kind of systemic issues at that time there we can uh I mean we can say that at that particular point of time topical fluoride therapy is not advisable but otherwise starting from I mean uh I mean a child who is having a primary dentition permanent dentition and old age groups it is usually beneficial.

[01:05:38]So we can stop or say no only in case of specific clinical conditions.

[01:05:47]>> Thank you so much ma'am. Uh another one of our participants has asked that in case uh there's a high KD risk child and if he's already using fluoride toothpaste are additional in office application still necessary or are we overflidating?

[01:06:04]So if the child is already having I mean already if I mean you are saying two things one is the child is already a high carries risk child that means he is having ACC type two or three I mean he is having multiple carous lesions in his oral cavity. So the reasons for that could be either the oral hygiene is not good or if he's already having a toothpaste containing fluide he is not being monitored properly by the parents that means I mean toothpaste but actually the child is not using because most of the parents do not know how to I mean guide their child to do brushing with proper paste.

[01:06:50]So yes definitely if a child if he or she is actually already using fluidated toothpaste but coming to the pediatric um department with high carries risk multiple carious teeth we do need to apply topical fluorides because we are we are applying if we if he is coming under nuts and technique then we'll be applying for 37113 I mean as per that protocol otherwise otherwise we will be using everything in our control and only for the benefit of the child. So it is not going to do any kind of right toxicity or additional damage because actually on paper he is having fluidated paste but if he would had been using it properly and along with oral hygiene instructions and care then he would not have I mean come under the high carries risk. So understand I mean uh it is required they are always beneficial.

[01:07:50]>> Thank you ma'am. We'll just take up one more question. Uh what is your approach when a parent is apprehensive about fluoride toxicity?

[01:08:00]>> So when we have to uh I mean uh prescribe any parent about the topical fluoride application they must have heard about the fluoride toxicity. We need to make the parent convinced and we need to guide them properly that it is not going to do any kind of harmful effect when we are giving it under our control. So we need to explain the parent uh that it is dose related. Normally whenever we will be doing topical fluoride application a limited amount and in a prescribed manner would be done that is not going to create any kind of right toxicity.

[01:08:43]So patients are always apprehensive.

[01:08:46]Parents are always apprehensive even for uh getting the fillings done. They're always apprehensive for getting the root canals done. But we need to convince them rather parents are always apprehensive to get the primary teeth treated. they would come and say that.

[01:09:04]So every time we need we as pediatric dentists, we need to convince the patient that primary teeth form the base of the whole dentition. So they should be preserved. Likewise, if it is required, it is required. Means if topical collide application is required, it has to be done. So patient has to come out of that fear. We need to convince the parents that yes your child needs it and and no kind of I mean um harmful effects are going to occur with this kind of right there.

[01:09:40]>> Thank you ma'am. Due to time constraints any remaining questions will be addressed personally via email. So please do watch your inboxes. Now I humbly request Dr. A Gar professor department of pediatric and preventive dentistry at thesh institute of research and dental sciences for to share a few words.

[01:10:04]Good afternoon everyone. On behalf of the department I would like to express our heartfelt gratitude to our esteemed guest speaker for such an informative and engaging session. Your valuable thoughts and guidance truly enhanced our knowledge and inspired us all. I would also like to sincerely thank our respected principal and management for giving us this wonderful opportunity to organize this webinar. Their constant support and encouragement made this event possible. Thank you everyone for your participation and presence.

[01:10:43]Thank you ma'am. Now we invite our principal sir Dr. MK Sunil once again to present a certificate of appreciation on behalf of everyone at DS to our esteemed guest speaker Dr. Nirjit K as a token of our gratitude.

[01:11:00]A >> very good afternoon one and all.

[01:11:03]Definitely ma'am I missed out some of the points but uh overall I was there continuously in my system I was hearing about your uh lecture ma'am I have one doubt if the crowd permits if madam permits one small question >> yes >> uh see I have been seen a very endemic areas I worked in a florosis zone >> in my career uh I was a alliance club member in my district so I was actively participating In the thing I have been attended the defluidation programs also.

[01:11:37]>> So but thing is particularly when we child the child with a fluorosis. So definitely we we refer to the any doctor particular the specialist. So they say that apply topical fluorides and all those thing prevention etc. So do you think that is there any this topical fluorides or fluoride will really helpful for the kids in that particular stage particular when there is a more fluorosis cases >> type one type two particular >> yeah so in cases of fluorosis so there are different stages if there is a pitting >> so that pitting will eventually lead to carious cavitation >> okay yes >> so topical fluoride will help to remmininalize those pitted enamel areas.

[01:12:25]So systemic flidation overidation.

[01:12:31]So this yes so we have to prevent the cavitation. So already pitted animal is weak that is more susceptible to carries. So prevent that pitted or I mean already to make that I mean stable form we need topical fluoridation it is never going to be harmful. So systemic fluidation has done it effect as fluorosis but fluorosis fluorosis while teeth will eventually lead to the carious tooth.

[01:13:04]>> Yes. to prevent them to I mean preserve them from getting carious or cavitated we need this topical fluoration.

[01:13:14]>> Thanks for enlightening us about the topical fluorides and the uh various modalities various products which you have been highlighted and really very much thankful. I think everybody who has been joined this webinar will be definitely beneficial and they might enrich the knowledge about the topical fluorides. Thank you. Thank you so much ma'am for accepting our invitation to be part of our series of webinar and I thank you sir thank kindly accept our certificate of appreciation from our college side from Dashm college of institute of research and dental sciences and I thank to our Dr. Mino madam and his team in her and her team who have supported in organizing this series of webinar thank you so much >> thank you so much sir I would like to thank you principal sir Dr. Mino and the whole management and the associated staffs in organizing and managing this whole event. Thank you very much. Thank you.

[01:14:11]>> Thank you ma'am. Thank you so much.

[01:14:13]>> Thank you.

[01:14:15]>> Thank you ma'am. Now I would like to invite Dr. Samar, assistant professor in the department of pediatric and preventive dentistry the sme institute of research and dental sciences far to conclude this wonderful session.

[01:14:31]>> Good afternoon everyone. As we come to an end, I would like to express my sincere appreciation to all the participants who enthusiastically engagement truly made today's session a resounding success. A special word of thanks to my colleagues, our postgraduates and interns who have worked diligently behind the scenes from planning and coordination to such a seamless execution. Also, I would like to inform all the attendees that ecertificates will be sent to your registered email addresses. Lastly, thank you once again everyone for joining us and making this event memorable. Thank