Fluorine prevention is two main types – endogenous and exogenous. In endogenous prevention fluorine enters the body through the digestive system and then it is transferred to bones and teeth through the blood. In exogenous prevention the fluorine is delivered directly to the tooth surface through various carriers (gels, paints, foams, toothpaste, etc.). Fluorine in all fluorine sources is not in a free state, but it is connected in compounds such as NaF (sodium fluoride) which ensures stability.
Nowadays, there are two main views about fluorine prophylaxis.
One is positive due to the extremely high level of protection from tooth decay in children, undergoing fluorine prophylaxis.
The other view is negative and is due to the ability of fluorine to cause a disease called dental fluorosis, which is characterized by the formation of white to brown stains on teeth with fluorine overdose. The separation of the society into two groups – advocates and opponents of fluorine prevention has contributed much to its development and improvement. This has resulted in a level that is optimal – creates the highest degree of protection from tooth decay at negligible risk of developing dental fluorosis, only in the event of failure and neglect to follow the prevention guidelines.
Another important feature, which the opponents of fluorine prevention do not emphasize on, is that exogenous fluorine prophylaxis cannot lead to dental fluorosis. This is due to its nature.
Exogenous fluorine prophylaxis
It is a method suitable for all ages, in which fluorine is delivered directly to the enamel surface through various forms of administration. They are two types – for home use (fluorine-containing chewing gum, pastes, solutions for gargling, etc.) and for use in the dental practice (fluorine varnishes, gels, foams, etc.). The ones for home use are to be applied for an extended period of time, so they have a very low fluorine content, and respectively their effect is small. The formulations for use in the dental practice are applied once by the dentist for a certain period of time and contain a higher concentration of fluorine, which gives a better effect. It is important that the toothpaste or solutions are not swallowed with exogenous fluorine prevention. Therefore, it is recommended parenteral control when younger children are brushing their teeth.
Endogenous fluorine prophylaxis
It takes place from birth to about two years after the growth of permanent teeth. Until then, the most active processes are the formation and construction of the roots of the teeth. With this type of prevention fluorine is delivered to the teeth through the intake of the body and reaches them through the blood and saliva.
Endogenous forms of fluorine are several (fluorine tablets, fluorine drops, mineral water, fluorinated milk, fluorinated salt). In order to achieve maximally useful and safe prevention at the same time, it is necessary to take account of the total fluorine intake from these five main sources. This is essential for achieving the correct dosage of fluorine intake for children. There are established dose ranges for fluorine necessary for the proper development of bones and teeth that do not cause dental fluorosis and have no harmful effect. They are dependent on the age and weight of the child and are as follows:
Up to 3 years old – 0.5-0.8 mg
From 3 to 6 years old – 0.8-1.0 mg
From 6 to 10 years old – from 1.0 to 1.3 mg
Over 10 years old – 1.3-1.5 mg
These amounts of fluorine must be obtained by the body. Obtaining them should be done by firstly taking into account the natural water intake. For example, children living in areas with water poor in fluorine will have insufficient fluorine intake, unlike children living in Hisarya (resort town in Bulgaria), which drink water with a high concentration of fluorine. So when prescribing fluorine tablets or drops with the same content of fluorine, for children of the same age, one of whom lives in an area with high fluorine content water and the other one in an area with low fluorine content, the effect will be different. The child from the area with high fluorine levels will develop dental fluorosis, while the child from the poor fluorine region will achieve teeth, which are healthy and maximally protected from caries. This is just one of the factors that must be taken into account when setting up a plan for fluorine prophylaxis in children.
Another key factor is the regular intake of bottled mineral water. Different brands have different water fluorine content, which is indicated on the label. Some of them are highly mineralized and the regular use should be taken into account when preparing the plan to avoid fluorine overdose.
Merichlerska – 5.7 mg/l
Hisarska – 4.7 mg/l
Devin – 4.0 mg/l
In the preparation of an individual plan for endogenous fluorine prophylaxis, all sources of fluorine should be included, making sure the quantities of fluorine in them are properly interpreted. It is prepared by the dentist according to the place of residence and the lifestyle of the child and is strictly individual. Strict and responsible compliance to the programme decreases the risk of dental fluorosis and ensures the child’s teeth are optimally protected from decay. Fluorine prevention is not compulsory and the choice to do so is decided by the parents of the child. The dentist may recommend and develop a programme for carrying out such prevention, but the proper implementation and outcome depend only on the parents.