Text III. The role of fluoride in dentistry

The history of fluoride in dentistry is over 100 years old. Sir James Crichton Browne made an inspired guess about the impor­tance of fluoride in the diet in 1892. Fluoride was isolated from water supplies in 1931 and has been incorporated into water, milk, salt, tablets, and drops. It has also been included as an active agent for the prevention of dental caries in toothpastes, profes­sionally applied topical fluoride agents and mouth rinses.

The use of fluorides for dental purposes began in the nineteenth century. The first entirely speculative ideas led to the develop­ment of fluoride-containing pills in the 1890s. The first reference to a prophylactic role for fluoride may well have been made by Erhadt in 1874. He reported: “As, for a long time, Iron was given for the blood, Calcium and Phosphorus for the bones, so has it been successful to add Fluoride to the tooth enamel in a soluble and absorbable form. It is Fluoride that gives hardness and dura­bility to the tooth enamel and protects against caries”.

In 1908 the British Dental Journal, under the heading 'Calcium fluoride in therapeutics' gave an abstract from a French pharmaceutical journal on fluoride dosages. The article referred to the beneficial effect of fluoride in the healing of bone fractures and stated that it was 'generally recognized' that fluoride is necessary for the health of teeth.

The study of the relationship between fluoride concentration in drinking water, mottled enamel, and dental caries was begun by young dental officer of the US Public Health Service, Dr H. Trendley Dean. His aim was to find out the 'minimal threshold' of fluorine—the level at which fluorine began to blemish the teeth. He showed conclu­sively that the severity of mottling increased with increasing flu­oride concentration in the drinking water.

What about dental fluorosis?

Dental fluorosis is a hypoplasia or hypomaturation of tooth enamel or dentine produced by the chronic ingestion of excessive amounts of fluoride during the period when teeth are developing. The major cause of dental fluorosis is the consumption of water, containing high levels of fluoride by infants and children during the first six years of life. Although both primary and permanent teeth may be affected by fluorosis, under uniform conditions fluorosis tends to be greater in permanent teeth than primary ones. This disparity may be due to the fact that much of the mineralization of primary teeth occurs before birth and the placenta serves as a barrier to the transfer of high concentrations of plasma fluoride from a pregnant mother to her developing fetus. Other reasons may be that the period of enamel formation for primary teeth is shorter than for permanent teeth and that the enamel of primary teeth is thinner than that of permanent teeth.

In the last 10 years a number of workers have drawn attention to the possibility of an increase in the prevalence of dental fluoro­sis. The available evidence points to an increase in dental fluo­rosis in both fluoridated and non-fluoridated communities. Increased fluoride exposure from a variety of fluoride-containing dental products is the most likely source. In some cases, health professionals may prescribe fluoride dietary supplements inappropriately, or fail to advise parents to teach their small children to spit out, not to swallow, fluoride toothpaste. Increases in dental fluorosis are an indication that total fluoride exposure is increasing and may be more than necessary to prevent tooth decay. Prudent public health practice dictates using no more than the amount necessary to achieve a desired effect.

Speaking

Case 1.

Imagine yourself working as a Health Department authority. At the annual sittings it was decided to reduce the financing if the programs aimed at preventing dental diseases. Prove that this decision was wrong.

Case 2.

Imagine yourself working in the sphere of dental products development. Prove the necessity of xylitol and fluorine use in the oral hygiene products.

Case 3.

Imagine yourself working as a pedodontist. A woman broughta six-year-old child and you paid attention that more than 15 months had passed since their last visit. Explain the importance of regular check-ups for her child’s dental health.

†Appendix 1

Course Schedules (Baylor College of Dentistry)-

First Year (Study hours 8.00 a.m.- 12.00;

1.00p.m.-2.00 p.m. in fall semester and to 4p.m. in spring semester)

Subjects (in the order of introduction)

Dental Anatomy/ Dental Anatomy Lab

Biochemistry/Nutrition

Principles of Epidemiology & Dental Public Health

Cell/ Molecular Biology

Introduction to Clinical Practice I

History of Dentistry

Library Orientation

Gross Anatomy/Gross Anatomy Lab

Information Technology in Dentistry

Growth & Development

General Histology/General Histology Lab

Micro/ Immunology

Physiology

Neuroscience

Operative dentistry

Occlusion

Human Behavior in Dentistry

Second year(Study hours 8.00 a.m.- 12.00; 1.00p.m.- 3.00p.m.)

Subjects (in the order of introduction)

Operative Dentistry/ Operative Dentistry Lab

Removable Prosthodontics/ Removable Prosthodontics Lab

Oral Radiology

Periodontics

General Pathology

Fixed Prosthodontics/Fixed Pros. Lab

Dental Pharmacology

Preclinical Diagnostic

Introduction to Clinical Practice II

Endodontics/Endodontics Lab

Applied Preventive Dentistry

Local Anesthesia & Nitrous Oxide Sedation

Pediatric Dentistry

Orthodontics/Orthodontics Lab

Oral Pathology

Basic Dentoalveolar Surgery

Third year (Study hours – 8.00p.m. – 10.00;

10.00- 12.00 and 1p.m.-2p.m.- clinic)

Subjects (in the order of introduction)

Professional Ethics

Advanced Dentoalveolar Surgery

Medical Pharmacology

Human Behavior in Dentistry

Clinical Principles of Patient Evaluation

Anesthesia in Dentistry

Oral & Maxillofacial Surgery

Advanced Removable Prosthodontics/Dental Implants

Implant Dentistry

Occlusion

Clinical Principles of Patient Evaluation

Selectives

Fourth year (Study hours – 8.00a.m.-10.00;

10.00-12.00 and 1.00p.m.-2.00p.m.-clinic)

Oral & Maxillofacial Surgery

Pediatric Dentistry

Professional Ethics & Dental Jurisprudence

Orthdontics

Applied Pharmacology

Advanced Principles of Patient Evaluation

Advanced Techniques & Materials

Geriatric Dentistry

Selectives

†Appendix2