Fluorides, dental

Susheela AK (1998) Scientific evidence on adverse effects of fluoride on human tissues due to fluoride contaminated drinking water, due to fluoridated dental products, due to fluoride therapy. Document presented to Members of Parliament, House of Lords and House of Commons, Westminster, London. 

Fluoride dental gel may be packed in a coated aluminium tube (see Sect. 24.4.8) or in a plastic bottle with a dosing pump or spraying device. For phosphoric acid gel a plastic bottle with a dosing device or a syringe with a cap is the... 

Fluoride Dental fluorosis, skeletal effects 4 Geological deposits, drinking water additive, aluminum industries... 

The presence of fluorine as a soluble fluoride in drinking water to the extent of 2 ppm may cause mottled enamel in teeth, when used by children acquiring permanent teeth in smaller amounts, however, fluorides are added to water supplies to prevent dental cavities. 

Fluorides ia small (1 ppm ia water, 0.1% ia dentifrices) quantities have been shown to provide dramatic reduction ia dental decay. Fluorides also show promise for bone treatment and ia pharmaceuticals (qv) (see also Chemotherapeutics, anticancer Steroids). However, larger quantities of fluorides can lead to dental fluorosis, bone fracture, and even death. The oral LD q for free fluoride ion ia rats appears to be 50 to 100 mg/kg body weight based on LD q values for several fluorides. 

E. Newbmn, ed.. Fluorides and Dental Caries Charles C Thomas PubHshers, Springfield, HI., 1975. 

Health and Safety Factors. Boron trifluoride is primarily a pulmonary irritant. The toxicity of the gas to humans has not been reported (58), but laboratory tests on animals gave results ranging from an increased pneumonitis to death. The TLV is 1 ppm (59,60). Inhalation toxicity studies in rats have shown that exposure to BF at 17 mg/m resulted in renal toxicity, whereas exposure at 6 mg/m did not result in a toxic response (61). Prolonged inhalation produced dental fluorosis (62). High concentrations bum the skin similarly to acids such as HBF and, if the skin is subject to prolonged exposure, the treatment should be the same as for fluoride exposure and hypocalcemia. No chronic effects have been observed in workers exposed to small quantities of the gas at frequent intervals over a period of years. 

Sodium monofluorophosphate is used ia most dentifrices at a concentration of 0.76 wt % which produces the desired fluoride level of 1000 ppm although one extra strength dentifrice has 1.14 wt % and 1500 ppm F. Although the mechanism of its efficacy ia reducing dental decay is not completely understood (75), it almost certainly reacts with the apatite of the tooth converting it to fluoroapatite which is less soluble ia mouth acids (see Dentifrices). 

Fluoridation of potable water suppHes for the prevention of dental caries is one of the principal uses for sodium fluoride (see Water, municipal WATER treatment). Use rate for this appHcation is on the order of 0.7 to 1.0 mg/L of water as fluoride or 1.5 to 2.2 mg/L as NaF (2). NaF is also appHed topically to teeth as a 2% solution (see Dentifrices). Other uses are as a flux for deoxidiziag (degassiag) rimmed steel (qv), and ia the resmelting of aluminum. NaF is also used ia the manufacture of vitreous enamels, ia pickling stainless steel, ia wood preservation compounds, caseia glues, ia the manufacture of coated papers, ia heat-treating salts, and as a component of laundry sours. 

Stannous fluoride is used in dentifrices and dental preparations. The OSHA permissible exposure limit (44) and ACGIH (45) estabUshed TLV for fluoride is 2.5 mg/m of air. 

The calcium pyrophosphates are utilized primarily as dental abrasives in fluoride-containing toothpastes. Typically, a mixture of P- and y-Ca2P202 achieves a balance of abrasivity and fluoride compatibiUty. 

Several crystalline condensed phosphates may also be formed by the dehydration of monosodium phosphate (MSP). Maddrell s salt exists as Form 11 (high temperature MaddreU, NaPO -ll, insoluble metaphosphate-11) and Form 111 (low temperature MaddreU, NaPO -lll, insoluble metaphosphate-111). Both forms are highly polymerized and difficult (slow) to dissolve in water. Mixtures of the two forms are marketed as a dental abrasive for toothpaste formulations containing soluble fluoride. Maddrell s salt is also used with disodium phosphate as a cheese emulsifying aid. 

Fluoride is added to table salt in countries such as France, Mexico, and Switzerland for the prevention of dental caries. 

The principal commercial use of stannous fluoride is in toothpaste formulations and other dental preparations, eg, topical solutions, mouthwash, chewing gum, etc, for preventing demineralization of teeth (21—23) (see Dentifrices). 

Fluoride. A fluoride concentration of ca 1 mg/L is helpful in preventing dental caries. Eluoride is deterrnined potentiometrically with an ion-selective electrode. A buffer solution of high total ionic strength is added to the solution to eliminate variations in sample ionic strength and to maintain the sample at pH 5—8, the optimum range for measurement. (Cyclohexylenedinitrilo)tetraacetic acid (CDTA) is usually added to the buffer solution to complex aluminum and thereby prevent its interference. If fluoroborate ion is present, the sample should be distilled from a concentrated sulfuric acid solution to hydrolyze the fluoroborate to free fluoride prior to the electrode measurement (26,27). 

Fluorides. Most woddwide reductions in dental decay can be ascribed to fluoride incorporation into drinking water, dentifrices, and mouth rinses. Numerous mechanisms have been described by which fluoride exerts a beneficial effect. Fluoride either reacts with tooth enamel to reduce its susceptibihty to dissolution in bacterial acids or interferes with the production of acid by bacterial within dental plaque. The multiple modes of action with fluoride may account for its remarkable effectiveness at concentrations far below those necessary with most therapeutic materials. Fluoride release from restorative dental materials foUow the same basic pattern. Fluoride is released in an initial short burst after placement of the material, and decreases rapidly to a low level of constant release. The constant low level release has been postulated to provide tooth protection by incorporation into tooth mineral. 

Mechanical removal of plaque is the most effective measure against plaque-caused diseases, dental caries, and periodontal diseases. Even before the advent of fluoride treatments, it was assumed that a clean tooth does not decay. A toothbmsh is effective in removing dental plaque and, for those individuals who optimize its use, it usually can adequately control plaque. Despite the proven efficacy of mechanical plaque removal, the amount of patient involvement is such that only about 30% of the population in developed countries and considerably less in undeveloped countries can be expected to adequately remove plaque (1). Hence, supplementary measures such as dentifrices and dental rinses are necessary. 

The addition of therapeutic or cosmetic agents to dentifrices has paralleled advances in knowledge about factors affecting the human dentition. Agents added to dentifrices can act directly on the host tooth stmcture or on specific oral accumulations, for example, the principal action of fluoride is on the tooth enamel. The primary action of an abrasive, however, is on an accumulated stained pellicle. Oral accumulations of interest to preventive dentistry are dental pellicles, dental plaque, dental calculus (tartar), microbial populations responsible for oral malodor, and oral debris (food residues, leukocytes, etc). Plaque is most important because of its potential to do harm. 

Eluoride added to a compatible dentifrice base at a level of 1000 ppm has been clinically proven to reduce the incidence of dental caries by about 25% on average, even in areas where the water supply is fluoridated (4). Elevation to 1500 ppm increases the protection. Sources of fluoride approved for use in dentifrices are sodium fluoride [7681-49-4] (0.22%), sodium monofluorophosphate (0.76%), and stannous fluoride [7783-47-3] (0.41%). The Eood and Dmg Administration regulates fluoridated dentifrices as dmgs and has estabUshed parameters for safe and effective products. CompatibiUty of the fluoride with the abrasive is an important requirement. 

Several agents deUvered via toothpaste inhibit the accumulation of dental calculus. Pyrophosphate salts, with or without a methoxyethylene—maleic acid copolymer, and zinc salts have given positive results in clinical trials (5). Pyrophosphates were added as potassium or sodium pyrophosphate or mixtures at a level of about 2—6%. The zinc salt was zinc citrate [546-46-3] (0.5—2.0%) or zinc chloride [7646-85-7] (2.0%). The products all contained fluoride in addition to the calculus inhibitor. The anticaries activity of the fluoride was not compromised (6). 

The incidence of dental caries has decreased dramatically in recent years. It has fallen to such an extent as to reduce the need for professional dental health services related to caries significantly. The cause is not clear, but water fluoridation, addition of fluoride to toothpaste, and other modes of fluoride adrninistration are generally conceded to be important contributors to the phenomenon and the American Dental Association recommends use of a fluoride toothpaste for all patients (10). 

Fluoride F Few major industrial water problems Reduces dental decay Alum coagulation Magnesium Hydroxide reaction Anion exchange Membrane separation... 

F H. T. Dean et al. put the correlation between decreased incidence of dental caries and the presence of fluoride ions in drinking water on a quantitative basis... 

NaF for water fluoridation, wood preservatives, the formulation of insecticides and fungicides, and use as a fluxing agent. It is also used to remove HF from gaseous Fz in the manufacture and purification of Fz-SnFz in toothpastes to prevent dental caries,... 

Though dental afflictions constitute a very significant disease entity, these have received relatively little attention from medicinal chemists. (The fluoride toothpastes may form an important exception.) This therapeutic target Is, however, sufficiently Important to be the focus of at least some research. A highly functionalized piperazine derivative that has come out of such work shows prophylactic activity against dental caries. Condensation of the enol ether 1 of thiourea with ji-pentylisocyanate gives the addition product 1J. Reaction of this with diamine 78, derived from piperazine, leads to substitution of the methylthio moiety by the primary amine, in all likelihood by an addition-elimination sequence. There is thus obtained ipexidine (79). ... 

Dissolved mineral salts The principal ions found in water are calcium, magnesium, sodium, bicarbonate, sulphate, chloride and nitrate. A few parts per million of iron or manganese may sometimes be present and there may be traces of potassium salts, whose behaviour is very similar to that of sodium salts. From the corrosion point of view the small quantities of other acid radicals present, e.g. nitrite, phosphate, iodide, bromide and fluoride, have little significance. Larger concentrations of some of these ions, notably nitrite and phosphate, may act as corrosion inhibitors, but the small quantities present in natural waters will have little effect. Some of the minor constituents have other beneficial or harmful effects, e.g. there is an optimum concentration of fluoride for control of dental caries and very low iodide or high nitrate concentrations are objectionable on medical grounds. 

A town adds 2.0 ppm of F ion to fluoridate its water supply (fluoridation of water reduces the incidence of dental caries). If the concentration of Ca2+ in the water is 3.5 X 10-4 M, will a precipitate of CaF2 form when the water is fluoridated ... 

Stannous fluoride is used in toothpastes and dental rinses to protect tooth enamel from attack by bacteria—cavities (also known as dental caries). It was the first fluoride used for that purpose, in the toothpaste Crest. 

The addition of fluoride ions to domestic water supplies (in the form of NaF) is now widespread and has resulted in a dramatic decrease in dental cavities. Fluoridated toothpastes, containing either tin(II) fluoride or sodium monofluorophos-phate (MFP, Na2FP03), are also recommended to strengthen tooth enamel. 

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