Fluorides

yeah hi everyone uh today I'm just going to cover the fluorides uh I mean it's all about the numericals of the fluorides uh first of all um as I was discussing yesterday uh I mean the ma the majority of the tooth structure either in the anamel or in the Dentin that is hydroxyapetite whenever it reacts with the fluoride it's going to form fluo hydroxy right so uh the molecular size of this hydroxyapetite will be like this and floro hydroxyde will be like this means it will be larger in size and it requires more acid for the dissolution or the floro hydroxy is more resistance to the acid dissolution when you compare with the hydroxyapetite as already discussed the normal critical pH is 5.2 to 5.5 for the hydroxyde where the critical pH for the fuoh hydroxyde is 4.2 to 4.5 so these are the basic things okay so if you go in detail um uh coming to the advantages of the fluoride the fluoride has two main to the tooth okay or related to the decay of the teeth first of all uh they causes uh remineralization lost it will come back second one is it inhibits the demineralization okay I think you are very clear it inhibits the demineralization and it it promotes the remineralization so when compared with these two properties remineralization is more rather than the demetalization so uh they can ask a question which of the following is more faved whether it's rem metalization or demetalization means the answer is rization is more when compared to that of the demetalization if if it is related to the fluorides and they can ask a question like if you take it as an anterior your teeth fluorides okay higher concentration of the fluorides are present at the incisal area when compared to that of the cervical okay this is one one more important point that you have to make a note okay so moving to the second part uh it's all about like one of the important factor the fluoride is going to act or the enzyme ANS okay an at a PPM of 50 PPM 50 PPM it's going to act on the enzy anolas so in in such a way that it's going to uh affect the bacteria also I mean the bacterial cycle also it affects by inhibiting the enzyme anoles which is one of the important enzyme that helps in the I mean that is involved in the carbohydrate metabolism okay so this is one of the important point that you have to make a not and apart from this you have to make a note about the two formulas which are frequently asked one is Flor reptite that is CA 10 P4 6 F2 and second one is cryolite cryolite is na3 Al F6 so please make a note of these two because these two are most commonly asked and one of the major effect of NF okay NF is used as a tropical asent and it causes chalking effect chalking effort is nothing but whenever NF is applied it's going to react with the calcium that is present and once it's going to react with the calcium it's going to cause a chalking effect means uh it it doesn't allows the next fluoride to enter Because it forms a layer of layer with reacting with the calcium that is present and it forms an layer over it and it does not allow so this is most commonly seen with NF tropical application so moving on for this I just want to cover few important things about the fluorides that is absorption of the fluorides generally takes place with the stomach and small intestine that is passive so absorption of the fluorides is a stomach and small intestine and absorption of fluorides is very rare through skin I hope you are very clear so coming to the absorption of the Mercury so similarly they will ask questions related to the mercur in operator so absorption of the Mercury is very high in lungs and it is least in kidneys so these are the questions these are most commonly asked questions absorption of the fluoride occurs mainly to the stomach and the small intestine in the form of passive way absortion of the fluorides is very rare through the skin absor of the Mercury is high through the lungs and absortion of the mercur is least through the kidney okay so next is uh coming to the excretion of the fluorides fluides uh excretion takes place through urine feces milk tears and sweat and the stor is is places with calcium bone and teeth they are the one which has calcium so bone and teeth are the areas of the storage of this fluides so moving on to the next part uh we know that the fluorides also transform through the placenta okay they are transferred through the placenta they transferred through the milk I mean they exted in the milk and fluorides in blood is again an important McQ fluorides in the blood are in the range of 3 to 4 and 1/4 3 to 4 will be present in the plasma and 1/4 are present in the RBC so they can ask a question which of the following component of the blood has majority of the fluorides in it that is a plasma plasma has majority because 34 will be in the plasma so next is community water fluoridation in that they can ask question like 100% of community water fluoridation are found in which of the following countries the answer is Hong Kong and Singapore and the First Community water fluoridation they will ask a question this is one of the most commonly asked question Grand Rapids here is very important 1945 Jan 25th and it is called as a 22 cities study I hope we are very very clear with the stuff that is discussed until now and from now I'm just going to stick on only to the uh numerical part okay so uh I mean uh this community water fluoridation wh in 1917 they have uh announced with a range of 0.7 to 1.2 PPM and in the year 1994 with a range of 0.5 to 1 PPM so adding a note about the school Water fluoridation School water fluoridation the increasing in the PPM of 4 to six times normal this is the normal range whereas in the school water fluoridation it is increased to four to six times than the normal because the exposure time for the children in the school is less so they increase the PPM so that's what and uh the first uh the first uh I mean uh the first uh place where the school water FL radiation was started was St Thomas where China is lands in the year 1954 okay I hope you are very clear with this wh1 in the 1971 if they mention specifically you need to go for this if they mention 1994 you can go for this if they don't mention you can go for any of these ranges that 0.5 to 1 PPM and why there is a range is like in the winter they drink less water so more PPM is required in the summer they drink more water so less PPM is required so that's the reason as Co water fluoridation there is four to six times more because there will be less exposure time and the first place where the school water fluoridation was done was St Thomas Virgin Island in the year 1954 I hope you're very clear moving next okay and uh you need to make a note about the milk fluoridation next truly speaking milk is not a good Agent uh to provide fluoride because it's going to react with the calcium calcium is one of the thing that inhibits the absorption of the fluoride and uh first introduced by Zer and uh First Community milk water fluoridation scheme was introduced in the place like belgia in the year 1988 so preschoolers preschool children in the a of 3 to 5 years they have a they have we have to provide 0.9 sorry 0 .4 Mig whereas cool people age of 6 to 9 years how to provide 0.7 Mig all these are mcqs milk FL flation is not uh recommended because calcium is the one that it's not a correct vehicle for the uh fluorides and the place it was introduced by it was introduced I mean the scheme was first introduced in the year and in the place what are the values that you have to Mo preschool 3 to 5 they they're going to mention mly on the on this a okay School 6 to 9 these are the ranges that you have to follow next coming is the salt salt fluoridation uh it was introduced by W it was introduced in Switzerland salt in the form of NF or KF or cf2 is provided so logically you have to give five 1.5 mg for 5 G of salt mean simply they're going to ask question like what it's going to be for 1 kg right so you're going to convert 5 G 5 G of so contains 1.5 mg of a fluoride so what it's going to be for one case simple so initially uh you have to give 90 mg per 1 KC I mean initially they used to do and now uh the recommended you need to go with these value this is more important now the recommended is 200 to 250 mg per kg of salt I hope you are very clear introduced by introduced in the place introduced in this form NF KF cf2 1.5 mg per 5 G of salt initially they used to give this now the recommended value is this this is this is very important okay so we're done with the salt now we are moving to the next part this is one of the very important this is actually a table that's give that's going to give about the supplement doses that is required I hope you guys know this 0.3 0.3 to0 birth to 6 month months 6 months to 3 years 3 years to 6 years and grer than 6 years so this is a table I think this table is most common that everyone of us knows so I'm just going to uh deal few important things majority of the things will move around this table in the florex they they are they they all to ask questions on this okay let's make it very simple uh you remember this the PPM of the fluoride drinking water is 0.3 less than 0.3 PPM of fluoride in the range of 0.3 to 0.6 PPM greater than 6 0.6 PPM so these are the ones here 0 to 6 months 6 months to 3 years 3 years to 6 6 years so last column is everything zero 0 0 0 0 First Column first one is zero second column 1 2 or zero 1 is Zer 1 2 Z all are zero so these are the things and here 0.25 0.50 1 same 0.25 0.50 clear 0 1 0 1 02 0 all are zeros 0.25 0.50 just an increase 0.25 double 0.50 double 1as cross is same they ask they're going to give an information that this is the AE of a particular child and this is the water fluoridation that is present what is the additional fluoride that is required this is the answer I just want to make it in a word format a a of three a or four years of child approach the department and they gives a history that uh uh I mean they have undergone the analysis of the water that is present and the water has a PPM of 0.4 PPM of the fluide what is the additional doses that is required clearly mentioned age is this 4 years will come under this Ro and the column is 0.4 PPM so in the range of 0.3 to 0.6 the additional fluide requir is 0.25 one more question I'm going to ask a 10 years child approach the department and they gives a history of the Water Analysis Community water which has a PPM of 0.8 0.8 is greater than 0.6 and this is the AE age of 10 years greater than so if it is like 0 greater than 0.8 there is no need of any floride supplementation so no need of flid supplementation the answer is zero the questions will be like this we'll move around I hope you're clear with this and next uh few comparisions uh when compared to that of the erupted teeth unerupted teeth will observe 8 times more fluoride when comp fact that the primary teeth and permanent teeth primary teeth absorbs two times more fluoride when compared with the defective enamel and normal enamel defective enamel absorbs more fluoride defective Dentin absorbs more fluoride okay so these are the few things that you have to make a note erupted teeth unted teeth unerupted teeth absorbs eight times more fluoride primary teeth and permanent teeth primary teeth observes two times more fluide defective enamel or defective Dentin or defective cementum when compared with the normal structures they absorb more fluoride okay done it's clear so now uh I'm just going to cover as much as numericals as possible so these are the most commonly asked numerical the first is uh fluoride toothpaste fluoride paste is Contra is indicated only after 4 years fluoride mouth wash after 6 years and fluide tablets after 1 and half year or you can go for 18 months so these are the important values fluoride past are indicated are indicated or prescribed to the patients only after 4 years mouthwash only after 6 years tablets only after one and half year hope you're clear with this so next important point is like human milk the fluoride that is present is 6 to 12 mg per ml PPM of seafish is 10 to 20 PPM very clear human milk 6 to 12 mg per ml seafish 10 to 20 PPM so the next is uh is going to be some some some stuff related to the toxicity so the toxicity I'm just going to uh cover the numericals that is acute toxicity the value is 35 to 70 Mig of the fluoride per kg body weight or it can be 5 to 10 G of NF so values that you have to make a note is M that is minimum minimum toxic doses the minimum toxic doses is 2 mg of fluoride per kg weight second one is probable toxic doses probable toxic doses is 5 mg of fluoride per kg weight third one is safety SA safely tolerable doses the safely tolerable doses is 1.25 to 2.50 G of Naf or 8 to 16 mg of fluoride for kg body weight and to be it is almost of the certainly lethal doses CL certainly lethal doses we discussing now this this is C is called as name certainly lethal doses I already said it is four times it is 1/4 means four times so it is four times means uh the value is 5 to 10 G of NF or 32 to 64 mg of fluoride per KGB okay so please make a note acute 35 to 70 mg of fluoride per kg body weight or 5 to 10 Mig of NF minimum toxic doses that is 2 g 2 Mig of fluoride for kg body weight prop toxic doses 5 mg of fluoride for kg body weight safety tolerable doses which is 1.25 mg 25 to 2 or 8 to 16 mg of fluoride for 1/4 of the CD c is nothing but certain lethal doses which is 5 to 10 G of NF or 30 2 to 64 mg per the kg body weight so the plasma half life plasma half life of fluoride is 4 to 10 hours and the plasma concentration is 0.15 to 0.25 PPM and the renal renal clearance is 35 mg per minute duration of plasma concentration is 30 minutes dry tea leaves the PPM is 100 to 400 p PPM an AML 2,200 to 3,200 PPM pulp 100 to 650 PPM I'm just going to repeat again plasma half lifee of the fluoride is 4 to 10 hours plasma concentration of the fluoride is 0.15 to 025 PPM renal clearance of the fluoride is 35 Mig per minute duration of the plasma concentration is 30 minutes dry tea leaves 100 to 400 PPM enamel 2,200 to 3,200 PPM pulp 100 to 650 PPM so next is cementum is the highest among all the dental structur that is 4,500 PPM salav glands 0.05 to 0.07 p we have covered uh dry tea leaves they regularly ask for the tea also normal te is 97 PPM and DED tea leaves is in the range of 100 to 400 PPM Dentin is 200 to 300 PPM shellfish is 10 to 20 PPM Dental plaque is 15 to 64 PPM okay uh clear cementum is 4,500 highest among all the dental structures salivary glands is 0.05 to 0.07 PPM normal te is 97 dry tea is 100 to 400 Dentin is 200 to 300 shellfish is 10 to 20 PPM Dental plaque is 15 to 64 PPM now is mouthwash required 2 percentage of NF the PPM is 9,000 PPM so they can ask next like what is 0.2 percentag NF by 10 so it is 900 PPM so this is generally recommended weekly okay so they can ask 0 point 05 NF you have to convert 2 percentage is 9,000 what is 0.05 NF 0.05 NF is 225 PPM which is given daily so next is 0.025 NF that is generally given for the fourth night so these are the values weekly how much amount of the NF is required 0.2% daily how much NF requires 0.0 5 NF fourth night how much amount of NF required 0.0025 NF they can ask like like in the terms of ppms amount of NF in terms of PPM that should be given for weekly that should be given for daily simple okay let's make it very simple so last but not the least I'm just going to cover what is 1 PPM of fluoride 1 PPM of fluoride is nothing but 1 mgram per kg of material it may be paste or anything I mean it is weight it is 1 mg per kg weight so another terms is like what is 1 PPM one part per million or it can be 1 mg per liter in terms of liquid is 1 Mig per liter in terms of weight it is 1 mg per kg of paste I hope you're clear with this so next I want to cover element fluoride I hope you know the atomic number of the fluoride that is nine so element fluoride was uh discovered in the year 1931 and the person associated with this is Churchill n technique defluoridation technique you know in the year 1975 so moled anamel is a term that is used for the fosis in the year 1901 by macki so these are the few uh things that you have to make a note uh I hope I have covered as much of stuff as possible uh relevant to the florid I mean then I just want to add the percentage of decrease of the carries in community water fluoridation is 60% and in school water flu radiation is 25 to 40% is okay so areas of I mean emic areas of fluoride in India are 5% so I'm done with the fluorides thank you and signing off stre from MDS conquer