Fluoride( 氟化物 )陳弘森 副教授高雄醫學大學兒童牙科07-3121101 轉 7008, 7020hosech@kmu.edu.tw

學習目標 氟化物的來源 氟化物的代謝 氟化物的毒性 氟化物的應用

學習資源： Murray JJ: Appropriate use of fluoride for

human health. WHO, Geneva, 1996

FluorideFluorine

氮 Nitrogen N 拉丁文 nitrum = 硝石 1772

氧 Oxygn O 希臘文 oxy-genos = 造成酸的

1774

氟 Fluorine F 拉丁文 flurre = 流動 1886

氛 Neon Ne 希臘文 neos = 新的 1898

氟化物 (Fluoride)

Fluoride geochemistry 鹵素族第一個 陰電荷最強的元素 佔地球元素地 17 位 (0.03%)

In minerals

Fluospar (fluorite) CaF2/ 氟石 Cryolie (greenland spare, icetone)

Na3AlF6/ 冰晶石 Fluorapatite Ca5(PO4)3F/ 氟磷灰石

In foods

China tea( 中國茶 ) Chicken( 雞肉 ) Fish( 魚肉 ) Taro( 芋 )

Metabolism of fluorideBy oral

↓

Hydrofluoride acid (HF)

(Passive diffusion)

↓

Fluoride in blood(plasma)

↓

Ionic form, No ionic form

↓

Soft tissue Bones, teeth

↓

Sweat , Saliva , Breast milk Digestive juice, Urine ,stool

Organic fluoride(Inhalation anesthesia)

Halothane

Methoxyflurane

Enflurane

↓

Excreted unchanged in expired air

Toxicology of fluoride

Acute toxicity

1. Chemical burn (ulceration / necrosis)

2. Inhibit enzyme (protoplasmic poison)

3. Binds calcium (nerve action)

4. Hyperkalemia (cardiotoxicity)

Gastrointestinal

Nausea , Vomiting Diarrhea , Cramps Abdominal pain

Blood chemistry

Acidosis Hypocalcemia hypomagnesemia

Cardiovascular system

Week pulse Hypotension Pallor , shock Cardiac irregularities Utimately failure

Neurological

Paresthesia , Paresis Tetany , Coma CNS depression

Treatment

Immediate treatment Induced vomiting Protection of stomach Maintaince of blood calcium

Danger

Acute lethal dose 50 mg/kg Acute early symptoms (3 mg/kg) of 5

years old child(BW 20kg)

Chronic toxic dose

Dental fluorosis Bone fluorosis

Table4 □ Toxic effect of chromic excessive fluoride ingestion

Effect Dosage Duration

Dental fluorosis > 2 times optimal Until 5 years of age (excluding 3rd molars)

Skeletal fluorosis 10-25 mg/day 10-20 yrs

Kidney damage* 5-10 mg/kg 6-12 mos

* In animals

Dental fluorosis

Bone fluorosis

Dental benefits of fluoride

Prophylaxis of dental caries Treatment of sensitive dentine Treatment of various bone disease

Systemic

Drinking water Tablet salt Milk Tablets Drops

Topic

• Toothpaste

• Mouth rinses

• Painting solution

• Varnishes

• Sucking tablets

• Chewing gum

Table3. DIFFERENT WAYS TO DELIVER FLUORIDE

F Concentration Frequency of Application

Water fluoridation Optimal 1 ppm Continuously

Fluoride toothpaste 500~1500 ppm Twice daily

Fluoride tablets 0.25~1 mg/tablet Daily

Fluoride drops 1000~2000 ppm Daily

Rinsing solutions 250~1000 ppm Daily

Salt fluoridation 250~350 ppm Continuously

Milk fluoridation 7.5 ppm At school

Concentrated solutions 10,000 ppm Biannual

Concentrated gels 4000~12,300 ppm Biannual

Lacquers 1000~22,600 ppm Biannual

1. Improve resistance of enamel

2. Elevated rate of maturation

3. Remineralization of incipient lesion

4. Interference with microrganism

5. Improve tooth morphology

Ｈ＋ + F-

Ｈ F

ＨF

Ｈ＋ + F-

pH7 Ｈ＋ + F- Ｈ F

pH 4.5 Ｈ＋ + F- Ｈ F

Fig. 6. Schematic representation of fluoride entering a bacterial cell in the form of HF at lower pH values, dissociating, and thereby providing H+

and F- ions inside the cell.

2% neutral sodium fluoride (0.9% fluoride ion)

8% stannous fluoride (2% fluoride ion)

2.8% acidulated phosphate fluoride (1.23% fluoride ion)

Recommended application techniques

1. Paint ─ on technique

2. Tray technique

3. Topic electrolytic application

Mouth rinse solution

0.2% NaF / week

0.05% NaF / day

超氟牙膏： 1000 ppm 以上 含氟牙膏： 800-1000 ppm 低氟牙膏： 500-800 ppm 兒童含氟牙膏： 250-500 ppm

Zymafluor 0.25mg / Tab

100 tablets / Bot

◎ Journal of the American Academy of Pediatric Dentistry, Special Supplement 1995-1996, Vol.17, No. 6, P.24.

飲水氟含量

年齡

<0.3 ppm 0.3 – 0.7 ppm >0.7 ppm

出生 6 個月 ~ 3 歲 0.25 mg 0 0

3 ~ 6 歲 0.5 mg 0.25 mg 0

6 ~ 16 歲 1 mg 0.5 mg 0

Name Johnny Jones .

Address 128 Peaks Street Age 5 .

Buchanan, Virginia .

Rx Sodium Fluoride Tablets, 2.2 mg

(1.0 mg F)

Dispense 120 tablets

Sig. One tablet each day: chew and swish for one minute before swallowing or allow to dissovle in mouth.

Signed Robert L. Smith, D.D.S.

Duraphat®

Fluoride varnish

The outstanding preparation for

topical caries prophylaxis and

treatment of hypersensitive necks

of teeth

Water fluoridation

Powder type

Sod. fluorosilicate 氟化矽鈉 Sod. fluoride 氟化鈉

Liquid type

fluosilicic acid 矽氟酸 (H2SiF6)

1ppm[F-] = 1 mgF/l

= 1mgF/kg

= 1x10─4 %F

Water fluoridation

Growth & development Cancer death rate Down’s syndrome Mortality rate

Magnitude of increase between asymptomic and lethal dose levels of four well-know substances

Morphine Sulfate(mg)

Salicylate(g)

Digoxin(mg)

Fluoride(mg)

Asymptomic 0.3 0.1 0.1 0.1

Therapeutic 1.6~3.0 0.3~3.6 1.0 1.0

Toxic 30~60 7~13 1.2 264

Lethal 200~400 30~40 2.5 2500

% NaF x 1/2.2 = % F

% Na2PO3F x 1/7.6 = % F

% SnF2 x 1/4.1 = % F

How many ppm in 2.2% NaF (Na=23,F=19)

2.2 x ( 19 / 23 + 19 ) = X ppm .

100 1000000

X = 9952 ppm

結論 從這個課程可了解氟化物的抗齲齒作用在牙科公衛上所扮演的角色

Thanks for your listening!

中興新村 草屯

0.07ppm 0.08ppm

0.6ppm 未添加減少 40% 增加 19%(3 歲

組 )

前者較草屯減少 66% (12 歲組 )

Effectiveness of Various Modes of Administering Fluorides in Improving Dental Health

Mode Concentration of Dose % Reduction in Dental Caries

Remarks

Community water fluoridation 1 ppm (1 mg/liter)* 55-70 Continues into adult life

School water fluoridation 4.5 ppm (4.5 mg/liter)* About 40 Only for school age children

Topical application 2% NaF solution 8% stannous fluoride1.2% acidulated phosphate fluoride, or gel

30-40 For children of all ages

Mouth rinse: Home or school rinsing daily Supervised school rinsing weekly

0.05% NaF0.2% NaF

20-50 Probably more effective under supervision

Tablets 2.2 mg NaF↑ 20-40 Effective in supervised school distribution: chew, swish, and swallow

Drops 2-2.2 mg NaF total of 4-12 drops

Probably same as tablets

Latitude in partial doses

Dentrifices 0.4% stannous fluoride, 0.22 % NaF, 0.76% Na monofluorophosphate

15-30 Adults and children: may be used in fluoridated areas

* Dosage in a temperate climate.↑ No vitamin fluoride mixtures have been accepted by the ADA Council on Dental Therapeutics because they lack flexibility in altering fluoride dosage.