Different fluoride formulations

[Kareful]

From dentifrices to topical gels and varnishes there are numerous marketed vehicles for delivery of fluoride to the tooth surface. There are also many different forms of fluoride as well (NaF, SnF2, APF, Na2PO3F, etc.). My main question resolves around APF or acidulated phosphate fluoride. That is, why is this product used if the pH of the material is below that of the pH that causes demineralization of enamel? I understand that one of the reasons was that at this particular pH more fluoride is incorporated into the biogenic apatite lattice, but does its relative acidity not contribute to the dissolution of the ions from apatite? Curious as to what thoughts are from current dental professionals, residents, or dental students.

I also am wondering how much do dental schools teach you about the action of restorative dental products on the chemical level? I mean, should not our education be more on mitigating the prevalence of oral diseases rather than patching someone up with a filling/root canal/crown/implant and sending him/her on their way?

The only reason I ask, is because the proprietary information of these companies who produce these products is really hindering me finding out specific details for my thesis. Thanks in advance! K

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[KillaCam]

In regards to acidity, there has to be an acid in that formula below that critical pH <5.5 in order for hydroxyapetite to have some level of dissolution for fluoride to incorporate into this matrix to make the ever so strong fluorohydroxyapeptite. There is no way to get this stronger compound deeper (although not that deep) into the tooth (rather than just very superficially). Schools definitely teach about the chemical and biochemical aspects of restorative materials, preventative chemicals and such, but you don't use this info in everyday practice in order to get things done on a mechanical level. Also, to be quite honest, if everyone was so heavy into prevention in their practice there would be less work to do, less money to be made. Not saying that education is not given in offices about prevention and such, just saying that someone may not take 10 min to talk about these things in a thriving busy practice when that time can be spent making money doing another filling/extraction/ect.

Westside bestside

 

[Kareful]

In regards to acidity, there has to be an acid in that formula below that critical pH <5.5 in order for hydroxyapetite to have some level of dissolution for fluoride to incorporate into this matrix to make the ever so strong fluorohydroxyapeptite. There is no way to get this stronger compound deeper (although not that deep) into the tooth (rather than just very superficially). Schools definitely teach about the chemical and biochemical aspects of restorative materials, preventative chemicals and such, but you don't use this info in everyday practice in order to get things done on a mechanical level. Also, to be quite honest, if everyone was so heavy into prevention in their practice there would be less work to do, less money to be made. Not saying that education is not given in offices about prevention and such, just saying that someone may not take 10 min to talk about these things in a thriving busy practice when that time can be spent making money doing another filling/extraction/ect.

Westside bestside

So in your words, the acidic component is necessary for this composition just to incorporate fluoride into a superficial layer of apatite? Would not the low pH dissolve more enamel than is precipitated back as fluoroapatite/fluorohydroxyapatite? Also, whose to say that bound fluoride (fluoride in the place of hydroxide) should be the goal if it means applying acidic materials to the tooth surface? I mean, unbound fluoride in the form of CaF2 is really what contributes to the antibacterial claims of fluoride treatments anyways. If the pH of the mouth is going to decrease sooner or later due to diet than why not have a thin film of CaF2 that will be dissolved and taken up by the enamel/dentin anyways. It just seems like a lot of the basic science is skimmed over in the literature and too much is assumed, from my research anyways.

Well, that seems to be a problem. More cavities, more money! Who cares about oral health, right? I just want to drill and fill and make that dough. I haven't taken ethics, but that seems like an issue.

 

[schmoob]

So in your words, the acidic component is necessary for this composition just to incorporate fluoride into a superficial layer of apatite? Would not the low pH dissolve more enamel than is precipitated back as fluoroapatite/fluorohydroxyapatite? Also, whose to say that bound fluoride (fluoride in the place of hydroxide) should be the goal if it means applying acidic materials to the tooth surface? I mean, unbound fluoride in the form of CaF2 is really what contributes to the antibacterial claims of fluoride treatments anyways. If the pH of the mouth is going to decrease sooner or later due to diet than why not have a thin film of CaF2 that will be dissolved and taken up by the enamel/dentin anyways. It just seems like a lot of the basic science is skimmed over in the literature and too much is assumed, from my research anyways.

Well, that seems to be a problem. More cavities, more money! Who cares about oral health, right? I just want to drill and fill and make that dough. I haven't taken ethics, but that seems like an issue.

Because the fluoroapatite lattice structure reduces that critical pH from around 5.5 to 4.5. That's a 10-fold increase in dissolution resistance. Dentin is much less resistant because it is mostly collagen, so the goal is to keep that decay from passing the DEJ.