Fluoride

The use of fluoride in caries prevention has been studied for over 100 years. Its safety and efficacy has been studied extensively over this time period, and water fluoridation became routine in many cities to reduce cavities. There have been a lot of studies and discussions on the use of fluoride for remineralization. When looking at the structure of enamel and understanding the crystalline structure is comprised of hydroxyapatite and fluorapatite crystals, helps one to appreciate the strength and beauty of this structure. Fluorapatite is more structurally and chemically sound than hydroxyapatite making it more resistant to decay.¹⁶ Knowing this piece of information naturally motivates us to recommend the use of fluoride.

Utilizing fluoride varnishes for the orthodontic patient is beneficial for a variety of reasons. Fluoride varnishes are considered easy to use and safe as well as having substantivity. Varnish was first available in Europe in 1960, and did not receive FDA approval in the United States until the late 1990’s. This approval was originally for sensitivity in adults; although a lot of recent data has shown it more effective than older technologies in decay prevention.¹⁷ One of the wonderful benefits of fluoride varnish is its ability to have a longer contact time with the tooth due to its varnish effect. It has been discovered a high level of fluoride is released from fluoride varnishes during the first 24 hours after application.¹⁸ Several types of orthodontic cements are glass ionomer based and have the ability to release fluoride into the enamel. It is important to have fluoride applied to these areas to recharge the cement providing continual fluoride release in areas more prone to decay at the parameters of orthodontic brackets and bands. Obviously, providing a more flowable varnish is ideal. There are liquid varnishes available to provide flowability in these caries susceptible areas.

The apatite compound contains calcium and phosphate. Therefore, replacing these chemicals will assist in the process of remineralization and rebuild the apatite crystalline structure. Some remineralization products contain a combination of fluoride with calcium phosphate and have been found to be significantly more effective in remineralization than fluoride alone. In one particular study the remineralization depth of 1150 ppm F dentifrice was comparable to 500 ppm F plus functional tricalcium phosphate (fTCP) dentifrice. Respectively, the amount of fluoride was less, but with the addition of the fTCP, the remineralization depth was the same.¹⁹

Comparative studies of acidulated phosphate fluoride (APF) oral rinses and neutral sodium fluoride in orthodontic patients with fixed appliances have proven that the APF oral rinse was more effective in reducing gingivitis and preventing white spot lesions over a six-month period. Therefore, it can be concluded that adding an oral rinse to the prevention regimen for the orthodontic patient would be beneficial in maintaining oral health.²⁰