 Welcome back to dentistry and more. So today we have a new session on our continuation of fluorides. So today's topic is systemic fluoride. So systemic fluoride is about how fluoride is used by a person. We can use it by two methods. One is systemic root and the another one is topical roots. So today's video will cover the systemic fluorides and its methods, its advantages, the mechanism. The next video I'll be covering about the topical fluorides. So in systemic fluorides, as the name suggests, it's the root of administration in systemic. And its effect on the teeth is different compared to the topical one. So let's move on to the topic. So let's see what are the contents, how it is working and types and what are fluidization studies, coolant, salt, milk fluidization, and other supplements, shingled roots, tablates, low changes, and other things. So systemic fluorides, it provides a very low concentration of fluoride to the teeth for a longer period of time. Mostly the systemic fluoride works till six or seven years. Why? Because it affects the mineralization stages of teeth. So mineralization stages complete by seven years. That is the second molars, the second last tooth of our eruption sequence. Second last tooth is second molar. It gets mineralized by the age of six or seven. So the systemic fluoride should use this potential. After that, there is no point for systemic fluidization because it goes to a bloodstream, it enters to a bloodstream. Then this fluoride enters to the teeth while it's getting mineralized. And it gives a firm structure to the firm, hard structure to the enamel. So it becomes resistant to dental caries. That is the rational behind the systemic fluidization. So it should be before six to seven years. So once the teeth erupts, fluoride contacts the teeth through the salivary secretion. But that is a topical effect. So that is systemic fluorides. So I mentioned you about its mechanism. It goes to the developing stages of teeth until six or seven years. And it replaces a hydroxyl ion in the enamel lattice and replaces replaced with fluoride. It makes the enamel lattice more stronger. So that is the mechanism. So we have various types of systemic fluorides. The common one is water fluoration, then salt, milk and fluoride tablets. In water fluoration, we have community and school water fluoration. So it's all we are consuming inside. It enters the systemic circulation. So let's see a brief intro of all these mechanisms. Water fluoration, commonly we use one PPM, that is one parts per million. In salt or school water fluorage, it ranges from two to three PPM because the amount of water consumed by the school children will be low. And the amount of the days the children's attempt will be less compared to community water fluoration because community water fluorides supplies water to the house. So we tend to drink more water from the house than compared to the school. So to get a one PPM effect, we need to have more increase the PPM or concentration of fluoride because of the less intake in salt or school water fluoration, milk. Again, it is comparatively very less consumption than the salt or school water. So it has to be by PPM to get a one PPM net effect. And we have some other supplements like fluoride tablets, APF, sodium fluoride and other stuff. So by definition, it is upward adjustment of concentration of fluoride. So we are increasing the amount of fluoride to get an optimal level so as to give a maximum protection against dental caries. So it is upward adjustment of the concentration of fluoride in community water supply to achieve a maximum caries reduction and clinically in significant level of fluorosis. So we are giving an upward adjustment. So deflugation we'll be learning in the future videos. So that will be downward adjustment. So water fluoration is always upward adjustment. Presently the fluoride amount will be very less. So we increase the amount of fluoride. So water fluoration is one of the common delivery mechanisms because of its low or stand long range. The problem is always we need to control the PPM water and it depends on the regional temperature. If it is a hot climate or hot region, we have to give less PPM and it on a colder climate, we have to increase the PPM. So the optimal as I mentioned, it should be one PPM or one parts per million. It gives a 50 to 70% range of reduction from the dental caries. So we have seen the history of fluoride, how this fluoride evolved and ultimately reached to the water fluidation. So we have some water fluidation studies. So it proves that the water fluidation mechanism would definitely reduce the caries by 40 to 60% days. So the first two water fluidation program was started in United States in 1945. There was Grand Rapids Muskegon study, the Newark Instance, Evanston Oak Park, Grand Ford, Sarnia Stratford study and Till Brunberg study. So all these studies are very important with respect to the water fluidation. First study we need not to go very in detail about all these studies. You just need to know what time it started, what was the percentage reduction and how much duration was it. So it started in 1945 in Grand Rapids. That was the water fluidation city and Muskegon was kept as controlled. After six years, the caries reduction was 50% age compared to the control city. Okay, so that is the first study Grand Rapids Muskegon study. So always the first city will be the intervention city and the second name will be the control city. The reduction was 50% age and after six years, started in 1945, checked 1951. Okay, so the second study in Newberg, Kingston, Newberg was the intervention and Kingston was the control. It started in 1945, after 10 years, the reduction was 23.5 to 13.9% age. So the next study is Evanston Oak Park, 1946. The intervention was at Evanston and Illinois is on the New York community, Oak Park, actor as a control town. So it was 14 years of fluidation and the reduction was 49% age. So Evanston was a intervention city, Oak Park at Illinois, where the control cities. The Brandford, Sarnia, Bradford study. So Brandford was intervention was in Canada. So 1945, so Sarnia along with Stratford were kept as a control. So after 17 years of fluidation, the Brandford, Brandford and Brandford were reported, Brandford and this Stratford controls were reported, 50% age of flow over and the control. So this was the intervention. These two were the controls of 55% age of reduction of carriage was reported at intervention, that is Brandford city. Teal Coulomburg was, Teal was in study was in 1953. Teal was fluoridated, Coulomburg was kept as control and after 13 years, it was 58% age reduction in the intervention city, that is Teal. So those were the water fluidation studies. Most of the studies reported around 50 to 60% age of reduction of dental caries. So how the temperature affects this fluoride level, that is we're going to discuss. We have said the optimal level is not exactly one. It ranges from 0.71 to 1.2 because when it is very high temperature or the temperature of this area or the water is more, we have to give very less amount, that is 0.7 is fine. And now on a colder side, we have to give 1.2 PPM. So it is based on a formula, that is Galgan's formula, that is 0.34 divided by E. E is minus 0.038 plus 0.062 X temperature of the area. So we have to multiply into temperature. So E is coming at the denominator. So always temperature is inversely proportional to the amount of fluoride. So what are the prerequirements of water fluidation? So there should be some significant amount of caries in community and level of fluoride concentration should be low. There should be centralized water supply and there should be acceptance from the community and there will be huge installation and maintenance cost. So this is important because these are the three mechanisms or the equipments used for water fluidation, that is dry feeder, solution feeder and saturation method. In dry feeder, the amount, the compound such as ammonium, silica fluoride and flow spar, sodium silica fluoride is used solution feeder, hydrofluorosilicic acid. So three mechanisms. This is a mechanism used for water fluidation or the equipments, fluoride equipments, dry feeder, solution feeder and saturation feeder. How fluoride is mixed to the water, community water. So then the saturation system, the last system, what we are doing is 4% saturated solution of sodium fluoride. It is injected at desired concentration in the water distribution using a pump. So 4% solution of sodium fluoride is injected to the water. In dry feeder, the sodium fluoride or silica fluoride in the form of powder is introduced and dissolved. So here it is a solution, here it is powder. That's why dry feeder is a saturated system. And solution feeder is volumetric pump, permitting the addition of a given quantity. So we use a pump, volumetric pump and put hydrofluorosilic acid in proportion to the water of water, what we are going to treat. So this is a volumetric pump mechanism. And dry feeder is different, where we add powder into this dissolving basin and saturator is solution we inject with a pump. So what are the advantages of water fluidization? Because it can give benefit to a very large number of people because it is mixed in a community water supply. An entire city can be prevented, carries by 50% each. So it not just act systemically, but also it has a topical effect through the release of saliva. So it has definitely a systemic effect. It enters to the blood circulation and it goes to the teeth formation. Similarly, it has a saliva effect. So it always keep replenishing the lost minerals or lost fluoride from the tooth. So it has a topical and systemic effect. So fluoridation of community is the least expensive way to provide fluoride to a large group of people. So it is the least, because even though it has a very big amount of installation cost, considering the large population it serves, it becomes the least expensive way. But on the other side, we have some disadvantages and one is the ethical issue. Because ultimately, once we start a community water supply, all the people in that community are bound to drink that water. There is no choice of rejection. If I don't want to drink that particular water for any reason, I can't do that because the water supply is coming to my house and I am bound to drink that particular water. So human rights is violated here. The right to reject is violated. The ethical issues are there. And we have other modes which is not considered here. And common source of water supply, if it is not there, this is not possible. It has to be. There has to be a central supply of water. Then only this will be possible. So what we have seen is a community water supply. That is a community, a common centralized water is mixed with fluoride by any of the methods, dive feeder, solution feeder, or the saturator feeder system. And all of the community people drinking that water. The next is cool water fluidization. Now we are mixing the fluoride to the school water tank. Okay. So school water fluidization, in the beginning I told you the amount of PPM will be high because the number of hours a student spends in the school is less and the amount of water he drinks is also less. So to get a one PPM net effect, he has to drink a water with as more PPM or three, 3.5 PPM water. If he drinks, then only that one PPM net effect he would get. So usually three to four, four to five PPM. So it ranges between three, four, five. So usually these are the reasons because of the short period of stay at school to compensate for holidays and vacations. So it first started in 1954 at St. Thomas, St. Virgin Islands. So there it started. So it has to be at a higher level of PPM. So we can give four to five PPM to compensate their shorter period and holidays and vacations. So usually we give four to five, that's 4.5 times or four to five PPM. Normally it is one PPM. So that would be four or five times more. So it also gives reduction 20 to 25 to 40 percentage. So advantages, good result, minimal equipments and not very expensive. But the disadvantages, children do not receive the benefit until they go to school because they go to school by the age of five. By that time, most of the teeth are already mineralized. So we are not able to use the pre-reptive mineralization cycle. That is the ultimate aim of this systemic fluidization because we have to get fluoride incorporated into the tooth while it gets mineralized so that finishes by six years or seven years. So what if the child goes to school at five years? So most of the teeth maybe molars and pre-molars are already mineralized. The left is second molars and canines. So the major portion of the major parts or the major tooth are already mineralized. So that is one problem. And next is not all children go to the school. Some from the poor countries and towns, villages, they don't go to the school. So amount of water drink also can't be regulated. Some people drink water. Some people don't drink. Students' drinking habit is not regularized. We can't monitor it. So some people may get the benefit. Some people may not. So all these problems are there with regard of this school water fluidization. So next we have salt fluidization. Salt fluidization is started by WESPE in Switzerland in 1948. So in 1955 onwards they started selling fluoride salt. So usually sodium or potassium fluoride is mixed with salt. So it is like 90 milligram of fluoride per kilogram of salt or 250 to 350 milligram per kilogram. So it can be added by two processing known as one is batch processing and the continuous processing. So for the better caries prevention, fluoride must be present in anic form when salt is dissolved in water. That is sodium chloride. So it should be anic form. That is fluoride has to be at its anic form when the sodium chloride is dissolved in water then only the caries prevention will happen. So we can, there are essentially two different salt production process like batch processing and continuous processing. So one method is fluoride is added to the salt by spraying concentrated solution of sodium fluoride or potassium fluoride. So the solution is directly spread to the salt. Sodium fluoride or potassium fluoride we spray it on the normal salt or we have granules of sodium fluoride and calcium fluoride. So premixed granules of sodium fluoride and calcium fluoride with phosphate are added to the common salt. Either the granules are just spraying. So advantages it is safe and it does not require community water supply as in case of water fluoration we can, there's no need of any centralized supply and it has no ethical issues. If somebody doesn't want, it can reject it, it's low cost. So all these are the advantages and disadvantages. The main problem is sodium is always associated with hypertension. And there is international effort to reduce and take off sodium and there is no precise control how much salt it varies from person to person. So we cannot just regulate the amount being consumed. The next one is milk fluoration. It started by Ziegler. Salt was started by Vespy, this was started by Ziegler and both are in Switzerland. Okay. So this is like mixing fluoride into water. So it gives additional benefits because already milk has some benefits. It gives calcium and vitamin D for kids along with fluoride also will be added beneficial. Rational is nothing but the nutritional value and it gives, milk products are very good for their teeth and bones. So added benefit will be given if it is fluoridated. So how we distribute milk? We can distribute through the school system and like school milk program or such programs will be there for kindergarten or nursery schools. So either fluoridated milk can be produced like one liquid pasteurized and sterilized or powder can be mixed into this. This milk. So just like salt, continuous and batch processing is there, milk also, you can either use in a form of liquid or powder. So all these are the products which can be used, calcium fluoride, sodium fluoride, isodium monofluorophosphate and isodium silicofluoride. So after that we have fluoride supplements like tablets, drops, lozenges, so these are not commonly available over the counter but can be prescribed by a dentist or pediatrician. So it has to be, these all are supplements, most commonly used is sodium fluoride. It has to be at a range of 0.25 milligram or 0.5 milligram or one milligram and they should be taken on a daily basis. So this is a chart which we can, which can be used to calculate the amount of fluoride be given to a particular child. So this is the amount of fluoride existing in the fluoride water, that is the water which we drink or the child drinks. So if the particular child drinks water with a amount of less than 0.3 ppm and his age is less than six months, we don't need to supplement anything. And if the age between six months to three years, we can give 0.25 gram additional and up to six years, 0.5 gram and six to 16 years, one gram we can give additional. And if the water supply is less than six ppm and greater than 0.3 ppm, we don't need to supplement up to three years, three to six years we can give 0.25 and six to 16 years we can give 0.5 gram supplement additionally. If the water drinking water has more than six ppm, we don't need to supplement fluoride for that particular child. So there are so much benefits for these tablets, losenges and drops which gives a reduction 16 to 65% age because it has both systemic and topical effects. We should always take precautions because of the toxicity because toxicity will be covered in detail on the next video. So that's all about fluorides that is systemic fluorides. I was explaining about the various fluidization studies and various mechanisms. Studies were important and why and how this is getting into this tooth lattice at what age it gives the protection to six years why systemic fluoride works. Beyond that it won't have any much effect because teeth mineralization of tooth will be completed almost two second molar completed by six to seven years. So why this fluoride ppm is different for water fluoridation and salt or milk fluoridation? This is community water fluoridation as one ppm but school this salt milk has four to five ppm because the amount and duration of consumption is very different compared to community because community we will be drinking 24 by seven unlike school salt or milk fluoridation and various studies. We have many studies all we need to remember the intervention city control city the year, the duration and the percentage of protection. Then the fluoride equipments how we add fluoride into community water supply that is dry feeders solution feeder and saturated methods and various advantages and the disadvantages for water fluoridation will be four to five ppm that is four or five times greater and why the reason it was started in 1954. Next is salt fluoridation and batch process and continuous process. It's advantages and disadvantages milk fluoridation. It's advantages and liquid and powder application and various methods, droplets, lozenges and tablets it should be daily taken and this table given by American Dental Association drinking water has dismissed ppm. We should supplement this amount of ppm to get maximum protection against tender carries. Okay, so that's all about system fluoridation and system fluoridation. The unfortunate part is nowadays very few countries are following system of fluoridation because researchers has confirmed that the net effect of water fluoridation and topical fluoridation is almost same. The carries reduction is almost same for water fluoridation and that is system fluoridation and topical fluoridation. System fluoridation requires a lot of installation charges where topical fluoridation can be achieved by a single toothpaste. So why to waste so much investment time and manpower for community water fluoridation and it violates human rights. So from 1970 onwards, most of the system in fluoridation that is community water fluoride plans were closed because of the ethical issues and installation and maintenance charge. And nowadays, the topical effect is more concentrated than the systemic effect because most of the time we think about systemic effect but nowadays the researchers are stressing on the topical effect because to always keep a amount of fluoride in the saliva and GCF that gives a continuous protective effect against carries than the systemic effect. But that was a very recent invention but still 1970 was believed that the water fluoridation was the best method and that's all about systemic fluoridation. So I'll come up with topical fluoridation on my next video. So thank you.