Most of oral hygiene products contain topical fluorides, for use at home by the patient.
- Fluoride toothpastes – the current recommended dose for all is 1000 parts per million (ppm), or even 1500ppm for adults at high-risk caries.
- Brushing – twice daily with a pea-sized amount of toothpaste achieves the maximum benefit.
- Rinsing – patients should not rinse the toothpaste out after brushing, but should be instructed just to spit so the toothpaste continues its contact with the teeth.
- Fluoride mouthwashes – these are available for regular use during orthodontic treatment, or for those with a high caries incidence.
- Fluoridated floss – using this allows topical fluoride application to the inter proximal areas of the teeth.
Topical applications of fluoride may also be undertaken by the dentist, hygienist, or therapist, but usually confined to high-risk patients and those with special needs, such as:
- Children with rampant caries
- Patients with medical conditions, such as hemophilia and heart defects, which would make tooth extraction dangerous
- Patients with disabilities who cannot achieve adequate oral hygiene themselves
The frequency of topical fluoride application depends on the individual patient’s requirements.
A popular method of application is fluoride gel in a special applicator tray. Many such trays are available but they all provide full coverage of the entire arch; some permit both arches to be treated at the same time. These gels are pleasantly flavoured and well tolerated by patients.
The technique has two stages, first a thorough polish is done to remove plaque, after which the teeth are washed and dried. Second, the gel is applied in the special tray for a few minutes. On removal of the tray, patients are instructed not to rinse, drink, or eat for half-an-hour. An alternative method is to paint the teeth with a fluoride varnish, such as Duraphat. As before, teeth must still be cleaned and dried first.
Roots exposed by gingival recession or periodontal surgery may become very sensitive to hot or cold fluids. Fluoride varnish is applied to such areas to relieve this cause of pain.