fluoride supplements

Therapeutic Classification: dental caries prophylactic agents

Pharmacologic Classification: minerals electrolytes

Indications ⬆ ⬇

REMS

Prevention of dental caries in children where insufficient fluoride is available in drinking water.

Action ⬆ ⬇

Fluoride becomes incorporated into bone and teeth, where it serves to stabilize crystalline matrix. It promotes remineralization and may retard the growth of dental plaque. The presence of fluoride on the enamel surface of teeth promotes resistance to acid and prevents caries by interrupting the cariogenic microbial process.

Therapeutic effects:

Decreased incidence of dental caries in children.

Pharmacokinetics ⬆ ⬇

Absorption: Topical fluoride is taken up by enamel and plaque. Acidulated solutions are taken up by enamel to a greater extent than neutral solutions. Well absorbed after oral administration.

Distribution: Stored in bone and developing teeth. Readily crosses the placenta; small amounts enter breast milk.

Metabolism/Excretion: 50% excreted unchanged by the kidneys. Small amounts excreted in feces and sweat.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	30–60 min	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Dietary sodium restriction;
Where fluoride in drinking water exceeds 0.7 parts per million (ppm);
Some products contain tartrazine and other additives; avoid use in patients with known intolerance;
Children <3 yr or when fluoride in drinking water exceeds 0.3 ppm (for 1 mg tablets);
Children <6 yr (for 1 mg/5 mL rinse).

Use Cautiously in:

Situations in which fluoride content of water is not known.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: atopic dermatitis

GI: nausea, vomiting

Misc: mottling of teeth (toxicity)

Interactions ⬆ ⬇

Drug-drug:

Products containing calcium, aluminum, or magnesium decrease absorption.

Drug-Food:

If taken concurrently withdairy foods, calcium fluoride will form and fluoride will not be absorbed.

Route/Dosage ⬆ ⬇

Oral Fluoride—Fluoride Content of Drinking Water 0.3 ppm

PO (Adults and Children >16 yr): No supplementation.
PO (Children 6–16 yr): 1 mg/day.
PO (Children 3–6 yr): 0.5 mg/day.
PO (Children 6 mo–3 yr): 0.25 mg/day.
PO (Children <6 mo): No supplementation.

Oral Fluoride—Fluoride Content of Drinking Water 0.3–0.6 ppm

PO (Adults and Children >16 yr): No supplementation.
PO (Children 6–16 yr): 0.5 mg/day.
PO (Children 3–6 yr): 0.25 mg/day.
PO (Children <3 yr): No supplementation.

Topical Fluoride

(Adults and Children >12 yr): Dental rinse or gel–10 mL/day. (Prevident and Fluorinse are used once weekly.) Cream: brush teeth with cream once daily. Lozenge: 1 lozenge daily.
(Children 6–12 yr): Dental rinse or cream–5–10 mL/day. (Fluorinse is used once weekly.) Cream: brush teeth with cream daily.

Availability ⬆ ⬇

(Generic available)

Generic available for chewable tablets only. Amounts listed as fluoride content

Tablets: 0.25 mg; 0.5 mg; 1 mg
Chewable tablets: 0.25 mg; 0.5 mg; 1 mg
Drops: 0.125 mg/drop; 0.25 mg/drop; 0.5 mg/drop
Lozenges: 1 mg
Solution: 0.2 mg/mL
Rinse: 0.01%^OTC; 0.02%^OTC; 0.04%^OTC; 0.09%
Cream: 1.1%
Gel: 0.1%^{Rx, OTC}; 0.5%
Gel drops: 0.5%

Assessment ⬆ ⬇

Examine teeth for staining or mottling periodically. Notify dentist if this occurs.

Implementation ⬆ ⬇

Drops may be administered undiluted orally or mixed with food or fluids.
Do not administer sodium fluoride within 2 hr of milk or other dairy products; will cause decreased absorption of sodium fluoride.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take fluoride supplement as directed, according to directions included with each preparation.
Rinses and gel are most effective if used immediately after brushing or flossing and just before sleep. Instruct patient to expectorate any excess; do not swallow Patient should not eat, drink, or rinse mouth for 30 min after application.
Instruct patient to use dental cream in place of toothpaste and brush teeth for 2 minutes, preferrably at bedtime.
Advise parents to keep fluoride out of reach of children.
Encourage patient to have routine dental examinations to monitor dental hygiene.

Evaluation/Desired Outcomes ⬆ ⬇

Prevention of dental caries.

US Brand Names ⬆ ⬇

sodium fluoride (oral): Flura-Drops, Luride, Pharmaflur, Phos-Flur,

fluoride (topical): ACT, Fluorigard, Fluorinse, Gel Kam, Gel-Tin, Prevident, Stop, Thera-Flur

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Pronunciation ⬇

Classifications ⬆ ⬇