reductions of 50-70% have been reported in Scandinavian studies.
Slow-release fluoride devices
Many dental materials like amalgam, composites, cements, acrylics, and fissure
sealants have had fluoride added, but the fluoride release was either short term or the
properties of the materials were adversely affected, to make them of any use to
provide a long-term source of intraoral fluoride. Glass ionomer cements are a group of
materials that have fluoride, but long-term release is debatable. Some researchers
have reported that these materials have a fluoride 'recharging' capacity. That is when
the fluoride is released from the material it later takes up fluoride from other dental
products that are used by the patient, for example, fluoride toothpaste or mouth rinse,
and this fluoride is released at a later time. The very latest fluoride research is with
slow-release devices. The objective is to develop an intraoral device that will release a
constant supply of fluoride over a period of at least a year. The fluoride glass slow-
release devices (255HFig. 6.17) were developed at Leeds and shown to release fluoride for
at least 2 years. Studies in Leeds demonstrated that there were 67% fewer new carious
teeth and 76% fewer new carious surfaces in high caries-risk children after 2 years in
a clinical caries trial for children with the fluoride devices in comparison to the
control group with placebo devices. There were 55% fewer new occlusal fissure
carious cavities showing that occlusal surfaces were also protected by the fluoride
released from the devices. The fluoride glass devices release low levels of fluoride for
at least 2 years and have great potential for use in preventing dental caries in high
'caries-risk' groups and irregular dental attenders. The fluoride glass devices have
been patented and commercial development is now under progress. The provision of
fluoride for each individual must be tailor-made to suit varying social and working
circumstances. Slow-release fluoride devices seem ideal for targeting the high caries-
risk groups who are notoriously bad dental attenders with very poor oral hygiene and
motivation. This is a very promising development with application for use in
numerous high-risk groups including the medically compromised.
Deciding which fluoride preparation to use for differing clinical situations:
This will depend on:
(1) Which groups of children?
(2) Which fluoride preparation?
(3) Daily or weekly use?
(4) Topical or systemic application?
In addition, the expected patient/parent motivation and compliance is very important
in deciding what to use. Each individual patient will require a 'tailor-made' fluoride
regime, and the dentist will need to use his expertise and knowledge of each patient in
formulating individual fluoride regimes and preventive treatment plans. 256HTable 6.8
gives some suggestions for some different clinical situations.