Physicochemical perspectives on the cariostatic mechanisms of systemic and topical fluorides

The cariostatic mechanisms of systemic and topical fluoride agents are considered in light of a previously proposed model for the caries process. It is noted that fluoride, in principle, can induce a cariostatic effect: by (1) reducing enamel solubility when incorporated into the mineral structure; (2) by fostering the remineralization of incipient enamel lesions and the deposition of fluoridated phases (within dental plaque) which provide a source of mineral ions (Ca, P, F) under acidic conditions; and (3) by reducing the net rate of transport of matter out of the enamel surface, under acidic conditions, by inducing the reprecipitation of fluoridated hydroxyapatite phases within enamel. It is also noted that relatively high (approximately 12,000 ppm) concentrations of professionally applied topical fluorides significantly reduce the rate of acid production of cariogenic organisms (e.g., S. mutans). Based on an analysis of available clinical and laboratory data, it is concluded that the benefits provided by water fluoridation result, to a large degree, from a topical effect. It is suggested that clinical procedures be developed to establish and maintain low levels of free fluoride in plaque fluid. It appears that this will require frequent exposure to topical fluorides.

The pre- and posteruptive effects of fluoride in the caries decline

The widespread availability of fluoride from many sources is accepted as a major reason for the caries decline among children in developed countries. There is still controversy, however, about its principal mode of action. This article reviews the evidence on fluoride's preeruptive and posteruptive effects, and suggests reasons for its continuing role in the caries decline. Early fluoridation studies accepted that fluoride acted preruptively through incorporation into developing enamel; but further research could not explain why fluoride levels were not clearly higher in enamel exposed to fluoride, nor why there were no clear correlations between caries experience and enamel fluoride concentration. Instead, considerable evidence suggests that fluoride acts mainly, though not entirely, through posteruptive remineralization of demineralized enamel. Caries experience has declined in nonfluoridated as well as in fluoridated areas, though DMF scores are still consistently lower in fluoridated areas. Posteruptive remineralization effects are seen from fluoridated drinking water as well as with fluoride from other sources. The continuing caries decline, beyond the level suggested by early fluoridation field trials, can be attributed either to more efficient remineralization or to long-term, intraoral ecological change, or to both.

Effect of low levels of fluoride in solution on enamel demineralization in vitro

The effect of low levels of fluoride in solution on in vitro enamel demineralization has been studied. Extracted human teeth were exposed to 0.1 M lactate solutions (at pH 4.3) which were partially saturated with respect to enamel mineral and which contained between 0.004 and 1 ppm fluoride. Enamel demineralization was monitored using SEM and polarized light microscopy. It was observed that, in the absence of fluoride, rapid enamel demineralization occurred, resulting in the formation of cavitations within 72 hours. Using the same demineralizing medium containing as little as 0.024 and 0.054 ppm fluoride, we observed a remarkable protection of the enamel surface. Subsurface enamel demineralization was, however, observed under these conditions as well as in a solution containing 0.154 ppm fluoride. When the demineralizing solution containing 1 ppm fluoride was used, no mineral loss was detected. The observed inhibition of enamel demineralization was also shown to be associated with a significant uptake of fluoride by the enamel mineral. These observations have been noted to correlate with an increase in solution supersaturation with respect to fluoridated apatitic species. The results obtained were found to be consistent with a proposed hypothesis that the net rate of enamel demineralization will be reduced in a demineralizing medium supersaturated with respect to less soluble fluoridated phases, due to the enhancement of the precipitation rate of fluoridated apatitic phases relative to the rate of dissolution of the original enamel surface.

Salivary fluoride and calcium concentrations, and their relationship to the secretion of saliva and caries experience

Samples were collected from the stimulated saliva of 113 students enrolled in institutions of higher education. The students were divided into three "carries-diagnostic groups" on the basis of indications given by the Dentocult saliva test, which shows the frequency of lactobacilli and other aciduric microorganisms in saliva. The frequency of such microorganisms in 1 ml saliva in Group A was less than or equal to 103, in Group B greater than 10(3), less than 10(4) and in Group C greater than or equal to 10(4). The rate of secretion of saliva in Group A was significantly higher than in Group C (P less than 0.05). On the average, a rise was noted in the fluoride and calcium concentrations with increasing "caries activity". In the material as a whole, there was a negative and highly significant correlation between the secretion rate of saliva and the concentrations of fluoride and calcium. In the examination by groups, significant correlations were observed between fluoride concentration and rate of saliva secretion in Group A, and with respect to fluoride and calcium only in Group C. The results suggest that the extra salivary fluoride is likely to be derived from the enamel.