FLUORIDE SUPPLEMENTS

General

FLOOR-ide

sodium fluoride (oral)

• Fluor-A-Day [Canada]

• Flura-Drops

• Luride

• Pharmaflur

• Phos-Flur

• Solu-Flur [Canada]

fluoride (topical)

• ACT

• Fluorigard

• Fluorinse

• Gel Kam

• Gel-Tin

• Prevident

• Stop

• Thera-Flur

Pregnancy Category
Category Unknown

Ther. class.
dental caries prophylactic agents

Pharm. class.
minerals electrolytes

Indications

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 Effect(s):
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 and 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

Contraindication/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.

Adverse Reactions/Side Effects

GI: nausea, vomiting.

Derm: atopic dermatitis.

Misc: mottling of teeth (toxicity).

*CAPITALS indicates life-threatening.
*italic indicates most frequent.

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

• Topical (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..

• Topical (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 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.

Potential Nursing Diagnoses

• Deficient knowledge , related to medication regimen (Patient/Family Teaching)

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.