SODIUM FLUORIDE

SODIUM FLUORIDE
(sod'i-um)
Fluorinse, Fluoritab, Flura-Drops, Karidium, Pediaflor, Point-Two, Thera-Flur-N
Classifications: electrolyte replacement agent; dental prophylactic;
Therapeutic: dental prophylactic

Pregnancy Category: B topical, C oral

Availability

0.25 mg, 0.5 mg, 1 mg tablets; 0.125 mg, 0.25 mg, 0.5 mg drops; 0.2 mg/mL solution; 0.02%, 0.04%, 0.09%, 2% rinse; 0.5%, 1.2% gel

Action

Source of the fluorine ion, a trace element. Incorporates into developing tooth enamel, hardens surfaces, and increases resistance to cariogenic microbial processes. Topical application reduces acid production by bacteria in dental plaque and promotes remineralization of acid-damaged enamel. Application to exposed root surfaces supports formation of insoluble materials within dentinal tubules, thereby blocking transport of offending stimuli. Arrests rapid dental decay associated with drug-, radiation-, or age-related xerostomia. Oral form stimulates osteoblastic activity leading to increased bone mass.

Therapeutic Effect

Topical application reduces acid production by bacteria in dental plaque and promotes remineralization of enamel.

Uses

When fluoride ion concentration in drinking water is 0.7 ppm or less, to prevent periodontal disease and dental caries, to treat dental cervical hypersensitivity, and to control dental caries associated with xerostomia.

Unlabeled Uses

Adjunctive treatment of osteoporosis; management of bone lesions in multiple myeloma; to reduce bone pain in patient with metastatic prostatic carcinoma; to stabilize progression of hearing loss in a limited number of patients with otosclerosis.

Contraindications

When daily intake of fluoride from drinking water exceeds 0.7 ppm; low-sodium or sodium-free diets; rheumatoid arthritis; hypersensitivity to fluoride; gels or dental rinses by children <6 y, 1 mg tablet or rinse in children <3 y, or 1 mg rinse in children <6 y, pregnancy (topical form category B and oral form category C); lactation (oral form); GI disease.

Cautious Use

Renal dysfunction; rheumatoid arthritis; arthralgia.

Route & Dosage

Prevent Periodontal Disease (Drinking Water Concentration <0.3 ppm)
Child: PO Birth–2 y, 0.25 mg/d; 2–3 y, 0.5 mg/d; 3–13 y, 1 mg/d

Prevent Periodontal Disease (Drinking Water Concentration 0.3–0.7 ppm)
Child: PO Birth–2 y, 0.125 mg/d; 2–3 y, 0.25 mg/d; 3–13 y, 0.5 mg/d

Prevent Dental Caries
Child: Topical 6–12 y, 5 mL of 0.2% solution daily; >12 y, 10 mL of 0.2% solution daily

Desensitization of Exposed Root Surfaces
Child: Topical 0.2% rinsing solution once nightly after brushing and flossing

Administration

Oral
  • Avoid giving sodium fluoride with milk or dairy products. Calcium from these products combines with fluorine, decreasing its absorption.
  • Give drops preferably after meals. Give undiluted or mixed with fluids or foods.
  • Dissolve tablets in the mouth or chew before swallowing. Administer at bedtime (after brushing the teeth).
Topical
  • Apply all fluorine preparations after thoroughly brushing and flossing; preferably at bedtime.
  • Do not swallow topical or rinse preparations.
  • If patient's mouth is sore, the neutral preparation (Thera-Flur N) is better tolerated.
  • Use as treatment for dental cervical hypersensitivity: thoroughly brush teeth; then swish PO solution around and between teeth for 1 min; expectorate. If gel is used, apply a few drops to toothbrush and brush gently onto affected surfaces.
  • Apply Gel-drops with applicators supplied by the dentist. Spread gel on inner surfaces of applicators, which are placed over lower and upper teeth at the same time. User bites down lightly for 6 min, then removes applicators and rinses mouth thoroughly. Applicators are cleaned with cold water.
  • Store all forms in tight plastic or paraffin-lined glass containers (sodium fluoride reacts with ordinary glass at a slow but appreciable rate) at 15°–30° C (59°–86° F). Avoid freezing.

Adverse Effects (≥1%)

Skin: Rash, atopic dermatitis, urticaria, stomatitis. Body as a Whole: GI and respiratory allergic reactions, salty or soapy taste, dehydration, thirst, excessive salivation, muscle weakness, tremors, shock, death from cardiac and respiratory failure. Musculoskeletal: Dental fluorosis (brown or white mottling of tooth enamel), osseous fluorosis (patchy mineralization and possible decrease in bone strength).

Interactions

Drug: Aluminum, calcium, magnesium-containing products may decrease fluoride absorption.

Pharmacokinetics

Absorption: Readily from GI tract. Distribution: Fluoride is stored in bones and teeth; crosses placenta; distributed into breast milk. Elimination: Rapidly excreted, primarily in urine with small amounts in feces.

Nursing Implications

Assessment & Drug Effect

  • Monitor therapeutic effectiveness.

Patient & Family Education

  • Do not eat, drink, or rinse mouth for at least 30 min after using the rinsing solution.
  • Do not exceed recommended dosage. If mottling of teeth occurs, notify dentist.
  • Apply sodium fluoride gel or solution used in orthodontic treatment regimen immediately before attachment or reattachment of the tooth-encircling bands.
  • To be effective, fluorine supplementation must be consistent and continuous from infancy until 12–14 y.
  • Consult dentist about continuing fluoride therapy if you move or there is a change in water supply (mottling may occur if drinking water has fluorine content >1.5 ppm).

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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