Dental caries remains one of the most common oral health problems among children, particularly those of primary school age. Factors such as frequent consumption of sugary foods, suboptimal oral hygiene practices, and immature tooth surfaces increase children’s susceptibility to plaque accumulation and tooth decay. One important preventive strategy is topical fluoridation, which involves the direct application of fluoride compounds to the tooth surface to enhance enamel resistance to demineralisation and inhibit the growth of cariogenic bacteria.
A study conducted by a student of the Faculty of Dentistry, Universitas Gadjah Mada, Agustin Lis Setyorini, under the supervision of drg. Rinaldi Budi Utomo, MS., Sp.KGA(K), entitled “Pengaruh Topikal Aplikasi Sodium Fluoride 1% terhadap Pertumbuhan Plak dan Tingkat Keparahan Karies (Kajian pada Anak Perempuan Umur 6–8 Tahun di Pesantren Binbaz)”, found that topical application of 1% sodium fluoride resulted in a statistically significant reduction in plaque growth scores among girls aged 6–8 years. Although changes in caries severity were not statistically significant within the study period, these findings support the effectiveness of fluoridation as part of caries prevention strategies.
Mechanisms of Action of Topical Fluoridation
Topical fluoridation exerts its protective effects through several key mechanisms:
- Formation of Fluoroapatite
When fluoride ions are released into saliva and dental plaque, they can replace hydroxyl ions in hydroxyapatite crystals, forming fluoroapatite, which is more resistant to acid attack. - Reduction of Cariogenic Bacterial Activity
Fluoride inhibits the metabolic activity of plaque bacteria, particularly Streptococcus mutans and other acidogenic flora, thereby reducing acid production that leads to enamel and dentin damage. - Remineralisation of Tooth Surfaces
Fluoride accelerates the remineralisation process by supplying fluoride ions to early demineralised areas, helping to stabilise enamel crystal structure before further damage occurs. - Inhibition of Plaque Growth
The presence of fluoride on the tooth surface suppresses bacterial proliferation, resulting in a significant reduction in plaque scores, as demonstrated in the study.
Research Findings and Interpretation
In the cited study, 16 girls aged 6–8 years residing in a boarding school received topical applications of 1% sodium fluoride using the Knutson method. Plaque scores were assessed using the PHPM index, while caries severity was evaluated using the Caries Severity Index. The results showed:
- A decrease in mean plaque scores from 38.0625 ± 5.97 before application to 29.9375 ± 5.47 after four applications.
- After three months, plaque scores returned to levels close to baseline (38.5625 ± 5.93).
- Mean caries severity scores did not show significant changes (2.8125 ± 0.67709 before and after application).
These findings indicate that topical application of 1% fluoride is effective in inhibiting plaque growth in the short term. However, long-term benefits and reductions in caries severity require sustained interventions, integration with proper oral hygiene practices, and routine monitoring.
Clinical Implications and Recommendations
Based on the findings and underlying mechanisms, the following clinical recommendations are proposed:
- Importance of application frequency: Regular topical fluoride application (e.g., every 3–6 months) is recommended to maintain its protective effects.
- Combination with oral hygiene education: Fluoride application alone is insufficient; children must be educated to brush twice daily, use appropriate interdental cleaning tools, and limit sugary food and beverage intake.
- Targeting children aged 6–8 years: This transitional period from primary to permanent dentition is critical for establishing oral hygiene behaviours.
- Appropriate fluoride compounds and application methods: Proper selection of fluoride solutions, effective application techniques (such as the Knutson method), and pre- and post-treatment monitoring are essential.
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Topical fluoridation, such as the use of 1% sodium fluoride, demonstrates clear potential in reducing plaque growth among primary school-aged children—an important factor in the development of dental caries. Although reductions in caries severity were not statistically significant in the cited study, fluoride application remains a key strategy in paediatric caries prevention. Optimal outcomes require regular application combined with consistent oral hygiene education and practices.
References
Agustin Lis Setyorini, drg. Rinaldi Budi Utomo, MS., SpKGA(K), “Pengaruh Topikal Aplikasi Sodium Fluoride 1% terhadap Pertumbuhan Plak dan Tingkat Keparahan Karies (Kajian pada Anak Perempuan Umur 6-8 Tahun di Pesantren Binbaz)”, https://etd.repository.ugm.ac.id/penelitian/detail/51323
Author: Rizky B. Hendrawan | Photo: Freepik
