4. Fluoride and non-fluoride caries prevention agents Flashcards
What is fluoride’s mechanism of action?
inhibits demineralization
promotes remineralization
antibacterial by residing in plaque and disrupting enzymatic activity
What is optimal water fluoridation level?
0.7 mg/L (0.7 ppm)
dose to not exceed 0.2 mg/L (2.0 ppm)
What is the amount of fluoride in standard toothpaste?
0.1% (1000 ppm)
What is the recommend amount of fluoride for a patient less than 2 years old?
smear
0.1 g = 0.1 mg F
What is the recommend amount of fluoride for a patient older than 2 years old?
pea size
0.25 g = 0.25 mg F
What is the amount of fluoride in prescription toothpaste?
0.5% (5000 ppm)
What is the amount of fluoride in rinses?
0.05% NaF (2200 ppm)
1 mg/5 mL
What are indications for fluoride gels and rinses?
appliances
H and N radiation
high risk patients
What is the fluoride ingredient in GelKam
0.4% SnF (1000 ppm)
What is the fluoride content in varnish?
5% NaF (22500 ppm)
Is a prophy required for fluoride application?
No, pellicle does not inhibit uptake
What is the fluoride concentration in SDF?
38%
45000 ppm
What is the recommended reapplication of SDF
every 6 mo
What is the mechanism of action of SDF?
inhibits biofilm formation
anti-bacterial
penetrates to enamel and reduces solubility
What causes fluorosis
excess fluoride ingestion from ages 4-8
What is the toxic dose of fluoride?
5 mg/kg
What is the fatal dose of fluoride?
16 to 32 mg/kg (hodge)
15 mg/kg (whitford)
What is the treatment for fluoride OD?
slow absorption via milk, calcium carbonate, aluminum-magnesium based antacids
Should you induce vomiting with fluoride toxicity?
No, do not give ipecac or activated charcoal
If patient ingested less than 8 mg/kg and is asymptotic what treatment should be given?
slow absorption and monitor for 6+ hours
What are 4 non-fluoride based products that aid in dental prevention?
Casein phosphopeptide amorphous calcium phosphate (CPP-APP)
Polyols
Silver nitrate
CHX
When is Casein phosphopeptide amorphous calcium phosphate (CPP-APP) indicated?
When is it contraindicated?
Indicated: dry mouth and/or sensitivity
Contraindicated: milk allergy
What is the mechanism of action of CHX?
bacteriostatic at low doses
bactericidal at high doses
does not reduce risk of caries
Do water filters change fluoride concentrations?
Regular filters have very little effect on [F]
Reverse osmosis and distillation DO reduce [F] to low levels
It is estimated that approximately how much fluoride (in mg) can be swallowed by pre-school aged children when brushing bid?
0.2 - 0.3 mg
When does the AAPD recommend a child start using a fluoridated toothpaste?
with eruption of first tooth
What is the type of fluoride, concentration and frequency of use in a prescription mouthwash?
NaF 0.2%
weekly use
What are the types of fluoride in prescription gels?
- 1 % NaF (5000 ppm)
1. 1% APF (5000 ppm)
What are the formulations of professionally applied gels/foams?
1.23% APF (2,300 ppm)
2% NaF (9040 ppm) - not for preschool children, 4 min application
For fluoride supplementation, what’s the maximum mg that can be prescribed per Rx?
120 mg
Estimated fluoride levels of infant formula
0.1-0.3 ppm
What juice has the highest [F]
grape (1+ ppm)
What foods have the highest [F]
chicken and fish
Dietary supplementation recommendation by age
no fluoride supplementation if:
< 6 mo
16+ years
or current water source 0.6+ ppm
if supplementation warranted, depends on age and current water source concentration. Supplementation varies from 0.25 to 1.0 ppm
Is pre-natal fluoride supplementation recommended/effective?
no
