5. Caries Prevention I Flashcards
Types of Caries: pit and fissure lesions
- very ____ to remove biofilm
- frequent locations: ____ surfaces of ____ teeth
- followed by:
- ____ pits of ____ molars
- ____ pits of ____ incisors
difficult
occlusal
posteror
buccal
man
lingual
max
Assessment of Risks for Dental Decay
- Existing disease
- clinical and radiographic caries
- restorations within last ____ years
- ____ spot lesions
Biologic Factors • Exposed \_\_\_\_ • Deep \_\_\_\_ • Rotated Teeth & Malignment • \_\_\_\_ & Saliva Reducing Factors • \_\_\_\_ THERAPY
Behavior Factors • Poor Oral Hygiene • High \_\_\_\_ Diet • Infrequent \_\_\_\_ • \_\_\_\_ Appliances
3
white
roots
fissures
dry mouth
radiation
sugar
dental care
orthodontic
Disease indicators: WREC
Risk factors: BAD
Protective Factors: SAFE
WREC: white spots, restorations <3 years, enamel lesions, cavities/dentin
BAD: bad bacteria, absence of saliva, dietary habits (poor)
SAFE: saliva and sealants, antibacterals, fluoride, effective diet
Caries Risk Assessment Tools
- ____
____
____
Cariogram
ADA
CaMBRA
Control Bacteria to Prevent Decay
Ways to Control Bacteria Ø____: Toothbrush, Floss
Ø ____:
Ø 0.12% Chlorhexidine, Essential Oils or
Cetylpyridium Chloride Rinse
Ø Triclosan or.0454 Stannous Fluoride Toothpaste
mechanical
chemical
Caries Balance
Demineralization v. Remineralization
Both systemic & topical fluoride enhance fluoride, calcium and phosphate uptake for increased ____
remineralization
Fluoride Mechanism of Action
Enhances Remineralization
Absorbs onto crystal surface and attracts ____ ions first, then phosphate ions.
Excludes ____ to allow more crystal growth
Speeds growth of new crystalline surface by attracting more ____ & ____
Alters hydroxyapatite to ____ crystals in both topical and systemic modes
calcium carbonate calcium phosphate fluorapatite
Fluoride Mechanism of Action
Inhibits Demineralization
Fluoride in ____ phase collects in space and inhibits ____ of intercrystalline teeth
Fluorapatite in ____ crystal lattice is most resistant to demineralization. When ____ ion is lost and replaced by FAP, demineralization is inhibited.
water
acid dissolution
enamel
carbonate
Fluoride Mechanism of Action
Inhibit Bacterial Metabolism
Acid produced by mutans streptococcus converts topical fluoride into ____, which is incorporated in cells in biofilm
Reduces acid by inhibiting ____, enzyme necessary for ____ metabolism
Reduces ____ and inhibits ____
hydrogen fluoride ion enolase carbohydrate mucopolysaccharides glycolysis
Fluoride to Prevent Caries
Topical Fluoride
- Affects tooth ____ and ____ enamel of erupted teeth
- Remineralizes active ____ decay
Systemic Fluoride
- Affects developing tooth enamel via ____
- Increases ____ crystals in developing tooth
- Excreted in ____ for topical effect for all teeth
surface
subsurface
subsurface
bloodstream
fluorapatite
saliva
Fluoride Toothpaste (Dentifrice) 0.243% Sodium Fl 1100 ppm 0.454% Stannous Fl 1100 ppm (Crest Pro Health)
- Abrasivity of paste varies, with silica, mica and ca carbonate
- Whitening pastes = more ____
- SDS is ____ surfactant as a foaming detergent
- Sweeteners include ____ and ____, also serves as a humectant and antimicrobial
abrasive
anionic
saccharin
xylitol
Fluoride Home Rinses
____ ppm
- 05% Sodium (ACT, Fluorogard)
- 025% Sodium (Listerine AntiCavity Rinse (purple) 0.044% Acidulated phosphate (PhosFluor)
____ ppm
0.2% Sodium (DentiCare, NAF rinse)
Daily 250
Weekly 1000
Fluoride Home Rinses
“This review suggests that the regular and supervised use of fluoride mouthrinse by children
…result on average in 26% fewer ____, missing, or filled permanent tooth surfaces…
We found no evidence that this relative effect was dependent on ____ level or exposure to other fluoride sources, fluoride concentration and ____frequency.”
decayed
baseline caries
mouthrinsing
Topical At Home Fluoride
Gels
Daily 5000 ppm
Effective for ____ Control with neutral formulation
Good with ____ restorations & ____
Daily 1000 ppm
Effective in ____ sensitivity & caries control
Stains due to ____ ion & can pit ____ due to acidic formulation
caries
esthetic
dry mouth
root
tin
restorations
Topical Fluoride At Home Gels
Twenty Five Studies Pooled Together, with the Pooled PF of Caries Reduction was 28%
Effectiveness Varied Based on Type of ____ and Specific Group Studied, with Average Caries Reduction PF 19%
Gel
Other Remineralizing Agents
n Provide Additional ____ for Remineralizatoin, especially with Reduced Saliva
n ____ (CP/ACP) (Trident Xtra Care, MI Paste)
n ____ (ACP) (Enamel Care, Enamelon Toothpaste with stannous fluoride)
n Conflicting conclusions in two systematic reviews
calcium/phosphate
casein phosphopeptides/amrophous calcium phosphate
amorphous calcium phosphate
Professional Topical Fluoride Treatments
5.0% Sodium Fluoride Varnish 20,600 ppm
PF in DFS = 46% PF 14% greater than other TFT - \_\_\_\_ to apply, even in infants - accepted for \_\_\_\_sensitivity - off label use due to lack of USA FDA approval for caries prevention, only \_\_\_\_
easiest
root
densitization
Professional Topical Fluoride Treatments
1.23% Acidulated Phosphate Fluoride 12,300 PPM
- traditional foam or gel product, easily applied at six month intervals for ____ minutes, not minute gel
- PF 26% DMFS
- acidic formulation speeds fluoride penetration, but will pit or ____ esthetics
- difficult with patients with ____ or ____
four
stain
dry mouth
mucositis
Professional Topical Fluoride Treatments
- 0% Sodium Fluoride, 9,040 PPM
- neutral formulation safe for all patients easily applied for ____ minutes, not 1 minute
- Research Protocol application in ____ week intervals, so research
is regarding caries limited prevention with 2% sodium fluoride
four
4
Clinical Procedure
____ Teeth, Use Saliva Ejector
Paint Directly on Teeth, Lingual ____ first, Maxillary ____ Teeth Last
With Varnish, Avoid ____ until Bed Time
if gel is chosen, apply in tray for ____ minutes
____ with patient
ensure ____ of excess fluoride
With Gel, Patient should not eat drink OR SMOKE FOR ____ MINUTES AFTER
dry molars labial toothbrush 4 stay removal 30
Silver Diamine Fluoride (SDF)
- colorless liquid, pH 10
- contains: 24.4% to 28.8% ____, 5.0% to 5.9% (weight/volume ____ (44,800 ppm).
- caries control in children, adults, especially ____ caries in the ____
silver
fluoride
root
elderly
Silver Diamine Fluoride: Mechanism of Action
- fluoride ions in SDF mainly act by reacting with hydroxyapatite converting it to ____ which is more resistant to an acidic environment than hydroxyapatite
- silver acts against ____ bacteria
- the black stained layer > arrested ____ caries: hard and impermeable layer of ____
fluorapatite
cariogenic
dentin
silver phosphate
Silver Diamine Fluoride
- has been utilized internationally for decades to arrest dental caries in primary and permanent teeth
- 2014, the US FDA cleared the use of SDF in the US as a topical agent to decrease ____
- used ____ to arrest caries
- available SDF product for dental use is ____
sensitivity
off label
advantage arrest
Silver Diamine Fluoride versus Fluoride Varnish, or Both
Recent systematic reviews of human clinical trials have shown that SDF has greater anticariogenic effects than ____ alone and therefore maybe more effective in arresting caries than ____
fluoride
fluoride varnish
Systemic Fluoride
Water Fluoridation: “adjustment of fluoride”
Initial research at 1.0 PPM
____ current recommended amount
0.7 PPM
Evidence for Recommending Systemic Water Fluoridation, CDC, 2001
- Code ____: good evidence
- community water fluoridation for all areas
- fluoride supplements for children age 6 mos-16 years
- Code ____: lack of evidence or mixed evidence
- school water fluoridation in non-fluoridated areas
- fluoride supplements for pregnant women
A
C
Total Dietary Fluoride Intake table
0-6 mo: \_\_\_\_/day 6-12 mo: \_\_\_\_/day 1-3 yr: \_\_\_\_/day 4-8 yr: \_\_\_\_/day 9+ yr: \_\_\_\_/day
- 01 mg
- 5 mg
- 7 mg
- 1 mg
- 0-4.0 mg
Guidelines for Fl Supplementation
- 0-6 mo: ____ supplementation
- 6mo - 3 years: ____ when Fl less than 0.3 ppm
- 3-6 yr: ____ when Fl less than 0.3 ppm; ____ when Fl 0.3-0.6 ppm
- 6-16 yr: ____ when Fl less than 0.3 ppm; ____ when Fl 0.3-0.6 ppm
NO 0.25 mg 0.5 mg 0.25 mg 1 mg 0.5 mg
Fluoride Toxicity
- Certainly lethal dose - potential for causing detah
- ____ gram NaF or 32-64 mg F/kg
- Safely tolerated dose - consumed without toxic symptoms
- 1/4 CLD, or ____ mg F/kg
5-10
8-16
Look at dosage range for CLD/STD!
YAY
Fluoride Overdose Care
Less than 5.0 mg/kg: Give ____ (milk or lime juice)
More than 5.0 mg/kg: Empty stomach by inducing ____, give ____, ____
More than 15.0 mg/kg: ____, induce vomiting, give calcium ____, ____ monitoring
oral calcium vomiting oral calcium hospitalize hospitalize iv cardiac
Public Health Significance of Water Fluoridation
Proven caries reduction since 1945
50-60% caries reduction in 1950, 25-30% more recent studies
Benefits for both children and adults
Benefits regardless of ____ or ability to buy ____ or mouthrinse
dental visits
toothpaste
Community Wide Benefits from a Population Perspective
Access to all despite ____ or dental visits
Easy ____ without effort
Ambient fluoride from products made with ____ (soda, juice, spaghetti sauce, frozen foods) disseminate in population
Limited to those who drink ____ water
Brita filters OK, ____ filters out Fl
economics compliance fluoridated water tap reverse osmosis
