7 - Community based fluoride delivery

Question 1

Is topical or systemic fluoride more effective?

Answer 1

• topical is agreed to be more effective
• systemic is ineffective and passive

Question 2

How does fluoride prevent caries?

Answer 2

• promotes remineralisation
• fluroapatite is formed and is less susceptible to demineralisation
• fluoride affects bacterial metabolic pathways which reduces the amount of acid produced

Question 3

Describe the oral reservoir for fluoride.

Answer 3

• small
• fluoride from toothbrushing disappears quickly
• two types, mineral deposits (FAP) and biologically bound calcium fluoride

Question 3

What are examples of community fluoride therapy?

Answer 3

• water fluoridation
• school based brushing
• varnish
• (salt, milk, tablets, rinsing)

Question 4

What are practice based fluoride therapies?

Answer 4

• varnish
• gel/foam
• slow release

Question 5

What are home based fluoride therapies?

Answer 5

• toothpaste
• mouth rinse
• (tablets)

Question 6

What are the benefits of salt fluoridation?

Answer 6

• choice
• passive delivery

Question 7

What are the disadvantages of salt fluoridation?

Answer 7

Risk of CV disease

Question 8

What are the advantages of fluoridated milk?

Answer 8

• natural healthy drink
• important part of children’s diet

Question 9

What are the disadvantages of fluoridated milk?

Answer 9

• distribution delayed until school
• not all children drink milk
• increased cost

Question 10

When are fluoride tablets or drops used?

Answer 10

• at risk children over 6 years
• those with additional needs/special care requirements
• carries a fluorosis risk

Question 11

What are the advantages of fluoridated mouthwashes?

Answer 11

• commonly available
• daily rinsing more effective than stronger weekly rinsing
• good compliance

Question 12

What are acidulated mouth rinses?

Answer 12

• mouth rinse with low pH
• stimulates mild demineralisation on surface
• allows fluoride to get into teeth
• fluoride is more bioavailable due to low pH

Question 13

What are APFs?

Answer 13

• acidulated phosphate fluoride gels
• professionally applied with fluoride conc of 12,300ppm
• require special equipment to apply (including trays)
• uncommon

Question 14

What is duraphat?

Answer 14

• fluoride varnish with conc of 22,600ppm
• sustained contact due to resin setting on teeth, slow release of fluoride and calcium fluoride to tooth surface
• professionally applied

Question 15

How often is duraphat applied?

Answer 15

• 4x yearly for at risk
• 2x yearly for standard

Question 16

What factors impact the efficacy of fluoride toothpaste?

Answer 16

• concentration
• frequency of application
• rinsing behaviours
• when brushing occurs

Question 17

How does fluoride concentration affect caries reduction?

Answer 17

• increased conc decreases caries
• 6-7% reduction for every 500ppm

Question 18

How does frequency of toothbrushing affect caries reduction?

Answer 18

More frequent brushing reduces caries

Question 19

How does rinsing behaviour affect caries reduction?

Answer 19

• rinsing after brushing teeth increases caries
• rinsing removes the fluoride on the surface of the tooth and remove the protective barrier it provides

Question 20

What are optimal brushing habits?

Answer 20

• twice daily
• no rinsing
• 1500ppm toothpaste

Question 21

What is the advice on toothbrushing for pre-school children?

Answer 21

• 1500ppm
• smear of toothpaste
• parental supervision and help

Question 22

What are the risks of fluoride use?

Answer 22

• fluorosis of teeth (mottled enamel)
• acute toxicity if ingested
• chronic toxicity (fluorosis)