Anti-Caries and Remineralizing Agents (Amaechi 8) Flashcards
In pure hydroxyapatite the fluoride ions may exchange
with the hydroxyl ions to form _______.
fluorapatite (FA)
F forms strong hydrogen bonds with adjacent OH groups. The F-HO bond is _______ and more ______.
smaller and more stable
During tooth formation F may substitute for ______ groups
carbonate
Improvement in the crystallinity of the apatite by:
- increased _____ of the lattice structure
- reduction in the number of _____ and ______ within the crystals
- stability
- imperfections and dislocations
Larger crystal presenting smaller surface area/volume ratio, hence less _______.
reactivity
The net effects of fluoride are:
- low ______ solubility
- decreased rate of _______
- less susceptible to _____
- Acid
- Demineralization
- Caries
Cycles of de- and re- mineralisation result to a mineral of ________
better quality
A remineralized surface is more ______ to subsequent acid attack than the original apatite.
resistant
When the plaque pH returns to neutrality, ______ of dissolved calcium phosphate occurs.
redeposition
Fluoride in solution during de- and remineralization can react with the outer surfaces of dissolving HA crystals thereby forming a shell (of CaF2 nature) that has solubility properties of ______.
fluorapatite
At neutral pH, ____ ppm F inhibits acid production in dental plaque. ____ ppm gives greater effect. ____ ppm reduces bacterial growth. Higher concentrations (_____) become batericidal.
- 1-2
- 10
- 100
- > 1000
At acidic pH:
Reducing pH from 7 to pH 5 increases sensitivity of plaque bacteria to F. At pH 5, ____ ppm is bacericidial.
6-8
Fluoride can _____ demineralization, reduce _____ level, and ______ remineralization, which can be a _____ of the lesion or _____ of progression.
- Retard
- Bacterial
- Enhance
- Reversal
- Arrest
- Specifically a toothpaste ingredient
- Not used professionally
- Delivers 1000-1200 ppm F
- Water soluble
- Available OTC only
Sodium Monofluorophosphate
- One active ion
- Caries reduction
- Attraction to calcium
- Small ion - Limited ability to occlude tubules
- Water soluble
- Professionally available in .2%, 1.1%, 2.0%, 5.0%
- Delivery - Rinses, gels, foams, dentifrices, varnishes
Sodium Fluoride
- Caries, Hypersensitivity, Inflammation
- Professionally available - .4%, .63%, 1.64%
- Delivery - Gels and rinses (dentifrices)
Stannous Fluoride
- Unique
- 2 active ions
- Attraction to both calcium and phosphate
- Water insoluble (after uptake)
- May cause surface discoloration
Stannous Fluoride
- Antimicrobial (Bacteriocidal & Bacteriostatic)
- Interferes with the development of plaque nutrients
- Alters the electromagnetic charge of the cell wall
- Penetrates the bacterial cell wall, thus interrupting the formation of plaque
Stannous Fluoride
-Hypersensitivity
-Ability to block the orifice of the dentinal tubules so that the registration of pain cannot be transmitted
-The Sn ion is large enough to occlude the dentinal tubules. Because it is water insoluble it will not be washed away like
the F ion
Stannous Fluoride
- Prevents lamination
- Sn2+ is a crystal growth inhibitor. It adsorbs to active growth and dissolution sites on enamel crystals, thereby limiting not only their remineralization but also further dissolution
Stannous Fluoride
Other forms of Fluoride
- Amine fluoride
- Titanium(IV) Fluoride
- Silver fluoride
- Zinc fluoride
Systemic Method of Fluoride
- Fluoride ingested (fluids, prescription tablets, etc.) during the developmental stages of the tooth
- Very important from birth to 8 years (critical ages are 12-30 months)
- Can cause fluorosis if ingested in too much quantity
Topical Method of Fluoride
- Effects the teeth already in the mouth
- Delivered via rinses, dentifrices, gels, etc.
- Does not cause fluorosis
Patient Applications of Fluoride
- Toothpaste
- Mouthrinse
- Gels
Professional Applications of Fluoride
- Fluoride varnishes
- Acidulated Phosphate fluoride (APF) - gel/foam/mouthrinse
- Neutral Sodium Fluoride foam
Two stage process at high fluoride concentration
- release of Ca from enamel
- reaction with fluoride
- Formation of CaF2 material
5% NaF Varnish
-_____ ppm F
-Approved in the US in 1994 (Europe 1960’s)
US label claims ____ and _____, but “off-label” use - Fluoride treatment as a _______
- 22,600
- Cavity liner and hypersensitivity
- caries preventive
5% NaF Varnish
- Long lasting resin which holds fluoride against teeth for ______
- One treatment lasts up to ______
- 24-48 hours
- 3 months
Advantages of 5% Sodium Fluoride Varnish
- caries reduction ~ 40%
- easy to apply
- prolonged fluoride uptake
- small amount ingested
Disadvantages of 5% Sodium Fluoride Varnish
- taste
- yellow layer
Fluoride varnish applied 2 to 4 times a year does prevent caries in children and adolescents by up to ___%.
40
Uses of fluoride varnish
- Tooth sensitivity
- Remineralization
- High-risk patients
- Young children at risk
Acidulated Phosphate Fluoride
- Sodium fluoride with ______
- Prevention of caries
- Provides greater fluoride uptake (surface phenomenon)
- ______ pH
- Water soluble
- 1 active ion
- Professionally available - .0444%, .31%, 1.23%
- Delivery - Gels, foams, rinses, dentifrices
- phosphoric acid
- 3.0 - 4.0
Acidulated Phosphate Fluoride (APF) Limits enamel dissolution by _______ and _______ CaF2 globules.
- common ion effect
- Stabilizes
The rate of formation of FA is relatively slow at resting oral pH values, reducing the pH from 7.0 to ≈ 5.0 increases the rate considerably because…
Low pH may prolong mineral ions’ access to the lesion body by preventing surface-blocking and arrest
Advantages of 1.23% Acidulated Phosphate Fluoride
- caries reduction ~28%
- Acceptable taste
- Stable gel or foam for tray application
Disadvantages of 1.23% Acidulated Phosphate Fluoride
- Possible excessive ingestion causing gastrointestinal upset
- Intolerance to trays
- Porcelain & veneer etching
1.23% Acidulated Phosphate Fluoride Protocol
4 minute application
Acidic topical fluoride solutions such as APF solutions and other acidified fluoride preparations degrade ______, ______, and ______, and should be avoided in these cases
- glass-ionomer materials
- porcelain crowns
- veneers
Advantages of 2% neutral Sodium Fluoride
- caries reductions~29%
- acceptable taste
- stable gel or foam
Indications for NaF
- Sensitivity
- Caries Control
Indications for Varnish
- Sensitivity
- Caries Control (off label)
Indications for SnF2
- Inflammation
- Sensitivity
- Caries Control
- Antimicrobial
Indications for APF
Caries Control
Fluoride induces the precipitation of calcium & phosphate thereby enhancing the rate of ______.
remineralization
Fluoride in solution surrounding apatite crystals fluoride inhibits _______.
When incorporated into the apatite crystal it makes the apatite structure more resistant to ________.
- demineralization
- demineralization
Fluoride decreases the rate of metabolism of _______ (less acid is produced)
oral bacteria
Fluoride is important but ______ is important too.
Calcium
The goal is to ______ through better formulations and the addition of calcium
enhance remineralization
Challenge is to add calcium and formulate a better product that truly provides _______. Not just the same benefits. Should not reduce fluoride’s proven benefits.
added benefits
When TCP is blended/milled with organic materials:
- _______ bonds are broken
- Calcium oxides become ‘protected’ by the organic materials (Demonstrated by an increase in ______ after milling)
- Process allows the Innovative TCP ingredient to _____ with fluoride ions in an aqueous dentifrice base –> High fluoride availability
- Calcium – phosphate
- free phosphates
- coexist
As Tri-Calcium Fluoride reaches the tooth surface:
- Organic materials (often surfactants) have an affinity for tooth surfaces
- Carries the calcium to the tooth surface, protected from fluoride ion –> High _____ bioavailability during application
- Saliva activates the calcium compound degrading the protective coating, releasing calcium at the tooth surface –> ______ bioavailability during application
- fluoride
- Calcium
In CPP - ACP, _________ is:
- Derived from casein found in cow’s milk
- Binds Ca and P
- Keeps Ca and P in a soluble form
- Binds to tooth surfaces, plaque and bacteria in plaque
Casein Phosphopeptide
In CPP - ACP, _________ is:
-Free & available to be incorporated into the tooth structure
Amorphous Calcium Phosphate
Casein Phosphopeptide-stabilized Amorphous Calcium Phosphate (CPP-ACP):
- Provides the Ca and PO4 for lesion _______
- Prevent the mineral elution (Inhibit the ______)
- _______ the acid from bacteria (Neutralizing & buffering)
- remineralization
- demineralization
- Neutralizing
- Protects against acid challenges
- Antibacterial efficacy
- Occludes dentinal tubules
Functions of Stannous
- Increases fluoride release and uptake
- Works with stannous fluoride to increase fluoride uptake and reduce enamel solubility.
- Helps to occlude tubules
Functions of Amorphous Calcium Phosphate
Which sources of fluoride are anti-caries?
- Stannous F
- Sodium F
- Sodium MFP
Which sources of fluoride are anti-gingivitis?
-Stannous F
Which sources of fluoride offer sensitivity relief?
- Stannous F
- Sodium F (modest)
Nano-Hydroxyapatite dentifrices demonstrated the same remineralizing capacity as fluoridated dentifrices. Dentifrice with 10% nHAP inhibited ______ of a sound tooth surface.
demineralization
Toothpaste with arginine functions by producing ______ by deamination with the enzyme _______.
- Ammonia
- Arginine Deaminase System (ADS)
_______ induces increase in crystallite size and improvement in crystallinity of apatite
Theobromine
_______ forms 3 layers and releases 6 types of ions.
Surface Pre-reacted Glass-ionomer (PRG)
Actions of CHLORHEXIDINE GLUCONATE
- Reduces level cariogenic bacteria in oral cavity
- Prevents development of plaque
Chlorhexidine adheres strongly to the cell membrane of bacteria due to its high _____ charge, and acts by precipitating the protein in the cell membrane, resulting to cell being unable to maintain its ______ balance
- Positive
- electrolyte
Uses of Chlorhexidine
- Reduces S. mutans in high and moderate risk patients
- Reduces S. mutans in mothers/caregivers
Chlorhexidine application
30 sec rinse, last before bed for one week every month (highly compliant high risk patients)
Chlorhexidine Drawbacks
- Unpleasant taste
- Teeth discoloration with prolonged use
- Recolonization occurs within 3 months
There is not yet any long-term clinical evidence for caries prevention with ________, so these rinses should not be recommended for caries prevention
chlorhexidine-containing rinses
Xylitol is not readily______ by bacteria to produce acid for demineralization
metabolized
Xylitol has been reported to promote remineralization of arrest early caries lesions, possibly through _______.
Salivary stimulation
POVIDONE IODINE forms and uses
- Solution and swabs (10% PI = 1 ppm free iodine)
- Prevent early childhood caries in high risk infants
Triclosan Functions and Clinical efficacy
- provides antibacterial effects by disruption of bacterial cell wall.
- Provides anti-inflammatory effects by interlukin-1-b inhibition.
- Control of gingivitis and plaque
Anti-calculus agents & clinical efficacy
- 3.3% pyrophosphate
- Zinc chloride/citrate
- Reduce supra-gingival calculus formation (lingual to lower incisors) by 30-50%.
Probiotics tested for therapy of caries prevention
- Lactobacillus rhamnosus GG
- L. fermentum
- L. reuteri
- Bifidobacteria
Probiotics mechanism of action
- Bacteriocin activity (eg. Nisin)
- H2O2 production
- ↓ Biofilm/Plaque
- ↓ Glucosyltransferases
- ↓ Exopolysaccharides
- Bacterial co-aggregation
