CE: Intervention

Question 1

Basic success of caries prevention: fluoride

• Benefits?
• Goal?

Answer 1

Fluoride
- Benefits: reduce caries, but with excessive amount in early stages of development
can form dental fluorosis
- Goal: maximize anticaries benefits, while minimizing the risk of dental fluorosis

Question 2

3 mechanisms of action of fluoride

Answer 2

1. fluoride is present when acids are produced –> will go into the tooth at the same time or before the acid.
   - Stick or absorb at the surface of tiny crystals of the tooth and stop acid
   from dissolving the crystals, acts like a bodyguard.
2. If fluoride is present when acid is neutralized –> fluoride together with calcium
   and phosphate from saliva go into the tooth and remineralize or grow a new surface of crystals that is much more resistant
   - *extremely important
3. Fluoride if present among the bacteria when producing acid –> fluoride gets taken into the bacteria, slows them down or kills them.

Question 3

Reduced Demineralization and Enhanced Remineralization

Answer 3

• pH 5.5 or below - Hydroxyapatite starts to dissolve
• pH 4.5 or below - Fluorapatite starts to dissolve
• pH above 5.5 - fluoride enhances enamel-dentin remineralization
• Biofilm pH between 4.5 - 5.5 - fluoride available in low conc, fluorapatite
forms on surface of layers of enamel even if hydroxyapatite
dissolves
• Overall effect: reduce dental demineralization

Question 4

Antimicrobial Qualities

Answer 4

• Inhibit bacterial enzyme enolase (interferes with production of PEP)
• PEP = source of energy for bacteria and needed for sugar uptake

Question 5

Fluorosis

Answer 5

occurs with exposure of abnormally high conc of fluoride during early stages of tooth development –> can lead to hypo mineralization (gives chalky white lines/stains)

Question 6

Systemic Fluoride Delivery

Answer 6

Goal: promote remineralization and reducing demineralization o Water fluoridation: primary systemic method
o Salt fluoridation: common in other parts of the world
o Milk fluoridation: Implemented in other countries
o Fluoride supplements: CDC and ADA currently recommend oral fluoride supplements used for only high-risk children in nonfluorinated areas

Question 7

Topical Fluoride Delivery

Answer 7

toothpastes, gels, varnishes, paint-on formulation and mouth rinses that come into contact with tooth surface

Question 8

Fluoride mouth rinses

Answer 8

Fluoride mouth rinses:
o Some may need a prescription if have higher conc
o Can contain antimicrobial ingredients, many have little to no caries-reducing effects or have not been studied for their anti-caries effects

Question 9

Professional delivery of fluoride

Answer 9

• Given to patient with high risk of caries and if other dental care measures (good oral hygiene) are not working or being followed.
• High conc of ppm and recommended 2x/yr

Question 10

Professional slow-release fluoride - currently being developed.

Answer 10

Added to composite and amalgam fillings, with goal to prevent secondary caries and help remineralize caries in adjacent surfaces.

Question 11

Fluoride is incorporated into

Answer 11

the inorganic part of enamel, the inorganic phase, by substitution for either hydroxyl ions or carbonate ions within the apatite lattice.

Question 12

Fluoride ingested –>

Answer 12

distributed from plasma to all tissues and organs of body –> gradually becomes incorporated into the crystal lattice structure of teeth in the form of fluorapatite.

Question 13

Fluoride concentration

Answer 13

High on enamel layer
Remains constant at enamel-dentin junction
Increases inside the dentin and increases deeper into the tooth

Question 14

Fluoride DOES NOT have

Answer 14

hemostatic mechanism to maintain the body, so regular exposure to maintain fluoride conc in enamel, saliva, and biofilm on dental surfaces

Question 15

what are the common forms of toothpaste in the U.S.

Answer 15

sodium fluoride, sodium monofluorophosphate (SMFP), and stannous fluoride (SnF2)

Question 16

Toothpastes can include

Answer 16

abrasives to clean teeth, binders to prevent
separation of ingredients, coloring for visual appeal, buffers to maintain product stability, flavorings, and surfactants

Question 17

Fluoride dentifrices use

Answer 17

some combos to target different goals of the patient (plaque and gingivitis protection, tartar control, whitening, sensitivity protection, erosion protection)

Question 18

In summary, dental professionals should recommend to their patients

Answer 18

• An accredited fluoride toothpaste.
• A toothpaste with an appropriate fluoride concentration after assessing potential caries risk and overall fluoride exposure.
• To brush twice daily; once at night and once more at another time during the day, preferably around a mealtime.
• That children be given a minimum amount of toothpaste and be supervised when brushing.

Question 19

Brushing behavior should be

Answer 19

2x/day = 20% to 30% lower likelihood than brushing one or less daily.

Question 20

Rinsing behavior

Answer 20

if use a cup to rinse with water after brushing –> 20% more caries than those who use their hands because with the cup more fluoride is washed away