Community Based Flouride Delivery in Caries Prevention

Question 1

How does fluoride prevent caries?

Answer 1

Promotes remineralisation
Fluoro-apatite formed is less susceptible to demineralisation
May also have an effect on bacteria and metabolic pathways resulting in less acid being produced

Question 2

When is fluoride most effective?

Answer 2

Topically
On early lesions

Question 3

What are the oral reservoirs for fluoride?

Answer 3

Mineral deposits - CaF2, FAP
Biologically/bacterial bound CaF2

Question 4

Give examples of community based fluoride therapy

Answer 4

Water
School based brushing
Varnish
Salt
Milk
Tablets
Rinsing

Question 5

Give examples of office based fluoride therapy

Answer 5

Varnish
Gels and foams
Slow release

Question 6

Give examples of home based flouride therapy

Answer 6

Toothpaste
Mouthrinse
Tablets

Question 7

What are the advantages and disadvantages of fluoridated salt?

Answer 7

Requires little conscious action by the individual
Provides element of choice but public health effectiveness diminished
Challenging to get dose of salt correct for the area
Too much salt has risks of cardiovascular disease

Question 8

What can influence the results of fluoridated milk schemes?

Answer 8

Age at commencement
Population
F- concentration
Frequency of use
Distribution system
Consent/compliance/drop out rate

Question 9

What are the advantages of fluoridated milk?

Answer 9

Naturally healthy drinks for children
Important in diet - rich in nutrients
Enables fluoride to be targeted to those who would benefit most

Question 10

What are the disadvantages of fluoridated milk?

Answer 10

Distribution delayed until nursery/school age
Not all children drink milk
Shelf life
Cost issue - higher than water F-
Evidence base isn’t strong

Question 11

What are the UK guidelines for fluoride supplementation?

Answer 11

Not a public health measure
May be applicable to high risk children
6m - 3y = 0.25mg
3-6y = 0.5mg
>6y = 1mg

Question 12

What concentrations of flouride mouthwashes are available?

Answer 12

Daily - 0.05% 227ppmF
Weekly - 0.2% 909ppmF

Question 13

What are the advantages of flouride mouthrinses?

Answer 13

Reductions in caries of around 30%
Good benefit to risk ratio
Good compliance
Cost benefit ratio is low

Question 14

Describe acidulated mouthrinses

Answer 14

Low pH stimulated mild demineralisation on tooth surfaces
Presence of flouride stimulates remineralisation
More effective than non acidulated rinses at getting flouride into teeth

Question 15

Describe fluoride boosters (Tooth Mousse)

Answer 15

Used to be supplementary to F but now supplied with it
CPP-ACP - not suitable for those with milk allergies
Can be used at home or in office
Used to strengthen teeth affected by developmental defects
More research needed

Question 16

What are APF (acidulated phosphate fluoride) Gels?

Answer 16

Professionally applied or self applied under supervision
F conc 12,300ppm
30 minutes to apply up to 2x a year
Custom made trays needed
Acute toxicity risk - if ingested can causes sickness

Question 17

What is flouride varnish - Duraphat?

Answer 17

Sodium flouride 50mg/ml = 22,600ppm
Sustained contact precipitates CaF2 and progressively releases F
Professionally applies 2-4 times/yr

Question 18

Describe the flouride release from dental materials

Answer 18

GIC/RMGIC
Early washout about 4 weeks from surface layer
Slower diffusion through bulk cement
Actual amount very small, but sustained

Question 19

What factors determine the anti-caries activity of flouride toothpaste?

Answer 19

Fluoride concentration
Frequency of application
Rinsing behaviours
When brushing takes place

Question 20

How does fluoride concentration affect caries?

Answer 20

6-7% reduction in caries for every 500ppmF increase in F concentration

Question 21

How does rinsing affect fluoride present in the mouth?

Answer 21

Rinsing with small volume of water - removes excess fluoride and maintains fluoride in mouth
Rinsing with large volume of water - removes excess fluoride and reduces fluoride in mouth

Question 22

What is the current advice for brushing habits?

Answer 22

Brush at least twice daily
Pre-school children using 1500ppmF
Regulate quantity of toothpaste to smear or pea-sized amount
Parental help/supervision to avoid swallowing
Tooth brushing should commence as soon as primary teeth erupt

Question 23

What are the risks of fluoride use?

Answer 23

Risk from ingesting fluoride
Acute toxicity - very rare, generally potential problems in very young
Chronic toxicity (fluorosis)

Question 24

How much fluoride do children need to swallow to risk fluorosis?

Answer 24

0.1mg F/kg body weight
1mg per day for a 1 yo
2mg per day for a 5-6 yo
There is no lower limit below which fluorosis doesn’t occur

Question 25

Give examples of considerations regarding topical fluoride

Answer 25

Quantity of toothpaste applied not strongly associated with efficacy
Efficacy is primarily conc, as oral fluoride reservoir is small
Anti caries benefit is topical
Increased risk of developing fluorosis is systemic
Methods favouring topical delivery whilst minimising ingestion will have the best risk/benefit profile

Question 26

How can the anti-caries benefit be maximised whilst reducing fluorosis risk in young children?

Answer 26

Keep toothpaste out of reach of young children
Brush frequently - twice daily: evening and one other time
Supervise brushing by young children
Use a small amount (pea/smear) of paste
Discourage swallowing
Encourage spitting out, avoid excessive rinsing
Use a lower fluoride formulation if low caries risk, maximise fluoride concentration in relation to risk