Community Based Flouride Delivery in Caries Prevention Flashcards
How does fluoride prevent caries?
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
When is fluoride most effective?
Topically
On early lesions
What are the oral reservoirs for fluoride?
Mineral deposits - CaF2, FAP
Biologically/bacterial bound CaF2
Give examples of community based fluoride therapy
Water
School based brushing
Varnish
Salt
Milk
Tablets
Rinsing
Give examples of office based fluoride therapy
Varnish
Gels and foams
Slow release
Give examples of home based flouride therapy
Toothpaste
Mouthrinse
Tablets
What are the advantages and disadvantages of fluoridated salt?
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
What can influence the results of fluoridated milk schemes?
Age at commencement
Population
F- concentration
Frequency of use
Distribution system
Consent/compliance/drop out rate
What are the advantages of fluoridated milk?
Naturally healthy drinks for children
Important in diet - rich in nutrients
Enables fluoride to be targeted to those who would benefit most
What are the disadvantages of fluoridated milk?
Distribution delayed until nursery/school age
Not all children drink milk
Shelf life
Cost issue - higher than water F-
Evidence base isn’t strong
What are the UK guidelines for fluoride supplementation?
Not a public health measure
May be applicable to high risk children
6m - 3y = 0.25mg
3-6y = 0.5mg
>6y = 1mg
What concentrations of flouride mouthwashes are available?
Daily - 0.05% 227ppmF
Weekly - 0.2% 909ppmF
What are the advantages of flouride mouthrinses?
Reductions in caries of around 30%
Good benefit to risk ratio
Good compliance
Cost benefit ratio is low
Describe acidulated mouthrinses
Low pH stimulated mild demineralisation on tooth surfaces
Presence of flouride stimulates remineralisation
More effective than non acidulated rinses at getting flouride into teeth
Describe fluoride boosters (Tooth Mousse)
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
What are APF (acidulated phosphate fluoride) Gels?
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
What is flouride varnish - Duraphat?
Sodium flouride 50mg/ml = 22,600ppm
Sustained contact precipitates CaF2 and progressively releases F
Professionally applies 2-4 times/yr
Describe the flouride release from dental materials
GIC/RMGIC
Early washout about 4 weeks from surface layer
Slower diffusion through bulk cement
Actual amount very small, but sustained
What factors determine the anti-caries activity of flouride toothpaste?
Fluoride concentration
Frequency of application
Rinsing behaviours
When brushing takes place
How does fluoride concentration affect caries?
6-7% reduction in caries for every 500ppmF increase in F concentration
How does rinsing affect fluoride present in the mouth?
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
What is the current advice for brushing habits?
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
What are the risks of fluoride use?
Risk from ingesting fluoride
Acute toxicity - very rare, generally potential problems in very young
Chronic toxicity (fluorosis)
How much fluoride do children need to swallow to risk fluorosis?
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
Give examples of considerations regarding topical fluoride
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
How can the anti-caries benefit be maximised whilst reducing fluorosis risk in young children?
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
