Community based fluoride

Question 1

What is the primary mode of action of fluoride in reducing dental caries

Answer 1

post eruptive - topical effect

constant supply of fluoride in the oral cavity is most important factor to inhibit demineralization and encourage remineralisation

Question 2

What are the vehicles for fluoride delivery

Answer 2

water
salt 
milk
varnish/gels
rinses
supplements i.e drops and tablets
toothpaste

Question 3

What was the advantage of fluoridated salt

Answer 3

requires little conscious action by the individual

provides element of choice but public health effectiveness is diminished

Question 4

What was the disadvantages of fluoridated salt

Answer 4

in communities with small levels of water fluoridation, the need for varying levels of fluoride in salt is low

there is mixed messages form health professionals as increases risk of CV disease

Question 5

What are potential factors influencing results of fluoridated milk schemes

Answer 5

age at commencement 
population
fluoride concentration 
frequency of use
distribution system 
compliance/drop out rate

Question 6

What are the advantages of fluoridated milk

Answer 6

natural healthy drink for children
important part of childs diet - rich in nutrients
enables fluoride to be targeted to those who would benefit most

Question 7

What are the disadvantages of fluoridated milk

Answer 7

distribution is delayed until nursery/school age
not all children drink milk
distribution system/shelf life/cost issues (higher than fluoridated water)
lack of evidence for long term benefit

Question 8

What are the disadvantages of fluoridated cells

Answer 8

professionally applied
time consuming
special equipment necessary
acute toxicity risk if ingested
high cost per tooth surface

Question 9

What is the benefit of fluoride mouth rinses

Answer 9

reasonable to use for high caries risk populations
benefit doubtful in low risk
not recommended for <7

Question 10

What is the advice for fluoride tablets/drops

Answer 10

the systemic effect is much less important than the topical effect

it is appropriate to advise continuation beyond 6 years old for at risk children with additional needs and care requirements

Question 11

What is the agreed consensus on fluoride supplements

Answer 11

at a population level there tends to be poor compliance and it is not suitable as a public health measure

should be directed towards at risk children

requires careful assessment of risks and benefits for children <7 YO and at risk of fluorosis

Question 12

What is the point of varnish

Answer 12

it is professionally applied and designed to hold fluoride in close contact with tooth for a period

proven efficacy in caries prevention via systematic reviews

Question 13

What are the pros and cons of fluoride varnish

Answer 13

needs to be reapplied at regular intervals

emerging consensus re. optimum application frequency (2-4/year depending in caries risk)

cost effectiveness

major component of child smile

Question 14

What is the benefits of fluoride toothpaste

Answer 14

most widely used fluoride delivery vehicle in the world

considered as single most important facto run caries decline

Question 15

What are the most important factors in fluoride toothpaste and brushing

Answer 15

concentration
frequency of brushing
age at commencement
post brushing rinse

Question 16

What does evidence say on concentration of fluoride toothpaste

Answer 16

need to balance risk of fluorosis with benefit in caries reduction
current evidence is 1500ppm and limit to pea sized amount or smear
there is a loss of caries preventive efficacy with 500ppm or lower

Question 17

What is the evidence of frequency of tooth brushing

Answer 17

that the effect of fluoride toothpaste increases with higher frequency of use

brush twice daily

Question 18

What is the advice for pre school children in their brushing

Answer 18

regulate quantity of toothpaste to smear or pea sized amount

parental help/supervision to avoid swallowing

Question 19

What is the evidence on age at commencement of tooth brushing

Answer 19

should commence as soon as primary teeth erupt

Question 20

What is the current advice for parents and children for post brushing rinse

Answer 20

spit out excess toothpaste

refrain from resining with water post brushing

Question 21

What are the adverse effects of toothpaste

Answer 21

dental fluorosis risk
significant risk reduction when you start brushing after 12months
no significant risk depending on brushing frquency
if fluoride concentration greater than 1000ppm then marginally significant risk

Question 22

What is child smile core toothbrushing program

Answer 22

OH pack given to children at age 1, age 3, age 4 and age 5

all nursery schools invited to participate in daily supervised brushing programme

all primary schools in most deprived areas invited to participate in daily supervised brushing program for p1 and p2

Question 23

What are the principle objectives of child smile practice

Answer 23

raising parental awareness of good oral health behaviors and supporting parents to put them into practice

increasing the provision of oral health promotion and clinical prevention within dental primary care

Question 24

What is child smile nursery and school

Answer 24

targeted to priority nurseries and schools

program of 6 monthly fluoride varnish applications throughout nursery and primary school

Question 25

What is the population child smile approach

Answer 25

core programme

tailored program of care within primary care dental services

Question 26

What is the targeted child smile approach

Answer 26

additional home /community support

enhanced program of care within primary care dental services

additional clinical preventive programs targeting highest need nursery and primary schools

supervised toothrbushign p1 and p2 targeting highest need schools