Flouride Delivery In Community Non H2O

Question 1

Where does fluoride have the greatest effect?

Answer 1

Topical post eruptive - early lesions

Question 2

Where can fluoride be found in the oral cavity?

Answer 2

Mineral deposits - CaF2 or FAP

Biologically bound calcium fluoride

But the oral reservoir is small, so best to maintain elevated levels through little and often fluoride delivery

Question 3

Give some ways fluoride is delivered in the community?

Answer 3

Childsmile and school based brushing

Water

Fluoride varnish

Question 4

How does fluoride prevent caries?

Answer 4

May have felt on inhibiting bacterial metabolic pathways so ess acid produced

Fluoro-apatite more resistan

Question 5

Give some in office midstream fluoride delivery

Answer 5

Varnish

Foams or gels

Slow release fluoride

Question 6

Give some downstream fluoride delivery methods

Answer 6

Toothpaste

Mouthrinse

Tablets

Question 7

Give some evidence with regards to fluoridated milk. Pros and cons?

Answer 7

Fluoridated milk

— used in young children, NW England saw no caries reduction in primary dentition and only small reduction in permanent

Pros
- healthy drink
- fluoride to target children

Cons
- shelf life
- distributed at nursery age
- evidence base is poor

Question 8

When should fluoride tablets possibly be used, pros cons?

Answer 8

Topical effect > systemic

Cons
- risk of fluorosis
- evidence based on trials with flawed design

Pros
- good topical effect if swish and swallow?

Question 9

Pros and cons of fluoride mouthrinse

Answer 9

Pros

• 30% caries reduction
• daily (0.05%) > weekly (0.2%)
• good benefit to risk ratio

Cons

• swallowing can cause fluorosis
• studies showed little interest into adverse effects

Question 10

What is an acidulated mouthrinse?

Answer 10

Fluoride booster

• low ph to promote demineralisation
• leading to incorporation of fluoride in the enamel

Question 11

How does duraphat work? What are its ppmF and mg/ml

Answer 11

22600ppmF and 50mg/ml

Sustained contact with the teeth causing
- precipitation of calcium fluoride
- progressive release of topical fluoride

Question 12

What factors influence the anti caries activity of fluoride toothpaste?

Answer 12

Concentration

Frequency of application

Rinsing - bad

When brushing is done

Question 13

What are some risks of fluoride?

Answer 13

Increased risk of enamel fluorosis

Acute toxicity - very rare

Question 14

How much fluoride needed for young children to swallow to get fluorosis?

Answer 14

0.1mgF/kg

Question 15

How to maximise fluoride benefit and decrease risk in children?

Answer 15

Keep toothpaste out of reach

Brush twice per day, evening and one other

Pea sized amount of paste

Spit don’t rinse