Fluoride Flashcards
What are the different concentrations for fluoride toothpaste
1000ppm
1450ppm
2800ppm
5000ppm
What is the concentration of fluoride varnish
22600pmp
What is the concentration of fluoride mouthwash
225 ppm
What is the concentrations of fluoride tablets
1mg
What is the concentration of SDF
44,800ppm
What are the functions of fluoride
- Fluoride is incorporated into enamel crystal to form fluorapitite which is more caries resistant than hydroxyapatite
- Has bacteriocidal properties
- Interferes with the adhesion forces of bacteria reducing their ability to stick to the surface of teeth
Who is 1000ppm fluoride toothpaste suitable for
<3 years
How much toothpaste should <3 YO use
smear
Who should be using 1450ppm toothpaste
- standard risk adults
- 4-16 year olds who are standard risk
- high risk <10s
Who can be prescribed 2800ppm toothpaste
high risk >10 YO
Who can be prescribed 5000ppm toothpaste
high risk >16 year olds
Who can be prescribed 5000ppm toothpaste
high risk >16 year olds
How often and to who should fluoride varnish be given
- Topical fluoride should be applied to dentition at least twice yearly for pre-school children deemed at being high risk of caries
- Fluoride varnish can be administered for high risk adult
Who shouldn’t be given fluoride mouthwash
- Not recommended for children under the age of 6
- Always assess child’s ability to properly exporate
What dose of toothpaste would give a probable toxic dose
- 5mg/kg bodyweight
What is intervention for fluoride overdose dependant on
how much toothpaste was ingested
If less than 5mg/kg was ingested, what should the intervention be
- give calcium orally (milk) and observe for a few hours
If 5-15mg/kg was ingested, what should the intervention be?
- If 5-15 mg/kg ingested → give calcium orally (milk, calcium gluconate, calcium lactate) and admit to hospital
If >15mg/kg is ingested, what should the intervention be
- admit to hospital immediately, cardiac monitoring and life support, intravenous calcium gluconate
What should you not do to someone with suspected fluoride overdose
induce vomiting
risk of aspiration
What does SDF stand for
Silver diamine fluoride
What is SDF
- liquid substance used to help prevent tooth cavities (or caries) from forming, growing, or spreading to other teeth.
What is SDF
liquid substance used to prevent tooth cavities or caries from forming/growing/spreading to other teeth
Who is the manufacturer of SDF in the UK
riva star
What is the function of potassium iodide in SDF
reduces staining
What is SDF made of
- silver
- water
- fluoride
- ammonia
What is the function of the silver in SDF
- helps kill bacteria
What is the function of water in SDF
- Provides a liquid base for the mixture
What is the function of fluoride in SDF
- Helps your teeth rebuild the materials they’re made of (known as remineralisation)
What is the function of ammonia in SDF
Helps the solution remain concentrated so that it is maximally effective against cavity resonance
What colour does SDF turn caries
black
may temporarily stain soft tissues brown for 1-3 weeks
What is a rare side effect of SDF to the gingiva
- Rarely, it can cause a chemical burn to the gingivae
What are indications for SDF
- Asymptomatic cavitated dentine carious lesions in primary teeth
- Lesions that can be made cleansable
- Dentinal lesions that are non-restorable
- Root surface caries
- Promoting the arrest and remineralisation of active carious lesions
- Active dentinal lesions
- Pre-cooperative children
- Permanent teeth with MIH (blocking dentinal tubules may reduce sensitivity)
What are contraindications of SDF
- Signs/symptoms of irreversible pulpitis, or dental abscess or sinus
- Radiographic peri-radicular radiolucency or signs of pulpal involvement
- Infection/pain from pulpal origin or food packing
- Allergy to any ingredient inclusive of silver and other heavy metals
- Active ulceration, mucositis or stomatitis
- Pregnant or breastfeeding
- Patients undergoing thyroid gland therapy or on thyroid medication (if potassium iodide used)
What is the clinical procedure for SDF
Apply petroleum jelly to the soft tissues including the lips if possible
Protect the gingiva using petroleum jelly and cotton wool rolls or Riva Star gingival barrier
- Ensure teeth are clean and free of debris
- Dry teeth using a cotton wool roll or gauze
- Use the silver brush or another micro-brush to pierce the silver capsule
- Carefully apply the solution from the silver capsule (silver diamine fluoride) to the treatment site with the silver brush, a micro brush or other single use applicator. This should be left to dry for at least 1 minute, ideally 3 minutes.
- If a decision has been made with the family to use potassium iodide then follow 7
- 7a) pierce the foil of the green capsule
- 7b) apply solution from green capsule (potassium iodide) to treatment site, with the green brush, a micro brush or other single use applicator. Continue application until the creamy white solution present on the lesion turns clean
- Blot teeth dry using a cotton wool roll, gauze or fresh single use micro-brush
- Remove gingival barrier if used
When would a patient be followed up after application of SDF
2-4 weeks after first application
How do you know if the SDF has arrested caries
- hard, darkened lesion.
What is the function of fluoride varnish
- Slows down the development of decay by stopping demineralization
- Makes enamel more resistance to acid attack and speeds up remineralization – bonds with calcium and phosphate to create fluorapatite
- Can stop bacterial metabolism at high concentrations to produce less acid
How would you describe fluoride varnish to parents
- Provides extra protection against tooth decay when used in addition to brushing
- Pale yellow gel that sets quickly when applied to childrens teeth using a soft brush
What is the max amounts of applications for fluoride varnish
4 times a year
What are contraindications for fluoride varnish
- Allergy to colophony
- Hospitalized with severe asthma in past 12 months
- Ulcerative gingivitis
- Residual varnish is visible
- Child has had varnish applied in the past 24 hours
What ml of fluoride varnish should be used for children that are in < P1
0.25
What ml of fluoride varnish should be used for children >P2
0.4ml
What is the aftercare for fluoride varnish
- Eat soft foods for rest of the day to reduce chewing
- Children should not brush their teeth that evening but should continue to brush twice a day with fluoride toothpaste from the following morning (this is debatable - clinicians would probably disagree but this is whats on childsmile)
What is resin fissure sealant made from
- bis-GMA with dimethacrylaet monomer to make the sealant easy to flow
