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Patient Care 3 > Fluoride > Flashcards

Fluoride Flashcards

1
Q

–% of adults aged 20-64
have had dental caries in
permanent teeth

A

92

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2
Q

—% of adults aged 20-64
have untreated decay

A

26

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3
Q

Fluoride is a — to caries prevention-not a
solution on its own

A

SUPPLEMENT

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4
Q
  • — control is priority
A

Oral hygiene/plaque

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5
Q
  • — habits must be addressed with patient
A

Dietary

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6
Q

Systemic application:

A

ingested agents that
become incorporated into forming tooth
structures

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7
Q

systemic application
ex (3)

A
  • Water
  • Supplements
  • Food/beverages
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8
Q

Topical application:

A

strengthen teeth
already in the mouth making them more
resistant to caries

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9
Q

Topical application
ex (3)

A
  • Water
  • Homecare products (toothpaste,
    mouth rinses, etc.)
  • In-office products
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10
Q

Systemic

A
  • Ingested and incorporated into
    enamel during development of
    tooth structures
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11
Q

Topical
* Promotes
* Inhibits

A

remineralization and
prevents demineralization after
eruption

glycolysis in bacteria,
thereby inhibiting the ability of
bacteria to metabolize
carbohydrates and produce acid

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12
Q

Water
Fluoridation

A
  • An increase of the natural fluoride level in a
    community’s water supply to a level
    optimal for dental health
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13
Q

Fluoridation has contributed to a major
decline in

A

dental caries from the 1950s to
the 1980s and continues to reduce and
prevent tooth decay

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14
Q

When cities discontinue water fluoridation,
evidence demonstrates

A

rapid increase in
caries rates

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15
Q

Water fluoridation is considered one of the
most — preventive dental
program by public health

A

cost-effective

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16
Q

Benefits of
Water
Fluoridation
—% decrease in caries in
primary dentition

A

30-39

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17
Q

—% decrease in
children/adolescent permanent
dentition

A

35

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18
Q

Approximately —% decrease in
coronal caries and —% decrease
in root caries in adult population

A

20-30
20-40

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19
Q

Levels of Water Fluoridation
Optimal =

A

minimal
caries with
minimal fluorosis

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20
Q

– ppm decreases
caries with <10%
of population with
fluorosis

A

.7

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21
Q

Optimal range:
— ppm

A

0.6-1.2

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22
Q

What is
Fluorosis?

A

Changes in the appearance
of enamel caused by too
much systemic fluoride

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23
Q

Demineralization of Tooth Structures
Upon exploring, tooth surfaces will feel —

A

rough

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24
Q

Fluorosis
Upon exploring, tooth surfaces will feel —

A

smooth

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25
Q

How does
Topical Fluoride
work?
(4)

A
  • Fluoride deposited in enamel during enamel
    maturation phase results in a concentration of
    fluoride in the enamel
  • Highest concentration occurs on the outermost
    portion (5-10 microns) and decreases as you move
    toward the dentin
  • Fluoride ions are substituted into the hydroxyapatite
    crystal and form a stable, more compact bond making
    the tooth resistant to demineralization
  • It does NOT cause fluorosis
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26
Q

Fluoride/Enamel
Reaction to Fluoride
Influenced by concentration of (3)

A

fluoride, pH of
fluoride, and length of exposure

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27
Q

Acidic fluorides typically form

A

calcium
fluoride

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28
Q
  • Higher concentrations form
A

calcium fluoride

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29
Q

In-office fluorides are >9000 ppm, so
they typically form

A

calcium fluoride

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30
Q
  • Neutral fluorides <100 ppm form
A

fluorapatite

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30
Q
  • Neutral fluorides <100 ppm form
A

fluorapatite

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31
Q

Benefits of Topical Fluoride- continued
(3)

A

Remineralization
Interferes with bacterial metabolism
Prevention

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32
Q

2% Neutral sodium
fluoride (9000 ppm)

A

Available as a
foam or gel
application

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33
Q

1.23% Acidulated
Phosphate Fluoride
(APF) (12,3000 ppm)

A

Available as a
foam or gel
application

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34
Q

5.0% NaF
(22,600 ppm)

A

Available as a
varnish
application
Commonly
used in dental
practices

35
Q
  • Initial deposits of fluoride is not permanent
    (2)
A
  • Relatively rapid loss after 24 hours
  • Loss continues for several weeks
36
Q

After every application of topical fluoride, there is an
increase in the amount of permanently bound fluoride in
the

A

outermost layer of enamel

37
Q

This causes a decrease in — susceptibility (initiation and
progression)

A

caries

38
Q

Fluorohydroxyapatite-

A

most desired form of
fluoride for enamel in caries prevention
* From prolonged exposure of enamel to
low concentrations of fluoride

39
Q

Calcium fluoride-

A

source of fluoride for
remineralization of enamel
* Deposits of calcium fluoride are
dissolved by plaque acids and are
available as a source to facilitate
remineralization

40
Q

The benefits of topical fluoride treatments is directly
related to the amount of topical fluoride treatments
provided
(3)

A
  • The type of topical fluoride system used does not
    affect the benefit
  • Does not benefit sound enamel
  • Greater uptake with higher concentrations of
    fluoride
41
Q

When Should Topical
Fluoride Be Used?
(6)

A
  • High caries risk individuals
  • Sensitive teeth/exposed root surfaces
  • Around margins of older restorations
  • Overdentures (with natural teeth)
  • Xerostomia
  • Newly erupted teeth
42
Q

Probable Toxic Dose (PTD)
Based on

A

body weight
Considered to be 5mg F/kg of body weight

43
Q
  • <5mg/kg:
A

office use of available calcium, aluminum or
magnesium products

44
Q
  • > 5mg/kg:
A

same as above plus hospital observation

45
Q
  • > 15mg/kg:
A

same as above plus emergency response (911)

46
Q

skipped
Fluoride Toxicity
(4)

A

Concentrated fluoride salts can cause chemical burn when in contact with oral
mucosa
Inhibits enzyme systems
Binds calcium
Cardiotoxic due to hyperkalemia

47
Q

Signs &
Symptoms
of too
much Fluoride
(5)

A

Nausea
Vomiting
Diarrhea
Abdominal cramping
Increased salivation/dehydration

48
Q

Fluoride Varnish- 5% NaF
PROS
(3)

A
  • Proven efficacious in decreasing
    caries, especially in early-childhood
  • Easy to apply following oral exam and
    prophylaxis
  • Easy to follow post-op instructions
49
Q

Fluoride Varnish- 5% NaF
CONS
(2)

A
  • Leaves a thin-visible film on teeth that
    some patients do not like
  • Possible allergies linked to specific
    brands of fluoride varnish
50
Q

Application of Fluoride Varnish
(3)

A
  • Applied to clean tooth surfaces (following a prophylaxis or
    toothbrushing)
  • Varnish is retained on teeth from 24-48 hours after
    application, during which time fluoride is released for
    reaction with the underlying enamel
  • Applications should occur every 3-6 months (dependent
    upon caries risk)
51
Q

Clinical evidence demonstrates fluoride
treatment refusal by —% of parents
during preventive dental visits

A

13

Many other parents have unresolved
concerns regarding fluoride treatments

52
Q

One study points out that fluoride refusal
was significantly associated with

A

vaccination refusal

53
Q

skipped
Assess

A

Assess parents’ knowledge, beliefs and attitudes about
fluoride with open-ended, nonjudgmental questions

54
Q

skipped
Incorporate

A

Incorporate caries risk into discussions with parents during
preventive visits

55
Q

skipped
Obtain

A

Obtain information about why a parent refuses fluoride
treatment (listening is key and will help build trust with a
fluoride-hesitant parent)

56
Q

skipped
Provide

A

Provide a tailored explanation of why topical fluoride is
important

57
Q

skipped
Maintain

A

Maintain open communication, even when refusal continues

58
Q

skipped
Communicate

A

Communicate with local health professionals to reinforce the
importance of fluoride

59
Q

skipped
History of Silver

A

silver first used in dentistry un the 1840s known as nitrate of silver
it was extremely caustic and early american dentists used it to instantaneously cauterize carious lesions
popular dental medicament used through the era of GV black
in 1917, a silver nitrate solution was developed and marketed as an antimicrobial that could penetrate even deeper into dentin
in the 1970s, the wester australia school dental service used silver fluoride as the initial part of a minimally invasive treatment process for disadvantaged young children in new south wales
AgF was seen as essential to inhibiting the growth of existing lesions
stannous fluoride was then applied to act as reducing agent to AgF and to prevent new lesions from occurring
this two step metal fluoride approach resulted in 74% of the existing lesions remain unchanged and only 35% of all lesions requiring additional treatment

60
Q

skipped
Silver Diamine Fluoride
(4)

A
  • First investigated in 1969 as part of a PhD student’s thesis in
    Japan (Mizuho Nishino)
  • She combined the antimicrobial properties of silver with the
    benefits of high dose fluoride
  • This formulation additionally resulted in a precipitate that
    occluded dentinal tubules and reduced hypersensitivity
  • This product initially emerged from dental public health
    researchers in the developing world, where access to oral health
    care was extremely limited
  • Primary population studies came from
    Argentina, Brazil, China, Cuba, Japan and
    Nepal
  • 38% SDF was found to be most superior
    at arresting caries compared to lower
    concentrations of 10 or 12%
  • SDF was also superior at arresting dental
    caries and preventing new caries
    compared to fluoride varnish alone,
    however, did not hold true when used as
    a sealant over NON-cavitated molar
    grooves
  • Multiple applications of SDF were found
    to be more successful at arresting dental
    caries than one-time placement
61
Q

SDF gained clearance from the FDA in the US
in —

A

2014

62
Q

SDF
Approved for use to treat dentin
— in adults

A

hypersensitivity

63
Q

In October 2016, the FDA awarded SDF the
designation of “breakthrough therapy” based
on its

A

arrest of decay in children and adults,
the first for oral health therapy

64
Q
  • Fluoride and silver are made soluble in water
    by the addition of
A

ammonia

65
Q
  • The — ions are a broad-spectrum
    antimicrobial that has high biocompatibility
    and low toxicity in humans
A

silver

66
Q
  • These ions act as tiny ‘silver bullets’ that
A

damage and degrade bacterial cell walls,
disrupt bacterial DNA synthesis and
replication and disrupt intracellular metabolic
activity, eventually leading to cell death

67
Q
  • The killed bacteria further act as a carrier for
    silver ions and can kill living bacteria nearby in
    a process known as the
A

“zombie effect”

68
Q
  • Once applied, a physical barrier precipitates out of
    the
A

clear solution onto the carious lesion

69
Q

SDF
* 2 products form–

A

silver phosphate which acts as a
reservoir of phosphate ions, and

calcium fluoride,
which is a pH-regulated fluoride supply available
during cariogenic challenge

70
Q

major nonmedical side effect of SDF

A
  • Free silver ions in the lesion are reduced by
    environmental oxygen and turn the lesion black
71
Q
  • 5% SDF solution contains — ppm fluoride
A

44,800
(almost twice as much as % NaF varnish)

72
Q

5% SDF solution contains 44,800 ppm fluoride
(almost twice as much as % NaF varnish)
* In this concentration, SDF reacts with calcium
and phosphate ions to produce

A

fluorohydroxyapatite crystals, which are less
susceptible to solubility and crucial to tooth
remineralization

73
Q

Despite the high concentration, the small
amount of SDF required to be effective suggests
that it is

A

well within the margin of safety for use

74
Q

One application of SDF is not sufficient for
ultimate results- may need to

A

place SDF a few
times for effectiveness in treating the area

75
Q

When to Use SDF
(2)

A
  • Dentin hypersensitivity
  • Uncooperative patients (i.e., children or
    patients with cognitive disabilities), root
    surface caries on elderly patients with
    existing restorations, patients without
    access to restorative care, difficult to treat
    lesions
76
Q

Placement of SDF
(6)

A

Dry tooth on which SDF will be placed
Using a micro brush, apply SDF sparingly to tooth
Allow area to dry slightly (1-3 minutes) then rinse
Caries will be arrested over time and will turn black as a result
SDF has an unpleasant metallic taste
DO NOT use with a silver allergy of pulpal involvement

77
Q

Prophy Paste &
Fluoride
(2)

A
  • Fluoridate prophy paste is not considered a
    therapeutic/preventive agent for caries
  • Polishing alone removes 0.1-1.0 microns of
    fluoride-rich enamel, therefore, at best,
    fluoride in prophy paste will replace the
    fluoride lost by the abrasive paste
78
Q

Toothpastes
(OTC)
(2)

A
  • Average Concentration 0.22% NaF (1000 ppm)
  • Sodium Fluoride (NaF) most effective dentifrice system for caries prevention
  • Risk of fluorosis and toxicity if ingested (hence, pea-sized amount for small
    children)
79
Q

Fluoride
Rinses
ingredients (3)

A

alcohol free
0.02% sodium fluoride (100 ppm) in 33.8 fl oz bottle
0.05% sodium fluoride (225 ppm) in 19 fl ox bottle

80
Q

Fluoride
Rinses
what fluoride rinse does (3)

A

remineralizes tooth structure
strengthens enamel to prevent caries
kills bad breath

81
Q

Fluoride
Rinses
how to use it (2)

A

twice daily after brushing/flossing, swish with 10 mL for 1 min then expectorate
no eating/drinking for 30 min after

82
Q

Other Types of
ACT Rinse
All the active ingredients remain
the same between – oz and
– oz bottles

A

18
33.8

83
Q

Listerine
(3)

A
  • 0.02% Sodium Fluoride (100 ppm)
  • 21.6% v/v alcohol
  • No difference in instructional use
84
Q

MI PASTE PLUS (OTC)
(2)

A

MI paste alone used recaldent to relieve tooth sensitivity not to prevent decay
MI paste plus has 0.20% NaF (900 ppm) and can be used for caries prevention and tooth sensitivity

85
Q

Prevident toothpaste:

A

1.1% NaF (5000 ppm)

86
Q

Prevident mouth rinse:

A

0.2% NaF (900 ppm)

Patient Care 3 (25 decks)

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