Fluoride Flashcards
what percentage of adults 0-64 have had caries in permanent teeth
92%
what percentage of adults have untreated decay
26%
fluoride is a _____ to caries prevention; not a ____
supplement; solution
what are systemic application of fluoride
-ingested agents that become incorporated into enamel during development of tooth structures
- water
- supplements
-food/beverages
what are the types of fluoride therapy
- systemic
- topical
what is topical application therapy
strengthen teeth already in the mouth making them more resistant to caries
- water
-homecare products
- in office products
what is the mechanism of action of topical fluoride
- promotes remineralization and prevents demineralization after eruption
- inhibits glycolysis in bacteria, thereby inhibiting the ability of bacteria to metabolize carbohydrates and produce acid
what is water fluoridation
an increase of the natural fluoride in a community’s water supply to a level optimal for dental health
what is one of the most cost effective preventative dental program by public health
water fluoridation
what are the benefits in water fluoridation
- 30-39% decrease in caries in primary dentition
- 35% decrease in children/adolescent permanent dentition
- approximately 20-30% decrease in coronal caries and 20-40% decrease in root caries in adult population
what is the optimal levels of water
0.6-1.2 ppm
what level of water fluoridation is associated with decreased caries in less than 10% of population
0.7 ppm
what is fluorosis
changes in the apperance of enamel caused by too much systemic fluoride
what is optimal level of water fluoridation consider
minimal caries with minimal fluorosis
what do tooth structures feel like that are demineralized
rough
what do tooth structures feel like with fluorosis
smooth
how does topical fluoride work
- fluoride deposited in enemael during enamel maturation phase in a concentration of fluoride in the enamel
- highest concentration occurs on the outermost portion 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
- does not cause fluorosis
what is the fluoride/enamel reaction influenced by
concentration of fluoride, pH of fluoride and length of exposure
acidic fluorides typically form:
calcium fluoride
higher concentrations form:
calcium fluoride
what is the concentration of in office fluorides
greater than 9000 ppm
what concentration of fluorides form fluoroapatite
less than 100 ppm
what are the benefits of topical fluoride
- remineralization
- interferes with bacterial metabolism
- prevention
what are the types of topical fluoride applications
- 2% neutral sodium flouride (9000 ppm): foam or gel, rarely used
- 1.23% acidulated phosphate fluoride (12,300 ppm): foam or gel, rarely used
- 5% NaF (22,600 ppm): varnish, commonly used
describe the initial deposit of fluoride
-not permanent
- relatively rapid loss after 24 hours
what happens after every application of topical fluoride
there is an increase in the amount of permanently bound fluoride in the outermost layer of enamel which causes a decrease in caries susceptibility
what are the types of fluoride
- flurohydroxyapatite
- calcium fluoride
describe fluorohydroxyapatite
- most desired form of fluorisde for enamel in caries prevention
- from prolonged exposure of enamel to low concentrations of fluoride
describe calcium fluoride
- source of fluoride for remineraliation of enamel
- deposits of calcium fluoride are dissolved by plaque acids and are available as a source to facilitate remineralization
what are the benefits of topical fluoride
-directly related to the amount of topical fluoride treatments provided
- the type of topical fluoride system used does not affect the benefit
- does not benefit sound enamel
- greater uptake with higher concentrations of fluoride
when should topical fluoride be used
- high caries risk individuals
- sensitive teeth/exposed root surfaces
- around margins of older restorations
- overdentures
- xerostomia
- newly erupted teeth
what is the probable toxic dose (PTD) calculated to be
- based on body weight
- 5mg F/kg body weight
what should you do when less than 5mg F/kg PTD
office use of available calcium, aluminum or magensium products
what should you do when greater than 5mg F/kg PTD
-office use of available calcium, aluminum, or magnesium products
- plus hospital observation
what should you do when greater than 15 mg/kg
- office use of available calcium, aluminum, or magnesium products
- hospital observation
- emergency response
describe fluoride toxicity
- concentrated fluoride salts can cause chemical burn when in contact with oral mucosa
- inhibits enzyme systems
- binds calcium
- cardiotoxic due to hyperkalemia
what are signs and symptoms of too much fluoride
- nausea
- vomitting
- diarrhea
- abdominal cramping
- increased salivation/ dehydration
what are the pros to 5% NaF fluoride varnish
- proven efficacious in decreasing caries, especially in early childhood
- easy to apply following oral exam and prophylaxis
- easy to follow post of instructions
what are the cons to fluoride varnish 5% NaF
- leaves a thin visible film on teeth that some patients do not like
- possible allergies linked to specific brands to fluoride varnish
describe the application of fluoride varnish
- applied to clean tooth surfaces following prophy or tooth brushing
- 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 depending on caries risk
what percentage of parents refuse fluoride tx
13%
what are the strategies to manage Fluoride tx refusal
- assess
- incorporate
- obtain
- provide
- maintain
- communicate
describe silver diamine fluoride
- first investigated in 1969
- antimicrobial properties of silver with benefits of high dose fluoride
- results in a precipitate that occluded dentinal tubules and reduced hypersensitivity
- initially emerged from dental public health researchers in the developing world where access to oral health care was limited
what concentration of silver diamine fluoride is best at stopping caries
38%
SDF is better at stopping caries than:
fluoride varnish alone
how should you apply SDF
multiple applications
what is the mechansim of SDF
- fluoride and silver are made soluble in water by the addition of ammonia
- the silver ions are a broad spectrum antimicrobial that has high biocompatibility and low toxicity in humans
- these ions act as tiny silver bullets that damage and degrade bacterial cell walls, disrupt bacterial DNA synthesis and replication and disrupt intracellular metabolic activity, eventually leading to cell death
- the killed bacteria further act as a carrier for silver ions and can kill living bacteria nearby in a process known as the zombie effect
- once applied a physical barrier precipitates out the clear solution onto carious lesion
- 2 products form: silver phosphate and calcium fluoride
- free silver ions in the lesion are reduced by environmental oxygen and turn the lesion black which is the major nonmedical side effect of SDF
what does silver phosphate act as
a reservoir of phosphate ions
what does calcium fluoride do
a pH regulated fluoride supply available during cariogenic challenge
a 5% SDF solution contains what concentration of fluoride
44,800 ppm
what does SDF react with at a 5%SDF solution
calcium and phosphate ions to produce fluorhydroxyapatite crystals which are less susceptible to solubility and crucial to tooth remineralization
what is SDF used to treat in adults
dentin hypersensitivity
how do you place SDF
- dry tooth
- using a micro brush apply sparingly to tooth
- allow area to dry slightly 1-3 mins then rinse
- caries will be arrested over time and turn black
when should you not used SDF
silver allergy of pulpal involvement
what is fluoridate prophy paste considered
a therapeutic/preventative agent for varies
what does fluoride prophy paste replace
fluoride lost by abrasive polishing which alone removes 0.1-1.0 microns of fluoride rich enamel
what is the concentration of NaF in toothpastes
0.22%
when is there a risk of fluorisis and toxicity witth toothpaste
if ingested
what are the ingredients in ACT mouthwash
- alcohol free
- 0.02% sodium fluoride (100 ppm) in 33.8 oz bottle
- 0.05% sodium fluoride (225 ppm) in 18 oz bottle
when do you use SDF
- dentin hypersensitivity
- uncooperative patients, roor surface caries on elderly patients with existing restorations, patients without access to restorative care, difficult to treat lesions
what does fluoride rinse do
- remineralizes tooth structure
- strengthens enamel to prevent caries
- kills bad breath
how do you use fluoride rinse
- twice daily after brushing/flossing swish with 10mL for 1 minute
- no eating or drinking for 30 minutes after
what is the ingredients in listerine
- 0.02% sodium fluoride 100 ppm
- 21.6% v/v alcohol
- same instructions
what is MI paste plus
- uses RECALDENT ( a milk derived protein) to relieve tooth sensitivity not to prevent decay
- 0.20% NaF (900ppm) and can be used for caries prevention and tooth sensitivity
what is the concentration in prevident toothpaste
1.1% NaF (5000 ppm)
what is the concentration of prevident mouth rinse
0.2 NaF 900ppm
