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Patient Care 3 > Fluoride > Flashcards

Fluoride Flashcards

1
Q

what percentage of adults 0-64 have had caries in permanent teeth

A

92%

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2
Q

what percentage of adults have untreated decay

A

26%

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3
Q

fluoride is a _____ to caries prevention; not a ____

A

supplement; solution

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4
Q

what are systemic application of fluoride

A

-ingested agents that become incorporated into enamel during development of tooth structures
- water
- supplements
-food/beverages

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5
Q

what are the types of fluoride therapy

A
  • systemic
  • topical
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6
Q

what is topical application therapy

A

strengthen teeth already in the mouth making them more resistant to caries
- water
-homecare products
- in office products

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7
Q

what is the mechanism of action of topical fluoride

A
  • promotes remineralization and prevents demineralization after eruption
  • inhibits glycolysis in bacteria, thereby inhibiting the ability of bacteria to metabolize carbohydrates and produce acid
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8
Q

what is water fluoridation

A

an increase of the natural fluoride in a community’s water supply to a level optimal for dental health

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9
Q

what is one of the most cost effective preventative dental program by public health

A

water fluoridation

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10
Q

what are the benefits in water fluoridation

A
  • 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
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11
Q

what is the optimal levels of water

A

0.6-1.2 ppm

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12
Q

what level of water fluoridation is associated with decreased caries in less than 10% of population

A

0.7 ppm

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13
Q

what is fluorosis

A

changes in the apperance of enamel caused by too much systemic fluoride

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14
Q

what is optimal level of water fluoridation consider

A

minimal caries with minimal fluorosis

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15
Q

what do tooth structures feel like that are demineralized

A

rough

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16
Q

what do tooth structures feel like with fluorosis

A

smooth

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17
Q

how does topical fluoride work

A
  • 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
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18
Q

what is the fluoride/enamel reaction influenced by

A

concentration of fluoride, pH of fluoride and length of exposure

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19
Q

acidic fluorides typically form:

A

calcium fluoride

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20
Q

higher concentrations form:

A

calcium fluoride

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21
Q

what is the concentration of in office fluorides

A

greater than 9000 ppm

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22
Q

what concentration of fluorides form fluoroapatite

A

less than 100 ppm

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23
Q

what are the benefits of topical fluoride

A
  • remineralization
  • interferes with bacterial metabolism
  • prevention
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24
Q

what are the types of topical fluoride applications

A
  • 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
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25
Q

describe the initial deposit of fluoride

A

-not permanent
- relatively rapid loss after 24 hours

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26
Q

what happens after every application of topical fluoride

A

there is an increase in the amount of permanently bound fluoride in the outermost layer of enamel which causes a decrease in caries susceptibility

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27
Q

what are the types of fluoride

A
  • flurohydroxyapatite
  • calcium fluoride
28
Q

describe fluorohydroxyapatite

A
  • most desired form of fluorisde for enamel in caries prevention
  • from prolonged exposure of enamel to low concentrations of fluoride
29
Q

describe calcium fluoride

A
  • 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
30
Q

what are the benefits of topical fluoride

A

-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

31
Q

when should topical fluoride be used

A
  • high caries risk individuals
  • sensitive teeth/exposed root surfaces
  • around margins of older restorations
  • overdentures
  • xerostomia
  • newly erupted teeth
32
Q

what is the probable toxic dose (PTD) calculated to be

A
  • based on body weight
  • 5mg F/kg body weight
33
Q

what should you do when less than 5mg F/kg PTD

A

office use of available calcium, aluminum or magensium products

34
Q

what should you do when greater than 5mg F/kg PTD

A

-office use of available calcium, aluminum, or magnesium products
- plus hospital observation

35
Q

what should you do when greater than 15 mg/kg

A
  • office use of available calcium, aluminum, or magnesium products
  • hospital observation
  • emergency response
36
Q

describe fluoride toxicity

A
  • concentrated fluoride salts can cause chemical burn when in contact with oral mucosa
  • inhibits enzyme systems
  • binds calcium
  • cardiotoxic due to hyperkalemia
37
Q

what are signs and symptoms of too much fluoride

A
  • nausea
  • vomitting
  • diarrhea
  • abdominal cramping
  • increased salivation/ dehydration
38
Q

what are the pros to 5% NaF fluoride varnish

A
  • proven efficacious in decreasing caries, especially in early childhood
  • easy to apply following oral exam and prophylaxis
  • easy to follow post of instructions
39
Q

what are the cons to fluoride varnish 5% NaF

A
  • leaves a thin visible film on teeth that some patients do not like
  • possible allergies linked to specific brands to fluoride varnish
40
Q

describe the application of fluoride varnish

A
  • 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
41
Q

what percentage of parents refuse fluoride tx

A

13%

42
Q

what are the strategies to manage Fluoride tx refusal

A
  • assess
  • incorporate
  • obtain
  • provide
  • maintain
  • communicate
43
Q

describe silver diamine fluoride

A
  • 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
44
Q

what concentration of silver diamine fluoride is best at stopping caries

A

38%

45
Q

SDF is better at stopping caries than:

A

fluoride varnish alone

46
Q

how should you apply SDF

A

multiple applications

47
Q

what is the mechansim of SDF

A
  • 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
48
Q

what does silver phosphate act as

A

a reservoir of phosphate ions

49
Q

what does calcium fluoride do

A

a pH regulated fluoride supply available during cariogenic challenge

50
Q

a 5% SDF solution contains what concentration of fluoride

A

44,800 ppm

51
Q

what does SDF react with at a 5%SDF solution

A

calcium and phosphate ions to produce fluorhydroxyapatite crystals which are less susceptible to solubility and crucial to tooth remineralization

52
Q

what is SDF used to treat in adults

A

dentin hypersensitivity

53
Q

how do you place SDF

A
  • 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
54
Q

when should you not used SDF

A

silver allergy of pulpal involvement

55
Q

what is fluoridate prophy paste considered

A

a therapeutic/preventative agent for varies

56
Q

what does fluoride prophy paste replace

A

fluoride lost by abrasive polishing which alone removes 0.1-1.0 microns of fluoride rich enamel

57
Q

what is the concentration of NaF in toothpastes

A

0.22%

57
Q

when is there a risk of fluorisis and toxicity witth toothpaste

A

if ingested

57
Q

what are the ingredients in ACT mouthwash

A
  • alcohol free
  • 0.02% sodium fluoride (100 ppm) in 33.8 oz bottle
  • 0.05% sodium fluoride (225 ppm) in 18 oz bottle
57
Q

when do you use SDF

A
  • dentin hypersensitivity
  • uncooperative patients, roor surface caries on elderly patients with existing restorations, patients without access to restorative care, difficult to treat lesions
58
Q

what does fluoride rinse do

A
  • remineralizes tooth structure
  • strengthens enamel to prevent caries
  • kills bad breath
59
Q

how do you use fluoride rinse

A
  • twice daily after brushing/flossing swish with 10mL for 1 minute
  • no eating or drinking for 30 minutes after
60
Q

what is the ingredients in listerine

A
  • 0.02% sodium fluoride 100 ppm
  • 21.6% v/v alcohol
  • same instructions
61
Q

what is MI paste plus

A
  • 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
62
Q

what is the concentration in prevident toothpaste

A

1.1% NaF (5000 ppm)

63
Q

what is the concentration of prevident mouth rinse

A

0.2 NaF 900ppm

Patient Care 3 (22 decks)

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