Fluoride

Question 1

What is duraphat?

Answer 1

2.26% topical F-
23,000ppm
Used on early lesions to arrest caries
Only has systemic effect while teeth developing (not effective after 6yrs)

Question 2

When should topical fluoride varnish be applied?

Answer 2

All 3-6 year olds - 2x year

High carers risk - 3-4x year

Question 3

When should F- supplements be used?

Answer 3

Only for high caries risk
Not for those w/ F water
Not those under 3

Question 4

What are the different prescriptions of F toothpaste and who can use them?

Answer 4

Topical effect
2,800ppm - for active caries those 10+
5,000ppm - for active caries those 16+

Question 5

When can F- mouth rinse be used?

Answer 5

For children w/ active disease giving concen (e.g orthodontic)
Diff time to brushing
Must be able to rinse

Daily - 0.05%NaF
Weekly - 0.2%NaF

Question 6

What advice would you give to 0-3year old?

Answer 6

Parent should brush teeth or supervise
As soon as teeth erupt brush 2x day w/ F- (no less 1000ppm)
Smear toothpaste

Question 7

What advice give 3-6 year old?

Answer 7

Brush 2x day (no less 1000ppm)
F- varnish 2x year
If high caries: F- varnish 3-4x, toothpaste 1350-1500ppm

Question 8

What advice give 7years+?

Answer 8

F- toothpaste 2x day 1350-1500ppm

High caries risk: daily mouth rinse (0.05%), F varnish 2x year, prescribe toothpaste

Question 9

Example

What advice give 5 year old with active caries?

Answer 9

High risk - 1350-1500ppm 2x day

F- varnish - 3-4x year

Question 10

Example

What advice give 14 year old with active caries?

Answer 10

Duraphat 2800ppm prescribed
F- varnish 2x year
F- mouth rinse

Question 11

What could you recommend if child really can’t tolerate toothpaste (e.g if autistic)

Answer 11

oraNurse - comes in different conc and doesn’t foam/taste

Good children sensory/ hypersensitive to taste (e.g chemo)

Question 12

Contraindications for duraphat?

Answer 12

Severe asthmatic - check atopic issue, nebuliser, hospital

Contains colophony which is a resin - if child atopic can cause anaphylaxis

Question 13

What advice to give to a family who is against F-?

Answer 13

Advise pt need F- and is advisable –> try give evidence esp systematic review
If adamant won’t use push diet advice
Can use tooth moose - calcium phosphate prep (w/ or w/o F) - £10 box

Question 14

How does F- work?

Answer 14

F- ion similar to hydroxyl ion in calcium hydroxyapatite
F- substitute hydroxyl to form calcium fluroapatite
Has lower solubility in acid
F- can be taken into bacterial cells and interfere w/ glycolysis - stop conversion of sugars into acid

Question 15

What is the acute lethal dose of F-?

Answer 15

15mg/kg

Question 16

At what dose does F- cause problem?

Answer 16

Emergency tx - 5mg/kg (gastric lavage)

Subtoxic side effect- 1mg/kg

Question 17

What are subtoxic side effects and how tx?

Answer 17

Nausea and vomit

Drink milk- combines and reduces bioavailability

Question 18

How many mg of F- are in a dose of duraphat?

Answer 18

Normally 0.25ml per dose

Contains 5.6mg

Question 19

If average child weighs 11kg how much F- would be toxic dose?

Answer 19

11x5 = 75mg