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AU 15- Oral Micro > Fluoride and Dental Caries > Flashcards

Fluoride and Dental Caries Flashcards

1
Q

When Dr.McKay discovered fluorosis in 1901, he was moving from Pennsylvania to _______ which had much higher fluoride naturally in the water.

A

Colorado Springs

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2
Q

What is the ideal concentration of fluoride in drinking water that provides maximum benefit and minimum fluorosis?

A

1 ppm

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3
Q

Intervention studies for fluoride began in the ________ area and water in _______ was adjusted to 1ppm.

A

Lake Michigan

Grand Rapids, MI

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4
Q

Enamel is laid down by ______.

A

ameloblasts

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5
Q

During the ________ phase, the ameloblasts lay down the protein matrix for the rod crystal structure and the rods begin to form.

A

Secretory

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6
Q

During the _______ phase, the ameloblasts fill in the crystal structure with minerals.

A

Maturation (pre-eruptive)

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7
Q

When does fluorosis occur?

A

during development only, NOT after eruption

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8
Q

Very high physiologic levels of fluoride during the secretory stage can cause ______ and _______ (which is not common).

A

pitting

disturbances in form

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9
Q

Chronic moderately high levels of fluoride during the _______ stage causes disruptions in crystal formation that appear chalky white and weak.

A

PRE-ERUPTIVE (maturation stage)

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10
Q

At which stage of enamel formation do disruptions in crystal formations occur?

A

pre-eruptive maturation stage

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11
Q

True or False: A lot of fluoride is incorporated into enamel during the pre-eruptive maturation process.

A

False (little is incorporated)

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12
Q

Is there a benefit to swallowing fluoride?

A

No

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13
Q

Why is there no benefit to swallowing fluoride?

A

Fluoride is on the outer and inner surfaces of the tooth, NOT within the hydroxyappetite crystals.

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14
Q

Fluoride is highest pre-eruptively at the _______ surface and _______ interface.

A

enamel

dentin-pulp

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15
Q

True or False: Fluoride is high at the enamel-dentin junction.

A

False

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16
Q

Fluorapatite is highest on surfaces where there is ______ interaction.

A

follicular fluid

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17
Q

Development and widespread adoption of _______ has impacted the prevalence and severity of caries throughout the world.

A

topical products (especially toothpaste)

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18
Q

Effects of water fluoridation are ______.

A

topical

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19
Q

How is fluorosis risk increased?

A

by ingestion

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20
Q

How is water fluoridation still beneficial?

A

benefits those who don’t use topical products

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21
Q

True or False: Topical products are lower risk than systemic supplementation.

A

True

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22
Q

Systemic supplementation is still recommended for _____ risk children.

A

High

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23
Q

Alteration of the enamel surface occurs during the _________ stage.

A

Post-eruptive enamel maturation

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24
Q

What is enamel’s composition?

A

87% HA
11% water
2% organic matrix

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25
Q

Pure Hydroxyapatite is __________ (chemical form).

A

Ca10 (PO4)6 (OH)2

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26
Q

What types of impurities are often seen in newly formed crystals of a young tooth?

A

carbonate
sodium
other ions

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27
Q

When bathed in saliva (calcium and phosphate-rich) and exposed to fluoride, the HA crystal will tend to perfect itself in a process called __________.

A

POST-eruptive enamel maturation

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28
Q

What three replacements will occur during post-eruptive enamel maturation?

A

phosphate replaces carbonate
calcium replaces sodium
fluoride replaces hydroxyl

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29
Q

Replacements during the post-eruptive maturation stage will make hydroxyapatite _______ and therefore stronger.

A

less soluble

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30
Q

True or False: Young teeth or more susceptible to caries.

A

True

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31
Q

How far does pH have to drop before HA dissolves?

A

below 5.5

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32
Q

Hydrogen (acid) combines with _____ and ____ ions which removes solubility products from solution and drives the equilibrium toward more dissolution.

A

Phosphate (PO4) and Hydroxide (OH)

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33
Q

Fluoride ions prevent dissolving of ______ ions.

A

calcium

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34
Q

______ is less soluble than hydroxyapatite.

A

Fluorhydroxyapatite

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35
Q

If pH remains above _____ and ____ ions are available, fluorhydroxyapatite forms on the surface after HA dissolves from the subsurface.

A

4.5

fluoride

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36
Q

When pH rises above ____, fluoride ions enhance remineralization of enamel and dentin.

A

5.5

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37
Q

The surface of enamel has more fluoride and less ______.

A

carbonate

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38
Q

______ enamel is less soluble than _____ enamel.

A

Outer

Inner

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39
Q

True or False: fluoride does not diffuse well into the body of a lesion.

A

True

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40
Q

What kind of lesions will often have a very high fluoride concentration on their surface due to demin-remin cycles?

A

White-spot lesions

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41
Q

Areas covered by plaque have ______ fluoride levels.

A

HIGHER

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42
Q

Areas worn by erosion or abrasion will have _____ fluoride levels.

A

LOW

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43
Q

Why should you avoid wearing away the white-spot lesion?

A

the surface is very hard but the subsurface is very porous and changes become very rapid

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44
Q

When topical fluoride concentrations are low, 50ppm or less, _________ is formed on the outermost layers of enamel.

A

fluorhydroxyapatite

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45
Q

When topical fluoride concentrations are high, above 100ppm, ________ precipitates.

A

Calcium Fluoride

46
Q

How does acid assist with deposition of calcium fluoride?

A

By making calcium ions available

47
Q

What shape are the globules that precipitate on the surface, in crevices, and in plaque?

A

spherical

48
Q

A ________ effect occurs due to deposition of globules in micropores of initial lesions.

A

cariostatic

49
Q

Name four ways in which calcium fluoride deposition is increased?

A
  1. increasing concentration of fluoride
  2. increasing exposure time (aka varnish)
  3. lowering pH (makes Ca available to F)
  4. Protecting (limit rinsing, use varnish)
50
Q

Saliva is supersaturated with _____ and _____ so that teeth don’t dissolve.

A

calcium

phosphate

51
Q

What kind of proteins coat the enamel and prevent crystal growth from occurring?

A

salivary pellicle proteins

52
Q

What are the three salivary pellicle proteins that are important in preventing crystal growth?

A
  1. tyrosine-rich peptides
  2. statherin
  3. Proline-rich proteins
53
Q

Spontaneous precipitation in salivary ducts results in ______.

A

sialoliths (calcium stones)

54
Q

Interbacterial fluid in the _________ can have high concentrations of calcium and phosphate that assists in _______ BUT can also lead to _______.

A

plaque biofilm
remineralization
calculus formation

55
Q

True or False: Fluorosis typically occurs during puberty when growth hormone levels are high.

A

FALSE. it occurs during tooth development

56
Q

True or False: There is a homeostatic mechanism in place to control fluoride concentration.

A

False. Levels are dependent on daily intake and bone stores (released during remodeling =cumulative effect)

57
Q

Where in teeth is the fluoride concentration highest?

A

on the surface

58
Q

Surface concentration of fluoride is dependent on ______, ________, and _______.

A

topical exposure to F
acid exposure
wear

59
Q

True or False: Exposure to fluoride during development is not a major determinant of fluoride levels in enamel.

A

True

60
Q

Fluorosis is an increase in enamel ______ that appears as ________.

A

Porosity

chalky white

61
Q

Exposure to higher levels of fluoride during tooth development will determine ____ and _____ or fluorosis.

A

extent

severity

62
Q

If fluorosis is severe, enamel may be ______.

A

fragile

63
Q

Pits, bands, and lost areas of enamel will occur ______.

A

post-eruptively

64
Q

When and why does brown discoloration associated with fluorosis occur?

A

post-eruptively due to staining and browning of exposed protein

65
Q

Brown discoloration can also occur during growth of already seeded crystals during ________ ________.

A

enamel maturation (pre-eruptive)

66
Q

What are the three variations in appearance of fluorosis?

A

mild white mottling
severe pitting
brown staining

67
Q

True or False: There is a threshold for exposure to fluoride before discoloration effects are seen.

A

FALSE. no threshold

68
Q

True or False: Mild flourosis is sometimes perceived as attractive.

A

True

69
Q

____mg/kg is considered high risk for cosmetically objectionable fluorosis.

A

0.1

70
Q

On which teeth and at what age is there the greatest risk for fluorosis?

A

Upper central incisors

15-30 months

71
Q

Fluoride inhibits enzymes and regulatory proteins by binding to sites that would normally bind to ____.

A

OH-

72
Q

True or False: Fluoride is highly concentrated in plaque.

A

True

73
Q

True or False: Bacteria are able to eventually build up resistance to fluoride.

A

False!

74
Q

Which enzyme of the glycolytic pathway (lactate production) will be inhibited by fluoride?

A

enolase

75
Q

True or False: Binding of fluoride is enhanced by acidification.

A

True

76
Q

At low pH, bacterial intracellular concentrations of fluoride will _____ due to increased _____ crossing the membrane.

A

increase

HF

77
Q

When is fluoride most effective against glycolysis?

A

at low pH

78
Q

How does fluoride affect the ecology of biofilms?

A

by reducing enrichment of acid-tolerant species

79
Q

True or False: Fluoride has inhibitory effects at high or low pH.

A

False. No affect at high pH

80
Q

Does fluoride affect growth of bacteria at normal pH?

A

NO

81
Q

What are the three methods of fluoride delivery?

A
  1. Community-based water fluoridation
  2. Self-Applied
  3. Professionally applied
82
Q

Is there a direct benefit to swallowing fluoride?

A

NO

83
Q

When does fluoride present the greatest benefit?

A

when present during acid challenge

84
Q

______ fluoride is key.

A

topical

85
Q

______ is deposited on surface when topical fluoride is greater than 100ppm.

A

Calcium fluoride

86
Q

Studies of water fluoridation show that it is highly _______ but less beneficial than ______.

A

cost-effective

fluoride toothpaste

87
Q

How much fluoride is provided in toothpaste in the United States?

A

1000ppm

88
Q

In Europe do they provide more or less fluoride in toothpaste?

A

more, 1500ppm

89
Q

What was the first type of fluoride available in toothpaste?

A

stannous (1955 P&G)

90
Q

After fluoride was introduced in toothpaste, there was a _____% reduction in caries over 2-3 years.

A

25

91
Q

True or False: It is not ethical to use nonfluoridated toothpaste as a control in studies.

A

True. therefore, no new studies can be done

92
Q

What are the three varieties of fluoride available at equivalent concentrations and effectiveness?

A

NaF2
MFP
SnF2 (stannous)

93
Q

Which variety of fluoride is compatible with chalk-based formula and which is not?

A

Chalk-based: MFP

Non-Chalk: NaF2

94
Q

Which fluoride variety requires more expensive silca-based formula?

A

NaF2

95
Q

Up to _____ppm toothpastes are available by prescription.

A

5000

96
Q

True or False: there is no relationship between amount of toothpaste and caries.

A

True

97
Q

________ matters and _____ rinsing is better in measuring benefits of toothpaste.

A

Frequency

Less

98
Q

What is the safe amount of toothpaste for preschool children? Children less than two?

A

pea-sized

rice-sized

99
Q

Fluoride is indicated on toothpaste as %_____ or %______.

A

weight/weight

weight/volume

100
Q

Over the counter fluoride rinses contain _____% fluoride (200ppm).

A

0.02%

101
Q

Why is there a benefit to OTC rinses despite the low concentration of fluoride?

A

no rinsing!

102
Q

Professional fluoride products typically come as ____, ____, and ______.

A

foams
gels
rinses

103
Q

How often are professional F products (foam/gel/rinse) applied? What are the fluoride contents?

A

twice or more per year

  1. 23% acidulated phosphate (1230 ppm)
  2. 9% NaF2 (900ppm)
104
Q

The ____% reduction in caries from professional foams/gels is only a reduction in the amount left after effects of toothpaste use.

A

30

105
Q

Fluoride varnish contains _____% fluoride as _____. What is the resultant reduction in caries seen due to varnish?

A

2.2% NaF

40% reduction

106
Q

Topical products deposit _____ on the surface of the tooth which acts as a temporary reservoir that will be lost over time due to ______ and _____.

A

CaF

dissolution and wear

107
Q

During acid attack, CaF2 will _____ and _________ in order to become incorporated into fluorapatite.

A

dissolve

increase remineralization

108
Q

True or False: Water fluoridation deposits CaF onto the surface of the tooth.

A

False

109
Q

True or False: Incorporation of fluoride into enamel during development provides significant anti-caries benefit.

A

False, it does not

110
Q

True or False: Ingestion of fluoride carries a risk for fluorosis.

A

True

AU 15- Oral Micro (11 decks)

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