Fluoride / Caries Prevention Flashcards
What is the concentration of Fluoride in toothpaste?
0.22% NaF (1000 ppm) and 0.312% (1450 ppm) fluoride.
.1% = 1000 ppm
Toothpastes that contain fluoride with a MINIMUM concentration of 1,000 PPM to prevent tooth decay
Fluoride in toothpaste is usually in the form of sodium fluoride (NaF) or sodium monofluorophosphate (MFP).
What is the lethal dose of Fluoride?
5 mg/kg
The minimum dose of fluoride that can kill a human being
This dose is referred to in the medical literature as the “Probable Toxic Dose” or “PTD.”
Prevident:
% and ppm?
Indications, contraindications, directions?
1.1% Sodium Fluoride (NaF)
5000 ppm
- A dental caries preventive, for once daily self-applied topical use.
- Do not use in pediatric patients under age 6 years unless recommended by a dentist or physician.
What is the recommended amount of Fluoride toothpaste for a child under 2 years old?
a SMEAR of fluoride toothpaste
2x a day
“Grain of rice”
Smear: 0.1 gram of toothpaste or 0.1 mg fluoride
What is the recommended amount of Fluoride toothpaste for a child 2-6 years old?
a PEA-SIZED amount of fluoride toothpaste
2x a day
Pea-sized: 0.25 gram toothpaste or 0.25 mg FL
What is the strength of prescription toothpaste?
Fluoride 0.5% = 5000 ppm
Sodium Fluoride (NaF) 1.1%
Conversion rate of % compound to % fluoride for Na and Sn fluoride compounds?
NaF compounds:
% Na x .45 = % F
(ex: 5% NaF x .45 = 2.2% F)
SnF compounds:
% Sn x .25 = % F
(ex: 10% SnF x .25 = 2.5% F)
Conversion formula of ppm F to % F
ppm F / 10,000 = % F
Ex:
5000ppm / 10,000 = 0.5% F
1000ppm / 10,000 = 0.1 % F
or
.5% F x 10,000 = 5000 ppm
.1% F x 10,000 = 1000 ppm
What is the mean fluoride concentration of ready-to-feed infant formulas?
READY-TO-FEED formulas
- 15 ppm for MILK-based formulas
- 21 ppm for SOY-based formulas.
What is the Environmental Protection Agency/Department of Health and Human Services’ recommendation for optimizing F concentration community water supplies?
0.7 ppm fluoride
What is the % reduction in dmf in primary and permanent teeth in optimally fluoridated water?
What is the % risk of fluorosis in optimally fluoridated water?
When public water is fluoridated to an optimal level (.7 ppm)
35% reduction in decayed, missing, and filled PRIMARY teeth
26% fewer decayed, missing, and filled PERMANENT teeth.
The occurrence of FLUOROSIS causing esthetic concerns, has been reported to be 12%
T/F?
Drinking fluoridated water and brushing with fluoridated toothpaste TWICE daily are the MOST EFFECTIVE method in reducing dental caries prevalence in children.
True
When should fluoride toothpaste first be introduced to a infant per AAPD?
Begin use with eruption of FIRST tooth
What % of bottled water have optimal fluoride?
~5%
Do Carbon-Charcoal filtration systems reduce F concentrations?
No
What filtration systems reduce F to very low levels?
Reverse osmosis and Distillation
Fluorosis severity.
Dependent on what 3 factors?
Severity of the condition is dependent on:
Dose
Duration
Age of the individual during the exposure.
(First 4-8 years)
From roughly 7 YEARS OLD thereafter, most children’s permanent teeth would have undergone complete development (except their wisdom teeth), and therefore their SUSCEPTIBILITY to FLUOROSIS is greatly reduced, or even INSIGNIFICANT, despite the amount of intake of fluoride.
Describe the look of mild fluorosis.
The clinical manifestation of MILD dental fluorosis is mostly characterised a SNOW FLAKING appearance that LACK a CLEAR BORDER, opaque, white spots, NARROW WHITE LINES following the PERIKYMATA or patches as the opacities may coalesce with an intact, hard and SMOOTH enamel surface on MOST of the teeth.
Differential Diagnosis for Fluorosis
- TURNER’S hypoplasia (although this is usually more localized)
- Enamel defects caused by an undiagnosed and untreated CELIAC disease.
- Some MILD forms of AMELOGENESIS IMPERFECTA and enamel hypoplasia
- Enamel defects caused by INFECTION of a primary tooth predecessor
- DENTAL CARIES: Fluorosis-resembling enamel defects are often misdiagnosed as dental caries.
- DENTAL TRAUMA: Mechanical trauma to the primary tooth may cause disturbance to the MATURATION phase of enamel formation, which may result in enamel opacities on the permanent successors.
T/F
Dental fluorosis has been growing in the United States.
TRUE
Dental fluorosis has been growing in the United States concurrent with fluoridation of municipal water supplies, although disproportionately by race. A 2010 CDC report acknowledges an overall incidence of dental fluorosis of 22% from 1986-87 increased to 41% in the early 21st century, with an increase in moderate to severe dental fluorosis from 1% to 4%.
More than ONE IN FIVE American teens (23%) have moderate to severe dental fluorosis on at least two teeth.
PPM
is equal to?
1 ppm = 1 mg per liter = mg/Liter.
1 ppm / 1000 = mg/cc or ml
How is Fluoride antibacterial🦠?
- concentrates in plaque
- disrupts ENZYME systems
- *Fluoride is a known competitor of ENOLASE’s substrate 2-PG. Fluoride can form a complex with magnesium and phosphate, which binds in the active site instead of 2-PG.
- disrupting a step of GLYCOLYSIS
**SnF2 has a greater Bacterialstatic/cidal effect than NaF
5% NaF Fluoride Varnish in different F valuations. (%, ppm, mg/ml)
FLUORIDE VARNISH (NaF)
5% x .45 = 2.25% F
2.25% x 10,000 = 22,500 ppm
22,500 / 1000 = 22.5 mg/ml or cc
Indications for use of Fluoride Varnish?
- indicated for children at MODERATE or HIGH RISK for dental CARIES
- appropriate for PRE-SCHOOL aged children because a very small amount is ingested
- desensitizing agent for exposed root surfaces
What products slow the absorption of fluoride in case of an accidental overdose?
FLUORIDE OVERDOSE
administer if suspected OVER > 8 mg/kg
- Milk
- Calcium Carbonate (Tums/Mylanta - Antacid)
- Aluminum-Magnesium antacids (Gaviscon)
Do NOT induce vomiting with Syrup of Ipecac or Activated Charcoal
T/F
Pre-Natal use of Fluoride has been shown to be effective for developing fetus
FALSE
it is NOT shown to be effective
Silver Diamine Fluoride (SDF)
SDF is made of:
SILVER: helps kill bacteria
WATER: provides a liquid base for the mixture
FLUORIDE: helps your teeth remineralize
AMMONIA : helps the solution remain concentrated so that it’s maximally effective against cavity resonance
- It is 38% SDF, a silver fluoride SALT made soluble in water through the addition of ammonia.
- 45,000 ppm Fluoride: nearly TWICE the strength of commercially available 5% sodium fluoride varnishes used in primary care.
- 2/3 of all DENTINAL CARIES lesions studied (those that had progressed into the dentin) were found to be ARRESTED after treatment with SDF
- NON-TOXIC
Contraindications for SDF?
You shouldn’t use SDF if you have:
- SILVER ALLERGY
- ORAL ULCERATIONS/CANKER SORES
- advanced gum disease, or major tooth DECAY that’s EXPOSED the SOFT TISSUE of your tooth beneath the enamel.
***These conditions can have PAINFUL reactions with the acid or ammonia in SDF.
Chlorohexidine (CHX)
🕡 - 🕑🕑
CHLOROHEXIDINE: Cationic Bis-Biguanide
- Broad Spectrum Antibacterial. Both Bacterial-Static and Bacterial-Cidal
- DOSAGE: About 20 mg twice a day of concentrations of 0.1% to 0.2% recommended for mouth-rinse solutions with a duration of at least 30 seconds. 🕧
- USAGE: Using chlorhexidine as a supplement to everyday mechanical oral hygiene procedures for 4 to 6 weeks and 6 months leads to a MODERATE REDUCTION in GINGIVITIS
- limited evidence in reduction of caries*
-IMPORTANT: Chlorhexidine is a CATION which INTERACTS with ANIONIC components of TOOTHPASTE, such as sodium lauryl sulfate and sodium monofluorophosphate, and forms SALTS of LOW SOLUBILITY and antibacterial activity. Hence, to enhance the antiplaque effect of chlorhexidine, it seems best that the interval between toothbrushing and rinsing with C to be more than 30 minutes, cautiously close to 2 HOURS AFTER brushing. 🕑🕑
ADVERSE EFFECTS: including damage to the mouth lining, tooth discoloration, tartar build-up, and impaired taste
Casien Phosphopeptide (CPP-ACP)
MI Paste / Recaldent
CPP-ACP
NON-FLUORIDE Caries prevention agent.
-MI plus contains F
- CPP forms nanoclusters with ACP and they provide a pool of PHOSPHATE and CALCIUM to maintain supersaturation of SALIVA. Due to the fact that CPP-ACP stabilizes levels of these minerals in solution, they aid in BUFFERING of the pH of the PLAQUE.
- The CPP-ACP complexes readily INCORPORATE FLUORIDE IONS forming casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP)
- REMINERALIZES carious lesions in dental enamel.
contains MILK 🥛 products, contraindicated for people with DAIRY ALLERGIES
APPLICATION:
- BRUSH with a FLUORIDE toothpaste in the morning and at night
- Apply a pea-sized amount of MI Paste to your teeth’s surface using a cotton swab or finger
- Leave undisturbed for 3 minutes
- Expectorate (spit) but do not rinse; leave the excess to slowly dissolve.
How long should SDF be applied to a tooth?
30 SECONDS
Dry teeth with air, isolate affected tooth with gauze, place one drop onto affected area with microbrush, rinse with water.
CAN be used with conjunction with Fluoride Varnish.
What makes the stomach upset during Fluoride toxicity?
HYDROFLUORIC ACID
Ingestion of hydrofluoric acid may cause corrosive injury to the mouth, throat, and esophagus. Inflammation of the stomach with bleeding occurs commonly.
Nausea, vomiting, 🤮💩diarrhea, and abdominal pain may occur
Electrolytes ⬆️ in stomach
Gastric acid ⬆️ in stomach
How does Fluoride Remineralize?
Under NORMAL conditions, there is a STABLE EQUILIBRIUM between the calcium and phosphate ions in SALIVA and the crystalline HYDROXYAPATITE that comprises 96% of tooth enamel.
CARBOHYDRATES are converted to ACIDS by bacteria in the PLAQUE BIOFILM. When the PH drops below 5.5, the biofilm fluid becomes UNDERSATURATED with PHOSPHATE ion and enamel dissolves to restore balance.
When the PH on the TOOTH SURFACE becomes ACIDIC, phosphate in oral fluids combines with hydrogen ions (H+) to form hydrogen phosphate species. Under these conditions, PHOSPHATE is “PULLED” from TOOTH enamel to RESTORE phosphate LEVELS in the SALIVA, and the hydroxyapatite dissolves.
Ca10 (PO4) OH2 ➡️ Ca + PO4 ➡️ +H ➡️
Hydroxyapatite ⬅️ Free ions ⬅️ ⬅️
in enamel Saliva Acid
=
DISSOLVING Hydroxyapatite
Creating HYDROGEN PHOSPHATE in Saliva
pulling phosphate from tooth.
= HPO4
As pH returns to normal, the calcium and phosphate in saliva can recrystallize into the hydroxyapatite, remineralizing the enamel.
When FLUORIDE is present in SALIVA, FLUORAPATITE rather than hydroxyapatite, forms during the remineralization process.
Fluoride ions (F–) replace hydroxyl groups (OH–) in the formation of the apatite crystal lattice.
Ca10(PO4)OH2 ➡️ Ca(PO4)F2
Fluorapatite is inherently LESS SOLUABLE than hydroxyapatite, even under acidic conditions. When hydroxyapatite dissolves under cariogenic (acidic) conditions, if fluoride is present, then fluorapatite will form.
Because fluorapatite is less soluble than hydroxyapatite, it is also more resistant to subsequent demineralization when acid challenged
What is the amount of Fluoride in OTC rinses?
0.05% NaF rinse (F = 0.022%)
F = 2200 ppm F = 1MG/5ML
0.25% NaF rinse (F= 0.011%)
F=1100 ppm
F=1MG/10ML
effectiveness little evidence
PPM
Parts Per Million
Used for very dilute solution
Mass of Solute
———————- X 1,000,000 (1 million)
Mass of Solution
% of Concentrate
Mass of Solute
——————— X 100
Mass of Solution
make sure to ADD the mass of Solute to the Mass of Solution, since the mass of solute in solution is the solvent
1.1 NaF toothpaste has how many
% FL?
ppm FL?
5 %
5000 ppm
What is the Fluoride Compound in most TOOTHPASTE?
STANNOUS FLUORIDE
Stannous Fluoride, is a compound commonly used in toothpastes.
Although similar in function and activity to Sodium Fluoride (NaF), the conventionally added ingredient in toothpastes, stannous fluoride has been shown to be MORE EFFECTIVE at stopping and REVERSING dental lesions.
It manages and prevents dental caries and gingivitis by promoting enamel mineralization, reducing gingival inflammation and bleeding through its potential broad-spectrum antibiotic effect and modulation of the microbial composition of the dental biofilm. It is an FDA-approved over-the-counter product.
What stage of tooth development does Fluorosis occur?
Calcification
What is the difference between Fluorosis and Amelogenesis Imperfecta?
AI:
- Family History
- Involves ALL teeth
- Teeth may appear Taurodont ♉️
- High risk of Caries
- Primary and Permanent teeth equally effected
- Sensitive
Fluorosis:
- # of teeth effected depends on time of exposure
- Low risk of Caries
- Not Sensitive
What is APF?
Concentration?
Acidulated Phosphate Fluoride
APF
1.23 percent F
12,300 ppm F
What is the fluoride concentration in an OTC fluoride:
DAILY rinse?
WEEKLY rinse?
DAILY:
.05% NaF = .02% F
WEEKLY
.2% NaF =.09% F
Professional Fluoride Gels and Foams come in what %?
How long of application?
Preschool kids? Y/N?
1.23% APF
2% NaF
4 minute Application
Preschool kids use caution
What are Sugar Alcohols?
Found in?
Mechanism of action?
POLYOLS:
- Xylitol
- Sorbitol
- Mannitol
Found in Sugar-Free gum / Candies 🍬
Primarily act to stimulate SALIVARY FLOW
(Xylitol may have some anti-microbial properties)
What is Xylitol’s effect on Vertical Transmission?
LONG Term DECREASE of CARIES in children
Xylitol consumption of mothers was associated with a statistically significant reduction in the probability of mother–child transmission of MS assessed at 2 years of age.
Xylitol–associated reduction in the probability of mother–child transmission of MS was still found in the children’s MS counts at the age of 3 and 6 years.
What is the mechanism of Xylitol?
Changes oral bacteria
-Promotes mineralization by increasing the salivary flow
-Reduces plaque formation and bacterial
adherence
-Reduces Acid production inhibiting enamel demineralization
-Direct inhibitory effect on MS
-Reduces the levels of mutans streptococci (MS) in plaque and saliva by disrupting their energy production processes, leading to futile energy cycle and cell death.
What is the recommended time for chewing Xylitol gum after eating?
20 minutes
Consumption of xylitol chewing gum for ≥3 weeks leads to both long-term and short-term reduction in salivary and plaque S. mutans levels.
A decrease in caries incidence has been reported among children exposed to the daily use of xylitol for 12–40 months.
The long-term benefits have been observed up to 5 years after cessation of xylitol use
Xylitol Syrup
Indications?
Directions for use?
Xylitol syrup is indicated in young children with early childhood caries.
This method of administration of xylitol is most acceptable and safe for toddlers and young children.
Twice-daily administration of xylitol oral syrup at a total daily dose of 8 g was observed to be effective in preventing caries.
Using Xylitol and Chlorohexidine together has been found to be synergistic and more effective against oral bacteria than when used separately.
T/F
TRUE
The xylitol/chlorhexidine combination inhibited streptococci more when compared with xylitol or chlorhexidine being used alone.
S. sanguis was most sensitive to the antiseptic effects of chlorhexidine alone, while S. mutans colonies were more sensitive to the xylitol/chlorhexidine solution.
What is the juice recommendation for infants and children
- Juice should NOT be introduced into the diet of infants before 12 months of age unless clinically indicated.
- 4 ounces/day in toddlers 1 through 3 years
- 4 to 6 ounces/day for children 4 through 6 years
How will APF (acidulated fluoride) effect a Porcelain Veneer?
Effects SURFACE POROSITY
- Finish
- Topography (significantly greater)
- Texture
After 4 minutes of gel time
How much fluoride in .4 ml of Fluoride Varnish?
Fluoride Varnish = 5% NaF / 2.25% F
2.25% x 10,000 = 22,500 ppm
22,500 ppm / 1000 = 22.5 mg/ml or cc
1 cc = 1 ml
.4 ml ( 22.5 mg/ml x .04ml ) =
9.05 mg
Who can you NOT give MI paste too?
🥛
Allergic to milk / dairy 🥛
What is produced in SDF (Silver Diamine Fluoride) reaction?
SDF reacted with calcium and phosphate ions and produced fluorohydroxyapatite.
One proposed chemical reaction between SDF and hydroxyapatite of teeth involves the formation of silver phosphate and calcium fluoride.
The solubility of silver phosphate (6.4 × 10−3 g/100 ml) is higher than that of silver chloride (8.9 × 10−4 g/100 ml). Therefore, silver phosphate could react with alkali chlorides in remineralisation solutions to form silver chloride. This could explain why silver chloride was detected as the principal precipitate on the tooth surface after SDF treatment.
The subsequent dissolution of fluoride and calcium facilitates the formation of insoluble fluorapatite, which is a possible reaction product of fluoride ions with hydroxyapatite.
1.1% NaF
How many F ions? (PPM)
1.1% NaF = .5% F
.5% x 10,000 = 5000
5000ppm or F ions
Baby Formula extra fluoride amount?
.1 - .3 ppm on average for milk / soy formula
*some juices, particularly grape 🍇 juice have high fluoride (1+ ppm)
What is the sweetest sugar?
- NATURAL sugar: SUCROSE
- ARTIFICIAL sugar: THAUMATIN
Followed by Splenda>Saccharin>Aspartame
Most fluoride derived in infant formula?
MILK DERIVED POWDER
What is LEAST cariogenic?
Breast vs Regular milk?
Breast milk
Max Fluoride RX
120 mg
