FLUORIDE DELIVERY IN CARIES PREVENTION

Question 1

how is fluoride delivered to teeth?

Answer 1

• systemically
• topically

Question 2

how does fluoride prevent caries?

Answer 2

• fluoride present in fluid at the plaque/tooth interface which promotes remineralisation
• forms fluoro-apatite which is less susceptible to demineralisation
• topical effect greater than systemic

Question 3

how much fluoride can the mouth store?

Answer 3

NOT MUCH!
- gets washed away quickly

Question 4

what are the 2 oral reservoirs?

Answer 4

• mineral deposits
• biologically/bacterially bound calcium-fluoride

Question 5

what is meant by upstream prevention?

Answer 5

?

Question 6

what is meant by downstream prevention?

Answer 6

?

Question 7

how is fluoride delivered in the community?

Answer 7

• fluoridated water
• school based systems
• brushing
• varnish

Question 8

when was fluoridated salt introduced? how did this affect caries levels?

Answer 8

Switzerland in 1955
- 25% caries reduction after 12 years

Question 9

why might fluoridated salt be a good option for community fluoride deposition?

Answer 9

• requires little conscious action by the individual

Question 10

what are the disadvantages of fluoridating salt in the community?

Answer 10

• mixed messages from health professionals on the consumption of salt > increased risk of cardiac disease

Question 11

what are the advantages of fluoridating school milk as a means of providing community fluoride?

Answer 11

• natural healthy drink for children
• important part of children’s diet
• enables fluoride to be targeted to those who would benefit the most

Question 12

what are the disadvantages of fluoridating school milk as a means of providing community fluoride?

Answer 12

• distribution delayed until nursery/school age
• not all kids drink milk
• cost issues
• potential lack of long term benefit
• consent issues with parents

Question 13

what is the dosage for fluoride supplements for children aged 6 months - 3 years old?

Answer 13

0.25mg

Question 14

what is the dosage for fluoride supplements for children aged 3-6 years old?

Answer 14

0.5mg

Question 15

what is the dosage for fluoride supplements for children aged > 6 years old?

Answer 15

1.0mgF

Question 16

what is the fluoride content of daily fluoride mouthwash?

Answer 16

0.05% 227ppmF

Question 17

what is the fluoride content of weekly fluoride mouthwash?

Answer 17

0.2% 909ppmF

Question 18

what is the caries reduction seen in patients who use fluoride mouthwashes?

Answer 18

around 30%

Question 19

what age range is NOT recommended to use fluoride mouthwashes?

Answer 19

<7 years old

Question 20

how do acidulated mouthrinses work?

Answer 20

• low pH
• stimulates mild demin on tooth surfaces
• presence of fluoride stimulates this demin
  low pH environment > drives remineralisation by fluoride as it is more biocompatible in this environment

Question 21

who is NOT SUITABLE for fluoride boosters? (tooth mousse)

Answer 21

unsuitable for those with milk allergies

Question 22

what markets are suitable for tooth mouse use?

Answer 22

markets with no access to high fluorides

Question 23

what is the fluoride content of APF (acidulated phosphate fluoride) gels?

Answer 23

12300ppmmF

Question 24

what are the disadvantages of APF (acidulated phosphate fluoride)?

Answer 24

• time consuming to apply
• acute toxicity risk
• expensive

Question 25

what is the fluoride concentration of Duraphat fluoride varnish?

Answer 25

22600ppmF

Question 26

how does duraphat work?

Answer 26

Resin sets and hardens on the surface maintaining a sustained contact with tooth surface causing:
- precipitation of calcium fluoride
- progressive release of fluoride

Question 27

how often should duraphat varnish be applied in high risk individuals?

Answer 27

Professionally applied 2-4 times a year!

Question 28

what is considered as the single most important factor in caries decline?

Answer 28

usine fluoride toothpaste

Question 29

what factors determine the “anticaries” activity of fluoride toothpaste?

Answer 29

• fluoride concentration
• frequency of application
• rinsing behaviours
• what time toothbrushing takes place

Question 30

what are the risks of fluoride use?

Answer 30

• increased risk of enamel fluorosis
• acute toxicity from ingesting fluoride
• chronic toxicity (fluorosis)

Question 31

how much fluoride do young children need to swallow to risk fluorosis?

Answer 31

0.1mg f/kg of body weight

Question 32

how do we maximise caries benefit but reduce fluorosis risk in young children?

Answer 32

• keep toothpaste out of reach of young kids
• brush twice daily
• supervise brushing by young children
• use small amount toothpaste (pea/smear)
• discourage swallowing
• spit dont rinse

Question 33

what are the Childsmile Core oral health packs?

Answer 33

Oral health packs given to children at:
- 1st year of life
- age 3 (2 packs)
- age 4 (2 packs)
- age 5 (1 pack)