Fluoride & desensitizing agents Flashcards
what is fluoride
- naturally occurring mineral
what happens with consumption of excess fluoride during tooth formation
- enamel hypoplasia
what is the acceptable quantity of fluoride in water
- 0.7-1.2 ppm
what is the mechanism of action for fluoride (3)
- inhibits demineralization
- enhances remineralization
- inhibits bacteria in the biofilm
how does fluoride inhibit demineralization
- fluoride in fluid of biofilm around enamel crystals and dentin of root
- passes through the diffusion channels with the acids
- increases the fluoride of the subsurface lesion
- prevents the continued dissolution of the minerals in enamel and dentin
how does fluoride enhance remineralization
- fluoride absorbs to mineral crystals within the tooth and attracts calcium ions
- fluoride ions incorporate into the remineralizing tooth structure, resulting in the development of fluorapatite-like crystals
- fluoride levels in the mouth from fluoridated water are sufficient to enhance remineralization
does topical or systemic have a better benefit for fluoride
- greatest anti-caries benefit from topical exposure after eruption
- fluoride in saliva – incorporated into enamel crystals during remineralization
- evidence of fluoride remaining in saliva several hours – prolonger topical effect
what is the pH for tooth minerals and fluorapatite crystals
- tooth minerals dissolve at pH of 5.5
- fluorapatite dissolves at pH of 4.5
what causes erosion
- highly acidic foods and beverages
- medical conditions
how does erosion differ from caries
- not bacteria causing erosion - environment
2. minerals of the tooth that are lost
how does fluoride cause bacterial inhibition
- fluoride interferes with essential enzyme activity of bacteria
- crosses the bacterial wall (membrane) as hydrofluoric acid
- alkaline cytoplasm - fluoride ion, causes enzyme activity disruption of bacteria = death
what is substantivity
- the prolonged effect achieved when a chemical is released slowly over time
what are active ingredients in antibacterial rinses
- essential oils
- cetylpyridinium chloride
- triclosan
- ACS = acidified sodium chlorite
- PHMB = polyhaxamethylene biguanine
what does chlorhexidine do
- bactericidal
- opens the cell membrane
- recommended to be used in high risk individuals only, 1 min daily for 1 week/month and must be used in conjunction with fluoride remineralization therapy
- chx binds strongly onto many sites: mucous membranes and biofilm
- the bactericidal effect from a single dose is greatest for several hours, could even last as long as 5 days
what is chlorhexidine gluconate
- percentage concentration: ~2% in Europe, ~12% in usa and canada
- common names: peridex, periogard, oris chx
what is chlorhexidine gluconate the most effective agent for the reduction of
- biofilm = 55%
- gingivitis: 45%
what are side effects of chx
- brown stain on: teeth and tongue; composites, glass ionomer and compomers; acrylic teeth (dentures)
- bitter taste
- diet and brushing habits
- more frequent professional cleanings
what are phenolic compounds in essential oil rinses and what are the percentages of the phenolic compounds
- thymol = 0.063% - Listerine, 0.064% - Personelle
- eucalyptol = 0.091% - Listerine, 0.092% - Personelle
- menthol = 0.042% - Listerine, 0.042% - Personelle
what are 3 commercial rinses with phenolic compounds
- listerine
2. personelle and life
what are the 3 methods of delivery of topical fluoride
- drinking water and some beverages
- self applied: non prescription OTC products, prescription products
- professionally applied: prescription products
what is the fluoride content in over the counter self applied dentifrices
- 1000 ppm fluoride:
- sodium fluoride: crest pro health and Colgate total
- sodium monofluorophosphate (NaMFP)
- stannous fluoride (SnF2)
- 5000 ppm fluoride:
- prevident 1.1% NaF
what is the fluoride content in percentage in a weekly vs daily mouthrinse
- weekly: 0.2% NaF
- daily: 0.05% = 230 ppm of NaF, 0.4% SnF2
how much does over the counter fluoride rinses help with caries reduction and with what products
- 30-35% caries reduction with:
- daily rinsing (2x/day)
- 0.05% sodium fluoride
what are the instructions for fluoride mouth rinses
- rinse for 30-60 seconds
- spit out the excess
- do not eat or drink anything for 30 mins
- before bed!!!
what are 2 examples of weekly rinses and are they otc or prescription
- 0.63% stannous fluoride: prescription
2. 0.2% sodium fluoride: non prescription
when are self applied topical gel fluoride prescription products recommended
- moderate/high caries risk
- orthodontic with decal around brackets
- elderly - people with xerostomia/root exposure
what different types of self applied topical gel fluoride prescription products are available, which are most effective and what is an alternative option
- types available:
- 1.1% (5000 ppm) neutral sodium fluoride
- 1.23% (5000 ppm) APF
- 0.4% (1000 ppm) stannous fluoride = Gelstan
- most effective: 4 mins in custom trays/soft disposable trays
- alternative option: 1 minute brushing of fluoride gel
what are the 2 options of in office fluoride treatments and what is their percentage of uptake
- 1 min application - 85%
2. 4 min application - 100%
what is a disadvantage of the 1 minute application
- less uptake
what are 2 advantages/indications for use for the 1 minute uptake
- use it on patients like children because it’s hard for the to sit still for longer than 1 min
- good for patients with gag reflexes or a lot of saliva
what do fluoride varnishes contain
- contain 5% NaF
what is the application like for fluoride varnishes
- isolate and dry
- apply directly
- allow saliva to harden varnish
when is it indicated to apply a varnish to dentin and cementum
- recession
- helps with root caries, sensitivity
- young children if they have abrasion, abfraction or erosion
what are post op instructions for fluoride varnishes
- no brushing for 4-6 hours
2. no hard, sticky or crunchy foods for the next 4-6 hours
what are the 2 reasons children should be supervised when using fluoride
- don’t use too much toothpaste on toothbrush, make sure they are able to spit and not swallow
- avoid fluorosis on permanent teeth
what are the 3 main types of pastes recommended for sensitive teeth
- sensodyne
- crest: prohealth
- prevident: 1.1% sodium fluoride. most effective because stronger dose of fluoride
what are the different types of sensodynes
- sensodyne-R (original without fluoride): contains strontium chloride
- sensodyne-F: contains potassium nitrate 5%, sodium fluoride 0.254%, detergent SLS (sodium laurel sulphate)
- sensodyne repair and protect: contains nova min 5%, sodium monofluorphosphate 0.788%
- pronamel: less abrasives, no SLS - more available fluoride
what are the active ingredients of crest: prohealth
- stannous fluoride 0.0454%
- sodium hexametaphosphate 13%: decreases the ability of stain to adhere to the tooth. used in crest vivid white - has been shown to decrease stain moderately if used 2x/day
what is recaldent
- MI paste
- vitamins for the teeth
- milk derived protein
- CPP = casein phsophopeptide
- ACP = amorphous calcium phosphate
- CPP are naturally occurring molecules which are able to bind to calcium and phosphate ions and stabilize ACP (delivers calcium and phosphate ions into the tooth, repairing and strengthening areas of enamel)
how does MI paste work
- adheres to soft tissue, pellicle, biofilm, hydroxyapatite
- under acidic conditions recaldent releases: calcium, phosphate
when should you use MI paste
- xerostomia
- erosion
- hypersensitivity
- caries risk
- orthodontics (decal)
how do you use MI paste in office
- place a generous amount in tray
- position in patient’s oral cavity for 3 mins
- do not rinse, follow fluoride instructions
how do you use MI paste at home
- apply by rubbing onto affected area
- leave on overnight
what is xylitol, what does it do and how does it work
- other antibacterial therapeutic
- looks and tastes like sucrose
- inhibits attachment and transmission of bacteria
- does the following:
- enhances remin
- inhibits the transfer of bacteria from person to person
- inhibits future decolonization
- comes in chewing gum and lozenges
- two tabs of gum or lozenges 4-5x/day
what is sodium bicarbonate and what does it do
- other antibacterial therapeutic
- neutralizes acids produced by acidogenic bacteria and has antibacterial properties
- extreme-risk clients = those at high risk plus ry mouth or special needs
- delivered in gum, toothpaste or solution (for individuals with low salivary flow)
what is dentinal hypersensitivity
- an abnormal condition occurring when vital dentin is exposed to the environment of the oral cavity resulting in painful stimuli that reaches the pulp and is translated as pain
- commonly located at the cervical area of the tooth
- tooth sensitivity is most common complaint
- 1 in 4 patients report some degree of hypersensitivity
- 10 million Americans experience long-term hypersensitivity
- scores for root sensitivity double following pd surgery
what are factors contributing to hypersensitivity
- exposed dentin and open dentinal tubules
what causes exposure of dentinal tubules
- root exposure: due to gingival recession
- removal of coronal enamel: excessive attrition, abfraction = biomechanics bending due to stress created from grinding or clenching causing a ‘flaking off’ of enamel at the CEJ
what are _ reasons for root exposure
- gingival recession: result of pathology (disease)
- aging: results in continuous passive eruption of teeth and a gradual exposure of CEJ and eventually the root surface (2-3-4 mm by age of 55-60)
- chronic or long lasting PD accompanied by: progressive apical migration of the JE, loss of PDL fibre attachment, crest of alveolar bone destruction = all result in exposed root surfaces
- tooth positions within dental arch: bucco-version/labio-version may result in excess biofilm accumulation, difficulty in removing biofilm due to difficulty in placement of toothbrush
- PD surgery
- bruxism
- incorrect toothbrushing habits: too much pressure, abrasive tp, too hard a toothbrush
- root preparation/root debridement: calculus on cementum is impossible to remove without removing cementum too. will initiate a hypersensitive state
what are the 3 stimuli that produces hypersensitivity symptoms
- mechanical: tb bristles, flossing, metal eating utensils, dh instruments, denture clasp
- chemical: foods high in acids or sugars, bulimic/anorexic individual - acidic vomit residue, acid reflux
- thermal: hot/cold foods/beverages, cold air
what is the hydrodynamic theory of tooth sensitivity
- pain response caused by stimulus causing the dentinal fluid to move
- sensitive nerve endings located at the junction of the pulp and the dentin are deformed
- this causes the nerve endings to fire, which then produces a quick, localized sharp pain
what are desensitizing agents
- material that reduces or eliminates tooth sensitivity
how can we stop sensitivity
- block the dental tubules
what can cause sensitivity to return
- acidic foods, beverages
- toothbrushing
- scaling/root planing
what are some other causes of sensitivity
- cracked/fractured tooth
2. microleakages
how does desensitizing work
- introducing potassium nitrate chemical
- passes through dentinal tubules to pulp
- acts directly on the nerve (depolarizes it)
- soothing effect on the pulp
- desensitizing will create a chemical bond with the dentin which mineralized the openings of the exposed tubules. this creates a mechanical bond with the dentin which mineralizes the openings of the exposed tubules and creates a mechanical occlusion at the beginning of the tubules
what are 4 desensitizing agents
- toothpastes
- fluoride gel/varnish
- inorganic salts
- resin agents
