Fluoride - Sugars - Area Specific Curettes Flashcards
\_\_\_\_\_\_ application: ingested agents that become incorporated into forming tooth structures •Water •Supplements •Food/beverages
Systemic application
________: strengthen teeth already in the mouth making them more resistant to caries
•Water
•Homecare products (toothpaste, mouth rinses, etc.)
•In-office products
Topical application
______ application:
•Ingested and incorporated into enamel during development of tooth structures
Systemic application
______ application:
•Promotes remineralization and prevents demineralization after eruption
•Inhibits glycolysis in bacteria, thereby inhibiting the ability of bacteria to metabolize carbohydrates and produce acid
Topical application
- An increase of the natural fluoride level in a community’s water supply to a level optimal for dental health
- has contributed to a major decline in dental caries from the 1950s to the 1980s and continues to reduce and prevent tooth decay
- When cities discontinued this, evidence demonstrates rapid increase in caries rates
- is considered one of the most cost-effective preventive dental program by public health
Water fluoridation
Benefits of ________:
- 30-39% decrease in caries in primary dentition
- 35% decrease in children/adolescent permanent dentition
- Approximately 20-30% decrease in coronal caries and 20-40% decrease in root caries in adult population
Water Fluoridation
What is the optimal range of water fluoridation in ppm?
.6-1.2 ppm
Changes in the appearance of enamel caused by too much systemic fluoride
Fluorosis
Will teeth with fluorosis feel rough or smooth?
Smooth
Will individuals with fluorosis be susceptible to caries?
No
Does topical fluoride cause fluorosis?
No; only stays on very outer portion of enamel
Does fluoride stay on teeth permanently?
No
After each application of topical fluoride, there is an _____ in the amount of permanently bound fluoride in the outermost layer of enamel
Increase
________
-most desired form of fluoride for enamel in caries prevention•From prolonged exposure of enamel to low concentrations of fluoride
•Fluorohydroxyapatite
_______\
-source of fluoride for remineralization of enamel•
Deposits are dissolved by plaque acids and are available as a source to facilitate remineralization
Calcium fluoride
The benefits of topical fluoride treatments is directly related to the ______ of topical fluoride treatments provided
amount
When should \_\_\_\_ be used? •High caries risk individuals •Sensitive teeth/exposed root surfaces •Around margins of older restorations •Overdentures (with natural teeth) •Xerostomia •Newly erupted teeth
Topical Fluoride
Concentrated fluoride salts can cause chemical burn when in contact with oral mucosa
Inhibits enzyme systems
Binds calcium
Cardiotoxic due to hyperkalemia
Fluoride Toxicity
Signs & Symptoms of \_\_\_\_\_\_\_ Nausea Vomiting Diarrhea Abdominal cramping Increased salivation/dehydration
too much Fluoride
________
PROS
•Proven efficacious in decreasing caries, especially in early-childhood
•Easy to apply following oral exam and prophylaxis
•Easy to follow post-op instructions
CONS
•Leaves a thin-visible film on teeth that some patients do not like
•Possible allergies linked to specific brands of fluoride varnish
Fluoride Varnish-5% NaF
- First investigated in 1969 as part of a PhD student’s thesis in Japan (Mizuho Nishino)
- She combined the antimicrobial properties of silver with the benefits of high dose fluoride
- This formulation additionally resulted in a precipitate that occluded dentinal tubules and reduced hypersensitivity
- This product initially emerged from dental public health researchers in the developing world, where access to oral health care was extremely limited
Silver Diamine Fluoride
Mechanism of action of _____
Fluoride and silver are made soluble in water by the addition of ammonia
•The silver ions are a broad-spectrum antimicrobial that has high biocompatibility and low toxicity in humans
•These ions act as tiny ‘silver bullets’ that damage and degrade bacterial cell walls, disrupt bacterial DNA synthesis and replication and disrupt intracellular metabolic activity, eventually leading to cell death
•The killed bacteria further act as a carrier for silver ions and can kill living bacteria nearby in a process known as the “zombie effect”
•Once applied, a physical barrier precipitates out of the clear solution onto the carious lesion
•2 products form–silver phosphate which acts as a reservoir of phosphate ions, and calcium fluoride, which is a pH-regulated fluoride supply available during cariogenic challenge
•Free silver ions in the lesion are reduced by environmental oxygen and turn the lesion black, which is the major non-medical side effect of SDF
Silver Diamine Fluoride
How many ppm does 5% SDF solution contain?
44,800 ppm
When to use ______:
•Dentin hypersensitivity
•Uncooperative patients (i.e., children or patients with cognitive disabilities), root surface caries on elderly patients with existing restorations, patients without access to restorative care, difficult to treat lesions
SDF
Fluoridate _____ is not considered a therapeutic/preventive agent for caries
prophy paste
___ is used to relieve tooth sensitivity not to prevent decay
MI Paste
____ is used to relieve tooth sensitivity and prevent caries
MI Paste Plus
_____ is prescribed with moderate to high caries risk
Prevident
= sugar alcohols
•40% of the caloric content of sucrose
•Physical characteristics similar to sucrose
•Not great in baking
•Polyols
_______
•Occurs naturally in fruits and berries•Only half as sweet as sucrose
•Considered noncariogenic, however, it is slowly fermented by S. mutans
•Shown to be cariogenic in patients with decreased salivary gland function
•Can cause GI issues if large quantities digested
Sorbitol
_______
•Naturally occurring polyol found in seaweed
•Virtually no cariogenic activity due to slow metabolization from oral microorganisms
•Used as a dusting agent for chewing gum and bulking agent in powdered foods
Mannitol
_______
•Naturally occurring caloric 5-carbon sugar alcohol
•Nonfermentable by oral bacteria and exhibits antibacterial properties
•Produced commercially from birch trees, corncobs and the waste from sugarcane
•Sweetness approximates that of sucrose; however, it is 10x more costly to produce
•Primarily used in chewing gum, mints, mouthrinses, toothpaste, and sometimes found in syrup and candy
•Xylitol
- Decreases bacterial metabolism and produces a drop in dental plaque pH
- Reduces the volume and amount of supragingival plaque due to a reduced production of extracellular polysaccharides and biofilm matrix
- Promotes the selection of xylitol-resistant mutans streptococci
- Stimulates salivary secretion
•Xylitol
At least ____ of xylitol per day needed to achieve optimum therapeutic effect on S. mutans
5g
Are xylitol products toxic to animals?
Yes
- Natural sweetener extracted from the leaves of a shrub found in South America
- 100-300 times sweeter than table sugar
- Heat stable (good for baking)
- Supports the prevention of caries
Steveoside (Stevia)
- 200-700 times sweeter than sucrose
- Nonnutritive and noncariogenic
- Oldest artificial sweetener used in the US (Sweet ‘N’ Low)
- Used as a sweetener in some toothpastes
•Saccharin
•200 times sweeter than sucrose
•Soft drinks account for more than 70% of aspartame consumption
•FDA requires foods containing aspartame have the following label:
PHENYLKETONURICS: CONTAINS PHENYLALANINE
•Aspartame
- Noncariogenic, nonnutritive sweetener that is 600 times sweeter than sucrose
- Poorly absorbed and is largely excreted in the feces and urine, unchanged
- No carcinogenic risks posed to humans
Sucralose
ONEcutting edge; lower portion of the working-end
Rounded toe
Straight & complex shanks
Used in deep periodontal pockets due to their ability to adapt to root anatomy
Area specific curettes
Which area specific curette is used on all surfaces of anterior teeth?
Gracey 1/2
Which area specific curette is used on mesial, buccal, and lingual surfaces of posterior teeth?
Gracey 11/12
Which area specific curette is used on distal surfaces of posterior teeth?
Gracey 13/14
Which 2 gracey instruments are considered complementary instruments?
11/12 and 13/14
