Fluoride/ Traditional Caries Method Flashcards
What is enamel?
- Hardest and most mineralized tissue in the body
- Outer covering of enamel is made up of calcium and phosphate
What is dentin?
- Layer of tooth structure that is directly underneath the enamel and is positioned around the pulp
- Less mineralized than enamel, but more mineralized than bone or cementum
What is pulp?
- soft layer of a tooth that contains nerves, blood vessels, and connective tissue
What bacteria causes caries?
Caused by S. mutans and lactobacilli found within plaque biofilm
Bacteria metabolize fermentable and complex ______________ and produce acids
carbohydrates
Acids diffuse into tooth and dissolve calcium & phosphate minerals in a process called…
demineralization
If acid attacks are infrequent/short duration, saliva aids in repair of damage by…
neutralizing acid and replacing minerals and fluoride lost from tooth (remineralization)
If flow of saliva is low and bacterial level is high, tooth mineral lost by acid attacks are too great for repair by remineralization, thus resulting in…
caries
Acids diffuse into tooth and dissolve __________________ minerals
calcium & phosphate
What are the pathologic factors associated with caries?
- Acid-producing bacteria (S. mutans)
- Low salivary flow
- Carbohydrates in diet
What are the protective factors associated with caries?
- Minerals in saliva (calcium, phosphate, fluoride, proteins)
- Normal salivary flow
- Antibacterial agents
Untreated caries present in more than ________ adults
1 in 5
Caries rates are disproportionately distributed among those of lower…
socioeconomic status
___% of pediatric population has caries present in primary dentition
10%
___% of pediatric population has caries present in permanent dentition
<3%
Caries is most prevalent in…
ethnic minority groups from lower income families
What is fluoride?
- A natural inorganic occurring mineral
- Naturally present at low concentrations in most fresh and saltwater sources
- Either the fluorine ion (F-) or a compound containing fluoride (NaF)
In the correct concentrations _________ can decrease the likelihood of dental caries
fluoride
What does fluoride do for caries?
- Aids in REMINERALIZATION and decreases the risk of carious lesions by up to 25%
Fluoride is a _________ to caries prevention - not a solution on its own
SUPPLEMENT
What is the priority for caries prevention?
Oral hygiene/plaque control is priority
What is systemic application of fluoride?
ingested agents delivered to the oral cavity via the bloodstream
What is topical application of fluoride?
strengthen teeth already in the mouth making them more resistant to caries
What are examples of systemic application of fluoride?
Water
Supplements
Food/beverages
What are examples of topical application of fluoride?
- Water
- Homecare products (toothpaste, mouth rinses, etc.)
- In-office products
Fluoride inhibits ___________ when present in solution
demineralization
Fluoride present on tooth surfaces and in plaque fluid inhibits acid demineralization by…
reducing the solubility of the tooth mineral
Fluoride enhances remineralization and accelerates remin process by…
absorbing into tooth surfaces and attracting calcium ions
Fluoride ions incorporate into remin tooth structures that result in the development of fluorapatite crystals which are ____ soluble than original enamel
less
What are examples of available delivery for systemic fluoride?
- Community water fluoridation
- School water fluoridation
- Fluoride supplements
- Foods containing fluoride
- Salt
What is the pre-eruptive benefit of systemic fluoride?
Fluoride is incorporated into the mineralizing structure during tooth development
What are the post-eruptive benefit of systemic fluoride?
- Fluoride present in saliva enhances mineralization of enamel during enamel maturation phase
- Systemic fluoride can have a cross-over topical fluoride effect as it passes through the oral cavity
What is the goal of community water fluoridation?
An increase of the natural fluoride level in a community’s water supply to a level optimal for dental health
____________ is considered one of the most cost-effective preventive dental program by public health
Water fluoridation
When cities discontinue water fluoridation, evidence demonstrates rapid increase in ______ rates
caries
What are the benefits of water fluoridation?
- 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
The National Toxicology Program (NTP) evaluated claims surrounding fluoride use for oral health and its association with…
lowered IQ in developing children
A 2021 systematic review evaluated the association between fluoride exposure and neurological disorders and concluded there is…
not enough evidence to associate the two at this time
What is the optimal range for levels of water fluoridation?
0.6-1.2 ppm
What is the optimal range for the level of water fluoridation based on?
minimal caries with minimal fluorosis
___ ppm decreases caries with <10% of population with fluorosis
0.7
What is topical fluoride?
fluoride deposited in enamel during enamel maturation phase results in a concentration of fluoride in the enamel
Highest concentration of topical fluoride occurs on the outermost portion (5-10 microns) and ___________ as you move toward the dentin
decreases
Can topical fluoride cause fluorosis?
No
How does topical fluoride make the tooth more resistant to demineralization?
Fluoride ions are substituted into the hydroxyapatite crystal and form a stable, more compact bond making the tooth resistant to demineralization
The fluoride/enamel reaction is influenced by…
concentration of fluoride, pH of fluoride, and length of exposure
Acidic fluorides typically form ________
fluoride
calcium
Higher concentrations of fluoride form _______ fluoride
calcium
Neutral fluorides <100 ppm form…
fluorapatite
In-office fluorides are >9000 ppm, so they typically form ________ fluoride
calcium
What are the benefits of topical fluoride?
- Remineralization
- Interferes with bacterial metabolism
- Prevention
What are the types of topical fluoride applications?
- 2% Neutral sodium fluoride (9000 ppm)
- 1.23% Acidulated Phosphate Fluoride (APF) (12,3000 ppm)
- 5.0% NaF (22,600 ppm)
How is 2% Neutral sodium fluoride (9000 ppm) available?
Available as a foam or gel application (rarely used in practice)
How is 1.23% Acidulated Phosphate Fluoride (APF) (12,3000 ppm) available?
Available as a foam or gel application (rarely used in practice)
How is 5.0% NaF (22,600 ppm) available?
- Available as a varnish application
- Commonly used in dental practices
Initial deposits of topical fluoride is or is not permanent?
Is not
- Relatively rapid loss after 24 hours
- Loss continues for several weeks
Topical fluoride has a Relatively rapid loss after ___ hours
24
After every application of topical fluoride, there is an increase in
the amount of permanently bound fluoride in the outermost layer of enamel –> causes a decrease in caries susceptibility
What are the two types of fluoride in teeth?
- Fluorohydroxyapatite
- Calcium fluoride
What is the most desired form of
fluoride for enamel in caries prevention?
Fluorohydroxyapatite
How is fluorohydroxyapatite formed?
From prolonged exposure of enamel to low concentrations of fluoride
Deposits of calcium fluoride are dissolved by ______ ____ and are available as a source to facilitate remineralization
plaque acids
The benefits of topical fluoride treatments is directly related to the amount of
topical fluoride treatments provided
The type of topical fluoride system used does or does not affect the benefit?
does not
Does topical fluoride benefit sound enamel?
No
________ uptake with higher concentrations of topical fluoride
Greater
When should topical fluoride be used?
-High caries risk individuals
-Sensitive teeth/exposed root surfaces
-Around margins of older restorations
-Overdentures (with natural teeth)
-Xerostomia
-Newly erupted teeth
What is the probable toxic dose (PTD) for fluoride based on?
body weight
What is the probable toxic dose (PTD) for fluoride?
5mg F/kg of body weight
__mg/kg: office use of available calcium, aluminum or magnesium products
<5
___mg/kg: office use of available calcium, aluminum or magnesium products plus hospital observation
> 5
___mg/kg: office use of available calcium, aluminum or magnesium products plus hospital observation plus emergency response (911)
> 15
Concentrated fluoride salts can cause ________ burn when in contact with oral mucosa
chemical
What happens during fluoride toxicity?
- Inhibits enzyme systems
- Binds calcium
- Cardiotoxic due to hyperkalemia
- Chemical burns
What are the signs/symptoms of too much fluoride?
- Nausea
- Vomiting
- Diarrhea
- Abdominal cramping
- Increased salivation/dehydration
What are the pros of 5% NAF fluoride varnish?
- Proven efficacious in decreasing caries, especially in early-childhood
- Easy to apply following oral exam and prophylaxis
- Easy to follow post-op instructions
What are the cons of 5% NAF fluoride varnish?
- Leaves a thin-visible film on teeth that some patients do not like
- Possible allergies linked to specific brands of fluoride varnish
How do you apply fluoride varnish?
Applied to clean tooth surfaces (following a prophylaxis or toothbrushing)
Fluoride varnish is retained on teeth from _______ hours after application, during which time fluoride is released for reaction with the underlying enamel
24-48
Application of fluoride varnish should occur every ____ months (dependent upon caries risk)
3-6
Clinical evidence demonstrates fluoride treatment refusal by ___% of parents during preventive dental visits
13
One study points out that fluoride refusal was significantly associated with __________ refusal
vaccination
What are the strategies to manage fluoride treatment refusal?
*Assess parents’ knowledge, beliefs and attitudes about fluoride with open-ended, nonjudgmental questions
*Incorporate caries risk into discussions with parents during preventive visits
*Obtain information about why a parent refuses fluoride treatment
*Provide a tailored explanation of why topical fluoride is important
*Maintain open communication, even when refusal continue
*Communicate with local health professionals to reinforce the importance of fluoride
The use of professionally applied fluoride should be limited to….
those individuals and communities deemed to be at moderate and high-risk for developing dental caries
What is silver diamine fluoride?
A clear liquid composed of 24-29% silver and 5-6% fluoride (38% Ag(NH3)2F)
Silver diamine fluoride is considered alkaline at a pH level of…
10
Silver contributes to ___________ effect and fluoride _______ tooth structure
antimicrobial; remineralizes
Silver diamine fluoride was approved by FDA in 2014 for use in treating…
early childhood caries and to treat dentin hypersensitivity in adults
What is the mechanism of action of silver diamine fluoride?
- Derives its effectiveness from silver nitrate and fluoride
1. antibacterial action on cariogenic bacteria (by silver)
2. Remineralization and inhibition of demineralization of enamel and dentin (by fluoride)
3. Inhibition of dentin collagen type degradation (by fluoride)
___% SDF found to be most superior at arresting caries compared to lower concentrations
38
_____ superior at arresting dental caries and preventing new caries compared to fluoride varnish alone
SDF
What is more successful at arresting dental caries: multiple applications of SDF or a one-time placement
multiple applications
Who can you use silver diamine fluoride on beside children?
elderly
In October 2016, the FDA awarded SDF the designation of “_____________” based on its arrest of decay in children and adults, the first for oral health therapy
breakthrough therapy
Silver diamine fluoride is approved for use to treat dentin ____________ in adults
hypersensitivity
Fluoride and silver are made soluble in water by the addition of ___________
ammonia
The silver ions are a broad-spectrum _____________ that has high biocompatibility and low toxicity in humans
antimicrobial
The killed bacteria further act as a carrier for silver ions (SDF) and can kill living bacteria nearby in a process known as the…
“zombie effect”
How does silver kill bacteria?
damage and degrade bacterial cell walls, disrupt bacterial DNA synthesis and replication and disrupt intracellular metabolic activity, eventually leading to cell death
What two products form when using silver diamine fluoride?
– silver phosphate which acts as a reservoir of phosphate ions
- calcium fluoride, which is a pH-regulated fluoride supply
Free silver ions in the lesion are reduced by environmental oxygen and turn the lesion _____
black
5% SDF solution contains ________ ppm fluoride
44,800 (almost twice as much as % NaF varnish)
5% SDF reacts with calcium and phosphate ions to produce _____________________ crystals
fluorohydroxyapatite
The small amount of SDF required to be effective suggests that it is well within the margin of…
safety for use
T/F: One application of SDF is not sufficient for ultimate results
True
- may need to place SDF a few times for effectiveness in treating the area
When do you use SDF?
- 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
How do you place SDF?
- Dry tooth on which SDF will be placed
- Using a micro brush, apply SDF sparingly to tooth
- Allow area to dry slightly (1-3 minutes) then rinse
- Caries will be arrested over time and will turn black as a result
SDF has an unpleasent __________ taste
metallic
Do not use SDF on patients with…
silver allergy OR pulpal involvement
Is fluoridated prophy paste considered a therapeutic/preventative agent for caries?
NO
-at best fluoride in prophy paste will replace flurpoide lost by the abrasive paste
What is the average concentration of NaF in toothpastes?
0.22% (1000 ppm)
_______________ most effective dentifrice system for caries prevention
Sodium Fluoride (NaF)
What are the risks with fluoride toothpastes?
Risk of fluorosis and toxicity if ingested
What does fluoride rinse do?
- remineralize tooth structure
- strengthens enamel to prevent caries
- kills bad breath
What are the ingredients in ACT mouthwash?
- alcohol free
- 0.02% sodium fluoride in 33.8 fl oz bottle
- 0.05% sodium fluoride in 18 fl oz bottle
How do you use fluoride rinses?
- twice daily after brushing/flossing
- swish with 10 mL for 1 minutes then expectorate
- no eating/drinking for 30 minutes after
What are the ingredients in Listerine mouth rinse?
- 0.02% Sodium Fluoride (100 ppm)
- 21.6% v/v alcohol
What is MI paste alone used for?
to relieve tooth sensitivity not to prevent decay
MI paste PLUS has ____% NaF
0.20%
What is the interesting ingredient in MI paste?
Recaldent (milk-derived protein that releases calcium and phosphate to the surface of teeth)
What is MI paste PLUS used for?
caries prevention and tooth sensivity
Prevident toothpaste has ___% NaF
1.1% (5000 ppm)
Prevident mouth rinse has ___% NaF
0.2% (900 ppm)
What is fluorosis?
Changes in the appearance of enamel caused by too much systemic fluoride
How do tooth surfaces feel with demineralized tooth structure?
Upon exploring, tooth surfaces will feel rough
How do tooth surfaces feel with fluorosis?
Upon exploring, tooth surfaces will feel smooth
Will individuals with fluorosis be more susceptible to caries?
no –> extra mineralization
