Fluoride use in paediatric dentistry Flashcards
3 dietary fluoride sources + examples
- water
- diet (fish, offal, tea)
- medicinal (OTC, prescribed)
how much F- is ideal in water and why
1ppm
–> 50% less caries esp interproximal and smooth surfaces
30% less fissure caries
not enough to cause fluorosis (but can be if too much extra fluoride in diet, toothpaste etc)
what is the critical pH for fluoride and what does this mean
3.5-5.5
remineralisation and demineralisation (can become encorporated in to enamel –> fluoroapatite)
7 caries prevention strategies
- diet
- fluoride
- radiographs
- fissure sealants
- OH
- prevention of transmission of S mutans
- CPP-APP
8 ways to increase F- for kids
- toothpaste
- mouthwash (must be at least 6yo to rinse)
- varnish (duraphat)
- drops
- tablets
- gel
- foam
- glass beads (placed subgingivally for slow release F-)
variation in ppm F- in toothpaste
what PPM F is beneficial
500-1500
1000+
fluoride supplement dose at
a. 6months-3yo
b. 3-6yo
c. 6+ yo
a. 6months-3yo: sodium fluoride oral drops 550mcg/ 0.15ml 7 drops daily OR half 1.1mg tablet= 0.25mg F
b. 3-6yo: sodium fluoride 1.1mg daily= 0.5mg F
c. 6+ yo: sodium fluoride 2.2mg daily= 1mg F
*halve doses if water fluoridated 0.3-0.7ppm, do not use in >0.7ppm water
how often to apply duraphat in
a. low risk pts
b. high risk pts
a. low risk pts: 6 months
b. high risk pts: 3 months
fluoride dosage per 50 mg/ml duraphat
5%= 22600ppm F
how/ when to use duraphat
- after prophylaxis
- dry teeth only
- can be used to arrest lesions in pre-co operative pts
- refrain from eating/ drinking for 30 mins
pts NOT to use duraphat on 3
- ulcerative gingivitis
- stomatitis
- history of admission to hosp bc of allergy (inc asthma)
which topical F agent works best alone/ together
similar
not much advantage to using additional measures if tooth brushing with F toothpaste alone is effective
BDH fluoride policy
- diet diary and sugar reducing advice
- plaque control
- fluoride sources inc local water supply and provision of additional fluoride
- pit and fissure sealant for 6s
- twice daily tooth brushing, before bed and one other occasion, supervised under 7 years, spit don’t rinse
BDH policy for children’s brushing
a. age 0-3
b. aged 3+
c. high caries risk
a. age 0-3: SMEAR of 1000ppm fluoride toothpaste twice daily
b. aged 3+: PEA SIZED AMOUNT 1350-1500ppm fluoride toothpaste twice daily
plus duraphat twice yearly
c. high caries risk: duraphat every 3 months and F- mouthwash or toothpaste (prescription)
age limit for rinsing
6yo
for high risk caries, strength of F mouthwash
a. daily
b. weekly
a. daily: 0.05%, 10ml
b. weekly: 0.2%, 10ml
prescription toothpaste to use when mouthwash inappropriate
a. 10+ yrs
b. 16+ yrs
INSTEAD OF NORMAL TOOTHPASTE
a. 10+ yrs: 2800ppm (0.619% sodium fluoride)
b. 16+ yrs: 5000 ppm (1.1% sodium fluoride)
LEARN BDH CHILD CARIES PREVENTION FLOWCHART
2 types of fluoride overdose
- acute overdose
- fluorosis
toxic dose of fluoride
LEARN TABLE
1mg F/ kg body weight
lethal dose of fluoride
32-64mg F/kg body weight
some cases of death at 16mg F/kg
flurodie dosage ingested by 10kg child swallowing 50g tube of 1000ppm toothpaste
F= 1mgx50g= 50mg
child=10kg
F dosage ingested: 50mg/10kg= 5mg/kg
what happens with too much fluoride 3
- blocks cell metabolism
- interference with calcium metabolism
- nerve impulse and conduction
signs and symptoms of fluoride overdose
- nausea/ vomiting/ diarrhoea
- excess savilation/ tears/ mucus/ sweat
- headache
- generalised weakness
how to deal with F overdose 5
- get history
- check dose of F against packaging and check remaining vessel
- support vital signs
- management depends on dose
- as much milk as possible or milk of magnesia (anything casein-based)
management of overdose
a. 15mg/kg
a. 15mg/kg: send to ED. calcium gluconate IV, activated charcoal 1g/kg (max 50g) every 4 hours, gastric lavage. life support/ cardiac monitoring
fluorosis mechanism
impairs mineral acquisition of enamel
high risk of fluorisis
a. dose
b. teeth
c. age
a. dose: high dose bolus or repeated low level eg India
b. teeth: central incisors
c. age: 15-30 months. not after 6yo
appearance of fluorosis
a. mild
b. moderate
c. severe
a. mild: diffuse patches/ flecks
b. moderate: mottling/ striations/ yellow-brown
c. severe: enamel hypoplasia
7 ways to prevent fluorosis/ F overdose
- gd history taking
- examine packaging carefully
- aim for topical rather than systemic
- avoid critical age 0-6yo
- targeted use (only high caries risk)
- good education of parents/ carers
- prescribe max 120mg supplements at any time
% of sodium monoflurophosphate (Nampf) and ppm fluoride with sodium fluoride
a. 0.32%
b. 0.22%
c. 0.11%
a. 0.32%NaF: 1.14%Na mfp, 1500 ppm F
b. 0.22%NaF: 0.76%Na mfp, 1000 ppm F
c. 0.11%NaF: 0.38%Na mfp, 500ppm F
management of F overdose 5-15mg/kg
send to ED
–> milk, observe vital signs, gastric lavage (stomach pumped)
managemnt of F overdose >15mg/kg
ED
calcium gluconate IV
activated charcoal 1g/kg every 4 hours, gastric lavage
life support/ cardiac monitoring
