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Dental Public Health > Fluorides > Flashcards

Fluorides Flashcards

1
Q

T/F

Fluoride in drinking water is tasteless and odourless?

A

T

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2
Q

What is the level of fluoride in sea water? And what form is present in?

A

1.3ppm

Present in ionic from

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3
Q

What is the history of water fluoridation?

A

1902: Fred McKay Colarado Springs population in Colardo springs had Brown stain with low levels of decay
1933: Churchill identified fluoride In water supply 1938: Dean found 21 cities that had fluoride of 1.0ppm but no mottlimg and low decay
1944: Dean and co-workers testing safety of fluoridation
1945: Grand Rapids were fluoridated
1952: decay levels In Grand Rapids had decreased by ~50%

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4
Q

How does fluoride act?

A

many ways
One way is incorporated into enamel forming fluoapatie

Has pre and post eruptve effects

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5
Q

Which types of effect pre or post eruptive fluoride is considered more important?

A

Pre eruptve: enamel less susceptible to acid attack
post eruptive: interferes with bacteria metabolism and enhances remin of enamel

POST ERUPTIVE MORE IMPORTANT

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6
Q

What are the mechanisms of action for fluoride delivery?

A

Population and Individual level

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7
Q

What population based ways can fluoride be delivred?

A

water
milk
salt

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8
Q

How can fluoride be delieverd at an individual level?

A 
toothpaste
Mouthwash
beads
tablets
drops
varnish
Diet
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9
Q

What are the advanatages of using population based fluoride delivery?

A

cost effective
don’t require personnel
reduce inequalities because there is more universal coverage

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10
Q

How effective is supervised brishing in schools and nurseries? Reference

A

Curnow et al 2002
High risk children have signigficant less caries after being involved in toothbrushing programme
BUT only effective on days children attaneds and needs home support

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11
Q

What are the advanatges of fluoridated toothpaste?

A

Easy and effective
freedom of choice
Simplest method of fluoride delivery
Worldwide decline In decay since fluoridated toothpaste

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12
Q

What are the disadvanatges of fluoridated toothpaste?

A

toothpaste and toothbrush expensive and risk over overdose

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13
Q

How effective are fluoride gels in caries rediction?

A

Marhino 2009: systematic review

When applied few times a year preventative fraction of 21%

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14
Q

What are the advanatges of fluoride gels?

A

Effective
freedom of choice
useful in high risk children

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15
Q

What are the disadvanatges of fluoride gels?

A

compliance required

need to have good access to services

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16
Q

According to Marhino et al 2002, what is the best way for whole population exposure to fluoride? And in combination with which strategy can tooth paste distribution be used with?

A

In combination with tooth brush distribution (these have shown to be effective in reducing caries in a population) fluoridated toothpaste

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17
Q

How effective are tablets and drops in reducing caries ?

A

40-50% reduction in caries expereince

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18
Q

WHat are the advnatges of fluoride drops and varnish?

A

effecive and freedom of choice

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19
Q

What are the disadvanatges of using fluoride drops and varnish?

A

Compliance needed and risk of overdose

Need to be careful when prescribing this

20
Q

WHat are the advanatages of fluoridating milk? And how effective is it?

A

safe

Not enough evidence to see how effective yet

21
Q

What are the disadvanatges of fluoridating milk?

A

It remains untested in community settings and there is limited evidence base for its effectiveness
If used in schools only effective for those who attend on that day
relies on positive consent
What about those children with allergies to cows milk?

22
Q

What are the advantages of fluoridating salt and what is the level applied?

A

Effective and freedom of choice: DMFT of children aged 12 and 15 reduced significantly from 1984 to 1999
caries protection is as good as water fluoridation

250ppm

23
Q

What are the disadvantages of fluoridating salt?

A

conflict with general health and well being

conflict with general health messages about reducing salt intake

24
Q

What is water fluoridation?

A

The controlled addition of a fluoride compound to a public water supply in order to bring the fluoride concentration to a level that prevents dental decay

25
Q

what is the optimal concentration of fluoride in water?

A

1ppm or 1mg/L

26
Q

What is the evidence behind water fluoridation?

A

Water fluoridation increased proportion of children without decay by 15%
children in fluoridated areas have 2.25 fewer decayed teeth than those living in non fluoridated areas

27
Q

What percentage of people will suffer from fluorosis as a result of water fluoridation?

A

12.5%

28
Q

T/F water fluoridation is associated with bone fracture and cancer incidence?

A

F

29
Q

By how much percent can water fluoridation prevent caries in adults?

A

Griffin et al 2007
27%
Systematic review and meta analysis

30
Q

What is fluorosis ?T/F percentage of children suffering from fluorosis is fluoridated areas is the same in Non fluoridated areas?

A 
This is mottling of the enamel due to excessive fluoride  uptake during tooth development 
F
Tabari et al 2000
3% Fluoridated
0.5% non fluoirdate
31
Q

What percentage of the UK population receive fluoridated water?

A

10%

West Midlands and NE eengland

32
Q

What are the three main arguments against water fluoridation

A

Adverse health effects
Environmental concerns
Civil liberities

33
Q

What are the arguments for adverse health effects of wf?

A

Non evidence based

fluorosis issues and general health issues but based on areas where fluoride levels are VERY high

34
Q

What are the arguments against adverse health affects of wf?

A

Evidence based
no harm of fluoride at 1ppm
Fluorosos is only a minor concern

35
Q

What are the arguments against wf for environmental purposes??

A

contains impurities eg arsenic
considers wf same as dumping toxic wastes into water
threaten organic food indistry

36
Q

What are the arguments for wf for environmental purposes?

A

only trace amounts of arsenic at 1ppm

no effect of fluoride on marine, people animals and plants

37
Q

What are the civil arguments against fluoride?

A

mass medication

violation of human rights

38
Q

What are the civil arguments for water fluoridation?

A

fluoride is naturally present in water anyway
right to fluoride free water is not a civil right
EU permits drinking fluoride that contains up to 1.5ppm fluoride
Still some choice (drink bottled water)
Balance of personal preferences against common good

39
Q

how has the law changed re water fluoridation?

A

Water Industry act 1991 clause 58: no obligation for private water companies to fluoridate water

Amended in Water Industry act 2003 clause 58 where companies are compelled to do so if requested by the local authorities

40
Q

What does the water industry act 2003 state re indemnity and insurance for water fluoridation?

A

Indemnity is to be provided for the water company by the secretary of state for health

41
Q

Who must meet the cost for water fluoridation?

A

the strategic health authority and they must also review dental health in that area every 4 years

42
Q

How effective are mouth rinses in caries reduction? And what are the advantages and disadvantages?

A

Systematic review Marhino et al 2009
26% reduction

Advantage: effective, freedom of choice
Dis: compliance, risk of overdose , young cannot rinse , also advice on timing of when to use the mouthwash

43
Q

How effective is fluoride varnish at reducing caries?

A

Systematic review Marhino et al 2009
DMFS 46%
dmfs: 33%

BUT if there is significant decay they fluoride vanish has no effect

44
Q

When is the highest period of risk for mottling,for perm incisors?

A

18-36 months

45
Q

Name some of the pro fluoridation bodies

A 
BDA
BMA
Royal college of physicians 
British Fluoridation society 
Faculty of public health
46
Q

Name some anti fluoride parties

A

Green Party
Soil association
National pure water association

Dental Public Health (13 decks)

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