Fluorides Flashcards
T/F
Fluoride in drinking water is tasteless and odourless?
T
What is the level of fluoride in sea water? And what form is present in?
1.3ppm
Present in ionic from
What is the history of water fluoridation?
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%
How does fluoride act?
many ways
One way is incorporated into enamel forming fluoapatie
Has pre and post eruptve effects
Which types of effect pre or post eruptive fluoride is considered more important?
Pre eruptve: enamel less susceptible to acid attack
post eruptive: interferes with bacteria metabolism and enhances remin of enamel
POST ERUPTIVE MORE IMPORTANT
What are the mechanisms of action for fluoride delivery?
Population and Individual level
What population based ways can fluoride be delivred?
water
milk
salt
How can fluoride be delieverd at an individual level?
toothpaste Mouthwash beads tablets drops varnish Diet
What are the advanatages of using population based fluoride delivery?
cost effective
don’t require personnel
reduce inequalities because there is more universal coverage
How effective is supervised brishing in schools and nurseries? Reference
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
What are the advanatges of fluoridated toothpaste?
Easy and effective
freedom of choice
Simplest method of fluoride delivery
Worldwide decline In decay since fluoridated toothpaste
What are the disadvanatges of fluoridated toothpaste?
toothpaste and toothbrush expensive and risk over overdose
How effective are fluoride gels in caries rediction?
Marhino 2009: systematic review
When applied few times a year preventative fraction of 21%
What are the advanatges of fluoride gels?
Effective
freedom of choice
useful in high risk children
What are the disadvanatges of fluoride gels?
compliance required
need to have good access to services
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?
In combination with tooth brush distribution (these have shown to be effective in reducing caries in a population) fluoridated toothpaste
How effective are tablets and drops in reducing caries ?
40-50% reduction in caries expereince
WHat are the advnatges of fluoride drops and varnish?
effecive and freedom of choice
What are the disadvanatges of using fluoride drops and varnish?
Compliance needed and risk of overdose
Need to be careful when prescribing this
WHat are the advanatages of fluoridating milk? And how effective is it?
safe
Not enough evidence to see how effective yet
What are the disadvanatges of fluoridating milk?
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?
What are the advantages of fluoridating salt and what is the level applied?
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
What are the disadvantages of fluoridating salt?
conflict with general health and well being
conflict with general health messages about reducing salt intake
What is water fluoridation?
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
what is the optimal concentration of fluoride in water?
1ppm or 1mg/L
What is the evidence behind water fluoridation?
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
What percentage of people will suffer from fluorosis as a result of water fluoridation?
12.5%
T/F water fluoridation is associated with bone fracture and cancer incidence?
F
By how much percent can water fluoridation prevent caries in adults?
Griffin et al 2007
27%
Systematic review and meta analysis
What is fluorosis ?T/F percentage of children suffering from fluorosis is fluoridated areas is the same in Non fluoridated areas?
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
What percentage of the UK population receive fluoridated water?
10%
West Midlands and NE eengland
What are the three main arguments against water fluoridation
Adverse health effects
Environmental concerns
Civil liberities
What are the arguments for adverse health effects of wf?
Non evidence based
fluorosis issues and general health issues but based on areas where fluoride levels are VERY high
What are the arguments against adverse health affects of wf?
Evidence based
no harm of fluoride at 1ppm
Fluorosos is only a minor concern
What are the arguments against wf for environmental purposes??
contains impurities eg arsenic
considers wf same as dumping toxic wastes into water
threaten organic food indistry
What are the arguments for wf for environmental purposes?
only trace amounts of arsenic at 1ppm
no effect of fluoride on marine, people animals and plants
What are the civil arguments against fluoride?
mass medication
violation of human rights
What are the civil arguments for water fluoridation?
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
how has the law changed re water fluoridation?
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
What does the water industry act 2003 state re indemnity and insurance for water fluoridation?
Indemnity is to be provided for the water company by the secretary of state for health
Who must meet the cost for water fluoridation?
the strategic health authority and they must also review dental health in that area every 4 years
How effective are mouth rinses in caries reduction? And what are the advantages and disadvantages?
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
How effective is fluoride varnish at reducing caries?
Systematic review Marhino et al 2009
DMFS 46%
dmfs: 33%
BUT if there is significant decay they fluoride vanish has no effect
When is the highest period of risk for mottling,for perm incisors?
18-36 months
Name some of the pro fluoridation bodies
BDA BMA Royal college of physicians British Fluoridation society Faculty of public health
Name some anti fluoride parties
Green Party
Soil association
National pure water association
