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Yr 3 Primary Care - Child dental health > Fluorides > Flashcards

Fluorides Flashcards

1
Q

What are the different sources of fluoride?

A

Diet (fis, offal and tea)
Water
Medicinal (over the counter and prescribed)

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2
Q

What are the benefits of water fluoridation?

A

1ppm has best max effects and benefits of fluoride with minimum amount of mottling
= 50% reduction in caries (esp. interproximal and smooth surface) but also a 30% reduction in pits and fissures

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3
Q

What is it key to remember about the best level of water fluoridation?>

A

1ppm eas set before fluoride containing products were so readily available therefore now a lower dose may be better

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4
Q

How does fluoride work?

A

Decreases rates of demineralisation (mainly topically), creates fluorapatite crystals (more resistant to acid erosion), some effect on bacteria

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5
Q

What is the critical pH?

A

5.5 (remineralisation) - 3.5 (demineralisation)

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6
Q

What is the appearance of mild fluorosis?

A

Diffuse flecks/patches

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7
Q

What is the appearance of moderate fluorosis?

A

mottling, striations, yellow/brown

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8
Q

What is the appearance of severe fluorosis?

A

appearance of enamel hypoplasia

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9
Q

What happens with too much fluoride?

A
  • blocks cell metabolism
  • interferes with calcium metabolism
  • affects nerve impulses and conduction
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10
Q

What is acute overdose?

A

Fluorosis

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11
Q

What are the signs and symptoms of fluoride overdose?

A
  • Vomiting, nausea, and diarrhoea
  • Excessive salivation, tears, mucus and sweat
  • Headache
  • Generalised weakness
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12
Q

What dose causes lethal poisoning?

A

32-64 mg F/kg body weight (n.b. there have been some cases of death at 16 mg F/kg body weight)

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13
Q

When are you more likely to have a overdose of fluoride?

A

With a high dose bolus or repeated low levels

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14
Q

What is 1000ppm in mg F/g?

A

1mg F/g

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15
Q

What is 400ppm in mg F/g?

A

0.4mg F/g

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16
Q

What are the consequences of a toxic dose?

A

GI upset at approx 1mg F/kg body weight

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17
Q

How to deal with a fluoride overdose?

A
  • get clear history, check dose of fluoride (package)
  • Support vital signs
  • management depends on dose
  • drink as much milk/ milk of magnesia as possible (absorbs remaining fluoride in stomach)
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18
Q

How does fluorosis occur?

A
  • affects enamel maturation (impairs mineral acquisition)
  • greatest risk for centra 1’s is 15-30 months
  • corral development complete at 6 y/o = less of an issue
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19
Q

What are the maximum doses for a 2 y/o (10kg)?

A 
Fluoride drops = 3 ml
1mg tablets = x10
mouth rinse 0.05% = 43ml
mouth rinse 0.2% = 11ml
duraphat varnish = 0.43ml
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20
Q

What are the maximum doses for a 5 y/o (20kg)?

A 
Fluoride drops = 5 ml
1mg tablets = x20
mouth rinse 0.05% = 86ml
mouth rinse 0.2% = 22ml
duraphat varnish = 0.86ml
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21
Q

What are the maximum doses for a 10 y/o (30kg)?

A 
Fluoride drops = 8 ml
1mg tablets = x30
mouth rinse 0.05% = 130ml
mouth rinse 0.2% = 33ml
duraphat varnish = 1.3ml
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22
Q

What properties of the fluoride containing agents make a child more likely to overdose?

A

Nice colour and liquid if not secure

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23
Q

What do we do in the BDH for all children?

A
  • Diet diary (sugar reducing advice)
  • plaque control
  • Fluoride sources (local water and provision of additional fluoride)
  • Pit and fissure sealants for first permanent molars
  • 2X daily toothbrushing before bed and 1 other time, supervised
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24
Q

What ppm fluoride toothpaste should 0-3 y/o use?

A

1000 ppm F toothpaste

= smear 2 x daily

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25
Q

What ppm fluoride toothpaste should 3+ use?

A

1350-1500 ppm F toothpaste

= pea sized amount 2 x daily

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26
Q

What % fluoride mouthwash should 6+ use? and how often should they use it?

A

NaF 0.05% 10ml daily

NaF 0.2% 10ml weekly

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27
Q

When should a fluoride mouthwash be used?

A

Anytime between morning brush and evening brush i.e. when home from school

28
Q

How many times a year do we apply duraphat varnish to children teeth?

A

2x a year

29
Q

What ppm toothpaste is used by all high caries risk children?

A

1350-1500ppm

30
Q

What fluoride measures do all high caries risk children get?

A

Higher fluoride toothpaste AND Duraphat more frequently AND fluoride mouthwash/higher fluoride toothpaste prescribed

31
Q

How often is duraphat applied in high caries risk children?

A

3-4 x yearly

32
Q

What ppm toothpaste is prescribed for >10y/o if fluoride mouthwash is inappropriate?

A

2800 ppm (0.619% NaF)

33
Q

What ppm toothpaste is prescribed for 16y/o + if fluoride mouthwash is inappropriate?

A

5000 ppm (1.1% NaF)

34
Q

What are the different forms of fluorides?

A

Toothpaste, gel, mouthwash, varnish, drops, tablets, glass beads and foam

35
Q

How do we decide which form of fluoride to give?

A

Tailored for each patient

36
Q

What is 1500 ppm toothpaste equivalent to in % NaF and Na mfp?

A
  1. 32% NaF

1. 14% Na mfp

37
Q

What is 1000 ppm toothpaste equivalent to in % NaF and Na mfp?

A
  1. 22% NaF

0. 76% Na mfp

38
Q

What is 500 ppm toothpaste equivalent to in % NaF and Na mfp?

A
  1. 11% NaF

0. 38% Na mfp

39
Q

Why can toothpaste labels be misleading?

A

Can show fluoride level in ppm, % NaF or % Na mfp

40
Q

What is the lowest dose that is effective at preventing caries?

A

1000ppm

41
Q

What substance in fluoride varnishes can people be allergic to?

A

Colophony = tree resin

42
Q

What is the evidence for using fluoride varnishes 2 x a year?

A

decrease in DMFT by 46% and dmft by 33%

43
Q

Which conditions should you not use fluoride varnish with?

A

Ulcerative gingivitis, stomatitis or history of allergy (hospitalisation for asthma)

44
Q

What is the maximum exposure to fluoride varnishes?

A

every 3 months

45
Q

What are the different brand names for fluoride varnish?

A

Duraphat or vocopaste

46
Q

What concentration is fluoride varnish?

A

50mg/ml = 5% NaF = 22600 ppm F

47
Q

When applying fluoride varnish what should have been done to the teeth?

A

Dry

48
Q

What have fluoride varnishes been shown to do?

A

Reverse carious lesions

49
Q

For how long after fluoride varnish has been applied should you refrain from food and drink for?

A

30 mins

50
Q

What concentration fluoride drops should be used for 6 months - 3 years?

A

500mcg/0.15ml

51
Q

How frequently should fluoride drops be used?

A

7 x daily

52
Q

What dose and quantity of fluoride tablet should be given to 6 months- 3yrs?

A

1/2 1.1 mg NaF tablet daily = 0.25 mg F

53
Q

What dose and quantity of fluoride tablet should be given to 3-6 y/o?

A

1.1 mg NaF tablet daily = 0.5 mg F

54
Q

What dose and quantity of fluoride tablet should be given to 6y/o +?

A

2 x 1.1mg NaF tablet daily = 1 mg F

55
Q

In which instances should we halve the doses of fluoride tablets?

A

If they live in an area where water us 0.3-0.7 ppm

56
Q

When should fluoride tablets not be used?

A

If they live in an area where water >0.7ppm

57
Q

What are the main issues with fluoride tablets and drops?

A

Compliance and easy to overdose

58
Q

What is the evidence for fluoride supplements?

A

Decreases caries, effect is unclear on primary teeth and overall evidence is week

59
Q

How do glass beads work?

A

V. small encapsulated beads placed subgingivally = slowly release the contained fluoride

60
Q

At what age is there an increased risk of fluorosis and why?

A
61
Q

How do we identify the children in need of fluoride?

A

Risk based assessment

62
Q

What strategies do we combine fluoride with?

A

Diet, radiographs, fissure sealants, oral hygiene, prevention of s. mutans and CPP-ACP = helps remineralise teeth

63
Q

What can we do to fix the aesthetic consequences of fluorosis?

A

Vital bleach to remove dark staining, mask white areas with composite build ups

64
Q

How do we manage an overdose of fluoride

A

Milk + absorb for 4 hours

65
Q

How do we manage an overdose of fluoride 5-15 mg/kg?

A

send to emergency department, observe and support vital signs and give milk, gastric lavage (stomach pump)

66
Q

How do we manage an overdose of fluoride > 15 mg/kg?

A

Send to emergency department immediately, give IV calcium gluconate, activated charcoal 1g/kg (max 50g) every 4 hours and gastric lavage, life support and cardiac monitoring

67
Q

How can we prevent fluorosis and overdose?

A
  • Good history taking
  • examine package carefully
  • aim for topical not systemic
  • avoid critical age (0-6y/o)
  • good education for parents/carers
  • prescribe max 120 mg supplements at any one time

Yr 3 Primary Care - Child dental health (11 decks)

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