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Dent Y3 > Fluorides and Non-fluorides in paediatric dentistry > Flashcards

Fluorides and Non-fluorides in paediatric dentistry Flashcards

1
Q

What is the concentration of fluoride naturally present in water in the UK?

A

less than 0.7mg per litre

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2
Q

What is the concentration of fluoride artificially present in water in the UK?

A

1mg per litre

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3
Q

What percentage of water in the UK is fluoridated?

A

10%

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4
Q

What is the easiest way to increase the fluoride in children?

A

in the water supply

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5
Q

What is the level of overall caries reduction in 5 year olds in areas of 1ppm fluoride in water?

A

50%

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6
Q

Aside from water, what are some sources of fluoride from the diet?

A

fish, tea, coffee, grape fruit juice, seafood

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7
Q

Can you prescribe fluoride?

A

yes

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8
Q

How effective is low fluoride toothpaste at reducing caries? less than 1000ppm?

A

ineffective

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9
Q

What do you need to investigate to determine caries risk in students?

A

medical, social and dental histories

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10
Q

What are the prevention strategies aside from fluoride for preventing caries?

A

reducing cariogenic diet, fissure sealants, improving Oral Hygiene, preventing S.mutans transmission, tooth mouse, silver diamine

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11
Q

What products can we use to increase the levels of fluoride in patients oral care?

A

toothpaste, mouthwash, varnish, drops, tablets, gels, foam

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12
Q

How can systemic flouride be useful at reducing caries?

A

the fluoride will be incorporated into the developing tooth structure

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13
Q

How should you care for teeth in children up to 3 years of age?

A

brush teeth twice daily with fluoridated toothpaste once teeth errupt, once at night and one other occasion

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14
Q

What amount and concentration of fluoride toothpaste should you use for children up to 3 years of age?

A

a smear of no less than 1000ppm

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15
Q

How should you care for teeth in children 3-6 years of age?

A

brush last thing at night and one other occasion, brushing should be supervised by parent, spit and don’t rinse

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16
Q

What concentration of fluoride toothpaste should non high caries risk children use at 3-6 years of age?

A

over 1000ppm

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17
Q

What concentration of fluoride toothpaste should children older than 3 years use if they are high caries risk?

A

1350-1500ppm

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18
Q

How many times a year should you apply fluoride varnish in children older than 3 that are high caries risk?

A

more than twice a year but no more than 4 times

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19
Q

What is the concentration of fluoride in daily fluoride mouthwash that can be used by high caries risk children older than 7?

A

0.05% 10ml

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20
Q

What is the concentration of fluoride in high fluoride toothpaste that can be prescribed to children older than 10 with high caries risk?

A

2800ppm

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21
Q

What is the concentration of fluoride in high fluoride toothpaste that can be prescribed to children older than 16 with high caries risk?

A

5000ppm

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22
Q

What is the benefit to topical fluoride varnish?

A

increases the availability of topical fluoride

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23
Q

What is the concentration of fluoride in duraphat fluoride varnish?

A

22600ppm

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24
Q

How long should you refrain from eating or drinking after application of fluoride varnish?

A

30 mins

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25
Q

What are some contraindications to fluoride varnish?

A

ulcerative gingivitis, stomatitis, history of severe asthma or allergy to colophony

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26
Q

What is the percentage reduction of caries in permanent teeth with the twice yearly use of fluoride varnish?

A

43%

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27
Q

What is the percentage reduction of caries in primary teeth with the twice yearly use of fluoride varnish?

A

37%

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28
Q

What are the potential consequences of too much fluoride?

A

acute overdose or flurosis

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29
Q

What dose of fluoride can cause GI upset?

A

1mg per kg body weight

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30
Q

What dose of fluoride is classed as lethal poisoning in children?

A

16mg per kg body weight

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31
Q

What dose of fluoride is classed as lethal poisoning in adults?

A

32-64mg per kg body weight

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32
Q

What age group has the highest proportion of fluoride toxicity?

A

under 6 year olds

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33
Q

What is the toxic dose of fluoride in children?

A

5mg per kg body weight

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34
Q

What can happen if you overdose with fluoride?

A

formation of hydrofluoric acid on contact with moisture, cell metabolism is blocked, interference of calcium metabolism, hypocalcaemia

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35
Q

Why is the formation of hydrofluoric acid due to fluoride overdose a problem?

A

it will burn tissues and cause internal damage due to the low pH value

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36
Q

How can fluoride overdose lead to the cell metabolism being blocked?

A

the cells get poisoned due to the inhibition of enzymes that are needed for the physiological functioning of cells

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37
Q

How can interference of the calcium metabolism due to fluoride overdose cause problems in the body?

A

inhibition of nerve impulses or nerve functions

38
Q

How can fluoride overdose lead to hypocalcaemia?

A

fluoride forms complexes with calcium meaning the calcium cannot interact with receptors in the body

39
Q

What should you do if you suspect a fluoride overdose?

A

get a clear history including age and weight if possible, check patient’s condition, check dose of fluoride against packaging and check the container, support vital signs with O2, give calcium

40
Q

How do you manage fluoride overdose of less than 5mg per kg body weight?

A

give milk and observe for 4 hours

41
Q

How do you manage fluoride overdose of 5-15mg per kg body weight?

A

observe the patient and support vital signs, gastric lavage

42
Q

How do you manage fluoride overdose of over 15 mg per kg body weight?

A

IV calcium gluconate, activated charcoal 1g per kg body weight every 4 hours and gastric lavage, cardiac monitoring and life support if needed

43
Q

What is the mechanism of fluorosis?

A

chronic ingestion of fluoride of 0/1mg daily before the age of 6

44
Q

What age is there greatest risk of damage due to fluorosis?

A

15-30 months

45
Q

What does the severity of fluorosis depend upon?

A

the amount of excessive consumption of fluoride as well as the timing and duration of fluoride intake

46
Q

What will teeth with mild fluorosis look like?

A

opaque white or yellow patches

47
Q

What will teeth with moderate fluorosis look like?

A

yellow-brown mottling or striations in the teeth

48
Q

What will teeth with severe fluorosis look like?

A

enamel hypoplasia

49
Q

How is the enamel affected by fluorosis?

A

hypermineralised and porous

50
Q

How is the dentine affected by fluorosis?

A

dentine tubules will have irregular shape and distribution

51
Q

How can you prevent fluorosis and overdose?

A

good history taking, examine the packaging carefully and aim for topical rather than systemic fluoride supplementation, take special care with adding fluoride before 6 years old.

52
Q

When can you use toothpaste with less than 1000ppm fluoride?

A

for children at high risk of fluorosis living in areas of water fluorodation

53
Q

Why does caries develop more rapidly in primary teeth?

A

differences in enamel structure, dietary habits and level of oral hygiene maintenance at a young age

54
Q

What are the differences in enamel structure between primary and permanent teeth?

A

enamel is thinner, surface micro hardness is less, less well structured arrangement of crystals, less well mineralised

55
Q

Is caries a static or dynamic process?

A

dynamic

56
Q

Why is it important to assess a child’s caries risk?

A

to decide management and prevention strategies

57
Q

What factors do you need to consider when determining caries risk?

A

medical history, dietary habits, clinical evidence, plaque control, use of fluoride, social history

58
Q

What are the potential non-fluoride prevention methods?

A

diet modification, oral hygiene improvement, dental health education, fissure sealants, sugar free medicine, chewing gum, chlorhexidine

59
Q

How can you classify dietary sugars?

A

intrinsic or extrinsic sugars

60
Q

What are intrinsic sugars?

A

those inside the cell, such as in raw fruit

61
Q

What are extrinsic sugars?

A

those outside of the cell, such as milk sugars or added sugars

62
Q

What are some examples of non-milk extrinsic sugars?

A

fruit juices, honey, recipe sugar, table sugar

63
Q

What does COMA stand for?

A

Committee On Medical Aspects of food

64
Q

What did COMA conclude regarding dietary sugars and caries?

A

caries is positively related to frequency and amount of Non Milk Extrinsic sugar consumption

65
Q

What is the recommended percentage of energy intake that comes from sugars?

A

less than 5 percent

66
Q

How many times a day should added sugar consumption be limited to?

A

maximum of four times aday

67
Q

What is the major cause of dental caries?

A

frequent consumption of sugar

68
Q

Is incidence of caries the same in everyone with the same diet?

A

no

69
Q

Do all types of sugar affect the incidence of caries equally?

A

no

70
Q

What was the result of the hopewood house study?

A

that even if there is poor Oral Hygiene, a low sugar diet means low caries levels

71
Q

Why is selecting non cariogenic food difficult?

A

sugar content labelling is not always clear, access to healthy food is difficult in socially deprived areas, most adverts on TV promote cariogenic/erosive products, families don’t often tend to stick to 3 meals a day, school tuck shops are tempting

72
Q

What is a diet diary?

A

a way to investigate dietary habits of patients

73
Q

What four things should you focus on when analysing a diet diary?

A

amount of sugar intake, frequency of sugar intakes, frequency of snack intakes, how food and drink are consumed

74
Q

What is important to remember when suggesting ways to improve diet after analysing the diet diary?

A

recommend alternatives or improvements that fit with the families lifestyle

75
Q

What are the main ways oral hygiene can be used to help prevent against caries?

A

use disclosing tablets so children can see where plaque is, brush twice daily with fluoride toothpaste, educate parents and children on how to brush teeth, spit don’t rinse

76
Q

What are some tips you can give to parents regarding brushing their children’s teeth?

A

brush teeth last thing at night and one other occasion, avoid eating directly after brushing and brushing directly after eating

77
Q

What are fissure sealants?

A

a material that is placed in the pits and fissures of teeth to prevent the development of occlusal caries

78
Q

Which teeth should you select for fissure sealants?

A

deep fissures, those that have erupted sufficiently for good moisture control

79
Q

Which teeth should have fissure sealants if occlusal caries affects one permanent molar?

A

all other permanent molars

80
Q

What are the most common teeth to fissure seal?

A

first permanent molars, palatal pits of permanent lateral incisors, second permanent molars, all premolars

81
Q

What is the method for placing a fissure sealant?

A

take x-rays to check for caries (there should not be any pre-fissure sealing), etch with phosphoric acid for 30 seconds, wash and dry tooth, place fissure sealant and cure for 20 seconds

82
Q

What are the two types of sealant?

A

opaque and clear

83
Q

What are benefits of opaque sealant?

A

easier to see if the sealant is still good upon review

84
Q

What are benefits of clear sealant?

A

you can see if caries develops beneath the sealant

85
Q

What materials can be used for fissure sealant?

A

resin, GIC, Compomer, Fluoride containing sealants

86
Q

What is the most common material used for fissure sealants?

A

Resin

87
Q

When would GIC fissure sealants be indicated?

A

if moisture control is difficult, if teeth are only partially erupted but the patient is high risk

88
Q

Why are sugar free medicines useful to consider for prevention strategies?

A

there are concerns over iatrogenic damage to children’s teeth due to sugar containing medicines

89
Q

Why can chewing gum be useful as a preventative strategy?

A

increases saliva flow, sugar free gums contain xylitol or sorbitol which can help with caries reduction by blocking the sugar receptors of bacteria

90
Q

What is chlorhexidine?

A

an antibacterial agent useful for reducing caries

Dent Y3 (23 decks)

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