Fluorides and Non-fluorides in paediatric dentistry Flashcards
What is the concentration of fluoride naturally present in water in the UK?
less than 0.7mg per litre
What is the concentration of fluoride artificially present in water in the UK?
1mg per litre
What percentage of water in the UK is fluoridated?
10%
What is the easiest way to increase the fluoride in children?
in the water supply
What is the level of overall caries reduction in 5 year olds in areas of 1ppm fluoride in water?
50%
Aside from water, what are some sources of fluoride from the diet?
fish, tea, coffee, grape fruit juice, seafood
Can you prescribe fluoride?
yes
How effective is low fluoride toothpaste at reducing caries? less than 1000ppm?
ineffective
What do you need to investigate to determine caries risk in students?
medical, social and dental histories
What are the prevention strategies aside from fluoride for preventing caries?
reducing cariogenic diet, fissure sealants, improving Oral Hygiene, preventing S.mutans transmission, tooth mouse, silver diamine
What products can we use to increase the levels of fluoride in patients oral care?
toothpaste, mouthwash, varnish, drops, tablets, gels, foam
How can systemic flouride be useful at reducing caries?
the fluoride will be incorporated into the developing tooth structure
How should you care for teeth in children up to 3 years of age?
brush teeth twice daily with fluoridated toothpaste once teeth errupt, once at night and one other occasion
What amount and concentration of fluoride toothpaste should you use for children up to 3 years of age?
a smear of no less than 1000ppm
How should you care for teeth in children 3-6 years of age?
brush last thing at night and one other occasion, brushing should be supervised by parent, spit and don’t rinse
What concentration of fluoride toothpaste should non high caries risk children use at 3-6 years of age?
over 1000ppm
What concentration of fluoride toothpaste should children older than 3 years use if they are high caries risk?
1350-1500ppm
How many times a year should you apply fluoride varnish in children older than 3 that are high caries risk?
more than twice a year but no more than 4 times
What is the concentration of fluoride in daily fluoride mouthwash that can be used by high caries risk children older than 7?
0.05% 10ml
What is the concentration of fluoride in high fluoride toothpaste that can be prescribed to children older than 10 with high caries risk?
2800ppm
What is the concentration of fluoride in high fluoride toothpaste that can be prescribed to children older than 16 with high caries risk?
5000ppm
What is the benefit to topical fluoride varnish?
increases the availability of topical fluoride
What is the concentration of fluoride in duraphat fluoride varnish?
22600ppm
How long should you refrain from eating or drinking after application of fluoride varnish?
30 mins
What are some contraindications to fluoride varnish?
ulcerative gingivitis, stomatitis, history of severe asthma or allergy to colophony
What is the percentage reduction of caries in permanent teeth with the twice yearly use of fluoride varnish?
43%
What is the percentage reduction of caries in primary teeth with the twice yearly use of fluoride varnish?
37%
What are the potential consequences of too much fluoride?
acute overdose or flurosis
What dose of fluoride can cause GI upset?
1mg per kg body weight
What dose of fluoride is classed as lethal poisoning in children?
16mg per kg body weight
What dose of fluoride is classed as lethal poisoning in adults?
32-64mg per kg body weight
What age group has the highest proportion of fluoride toxicity?
under 6 year olds
What is the toxic dose of fluoride in children?
5mg per kg body weight
What can happen if you overdose with fluoride?
formation of hydrofluoric acid on contact with moisture, cell metabolism is blocked, interference of calcium metabolism, hypocalcaemia
Why is the formation of hydrofluoric acid due to fluoride overdose a problem?
it will burn tissues and cause internal damage due to the low pH value
How can fluoride overdose lead to the cell metabolism being blocked?
the cells get poisoned due to the inhibition of enzymes that are needed for the physiological functioning of cells
How can interference of the calcium metabolism due to fluoride overdose cause problems in the body?
inhibition of nerve impulses or nerve functions
How can fluoride overdose lead to hypocalcaemia?
fluoride forms complexes with calcium meaning the calcium cannot interact with receptors in the body
What should you do if you suspect a fluoride overdose?
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
How do you manage fluoride overdose of less than 5mg per kg body weight?
give milk and observe for 4 hours
How do you manage fluoride overdose of 5-15mg per kg body weight?
observe the patient and support vital signs, gastric lavage
How do you manage fluoride overdose of over 15 mg per kg body weight?
IV calcium gluconate, activated charcoal 1g per kg body weight every 4 hours and gastric lavage, cardiac monitoring and life support if needed
What is the mechanism of fluorosis?
chronic ingestion of fluoride of 0/1mg daily before the age of 6
What age is there greatest risk of damage due to fluorosis?
15-30 months
What does the severity of fluorosis depend upon?
the amount of excessive consumption of fluoride as well as the timing and duration of fluoride intake
What will teeth with mild fluorosis look like?
opaque white or yellow patches
What will teeth with moderate fluorosis look like?
yellow-brown mottling or striations in the teeth
What will teeth with severe fluorosis look like?
enamel hypoplasia
How is the enamel affected by fluorosis?
hypermineralised and porous
How is the dentine affected by fluorosis?
dentine tubules will have irregular shape and distribution
How can you prevent fluorosis and overdose?
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.
When can you use toothpaste with less than 1000ppm fluoride?
for children at high risk of fluorosis living in areas of water fluorodation
Why does caries develop more rapidly in primary teeth?
differences in enamel structure, dietary habits and level of oral hygiene maintenance at a young age
What are the differences in enamel structure between primary and permanent teeth?
enamel is thinner, surface micro hardness is less, less well structured arrangement of crystals, less well mineralised
Is caries a static or dynamic process?
dynamic
Why is it important to assess a child’s caries risk?
to decide management and prevention strategies
What factors do you need to consider when determining caries risk?
medical history, dietary habits, clinical evidence, plaque control, use of fluoride, social history
What are the potential non-fluoride prevention methods?
diet modification, oral hygiene improvement, dental health education, fissure sealants, sugar free medicine, chewing gum, chlorhexidine
How can you classify dietary sugars?
intrinsic or extrinsic sugars
What are intrinsic sugars?
those inside the cell, such as in raw fruit
What are extrinsic sugars?
those outside of the cell, such as milk sugars or added sugars
What are some examples of non-milk extrinsic sugars?
fruit juices, honey, recipe sugar, table sugar
What does COMA stand for?
Committee On Medical Aspects of food
What did COMA conclude regarding dietary sugars and caries?
caries is positively related to frequency and amount of Non Milk Extrinsic sugar consumption
What is the recommended percentage of energy intake that comes from sugars?
less than 5 percent
How many times a day should added sugar consumption be limited to?
maximum of four times aday
What is the major cause of dental caries?
frequent consumption of sugar
Is incidence of caries the same in everyone with the same diet?
no
Do all types of sugar affect the incidence of caries equally?
no
What was the result of the hopewood house study?
that even if there is poor Oral Hygiene, a low sugar diet means low caries levels
Why is selecting non cariogenic food difficult?
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
What is a diet diary?
a way to investigate dietary habits of patients
What four things should you focus on when analysing a diet diary?
amount of sugar intake, frequency of sugar intakes, frequency of snack intakes, how food and drink are consumed
What is important to remember when suggesting ways to improve diet after analysing the diet diary?
recommend alternatives or improvements that fit with the families lifestyle
What are the main ways oral hygiene can be used to help prevent against caries?
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
What are some tips you can give to parents regarding brushing their children’s teeth?
brush teeth last thing at night and one other occasion, avoid eating directly after brushing and brushing directly after eating
What are fissure sealants?
a material that is placed in the pits and fissures of teeth to prevent the development of occlusal caries
Which teeth should you select for fissure sealants?
deep fissures, those that have erupted sufficiently for good moisture control
Which teeth should have fissure sealants if occlusal caries affects one permanent molar?
all other permanent molars
What are the most common teeth to fissure seal?
first permanent molars, palatal pits of permanent lateral incisors, second permanent molars, all premolars
What is the method for placing a fissure sealant?
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
What are the two types of sealant?
opaque and clear
What are benefits of opaque sealant?
easier to see if the sealant is still good upon review
What are benefits of clear sealant?
you can see if caries develops beneath the sealant
What materials can be used for fissure sealant?
resin, GIC, Compomer, Fluoride containing sealants
What is the most common material used for fissure sealants?
Resin
When would GIC fissure sealants be indicated?
if moisture control is difficult, if teeth are only partially erupted but the patient is high risk
Why are sugar free medicines useful to consider for prevention strategies?
there are concerns over iatrogenic damage to children’s teeth due to sugar containing medicines
Why can chewing gum be useful as a preventative strategy?
increases saliva flow, sugar free gums contain xylitol or sorbitol which can help with caries reduction by blocking the sugar receptors of bacteria
What is chlorhexidine?
an antibacterial agent useful for reducing caries
