Fluorides in Pediatric Practice Mechanisms & Systemic Therapy Flashcards
Which is more effective, pre-eruptive systemic or post-eruptive topical administration? Why?
post-eruptive because little fluoride is incorporated during development
The benefits of water fluoridation are ___.
topical
no benefit before tooth eruption
T/F. Fluoridation must continue to maintain benefit and moving to a fluoridated area after tooth eruption is effective.
True.
___ fluoride is effective during oral transit and secreted in ___ provides topical benefit.
Ingested; saliva
What is the mechanism of action of fluoridation?
1 is more effective
- remineralizing demineralized enamel
- lowering enamel solubility
- inhibiting bacterial production of acid
During post-eruptive maturation, newly eruptive teeth have ___ crystal structure with impurities. Fluoride replaces ___ to strengthen crystal structure and is incorporated into enamel as ___. Teeth are now more resistant to ___.
loose; hydroxyl; fluorapatite; dimineralization
CaF2 from high concentration ___ products precipitates on surface, crevices and micropores of lesions.
topical
T/F. CaF2 is incorporated into enamel.
False, it is NOT incorporated into enamel
What serves as a reservoir of F- ions and promotes remineralization during an acid attack?
CaF2
white motting or brown staining
caused by excess ingestion during development
Fluorosis
T/F. Fluorosis is caused by ingestion and topical application.
False, Fluorosis is NOT caused by topical application
What is the concentration in water that will lead to fluorosis?
> 2ppm
Excess ingestion during enamel ___ stage (protein scaffold) produces pitting and hypoplasia
secretory
Excess ingestion during ___ stage (mineralization) causes chalky whiteness and weak enamel.
maturation
Why does mild fluorosis not bother most people?
considered beneficial
whiter teeth
What is the most critical age during tooth development that forms fluorosis?
22-26 mo (2 yr)
Fluroide in water is a naturally occuring trace element that can be toxic in excessive quantities. So why is it used?
No evidence for concern at 1ppm in H2O
Chronic toxicity for an average 3 yr old
RfD= 0.06 mg/kg-da
15kg * 0.06 mg/kg-da = 0.9 mg
1 mg in a liter of H2O and blob of toothpaste
Acute high-dose toxicity
PTD=5mg/kg
average 3 yo: 15kg* 5mg/kg = 75 mg
most likely an accidental ingestion
What are some symptoms of overdose?
nausea, vomiting , abdominal pain, diarrhea
hyper-salivation/drooling
numbness, tingling, muscle cramps, seizures
death with large overdoses
What are some mechanisms of acute fluoride toxicity?
GI Tract - HF formed in stomach = GI irritation, nausea, vomiting, diarrhea
Systemic effect - binds calcium ions (hypocalcemia) - direct cytotoxic effects -interference w/multiple enzyme systems results in respiratory paralysis, dysrhythmia, cardiac failure
How is fluoride toxicity treated?
Give Ca++ or Mg++ to bind fluoride (antacids and milk)
Hospitalization if over PTD
What are sources of systemic fluoride?
- water fluoridation
- dietary supplements
- ingestion of topical products
What is the biggest source of ingested fluoride?
beverages
