Fluorides in Pediatric Practice Mechanisms & Systemic Therapy

Question 1

Which is more effective, pre-eruptive systemic or post-eruptive topical administration? Why?

Answer 1

post-eruptive because little fluoride is incorporated during development

Question 2

The benefits of water fluoridation are ___.

Answer 2

topical

no benefit before tooth eruption

Question 3

T/F. Fluoridation must continue to maintain benefit and moving to a fluoridated area after tooth eruption is effective.

Answer 3

True.

Question 4

___ fluoride is effective during oral transit and secreted in ___ provides topical benefit.

Answer 4

Ingested; saliva

Question 5

What is the mechanism of action of fluoridation?

Answer 5

1 is more effective

1. remineralizing demineralized enamel
2. lowering enamel solubility
3. inhibiting bacterial production of acid

Question 6

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 ___.

Answer 6

loose; hydroxyl; fluorapatite; dimineralization

Question 7

CaF2 from high concentration ___ products precipitates on surface, crevices and micropores of lesions.

Answer 7

topical

Question 8

T/F. CaF2 is incorporated into enamel.

Answer 8

False, it is NOT incorporated into enamel

Question 9

What serves as a reservoir of F- ions and promotes remineralization during an acid attack?

Answer 9

CaF2

Question 10

white motting or brown staining

caused by excess ingestion during development

Answer 10

Fluorosis

Question 11

T/F. Fluorosis is caused by ingestion and topical application.

Answer 11

False, Fluorosis is NOT caused by topical application

Question 12

What is the concentration in water that will lead to fluorosis?

Answer 12

> 2ppm

Question 13

Excess ingestion during enamel ___ stage (protein scaffold) produces pitting and hypoplasia

Answer 13

secretory

Question 14

Excess ingestion during ___ stage (mineralization) causes chalky whiteness and weak enamel.

Answer 14

maturation

Question 15

Why does mild fluorosis not bother most people?

Answer 15

considered beneficial

whiter teeth

Question 16

What is the most critical age during tooth development that forms fluorosis?

Answer 16

22-26 mo (2 yr)

Question 17

Fluroide in water is a naturally occuring trace element that can be toxic in excessive quantities. So why is it used?

Answer 17

No evidence for concern at 1ppm in H2O

Question 18

Chronic toxicity for an average 3 yr old

Answer 18

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

Question 19

Acute high-dose toxicity

Answer 19

PTD=5mg/kg

average 3 yo: 15kg* 5mg/kg = 75 mg
most likely an accidental ingestion

Question 20

What are some symptoms of overdose?

Answer 20

nausea, vomiting , abdominal pain, diarrhea
hyper-salivation/drooling
numbness, tingling, muscle cramps, seizures
death with large overdoses

Question 21

What are some mechanisms of acute fluoride toxicity?

Answer 21

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

Question 22

How is fluoride toxicity treated?

Answer 22

Give Ca++ or Mg++ to bind fluoride (antacids and milk)

Hospitalization if over PTD

Question 23

What are sources of systemic fluoride?

Answer 23

1. water fluoridation
2. dietary supplements
3. ingestion of topical products

Question 24

What is the biggest source of ingested fluoride?

Answer 24

beverages

Question 25

Water fluoridation reduces caries by ___% in primary teeth, ___% mixed, and ___% in permanent teeth.

Answer 25

30-60%; 20-40%; 15-35%

Question 26

What is the historic water fluoride levels?

Answer 26

0.7-1.2mg/liter

Ohio = 1mg/L

Question 27

What are the new HHS recommendation for water fluoride levels? Why the changes?

Answer 27

0.7mg/L

increase sources of fluoride, increase in mild fluorosis, consumption no longer dependent on climate (air conditioning, less outdoor activity

Question 28

T/F. Private wells, bottled water, breast and formula feeding are all excellent sources of fluoridated water.

Answer 28

False, these do not have fluoride

Question 29

1ppm =

Answer 29

1mg/L

Question 30

what is the fluoride halo effect?

Answer 30

diffusion of fluoride in food (7up)

Question 31

___mg sodium fluoride contains 1 mg fluoride ion

Answer 31

2.2

Question 32

what directions would you give when prescribing fluoride tablets?

Answer 32

chew, swish and swallow
do not take with milk
take at bedtime

Question 33

Fluorides are primarily effective against ___ ___ decay.

Answer 33

smooth surface

Question 34

Fluoride has a smaller effect on ___ decay.

Answer 34

fissure