Non-Water Community Fluoride Delivery Flashcards
What is the primary mode of action of fluoride?
- topical
- post eruptive involvement
- dynamic process of de/remineralisation
How does fluoride prevent caries?
- formation of fluoroapatite
- less susceptible to demineralisation
- promotes remineralisation
- bacteriostatic effect
- interferes with metabolic pathways
- less acid produced
What are the oral reservoirs for fluoride?
- oral reservoir
- fluoride from toothbrushing disappears quickly
- 2 broad types of oral reservoir
- mineral deposits
- CaF2, FAP
- CAF2 in saliva and fluid phase of plaque - biologically/bacterially bound
- calcium fluoride
- mineral deposits
What different types of fluoride therapy exist and what settings are they delivered in?
- community
- water
- school based brushing
- varnish
- in office
- varnish
- gels and foams
- slow release
- home
- toothpaste
- mouthrinse
- tablets
What is fluoridated salt and what are the advantages and disadvantages?
- salt with added fluoride
- F-
- requires little conscious action by individual
- just required to consume product
- provides element of choice
- public health effectiveness diminished
- popular in some countries
- effective when no infrastructure for water fluoridation
- mixed messages from health professionals
- reduce salt intake to reduce risk of cardiovascular disease
- appropriate dosages difficult to manage
- variable need within geographic regions
What is fluoridated milk and what are the advantages and disadvantages?
- fluoride added to milk
- public health programme
- high levels of childhood caries, no alternative F- delivery
- mainly in schools
- only consumed around term time
- distribution delayed until nursery/school age
- reliant on parental consent
- some children don’t like milk
- enables targeted delivery - relies on sustained function
- shelf life and other cost issues
- distribution system expensive
- milk natural healthy drink
- rich in nutrients
- unsure on long term benefit
- limited overall evidence
- requires more RCTs
What are fluoride supplements and what are the advantages and disadvantages?
- tablets or drops containing fluoride
- proven topical cariostatic benefits
- increased risk of fluorosis
- topical effect more important that systemic
- used for at risk children over 6 years old
- additional support needs
- special care requirements
- best used with swish and swallow procedure
- crunch tablet and swirl around mouth
- erupted teeth
- UK guidelines
- 6 months-3 years
- 0.25mg - 3-6 years
- 0.5mg - > 6 years
- 1.0mg
- 6 months-3 years
What are fluoride mouthrinses and what are the advantage and disadvantages?
- fluoride containing mouthrinses for home use
- daily
- 0.05% 227ppmF
- slightly more effective - weekly
- 0.2% 909ppmF
- more cost effective
- daily
- reduction in caries of around 30%
- swishing around mouth important for efficacy
- good benefit-risk ratio
- cost-benefit ratio also low
- generally good compliance
What are acidulated mouthwashes?
- Low pH mouthwashes
- stimulate mild demineralisation on tooth surface
- fluoride stimulates remineralisation
- low pH makes fluoride more bioavailable - effectively gets fluoride into teeth
- more so than non-acidulated rinses
- fluoride stimulates remineralisation
What are fluoride boosters?
- tooth mousse
- contains CPP-ACP
- not suitable for those with milk allergies
- contains CPP-ACP
- at home application or in office application using trans
What are acidulated phosphate fluoride gels and what are the advantages and disadvantages?
- professionally applied gels
- can be self-applied under supervision
- custom made tray or toothbrush
- fluoride concentration of 12,300ppmF
- applied twice a year
- time consuming application, around 30 minutes - acute toxicity risk
- if ingested
- sickness
- not recommended for young children
Which dental materials release fluoride?
- glass ionomer/resin modified glass ionomer
- around 4 weeks from surface layer
- slower diffusion through bulk of cement
- small but sustained amount
What is fluoride toothpaste and what are the advantages and disadvantaged?
- most widely used method of fluoride delivery
- considered single most important factor in caries decline
- factors determining antiquaries activity
- fluoride concentration
- 1,450ppmF
- 1,000-5,000ppmF depending on risk - frequency of application
- twice daily - rinsing behaviours
- do not rinse
- removes excess fluoride
- spit don’t rinse - when brushing takes place
- before bedtime - quantity not strongly associated with efficacy
- fluoride concentration
What are the risks of fluoride use?
- ingestion
- particularly in young children
- systemic risk
- acute toxicity
- very rare
- enamel fluorosis
- chronic toxicity
- due to ingestion - fluoride required for fluorosis
- ~0.1mgF/kg body weight
- ~1mg daily for 1 year old
- ~2mg daily for 5-6 year old
- no lower limit for fluorosis
- chronic toxicity
How can caries benefit be maximised but fluorosis risk be reduced in young children?
- keep toothpaste out of reach of young children
- brush twice daily
- supervising brushing of young children
- use a pea/smear of toothpaste
- discourage swallowing
- encourage spitting to remove slurry