Non-Water Community Fluoride Delivery Flashcards

1
Q

What is the primary mode of action of fluoride?

A
  • topical
    • post eruptive involvement
    • dynamic process of de/remineralisation
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2
Q

How does fluoride prevent caries?

A
  • formation of fluoroapatite
    • less susceptible to demineralisation
    • promotes remineralisation
  • bacteriostatic effect
    • interferes with metabolic pathways
    • less acid produced
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3
Q

What are the oral reservoirs for fluoride?

A
  • 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
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4
Q

What different types of fluoride therapy exist and what settings are they delivered in?

A
  • community
    • water
    • school based brushing
    • varnish
  • in office
    • varnish
    • gels and foams
    • slow release
  • home
    • toothpaste
    • mouthrinse
    • tablets
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5
Q

What is fluoridated salt and what are the advantages and disadvantages?

A
  • 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
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6
Q

What is fluoridated milk and what are the advantages and disadvantages?

A
  • 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
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7
Q

What are fluoride supplements and what are the advantages and disadvantages?

A
  • 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
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8
Q

What are fluoride mouthrinses and what are the advantage and disadvantages?

A
  • fluoride containing mouthrinses for home use
    • daily
      - 0.05% 227ppmF
      - slightly more effective
    • weekly
      - 0.2% 909ppmF
      - more cost effective
  • reduction in caries of around 30%
    • swishing around mouth important for efficacy
  • good benefit-risk ratio
    • cost-benefit ratio also low
  • generally good compliance
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9
Q

What are acidulated mouthwashes?

A
  • 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
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10
Q

What are fluoride boosters?

A
  • tooth mousse
    • contains CPP-ACP
      - not suitable for those with milk allergies
  • at home application or in office application using trans
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11
Q

What are acidulated phosphate fluoride gels and what are the advantages and disadvantages?

A
  • 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
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12
Q

Which dental materials release fluoride?

A
  • glass ionomer/resin modified glass ionomer
    • around 4 weeks from surface layer
    • slower diffusion through bulk of cement
    • small but sustained amount
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13
Q

What is fluoride toothpaste and what are the advantages and disadvantaged?

A
  • 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
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14
Q

What are the risks of fluoride use?

A
  • 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
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15
Q

How can caries benefit be maximised but fluorosis risk be reduced in young children?

A
  • 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
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