Preventative Tute W3 Flashcards
High fluoride vs standard fluoride for adults?
High = 5000ppm Standard = 1000-1500ppm
Very High risk 18 month old patient: what ppm of fluoride is the maximum they can be prescribed?
1000ppm- smaller than rice grain amount
What is the mechanism of action of desensitising toothpaste?
Sensitivity caused by external stimulus → stimulates fluid movement in dentinal tubules - nerve endings are activated = sensitivity.
MOA: Physically blocks the tubules so that the nerve endings do not respond to the stimulus.
Compare manual vs electric toothbrushes.
Manual: soft, nylon, round ends. Appropriate size and shape.
Electric: Better. Rotating, oscillating, pulsating.
Floss aids, what is best to use for stroke patient vs orthodontic wires?
Handle floss (stroke patient) and super floss (ortho)
Patient has big interdental spaces, what product do you suggest to clean inbetween these teeth?
Interproximal brushes- picksters
For pregnant women why do you not suggest iodine mouth rinse?
Very high levels of iodine in pregnancy could lead to low levels of thyroid hormone (hypothyroidism) in the baby.
What is the concentration of chlorohexidine in mouth wash?
0.12% in mouthwash 0.2%/0.5% gel.
CPP-ACP active ingredients include?
Casein phosphopeptide can deliver amorphous calcium phosphate and can also help the ACP to bind with the dental enamel.
When is fluoride varnish used?
Moderate, high or very high risk of dental caries - frequency varies.
Which oral hygine brushes/aids would you use for orthodontic wires/ partially impacted 3rd molars?
Interdental brushes + toothbrush with large handle to improve the grip
Ideal for wide spaces hard to reach areas of erupting 3rd molars
What are the contraindications for alcohol containing mouth rinse? And have can you test?
- Test if soft tissue reacts!
- People with sores in mouth- SLS can create canker sores
- Chemotherapy patients- can remove healthy oral microbiome
- Patients with dry mouth- can make worse
- People allergic to SLS- a common ingredient of alcohol based mouth rises
What is CPP-ACP
(CASEIN PHOSPHOPEPTIDE–AMORPHOUS CALCIUM PHOSPHATE)
and who should and shouldn’t use it?
- A milk-based product for patients who are at risk of demineralisation to prevent dental caries.
- Promotes remineralization of enamel and cementum, as well as balancing the pH of saliva and partially reducing dentinal sensitivity.
- Should NOT be used on patients with milk protein allergy
What is the Mechanism of Action for CPP-ACP?
Casein phosphopeptide forms non clusters with amorphous calcium phosphate providing a pool of Ca and PO4 which maintains super saturation of saliva.
What is Tooth Mousse Plus?
- CPP-ACP with fluoride (900ppm)
- Delivered in a creme or chewing gum.
- Can be added to glass ionomer cement fillings and fissure sealant materials.
- The combination has a synergistic remineralisation potential.
The topical Fluoride form ‘varnish’ is superior from foams and gels. Why?
- Patient compliance
- Higher ppm of fluoride
- In contact with teeth longer
- Intraoral settings effectiveness
What is the concentration of Fluoride varnish?
How often is it applied for non-risk patient compared to a HIGH risk patient?
How long does the patient have to wait till eating?
- 5% sodium Fluoride (22.6mg/ml / 22600ppm)
- Non-risk = x2 a year
- High risk = repeated every 3 months + CPP-ACP with Fluoride
- wait 30 mins before eating
What is Silver Diamine Fluoride and who shouldn’t use it?
- Silver fluoride and potassium iodide
- Used for dentine desensitiser and arrest caries
- Do not prescribe to pregnant patient, causes hyperthyroidism
What are 4 factors that increase the risk of caries?
- Cariogenic diet (exposure and frequency of sweet foods/drinks)
- High amount of cariogenic bacteria
- Plaque retention via poor oral hygiene, irregular dental care, poor restorations
- Poor family oral health- enamel defects, pacifier
Describe the difference in risk levels of caries? (x3)
LOW RISK
- no new caries for over 3 years
MODERATE RISK
- 1-2 new carious lesions in past three years
- factor that increases risk
HIGH RISK
- 3 or more new lesions over 3 years.
- Any caries as child above 6 years of age. Presence of multiple factors.
- Minimal fluoride exposure.
- Xerostomia
Who are patients at VERY high risk of caries?
- Medically compromised
- Special needs
- Drug using
- Children in remote communities
- Radiation/chemo patients
Difference between Primary, Secondary and Tertiary Prevention?
Define Secondary Prevention and give an example.
Early signs of a disease, no obvious symptoms.
An intervention that halts a disease, includes simple repair and addresses the cause.
e.g. Find early carious lesions. Use topical fluoride varnish or CPP-ACP to remineralise, glass ionomer to restore if cavitated.
What are key components to follow for primary prevention?
- Educate, reinforce, recalls
- Sugar/fermentable carb exposure
- Acid exposure - intrinsic and extrinisic
- Plaque retention- anatomy
- OH- floss, brush, routine
- Lifestyle factors- smoking, stress, alcohol, drugs
- Medication
- Systemic factors- blood sugar (for periodontal disease and oral cancer)
- Family history for periodontal
Components of Secondary Prevention as Doctor?
REPS: Reverse- (remineralisation), educate- (reinforcement, recall), prevent progression, stabilise the disease process
Compare what you would do for a moderate risk patient to a high risk patient
Moderate risk: dietary advice, OH instructions, recalls, apply F varnish (+ every 6 months), Treat cavities, remineralise with CPP-ACP, encourage hydration,
High risk: dietary analysis, reinforce OH, educate, recalls, mouthwash- antimicrobial, apply F varnish (every 3 months), CPP-ACP + F, treat cavities, consider fissure sealants, xylitol, silver diamine F application.
