Preventative Tute W3

Question 1

High fluoride vs standard fluoride for adults?

Answer 1

High = 5000ppm 
Standard = 1000-1500ppm

Question 2

Very High risk 18 month old patient: what ppm of fluoride is the maximum they can be prescribed?

Answer 2

1000ppm- smaller than rice grain amount

Question 3

What is the mechanism of action of desensitising toothpaste?

Answer 3

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.

Question 4

Compare manual vs electric toothbrushes.

Answer 4

Manual: soft, nylon, round ends. Appropriate size and shape.

Electric: Better. Rotating, oscillating, pulsating.

Question 5

Floss aids, what is best to use for stroke patient vs orthodontic wires?

Answer 5

Handle floss (stroke patient) and super floss (ortho)

Question 6

Patient has big interdental spaces, what product do you suggest to clean inbetween these teeth?

Answer 6

Interproximal brushes- picksters

Question 7

For pregnant women why do you not suggest iodine mouth rinse?

Answer 7

Very high levels of iodine in pregnancy could lead to low levels of thyroid hormone (hypothyroidism) in the baby.

Question 8

What is the concentration of chlorohexidine in mouth wash?

Answer 8

0.12% in mouthwash 0.2%/0.5% gel.

Question 9

CPP-ACP active ingredients include?

Answer 9

Casein phosphopeptide can deliver amorphous calcium phosphate and can also help the ACP to bind with the dental enamel.

Question 10

When is fluoride varnish used?

Answer 10

Moderate, high or very high risk of dental caries - frequency varies.

Question 11

Which oral hygine brushes/aids would you use for orthodontic wires/ partially impacted 3rd molars?

Answer 11

Interdental brushes + toothbrush with large handle to improve the grip
Ideal for wide spaces hard to reach areas of erupting 3rd molars

Question 12

What are the contraindications for alcohol containing mouth rinse? And have can you test?

Answer 12

• 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

Question 13

What is CPP-ACP
(CASEIN PHOSPHOPEPTIDE–AMORPHOUS CALCIUM PHOSPHATE)

and who should and shouldn’t use it?

Answer 13

• 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

Question 14

What is the Mechanism of Action for CPP-ACP?

Answer 14

Casein phosphopeptide forms non clusters with amorphous calcium phosphate providing a pool of Ca and PO4 which maintains super saturation of saliva.

Question 15

What is Tooth Mousse Plus?

Answer 15

• 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.

Question 16

The topical Fluoride form ‘varnish’ is superior from foams and gels. Why?

Answer 16

• Patient compliance
• Higher ppm of fluoride
• In contact with teeth longer
• Intraoral settings effectiveness

Question 17

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?

Answer 17

• 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

Question 18

What is Silver Diamine Fluoride and who shouldn’t use it?

Answer 18

• Silver fluoride and potassium iodide
• Used for dentine desensitiser and arrest caries
• Do not prescribe to pregnant patient, causes hyperthyroidism

Question 19

What are 4 factors that increase the risk of caries?

Answer 19

• 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

Question 20

Describe the difference in risk levels of caries? (x3)

Answer 20

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

Question 21

Who are patients at VERY high risk of caries?

Answer 21

• Medically compromised
• Special needs
• Drug using
• Children in remote communities
• Radiation/chemo patients

Question 22

Difference between Primary, Secondary and Tertiary Prevention?

Answer 22

Question 23

Define Secondary Prevention and give an example.

Answer 23

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.

Question 24

What are key components to follow for primary prevention?

Answer 24

• 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

Question 25

Components of Secondary Prevention as Doctor?

Answer 25

REPS: Reverse- (remineralisation), educate- (reinforcement, recall), prevent progression, stabilise the disease process

Question 26

Compare what you would do for a moderate risk patient to a high risk patient

Answer 26

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.