prevention lecture Flashcards
When should children first be referred to the dentist?
1 yr, or within 6mo of their first tooth erupting. whichever comes first
High risk children should have a dental home established by _________
6mo
Caries in primary teeth (are / aren’t) predictive of caries in permanent teeth
are
What are the family/parent risk factors for children’s dental caries?
socioeconomic status
mom’s age
smoking status
parents education level (strongly predictive)
Routine recall frequency is ______ but can be ______ in high risk children
6mo
more frequent
What is “anticipatory guidance”
Alerting parents to impending changes in their child’s dental development at various stages of development
what fluoride product types have the lowest concentration of fluoride?
Rinses (220ppm)
What is the cost per capita of water fluoridation?
$0.12 to $5.41
When should children first be exposed to fluoride?
once they have their first tooth erupt
Brushing should begin when?
as soon as the first tooth erupts
When should flossing begin?
when there is proximal contact between teeth (usually around 2yrs)
Kids aged ______ should only use a “smear” of toothpaste on their toothbrush (to prevent ingestion)
under 2
Kids aged ______ should use a “pea sized” amount of toothpaste
2-5yrs
Plasma fluoride concentrations associated with water fluoridation are (consistent / inconsistent)
consistent (thus less fluorosis risk exists)
Plasma fluoride concentrations associated with dietary fluoride supplements are (consistent / inconsistent)
inconsistent (thus more fluorosis risk exists with these products)
Amount of fluoride found in NON-fluoridated water? Fluoridated?
non-fluoridated = 0.01-0.02ppm
fluoridated = 0.03-0.04ppm
(this small difference confers caries resistance)
recommended water fluoridation concentration?
0.7 - 1.2ppm
EPA only steps in if drinking water fluoride levels exceed what?
2ppm (EPA notifies community)
4ppm (EPA orders de-fluoridation)
Which state has the worst water fluoridation?
Hawaii
What % of the US population recieves fluoridated drinking water?
73.9%
No more than ______ of dietary fluoride should be prescribed to someone
120mg
How much supplemental dietary fluoride should be prescribed to a 0-6 month old?
none (no matter the fluoride concentration in drinking water)
How much supplemental dietary fluoride should be prescribed to a 6mo - 3yr old?
if drinking water has…
How much supplemental dietary fluoride should be prescribed to a 3-6yr old?
if drinking water has…
How much supplemental dietary fluoride should be prescribed to a 6-16yr old?
if drinking water has
What consumer beverage tends to have the highest fluoride levels?
grape juice (2-4ppm)
The (systemic / topical) effects of fluoride are most important after the tooth has calcified
topical
How is fluoride concentration distributed in the tooth?
first 10-20 microns of enamel are highly fluoridated
What are the degrees of fluorosis?
mild = white lacy appearance moderated = some brown staining severe = enamel hypomineralization
Mild fluorosis is caused by ingesting how much fluoride?
2mg/day
Why does fluorosis cause hypomineralization?
Too much fluoride is toxic to ameloblasts
Are teeth with fluorosis more resistant to caries?
No (but I thought Dr Carey said the opposite… oh well)
When is a person most susceptible to fluorosis?
before age 6, and SPECIFICALLY 18mo-36mo (during calcification of MX incisors)
Symptoms of chronic fluoride toxicity?
Fluorosis (1st symptom)
Joint and skeletal pain
Malaise
Loss of conciousness
The Institute of medicine determined that the daily adequate fluoride intake level is _______
0.05mg/kg
Safe daily consumption of fluoride for adult females? males?
adults females = 3mg
adult males = 4mg
Safe daily consumption of fluoride for children?
4-8yrs = 1mg 9-13yrs = 2mg 14-18yrs = 3mg
How much fluoride is contained in a single tube of toothpaste?
130mg
After age ______ fluorosis isnt a concern because permanent teeth (except for 3rds) have finished calcifying
8yrs
Acute fluoride toxicity symptoms?
GI upset
convulsions
coma
death in 2-4hrs
What are the mechanisms for acute fluoride toxicity?
corrodes stomach lining
binds up calcium, causing muscle spasms
inhibits enzymes
What is the “certain” lethal dose of fluoride?
32-64mg/kg (15mg/kg is the “probable” lethal dose)
what is the toxic dose of fluoride?
5-8mg/kg
What should be done is someone is exposed to a large dose of fluoride?
- ingest soluble calcium! (milk, antacids)
- go to ER
Fluoride mouth rinses are indicated when?
- orthodontics
- radiation therapy
- high caries risk
- prosthetics
Should you give fluoride mouth rinses to children?
no, not for infants or young children (they’ll swallow it)
Does the pellicle need to be removed before varnish application?
no (pellicle doesn’t inhibit fluoride uptake)
Fluoride foam and gel require a minimum of _____ minutes in contact with teeth to be effective
4 minutes
Has flouride varnish been associated with fluorosis?
nope
Fluoride varish (is / isn’t) approved for use as a cariostatic agent
isn’t (this is a common off-label use)
After varnish is applied, what instructions should be given to the patient?
- dont brush/floss until next morning (or 4-6hrs if absolutely necessary)
- soft food only
- no hot drinks
Does the bacterial flora of the mouth adapt to metabolize xylitol?
no (theres no published evidence of this)
How much xylitol is needed to be effective?
> 5mg per day
Should chlorhexidine rinses be used for caries prevention?
no, not until further evidence supports it. Other methods are better at this time.
What age should children get sealants?
age is not a consideration
What FDA approved topical agent is used to arrest decay, but causes black staining?
silver diamine fluoride
anticariogenic foods tend to be high in what?
protein, fat, and minerals
If someone sees dental care as “not important” how should you use motivational interviewing to change their mind?
- dont give advice
- ask about their values and goals
- ask what they want their life to be like
if someone has “low confidence” about oral health how should you use motivational interviewing to change their mind?
- provide info and advice
- ask what will help change
- ask about past successes, challeneges, strategies
- ask about strengths, abilities
