Preventive Procedures - Week 9 PP Flashcards
Patient Education Guidelines
- Listen carefully
◦ Each patient will have different needs - The initial instruction
◦ Explain the relationship of plaque to dental disease - Assess the patient’s motivations and needs
◦ Combine the patient’s motivating factors with the patient’s needs - Select the home cleaning aids
◦ Select a toothbrush, brushing method, and interproximal cleaning aids such as dental floss, and a toothpaste - Keep the instruction simple
◦ Comment positively on the patient’s efforts
Partners in Prevention
- To prevent dental disease, a partnership must be formed between the patient and the dental healthcare team
- Optimum oral health can become a reality when partners work together in a program that includes the following:
◦ Patient Education
◦ Use of fluorides
◦ Application of dental sealants
◦ Proper nutrition
◦ Plaque control program
About Fluoride
- Has been our primary weapon with which to combat dental caries since the 1950s
- Slows demineralization and enhances remineralization of tooth surfaces
- Is a mineral that occurs naturally in food and water
- A supply of both systemic and topical fluoride must be available
throughout life to achieve the maximum cavity prevention benefits
How Fluoride Works
- Preeruptive development
◦ Before a tooth erupts, a fluid-filled sac surrounds it
◦ Systemic fluoride present in this fluid strengthens the enamel of the developing tooth and makes it more resistant to acid - Posteruptive development
◦ After eruption, fluoride continues to enter the enamel and alters the
structure of the enamel crystals
◦ These fluoride-enriched crystals are less acid soluble than the original
structure of the enamel
Safe and Toxic Levels of Fluoride
- The fluorides used in the dental office have been
proven safe and effective when used as recommended - Chronic overexposure to fluoride, even at low concentrations, can result in dental fluorosis in
children younger than 6 years with developing teeth - Acute overdosage of fluoride can result in poisoning or even death
- Acute overdosage is very rare
Fluoride Precautions and Needs Assessments
- To prevent patients from receiving too much fluoride, evaluate the patient’s current fluoride
intake (to prevent fluorosis) - Fluoride needs assessment
1. Saves time by identifying risk factors
2. Opens communication between the dental professional and the patient
3. Helps “individualize” patient fluoride therapies
4. Allows the dentist to accurately select the appropriate
fluoride therapy
Sources of Fluoride - Fluoridated Water
◦ For more than 50 years, fluoride has been safely added to the communal water supply
◦ Most major cities in Canada have fluoridated water, and efforts to fluoridate water
in other communities continue, Calgary currently does not have fluoride in the
water however Fluoride naturally occurs in the Bow and Elbow Rivers, in
concentrations varying throughout the year, between 0.1 and 0.4 mg/L (City of
Calgary, 2018)
◦ From a public health standpoint, fluoridation of public water supplies is a good
way to deliver fluoride to lower socioeconomic populations who may not
otherwise have access to topical fluoride products such as fluoridated toothpaste
and mouth rinses
- Until recently it was believed that water fluoridation was effective in
preventing tooth decay as a result of systemic uptake and incorporation
of fluoride into the enamel of developing teeth - It has now been proved that the major effects of water fluoridation are topical, not systemic
- Topical uptake means the fluoride diffuses into the surface of the enamel of an erupted tooth rather than being incorporated into unerupted teeth during development
- 0.7 ppm is optimal for most of Canada
Fluoride in Bottled Water
- Bottled water may not be equal to tap water with regard to dental health
◦ Some bottled waters may contain fluoride; however, most are below the optimal level of fluoride - The amount of fluoride in bottled water depends on:
◦ The fluoride content of the source water
◦ The treatment the source water receives before bottling
◦ Whether fluoride additives were used
Systemic Fluoride
- Circulation to teeth through ingestion
- Sources:
* Drinking water (naturally contains fluoride, or that has been fluoridated)
* (45% of Canadians have fluoridated water)
* Prescribed dietary supplements
* Foods, in small amounts
* Foods and beverages prepared at home or processed commercially using water
that contains fluoride
* Varying small amounts ingested from dentifrice mouth rinses, supplements, and other fluoride-containing products used by the individual
Sources of Topical Fluoride (not injested)
- Toothpaste
◦ The primary source of topical fluoride - Mouth rinses
◦ Prescription
◦ Nonprescription - Gels
◦ Brush-on or reusable custom tray - Varnish
◦ Painted on the teeth - Professional applications
Topical Fluoride - Sodium Fluoride (NaF) PH=neutral (with Hydroxyapatite)
Form: Solution 2.5%
Application: Starting at the lower posterior teeth apply one continuous layer of varnish starting on the buccal.
Comments: For patients with a tree nut allergy, - as it is Colophony Free.
Post op: Avoid drinking alcohol, brushing, and flossing or 4 hours.
Topical Fluoride - Sodium Fluoride pH=neutral
-Most widely used
Form: Varnish 5%
Application: Slather on teeth (do not have to paint individual)
Comments: Contradicted for patients with..
- Ulcerative gingivitis and stomatitis
-Known allergy to nuts or fluoride
-Avoid injestion during application
-Known allergies to colopony or similar materials
-Avoid hot beverages, eat soft food diet and those products containing alcohol for 4 to 6 hours
- only topical fluoride application recommeded for children under 6
- Recommended for patients with dentinal hypersensitivity
Topical Fluoride - Sodium Fluoride (NaF) pH=neutral PH of 7
Form: Gel 2%
Application: Tray application, 4 minute application for best uptake.
Comments: Use of cotton rolls and suction required duing application to reduce risk of ingestion.
Topical Fluoride - Sodium Fluoride pH=neutral
Form: Foam 2%
Tray application, 4 minute application for best uptake
Comments: No clinical evidence of efficacy, not widely used
APF - Acidualated Phosphate Low pH of 3.5 = enhances fluoride uptake
Form: 1.23% Gel
application: tray application, 4 minute application for best uptake
Comments: for ages 6 and up, may etch porcelain, composite restorations and sealants. Breaks down the materials in the restorations
APF - Acidualated Phosphate
Form: % Foam
Application: Tray application, 4 minute application for best uptake
Comments: No clinical evidence of efficacy, not widely used
APF - Stannous Fluoride (Tn)II
Form: 0.4% Rinse, Gel Toothpaste
Application: Over the couter toothpaste and rinse, due to wide range of products application is per manufactuers instructions. Can be applied in a home tray application or brush on method (xerostomia)
Comments: Can cause staining of teeth, not commonnly applied professionally. Widely seen in toothpastes and mouth wash. Not recommended for ages 6 and under
APF - Silver Diamine Fluoride (SDF)
Form 24.4% to 28.5% Liquid
Appliaction: Applied to a brush to individual tooth, excess must be removed with gauze, cotton roll or pellets to minmize systemic absorption
Comments: SDF has also been shown to lower caries risk of the adjacent tooth surface. SDF has also shown efficaacy in management of root caries in the elderly.
Fluoride-Containing Prophylaxis Paste
Fluoride-containing paste used during dental prophylaxis.
* The abrasive paste, contains 4,000 to 20,000 ppm fluoride.
* Not effective as a fluoride application
Fluoridated Toothpaste Appplication - children less than 3 years of age
-higher risk of dental fluorosis
size: small amount the size of grain of rice
comments: adult supervision required, spread paste all over teeth before strating to brush so that all teeth benefit from large amounts of paste.. and not swallowed
Fluoridated Toothpaste Application - Children ages 3-5
Medium risk of dental fluororsis age 3-6, but most enamel past critical stage, also less swallowing
Size: small amount the size of a pea
Adult supervision required
Spread paste all over teeth before starting to brush so all teeth benefit and large amounts of paste is not swallowed
Training toothpaste for young children
Training toothpatse is fluoride free, and should also be used in small amounts
Fluoridated Toothpaste Application - Adult
Size: 1/2 inch
Brush 2x daily
Spread paste all over teeth before starting to brush so that all teeth benefit and large amounts of pasted arent swallowed
Mouthrinses
Age 6 and under not recommended
Ages 6 to 12 - some mouth rinses are approved for this age, they do not contain alcohol
Ages 12 and over - Alcohol containing rinses are never recommended for recovering alcoholics, greater compliance with daily rinsing vs weekly
Not recommended for patients that are unable to rinse de to physical or other limitations
Tray Technique for Application (gel or foam)
- Explain procedure to patient – 4 minutes – no swallowing
- Seat patient upright
- Tray selection – make sure the tray covers all tooth surfaces
- Trays maybe hinged or separate and are arched shape
- Fill tray no more than 1/3 full for gel and to the rim of the tray for foam
- Most gel is thixotropic – thick but then when put under stress thins so it will flow around teeth
- Gel we have in clinic is colourless and gluten free
Fluoride Tray Sizes
- Small – for children who do not have their 6 year molars
- Medium – 6 year molars are present but no 12 year molars
- Large – 12 year molars are present
Post Op Instructions: Topical gel, foam or rinse
- Have NOTHING by mouth for the next 30 minutes
- That includes:
◦ No eating
◦ No drinking
◦ No rinsing
◦ No brushing
◦ No smoking
◦ No gum-chewing
◦ These activities could disturb the action of the fluoride
Topical Application - Fluoride Varnish
- Explain procedure to patient (1-3 minutes no swallowing)
- Patient can be sitting upright or laid back (laying your patient back is easier)
- Available in individual packets with an applicator brush to mix and apply
- Available in different flavors and colors (white, yellow, clear)
- Varnish sets in the presence of saliva
- Beneficial to wipe excess saliva off teeth with a gauze 2x2
- Follow manufacturers directions
Post op instructions for Fluoride Varnish
-Feel like a coating on your teeth
* Not visible if clear is used
* Avoid eating hard foods
* Drinking hot or alcoholic beverages
* Brushing and flossing for at least 4-6 hours or till the next day
* Try to drink through a straw for the first few hours after application
* Ffollow manufacturers instructions
Fluoride Safety
- Beneficial in small amounts but can be injurious if used without
attention to dosage and frequency - Whole dental team needs to be familiar with the following:
- recommended procedure for use
- potential toxic effects
- how to administer general emergency measures
Signs and Symptoms of Acute Toxic Dose
- Symptoms begin 30 minutes after ingestion and can last 24 hours
- Fluoride mixes with the hydrochloric acid in the stomach and creates hydrofluoric acid
- This is an irritant to the stomach lining
- Symptoms:
- nausea/vomiting/diarrhea
- abdominal pain
- increased salivation and thirst
- If an individual swallows more than the recommended dose of fluoride..
◦ Call 911
◦ Induce vomiting
◦ Administer fluoride-binding liquid
* Milk
* Milk of Magnesia
Effects and Benefits of Fluoridation - Summary
- White, opaque, shiny appearance with no blemishes
- Number of carious lesions is reduced and the caries rate is reduced
- Fewer cases of root caries in areas with fluoridated water
- Tooth loss due to caries is increased in a non-fluoridated community
- Less malocclusion in the permanent dentition
- Improved bone density
- Effects on periodontal health
