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
