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2ND YR- CSA- Treatment planning > The Role of Fluoride in Caries Management > Flashcards

The Role of Fluoride in Caries Management Flashcards

1
Q

What are the legalities surrounding how much fluoride can be put into water?

A

Maximum 1ppm can be added water in the UK

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2
Q

Why is 1ppm the maximum fluoride that can be added to water?

A

As above 1ppm the risk of mottling increases substantially

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3
Q

Can water be fluoride free?

A

NO

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4
Q

How and where is fluoride ingested in the blood

A

Mainly in the stomach

It is absorbed as HF into the blood

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5
Q

How is fluoride excreted?

A

Excreted renally

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6
Q

How is fluoride used by the body?

A

It is incorporated into clarifying tissues

It also enters saliva

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7
Q

What does fluoride do to enamel?

A
  1. It decreases demineralisation of enamel
  2. It increases remineralisation of enamel
  3. It is incorporated in developing enamel
  4. It interfered with metabolism of some plaque bacteria
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8
Q

What is saliva rich in?

A

It is supersaturated with calcium and phosphate

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9
Q

What do you need to get decay?

A
  1. Tooth enamel
  2. Bacteria in a biofilm
  3. Fermentable carbohydrates (Food)
  4. Time
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10
Q

When does enamel dissolve?

A

When the pH is below 5.5 (critical pH)

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11
Q

What is the first sign of decay?

A

White spot lesions showing light demineralisation

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12
Q

What happens when acid is put on enamel?

A

The acid dissolves enamel crystals leaving porosities and unstable enamel

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13
Q

What does enamel need to remineralise?

A

Calcium

Phosphate

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14
Q

Where does calcium and phosphate come from?

A

Saiva
Diary food
CPP-ACP

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15
Q

If you prescribe fluoride to a patient but the decay they have isn’t getting smaller what might the patient have?

A

Reduced saliva flow

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16
Q

How does fluoride interfere with bacterial metabolism?

A

It changes the bacterial pH to acid conditions

Fluoride interferes with the glycolytic pathway

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17
Q

If you have a teenage that refuses to brush their teeth what can you do to try and remineralise early enamel lesions?

A

Put a fluoride varnish on their teeth but you still need to convince them to brush heir teeth

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18
Q

How is fluoride incorporated in developing enamel?

A

As fluoridated hydroxyapatite

As fluorapatite

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19
Q

How much fluoride is in prescribed fluoridated toothpaste?

A

5000ppm

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20
Q

What happens at pH 5.5?

A

Enamel dissolves

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21
Q

Which animal has the highest concentration of fluoride in them?

A

Sharks

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22
Q

What is the concentration of fluoride in fluoride varnishes?

A

7000-22600ppm

23
Q

What effect does fluoride in the water have on caries?

A

reduces caries by 50-60%

24
Q

Last year how many children had teeth extracted under General anaesthetic in the uk?

A

46,000

25
Q

What effect does fluoride in toothpaste have on caries?

A

reduces caries by 30-40%

26
Q

Give some sources of systemic fluoride

A
  1. Swallowed toothpaste
  2. Water
  3. Foods like fish and tea
  4. Tablets/drops
  5. Fluoridated milk
  6. Fluoridated salt
27
Q

What risk does toothpaste pose in children?

A

If children deliberately swallow toothpaste they can have too much systemic fluoride which can lead to fluorosis (mottled enamel)

28
Q

Which Socioeconomic group is impacted most by Systemic/Topical Fluoride and how are they affected

A

Impact is higher in low SES and areas with fluoridated water have a higher percentage of patients that are caries free

29
Q

As well as reducing the risk of caries what else does water fluoridation do?

A

It reduces the severity of caries

30
Q

Give some examples of topical fluoride

A
  1. Toothpaste
  2. Varnishes
  3. Rinses
  4. Silver diamine fluoride
  5. Glass ionomer cements
  6. Compomers
  7. Some fissure sealants
  8. Some resin composites
31
Q

What is silver diamine fluoride?

A

It is a form of topical fluoride that stops decay in its tracks
It is 60,000ppm fluoride

32
Q

What is the only negative associated with silver diamine fluoride?

A

It results in a black stained lesion

33
Q

What is the guideline surrounding fluoridated toothpaste for children up to 3 year olds?

A
  1. Toothpaste with 1000ppm fluoride
  2. Smear of toothpaste
  3. Parents brush Childs teeth
34
Q

What is the guideline surrounding fluoridated toothpaste for children 3-6 year olds?

A
  1. Toothpaste with 1350-1500ppm fluoride
  2. Pea size toothpaste
  3. Parents help with brushing
35
Q

When prescribing fluoride mouthwash what should you do?

A
  1. Consider the age of the patient
  2. Give appropriate instructions to the patient
  3. Check if the mouthwash has alcohol
36
Q

When is professional topical fluoride applied?

A

Applied 3-6 months depending on caries risk

37
Q

What is topical fluoride?

A

It is a fluoride prophylaxis paste

38
Q

Give an example of a dental material that contains slow release fluoride

A

Slow Release Fluoride Glass

39
Q

What is slow Release Fluoride Glass ?

A

It is a fluoride containing glass that relates fluoride over the span of 2 years

40
Q

When does dental fluorosis occur?

A

When more than trace amounts of fluoride are ingested during tooth development

41
Q

At what age is the risk for developing fluorosis on permeant anterior teeth greatest?

A

Between 18 months and 3 years of age

42
Q

Why is the risk of fluorosis grater in children under 3?

A

As children don’t learn to properly spit before the age of 3-4 so they end up swallowing toothpaste

43
Q

Describe the enamel of a patient with dental fluorosis

A

The enamel has a higher protein content

The enamel is hypomineralised

44
Q

Why is too much fluoride bad?

A

High levels of fluoride prevents the effective removal of the
protein matrix during maturation

45
Q

Describe the appearance of teeth with dental fluorosis

A

Chalky looking enamel with fine streaks

46
Q

What is the most common cause for dental fluorosis?

A
  1. water with naturally high levels of fluoride

2. Deliberate eating fluoride toothpaste

47
Q

How can we prevent dental fluorosis?

A

1, Additional systemic fluorides should beavoided before 3 yrs of age

  1. Parents should make sure there is only a smear of toothpaste on the brush for an infant
  2. Parents shouldn’t share their mouth wash
  3. All fluoride products should have child-safety tops
48
Q

How much 0.05% NaF daily mouthwash would a 2 year old child need to drink before a child feels unwell

A

13 ml

49
Q

How much 0.05% NaF daily mouthwash would a 2 year old child need to drink for it to be lethal?

A

199ml

50
Q

How much toothpaste 1000ppm would a 2 year old child need to eat before a child feels unwell

A

12g

51
Q

How much toothpaste 1000ppm would a 2 year old child need to eat for it to be lethal?

A

150g

52
Q

How many NaF 1.1 mg NaF tablets would a 2 year old need to eat before a child feels unwell?

A

24 tablets

53
Q

How many NaF 1.1 mg NaF tablets would a 2 year old need to eat for it to be lethal?

A

300 tablets

54
Q

If a child is suspected of eating NaF 1.1 mg NaF tablets what advice should you give?

A

Try and make the child vomit if not try and give the child milk
Then send the child to the emergency department

2ND YR- CSA- Treatment planning (5 decks)

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