The Role of Fluoride in Caries Management

Question 1

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

Answer 1

Maximum 1ppm can be added water in the UK

Question 2

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

Answer 2

As above 1ppm the risk of mottling increases substantially

Question 3

Can water be fluoride free?

Answer 3

NO

Question 4

How and where is fluoride ingested in the blood

Answer 4

Mainly in the stomach

It is absorbed as HF into the blood

Question 5

How is fluoride excreted?

Answer 5

Excreted renally

Question 6

How is fluoride used by the body?

Answer 6

It is incorporated into clarifying tissues

It also enters saliva

Question 7

What does fluoride do to enamel?

Answer 7

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

Question 8

What is saliva rich in?

Answer 8

It is supersaturated with calcium and phosphate

Question 9

What do you need to get decay?

Answer 9

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

Question 10

When does enamel dissolve?

Answer 10

When the pH is below 5.5 (critical pH)

Question 11

What is the first sign of decay?

Answer 11

White spot lesions showing light demineralisation

Question 12

What happens when acid is put on enamel?

Answer 12

The acid dissolves enamel crystals leaving porosities and unstable enamel

Question 13

What does enamel need to remineralise?

Answer 13

Calcium

Phosphate

Question 14

Where does calcium and phosphate come from?

Answer 14

Saiva
Diary food
CPP-ACP

Question 15

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

Answer 15

Reduced saliva flow

Question 16

How does fluoride interfere with bacterial metabolism?

Answer 16

It changes the bacterial pH to acid conditions

Fluoride interferes with the glycolytic pathway

Question 17

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

Answer 17

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

Question 18

How is fluoride incorporated in developing enamel?

Answer 18

As fluoridated hydroxyapatite

As fluorapatite

Question 19

How much fluoride is in prescribed fluoridated toothpaste?

Answer 19

5000ppm

Question 20

What happens at pH 5.5?

Answer 20

Enamel dissolves

Question 21

Which animal has the highest concentration of fluoride in them?

Answer 21

Sharks

Question 22

What is the concentration of fluoride in fluoride varnishes?

Answer 22

7000-22600ppm

Question 23

What effect does fluoride in the water have on caries?

Answer 23

reduces caries by 50-60%

Question 24

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

Answer 24

46,000

Question 25

What effect does fluoride in toothpaste have on caries?

Answer 25

reduces caries by 30-40%

Question 26

Give some sources of systemic fluoride

Answer 26

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

Question 27

What risk does toothpaste pose in children?

Answer 27

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

Question 28

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

Answer 28

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

Question 29

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

Answer 29

It reduces the severity of caries

Question 30

Give some examples of topical fluoride

Answer 30

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

Question 31

What is silver diamine fluoride?

Answer 31

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

Question 32

What is the only negative associated with silver diamine fluoride?

Answer 32

It results in a black stained lesion

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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

Question 35

When prescribing fluoride mouthwash what should you do?

Answer 35

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

Question 36

When is professional topical fluoride applied?

Answer 36

Applied 3-6 months depending on caries risk

Question 37

What is topical fluoride?

Answer 37

It is a fluoride prophylaxis paste

Question 38

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

Answer 38

Slow Release Fluoride Glass

Question 39

What is slow Release Fluoride Glass ?

Answer 39

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

Question 40

When does dental fluorosis occur?

Answer 40

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

Question 41

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

Answer 41

Between 18 months and 3 years of age

Question 42

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

Answer 42

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

Question 43

Describe the enamel of a patient with dental fluorosis

Answer 43

The enamel has a higher protein content | The enamel is hypomineralised

Question 44

Why is too much fluoride bad?

Answer 44

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

Question 45

Describe the appearance of teeth with dental fluorosis

Answer 45

Chalky looking enamel with fine streaks

Question 46

What is the most common cause for dental fluorosis?

Answer 46

1. water with naturally high levels of fluoride | 2. Deliberate eating fluoride toothpaste

Question 47

How can we prevent dental fluorosis?

Answer 47

1, Additional systemic fluorides should beavoided before 3 yrs of age 2. Parents should make sure there is only a smear of toothpaste on the brush for an infant 3. Parents shouldn't share their mouth wash 4. All fluoride products should have child-safety tops

Question 48

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

Answer 48

13 ml

Question 49

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

Answer 49

199ml

Question 50

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

Answer 50

12g

Question 51

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

Answer 51

150g

Question 52

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

Answer 52

24 tablets

Question 53

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

Answer 53

300 tablets

Question 54

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

Answer 54

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