The role of fluoride in caries management Flashcards
How does fluoride aid in caries management?
- Decreases demineralisation (dissolving) of enamel
- Increases remineralisation (repair) of enamel
- Incorporated in developing enamel
- Interferes with metabolism of some plaque bacteria
Physiology of fluoride?
Systemic absorption mainly stomach • Absorption as HF into blood • Excretion - mainly renal • Incorporated in calcifying tissues • Enters saliva
What PH does enamel dissolve?
5.5
Ideal place for fluoride?
In the saliva and at the enamel surface
How does fluoride slow down demineralisation?
Less calcium is lost under acid conditions when
fluoride is present
How does fluoride enhanced remineralisation?
Demineralised enamel will take up Fluoride
Important points about remineralisation?
Enamel will not remineralise without calcium and phosphate.
Calcium and phosphate from: saliva, dairy food, CPP-ACP
Need good saliva flow as well as appropriate fluoride concentration
Mechanisms of Action of Fluoride-(high concentration) fluoride varnish?
High fluoride conc - remineralisation of
surface enamel
Mechanisms of Action of Fluoride- (low concentration) water toothpaste
Low fluoride conc -remineralisation of whole enamel lesion
How does fluoride interfere with bacterial metabolism?
Fluoride changes the bacterial
cell pH to acid conditions
Fluoride interferes with the
glycolytic pathway
How is fluoride incorporated in developing enamel
As fluoridated hydroxyapatite
As fluorapatite
Fluoride has to be used……………………….
………………………… given while the teeth are forming
regularly (daily) to have an ongoing effect on prevention of dental caries.
Little protection if only
Fluoridated Water Fluoride Toothpaste Fluoride Toothpaste (prescribed) Gels/Foams (dental professional) Varnishes (dental professional) Silver diamine fluoride Alginate impression material Tea
0.7 - 1.0 1000 and ~1450 5000 12300 7000 – 22600 40000 >40000 4 - 8
Sources of Systemic Fluorides
Swallowed toothpaste Water – natural and added Foods – fish, tea, Tablets/Drops Milk Salt
38% Silver diamine fluoride on dental caries?
- 60000ppmF
- Effect of fluoride and silver
- > 75% arrest of caries depending on frequency of application
- Results in black-stained lesions
Toothpaste recommendation?
• Recommended at all ages to spit and not rinse after brushing
• Increased caries prevention.
Guidelines - Fluoride Toothpaste
• Children up to 3 years – toothpaste with 1000ppm F-
• Smear of toothpaste
• Parents brush
• Children 3-6 years – toothpaste with 1350-1500 ppm F-
• Pea size toothpaste
• Parents help with brushing
Professional Topical Fluorides
Applied 3-6 monthly depending on caries risk
• Fluoride prophylaxis paste
• Fluoride varnish (colophony-free if asthma)
• Important to dry teeth before applying
Other Sources of Topical Fluorides?
Glass Ionomer Cements
• Compomers
• Some Fissure Sealants
• Some Resin Composites
Slow Release Fluorides?
Dental materials - GIC, Compomer Slow Release Fluoride Glass • Fluoride containing glass • Fluoride released over a long period of time • Significant reduction in new caries • Fluoride mouthwash • High caries risk children and adolescents • Medically compromised • Orthodontics
Dental Fluorosis occurs when
more than trace amounts of
fluoride are ingested during tooth development.
The highest risk for developing fluorosis in the permanent anterior teeth is between ?
Because?
18 months and 3 years-of-age.
Children do not learn to spit properly before about 3-4 years of-age.Very important to give appropriate advice to patients and parents of children.
Enamel with dental fluorosis
has a higher protein content
High levels of fluoride prevent
the effective removal of the
protein matrix during maturation
Teeth with fluorosis look?
Chalky looking enamel with fine streaks
Enamel with fluorosis is hypomineralised
Teeth formed at the same time will have a similar appearance
