The role of fluoride in caries management

Question 1

How does fluoride aid in caries management?

Answer 1

• Decreases demineralisation (dissolving) of enamel
• Increases remineralisation (repair) of enamel
• Incorporated in developing enamel
• Interferes with metabolism of some plaque bacteria

Question 2

Physiology of fluoride?

Answer 2

Systemic absorption mainly stomach
• Absorption as HF into blood
• Excretion - mainly renal
• Incorporated in calcifying tissues
• Enters saliva

Question 3

What PH does enamel dissolve?

Answer 3

5.5

Question 4

Ideal place for fluoride?

Answer 4

In the saliva and at the enamel surface

Question 5

How does fluoride slow down demineralisation?

Answer 5

Less calcium is lost under acid conditions when

fluoride is present

Question 6

How does fluoride enhanced remineralisation?

Answer 6

Demineralised enamel will take up Fluoride

Question 7

Important points about remineralisation?

Answer 7

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

Question 8

Mechanisms of Action of Fluoride-(high concentration) fluoride varnish?

Answer 8

High fluoride conc - remineralisation of

surface enamel

Question 9

Mechanisms of Action of Fluoride- (low concentration) water toothpaste

Answer 9

Low fluoride conc -remineralisation of whole enamel lesion

Question 10

How does fluoride interfere with bacterial metabolism?

Answer 10

Fluoride changes the bacterial
cell pH to acid conditions

Fluoride interferes with the
glycolytic pathway

Question 11

How is fluoride incorporated in developing enamel

Answer 11

As fluoridated hydroxyapatite

As fluorapatite

Question 12

Fluoride has to be used……………………….

………………………… given while the teeth are forming

Answer 12

regularly (daily) to have an ongoing effect on prevention of dental caries.
Little protection if only

Question 13

Fluoridated Water
Fluoride Toothpaste 
Fluoride Toothpaste (prescribed) 
Gels/Foams (dental professional) 
Varnishes (dental professional) 
Silver diamine fluoride 
Alginate impression material 
Tea

Answer 13

0.7 - 1.0
1000 and ~1450
5000
12300
7000 – 22600
40000
>40000
4 - 8

Question 14

Sources of Systemic Fluorides

Answer 14

Swallowed toothpaste
 Water – natural and added
 Foods – fish, tea,
 Tablets/Drops
 Milk
 Salt

Question 15

38% Silver diamine fluoride on dental caries?

Answer 15

• 60000ppmF
• Effect of fluoride and silver
• > 75% arrest of caries depending on frequency of application
• Results in black-stained lesions

Question 16

Toothpaste recommendation?

Answer 16

• 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

Question 17

Professional Topical Fluorides

Answer 17

Applied 3-6 monthly depending on caries risk
• Fluoride prophylaxis paste
• Fluoride varnish (colophony-free if asthma)
• Important to dry teeth before applying

Question 18

Other Sources of Topical Fluorides?

Answer 18

Glass Ionomer Cements
• Compomers
• Some Fissure Sealants
• Some Resin Composites

Question 19

Slow Release Fluorides?

Answer 19

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

Question 20

Dental Fluorosis occurs when

Answer 20

more than trace amounts of

fluoride are ingested during tooth development.

Question 21

The highest risk for developing fluorosis in the permanent anterior teeth is between ?
Because?

Answer 21

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.

Question 22

Enamel with dental fluorosis

Answer 22

has a higher protein content

Question 23

High levels of fluoride prevent

Answer 23

the effective removal of the

protein matrix during maturation

Question 24

Teeth with fluorosis look?

Answer 24

Chalky looking enamel with fine streaks
Enamel with fluorosis is hypomineralised
Teeth formed at the same time will have a similar appearance

Question 25

Most likely causes of fluorisis?

Answer 25

water with naturally high levels of fluoride

– deliberate eating fluoride toothpaste