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pt care III > The Role of Fluoride in Caries Prevention > Flashcards

The Role of Fluoride in Caries Prevention Flashcards

1
Q

__-% of adults aged 20-64
have had dental caries in
permanent teeth

A

92% of adults aged 20-64
have had dental caries in
permanent teeth

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2
Q

____% of adults aged 20-64
have untreated decay

A

26% of adults aged 20-64
have untreated decay

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3
Q

What will fluoride do for
caries?
* tx on its own?
* Oral hygiene/plaque control?
* Dietary habits?

A

What will fluoride do for
caries?
* Fluoride is a SUPPLEMENT to caries prevention-not a
solution on its own
* Oral hygiene/plaque control is priority
* Dietary habits must be addressed with patient

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4
Q

Types of Fluoride
Therapy

A

systemic and topical

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5
Q

Systemic application:

A

Systemic application: ingested agents that become incorporated into forming tooth structures
* Water
* Supplements
* Food/beverages

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6
Q

Topical application:

A

Topical application: strengthen teeth
already in the mouth making them more
resistant to caries
* Water
* Homecare products (toothpaste,
mouth rinses, etc.)
* In-office products

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7
Q

mechanism of systemic application

A

ingested and incorporated into
enamel during development of
tooth structures
less soulble hydroxyapatite

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8
Q

promotes? inhibits?

mechanism of topical application

A

*Promotes remineralization and
prevents demineralization after
eruption
*Inhibits glycolysis in bacteria,
thereby inhibiting the ability of
bacteria to metabolize
carbohydrates and produce acid

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9
Q

Water
Fluoridation

A
  • An increase of the natural fluoride level in a community’s water supply to a level optimal for dental health
  • Fluoridation has contributed to a major decline in dental caries from the 1950s to the 1980s and continues to reduce and prevent tooth decay
  • When cities discontinue water fluoridation, evidence demonstrates rapid increase in caries rates
  • Water fluoridation is considered one of the most cost-effective preventive dental
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10
Q

Levels of Water Fluoridation

A
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11
Q

Fluorosis?

A

Changes in the appearance
of enamel caused by too
much systemic fluoride

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12
Q

how does flourosis compare to demineralization

A
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13
Q

Will individuals with fluorosis be susceptible
to caries?
Why or why not?

A

no, these teeth are more minerlaized

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14
Q

results in? where is [] highest? F subbed where? fluorosis?

How does
Topical Fluoride
work?

A
  • Fluoride deposited in enamel during enamel maturation phase results in a concentration of fluoride in the enamel
  • Highest concentration occurs on the outermost portion (5-10 microns) and decreases as you move toward the dentin
  • Fluoride ions are substituted into the hydroxyapatite crystal and form a stable, more compact bond making
    the tooth resistant to demineralization
  • It does NOT cause fluorosis
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15
Q

influenced by? acidic/ ^ [] forms? in office? neutral?

Fluoride/Enamel
Reaction

A

Influenced by concentration of fluoride, pH of fluoride, and length of exposure
* Acidic fluorides typically form calcium
fluoride
* Higher concentrations form calcium fluoride
* In-office fluorides are >9000 ppm, so
they typically form calcium fluoride
* Neutral fluorides <100 ppm form fluorapatite

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16
Q

mineral? bac metab? prevents?

Benefits of Topical Fluoride- continued

A
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17
Q

%/ppm, available as?

Types of Topical Fluoride Applications

A
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18
Q

initial deposits? where is the increase in F? this causes?

Caries & Topical Fluoride

A
  • Initial deposits of fluoride is not permanent: Relatively rapid loss after 24 hours, Loss continues for several weeks
  • After every application of topical fluoride, there is an increase in the amount of permanently bound fluoride in the outermost layer of enamel
  • This causes a decrease in caries susceptibility (initiation and progression)
19
Q

Types of Fluoride integration

A

Fluorohydroxyapatite- most desired form of fluoride for enamel in caries prevention
* From prolonged exposure of enamel to low concentrations of fluoride

Calcium fluoride- source of fluoride for
remineralization of enamel
* Deposits of calcium fluoride are
dissolved by plaque acids and are
available as a source to facilitate
remineralization

20
Q

Benefits of Topical Fluoride
* The benefits of topical fluoride treatments is directly related to?
* The type of topical fluoride system used?
* Does not benefit?
* Greater uptake with?

A
  • The benefits of topical fluoride treatments is directly related to the amount of topical fluoride treatments
    provided
  • The type of topical fluoride system used does not affect the benefit
  • Does not benefit sound enamel
  • Greater uptake with higher concentrations of fluoride
21
Q

When Should Topical
Fluoride Be Used?

A
  • High caries risk individuals
  • Sensitive teeth/exposed root surfaces
  • Around margins of older restorations
  • Overdentures (with natural teeth)
  • Xerostomia
  • Newly erupted teeth
22
Q

possible tx for each dose?

Probable Toxic Dose (PTD)

A
23
Q

burns? enzymes? Ca? cardio?

Fluoride Toxicity possible rxns

A
24
Q

Signs & Symptoms of too much Fluoride

A
25
Q

efficacious? ease? post-op?

Fluoride Varnish- 5% NaF pros

A
  • Proven efficacious in decreasing
    caries, especially in early-childhood
  • Easy to apply following oral exam and prophylaxis
  • Easy to follow post-op instructions
26
Q

Fluoride Varnish- 5% NaF cons

A
  • Leaves a thin-visible film on teeth that some patients do not like
  • Possible allergies linked to specific brands of fluoride varnish
27
Q

tooth surface? reatined for? occur every?

Application of Fluoride Varnish

A
  • Applied to clean tooth surfaces (following a prophylaxis or toothbrushing)
  • Varnish is retained on teeth from 24-48 hours after application, during which time fluoride is released for reaction with the underlying enamel
  • Applications should occur every 3-6 months (dependent
    upon caries risk)
28
Q

water flouridation and toothpastes, when to use F tx?

A
29
Q
  • SDF compared to flouride varnish alone
    when is this not true?
A
  • SDF was also superior at arresting dental caries and preventing new caries compared to fluoride varnish alone,

however, did not hold true when used as a sealant over NON-cavitated molar grooves

30
Q

approved for?

SDF gained clearance from the FDA in the US
in _____

A

2014

Approved for use to treat dentin
hypersensitivity in adults

31
Q

how is it soluble? affect on bacteria? products? color?

Mechanism of SDF

A
  • Fluoride and silver are made soluble in water by the addition of ammonia
  • The silver ions are a broad-spectrum
    antimicrobial that has high biocompatibility and low toxicity in humans
  • These ions act as tiny ‘silver bullets’ that damage and degrade bacterial cell walls, disrupt bacterial DNA synthesis and replication and disrupt intracellular metabolic activity, eventually leading to cell death
  • The killed bacteria further act as a carrier for silver ions and can kill living bacteria nearby in a process known as the “zombie effect
  • Once applied, a physical barrier precipitates out of
    the clear solution onto the carious lesion
  • 2 products form–silver phosphate which acts as a
    reservoir of phosphate ions, and calcium fluoride,
    which is a pH-regulated fluoride supply available
    during cariogenic challenge
  • Free silver ions in the lesion are reduced by environmental oxygen and turn the lesion black, which is the major nonmedical side effect of SDF
32
Q

%/ppm? why this %? how many uses?

Concentration
of SDF

A
  • 5% SDF solution contains 44,800 ppm fluoride (almost twice as much as % NaF varnish)
  • In this concentration, SDF reacts with calcium and phosphate ions to produce fluorohydroxyapatite crystals, which are less susceptible to solubility and crucial to tooth remineralization
  • Despite the high concentration, the small amount of SDF required to be effective suggests that it is well within the margin of safety for use
  • One application of SDF is not sufficient for ultimate results- may need to place SDF a few times for effectiveness in treating the area
33
Q

When to Use SDF

A
  • Dentin hypersensitivity
  • Uncooperative patients (i.e., children or patients with cognitive disabilities), root surface caries on elderly patients with existing restorations, patients without access to restorative care, difficult to treat lesions
34
Q

dry? application vehice? leave on for? color? taste? contraindication?

Placement of SDF

A
35
Q

Prophy Paste &
Fluoride
* Fluoridate prophy paste is not considered?
* Polishing alone removes?

A
  • Fluoridate prophy paste is not considered a therapeutic/preventive agent for caries
  • Polishing alone removes 0.1-1.0 microns of fluoride-rich enamel, therefore, at best, fluoride in prophy paste will replace the fluoride lost by the abrasive paste
36
Q

average con? risk?

most effective dentifrice system?
risk with ingestion?

Toothpastes
(OTC) and F

A
  • Average Concentration 0.22% NaF (1000 ppm)
  • Sodium Fluoride (NaF) most effective dentifrice system for caries prevention
  • Risk of fluorosis and toxicity if ingested (hence, pea-sized amount for small
    children)
37
Q

33 vs 18 oz? %/ppm?

flouride rinses ingredient lists

A
38
Q

mineralizes? effect on enamel? breath?

what flouride rinses do

A
39
Q

how to use flouride rinses

A
40
Q

Other Types of
ACT Rinse

A
  • All the active ingredients remain
    the same between 18 oz and
    33.8 oz bottles
    18oz: 0.05% NaF (225ppm)
    33oz: 0.02% NaF (100ppm)
41
Q

Listerine
* % Sodium Fluoride (ppm)?
* % v/v alcohol?
* difference in instructional use?

A

Listerine
* 0.02% Sodium Fluoride (100 ppm)
* 21.6% v/v alcohol
* No difference in instructional use

42
Q

MI paste vs MI plus

contraindication?

MI PASTE PLUS(available OTC)

A
43
Q

%NaF/ppm

Fluoridated Toothpaste/Mouthrinse
(Prescription Only, prevident)

A

Prevident toothpaste:
1.1% NaF (5000 ppm)
Prevident mouth rinse:
0.2% NaF (900 ppm)

pt care III (14 decks)

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