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Caries symposium 2 > The role of fluoride in caries prevention > Flashcards

The role of fluoride in caries prevention Flashcards

1
Q

how does fluoride prevent caries

A
  • fluoride present in fluid at the plaque/tooth interface promotes remineralisation
  • the fluoro-apatite formed is less susceptible to demineralisation
  • topical effect greater than systemic (F combining during amelogenesis) effect
  • fluoride may also have an effect on bacteria and metabolic pathways resulting less acid being produced
  • maintain elevated oral levels of fluoride for as long as possible (little and often)
  • fluoride most effective on early lesions
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2
Q

what are the oral reservoirs for F

A

2 broad types:

  • mineral deposits (CaF2 in saliva and fluid phase of plaque)
  • biologically/ bacterially bound calcium- fluoride
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3
Q

what is better, systemic or topical?

A

topical is better

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4
Q

why is water floridation good

A

universal and passive

ingest water, F becomes incorporated into saliva

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5
Q

what are different methods for delivering F in oral care products

A
  • toothpaste
  • mouth rinses
  • varnishes and gels
  • tablets
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6
Q

what is the amount of F in fluoridated water

A

0.8-1.0ppm

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7
Q

how effective are F mouthrinses

A
  1. commonally avaliable for home use as daily or weekly
  2. reductions in caries of around 30%
  3. daily rinsing slightly more effective than weekly rinsing, but more expensive
  4. swishing round mouth important
  5. good befefit to risk ratio
  6. generally good compliance
  7. cost benefit ratio is low
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8
Q

why is F varnish good

A
  • high F concentration (sodium fluoride 50mg/ml = 22600ppm F)
  • sustained contact
  • professionally applied (any DCP)
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9
Q

how does F varnish work

A
  • colophony resin hardens in contact with saliva to maintain contact of fluoride with the tooth
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10
Q

how does F varnish work

A
  • colophony resin hardens in contact with saliva to maintain contact of fluoride with the tooth
  • mobilisation of calcium ions in the enamel
  • precipitation of calcium fluoride
  • rapid adsorption on tooth surface (enamel and dentine)
  • increases F content of enamel up to 77% after a single application
  • progressive release of F over several months
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11
Q

How does calcium fluoride work?

A
  • acid attack
  • release of F ions
  • remineralisation

pH falls in acid attack, F products have a greater bioavaliability is the lower the pH, so the lower the pH the more F is released into the oral environment. Presence of F ions drives equation towards remineralisation

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12
Q

how do acidulated mouthrinses work

A
  • lower the pH the greater bioavaliability of F

- drives F to the tooth surface because of boosting the pH

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13
Q

When are CPP-ACP useful

A
  • useful in markets with no access to high F’s
  • can be used at home or in office in trays
  • not suitable for people with milk allergies
  • more research needed
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14
Q

how can dental materials release F

A
  • glass ionomer/resin modified
  • attached to tooth surface
  • some early release and slower diffusion through bulk GICs
  • small amounts but they are sustained
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15
Q

what are the effects of fluoride at the tooth surface

A
  • presence of F during caries process alters demin/remin dynamics
  • partially demineralised crystals act as nucleators
  • F ions adsorbed to crystal surface and attract Ca, P so new mineral is formed
  • principal mechanism of F in caries control relies upon F in saliva, F at plaque fluid and tooth interface and F in fluids around lesion mineral crystals
  • optimised by delivery of F to tooth surface, plaque and plaque fluid; also by maintaining F levels
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16
Q

what are the factors which determine the anticaries activity of F toothpaste

A
  • F concentration
  • frequency of application
  • rinsing behaviours
  • when brushing takes place
17
Q

how does F concentration affect effectiveness of toothpaste

A

6-7% reduction in caries for every 500ppm F increase in concentration (really important factor)

18
Q

how does frequency of brushing affect chance of caries

A

brushing twice per day or more results in lower caries increments

19
Q

how does rinsing behaviours affect chance of caries

A

any rinsing removes excess fluoride but large vol of water reduces the F in mouth. so,

spit dont rinse

20
Q

what is optimal brushing

A
  • twice daily
  • not using a beaker
  • 1500ppm F paste
21
Q

what is sub-optimal brushing

A
  • once daily
  • rinsing with beaker
  • 1000ppm F paste
22
Q

what is the difference between optimal and sub-optimal brushing

A

approx 40-50% difference in caries incidence

23
Q

how important is the amount of toothpaste for efficacy of F toothpaste

A

not very important

24
Q

what are the benefits with using F

A
  • efficacy of F toothpaste clearly demonstrated

- higher F content, more caries prevention

25
Q

what are the risks with F toothpaste

A
  • despite being topical, inevitable ingestion particularly in young
  • increased risk of enamel fluorosis
  • risk-benefit assessment between caries prevention and fluorosis risk
26
Q

what are the risks from ingesting fluoride

A

Acute toxicity

  • very rare
  • generally potential problem in very young
Chronic toxicity (fluorosis)
- developmental defect of enamel
27
Q

How much F do young children need to swallow to risk fluorosis?

A

there is no lower limit below which fluorosis does not occur

  • general consensus is ~0.1mg f/kg body weight
  • 1mg per day for 1 year old
  • 2mg per day for 5-6 year old
  • still possible to develop fluorosis at recommended daily intakes of 0.05-0.07 mg f/kg
28
Q

how does the stomach affect the bioavaliability of F

A

stomach is at a low pH so the bioavaliability of F is very high, however can be affected by presence of cations in the stomach which reduces the bioavaliability

29
Q

what increases the chance of fluorosis more, concentration or quantitiy of F toothpaste

A

quantity (20 fold compared to 3 fold)- see slide

so, best to use small quantity of higher concentration

30
Q

quantitiy of toothpaste is/isn’t strongly associated with efficacy

A

isn’t

31
Q

why is efficacy primarily concentration rather than dose dependant?

A

because oral fluoride reservoir is small

32
Q

is it best to brush before or after meals

A

from a caries point of view: after (most effective at time of cariogenic challenge/less readily absorbed)

from an erosion point of view: before

33
Q

why is it good to brush before bedtime

A

salivary flow rate reduced/ increased oral retention

34
Q

anti caries benefit is topical or systemic?

A

topical

35
Q

increased risk of developing fluorosis is topical or systemic?

A

systemic

36
Q

what can we do to maximise caries benefit but reduce fluorosis risk in young children

A
  • keep toothpaste out of reach of young children
  • brush frequently (2x daily: evening and one other time)
  • supervise brushing by young children
  • use a small amount (pea/smear) of paste
  • discourage swallowing
  • brush after meals to minimize effect of F ingestion
  • encourage spitting out, remove slurry: avoid excessive rinsing
  • maximise f conc in releaiton to risk
37
Q

what are community prevention tools

A

Fluoride

  • tooth brushing schemes
  • F varnish

Diet

  • healthy eating policies
  • free water/milk
  • no sugary drinks

Community at large
- outreach activites (sealants, varnish)

Caries symposium 2 (7 decks)

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