The role of fluoride in dental caries management Flashcards
who and when reported 1ppmF gave minimal mottling and low caries
1942- Dean showde 1pppmF - gave minimal mottling and low caries
what occurs when fluoride is ingested
- systemic absorption mainly stomach occurs very quickly
- F is absorbed across the mucosa as HF into the blood stream
- Fluoride enters saliva via the blood stream
- incorporated in calcifying tissue s- bone/ teeth
- excretion from the body is mainly renal.
how does fluoride decrease risk of dental caries
- decreases demineralisation (dissolving) of enamel
- increases remineralisation of enamel
- incorporated in developing enamel
- Interferes with metabolism of some plaque bacteria
what are the PH changes in the biofilm and how does it effect enamel
- when bacteria produce acid, the pH drops below 5.5 and enamel dissolves
- eating and drinking fermentable carbohydrates causes the PH to drop
what are the properties of fluoride
- slows down demineralisation
- promotes remineralisation
- fluoride is found in saliva and at enamel surface
- lowers the bacterial cell pH to acid conditions
- Interferes with the glycolytic pathway
how does fluoride decrease demineralisation?
- decrease demineralisation
- less calcium is lost under acid conditions when fluoride is present
what does enamel require to reminerlize
- calcium and phosphate from: saliva, dairy food, CPP-ACP
- need good saliva flow as well as appropriate fluoride concentration
why is it important to use fluoride regularly?
- to have an ongoing effect on prevention of dental caries
- little protection If fluoride is only used while teeth are forming
- Fluoride is incorporated into developing tooth enamel as fluoridated hydroxyapatite and as fluorapatite.
- little protection if fluoride is only used while teeth are forming
what concentration of fluoride is in the fluoride varnish used In clinic?
7000- 22600 ppmF
what are sources of systemic fluorides?
- swallowed toothpaste
- water - natural and added
- foods- fish, tea- natural
- tablets/drops
- milk- added
- salt- added
what is the impact of systemic/ topical fluoride in adults?
- increased levels of fluoride in the drinking water shown to be protective against caries in young adults
- water fluoridation has significant caries- preventive effects in adults
what is recommended to do when using fluoride toothpaste and how much should children up to 3 years sue and children up to 3-6 years use?
recommended to spit and not rinse after brushing
- increased caries prevention
guidelines
children up to 3 years- toothpaste with 1000ppmF
- smear of toothpaste
- parents brush
children 3-6 years - toothpaste with 1350-1500 ppm F
- Pea size toothpaste
- Parents help with brushing
what percentage of fluoride should be used in a daily or weekly fluoride mouthwash?
daily - 0.05% F
Weekly- 0.2%F
what should we consider when prescribing mouthwash?
- age of patient
- appropriate instructions
- does the mouthwash have alcohol
how often should you apply professional topical fluorides?
Apply 3-6 monthly depending on caries risk
- fluoride prophylaxis paste
- fluoride varies
- silver diamine fluoride
name other sources of topical fluorides?
- GICs
- Compomers
- Some fissure sealants
- some resin composites
- good protection for surrounding enamel and adjacent enamel
- less protection beneath he restoration unless it is completely sealed
when is the higher risk for developing fluorosis in the permanent anterior teeth?
between 18 months and 3 years of age
- children do not learn how to spit properly before about 3-4 years of age
- additional systemic fluorides should be avoided before 3 years of age
- parents should make sure there is only a smear of toothpaste on the brush for infants up to 3 years and a pea size up to 6 years
- Parents should be aware not to share their mouthwash or higher concentration F toothpaste with preschool children
- All fluoride products should have child safety tops
when does dentals fluorosis occur
when more than trace amounts of fluoride are ingested during tooth development
- enamel with dental fluorosis has a higher protein content
- high levels of fluoride prevent effective removal of protein matrix during maturation
- chalky looking enamel with fine streaks= hypo mineralised enamel
- teeth formed at the same time will have a similar appearance
- most likely causes - water with naturally high levels of fluoride
- deliberate eating fluoride toothpaste
what is the recommended level of fluoride in a fluoridated water supply
0.7- 1.0 ppmF
