The role of fluoride in dental caries management

Question 1

who and when reported 1ppmF gave minimal mottling and low caries

Answer 1

1942- Dean showde 1pppmF - gave minimal mottling and low caries

Question 2

what occurs when fluoride is ingested

Answer 2

• 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.

Question 3

how does fluoride decrease risk of dental caries

Answer 3

• decreases demineralisation (dissolving) of enamel
• increases remineralisation of enamel
• incorporated in developing enamel
• Interferes with metabolism of some plaque bacteria

Question 4

what are the PH changes in the biofilm and how does it effect enamel

Answer 4

• when bacteria produce acid, the pH drops below 5.5 and enamel dissolves
• eating and drinking fermentable carbohydrates causes the PH to drop

Question 5

what are the properties of fluoride

Answer 5

• 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

Question 6

how does fluoride decrease demineralisation?

Answer 6

• decrease demineralisation
• less calcium is lost under acid conditions when fluoride is present

Question 7

what does enamel require to reminerlize

Answer 7

• calcium and phosphate from: saliva, dairy food, CPP-ACP
• need good saliva flow as well as appropriate fluoride concentration

Question 8

why is it important to use fluoride regularly?

Answer 8

• 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

Question 9

what concentration of fluoride is in the fluoride varnish used In clinic?

Answer 9

7000- 22600 ppmF

Question 10

what are sources of systemic fluorides?

Answer 10

• swallowed toothpaste
• water - natural and added
• foods- fish, tea- natural
• tablets/drops
• milk- added
• salt- added

Question 11

what is the impact of systemic/ topical fluoride in adults?

Answer 11

• 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

Question 12

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?

Answer 12

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

Question 13

what percentage of fluoride should be used in a daily or weekly fluoride mouthwash?

Answer 13

daily - 0.05% F
Weekly- 0.2%F

Question 14

what should we consider when prescribing mouthwash?

Answer 14

• age of patient
• appropriate instructions
• does the mouthwash have alcohol

Question 15

how often should you apply professional topical fluorides?

Answer 15

Apply 3-6 monthly depending on caries risk
- fluoride prophylaxis paste
- fluoride varies
- silver diamine fluoride

Question 16

name other sources of topical fluorides?

Answer 16

• 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

Question 17

when is the higher risk for developing fluorosis in the permanent anterior teeth?

Answer 17

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

Question 17

when does dentals fluorosis occur

Answer 17

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

Question 18

what is the recommended level of fluoride in a fluoridated water supply

Answer 18

0.7- 1.0 ppmF