W1: Cariology: MOA of Fluoride/Diet Flashcards
objectives
- MOA of fluoride to stop decay
- diet control
- diff types of F
How does Fluoride protect teeth?
Gen action
- when F is systemic= only when teeth is developing
- topical effect , tp= stronger by
- lower demin: low sustained conc of F during acid attack (when we have plaque), can absorb onto apatite crystals forming shield
- promote remin: we have calcium phosphate in saliva, when F comes , pH comes normal again. F reacts with acid, excludes carbonate which will stop decay, enamel more stronger
- Antimicrobial: we got >500 species bacteria, healthy mouth (symbiotic), when imbalance of bacterial activity… F applied= lowers acid by attacking bacteria glycolytic pathway so can’t reproduce
- stops bacterial sugar breakdown. makes bacteria’s metabolism go whack. no polysach= no sticky = no plaque = no bacteria stick so lower B load
Where is guideline for fluoride modalities?
Guidelines for use of fluorides in Australia: update 2019
guidelines published by the Australian Research Centre for Population Oral Health
(ARCPOH).
https://www.adelaide.edu.au/arcpoh/dperu/fluoride/Guidelines_for_use_of_fluori
des_in_Australia update_2019.pdf
* Fluoride modalities should be assessed with reference to their potential
benefit (i.e. prevention of caries) and risk (i.e. dental fluorosis).
few things updated
- some F not in market anymore so new guide 2019
“Halo effect” of FL, what is it?
FL from foods, beverages, toothpastes and
topical agents results halo effect in low
fluoridated communities.
- there are some communities with no F in water. research done on those communities, shows no cavity as FOOD, drinks and tp has fluoride. Fluoride + good OH
- halo means not direct effect
What are the different forms of fluoride?
What is the topical effect of fluoride?
market forms
- tp, rinse, water (free), varnish, gel
- no more use: tablet
Topical effect
F + ca = reservoir of fluoride= remineralisation
Study by Backer Dirks O. The benefits of water fluoridation.
Caries Research 8: 2-15, 1974
Benefits of F water
found 75% lower in IP lesions 86% lower in gingival lesions
- kids no lesion on anterior teeth
- topical sf effct of F doesn’t go in pits n fissures. FS tx to protect surface.
Is Fluoride the only treatment for decay?
- F incorporated into tooth enamel as F apatite= preventative effect BUT more research found that
- in saliva we got more minerals (F is NOT only saviour)
- It is combined effect, and F is neccessary but not only factor
- natural F in water= need 0.8-1ppm in community water, hot countries just need 0.7ppm bc probs drink more water. weather considerations taken (bc hot weather= more water consumption, so less levels)
- F: lower root caries (hard to prevent)
The effect of discontinuing water
fluoridation
- show effect of fluoride
- 2-6 year increments
- decay increased heaps in 2 years time…
1966= 425 caries= high
removal of fluoride= more caries
Fluoride management is a balance of considering what?
Need to consider benifit and risk
What are the key guides of water F?
- F level in water 0.6-1.1 mg/L
- bottle labelled of F levels around 1mg/L
- to remove F you have to filter. Filters recc. to not remove F
- non F areas should have access to water bottles with F 1mg/L
0
What factors are considered when deciding what F product to recommend to pt?
pt might ask you what they have to do in RE fluoride.
Mx considerations
1. caries risk: high, medium, low
2. info based on risk
3. diet, cariogenicity
4. age. kids (talk to parents), 85 (consider compliance
5. use of systemic/topical
6. existing Mhx: normally doesn’t react. but rarely determine if any cotraindication
What Fluoridated toothpaste should you recc patients?
there is diff F levels in tp
Pt. might not know levels of F when you ask them.
F is combined with minerals
Just as long as F is in it= good
When should topical F be avoided?
1st trimester of pregnancy
under 18 months bc they can swallow- they have diff diet and parents can clean their teeth, also enough F in water already
Why did tablet F banned?
too high dose, cause fluorosis
- research, tablet is costly so only dentist has access to buy
- found that dentist who supplied it (only they can), fluorosis more common in dental pts.
Minimum level of F for 18 months-
~500
When can kids be given adult tp?
when 4-5 yo and have heaps of caries
What should you advise after brushing teeth to kids (and adults)?
brush, spit dont rinse
If no F water region, kid is younger than 1 what can we advise?
tp from 1yo 400-500ppm
What are the different levels of F in conventional tp?
What would you recommend
- under 18m
- under 18m with caries risk
- 18m- 5
- over 5
Under 18m: no tp, help em clean w brush
- 18 m caries: 500ppm
- 18m-5: 500
- over 5: 1500
Conventional lvls
- 1500ppm
- oral B 1450ppm, can cause mucosa ulceration
- neutrafluor
Comment
study shows fluoride is good
- frequency: 2 is better than once (long term= better)
comment on this study
fluoride + frequency= good
Which tp is better?
as long as there is F, doesn’t matter
- sodium fluoride is slightly more effective than SMFP (shorter name)
How often would you recommend patient fluoride rinse vs neutrafluor?
depends
daily vs weekly
neutrafluor rinse 900 ppm = 1/week (if t wants less frequency)
What did the Denmark study show about fluoride rinses?
how Topical f stop caries prevention
Over 2 months lesions arrested and remineralised
When should you recommend fluoride rinse?
Give them more fluoride to neutralise acid production
F rinse, Toothmouse
- Ability limited
- Braces/orth
- Cancer: bc hyposalivation after radiotx
- Decay
Chemo pts should get extra F why?
due to lower salivation
When is F rinse NOT allowed
Kids below 6 bc they might swallow it
When can we not use F gel?
under 10. use tooth mouse
What diff gels do we have?
APF: At clinic 12300ppm= 1.23%
Neutral NaF: broken down dentine 2%
Stannous: stop decay 0.4% BUT IT STAINS
Pt has severe erosion and attrition, what should you use in terms of F?
NEUTRAL NaF gel: 2%
Stannous fluoride gel (0.4%): is advised for what and what is a con?
stains
gel is good
How much F is in duraphat? How should you apply it?
What is MI varnish used for?
doesn’t flow, local application
MI varnish has calcium and phosphate (good for erosion)
MI varnish Vs duraphat?
Can varnish be used for kids under 10?
MI varnish= for erosion
yes for kids under 10 only if high caries risk.
When would you use FL varnish?
What age must you consider for it to be acceptable?
When not to?
- denture
- +6 y.o caries risk.i.e adult teeth
- root exposed due to gum recession
- can give to pt under 6yo with bad caries
NO USE
- ulcer
- healthy kids
- no cavity
Comment
F= good
Can you use F varnish for kids?
Recommendations 2019:
Fluoride varnish should be used for people who have an elevated risk of
developing caries, including children under the age of 10 years.
When to recc Toothmousse?
When pt. Doesn’t want to use fluoride. Next best in terms of cost and probs equal effectiveness. Don’t give to pt. With milk allergy tho.
Basically studying methods of remin in kids with early decay
Found no difference in
A) f toothpaste + ACCP straight after
B) f toothpaste only
Conc: F Toothepaste is enough
Con/pro of SDF?
Effective but stains
How does SDF work?
reacts to form Fappatite
silver phospate reacts/stops metabolism of bacteria
The 2019 Guideline on silver diamine fluoride
Silver diamine fluoride or silver fluoride might be used for
people with caries in situations where traditional treatment
approaches to caries management might not be possible.
Use when cavities bad, keeps happening.
What is the toxic dose of fluoride, the symptoms and tx?
nausea, vomit, sweating (when kids eat F)
route of F
Emergency Tx of fluoride
Comment
diet with sugar, how much time decay forms
- some food/drink has low caries risk= can advise that
good vs bad sugar are?
xylitol gum is good
Thaumatin = sweetener from the West African katemfe fruit. protein-based.
Aspartame is an artificial (chemical) sweetener widely used in various food and beverage products since the 1980s. Weight gain. Bad for health.
What are some new risk factors for caries? Think about consumption/diet…
❑ use of calorie risk sports drinks - gatoraid
❑ use of non-fluoridated bottled water
❑ tap filters that remove fluoride
What is basic conclusion of Oral hygiene tip you should give to patient?
- FOOD: Caries reduced by diet (lower snacks and bad carbs)
- Fluoride
- Frequent 2x brushing (allows remove plaque, retain saliva and remineralisation with fluoride)
Can patients use Neutrafluor long term?
only 4-6 wks, not forever. pt to resume normal tp
What is part 6 - 10 of the guidelines for fluoride tp?
Levels of fluoride
Under 18 = baby teeth
18m-5=500ppm
6+=1500ppm
No F access= start F young
Ault/teen caries risk=4000ppm
Comment
topical/ rinse F= good prevention
Comment on study: Fluoride gels for preventing dental caries in children and adolescents metanalysis of 23 studies.
Fluoride 28% reduction in DMFT than non fluoride placebo
19% more likely to get DMFS if u got non F placebo
Conc: fluoride reduces DMFT
Comment on this study
Comment on this study
ACP not proven fully effective
Summarse
CPP-ACP has been reformulated to add more F. Got to see research if it’s effective
2023 review; “Further clinical studies are needed to verify if this effect is clinically significant in reducing the caries lesion incidence or to revert the demineralizing process.”
Comment on study : Remineralisation and arresting caries in
children with topical fluorides. Evid Based Dent. 2017 Jun 23;18(2):41-42
2017
5% F varnish is good = early Enamel
38% silver fluoride better= arrest dentine demineralisation
