Fluoride

Question 1

Who discovered the optimum concentration of fluoride in water to allow protection against caries but minimising dental fluorosis?

Answer 1

H. Trendley Dean - 1ppm

Question 2

Who discovered Colorado brown stain and made the connection to water fluoridation?

Answer 2

Fredrick McKay discovered mottling on teeth without caries, H.V. Churchill discovered the link between water fluoridation in areas of the brown stain.

Question 3

What is the purpose of a polishing/abrasive agent in toothpaste?

Answer 3

• clean and polish tooth surface without damaging enamel, prevents stain accumulation
  e.g. sodium bicarbonate

Question 4

What is a humectant?

Answer 4

• prevents evaporation of water keeping paste moist
  e.g. glycerine, sorbitol

Question 5

What is a binding agent?

Answer 5

• holds all ingredients together and assists in creating texture of toothpaste
  e.g. carboxymethyl cellulose

Question 6

What is the purpose of a detergent/foaming in tooth paste?

Answer 6

• lowers surface tension and loosens debris which assists removal with a toothbrush
  e.g. sodium lauryl sulphate

Question 7

What is a preservative?

Answer 7

• prevent contamination of bacteria and to maintain purity of product
  e.g. formalin

Question 8

Why do manufacturers put colour/flavouring into toothpaste?

Answer 8

• masks flavour of other ingredients especially SLS, promotes patient compliance
  e.g. peppermint, spearmint, menthol

Question 9

What is waters purpose in toothpaste?

Answer 9

• acts as a solvent for some ingredients and provides consistency

Question 10

What therapeutic agents are used in toothpaste?

Answer 10

• Fluoride: anticaries, remineralisation
• Desensitising agents: reduce or eradicate dentine hypersensitivity by desensitising pulp nerve fibres e.g. strontium chloride
• Antiplaque agents: antibacterial reducing plaque formation e.g. triclosan
• Anticalculus: inhibits plaque mineralisation e.g. pyrophosphates, zinc citrate

Question 11

What are the modes of action of fluoride?

Answer 11

• remineralisation changing structure of enamel hydroxyapatite to fluorapatite with protective effects (higher resistance to acid attack)
• inhibits bacterial growth, bacteriostatic
• interferes with ability of strep. mutans to produce acid and reduces their growth
• reduces dentine sensitivity by blocking tubules
• said to have an effect on flatter, wider cusps

Question 12

What is the concentration of fluoride recommended in toothpaste in all age groups?

Answer 12

Standard prevention: 1000-1500ppm F
Enhanced prevention: 1350-1500ppm F
Children 10 and over at increased risk: 2800ppm F
Children/adults 16+ at increased risk consider: 5000ppm F

Question 13

What is the recommended maximum intake of fluoride per day for all sources?

Answer 13

• 0.1mg/kg/day for children upto 8
• 10mg/day for children 9 and over regardless of weight
  Fluorosis risk is omitted by around age 3 as all crowns should have developed

Question 14

What is the concentration of duraphat fluoride varnish?
Which mouthwash can be recommended and its concentration?

Answer 14

Duraphat: 22,600ppm F
Fluoriguard Daily - 225ppm F, no alcohol