4. Fluoride and non-fluoride caries prevention agents

Question 1

What is fluoride’s mechanism of action?

Answer 1

inhibits demineralization
promotes remineralization
antibacterial by residing in plaque and disrupting enzymatic activity

Question 2

What is optimal water fluoridation level?

Answer 2

0.7 mg/L (0.7 ppm)

dose to not exceed 0.2 mg/L (2.0 ppm)

Question 3

What is the amount of fluoride in standard toothpaste?

Answer 3

0.1% (1000 ppm)

Question 4

What is the recommend amount of fluoride for a patient less than 2 years old?

Answer 4

smear

0.1 g = 0.1 mg F

Question 5

What is the recommend amount of fluoride for a patient older than 2 years old?

Answer 5

pea size

0.25 g = 0.25 mg F

Question 6

What is the amount of fluoride in prescription toothpaste?

Answer 6

0.5% (5000 ppm)

Question 7

What is the amount of fluoride in rinses?

Answer 7

0.05% NaF (2200 ppm)

1 mg/5 mL

Question 8

What are indications for fluoride gels and rinses?

Answer 8

appliances
H and N radiation
high risk patients

Question 9

What is the fluoride ingredient in GelKam

Answer 9

0.4% SnF (1000 ppm)

Question 10

What is the fluoride content in varnish?

Answer 10

5% NaF (22500 ppm)

Question 11

Is a prophy required for fluoride application?

Answer 11

No, pellicle does not inhibit uptake

Question 12

What is the fluoride concentration in SDF?

Answer 12

38%

45000 ppm

Question 13

What is the recommended reapplication of SDF

Answer 13

every 6 mo

Question 14

What is the mechanism of action of SDF?

Answer 14

inhibits biofilm formation
anti-bacterial
penetrates to enamel and reduces solubility

Question 15

What causes fluorosis

Answer 15

excess fluoride ingestion from ages 4-8

Question 16

What is the toxic dose of fluoride?

Answer 16

5 mg/kg

Question 17

What is the fatal dose of fluoride?

Answer 17

16 to 32 mg/kg (hodge)

15 mg/kg (whitford)

Question 18

What is the treatment for fluoride OD?

Answer 18

slow absorption via milk, calcium carbonate, aluminum-magnesium based antacids

Question 19

Should you induce vomiting with fluoride toxicity?

Answer 19

No, do not give ipecac or activated charcoal

Question 20

If patient ingested less than 8 mg/kg and is asymptotic what treatment should be given?

Answer 20

slow absorption and monitor for 6+ hours

Question 21

What are 4 non-fluoride based products that aid in dental prevention?

Answer 21

Casein phosphopeptide amorphous calcium phosphate (CPP-APP)
Polyols
Silver nitrate
CHX

Question 22

When is Casein phosphopeptide amorphous calcium phosphate (CPP-APP) indicated?

When is it contraindicated?

Answer 22

Indicated: dry mouth and/or sensitivity

Contraindicated: milk allergy

Question 23

What is the mechanism of action of CHX?

Answer 23

bacteriostatic at low doses
bactericidal at high doses
does not reduce risk of caries

Question 24

Do water filters change fluoride concentrations?

Answer 24

Regular filters have very little effect on [F]

Reverse osmosis and distillation DO reduce [F] to low levels

Question 25

It is estimated that approximately how much fluoride (in mg) can be swallowed by pre-school aged children when brushing bid?

Answer 25

0.2 - 0.3 mg

Question 26

When does the AAPD recommend a child start using a fluoridated toothpaste?

Answer 26

with eruption of first tooth

Question 27

What is the type of fluoride, concentration and frequency of use in a prescription mouthwash?

Answer 27

NaF 0.2%

weekly use

Question 28

What are the types of fluoride in prescription gels?

Answer 28

1. 1 % NaF (5000 ppm)

1. 1% APF (5000 ppm)

Question 29

What are the formulations of professionally applied gels/foams?

Answer 29

1.23% APF (2,300 ppm)

2% NaF (9040 ppm) - not for preschool children, 4 min application

Question 30

For fluoride supplementation, what’s the maximum mg that can be prescribed per Rx?

Answer 30

120 mg

Question 31

Estimated fluoride levels of infant formula

Answer 31

0.1-0.3 ppm

Question 32

What juice has the highest [F]

Answer 32

grape (1+ ppm)

Question 33

What foods have the highest [F]

Answer 33

chicken and fish

Question 34

Dietary supplementation recommendation by age

Answer 34

no fluoride supplementation if:
< 6 mo
16+ years
or current water source 0.6+ ppm

if supplementation warranted, depends on age and current water source concentration. Supplementation varies from 0.25 to 1.0 ppm

Question 35

Is pre-natal fluoride supplementation recommended/effective?

Answer 35

no