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FINALS - Patient Management and Health Promotion > Community Water Fluoridation > Flashcards

Community Water Fluoridation Flashcards

1
Q

How does fluoride prevent caries?

A
  • Fluoride present in fluid at the plaque/tooth interface promotes remineralisation
  • The Fluoro-Apatite formed is less susceptible to demineralisation
  • Topical effect greater than systemic effect
  • Fluoride may also have an effect on bacteria and metabolic pathways resulting in less acid being produced
  • Maintain elevated oral levels of fluoride for as long as possible (little and often)
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2
Q

What lesions is fluoride most effective on?

A
  • Early lesions
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3
Q

What are the two broad types of Oral reservoirs?

A

Mineral deposits (CaF2; FAP)
- CaF2 in saliva and fluid phase of plaque

Biologically/bacterially bound calcium-fluoride

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4
Q

What is community water fluoridation?

A
  • Adjustment of natural fluoride content of community water supply to achieve optimum caries prevention whilst minimising risk of dental fluorosis
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5
Q

What are the constituents added to community water fluoride?

A
  • Hydrofluorosilicic acid or hexafluosilicic acid H2SiF6
  • Sodium fluorosilicate or sodium silicofluoride, Na2SiF6
  • Typically 0.5 – 1.2ppm, dependent on climate (related to ambient air temperature; latitude)
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6
Q

What act stipulates the community water fluoridation?

A
  • Section 87C (2) of the Water Act 2003
  • Code of practice from the Drinking water inspectorate
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7
Q

What is the fluoride Content of Scottish water?

A
  • Water Supplier Scottish water
  • Glasgow Dental School supplied by Milngavie M3 treatment works
  • Mean = 0.10mgF/l (<0.04 - 0.12) natural water fluoride content
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8
Q

What is the UK legislation in regard to water fluoride?

A
  • Water Fluoridation Act (1985)
  • Water Industry Act (1991)
    (Neither Act delivered change)
  • Water Act 2003, Section 58 (Fluoridation of Water supplies) Applies in England & Wales
    ‘may’ vs. ‘shall’
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9
Q

What is the Water Act 2003?

A
  • Replaced flawed legislation - Water (Fluoridation) Act 1985 / Water Industry Act 1991)
  • May replaced with shall
  • Requirement for public consultation before new scheme implemented
  • Statutory requirement for ‘authority’ o monitor heath effects of fluoridation (section 90A)
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10
Q

What is the current Legislation on water fluoridation in Scotland?

A
  • level of fluoride in the water varies from 0.001 ppm to 1ppm. Water fluoridation is adjusting this natural fluoride concentration to 1ppm.
  • Water (Fluoridation) Act 1985 (now consolidated into the 1991 Water Industry Act) still extant
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11
Q

What are some barriers to Water fluoridation?

A
  • Objections/acceptability (Moral/ethical) (Safety & efficacy)
  • Political barriers
  • Geographical barriers
  • Financial barriers
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12
Q

What are the ethical/ moral considerations of water fluoridation?

A
  • Need to take into account Human civil rights
  • Beneficial and has no harmful consequences
  • Not infringe any basic human right (choice to drink it)
  • Replicates a situation naturally
  • Question of is it unethical to fluoridate where practical to do so?
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13
Q

What are some safety/ efficacy considerations to water fluoridation?

A
  • The chemical used are industrial waste products
  • Fertilizer production - hydrogen fluoride reacts with silica to produce hexafluorosilicic acid
  • Concerns fluoride and fluoride components are toxic ( link to cancers/ bone disorders/ cognitive impairment?)
  • Acute toxicity
  • Cumulative posion
  • Fluorosis
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14
Q

When is fluorosis a concern?

A
  • Not a concern with community water fluoridation in addition to fluoride toothpaste
  • There is a dose response with fluorosis
  • Higher levels of fluoride worldwide with some areas 5.5-25ppmF is a concern
  • Concern when effects aesthetic/severity and skeletal
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15
Q

What is the Clinical presentation of Fluorosis?

A
  • Snow flaking appearance on teeth
  • Lack clear border, opaque, white spots, narrow white lines on enamel surface of most of the teeth
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16
Q

What are some efficacy concerns around water fluoridation?

A
  • Does it work in preventing caries?
  • Is there a declining effect of fluoridation
  • Can we get other sources of fluoride
  • How do we control for confounding factors like social class and population migration
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17
Q

What are some political barriers of water fluoridation?

A
  • Anti-fluoridation lobby very vocal
  • Highly emotive topic
  • Differing opinions across political parties
  • How to tackle increasing level of disease, rising health inequalities, financial and workforce challenges
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18
Q

What was the return on investment of oral health improvement programmes for 0-5 year olds?

A
  • Public health England
    included;
  • Targeted supervision tooth brushing programme
  • Targeted fluoride varnish programme
  • Water fluoridation provides universal programme
  • Targeted provision of toothbrushes and paste by post
  • Targeted provision of toothbrushes and paste by post and health visitors
  • Improvements generally but still not good enough with regional differences and inequality
19
Q

What issues were addressed with the development of novel techniques?

A

Bias
Objectivity
Longitudinal assessment
(population selection/recruitment)
All Tested and proven in clinical environment

20
Q

What is the conclusion from PHE Water fluoridation health monitoring report for England 2014?

A
  • Water fluoridation is safe and effective in public health intervention but ongoing review required
21
Q

What was the CATFISH study?

A
  • Assess effects and costs of systemic and topical exposure in utero abd exposure to water fluoridation
  • Following new WF scheme on cohort of children with falling disease levels compared to birth cohort of children in absence of WF
  • Measure impact of water fluoridation on social class inequalities in child dental health
22
Q

What were the outcomes of CATFISH study?

A
  • Modest benefit seen in caries reduction – much lower than seen in previous studies
  • Still noted to be cost-effective
  • No significant effect in reducing social gradient
23
Q

What is given as fluoride therapy in community settings?

A

Water
School based brushing
Varnish
Salt
Milk
Tablets
Rinsing

24
Q

What is given as fluoride therapy in office settings?

A

Varnish
Gels & Foams
Slow release

25
Q

What is given as fluoride therapy in home settings?

A

Toothpaste
Mouthrinse
Tablets

26
Q

What are the potential factors influencing results of fluoridated milk schemes?

A

Age at commencement
Population
F- concentration
Frequency of use
Distribution system
Consent/Compliance / drop out rate

27
Q

What are the advantages of fluoridated milk?

A
  • Natural healthy drink for children
  • Important part of child’s diet - rich in nutrients
  • Enables fluoride to be targeted to those who would benefit most
28
Q

What are the disadvantages of Fluoridated milk?

A
  • Distribution delayed until nursery/school age
  • Not all children drink milk
  • Distribution system/Shelf life/ Cost issues (higher than water F-)
  • ? Lack of long-term benefit
29
Q

What are fluoride supplements ?

A
  • Tablets or drops
  • used since 1940’s
  • Originally used birth to 6years
  • Later proven benefits children >5.5yrs old
  • Systemic effect less imp than topical effect
  • Advise continuation beyond 6years for at risk children like additional needs/ special care
30
Q

What are the advantages of fluoride mouthwash?

A

-Commonly available for home use as:
Daily (0.05% 227ppmF)
Weekly (0.2% 909ppmF)
- Reductions in caries of around 30%
- Daily rinsing slightly more effective than weekly rinsing, but more expensive
- Generally good compliance
- Weekly more cost effective than daily
- Cost benefit ratio is low

31
Q

What are the advantages of Acidulated mouthrinses?

A
  • Low pH
  • Stimulates mild demin on tooth surfaces
  • Presence of fluoride stimulates remin
  • Effective means of getting fluoride into teeth
  • More so than non acidulated rinses
32
Q

What are the advantages and disadvantages of Fluoride boosters?

A
  • CPP-ACP – not suitable for those with milk allergies
  • Used to be adjunct to F but now supplied with F
  • Can be used at home or in office in trays
  • Useful in markets with no access to high fluorides
  • Systematic reviews indicate more research needed
33
Q

What are APF (acidulated phosphate fluoride) gels?

A
  • Professionally applied
  • F conc 12,300 ppm
  • Time consuming to apply (approx. 30 mins) – up to x2 / year
  • Acute toxicity risk if ingested
  • High cost per tooth surface saved
34
Q

What is Duraphat Fluoride varnish?

A
  • Sodium Fluoride 50 mg/ml = 22 600 ppm F-
  • Gives sustained contact with Precipitation of calcium fluoride and Progressive release of fluoride
  • Professional applied at reg intervals 2-4times a year
35
Q

What factors determine anticaries activity of fluoride toothpaste?

A
  • Fluoride concentration
  • Frequency of application
  • Rinsing behaviours
  • When brushing takes place
36
Q

How does the rinsing behaviour effect the effectiveness of fluoride toothpaste?

A
  • Brushing with fluoride toothpaste elevates fluoride in mouth
  • Rinsing with small vol of water removes excess F- and maintains fluoride in mouth
  • Rinsing with large vol of water removes excess fluoride in mouth and reduces fluoride in mouth
37
Q

What is the current advise for parents/children after toothbrushing?

A
  • Spit out excess toothpaste
  • Refrain from rinsing with water post-brushing
  • Don’t eat or drink anything except water after brushing at night
38
Q

What is the optimal brushing habits?

A

twice daily
not using beaker
1500 ppm F paste

39
Q

What are some issues with using fluoride?

A
  • Despite being topical – inevitable ingestion, particularly in young
  • Increased risk of enamel fluorosis
  • Risk – Benefit assessment between caries prevention and fluorosis risk
40
Q

What are the risks from ingesting fluoride?

A

Acute toxicity
- Very rare
- Generally potential problem in very young
Chronic toxicity (fluorosis)

41
Q

How Much Fluoride do Young Children Need to Swallow to Risk Fluorosis?

A

General consensus ~ 0.1 mg f/kg body weight
- 1 mg per day for 1 year-old
- 2 mg per day for 5-6 year-old

42
Q

What are some considerations regarding topical fluoride?

A
  • Quantity of toothpaste applied not strongly associated with efficacy.
  • Efficacy is primarily concentration, not dose dependent as oral fluoride reservoir is small.
  • Brush before bedtime - salivary flow rate reduced/increased oral retention.
  • Anti caries benefit is topical.
  • Increased risk of developing fluorosis is systemic.
  • Methods favouring topical delivery whilst minimising ingestion will have the best risk/benefit profile.
43
Q

How to maximise caries benefit but reduce fluorosis risk in young children?

A
  • Keep toothpaste out of reach of young children.
  • Brush frequently (twice daily: evening and one other time).
  • Supervise brushing by young children.
  • Use a small amount (pea/smear) of paste.
  • Discourage swallowing
  • Encourage spitting out, remove slurry: avoid excessive rinsing.
  • Use a lower fluoride formulation if low caries risk, maximize fluoride concentration in relation to risk .

FINALS - Patient Management and Health Promotion (13 decks)

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