fluoride

Question 1

what are hydroxyapatite crystals made up of?

Answer 1

calcium
phosphate
hydroxide

Question 2

how are the crystals arranged?

Answer 2

tightly packed to form prisms

Question 3

what occurs as apatite dissolves?

Answer 3

calcium, phosphate and hydroxide ions dissolve into surrounding solution (saliva)

Question 4

when does dissolution stop?

Answer 4

when surrounding solution is saturated in comparison to apetite

Question 5

what happens in the presence of fluoride?

Answer 5

hydroxide is replace with fluoride to from fluorapetite.

Question 6

what two things are required to form fluorapetite?

Answer 6

hydrogen

fluoride

Question 7

for every 2 fluoride ions, how many calcium and phosphate are required to make a unit of fluorapetite?

Answer 7

10 ca, 6 po4

Question 8

what proteins do saliva bind to in ssaliva?

Answer 8

CPP- casein phosphopeptide

ACP- amorphous calcium phosphate

Question 9

what else do these proteins do? CPP, ACP

Answer 9

buffer ca and po ions from plaque, promoting remineralisation

Question 10

name the three modes of action re. fluoride?

Answer 10

enamel solubility
effect on plaque bacteria
tooth morphology

Question 11

describe enamel solubility:

Answer 11

after dissolution of apetite crystals, fluoride from the surrounding solution/ saliva takes the places of hydroxide forming fluorapetite.
fluoratpetite is a larger crystal with less imperfection
its critical PH is 4.5 therefore requires a larger fall in PH to demineralise

Question 12

describe the effects on plaque bacteria

Answer 12

plaque accumulates fluoride
fluoride inhibits enzymes (enolase) involves in glycolysis and therefore less lactic acid is produced
fluoride inhibits storage of intracellular polysachardes and prevents acid production between meals

Question 13

describe the effect on tooth morphology

Answer 13

rounded cusps

shallower fissures

Question 14

what studies have been carried out re. plaque bacteria?

Answer 14

Jenkins 1969

Edgar 1970

Question 15

what is fluorosis?

Answer 15

caused by high fluoride exposure during tooth developement

Question 16

what indicates mild fluorosis

Answer 16

fine white lines

Question 17

what indicates moderate fluorosis

Answer 17

opaque discoloured enamel

Question 18

what indicated severe fluorosis

Answer 18

loss of enamel

Question 19

how is fluorosis caused?

Answer 19

reduced enamel matrix protein degregation
increased amelogenin retention
incomplete crystal growth

Question 20

what studies were carried out re. mottling

Answer 20

Frederick mackay- Colorado springs ( brown stain)
mottling linked to water supply
later GV Black noticed absence of decay

Question 21

what studies have been carried out re. fluoride and caries?

Answer 21

H Trendly Dean
examined caries in 21 cities in over 7000 children
aged 12-14
higher fluoride in water = less caries

Weaver 1944
children evacuated from south shields in WW1 where fluoride in water was 2ppm had lower DMFT scores

Question 22

To what concentration is water fluoridated?

Answer 22

1ppm

Question 23

what case caused water fluoridation to cease in many areas?

Answer 23

McColl 1978

Question 24

where are the fluoridated areas in the UK?

Answer 24

Birmingham
Newcastle
Bedford
durhan
Gateshead
derby
southhamptom

Question 25

What are systemic approaches to fluoridation?

Answer 25

``` water milk salt tablets drop ```

Question 26

what are home methods of fluoride delivery?

Answer 26

toothpaste mouthwashes tablets

Question 27

what are dental surgery approached to fluoride delivery?

Answer 27

fluoride varnish

Question 28

what is the concentration of fluoride varnish?

Answer 28

22, 650 ppm

Question 29

what is the concentration of regular toothpaste?

Answer 29

1450 ppm

Question 30

what form does fluoride take in toothpastes?

Answer 30

sodium monofluoraphosphate sodium fluoride stannous fluoride

Question 31

what concentrations are prescription toothpastes?

Answer 31

2800- not for under 10s | 5000- not for under 16s

Question 32

what is fatal dose re. fluoride poisoning?

Answer 32

5-10g | 32-64 mg/kg

Question 33

what is toxic dose in children?

Answer 33

5mg/kg

Question 34

what are the symptoms of fluoride toxicity?

Answer 34

``` nausea vomiting GI pain muscular weakness spasms ```

Question 35

what is the management for fluoride poisoning

Answer 35

milk | A+E

Question 36

what is the recommended dose re. fluoride varnish?

Answer 36

2-5 years: 0.25mls | 6+: 0.4mls

Question 37

what concentrations should fluorides tablets/drops be given?

Answer 37

6months-3 years: 0.25mg 3-6 years: 0.5mg 6+ 1mg

Question 38

detail the Strathclyde case. re water fluoridation

Answer 38

1978 a citizen of Glasgow claimed water fluoridation violated informed consent main grounds: beyond the powers of the public nuisance- harmful in relation to cancer breach of water act council providing medicinal product without liscence

Question 39

what does the knox report conclude?

Answer 39

1980 department of health commissioned a report on the links of fluoride to cancer finding in 1985 proved no effects fluoridation I a safe and effective measure of reducing decay

Question 40

what concentration re. fluoride mouthwash?

Answer 40

0.05% | 225 ppm

Question 41

what % fluoride varnisih?

Answer 41

5% | 22600 ppm