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clinical practice > fluoride > Flashcards

fluoride Flashcards

1
Q

what are hydroxyapatite crystals made up of?

A

calcium
phosphate
hydroxide

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2
Q

how are the crystals arranged?

A

tightly packed to form prisms

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3
Q

what occurs as apatite dissolves?

A

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

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4
Q

when does dissolution stop?

A

when surrounding solution is saturated in comparison to apetite

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5
Q

what happens in the presence of fluoride?

A

hydroxide is replace with fluoride to from fluorapetite.

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6
Q

what two things are required to form fluorapetite?

A

hydrogen

fluoride

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7
Q

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

A

10 ca, 6 po4

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8
Q

what proteins do saliva bind to in ssaliva?

A

CPP- casein phosphopeptide

ACP- amorphous calcium phosphate

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9
Q

what else do these proteins do? CPP, ACP

A

buffer ca and po ions from plaque, promoting remineralisation

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10
Q

name the three modes of action re. fluoride?

A

enamel solubility
effect on plaque bacteria
tooth morphology

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11
Q

describe enamel solubility:

A

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

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12
Q

describe the effects on plaque bacteria

A

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

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13
Q

describe the effect on tooth morphology

A

rounded cusps

shallower fissures

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14
Q

what studies have been carried out re. plaque bacteria?

A

Jenkins 1969

Edgar 1970

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15
Q

what is fluorosis?

A

caused by high fluoride exposure during tooth developement

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16
Q

what indicates mild fluorosis

A

fine white lines

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17
Q

what indicates moderate fluorosis

A

opaque discoloured enamel

18
Q

what indicated severe fluorosis

A

loss of enamel

19
Q

how is fluorosis caused?

A

reduced enamel matrix protein degregation
increased amelogenin retention
incomplete crystal growth

20
Q

what studies were carried out re. mottling

A

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

21
Q

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

A

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

22
Q

To what concentration is water fluoridated?

A

1ppm

23
Q

what case caused water fluoridation to cease in many areas?

A

McColl 1978

24
Q

where are the fluoridated areas in the UK?

A 
Birmingham
Newcastle
Bedford
durhan
Gateshead
derby
southhamptom
25
Q

What are systemic approaches to fluoridation?

A 
water
milk
salt
tablets
drop
26
Q

what are home methods of fluoride delivery?

A

toothpaste
mouthwashes
tablets

27
Q

what are dental surgery approached to fluoride delivery?

A

fluoride varnish

28
Q

what is the concentration of fluoride varnish?

A

22, 650 ppm

29
Q

what is the concentration of regular toothpaste?

A

1450 ppm

30
Q

what form does fluoride take in toothpastes?

A

sodium monofluoraphosphate
sodium fluoride
stannous fluoride

31
Q

what concentrations are prescription toothpastes?

A

2800- not for under 10s

5000- not for under 16s

32
Q

what is fatal dose re. fluoride poisoning?

A

5-10g

32-64 mg/kg

33
Q

what is toxic dose in children?

A

5mg/kg

34
Q

what are the symptoms of fluoride toxicity?

A 
nausea
vomiting
GI pain
muscular weakness
spasms
35
Q

what is the management for fluoride poisoning

A

milk

A+E

36
Q

what is the recommended dose re. fluoride varnish?

A

2-5 years: 0.25mls

6+: 0.4mls

37
Q

what concentrations should fluorides tablets/drops be given?

A

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

38
Q

detail the Strathclyde case. re water fluoridation

A

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

39
Q

what does the knox report conclude?

A

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

40
Q

what concentration re. fluoride mouthwash?

A

0.05%

225 ppm

41
Q

what % fluoride varnisih?

A

5%

22600 ppm

clinical practice (18 decks)

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