prevention lecture

Question 1

When should children first be referred to the dentist?

Answer 1

1 yr, or within 6mo of their first tooth erupting. whichever comes first

Question 2

High risk children should have a dental home established by _________

Answer 2

6mo

Question 3

Caries in primary teeth (are / aren’t) predictive of caries in permanent teeth

Answer 3

are

Question 4

What are the family/parent risk factors for children’s dental caries?

Answer 4

socioeconomic status
mom’s age
smoking status
parents education level (strongly predictive)

Question 5

Routine recall frequency is ______ but can be ______ in high risk children

Answer 5

6mo

more frequent

Question 6

What is “anticipatory guidance”

Answer 6

Alerting parents to impending changes in their child’s dental development at various stages of development

Question 7

what fluoride product types have the lowest concentration of fluoride?

Answer 7

Rinses (220ppm)

Question 8

What is the cost per capita of water fluoridation?

Answer 8

$0.12 to $5.41

Question 9

When should children first be exposed to fluoride?

Answer 9

once they have their first tooth erupt

Question 10

Brushing should begin when?

Answer 10

as soon as the first tooth erupts

Question 11

When should flossing begin?

Answer 11

when there is proximal contact between teeth (usually around 2yrs)

Question 12

Kids aged ______ should only use a “smear” of toothpaste on their toothbrush (to prevent ingestion)

Answer 12

under 2

Question 13

Kids aged ______ should use a “pea sized” amount of toothpaste

Answer 13

2-5yrs

Question 14

Plasma fluoride concentrations associated with water fluoridation are (consistent / inconsistent)

Answer 14

consistent (thus less fluorosis risk exists)

Question 15

Plasma fluoride concentrations associated with dietary fluoride supplements are (consistent / inconsistent)

Answer 15

inconsistent (thus more fluorosis risk exists with these products)

Question 16

Amount of fluoride found in NON-fluoridated water? Fluoridated?

Answer 16

non-fluoridated = 0.01-0.02ppm
fluoridated = 0.03-0.04ppm
(this small difference confers caries resistance)

Question 17

recommended water fluoridation concentration?

Answer 17

0.7 - 1.2ppm

Question 18

EPA only steps in if drinking water fluoride levels exceed what?

Answer 18

2ppm (EPA notifies community)

4ppm (EPA orders de-fluoridation)

Question 19

Which state has the worst water fluoridation?

Answer 19

Hawaii

Question 20

What % of the US population recieves fluoridated drinking water?

Answer 20

73.9%

Question 21

No more than ______ of dietary fluoride should be prescribed to someone

Answer 21

120mg

Question 22

How much supplemental dietary fluoride should be prescribed to a 0-6 month old?

Answer 22

none (no matter the fluoride concentration in drinking water)

Question 23

How much supplemental dietary fluoride should be prescribed to a 6mo - 3yr old?

Answer 23

if drinking water has…

Question 24

How much supplemental dietary fluoride should be prescribed to a 3-6yr old?

Answer 24

if drinking water has…

Question 25

How much supplemental dietary fluoride should be prescribed to a 6-16yr old?

Answer 25

if drinking water has

Question 26

What consumer beverage tends to have the highest fluoride levels?

Answer 26

grape juice (2-4ppm)

Question 27

The (systemic / topical) effects of fluoride are most important after the tooth has calcified

Answer 27

topical

Question 28

How is fluoride concentration distributed in the tooth?

Answer 28

first 10-20 microns of enamel are highly fluoridated

Question 29

What are the degrees of fluorosis?

Answer 29

``` mild = white lacy appearance moderated = some brown staining severe = enamel hypomineralization ```

Question 30

Mild fluorosis is caused by ingesting how much fluoride?

Answer 30

2mg/day

Question 31

Why does fluorosis cause hypomineralization?

Answer 31

Too much fluoride is toxic to ameloblasts

Question 32

Are teeth with fluorosis more resistant to caries?

Answer 32

No (but I thought Dr Carey said the opposite... oh well)

Question 33

When is a person most susceptible to fluorosis?

Answer 33

before age 6, and SPECIFICALLY 18mo-36mo (during calcification of MX incisors)

Question 34

Symptoms of chronic fluoride toxicity?

Answer 34

Fluorosis (1st symptom) Joint and skeletal pain Malaise Loss of conciousness

Question 35

The Institute of medicine determined that the daily adequate fluoride intake level is _______

Answer 35

0.05mg/kg

Question 36

Safe daily consumption of fluoride for adult females? males?

Answer 36

adults females = 3mg | adult males = 4mg

Question 37

Safe daily consumption of fluoride for children?

Answer 37

``` 4-8yrs = 1mg 9-13yrs = 2mg 14-18yrs = 3mg ```

Question 38

How much fluoride is contained in a single tube of toothpaste?

Answer 38

130mg

Question 39

After age ______ fluorosis isnt a concern because permanent teeth (except for 3rds) have finished calcifying

Answer 39

8yrs

Question 40

Acute fluoride toxicity symptoms?

Answer 40

GI upset convulsions coma death in 2-4hrs

Question 41

What are the mechanisms for acute fluoride toxicity?

Answer 41

corrodes stomach lining binds up calcium, causing muscle spasms inhibits enzymes

Question 42

What is the "certain" lethal dose of fluoride?

Answer 42

32-64mg/kg (15mg/kg is the "probable" lethal dose)

Question 43

what is the toxic dose of fluoride?

Answer 43

5-8mg/kg

Question 44

What should be done is someone is exposed to a large dose of fluoride?

Answer 44

- ingest soluble calcium! (milk, antacids) | - go to ER

Question 45

Fluoride mouth rinses are indicated when?

Answer 45

- orthodontics - radiation therapy - high caries risk - prosthetics

Question 46

Should you give fluoride mouth rinses to children?

Answer 46

no, not for infants or young children (they'll swallow it)

Question 47

Does the pellicle need to be removed before varnish application?

Answer 47

no (pellicle doesn't inhibit fluoride uptake)

Question 48

Fluoride foam and gel require a minimum of _____ minutes in contact with teeth to be effective

Answer 48

4 minutes

Question 49

Has flouride varnish been associated with fluorosis?

Answer 49

nope

Question 50

Fluoride varish (is / isn't) approved for use as a cariostatic agent

Answer 50

isn't (this is a common off-label use)

Question 51

After varnish is applied, what instructions should be given to the patient?

Answer 51

- dont brush/floss until next morning (or 4-6hrs if absolutely necessary) - soft food only - no hot drinks

Question 52

Does the bacterial flora of the mouth adapt to metabolize xylitol?

Answer 52

no (theres no published evidence of this)

Question 53

How much xylitol is needed to be effective?

Answer 53

>5mg per day

Question 54

Should chlorhexidine rinses be used for caries prevention?

Answer 54

no, not until further evidence supports it. Other methods are better at this time.

Question 55

What age should children get sealants?

Answer 55

age is not a consideration

Question 56

What FDA approved topical agent is used to arrest decay, but causes black staining?

Answer 56

silver diamine fluoride

Question 57

anticariogenic foods tend to be high in what?

Answer 57

protein, fat, and minerals

Question 58

If someone sees dental care as "not important" how should you use motivational interviewing to change their mind?

Answer 58

- dont give advice - ask about their values and goals - ask what they want their life to be like

Question 59

if someone has "low confidence" about oral health how should you use motivational interviewing to change their mind?

Answer 59

- provide info and advice - ask what will help change - ask about past successes, challeneges, strategies - ask about strengths, abilities