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BDS2/3 Caries Symposium 2 > Role of Fluoride in Caries Prevention > Flashcards

Role of Fluoride in Caries Prevention Flashcards

1
Q

What fluoride therapy is available in the community?

A
  • School-based brushing and varnish (childsmile)

- Water (some areas)

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2
Q

What fluoride therapy is available/done in clinic?

A
  • Varnishes
  • Gels and foams

-Slow release devices (GI etc)

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3
Q

In what setting is there the most fluoride exposure/therapy?

A

At home

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4
Q

What fluoride therapy can be done at home?

A
  • toothpaste
  • mouthrinse

-tablets

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5
Q

What is SDF and when is it good to use?

A

Silver diamine fluoride

Is good for active carious lesions in primary dentition

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6
Q

How does fluoride prevent caries?

A
  • it promotes remineralisation

- it forms fluoro-apatitie which is less susceptible to demineralisation than hydroxyapatite

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7
Q

Is the topical or systemic effect of Fl- greater?

A

The topical effect

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8
Q

What might fluoride also have an effect on which does something to acid levels?

A

May have an effect on bacteria and metabolic pathways resulting in less acid being produced

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9
Q

What is the key to maintaining elevated levels of oral fluoride for as long as possible?

A

Little amounts often

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10
Q

On what lesions is Fl- most effective?

A

EARLY lesions

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11
Q

The oral reservoir of Fl- is small. What are the 2 broad types of resevoir?

A
  • Mineral deposits (CaF2 in saliva and fluid phase of plaque)
  • Biologically/bacterially bound calcium-fluoride
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12
Q

The aim is to keep F levels in oral fluids at what level?

A

Cariostatic level

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13
Q

Are fluoride tablets any good?

A

some studies showed reductions in caries but flawed designs

Topical effect of chewing and swishing around the mouth is what gave any effect

Systemic effect not proven to do anythin

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14
Q

What are the UK guidelines for Fl- tablets?

A

It is NOT a public health measure

May be applicable to high risk children

Poor risk-benefit balance

Compliance issues

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15
Q

Fluoride mouthwashes see a reduction in caries by around what percent?

A

30

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16
Q

Is daily or weekly rinsing with Fl- mouthwashes more efective?

A

daily

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17
Q

Doing what with the Fl- mouthwash is important for the efficacy?

A

Swishing it around the mouth

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18
Q

What is the P compliance like with the FL- mouthrinses?

A

generally good compliance

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19
Q

What is the benefit to risk ratio like for Fl- mouthwashes?

A

good ratio

cost benefit ratio is also low

20
Q

What is the fl conc in varnish?

A

22,600 ppm

21
Q

What kind of contact is there with varnish?

A

Sustained contact

22
Q

How does fluoride varnish work?

A

The colophony resin hardens in contact with saliva to maintain contact of fluoride with the tooth

During the contact there is mobilisation of calcium ions in the enamel and precipitation of calcium fluoride onto the tooth surface

23
Q

The absorption of fl from the varnish onto tooth surface (enamel and dentine) is what?

A

rapid

24
Q

After a single application, the fl content of enamel can increase up to what percent?

A

70%

25
Q

The Fl- release from varnish can last how long?

A

several months

26
Q

How does calcium fluoride work?

A

When there is an acid attack the pH falls. Fl- has greater bioavailability when pH is lower so more Fl is released leading to remineralisation

27
Q

What are acidulated mouthwashes and how do they work?

A

Low pH mouthwashes.

They stimulate mild demineralisation on tooth surfaces but presence of fluoride from the washes remineralies it.

It is an effective means of getting Fl into teeth (more so than non-acidulated mouth rinses)

28
Q

Fluoride mousses are useful where? What is the downfall?

A

In markets with no access to high fluorides (no professionals etc)

There needs to be more evidence regarding them

29
Q

Describe Fl- release from GI/RMGI.

A
  • slow diffusion
  • very small amount but sustained

-possible fl recharge of the GI

30
Q

Describe how Fl- aids remineralisation of tooth surface.

A

The Fl- ions absorbed into tooth surface act as nucleators

Ca, P are attracted which drives the formation of new mineral (hydroxyapatite)

31
Q

What factors determine the anticaries activity of Fl- toothpastes? (4)

A
  • Fl- conc
  • Frequency of application
  • Rinsing behaviours
  • When brushing takes place
32
Q

For every 500ppm increase of Fl- in toothpastes, what is the reduction in caries percent?

A

6-7%

33
Q

The choice of toothpaste for specific patients depends on what?

A

Careful risk benefit assessment

34
Q

Describe how the frequency of brushing/application effects the toothpastes anticaries effect?

A

More frequent brushing results in lower caries increments

35
Q

Describe how rinsing behaviour affects the fluoride concs in the mouth after brushing. (rinsing with small water volume vs large water volume)

A

Rinsing with small water vol. removes excess fl in the mouth and a little fl is retained (reservoirs maintained)

Rinsing with large vol. = removal of excess fluoride and reduces the fl in the mouth (rinses out reservoirs as well)

36
Q

Is rinsing with or without a beaker worse ? (cup vs cupped hands etc)

A

with a beaker is worse

37
Q

What are the optimal brushing conditions?

A
  • twice daily
  • no rinsing

-1500ppm F paste

38
Q

Optimal brushing vs sub-optimal brushing led to what % diff in caries incidence?

A

40-50%

39
Q

Does the quantity of toothpaste applied correlate with efficacy?

A

Not really - quantity of toothpaste not strong associated with efficacy

40
Q

What are the risk of using fluoride?

A
  • inevitable ingestion in young people which can lead to fluorosis
  • increased risk of enamel fluorosis
41
Q

Acute toxicity from ingesting Fl is very rare but in what group is it a potential prob?

A

In very young children

42
Q

What is chronic toxicity from Fl?

A

Developmental defect of enamel (fluorosis)

43
Q

What is the general consensus about how much fl a young child has to swallow to risk fluorosis?

A

0.1mg/kg body weight

1mg per day for 1y/o or 2mg/day for 5-6y/o

44
Q

Although 0.1mg.kg is the general consensus of fl swallowed to risk fluorosis, what is the lower limit?

A

There is NO LOWER LIMIT below which fluorosis does not occur

NOTE: there seems to be a dose response to severity

45
Q

The bioavailability of ingested Fl is affected by what?

A

Stomach contents

i.e. full stomach = lower bioavailability

46
Q

Describe the impact of an increase in toothpaste conc vs an increase in toothpaste quantity on mg of Fl ingested and therefore increase of fluorosis

A

increase in conc has less effect than increase in quantitiy

47
Q

What can we do to maximise caries benefit but reduce fluorosis risk in young children?

A
  • keep toothpaste out of reach
  • Brush frequently
  • Supervise brushing by young children to reduce risk of swallowing
  • use small amount of toothpaste (smear or pea)
  • discourage swallowing
  • Brush after meals t minimise effect of fluoride ingestion
  • encourage spitting out
  • avoud excess rinsing (SPIT DONT RINSE)
  • Use fl- conc with regards to risk of caries in child

BDS2/3 Caries Symposium 2 (1 decks)

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