role of fluoride in dental caries

Question 1

how does the community receive fluoride?

Answer 1

water fluoridation

school based incentives e.g. child-smile

varnish from dentist

Question 2

how is fluoride delivered in the clinic?

Answer 2

varnish

fluoride gels and foams

slow-release fluoride from dental materials

Question 3

how may fluoride be delivered at home?

Answer 3

toothpaste

mouthrinse

fluoride tablets

Question 4

how does fluoride prevent caries?

Answer 4

infiltrates hydroxyapatite to create fluoro-apatite

This is much less susceptible to demineralisation

hinders bacterial acid production

Remineralises tooth structure

Decreases enamel solubility

Question 5

where and when does fluoride impact the most?

Answer 5

fluoride impacts the most topically and on early caries lesions

Question 6

benefits and risks of fluoride tablets?

Answer 6

• poor benefit : risk ratio
• effectiveness varied :
  
  • better when the tablet is swished around and not swallowed
  • better topically
• risk of fluorosis

Question 7

benefits and risks of mouthrinse?

Answer 7

the benefit of topical application

daily better than weekly but less cost-effective

good general compliance from patients

little to no risk unless swallowed or used too often

Question 8

benefits and risks of fluoride varnish? how does it work?

Answer 8

applied by any DCP

very high sustained topical fluoride concentration

Resin hardens in contact w/saliva, maintaining contact with the tooth.

calcium ions mobilise and fluoride ions form precipitation on the surface.

Question 9

any variations of mouthrinse that can be used?

Answer 9

ones with lower pH.

lower pH increases bioavailability for fluoride ions, so greater topical effect.

Question 10

what fluoride delivery does caries control mainly rely on? how is it boosted?

Answer 10

fluoride in saliva

fluoride at plaque fluid and tooth interface

fluoride in fluids around mineral crystals

boosted by delivery of fluoride e.g. rinse or varnish

and also boosted by frequency of fluoride exposure

Question 11

any issues with using fluoride?

Answer 11

fluorosis - risk is systemic

Question 12

what is the amount of fluoride for the risk of fluorosis in paediatric patients?

Answer 12

0.1mg f/kg body weight

no lower limit to where it doesn’t occur

Question 13

describe fluorosis symptoms

Answer 13

discoloured teeth due to fluoroapatite

mainly on permanent dentition when it erupts