The Role of Fluoride in Caries Prevention

Question 1

__-% of adults aged 20-64
have had dental caries in
permanent teeth

Answer 1

92% of adults aged 20-64
have had dental caries in
permanent teeth

Question 2

____% of adults aged 20-64
have untreated decay

Answer 2

26% of adults aged 20-64
have untreated decay

Question 3

What will fluoride do for
caries?
* tx on its own?
* Oral hygiene/plaque control?
* Dietary habits?

Answer 3

What will fluoride do for
caries?
* Fluoride is a SUPPLEMENT to caries prevention-not a
solution on its own
* Oral hygiene/plaque control is priority
* Dietary habits must be addressed with patient

Question 4

Types of Fluoride
Therapy

Answer 4

systemic and topical

Question 5

Systemic application:

Answer 5

Systemic application: ingested agents that become incorporated into forming tooth structures
* Water
* Supplements
* Food/beverages

Question 6

Topical application:

Answer 6

Topical application: strengthen teeth
already in the mouth making them more
resistant to caries
* Water
* Homecare products (toothpaste,
mouth rinses, etc.)
* In-office products

Question 7

mechanism of systemic application

Answer 7

ingested and incorporated into
enamel during development of
tooth structures
less soulble hydroxyapatite

Question 8

promotes? inhibits?

mechanism of topical application

Answer 8

*Promotes remineralization and
prevents demineralization after
eruption
*Inhibits glycolysis in bacteria,
thereby inhibiting the ability of
bacteria to metabolize
carbohydrates and produce acid

Question 9

Water
Fluoridation

Answer 9

• An increase of the natural fluoride level in a community’s water supply to a level optimal for dental health
• Fluoridation has contributed to a major decline in dental caries from the 1950s to the 1980s and continues to reduce and prevent tooth decay
• When cities discontinue water fluoridation, evidence demonstrates rapid increase in caries rates
• Water fluoridation is considered one of the most cost-effective preventive dental

Question 10

Levels of Water Fluoridation

Answer 10

Question 11

Fluorosis?

Answer 11

Changes in the appearance
of enamel caused by too
much systemic fluoride

Question 12

how does flourosis compare to demineralization

Answer 12

Question 13

Will individuals with fluorosis be susceptible
to caries?
Why or why not?

Answer 13

no, these teeth are more minerlaized

Question 14

results in? where is [] highest? F subbed where? fluorosis?

How does
Topical Fluoride
work?

Answer 14

• Fluoride deposited in enamel during enamel maturation phase results in a concentration of fluoride in the enamel
• Highest concentration occurs on the outermost portion (5-10 microns) and decreases as you move toward the dentin
• Fluoride ions are substituted into the hydroxyapatite crystal and form a stable, more compact bond making
  the tooth resistant to demineralization
• It does NOT cause fluorosis

Question 15

influenced by? acidic/ ^ [] forms? in office? neutral?

Fluoride/Enamel
Reaction

Answer 15

Influenced by concentration of fluoride, pH of fluoride, and length of exposure
* Acidic fluorides typically form calcium
fluoride
* Higher concentrations form calcium fluoride
* In-office fluorides are >9000 ppm, so
they typically form calcium fluoride
* Neutral fluorides <100 ppm form fluorapatite

Question 16

mineral? bac metab? prevents?

Benefits of Topical Fluoride- continued

Answer 16

Question 17

%/ppm, available as?

Types of Topical Fluoride Applications

Answer 17

Question 18

initial deposits? where is the increase in F? this causes?

Caries & Topical Fluoride

Answer 18

• Initial deposits of fluoride is not permanent: Relatively rapid loss after 24 hours, Loss continues for several weeks
• After every application of topical fluoride, there is an increase in the amount of permanently bound fluoride in the outermost layer of enamel
• This causes a decrease in caries susceptibility (initiation and progression)

Question 19

Types of Fluoride integration

Answer 19

Fluorohydroxyapatite- most desired form of fluoride for enamel in caries prevention
* From prolonged exposure of enamel to low concentrations of fluoride

Calcium fluoride- source of fluoride for
remineralization of enamel
* Deposits of calcium fluoride are
dissolved by plaque acids and are
available as a source to facilitate
remineralization

Question 20

Benefits of Topical Fluoride
* The benefits of topical fluoride treatments is directly related to?
* The type of topical fluoride system used?
* Does not benefit?
* Greater uptake with?

Answer 20

• The benefits of topical fluoride treatments is directly related to the amount of topical fluoride treatments
  provided
• The type of topical fluoride system used does not affect the benefit
• Does not benefit sound enamel
• Greater uptake with higher concentrations of fluoride

Question 21

When Should Topical
Fluoride Be Used?

Answer 21

• High caries risk individuals
• Sensitive teeth/exposed root surfaces
• Around margins of older restorations
• Overdentures (with natural teeth)
• Xerostomia
• Newly erupted teeth

Question 22

possible tx for each dose?

Probable Toxic Dose (PTD)

Answer 22

Question 23

burns? enzymes? Ca? cardio?

Fluoride Toxicity possible rxns

Answer 23

Question 24

Signs & Symptoms of too much Fluoride

Answer 24

Question 25

# efficacious? ease? post-op? Fluoride Varnish- 5% NaF pros

Answer 25

* Proven efficacious in decreasing caries, especially in early-childhood * Easy to apply following oral exam and prophylaxis * Easy to follow post-op instructions

Question 26

Fluoride Varnish- 5% NaF cons

Answer 26

* Leaves a thin-visible film on teeth that some patients do not like * Possible allergies linked to specific brands of fluoride varnish

Question 27

# tooth surface? reatined for? occur every? Application of Fluoride Varnish

Answer 27

* Applied to clean tooth surfaces (following a prophylaxis or toothbrushing) * Varnish is retained on teeth from 24-48 hours after application, during which time fluoride is released for reaction with the underlying enamel * Applications should occur every 3-6 months (dependent upon caries risk)

Question 28

water flouridation and toothpastes, when to use F tx?

Answer 28

Question 29

* SDF compared to flouride varnish alone when is this not true?

Answer 29

* SDF was also superior at arresting dental caries and preventing new caries compared to fluoride varnish alone, however, did not hold true when used as a sealant over NON-cavitated molar grooves

Question 30

# approved for? SDF gained clearance from the FDA in the US in _____

Answer 30

2014 | Approved for use to treat dentin hypersensitivity in adults

Question 31

# how is it soluble? affect on bacteria? products? color? Mechanism of SDF

Answer 31

* Fluoride and silver are made soluble in water by the addition of ammonia * The silver ions are a broad-spectrum antimicrobial that has high biocompatibility and low toxicity in humans * These ions act as tiny ‘silver bullets’ that damage and degrade bacterial cell walls, disrupt bacterial DNA synthesis and replication and disrupt intracellular metabolic activity, eventually leading to cell death * The killed bacteria further act as a carrier for silver ions and can kill living bacteria nearby in a process known as the “zombie effect * Once applied, a physical barrier precipitates out of the clear solution onto the carious lesion * 2 products form–silver phosphate which acts as a reservoir of phosphate ions, and calcium fluoride, which is a pH-regulated fluoride supply available during cariogenic challenge * Free silver ions in the lesion are reduced by environmental oxygen and turn the lesion black, which is the major nonmedical side effect of SDF

Question 32

# %/ppm? why this %? how many uses? Concentration of SDF

Answer 32

* 5% SDF solution contains 44,800 ppm fluoride (almost twice as much as % NaF varnish) * In this concentration, SDF reacts with calcium and phosphate ions to produce fluorohydroxyapatite crystals, which are less susceptible to solubility and crucial to tooth remineralization * Despite the high concentration, the small amount of SDF required to be effective suggests that it is well within the margin of safety for use * One application of SDF is not sufficient for ultimate results- may need to place SDF a few times for effectiveness in treating the area

Question 33

When to Use SDF

Answer 33

* Dentin hypersensitivity * Uncooperative patients (i.e., children or patients with cognitive disabilities), root surface caries on elderly patients with existing restorations, patients without access to restorative care, difficult to treat lesions

Question 34

# dry? application vehice? leave on for? color? taste? contraindication? Placement of SDF

Answer 34

Question 35

Prophy Paste & Fluoride * Fluoridate prophy paste is not considered? * Polishing alone removes?

Answer 35

* Fluoridate prophy paste is not considered a therapeutic/preventive agent for caries * Polishing alone removes 0.1-1.0 microns of fluoride-rich enamel, therefore, at best, fluoride in prophy paste will replace the fluoride lost by the abrasive paste

Question 36

# average con? risk? most effective dentifrice system? risk with ingestion? Toothpastes (OTC) and F

Answer 36

* Average Concentration 0.22% NaF (1000 ppm) * Sodium Fluoride (NaF) most effective dentifrice system for caries prevention * Risk of fluorosis and toxicity if ingested (hence, pea-sized amount for small children)

Question 37

# 33 vs 18 oz? %/ppm? flouride rinses ingredient lists

Answer 37

Question 38

# mineralizes? effect on enamel? breath? what flouride rinses do

Answer 38

Question 39

how to use flouride rinses

Answer 39

Question 40

Other Types of ACT Rinse

Answer 40

* All the active ingredients remain the same between 18 oz and 33.8 oz bottles 18oz: 0.05% NaF (225ppm) 33oz: 0.02% NaF (100ppm)

Question 41

Listerine * % Sodium Fluoride (ppm)? * % v/v alcohol? * difference in instructional use?

Answer 41

Listerine * 0.02% Sodium Fluoride (100 ppm) * 21.6% v/v alcohol * No difference in instructional use

Question 42

# MI paste vs MI plus contraindication? MI PASTE PLUS(available OTC)

Answer 42

Question 43

# %NaF/ppm Fluoridated Toothpaste/Mouthrinse (Prescription Only, prevident)

Answer 43

Prevident toothpaste: 1.1% NaF (5000 ppm) Prevident mouth rinse: 0.2% NaF (900 ppm)