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DPH Exam 2 > Topical Fluorides > Flashcards

Topical Fluorides Flashcards

(42 cards)

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1
Q

Most widely used fluoride treatments

A

o Fluoride varnishes
o Home rinses and gels
o Fluoride toothpastes
o Fluoride mouthwashes
o Fluoride supplements

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2
Q

Fluoride varnishes

A

o Application frequency for fluoride varnish ranges from 2 to 4 times per year
o Significant reduction in DMFS/dfs
o The CDC concluded that the quality of evidence for using fluoride varnish to prevent and control dental caries in children is Grade 1
o Strength of recommendation is A, and should be targeted toward populations at high risk for dental caries

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3
Q

In the United States, fluoride varnish has been approved
by the FDA for use as a

A

cavity liner and root desensitizer, but not specifically as an anti-caries agent

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4
Q

Varnish is a professionally applied, sticky resin of

A

highly concentrated fluoride (up to 22,600 ppm)

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5
Q

For caries prevention, fluoride varnish is an

A

“off label” product

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6
Q

examples of fluoride varnishes

A

look at slide 5

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7
Q

Fluoride varnishes – Cochrane review
13 trials that looked at children and adolescents with
permanent teeth found that the

A

young people treated with fluoride varnish experienced on average a 43% reduction in DMFS.

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8
Q

Fluoride varnishes – Cochrane review
10 trials looking at the effect of fluoride varnish on
primary teeth the evidence suggests

A

a 37% reduction in dfs

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9
Q

Fluoride gels

A

o Fluoride gels are professionally applied or prescribed for home use under professional supervision
o They are typically recommended for use twice per year or 4 times per year depending on the risk of the patient
o The CDC concluded that the quality of evidence for using fluoride gel to prevent and control dental caries in children is Grade 1
o Strength of recommendation is A, and should be targeted toward populations at high risk for caries

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10
Q

Fluoride gels: Acidulated phosphate fluoride (APF) gel

A
  • 2.72% APF delivers 12,300ppm F
  • formulated with NaF and 0.1M phosphoric acid
  • partially dissolves tooth surface and re-precipitates
    as FHAP
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11
Q

Fluoride gels: Neutral sodium fluoride (NaF) gel

A
  • 2% NaF delivers 9200ppm F
  • indicated for composite restorations, as neutral pH will not etch glass filler particles of composites
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12
Q

Home rinses and toothpastes

A
  • Rx products (daily or weekly use products)
  • 0.2% NaF (910ppm F)
  • 0.4% SnF 2 (970ppm F)
  • 1.1% NaF (5000ppm F)
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13
Q

Home gels

A
  • Rx products
  • 1.1% NaF (5000ppm F)
  • 0.4% SnF2 (1000ppm F)
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14
Q

Fluoride gels – Cochrane review

A
  • Moderate quality evidence of a large caries-inhibiting effect of fluoride gel in the permanent dentition.
  • Caries-preventive effect of fluoride gel on the primary dentition, which also shows a large effect, is based on low quality evidence from only three placebo-controlled trials.
  • Little information on adverse effects or on acceptability
    of treatment.
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15
Q

Professional topical F products – ADA recommendations

A

look at slides 11 through 15

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16
Q

Fluoride toothpastes

A

o Toothpaste is the most recognizable source of topical
fluoride
o The addition of fluoride to toothpaste began in the late
1950s
o Brushing with fluoridated toothpaste is associated with at least a 24% reduction in DMFT/DMFS
o The CDC concluded that the quality of evidence for
fluoridated toothpaste in reduction of caries is grade 1
o Strength of recommendation is A and should be used by everyone

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17
Q

Fluoride toothpastes: Sold as pastes or gels

Study These Flashcards
A
  • Both contain similar levels of active
  • Both contain similar abrasive systems
  • no difference in abrasivity between pastes and gels
18
Q

Fluoride toothpastes: FDA allows three different F sources to be used in the U.S.

Study These Flashcards
A
  • Sodium fluoride (NaF)
  • Sodium monofluorophosphate (Na2PO3F)
  • Stannous fluoride (SnF2)
  • all three F actives have been demonstrated clinically effective
19
Q

Fluoride toothpastes: Outside the U.S. (Europe)

Study These Flashcards
A
  • Amine fluoride (AmF)
20
Q

When used as directed, brushing with fluoride toothpaste is both safe and effective; and it represents

Study These Flashcards
A

one of the most cost effective means available for preventing and reversing the caries process.

21
Q

Sodium Fluoride (NaF): Often referred to as the “simple” fluoride

Study These Flashcards
A
  • Ionic form of fluoride
  • F is released upon contact with saliva
  • Available to react with tooth surface almost immediately
  • Marketed products contain 0.22 - 0.33% NaF (1000-
    1500ppm F)
  • Clinical efficacy in the 25-50% range (vs. placebo)
  • Also demonstrated effective against root caries
22
Q

Sodium Monofluorophosphate (Na2PO3F): More complex than sodium fluoride

Study These Flashcards
A
  • Less reactive form of F
  • Can be formulated with a wide range of abrasive systems
  • Silica, CaCO3, dicalcium phosphate dihydrate (DCPD)
  • Marketed products contain 0.76 – 1.14% SMFP (1000 – 1500ppm F)
  • Clinical efficacy approximately 15-30% (vs. placebo)
23
Q

Stannous Fluoride (SnF2)Z: A “double action” fluoride / **dental erosion

Study These Flashcards
A
  • Ionic form of fluoride
  • Provides efficacy against bacterial acids as well as fluoridating benefits
  • Tin (stannous) coats tooth surface to provide a protective barrier against acid attack
  • F penetrates tooth surface to enhance remineralization
  • Highly reactive species
  • Difficult to formulate
  • Most effective formulations are those that are “stabilized” using various proprietary methods
  • Current products contain 0.454% SnF 2 (1100ppm F)
  • Clinically proven effective against caries, plaque and gingivitis, dental erosion, sensitivity and halitosis
24
Q

Amine Fluoride (AmF3): A surfactant based fluoride

Study These Flashcards
A
  • Claimed to attach to tooth surface via a surfactant chain
  • Published clinical performance similar to SMFP
  • Not allowed to be marketed in the US under the FDA anticaries monograph; available in Europe
  • Marketed products commonly contain up to 1500ppm F
25
No clinical trials have demonstrated the combination of F actives provides
greater anticaries effectiveness than a single active product formulated at the same level of total F
26
some combination fluoride systems (outside the US) provide additional benefits, such as
erosion protection, gingivitis benefits and sensitivity reduction that individual F sources might not provide
27
Examples of combination active products include:
- NaF + SMFP - SnF2 + NaF - AmF + SnF2
28
Fluoride supplemented with calcium
No clinical trials have demonstrated the combination of F actives with calcium containing ingredients provides greater anticaries effectiveness than fluoride alone.
29
1gram of toothpaste =
1mg of Fluoride
30
Fluoride toothpaste – Cochrane review This review confirms the benefits of using fluoride toothpaste in preventing caries in children and adolescents when compared to placebo, but only significantly for fluoride concentrations of
1000 ppm and above. The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration.
31
Strategies to Minimize Toothpaste Ingestion
* Limit the amount of toothpaste on the toothbrush * Discourage children from swallowing toothpaste * Encourage spitting of toothpaste * Supervise brushing until spitting can be ensured
32
Fluoride mouthrinses
o Mouthrinses containing fluoride are recommended to be used in a “swish and spit” manner for children at least age 6 o Mouthrinses are available over the counter. * Daily use of a 0.05% sodium fluoride rinse may benefit children over 6 years who are at high risk for dental caries * No additional benefit shown beyond daily fluoridated toothpaste use for children at low risk for caries o The CDC concluded that quality of evidence for fluoride mouthrinses is Grade 1 o Strength of recommendation is A and should be targeted toward populations at high risk for dental caries
33
Fluoride mouthrinses: OTC products (daily use products)
* 0.05% NaF (250ppm F): 1x/day use * 0.02% NaF (125ppm F): 2x/day use
34
Confirmation of anticaries effectiveness: ADA Seal of Acceptance guidelines
* Sets a higher standard than FDA * In addition to meeting FDA requirements, manufacturers must demonstrate fluoride release profiles, provide fluoride stability data, and conduct more robust efficacy modeling compared to standard FDA tests
35
Fluoride supplements: Local Water
slide 32
36
New Approaches to Caries Control
Silver Diamine Fluoride 38%
37
Silver Diamine Fluoride - Description
o Silver Diamine Fluoride (SDF) is a clinically applied treatment that is approved for use in treating hypersensitivity o SDF has also been shown to be effective in controlling active dental caries and aid in preventing further progression of the disease o SDF has a dual mechanism of action o The silver component acts as an anti-microbial agent, killing bacteria and preventing the formation of new biofilm o The fluoride acts to prevent further demineralization of tooth structure.
38
Silver Diamine Fluoride - Application
o Application of SDF is simple and noninvasive o Initially, the teeth are brushed without paste and rinsed o Carious teeth are isolated, kept dry, and excess debris is removed o A microbrush is used to place a drop of SDF on the lesion(s) - for two minutes o Excess SDF is removed and patients are instructed to not eat or drink for one hour
39
Silver Diamine Fluoride – Side Effects
o The primary side effect is permanent staining of the decayed tooth area at the site of application. o Once arrested, stain tooth areas can be replaced with a filling or a crown o Healthy tooth structure will not stain o Tooth colored fillings and crowns may discolor if SDF is applied to them (these can normally be polished off) o If accidentally applied to the skin or gums, a harmless brown or white stain may occur; this will usually disappear in one to three weeks
40
Silver Diamine Fluoride - Cost
o Each bottle of Silver Diamine Fluoride contains 8 mL, which provides approximately 160 drops of product. o If 4 drops of SDF are required per person, 160 drops will treat roughly 40 people. o Depending on the cost that you are able to acquire the product, it has the potential to be very cost effective, especially considering the high level of effectiveness that has been reported.
41
How Erosion Differs from Caries
- Strong acids (citric acid) - Surface damage - saliva and pellicle are overwhelmed - Irreversible surface damage - Prevention is key for managing
42
The primary mechanism of action of fluoride in preventing dental caries is
topical * It inhibits demineralization of the tooth enamel * It enhances remineralization of the tooth enamel * It makes cariogenic bacteria less able to produce acid from carbohydrates

DPH Exam 2 (3 decks)

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