Fluoride and Dental Caries Prevention
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Questions and Answers

How does fluoride contribute to the prevention of caries?

  • By promoting enamel glossiness
  • By enhancing saliva production
  • By increasing tooth sensitivity
  • By making teeth more resistant to demineralization (correct)
  • What is the primary mechanism by which fluoride is absorbed during the pre-eruptive stage?

  • Via direct application on the teeth
  • By being swallowed (correct)
  • Through foods high in calcium
  • Through the saliva
  • Which component does fluoride replace in the enamel during tooth formation?

  • Calcium phosphate
  • Fluorapatite
  • Dentin
  • Hydroxyapatite (correct)
  • What may occur due to excess fluoride during enamel development?

    <p>Discoloration known as fluorosis (A)</p> Signup and view all the answers

    During which stage does fluoride deposition primarily occur after calcification but prior to tooth eruption?

    <p>Maturation stage (A)</p> Signup and view all the answers

    Who documented the 'stain' on teeth in Colorado Springs in 1916?

    <p>Dr Frederik McKay (B)</p> Signup and view all the answers

    What investigation did Churchill conduct in 1931?

    <p>He tested water samples for fluoride content. (A)</p> Signup and view all the answers

    What was suggested by McKay in 1932 regarding fluoride?

    <p>Fluoride may reduce the chance of caries. (D)</p> Signup and view all the answers

    What was Dr H Trendley-Dean assigned to research?

    <p>The relationship between fluoride, mottling, and decay. (A)</p> Signup and view all the answers

    What was identified as a possible cause of mottling according to Churchill's findings?

    <p>High fluoride content in water. (A)</p> Signup and view all the answers

    How did the teeth with mottling differ in terms of decay compared to normally calcified teeth according to McKay?

    <p>They showed no greater chance of decay. (A)</p> Signup and view all the answers

    What role did GV Black play in relation to the Colorado stain?

    <p>He collaborated with McKay to investigate the stain. (C)</p> Signup and view all the answers

    What innovation followed McKay's investigation regarding fluorosis?

    <p>Addition of fluoride to public water supplies. (D)</p> Signup and view all the answers

    What is the consequence of frequent acid attacks on dental health?

    <p>Increased risk of caries (A)</p> Signup and view all the answers

    What is the atomic number of fluorine?

    <p>9 (A)</p> Signup and view all the answers

    Which of the following is NOT a natural source of fluorine?

    <p>Artificial sweeteners (B)</p> Signup and view all the answers

    What is a significant historical study related to fluoride and caries reduction?

    <p>Ainsworth UK water fluoride comparison studies (B)</p> Signup and view all the answers

    What reaction occurs between fluorine and metals?

    <p>Forms salts or halides (A)</p> Signup and view all the answers

    Which year marked the first experiment of artificial water fluoridation?

    <p>1945 (B)</p> Signup and view all the answers

    In which year did the Royal College of Physicians conduct an enquiry into water fluoridation?

    <p>1976 (C)</p> Signup and view all the answers

    What term is often used to refer to fluoride when it bonds with other elements?

    <p>Halides (A)</p> Signup and view all the answers

    Who was involved in the investigation of Colorado Stain related to fluoride?

    <p>Frederick McKay (D)</p> Signup and view all the answers

    What is the classification of fluorine on the periodic table?

    <p>Halogen (C)</p> Signup and view all the answers

    What effect does fluoride have on the wettability of enamel?

    <p>Decreases wettability (B)</p> Signup and view all the answers

    How does reduced pellicle formation impact plaque accumulation?

    <p>Decreases plaque accumulation (B)</p> Signup and view all the answers

    Which of the following structural changes may result from systemic fluoride during tooth development?

    <p>Shallower pits (B)</p> Signup and view all the answers

    What is root caries primarily associated with?

    <p>Exposure of dentine and cementum (D)</p> Signup and view all the answers

    Which group is more susceptible to root caries?

    <p>Patients with xerostomia (B)</p> Signup and view all the answers

    Which mechanism does fluoride use to reduce the likelihood of root caries?

    <p>Providing antibacterial effects (B)</p> Signup and view all the answers

    What is one of the main benefits of fluoride during the remineralization process?

    <p>Incorporating into tooth surfaces (B)</p> Signup and view all the answers

    What happens to bacteria adherence due to fluoride's effectiveness?

    <p>Reduces as enamel wettability decreases (A)</p> Signup and view all the answers

    What causes the drop in pH during the post-eruptive stage?

    <p>Bacterial acid production (B)</p> Signup and view all the answers

    Which mineral is primarily lost from the tooth surface during demineralization?

    <p>Calcium (A)</p> Signup and view all the answers

    What is the primary function of fluoride during the post-eruptive stage?

    <p>To reduce the progression of caries (A)</p> Signup and view all the answers

    Why is the uptake of fluoride greater in the first few years post-eruption?

    <p>The teeth are more porous (C)</p> Signup and view all the answers

    What composes fully reformed hydroxyapatite after remineralization?

    <p>Calcium and phosphate (D)</p> Signup and view all the answers

    What role does demineralized enamel play concerning fluoride absorption?

    <p>It facilitates fluoride absorption (C)</p> Signup and view all the answers

    What happens when fluoride is applied topically to teeth?

    <p>It does not penetrate deeply (A)</p> Signup and view all the answers

    Which statement regarding fluoride replacement is accurate?

    <p>Fluoride can be replaced as the tooth surface is abraded (D)</p> Signup and view all the answers

    What is the significance of fluoroapetite in dental health?

    <p>It enhances the hardness and stability of tooth enamel. (A)</p> Signup and view all the answers

    How does fluoroapetite contribute to reducing caries incidence?

    <p>By promoting remineralisation and inhibiting demineralisation. (B)</p> Signup and view all the answers

    What is the critical pH of fluoroapetite, and why is it important?

    <p>4.5; it makes the tooth more resistant to acid attacks. (C)</p> Signup and view all the answers

    What is one way fluoride contributes to tooth remineralisation?

    <p>Through bonding with calcium to form calcium fluoride. (C)</p> Signup and view all the answers

    Which of the following topical fluoride sources generally does not require a prescription?

    <p>Water Fluoridation (C)</p> Signup and view all the answers

    Why is a regular supply of low-level fluoride important for dental health?

    <p>It prevents the loss of fluoride ions during acid attacks. (D)</p> Signup and view all the answers

    What fluoride level is typically found in fluoride mouth rinses?

    <p>225ppm (A)</p> Signup and view all the answers

    What happens to fluoride when an acid attack occurs on teeth?

    <p>Fluoride is released from calcium fluoride in saliva. (B)</p> Signup and view all the answers

    Flashcards

    Infrequent attacks

    Attacks on teeth that occur less often.

    Demineralization

    The loss of minerals from tooth enamel.

    Frequent attacks

    Attacks on teeth that occur more often.

    Caries risk

    The probability of getting cavities.

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    Fluoride

    A chemical compound of fluorine that is naturally found in water, rocks, soil, and tea.

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    Halogen

    A group of chemical elements in the periodic table.

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    Fluorine

    A highly reactive chemical element having symbol F and atomic number 9.

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    Colorado Stain

    A type of tooth staining linked to water chemistry.

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    Water fluoridation

    Additives of fluoride to public water supplies.

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    Artificial Water fluoridation

    Adding fluoride to water for public health.

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    Churchill Water Testing (1931)

    Churchill investigated water sources in Arkansas, correlating higher fluoride with tooth staining, although no direct link to the staining was proven.

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    Fluoride and Caries Reduction (1932)

    McKay proposed that the same fluoride compound causing mottling may also reduce cavities, although the teeth showing mottling demonstrated no higher decay risk than normal teeth.

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    Shoe Leather Studies (1930-1940)

    Extensive research studies, led by Dr. H Trendley-Dean, investigated the potential links between fluoride in water, tooth staining, and reduced cavities, expanding on observations from Colorado and Arkansas.

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    Dr. Frederik McKay

    A dentist who first documented the 'Colorado Stain' in 1916, exploring connections with water sources and tooth discoloration.

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    GV Black

    A collaborator with Dr. Frederik on the investigation of Colorado stain and published a paper on its cause.

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    Fluoride in Water

    A mineral that was found in higher concentrations in water sources where tooth mottling occurred.

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    Tooth Mottling

    A type of tooth discoloration resulting from the exposure to high fluoride levels during tooth development that can have limited link to the likelihood of future tooth decay.

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    Fluoride uptake during tooth development

    Fluoride is absorbed from swallowed water and travels through the bloodstream to developing tooth buds. It gets deposited into the enamel as fluoroapatite during enamel formation, replacing the usual hydroxyapatite, making the tooth more resistant to demineralization.

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    Pre-eruptive Fluoride

    Fluoride absorbed from systemic sources (swallowed fluoride) during the tooth development stage, before the tooth emerges through the gums, resulting in the deposition of fluoroapatite within the enamel.

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    Post-eruptive Fluoride

    Fluoride absorbed from topical sources (toothpaste, mouthwash) after the tooth erupts, resulting in the deposition of fluoroapatite on the enamel surface.

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    Fluorosis

    Excessive fluoride intake during tooth development can inhibit ameloblast activity, affecting enamel development and causing 'mottling' or discoloration, often termed fluorosis.

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    Fluoroapatite

    Fluoride replaces hydroxide in hydroxyapatite, forming fluoroapatite. Fluoroapatite is stronger and more resistant to acid attack, making the tooth more resilient to demineralization and caries.

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    Post-Eruptive Stage

    The period after a tooth emerges from the gum, during which it's most susceptible to fluoride uptake.

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    Fluoride Uptake

    The process of fluoride being absorbed into the tooth structure, making enamel more resistant to acid attacks.

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    Why is the post-eruptive stage critical?

    The first few years after a tooth emerges are when it's most porous, allowing for maximum fluoride absorption.

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    How does fluoride affect demineralized enamel?

    Demineralized enamel (weakened enamel) absorbs fluoride more readily, making it stronger and less prone to further decay.

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    Fluoride's role in remineralization

    Fluoride helps to remineralize teeth by replacing lost calcium and phosphate with fluoroapatite, a stronger form of hydroxyapatite.

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    Fluoride's limitations

    Fluoride works best to slow down the progression of cavities rather than completely preventing them. It doesn't penetrate the tooth deeply.

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    Fluoride and abrasion

    Fluoride absorbed into the tooth surface can be replaced as the surface is abraded through brushing or chewing.

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    Fluoride application timing

    Topical fluoride applications are most beneficial during the post-eruptive stage, when the tooth is still developing.

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    Fluoride's effect on enamel wettability

    Fluoride makes the enamel surface less wettable, reducing the 'stickiness' of the surface, making it harder for bacteria to adhere and form plaque.

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    Pellicle formation and plaque

    Pellicle is a thin film of proteins that forms on tooth enamel. It serves as a 'sticky' surface for bacteria to attach to, forming plaque. Fluoride reduces pellicle formation, thus reducing plaque accumulation.

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    Fluoride's impact on tooth morphology

    Systemic fluoride, taken during tooth development, can alter tooth morphology, resulting in shallower pits, reduced fissure depth, and lower cusp height. This makes the tooth more easily cleanable.

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    Root caries

    Root caries occur when dentin and cementum, exposed by gingival recession, are attacked by bacteria and decay. This is more common in patients with xerostomia (dry mouth) and those undergoing radiotherapy.

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    Fluoride's role in preventing root caries

    Fluoride helps prevent root caries by incorporating into the root surface during remineralization, reducing surface wettability, and having antibacterial effects.

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    How does fluoride prevent root caries?

    Fluoride contributes to the prevention of root caries through three mechanisms: incorporation during remineralization, reducing surface wettability, and possessing antibacterial effects.

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    Why is fluoroapatite important?

    Fluoroapatite is more resistant to acid attacks due to its lower critical pH, making teeth less soluble and promoting remineralization. This ultimately reduces the chances of getting cavities.

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    How does fluoroapatite form?

    Fluoride ions replace hydroxyl ions during the remineralization process, forming fluoroapatite. This molecule is more stable due to strong hydrogen bonds, fewer imperfections, and larger crystals.

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    What is the role of topical fluoride?

    Topical fluoride applications create a reservoir of fluoride in saliva, which binds to calcium. This reservoir releases fluoride during acid attacks, enabling it to enter the tooth and promote remineralization.

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    How does fluoride work in real life?

    Fluoride from topical sources like toothpaste and mouthwash enters the tooth during remineralization, strengthening enamel and reducing the risk of cavities.

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    What is the importance of regular fluoride supply?

    Regular exposure to low-level fluoride is crucial to replace lost ions and maintain enamel strength, reducing the risk of tooth decay.

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    How does toothpaste contribute to caries prevention?

    Toothpaste containing fluoride helps build a reservoir of fluoride in saliva, which is released during acid attacks, promoting remineralization and reducing cavities.

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    Why is fluoride varnish prescribed?

    Fluoride varnish contains a high concentration of fluoride, making it a powerful tool for promoting remineralization and preventing cavities.

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    What is the significance of water fluoridation?

    Water fluoridation provides a consistent source of fluoride, promoting enamel health and reducing the incidence of cavities in communities.

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    Study Notes

    Fluoride and the Tooth Surface

    • Topic: Fluoride and its role in dental caries prevention.
    • Learning Outcomes:
      • Describe the properties of relevant medicines and therapeutic agents related to patient management, and discuss their application.
      • Provide patients with accurate preventative education and instructions to encourage self-care and motivation.
      • Underpin all patient care with a preventative approach contributing to long-term oral and general health.
      • Prescribing and applying a range of preventative materials and treatments.
      • Describe and evaluate the role of health promotion in changing environments, community, and individual behaviours to deliver health gains.
      • Explain evidence-based prevention and apply it appropriately
    • Pre-reading:
      • Aetiology of Dental Caries (time, susceptible tooth surface, plaque bacteria, fermentable carbohydrates)
      • Histology of enamel and dentine
    • Intended Learning Outcomes:
      • List key milestones in fluoride history and its use in caries prevention.
      • Outline the stages in fluoride deposition.
      • Describe the modes of fluoride action.
      • Explain how fluorosis occurs.
      • Identify and assess fluorosis severity.
    • Refresher session:
      • Enamel is mainly hydroxyapatite(96%), which has a lattice structure and is made of phosphate and calcium ions (Ca10(PO4)6(OH)2).
      • Low pH (below 5.5) leads to demineralisation.
      • Frequent acid attacks increase demineralisation risk, while infrequent ones reduce it.
    • How is fluoride relevant to dental professionals?: Relevance to dental practice.
    • Fluorine: Detailed description.
    • Fluoride History: Key events in fluoride history, including the identification of Colorado stain (1916), water sampling studies (1931), identification of fluoride reduction of caries (1932), shoe leather studies (1930-1940).
    • Cochrane Review 2015:
      • Fluoridated water reduces caries in children's permanent teeth by 26%.
      • Fluoridation increases the percentage of children with no decay in deciduous teeth by 15%.
      • 73% of the studies focused on areas with natural fluoridation.
    • Modern Day: Controversy, prevalence of fluoridated water in the UK (approximately 10%).
    • How does fluoride prevent caries?: Fluoride uptake into the tooth surface, making it more resistant to demineralization, occurring through multiple stages (pre-eruptive and post-eruptive stages (systemic and topical fluoride), matrix secretion, maturation).
    • How is it absorbed?: Matrix secretion and maturation stage.
    • Post-eruption stage: Crucial role of frequent fluoride supply to replace lost ions.
    • Key points on Post-eruptive stage: acquisition of fluoride during the 2-3 years post-eruption, porous enamel that facilitates uptake due to demineralized enamel, fluoride reacts strongly with calcium, maximum uptake, efficacy for caries.
    • Why is fluoroapatite important?: Critical role in preventing future acid attacks, reduces demineralisation, formed by replacing hydroxyl ions during remineralisation (more stable due to improved hydrogen bonds, fewer imperfections, and larger crystals). Lower critical pH makes the tooth less soluble preventing demineralisation.
    • Where does the fluoride come from?: Topical applications create a fluoride reservoir in saliva; fluoride bonds to calcium forming CaF2; when acid attacks occur and pH drops, fluoride is released; this fluoride enters the tooth during remineralisation.
    • Ways to ensure a regular fluoride supply: Topical fluoride sources (toothpaste, mouth rinse, restorative materials, fluoride varnishes).
    • Fluoridation:
      • Water fluoridation: A key public health measure, potentially reducing caries. No association with bone fractures or cancer.
    • Important Indices:
      • Details of Indices for recording fluorosis (Dean Index, Thylstrup and Fejerskov Index)
    • Root Caries Recap:
      • Gingival recession exposes dentine and cementum; they are less mineralized, and decay progresses faster
      • Xerostomia patients and those undergoing radiotherapy are more susceptible
    • How does fluoride prevent root caries?:
      • Incorporating into surface during remineralisation
      • Reducing surface wettability
      • Antibacterial effects
    • What does research say about topical fluoride?:
      • Professionally applied fluoride (e.g., silver diamine fluoride, fluoride varnish) reduces risk of root caries.
      • Self-applied fluoride (e.g., various sodium fluoride concentrations, fluoride toothpaste) reduces risk of root caries at 1 year.
    • Fluorosis: Definition of fluorosis—associated with excess ingestion and its variations, from white opacities and lines/flecks to brown-yellow mottling.
    • Mechanism of fluorosis: excess fluoride inhibits ameloblast activity; hypomineralization, more porous enamel that readily takes up stain.
    • Aetiological agents for fluorosis: Dietary fluoride supplements, drinking water, toothpaste, and topical applications.
    • How to identify fluorosis?: Based on physical characteristics, indices (Dean Index, Thylstrup and Fejerskov Index-score from 0 to 9), and clinical presentation.
    • Fluoride action on bacteria: High fluoride concentrations are antibacterial, reducing bacterial plaque growth.
    • Action on enamel surface and tooth morphology: Fluoride reduces enamel surface energy, reducing bacteria adhesion.
    • Action on bacterial enzymes: Fluoride inhibits glycolysis. Also, fluoride inhibits enzyme systems.
    • Summary (in various formats): Diagrams showing stages of fluoride deposition, mode of action of fluoride, and summaries of different aspects of the topic.

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    Description

    This quiz covers the essential role of fluoride in preventing dental caries. It explores the properties of therapeutic agents, patient management, and the importance of preventative education to enhance oral health. Participants will understand the evidence-based approaches to promoting health within communities and individual behaviors.

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