Fluoride and Tooth Surface
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Questions and Answers

Who was the first to document the appearance of the Colorado stain?

  • Churchill
  • Dr Frederik McKay (correct)
  • GV Black
  • Dr H Trendley-Dean
  • What did Churchill investigate regarding the mottling effect on teeth?

  • The impact of local mining activities
  • The water source changes (correct)
  • Dental hygiene practices
  • Local dietary habits
  • What was McKay's suggestion about the correlation between mottling and dental caries?

  • There is no correlation between mottling and decay.
  • Fluoride causes mottling and increases decay.
  • Mottled teeth are more prone to decay.
  • Mottled teeth have a lower chance of decay. (correct)
  • Which report did not specifically address fluoride and its effects?

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

    What was the primary focus of Dr H Trendley-Dean's research?

    <p>Links between fluoride, mottling, and caries reduction (D)</p> Signup and view all the answers

    What did Churchill find about fluoride content in water related to mottling?

    <p>Higher fluoride was found in water where mottling occurred. (D)</p> Signup and view all the answers

    When were the shoe leather studies conducted?

    <p>1930-1940 (D)</p> Signup and view all the answers

    What type of fluoride is absorbed during the systemic stage of tooth development?

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

    Which process is primarily enhanced by fluoride during caries prevention?

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

    What potential issue can excess fluoride during enamel development cause?

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

    At which stage is fluoride deposition from surrounding tissue fluids most crucial?

    <p>Post-eruptive stage (A)</p> Signup and view all the answers

    What role does the blood play in fluoride absorption during tooth development?

    <p>It carries fluoride to developing tooth buds. (B)</p> Signup and view all the answers

    What property does fluoroapetite confer onto the tooth structure?

    <p>Greater resistance to demineralization (D)</p> Signup and view all the answers

    Which statement about fluoride's effect on ameloblast activity is true?

    <p>Excess fluoride inhibits ameloblast activity. (D)</p> Signup and view all the answers

    What is a primary reason fluoride is advocated in caries prevention?

    <p>It helps in enamel remineralization. (C)</p> Signup and view all the answers

    Which fluoride absorption stage occurs after calcification but prior to tooth eruption?

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

    What effect does fluoride have on the wettability of enamel?

    <p>It decreases the wettability of enamel. (A)</p> Signup and view all the answers

    How does fluoride contribute to the prevention of plaque accumulation?

    <p>By reducing pellicle formation on the tooth surface. (A)</p> Signup and view all the answers

    Which of the following effects on tooth morphology is associated with systemic fluoride?

    <p>Shallower pits and reduced fissure depth. (A)</p> Signup and view all the answers

    Root caries is more common in which of the following patient groups?

    <p>Patients with xerostomia or limited saliva. (A)</p> Signup and view all the answers

    What are the mechanisms by which fluoride helps prevent root caries?

    <p>Incorporating into surface during remineralisation and reducing surface wettability. (C)</p> Signup and view all the answers

    What causes a drop in pH in the post-eruptive stage of teeth?

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

    During the post-eruptive stage, what is primarily lost from the tooth surface?

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

    What process leads to the formation of fluoroapatite in teeth?

    <p>Absorption of calcium, phosphate, and fluoride (A)</p> Signup and view all the answers

    Why is fluoride more effectively absorbed during the first 2-3 years post-eruption?

    <p>Enamel is more porous (C)</p> Signup and view all the answers

    What happens when fluoride is applied topically to teeth?

    <p>It reacts strongly with calcium (D)</p> Signup and view all the answers

    What is a key reason for using fluoride in caries management?

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

    What effect does demineralization have on enamel’s ability to absorb fluoride?

    <p>Increases absorption capability (B)</p> Signup and view all the answers

    What limits the maximum uptake of fluoride in tooth enamel?

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

    What happens to the pH during the process of remineralization?

    <p>It increases (D)</p> Signup and view all the answers

    What is the primary mineral lost from hydroxyapatite during the demineralization process?

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

    What is a significant reason why fluoroapetite is important in dental health?

    <p>It is less soluble than hydroxylapatite. (C)</p> Signup and view all the answers

    How does fluoride from topical applications contribute to tooth remineralisation?

    <p>It creates a reservoir in saliva that releases fluoride when needed. (C)</p> Signup and view all the answers

    What is the critical pH at which fluoroapetite begins to demineralise?

    <p>4.5 (A)</p> Signup and view all the answers

    What effect does the presence of larger crystals in fluoroapetite have?

    <p>It enhances resistance to future acid attacks. (D)</p> Signup and view all the answers

    What is the fluoride concentration in fluoride varnish?

    <p>22,600ppm (A)</p> Signup and view all the answers

    How should fluoride toothpaste be used according to prescription guidelines?

    <p>A higher concentration is prescribed for specific cases. (C)</p> Signup and view all the answers

    What is one method of ensuring a regular supply of fluoride?

    <p>Regular professional fluoride treatments. (C)</p> Signup and view all the answers

    What role does calcium fluoride (CaF2) play during acid attacks?

    <p>It releases fluoride when pH drops. (B)</p> Signup and view all the answers

    Which fluoride product has the highest concentration?

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

    Why is a regular low-level supply of fluoride essential in caries prevention?

    <p>It supports the remineralisation process, replacing lost ions. (B)</p> Signup and view all the answers

    Flashcards

    Colorado Stain

    A discoloration of teeth, first documented in Colorado Springs in 1916 by Dr. Frederik McKay.

    Churchill Water Testing (1931)

    A study investigating the link between water source changes, particularly higher fluoride content, and tooth discoloration in Arkansas.

    Fluoride and Caries (1932)

    McKay proposed a link between fluoride in water and reduced tooth decay, despite the presence of mottling.

    Shoe-Leather Studies (1930-1940)

    Research led by Dr. H. Trendley Dean investigating the relationship between fluoride in water, tooth discoloration, and tooth decay reduction across 21 cities in the US.

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    Dr. Frederik McKay

    A dentist who documented the Colorado Stain and proposed a link between fluoride and reduced tooth decay (despite mottling).

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    GV Black

    A collaborator with Dr. McKay in investigating the cause of the Colorado Stain.

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    Dr. H. Trendley Dean

    A researcher who investigated fluoride's effect on tooth decay reduction, following McKay's research.

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    Fluoride's Role in Caries Prevention

    Fluoride strengthens tooth enamel, making it more resistant to acid attacks from bacteria, reducing the risk of cavities.

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    Pre-Eruptive Fluoride

    Fluoride absorbed into the tooth during its development before it erupts, primarily from swallowed fluoride (systemic fluoride)

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    Post-Eruptive Fluoride

    Fluoride that is absorbed into the tooth after it erupts, primarily from topical fluoride sources like toothpaste.

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    How does Fluoride strengthen Teeth?

    Fluoride replaces hydroxyl ions in the tooth's hydroxyapatite structure with fluoride ions, forming a more resistant fluoroapatite.

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    Matrix Secretion Stage

    The stage of tooth development where fluoride is absorbed from systemic sources (swallowed fluoride) and deposited into the developing enamel.

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    Maturation Stage

    The stage of tooth development where fluoride is absorbed from systemic sources, deposited on the enamel surface, and continues to strengthen the tooth after calcification, but before eruption.

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    Fluorosis

    A condition that affects the appearance of tooth enamel due to excessive fluoride intake during tooth development.

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    Fluoroapatite vs. Hydroxyapatite

    Fluoroapatite is a stronger and more resistant form of tooth enamel than hydroxyapatite, thanks to the presence of fluoride.

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    Topical Fluoride

    Fluoride applied directly to tooth surfaces after eruption, usually through toothpaste, mouthwash, or fluoride treatment.

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    Post-Eruptive Stage

    The period following tooth eruption where enamel is still maturing and more susceptible to fluoride uptake. This is the optimal time for fluoride to be absorbed by enamel.

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    Fluoride Uptake During Post-Eruptive Stage

    Fluoride is absorbed by enamel during the post-eruption stage, where it strengthens the tooth structure, increasing its resistance to decay.

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    Why is Post-Eruptive Stage Important for Fluoride?

    Enamel during this period is more porous, allowing for greater fluoride absorption and more effective protection against decay.

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    Fluoride and Demineralised Enamel

    Fluoride readily binds to demineralised enamel, helping to remineralise the tooth surface and strengthen it.

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    Topical Fluoride Application

    Applying fluoride topically, like with toothpaste, helps strengthen the enamel surface. However, it doesn't penetrate deeply due to fluoride's strong reaction with calcium.

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    Fluoride and Caries Progression

    Fluoride is more effective in slowing down the progression of existing caries than preventing them altogether.

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    Fluoride Usage for Enamel Strengthening

    Fluoride is crucial for strengthening enamel during the post-eruption stage, enhancing its resistance to decay.

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    Fluoride and Hydroxyapatite

    Fluoride reacts with calcium and phosphate in saliva, forming a stronger mineral called fluoroapatite, making enamel more resistant to acids.

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    Maximum Fluoride Uptake

    There is a limit to how much fluoride enamel can absorb, but fluoride can be replenished as the surface is worn down by abrasion.

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    Fluoride: Prevention vs. Progression

    Fluoride plays a more significant role in slowing the progression of existing caries rather than completely preventing them.

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    Fluoride's Role in Wettability

    Fluoride reduces the surface tension of enamel, making it less wettable. This hinders bacteria from adhering to the tooth surface.

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    Pellicle Formation and Fluoride

    Fluoride prevents the formation of pellicle, a thin film of proteins on enamel that bacteria use to attach.

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    Fluoride's Impact on Plaque

    Less pellicle means less plaque accumulation because bacteria have fewer surfaces to stick to.

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    Fluoride and Tooth Morphology

    Systemic fluoride can alter tooth morphology during development, creating shallower pits, reduced fissure depth, and lower cusp height.

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    How Does Fluoride Prevent Root Caries?

    Fluoride prevents root caries by incorporating into the tooth surface during remineralization, reducing surface wettability, and inhibiting bacterial growth.

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    What is fluoroapetite?

    A more stable mineral form of tooth enamel, created when fluoride ions replace hydroxyl ions during remineralization.

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    Why is fluoroapetite important?

    Fluoroapetite is more resistant to acid attacks due to its lower critical pH, making teeth less susceptible to demineralization and decay.

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    How does fluoroapetite form?

    Fluoride ions from saliva replace hydroxyl ions in tooth enamel during remineralization, forming fluoroapetite, a stronger and more stable mineral.

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    What is remineralization?

    The process of restoring lost minerals, primarily calcium and phosphate, to tooth enamel.

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    What does demineralization mean?

    The process of losing minerals from tooth enamel, typically caused by acids from bacteria.

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    How does fluoride help with caries prevention?

    Fluoride helps prevent cavities by forming fluoroapetite, a more resistant enamel, and by promoting remineralization.

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    Where does fluoride come from for tooth health?

    Topical sources like toothpaste, mouthwash, and fluoride varnish deliver fluoride directly to the teeth.

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    How does topical fluoride work?

    Topical fluoride creates a reservoir in saliva that releases fluoride ions during acid attacks, enabling remineralization and strengthening enamel.

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    Why is a regular supply of fluoride essential?

    Regular fluoride intake is crucial to replenish the ions lost during demineralization, ensuring continuous remineralization and optimal tooth health.

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    What are some common sources of fluoride?

    Fluoride is incorporated in various products like toothpaste, mouthwash, fluoride varnish, and even drinking water.

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    Study Notes

    Fluoride and the Tooth Surface

    • Fluoride is absorbed into tooth surfaces, making them more resistant to demineralization.
    • This occurs at multiple stages, including pre-eruptive and post-eruptive stages.
    • Pre-eruptive fluoride (systemic) is absorbed via the bloodstream and deposited into the developing tooth during enamel formation.
    • Post-eruptive fluoride (topical) is absorbed into the surface of the tooth during remineralization after demineralization.
    • Fluoride uptake occurs during the first 2-3 years post-eruption.
    • Demineralisation occurs when pH drops below critical levels (5.5 for hydroxyapatite).
    • Demineralisation results in a loss of calcium and phosphate ions from hydroxyapatite.
    • Fluoride replaces hydroxyl ions in the hydroxyapatite structure, creating fluoroapatite.
    • Fluoroapatite is more stable than hydroxyapatite, making the teeth more resistant to further acid attacks.
    • Regular fluoride intake is vital to replace lost ions to maintain the process of prevention.
    • Topical fluoride applications create a reservoir in saliva, enabling fluoride to be available during remineralization.
    • Tooth surface wettability is affected.
    • Fluoride reduces bacterial adhesion on tooth surfaces.
    • Fluoride can affect tooth morphology, creating shallower pits, reduced fissure depths, and lower cusp heights
    • Root caries are more likely to develop in areas where enamel has been lost.
    • This happens because root surfaces are less mineralised and so are more susceptible to decay.
    • Fluoride incorporation into the root surface during remineralisation, reduction of surface wettability, and antibacterial effects, help to prevent root caries.

    GDC Learning Outcomes

    • Describe the properties of relevant medicines and therapeutic agents, discussing their application to patient management.
    • Provide comprehensive and accurate preventative education and instruction to patients, encouraging self-care and motivation.
    • Underpin all patient care with a preventative approach to contribute to long-term oral and general health.
    • Advise on and apply preventative treatments and materials as appropriate.
    • Describe and evaluate the role of health promotion in terms of changing environments, community and individual behaviours to deliver health gain.
    • Explain evidence-based prevention and apply it appropriately.

    Pre-reading: Aetiology of Dental Caries

    • Susceptible tooth surface
    • Plaque bacteria
    • Fermentable carbohydrates
    • Time

    Pre-reading: Histology of Enamel and Dentine

    • This section focuses on the structure of the tooth enamel and dentine.

    Intended Learning Outcomes

    • List key milestones in fluoride history and use in caries prevention.
    • Outline and describe stages in fluoride deposition.
    • Describe modes of action of fluoride.
    • Explain how fluorosis occurs.
    • Identify and assess the severity of fluorosis.

    Refresher Session: Properties of Enamel

    • Normal enamel is primarily hydroxyapatite (Ca10(PO4)6(OH)2).
    • Hydroxyapatite accounts for 96% of enamel.
    • Enamel is a lattice structure.
    • Enamel is composed of phosphate and calcium ions.

    Refresher Session: Demineralisation and Caries

    • Demineralisation occurs when pH drops below the critical level (5.5).
    • Extensive demineralization can lead to caries.
    • Components of hydroxyapatite breakdown into calcium, phosphate, and hydroxyl ions.

    Refresher Session: Stephen Curves and Demineralisation/Remineralisation

    • Infrequent sugar attacks correlate with less time below the critical pH, reducing demineralization.
    • Frequent sugar attacks mean more time below the critical pH, increasing demineralization risks.

    Fluorine as a Chemical Element

    • Fluorine has the symbol F and atomic number 9.
    • It is a halogen.
    • It is found naturally in water, rocks, soil, and tea.
    • Fluorine is highly reactive with metals, forming salts or halides (fluorides).

    Fluoride History

    • Key dates, milestones, and researchers related to fluoride and its use in caries prevention
    • Examples include investigations into Colorado Stain, water sampling in Arkansas, and subsequent research into water fluoridation and anti-fluoride campaigns.
    • Important reports in the history of fluoridation

    Colorado Stain - 1916

    • Dr Frederick McKay documented staining on teeth in Colorado Springs.
    • McKay enlisted the help of GV Black to investigate the cause of the staining.
    • GV Black published a paper on the Colorado Stain.

    Water Sampling - 1931

    • McKay's work led to Churchill's investigation into water source changes and potential link to mottling in Arkansas.
    • This involved identifying higher fluoride levels in water sources that showed mottling.

    Identification of Fluoride's Anti-Caries Effect - 1932

    • McKay identified that though mottled, teeth exposed to higher fluoride content showed no greater chance of decay.

    Shoe Leather Studies - 1930-1940

    • Dr H Trendley Dean researched the link between fluoride in water, mottling changes, and caries reduction.
    • Dean's studies exhibited increased mottling with increased fluoride, and decreased caries where water was fluoridated.

    Knox Report- 1985

    • Review of papers evaluating links between fluoride and cancer.
    • Concluded no link exists between fluoridation and cancer risk.

    York Report - 2000

    • Reviewed evidence from hundreds of studies into water fluoridation.
    • No association was found between fluoridation, bone fractures, or cancer.

    Cochrane Review 2015

    • Review indicated that fluoridated water reduced caries in children's permanent teeth by 26% and deciduous teeth by 35% .
    • Also that infrequent exposure to critical PH reductions results in lower caries risks.
    • Fluoride ingestion results in 12% chance of aesthetic concerns in children (fluorosis).

    Modern Day

    • Fluoride use in water remains a subject of debate and societal discussions.

    How Does Fluoride Prevent Caries?

    • Fluoride is absorbed into tooth surfaces during remineralization, which makes the teeth more resistant to demineralisation.
    • Fluoride can reduce bacterial adhesion and affect tooth morphology.

    Why is Fluoroapatite Important?

    • Fluoroapatite is more stable than hydroxyapatite.
    • This increased stability makes the tooth more resistant to acid attacks.

    Where Does Fluoride Come From?

    • Topical fluoride applications create a reservoir in saliva, which is actively used during remineralization phases.

    Topical Fluoride Sources

    • Fluoride levels in various topical sources.

    How Does That Work in Real Life?

    • Diagram showing fluoride ions and hydroxyapatite/fluoroapatite in relation to pH changes.
    • Illustration of how demineralisation results and reduction in pH result from fluoride incorporation.

    Does Fluoride Have Any Other Mechanisms of Action?

    • Fluoride can inhibit bacterial activity and reduce bacterial plaque.
    • Fluoride affects the surface energy of enamel, affecting wettability, and thus reducing bacterial adhesion.

    Root Caries Recap

    • Gingival recession causes exposed root surfaces
    • Demineralisation processes occur faster for root surfaces
    • Xerostomia patients have reduced saliva and thus are more susceptible to root caries

    How Does Fluoride Prevent Root Caries?

    • Incorporating into the surface during remineralization.
    • Reducing surface wettability.
    • Antibacterial effects.

    What Does The Research Say?

    • Professionally applied fluoride reduces risk of root caries.
    • Self-applied fluoride reduces risk of root caries.

    Fluorosis: What is it and How Does it Form?

    • Fluorosis is a condition associated with excessive fluoride intake, visible on developing teeth.
    • Fluoride intake during tooth development can result in enamel defects, termed fluorosis.
    • Ingestion of fluoride during tooth development can result in defects, visibly seen as opacities, lines, or yellow mottling, depending on dose and length of exposure during development.

    Mechanism of Fluorosis

    • Excess fluoride inhibits ameloblast activity during enamel matrix formation and maturation, resulting in hypomineralisation (and hypoplasia).
    • Hypomineralisation leads to porous enamel.
    • Porous enamel readily absorbs stains, creating discolouration.

    Aetiological Agents of Fluorosis

    • Dietary fluoride supplements, drinking water, toothpaste, and topical applications can cause excessive fluoride intake with visible implications.

    Is it Fluorosis?

    • Description of clinical characteristics to differentiate between fluorosis manifestations and other enamel opacities.

    Indices for Recording Fluorosis

    • Methods for quantifying and classifying fluorosis severity.

    Summary (various)

    • Summary of fluoride deposition stages
    • Summary of fluoride modes of action

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    Description

    Explore the role of fluoride in enhancing tooth durability. This quiz covers the absorption processes of fluoride during both pre-eruptive and post-eruptive stages, as well as its impact on demineralization and remineralization. Test your understanding of how fluoride helps in maintaining tooth health.

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