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Questions and Answers
What is a primary benefit of using silver diamine fluoride?
What is a primary benefit of using silver diamine fluoride?
What is a potential side effect of silver diamine fluoride?
What is a potential side effect of silver diamine fluoride?
What is a characteristic feature of glass ionomer cements?
What is a characteristic feature of glass ionomer cements?
Why is prophylaxis paste not indicated solely for prevention?
Why is prophylaxis paste not indicated solely for prevention?
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When is silver diamine fluoride particularly useful?
When is silver diamine fluoride particularly useful?
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How does glass ionomer cement release fluoride over time?
How does glass ionomer cement release fluoride over time?
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What is true about the fluoride concentration in systemically applied fluoride methods?
What is true about the fluoride concentration in systemically applied fluoride methods?
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What concentration of fluoride toothpaste is generally considered effective for controlling caries?
What concentration of fluoride toothpaste is generally considered effective for controlling caries?
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Which of the following toothpastes is available only by prescription?
Which of the following toothpastes is available only by prescription?
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What is the recommended fluoride concentration for children over 3 years old?
What is the recommended fluoride concentration for children over 3 years old?
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What is a key consideration for using high fluoride toothpaste in children under 3 years?
What is a key consideration for using high fluoride toothpaste in children under 3 years?
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At what age can a child be prescribed duraphat 2800ppm sodium fluoride toothpaste?
At what age can a child be prescribed duraphat 2800ppm sodium fluoride toothpaste?
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What should be remembered when administering fluoride toothpaste to children?
What should be remembered when administering fluoride toothpaste to children?
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What size of toothpaste is recommended for children under 3 years old?
What size of toothpaste is recommended for children under 3 years old?
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When can children over 16 be prescribed duraphat 5000ppm sodium fluoride toothpaste?
When can children over 16 be prescribed duraphat 5000ppm sodium fluoride toothpaste?
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What is the recommended fluoride level for children aged 3-6 years?
What is the recommended fluoride level for children aged 3-6 years?
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What does the recommendation 'spit don’t rinse' aim to preserve?
What does the recommendation 'spit don’t rinse' aim to preserve?
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Which age group is recommended to use toothpaste with at least 1350ppm of fluoride?
Which age group is recommended to use toothpaste with at least 1350ppm of fluoride?
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What is a potential risk of using fluoride toothpaste in young children?
What is a potential risk of using fluoride toothpaste in young children?
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What fluoride level is recommended for adults with active caries?
What fluoride level is recommended for adults with active caries?
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Why might it be challenging to control the fluoride dosage in toothpaste?
Why might it be challenging to control the fluoride dosage in toothpaste?
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What is one of the advantages of using fluoride toothpaste?
What is one of the advantages of using fluoride toothpaste?
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What is NOT recommended for patients to do after using fluoride toothpaste?
What is NOT recommended for patients to do after using fluoride toothpaste?
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In the case of children aged 0-3 years, what is the maximum recommended amount of toothpaste?
In the case of children aged 0-3 years, what is the maximum recommended amount of toothpaste?
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What fluoride level should be used by young adults with active caries?
What fluoride level should be used by young adults with active caries?
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Which group of patients is NOT recommended for fluoride varnish application?
Which group of patients is NOT recommended for fluoride varnish application?
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How often should fluoride varnish be applied to high risk children of any age?
How often should fluoride varnish be applied to high risk children of any age?
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What is the main purpose of applying fluoride varnish?
What is the main purpose of applying fluoride varnish?
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Which of the following is a correct post-operative instruction after fluoride varnish application?
Which of the following is a correct post-operative instruction after fluoride varnish application?
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Fluoride varnish is recommended for which of the following patients?
Fluoride varnish is recommended for which of the following patients?
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What is the typical concentration of fluoride found in varnish?
What is the typical concentration of fluoride found in varnish?
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What should be done to the teeth before applying fluoride varnish?
What should be done to the teeth before applying fluoride varnish?
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Which of these is an evidence-supported benefit of fluoride varnish?
Which of these is an evidence-supported benefit of fluoride varnish?
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Which of the following is true regarding fluoride supplements after varnish application?
Which of the following is true regarding fluoride supplements after varnish application?
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What is a common characteristic of fluoride varnish when applied?
What is a common characteristic of fluoride varnish when applied?
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What is the fluoride concentration in over-the-counter mouthwash?
What is the fluoride concentration in over-the-counter mouthwash?
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At what age can prescription rinses generally be given to children?
At what age can prescription rinses generally be given to children?
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Why should mouthwash not be used immediately after brushing?
Why should mouthwash not be used immediately after brushing?
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Which of the following is a potential risk of fluoride rinses for young children?
Which of the following is a potential risk of fluoride rinses for young children?
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What is a recommended approach for individuals at higher dental caries risk?
What is a recommended approach for individuals at higher dental caries risk?
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Fluoride rinses prescribed on a weekly basis typically contain what concentration?
Fluoride rinses prescribed on a weekly basis typically contain what concentration?
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What is one of the pros of using fluoride rinses?
What is one of the pros of using fluoride rinses?
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Which of the following is a concern regarding the use of fluoride rinses?
Which of the following is a concern regarding the use of fluoride rinses?
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For whom are fluoride rinses particularly beneficial?
For whom are fluoride rinses particularly beneficial?
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Which of the following statements about fluoride rinses is misleading?
Which of the following statements about fluoride rinses is misleading?
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Study Notes
Fluoride Delivery Methods
- Fluoride is important for preventing tooth decay.
- Various methods exist for fluoride delivery.
- Different sources of fluoride exist, both over-the-counter and prescription.
- Professionals apply fluoride in various ways, including varnish, and cement among others.
- Systemic fluoride: ingested and incorporated into tooth structures.
- Topical fluoride: strengthens existing teeth, making them more resistant to decay.
- Important to understand the different concentrations of fluoride in various products (e.g., toothpaste, mouth rinses, fluoride varnishes, fluoride tablets/lozenges/drops).
- Different dosages of fluoride are recommended for different age groups.
- Fluoride concentration levels can be harmful if taken in high amount.
GDC Learning Outcomes
- Describe the properties of medicines and therapeutic agents, and how they're used in patient management.
- Provide patients with comprehensive and accurate preventative education, emphasizing self-care and motivation.
- Underpin all patient care with a preventative approach, promoting long-term oral and general health.
- Advise on and apply various preventative materials and treatments appropriately.
- Describe and evaluate health promotion's role in changing environments, communities, and individual behaviors.
- Explain evidence-based prevention and apply it effectively.
Pre-reading: Aetiology of Dental Caries
- Caries development is influenced by susceptible tooth surfaces, time, and fermentable carbohydrates, and plaque bacteria.
Pre-reading: Histology of Enamel and Dentine
- The histology of enamel and dentine is a key topic in pre-reading.
Pre-reading: Fluoride and Tooth Surface
- Fluoride's impact on the tooth surface is a key lecture topic.
Learning Objectives
- List over-the-counter and prescription options for fluoride supplementation.
- Describe professional fluoride applications.
- Discuss dangerous fluoride levels for different age groups.
Recap - What do We Know So Far?
- Summarize important details about fluoride and its role in preventing tooth decay.
How is it Absorbed? - Post-Eruptive Stage
- Explains the process of fluoride absorption in the tooth after it erupts.
- Discusses how a drop in pH due to bacterial acid leads to demineralization and how addition of calcium, phosphates, and fluoride from saliva form fluoroapatite.
- This explains the remineralization process.
How does it Work? - Uptake into the Tooth
- Describes how fluoride is absorbed into the tooth surface to make it resistant to demineralization (during multiple developmental stages).
- Discusses pre-eruptive and post-eruptive fluoride stages.
How is it Absorbed? - Post-Eruptive Stage (Key Points)
- Most fluoride is acquired during the first 2-3 years after tooth eruption.
- Tooth enamel is porous, facilitating fluoride diffusion and uptake.
- Demineralized enamel readily absorbs fluoride, helping in remineralization.
Fluoride Sources Without Prescription
- Include items such as toothpaste, mouth rinse, fluoridated water, and fluoridated salt, fluoridated milk.
Fluoride Sources with Prescription
- Includes stronger concentrations of fluoride in toothpaste, mouth rinses, etc.
Professionally Applied Sources
- Discusses professional applications of fluoride in varying forms like varnishes, and cements.
Systemic vs Topical Fluoride
- Systemic fluoride is ingested and becomes incorporated into tooth structures.
- Topical fluoride strengthens existing teeth by increasing their resistance to decay.
Fluoride Concentration of Topically Applied Fluoride
- Covers the concentration of fluorides in various topical applications.
- The pros and cons of using these types of fluoride are discussed too.
Toothpaste
- Toothpastes vary in fluoride concentration (e.g., 1000ppm).
- Children under 3 should use toothpaste with a minimum of 1000ppm.
- Fluoride toothpaste less than 1450 ppm (often less than 1000ppm) proves ineffective for controlling cavities.
- Toothpaste containing 2800ppm and 5000ppm fluoride is available but usually requires a prescription.
- Important to use the correct amount of fluoride for specific age groups to prevent fluorosis.
- Children under 3 should use a smear amount of toothpaste.
- Children over 3 use a pea-sized amount.
Recommendations
- Age-appropriate fluoride recommendations (0-3, 3-6, 6-17 years, Adults).
- Fluoride ppm and corresponding amounts for different age groups.
- The factors to consider using higher fluoride concentrations.
Pros and Cons of Different Fluoride Methods
- Pros and cons of fluoride in various forms.
- Discuss the ease of use and regular use factors.
- Mention aspects regarding dosage control like risk levels.
- The impact of using fluoride may be seen to be cheap and readily available.
- Fluoride intake may be controlled based on individual risk levels.
Fluoride Levels
- A full list of fluoride levels in different products is in the Delivering Better Oral Health Document.
What does the term "Spit Don't Rinse" mean?
- Spitting after brushing is crucial to help keep fluoride in the saliva for remineralization.
Mouthwash
- Many over-the-counter mouthwashes contain fluoride.
- Fluoride concentration in over-the-counter mouthwash is 0.05%.
- Note that fluoride rinses can also be prescribed on a daily and weekly basis.
- Rinses are often advised when brushing is not done at the same time.
Recommendation for Mouthwash Use
- Recommend using a fluoride rinse (0.05%) at a different time for brushing, or when not able to rinse without swallowing.
- Especially for high caries risk patients
Recommendations Regarding Patients with Concerns
- Potential issues in patients with active cavities, or those with orthodontic appliances, or reduced salivary flow, or special needs.
Fluoride Varnish
- This is a topical fluoride application.
- It is used to treat and prevent cavities.
- It contains a 'sticky' substance that is professionally applied to the teeth and is used to help prevent decay.
Fluoride Varnish Indications
- Caries-prone adults who cannot use fluoride mouth rinse.
- Patients with removable orthodontic appliances.
- Twice yearly application for children over 3.
- High risk children of any age.
- Localizing application for caries progression arrests.
- Protection for exposed vulnerable root surfaces.
Fluoride Varnish Application Procedure
- Ensure no contraindications exist, and isolate/clean and dry teeth.
- Use a microbrush or floss to apply varnish interproximally.
- Provide post-operative instructions.
Fluoride Varnish Application Instructions
- Patients should avoid eating, drinking, or rinsing for 30 minutes after application.
- Brushing can be resumed after that period
Pros and Cons of Using Fluoride Varnish
- Allows targeting specific populations at high risk.
- Ease of discontinuation when not needed.
- Available in many flavors, thus making it more palatable.
Silver Diamine Fluoride
- This is a liquid that can be used to arrest dental caries in high-risk adults/children with difficult to control lesions or problems, and intolerance of treatments.
- This has the highest fluoride concentration (44,800 ppm).
- It's used to manage severe to extensive to restore lesions that aren't associated with pain, or infections.
- May be due to an intolerance, the elderly, medically compromised, or additional care needs.
Silver Diamine Fluoride - Chemical Reactions on Application
- When applied, silver diamine fluoride causes chemical reactions, leading to dentinal tubule blockage, bacterial death, remineralization and collagen breakdown inhibition.
Silver Diamine Fluoride Side Effects
- A permanent black staining can occur as a side effect.
Silver Diamine Fluoride Usefulness
- Useful in children, but may need to be used as a 'time-buying' measure due to lack or delay of treatment options such as general anaesthesia (GA) being used in patients with anxiety or other issues.
Toxicity of Silver Diamine Fluoride
- Includes important safety precautions, especially regarding potential harmful levels.
Glass Ionomer Cements
- Glass ionomer cement materials may contain fluoride.
- These materials are able to leach fluoride into the underlying demineralized tooth surface.
- Studies suggest the slow release of fluoride for up to 8 years and are often topped up with further fluoride applications.
- The fluoride is leached at a low rate, impacting how great the effects will be.
Prophylaxis Paste
- Fluoride content may be present in some formulations, but not necessarily the key focus.
- Some prophylaxis pastes are abrasive, and loss of enamel due to these types of pastes can impact the extent of fluoride benefit.
- Their role for prevention may be limited.
Fluoride Tablets/Lozenges/Drops
- Different concentrations and dosage forms (0.25/0.5/1mg).
- They are usually prescription-only.
- Important to consider that dosage is dependent on the availability of fluoride in drinking water or other sources.
- They may increase the risk of fluorosis (check with professional).
Systemic Fluoride Recommendations
- Can be considered for high-risk (decay or special needs) patients, but not a first line treatment.
- Systematic reviews show unclear evidence on deciduous teeth.
Recommendations and Considerations for all the Fluoride Types
- Ensure that the type of fluoride used is appropriate for the patient's age.
- Ensure ingestion of fluoride is not possible from other fluoride sources (e.g., toothpaste).
- Ensure that all diet and oral hygiene instructions are strictly followed.
- Fluoride supplements should be taken at a different time of day compared with brushing to ensure maximized benefit.
Fluoride Toxicity
- The acute lethal dose of fluoride is approximately 15mg/kg body weight.
- As little as 5 mg/kg body weight may be fatal to some children, triggering immediate emergency action.
- Symptoms of sub-lethal toxicity may include salivation, nausea, and vomiting.
Pre-natal fluoride administration
- Fluoride supplementation during pregnancy may aid in preventing dental caries in offspring.
- Yet, the evidence for this is still under debate (lacks conclusive proof), hence clinical applications are still inconclusive.
Fluoridated Salt
- Some countries mandate fluoride in salt.
- Bypassing concerns about some people not having access to fluoridated tap water.
- 250mg fluoride per kg of salt.
- Pros (e.g widely used commodity, available/ easy to consume) and cons (e.g may not target certain population, may not be used as part of a diet, if compulsory, may eliminate freedom of choice).
Fluoridated Milk
- A free fluoridated milk program may exist in some regions such as school programmes.
- Children should not take part if already on fluoride supplements.
- 200ml cartons usually contain 1mg of fluoride.
- May be more useful or beneficial to areas with high decay rates e.g., Blackpool area.
Summary of fluoride use in practice
- Dental professionals must provide clear instructions and monitoring regarding fluoride use for all patients, especially for children.
- This applies to topical and systemic fluoride, considering factors like patient compliance, and risk levels.
References
- Relevant texts regarding the topic above are referenced in the document.
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Description
This quiz explores the various methods of fluoride delivery and their role in preventing tooth decay. It covers systemic and topical fluoride applications, different delivery forms, and the importance of proper dosages for different age groups. Understanding these methods is crucial for effective patient management in dental care.
