Fluoride Delivery Methods Quiz

Fluoride Delivery Methods

• Fluoride is used to prevent tooth decay.
• There are various methods of fluoride delivery, both over-the-counter and prescription.
• Over-the-counter fluoride sources include toothpaste, mouthwash, fluoridated water, fluoridated salt, and fluoridated milk.
• Prescription fluoride sources include higher concentration toothpastes, mouthwash, fluoride tablets, fluoride drops.
• Professionally applied fluoride sources include varnish, fluoride varnish, glass ionomer cement, and silver diamine fluoride.
• Systemic fluoride is ingested and incorporated into tooth structure, while topical fluoride strengthens existing teeth.
• Fluoride concentration in various products varies.
• Recommendations for fluoride use are dependent on age and risk factors.

GDC Learning Outcomes

• Dental professionals must describe the properties of relevant medications and therapeutic agents, as well as discuss their application to patient management.
• Provide comprehensive and accurate preventative education and instruction, encouraging patient self-care and motivation.
• Patient care should integrate a preventative approach focusing on long-term oral and general health.
• Dental professionals advise on and apply preventative materials and treatments appropriately.
• Understanding the role of health promotion in changing environments, communities, and individual behaviors is crucial for delivering health gains.
• Evidence-based prevention strategies should be explained and applied appropriately.

Aetiology of Dental Caries

• Dental caries (cavities) develop from the interaction of susceptible tooth surfaces, plaque bacteria, and fermentable carbohydrates over time.

Histology of Enamel and Dentine

• This section likely covers the microscopic structures of enamel and dentine, including their components and arrangement.

Fluoride and the Tooth Surface

• This lecture focuses on how fluoride interacts with the tooth surface.

Learning Objectives

• List over-the-counter and prescription fluoride supplements.
• Describe professionally applied fluoride approaches.
• Identify dangerous levels of fluoride for various age groups.

Recap - What do we know so far?

• A brief summary of previously discussed information.

How is Fluoride Absorbed? - Post-Eruptive Stage

• Tooth surface loses calcium and phosphate, leading to demineralization.
• Addition of calcium, phosphate, and fluoride from saliva forms fluoroapatite (remineralization), making teeth more resistant to decay.
• The process involves changes in pH, bacterial acidity, and the addition of minerals and fluoride.

How does Fluoride Work? - Uptake Into the Tooth

• Fluoride uptake into the tooth surface makes it more resistant to demineralization from caries, affecting multiple stages.
• There are pre-eruptive and post-eruptive stages of fluoride action.

How is Fluoride Absorbed? - Post-Eruptive Stage (Key Points)

• Most fluoride is acquired in the two to three years after tooth eruption.
• Tooth porosity increases fluoride uptake.
• Demineralized enamel absorbs fluoride easily during remineralization.

Sources Without Prescription

• Different sources without a doctor's order (over-the-counter) were listed. They include fluoride toothpaste, mouthwash, fluoridated water, salt, and milk.

Sources With Prescription

• Different sources requiring a prescription are listed, including high-concentration fluoride toothpastes, fluoride mouthwash, fluoride tablets, and fluoride drops.

Professionally Applied Sources

• These fluoride sources must be applied by a dentist or dental hygienist and include varnishes, fluoride varnish, glass ionomer cement, and silver diamine fluoride.

Systemic vs Topical Fluoride

• Systemic fluoride is ingested, incorporating fluoride into forming tooth structures.
• Topical fluoride strengthens already present teeth, increasing their decay resistance.

Mouthwash

• Many over-the-counter mouthwashes contain fluoride, but lower concentrations than toothpaste.
• Fluoride rinse concentration is usually 0.05% or 0.2%.
• Use as a separate time from brushing, as using mouthwash immediately following toothpaste can reduce the effectiveness of fluoride.

Toothpaste

• Fluoride toothpaste below 1450ppm is less effective at controlling caries than toothpastes higher than 1450ppm.
• The amount or concentration of fluoride can vary depending on the user's age.

Toothpaste - Recommendations

• Children under 3 should utilize a toothpaste with 1000ppm fluoride.
• 3+ year olds and adults should use 1350-1500ppm fluoride toothpaste.
• High-risk groups may require higher fluoride concentrations.
• Proper application of paste amount depending on age.

Recommendations for Fluoride Use

• Proper fluoride application/intake levels based on age.
• Recommended amounts for all age groups, factoring possible risk factors.

Fluoride Levels

• A full fluoride level list is likely to be in a separate document.

Spit Don't Rinse

• Spitting (not rinsing) after using fluoride toothpaste helps maintain fluoride in saliva for greater effectiveness.
• This action helps maximize the beneficial effects of fluoride.
• Mouthwash has lower fluoride concentrations, reducing efficacy when compared with toothpaste, if used directly following fluoride use.

Mouthwash - Pros and Cons

• Easy to use and tailor dosage depending on the risk level.
• Relatively inexpensive and readily accessible.
• However, if not used correctly or frequently, it might be ineffective, or in high risk cases, lead to a higher risk of infection.

Recommendations for use of fluoride mouthwash

• Use fluoride mouthwash at different times from brushing.

Patients who may have higher risk of caries

• Individuals with obvious active cavities, orthodontic appliances, reduced salivary flow conditions, or special needs should be examined on a case by case basis.

Fluoride Varnish

• Fluoride varnish is a sticky substance applied to teeth during a dental procedure.

Fluoride Varnish - Application

• Ensure no contraindications apply.
• Clean, dry, and isolate teeth to be treated.
• Use a microbrush or dental floss to apply varnish.
• Give post-operative guidelines to the patient or guardian.

Fluoride Varnish - Post Application Considerations

• Do not eat, drink, or rinse for 30 minutes after application.
• Patients can resume brushing schedules after the recommended time.

Fluoride Varnish - Pros and Cons

• Can be applied to target specific patient groups with high caries risk.
• Application can be adjusted as needed, according to patient needs.
• Offering different flavors can greatly improve patient compliance.
• Application time is shorter than other interventions.
• However, the application requires a clinical setting.
• Difficult to control dosage without professional supervision.

Silver Diamine Fluoride

• Silver diamine fluoride is a clear, odorless liquid used to control caries in adults and children at high risk, as well as those with difficult-to-control, progressing lesions.
• High concentration of fluoride (44,800ppm)
• Can cause permanent black staining.

Silver Diamine Fluoride - Potential Usage

• Used for pre-emptive treatment of dental lesions.
• It may take time for effects to show, providing time for acclimatisation to dental care and other, further, treatment plans.

Silver Diamine Fluoride - Action Mechanism

• Chemical reactions inhibit bacterial growth and promote remineralization.
• Inhibits breakdown of collagen.

Silver Diamine Fluoride - Indications

• For individuals with obvious caries,
• those with orthodontic appliances,
• individuals with low saliva flow conditions,
• those needing special care.

Silver Diamine Fluoride - Limitations and Considerations

• Not suitable for all situations. It requires professional application and presents a permanent black stain.
• Extensive lesions, pain, or infection may be contra-indications for use.

Glass Ionomer Cements

• Restorative materials that release fluoride into the demineralized tooth surface.
• Can release low levels of fluoride for several years (up to 8 years).

Prophylaxis Paste

• Used for removal/cleaning of plaque and other substances.
• Has fluoride.
• Should not be used to prevent tooth decay, but for preventative/therapeutic measures.

Systemically Applied Fluoride Methods

• Concentrated forms of fluoride.
• Different methods of intake depending on age and risk factors.

Fluoride Tablets/Lozenges/Drops

• Varying dosage for different age groups from 0.25mg to 1mg.
• Usually taken at a different time from brushing.

Recommendations - Systemically Applied Fluorides

• Fluoride, a significant substance for reducing risk and impacting tooth decay, intake levels vary widely.
• Should be evaluated based on age-appropriate guidelines and risk factors.

Pre-natal Fluoride Administration

• Some studies suggest that fluoride supplementation during pregnancy may have benefits for offspring's dental health, but evidence is not robust enough to support widespread use.
• Cochrane systematic review found no evidence that prenatal fluoride intake affects offspring's dental health.

Fluoridated Salt

• Salt fluoridation is a method of adding fluoride to salt, and is used in some regions to increase fluoride intake and reduce risk of tooth decay, but is not common in the UK.

Fluoridated Milk

• Free fluoridated milk programs for school children.
• Children under 5 years old, should consume cartons that contain 1mg of fluoride every other day.
• High caries rate areas may require a higher intake frequency.

Oral Health - General Considerations

• Dental products should be kept out of the reach of young children.

Fluoride Toxicity Consideration

• Acute lethal dose 15mg/kg body weight.
• 5mg/kg may be fatal in some children.
• 1mg/kg can cause sub-lethal effects.

Oral Health - General Considerations

• Oral Hygiene advice and treatment, should be applied in order of priority.
• The oral health and treatment plan for each patient/child/individual, must be tailored depending on their lifestyle and needs.
• It is essential to use the most appropriate, age-appropriate and suitable preventative and/or therapeutic approach for each patient.

Test your knowledge on the various fluoride delivery methods available for dental care. This quiz focuses on identifying which methods can be purchased over-the-counter. Enhance your understanding of fluoride use in oral health.