Fluoride Delivery Methods
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Questions and Answers

What is the primary benefit of topical fluorides?

  • They only affect baby teeth.
  • They provide long-term systemic benefits.
  • They make existing teeth more decay resistant. (correct)
  • They are ingested to create new tooth structures.

    • Which fluoride toothpaste concentration is generally considered effective for controlling caries?

  • 1450ppm (correct)
  • 2000ppm
  • 1000ppm or lower
  • 2800ppm

    • What type of fluoride source requires a prescription and has a concentration of 5000ppm?

  • Fluoride drops
  • Standard fluoridated toothpaste
  • 5000ppm sodium fluoride toothpaste (correct)
  • Fluoridated mouth rinse

    • Which of the following is NOT a commonly used method for systemic fluoride delivery?

    <p>Duraphat fluoride varnish</p> Signup and view all the answers

    Which class of fluoride is described as those that are ingested and incorporated into forming tooth structures?

    <p>Systemic fluorides</p> Signup and view all the answers

    What is the purpose of fluoride supplements?

    <p>To prevent decay in high-risk patients</p> Signup and view all the answers

    What is the recommended administration time for fluoride tablets?

    <p>Preferably in the evening, separate from brushing</p> Signup and view all the answers

    At what fluoride concentration should children aged 6 months to 2 years take supplements?

    <p>0.25mg if water is below 0.3ppm</p> Signup and view all the answers

    Which of the following statements about fluoride use is NOT true?

    <p>Fluoride should be used as a first-line treatment.</p> Signup and view all the answers

    Why should fluoride supplements be administered with caution?

    <p>They may lead to excess fluoride intake from other sources.</p> Signup and view all the answers

    What is the main reason patients should not rinse after using toothpaste?

    <p>Rinsing removes the fluoride reservoir in saliva.</p> Signup and view all the answers

    Why should mouthwash not be used immediately after brushing with toothpaste?

    <p>Mouthwash has a lower fluoride concentration than toothpaste.</p> Signup and view all the answers

    Which concentration of fluoride is typically found in over-the-counter mouthwash?

    <p>0.05%</p> Signup and view all the answers

    What is a potential risk of using fluoride rinses, particularly for young children?

    <p>They may inadvertently ingest the rinse.</p> Signup and view all the answers

    What is the recommended fluoride concentration for daily rinses for those older than 7?

    <p>0.05% NaF</p> Signup and view all the answers

    Which type of patients is likely to benefit most from using a daily fluoride rinse?

    <p>Patients with a high risk of dental caries.</p> Signup and view all the answers

    What is a condition that may limit the use of fluoride rinses in children?

    <p>Children unable to spit out the rinse.</p> Signup and view all the answers

    What is a disadvantage of weekly fluoride rinses?

    <p>They may be forgotten by patients.</p> Signup and view all the answers

    What type of advice should be provided to patients regarding toxic effects of certain treatments?

    <p>Advice should be tailored to the needs of the individual patient</p> Signup and view all the answers

    Which method is proposed as an alternative for preventing dental caries?

    <p>Salt fluoridation</p> Signup and view all the answers

    What type of products are discussed for fluoride supplementation in children?

    <p>Fluoride tablets, drops, lozenges, or chewing gums</p> Signup and view all the answers

    What was one of the focuses of the Cochrane database reviews regarding fluoride?

    <p>Fluoride supplementation for preventing tooth decay in pregnant women</p> Signup and view all the answers

    Which of the following has been discussed as a clinical effect of glass ionomers?

    <p>Their ability to release fluoride</p> Signup and view all the answers

    What is the recommended fluoride level for children aged 0-3 years?

    <p>No less than 1000ppm</p> Signup and view all the answers

    At what age can children start using toothpaste with 1350-1500ppm fluoride if they can spit it out?

    <p>6 years</p> Signup and view all the answers

    Which of the following statements is true about fluoride toothpaste for young children?

    <p>Supervision is needed until children are at least 7 years old.</p> Signup and view all the answers

    What toothpaste fluoride level is prescribed for children over 10 years with active caries?

    <p>2800ppm</p> Signup and view all the answers

    What does the term ‘Spit don’t rinse’ refer to in dental care?

    <p>To avoid rinsing out fluoride after brushing</p> Signup and view all the answers

    What is a potential risk of using fluoride toothpaste in young children?

    <p>Risk of ingestion</p> Signup and view all the answers

    Which fluoride level is advised for adults with active coronal or root caries?

    <p>Both B and C</p> Signup and view all the answers

    Which factor may affect the dosing of fluoride toothpaste for certain patients?

    <p>Risk level of caries</p> Signup and view all the answers

    At what age can children normally start using toothpaste with a pea-sized amount without supervision?

    <p>7 years</p> Signup and view all the answers

    What is a common misconception regarding fluoride levels in toothpaste?

    <p>All children's toothpaste have the same fluoride level.</p> Signup and view all the answers

    What is the immediate action required if a child ingests 5mg/kg of fluoride?

    <p>Trigger emergency action</p> Signup and view all the answers

    What symptoms may result from a sub lethal dose of fluoride (1mg/kg)?

    <p>Salivation and nausea</p> Signup and view all the answers

    If a child ingests a small quantity of fluoride, what is recommended to neutralize it?

    <p>Large volume of milk</p> Signup and view all the answers

    What is the potentially lethal dose of Sodium Fluoride Varnish for a 5-year-old child weighing 20kg?

    <p>4ml</p> Signup and view all the answers

    What should be done if there is doubt about the quantity of fluoride ingested by a child?

    <p>Take the child to A&amp;E</p> Signup and view all the answers

    What is the typical timeline for symptoms to appear after fluoride ingestion?

    <p>After 1 hour</p> Signup and view all the answers

    Which fluoride preparation poses a lower risk for topical application in a high-risk patient?

    <p>Sodium Fluoride Varnish</p> Signup and view all the answers

    What is the maximum amount of Toothpaste with 1500ppm fluoride that can be safely used by a 5-year-old child?

    <p>22ml</p> Signup and view all the answers

    What should parents do regarding young children's use of toothpaste?

    <p>Supervise their usage</p> Signup and view all the answers

    What is recommended to combine with the use of fluorides in dental practice?

    <p>Dietary advice and oral hygiene practices</p> Signup and view all the answers

    Study Notes

    Fluoride Delivery Methods

    • Fluoride is crucial for oral health, combating bacteria and sugars that contribute to tooth decay.
    • Various methods deliver fluoride, both over-the-counter and prescription.
    • Different fluoride sources vary in concentration and application, impacting their efficacy.

    GDC Learning Outcomes

    • Dentists must possess knowledge of relevant medicines and therapeutic agents and how they affect patients.
    • Effective preventative education and instruction are vital for patient self-care and motivation.
    • Dental care should focus on maintaining long-term oral and general well-being.
    • This includes promoting the use of preventative materials and treatments for optimal patient care.
    • Health promotion plays a crucial role in tailoring care to community and individual needs.

    Pre-reading: Aetiology of Dental Caries

    • The lecture covers the factors that lead to dental caries (cavities).
    • It involves understanding the relationship between susceptible teeth surfaces, time, bacteria, and fermentable carbohydrates.

    Pre-reading: Histology of Enamel and Dentine

    • The lectures cover the microscopic structure and composition of tooth enamel and dentine.

    Pre-reading: Fluoride and the Tooth Surface

    • The lecture focuses on how fluoride interacts with tooth surfaces.

    Learning Objectives

    • Students should be able to identify over-the-counter and prescription fluoride supplements.
    • Students should understand professionally administered fluoride interventions.
    • Students should know the different fluoride levels considered to be dangerous for various age groups/ stages.

    Recap - What do we know so far?

    • This section summarizes previous knowledge of fluoride delivery methods.

    How is it absorbed - Post-Eruptive Stage

    • Tooth surfaces experience fluctuations in pH levels due to bacterial acid production.
    • Calcium and phosphate loss from hydroxyapatite, a crucial tooth component, causes demineralization.
    • Saliva delivery of fluoride, calcium and phosphate causes remineralisation of tooth surfaces to form fluoroapatite.
    • This process involves increase in ph, and addition of minerals.

    How does it work - Uptake into the tooth

    • Fluoride is absorbed into tooth surface.
    • This makes the tooth more resistant to demineralization from caries (tooth decay).
    • Fluoride uptake occurs in multiple stages. This explains different types of fluoride.

    How is it absorbed - Post-Eruptive Stage (Key Points)

    • Most fluoride is absorbed during the 2-3 years after tooth eruption.
    • Tooth enamel is more porous just after eruption and absorbs fluoride easily allowing uptake for remineralisation.
    • Demineralised enamel absorbs fluoride easily.

    Caries prevention with fluoride

    • Maintenance of fluoride present at low levels in the mouth is essential for preventing tooth decay.
    • This replaces lost ions and strengthens tooth enamel against future decay.

    Recap (Fluoride effects)

    • Fluoridated water reduces permanent teeth decay in children by 26%.
    • Fluoridated water reduces early (baby) teeth decay in children by 35%.
    • Fluoridation increases the percentage of children without decay in primary teeth by 14-15%.
    • Insufficient evidence exists on the effects of fluoride in adults.

    Sources (without prescription)

    • Common sources of fluoride without a doctor's prescription include toothpaste, mouthwash, fluoridated water, fluoridated salt, fluoridated milk

    Sources (with prescription)

    • Sources of fluoride requiring a doctor's prescription include higher concentration toothpaste (e.g, 2800ppm), mouth rinses (e.g, 5000ppm), fluoride tablets, and fluoride drops.

    Professionally applied sources

    • Professionally-applied fluoride treatments include fluoride varnish, utilizing microbrushes or floss to reach hard-to-reach areas.
    • Duraphat Fluoride Varnish, Profluorid Fluoride Varnish, and Glass Ionomer Cement.
    • Other applications like Silver Diamine Fluoride (SDF).

    Systemic vs Topical Fluoride

    • Systemic fluoride is ingested and incorporated into tooth structure.
    • Topical fluoride strengthens existing teeth in the mouth.

    Fluoride Levels

    • The concentrations of fluoride in commercially available products are detailed in the document.

    Toothpaste

    • Fluoride toothpaste concentrations below approximately 1450 ppm are ineffective.
    • Common fluoride toothpaste contains 1450 ppm fluoride.
    • Children under 3 need a smear amount of toothpaste.
    • Children over 3 need approximately a pea-sized amount of toothpaste.

    Toothpaste (additional details)

    • 2800ppm and 5000ppm fluoride toothpastes are prescription-only.
    • Fluoride levels within toothpaste must be considered for age.

    Recommendations (fluoride application to different patient groups based on age)

    • Recommendations for fluoride usage differ according to age.

    Recommendations (additional guidelines)

    • Other fluoride sources should be considered appropriate for the age of patient.
    • Diet advice and oral hygiene should be prioritized over fluoride supplements.
    • Fluoride supplements should be taken at a different time than brushing and not with food.

    Recommendations (children fluoride requirements)

    • Different fluoride levels are recommended depending on age (0-.3, .3-.7, >.7 ppm).

    Fluoride Tablets/Lozenges/Drops and Administration

    • Fluoride supplements can be added to water, chewed, or sucked.
    • These are prescription-only, with dosages dependent on availability.

    Recommendations (for consideration)

    • Consideration on patient's needs (eg, high-risk for tooth decay and medical conditions).
    • fluoride supplementation is not a first-line recommendation.
    • Additional sources should match age.

    Recommendations (general instruction on fluoride application)

    • Diet recommendations and good oral hygiene practice should come first, followed by fluoride supplementation, if necessary.

    Fluoride Toxicity

    • Acute lethal doses vary according to weight, and lower doses (1 mg/kg) can lead to adverse effects.
    • Symptoms (due to acute ingestion of fluoride) include, nausea, vomiting, and salivation.
    • Overdose can lead to damage to respiratory and cardiac functions if ingested.
    • Drinking milk can reduce fluoride toxicity.

    Toxicity (of fluoride preparation for a 5 year old weighing 20 kg)

    • Provides a table detailing sublethal and potentially lethal doses of various fluoride preparations for a 5-year-old child of 20 kg.

    Summary (fluoride options)

    • Fluoride varnish is often the chosen application for high-risk patient groups, particularly as oral health compliance might be a problem.
    • Parents should always supervise their children's oral hygiene and fluoride use.
    • Dental products containing fluoride should be kept separate from young children.
    • Topical fluoride applications should be used with caution as potential side effects may occur if administered incorrectly.

    References (Sources)

    • Relevant research and reports (including studies, articles, and guidelines) pertaining to fluoride are detailed for further research.
    • Cochrane Systematic reviews include detailed resources about milk fluoridation, fluoride supplementation in pregnant women, and fluoride supplements for tooth decay in children, along with salt fluoridation.

    Fluoride Varnish (Additional details)

    • Fluoride varnish is stick, requires teeth cleaning and isolation before application.
    • Post-application instructions (no food/drink) are critical for optimal results.
    • The application can be done by trained nurses or dentists.
    • For children over 3, only appropriate application are allowed.

    Fluoride Varnish (Indications)

    • Can be used in patients who cannot or are unwilling to utilize fluoride rinses.
    • Recommended or suitable for patients of or older than 3, with or without orthodontics, and/or high risk of tooth decay.
    • Localised application is suitable for high risk patient.
    • Protection of vulnerable tooth root surfaces is a key application for this specific varnish usage.

    Fluoride Varnish (Application)

    • A sticky substance is applied to teeth.
    • Ensure no contraindications.
    • Clean, isolate and dry teeth.
    • Utilize a microbrush or floss to ensure penetration.
    • Post-operative instructions are important.

    Fluoride Varnish (Pros and cons)

    • Fluoride varnish has the option to target at risk groups.
    • Removal of varnish when indicated can be done.
    • Fluoride varnish offers options for taste.
    • Fluoride varnish is a good option for patients who do not want to use other fluoride types.
    • The dose of fluoride varnish can be difficult to control.

    Silver Diamine Fluoride (SDF)

    • SDF is a clear, odourless liquid used to treat dental caries.
    • Effective for children/adults with difficulty in controlling caries.
    • Side effect is staining of tooth surface.
    • SDF is effective but long-term results may be needed.

    Silver Diamine Fluoride (SDF): Action

    • SDF interacts with tooth enamel in a way that stops bacteria from damaging the tooth surface causing decay.
    • This leads to remineralisation, thereby preventing cavities and decay.
    • SDF does not affect organic (living) structure of the tooth but alters the mineral content of the tooth.

    Silver Diamine Fluoride (SDF): Indications

    • Used for managing cavities, where traditional treatment is not appropriate, making it particularly useful for anxious or cooperative patients and medically vulnerable or patients with special needs.
    • It's ideal for cavity-prone adults and children and in cases with difficult-to-manage caries risk,.
    • It also works in situations where it's harder for a patient to manage traditional tooth treatments.
    • Twice yearly application for higher risk children and patients.

    Silver Diamine Fluoride (SDF): Contraindications

    • Patients with hypersensitivity to fluoride, potassium iodide and/or ammonia.
    • Patients undergoing thyroid therapy or using thyroid medication.

    Silver Diamine Fluoride (SDF):Advantages

    • Suitable for individuals facing challenges with traditional treatments or those who may not comply with routine dental care or who have a high risk of caries.
    • Useful in patients needing a quicker solution or who cannot have traditional restorative treatments.

    Silver Diamine Fluoride (SDF):Disadvantages

    • Concerns exist regarding the possible side effect of permanent tooth staining.
    • Success in arresting caries is not guaranteed in all cases, depending on patient or medical circumstances.

    Glass Ionomer Cements

    • Glass ionomer cement can release fluoride into teeth.
    • Fluoride is released into the demineralised area.
    • Low levels over longer period of time are beneficial.

    Prophylaxis Paste

    • Prophylaxis paste can be used for cleaning; but not for preventive purposes only.
    • Its abrasive nature can lead to enamel loss that might counter any fluoride benefits.
    • Should be used with fluoride.

    Fluoride Concentration/Systemically applied fluoride methods

    • Different systemically-applied fluoride methods have varying concentrations.
    • Detailed information about these concentrations and their potential associated cons/pros is included.

    Fluoride Tablets/Lozenges/Drops

    • These are available as supplements in 0.25, 0.5, or 1 mg concentrations.
    • Administered by sucking or dissolving in the mouth.
    • Daily use, ideally in the evening.
    • Dosage should depend on the availability of fluoride in the drinking water.

    Recommendations (for high risk of tooth decay)

    • High-risk patients who may have compliance problems with treatments, including children or medically compromised patients should be treated on a case-by-case basis, taking their dietary habits into consideration.

    Recommendations (alternative fluoride sources to be used in place of supplements)

    • Other fluoride sources (eg, toothpaste) should match the patient's age and other medical requirements.
    • Diet advice and oral hygiene instructions should always be the first line of treatment for a patient or child in their early years.

    Pre-natal Fluoride administration

    • Fluoride supplementation isn't always recommended in pregnancy, as evidence doesn't conclusively support its effectiveness.

    Fluoridated Salt

    • Salt fluoridation is a method used in some countries outside the UK and some areas in Europe and South America.
    • It avoids some potential concerns about tap water fluoridation.

    Fluoridated Salt (Pros and Cons)

    • Widely available Commodity, simple to use, easy to administer.
    • No consistent dose, uneven intake, unable to target a certain population, can be detrimental to those with health problems.
    • Risk of Fluorosis if used in conjunction with other sources.
    • Use discouraged as part of a healthy diet.

    Fluoridated Milk

    • Fluoride is added to milk in schemes across certain areas outside the UK.
    • Children should not take part if already consuming supplement fluoride.

    Fluoridated Milk (Pros and Cons)

    • Targeted populations including children are easily reached, palatable by children and there is an option to discontinue usage when needed.
    • Expensive, often too late for treatment when needed, inaccurate dose.

    Dental Health Products (general recommendations)

    • Products for home-use should be kept out of reach of young children.
    • Supervise young children's fluoride use as needed, such as the use of fluoride toothpaste or fluoride rinses.

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