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

What is the purpose of fluoride supplements?

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

What is the recommended administration time for fluoride tablets?

<p>Preferably in the evening, separate from brushing (B)</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 (C)</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. (C)</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. (C)</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. (C)</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. (B)</p> Signup and view all the answers

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

<p>0.05% (C)</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. (A)</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 (A)</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. (A)</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. (A)</p> Signup and view all the answers

What is a disadvantage of weekly fluoride rinses?

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

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

<p>Salt fluoridation (A)</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 (C)</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 (A)</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 (C)</p> Signup and view all the answers

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

<p>No less than 1000ppm (A)</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 (D)</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. (C)</p> Signup and view all the answers

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

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

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

<p>Risk of ingestion (B)</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 (A)</p> Signup and view all the answers

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

<p>Risk level of caries (D)</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 (C)</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. (D)</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 (D)</p> Signup and view all the answers

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

<p>Salivation and nausea (A)</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 (A)</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 (A)</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 (B)</p> Signup and view all the answers

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

<p>After 1 hour (B)</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 (C)</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 (B)</p> Signup and view all the answers

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

<p>Supervise their usage (D)</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 (A)</p> Signup and view all the answers

Flashcards

Systemic Fluoride

Fluoride that is ingested and becomes part of the tooth structure during its formation.

Topical Fluoride

Fluoride applied directly to the teeth to strengthen the enamel and make them more resistant to decay.

High Fluoride Toothpaste

A type of fluoride toothpaste that contains a higher concentration of fluoride (typically 1450ppm).

Prescription Strength Toothpaste

A type of fluoride toothpaste that contains a very high concentration of fluoride (typically 2800ppm).

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Minimum Fluoride Concentration

The minimum concentration of fluoride in toothpaste needed for effective cavity prevention.

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Forms of Fluoride Supplements

Fluoride supplements come in different forms, such as tablets, lozenges, and drops, available in varying concentrations (e.g., 0.25mg, 0.5mg, 1mg).

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Prescribing Fluoride Supplements

Fluoride supplements are prescribed by a dentist or doctor, not available over-the-counter.

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Fluoride Supplement Dosage

The amount of fluoride supplement needed depends on the fluoride levels in your drinking water. More water fluoride means less supplement.

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Fluoride Supplements - First Line?

Fluoride supplements may not be the first line of defense for preventing tooth decay, especially for children with developing teeth.

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Fluoride Supplement Chart

Fluoride supplement dosage varies based on age, and the fluoride level in your water.

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Why "Spit don't Rinse"?

After brushing with fluoride toothpaste, it is important to spit out the excess paste and avoid rinsing the mouth with water or mouthwash.

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What happens when you rinse after brushing?

Fluoride from toothpaste creates a protective layer in saliva, which strengthens teeth and prevents cavities. Rinsing washes this layer away, reducing the benefit of the fluoride.

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Why is mouthwash not ideal for rinsing after brushing?

Mouthwash has a much lower concentration of fluoride compared to toothpaste, making it less effective at preventing cavities. Rinsing with mouthwash after brushing dilutes the fluoride in saliva, making it less effective.

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When is mouthwash okay to use?

Mouthwash can be used to supplement fluoride from toothpaste. Use mouthwash at a different time of day from brushing to maximize fluoride exposure.

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What are prescription fluoride rinses?

Prescription fluoride rinses contain a higher concentration of fluoride compared to over-the-counter rinses. They are typically prescribed for patients with a higher risk of cavities.

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Who should use a daily fluoride rinse?

Daily use of fluoride rinses (0.05% NaF) is recommended for those over 7 years of age or those who can rinse without swallowing. This helps to reduce the risk of cavities, especially for patients with a higher risk of developing them.

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Who are considered "high caries risk" patients?

Patients with a higher risk of developing cavities are more susceptible to tooth decay. This may include people with certain health conditions, poor oral hygiene practices, or a history of cavities.

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What are the benefits of fluoride rinses?

Fluoride rinses provide a way to deliver additional fluoride to teeth, especially for people who need extra protection against cavities. It's an easy and effective method for improving oral health.

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Tailored Fluoride Advice

Fluoride's varied impact on different individuals, demanding personalized guidance.

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Fluoride's Protective Effect

Fluoride's ability to strengthen enamel and protect against cavities, making teeth more resistant.

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Fluoride Concentration for Adults and Children Over 3

Toothpaste containing 1350-1500ppm fluoride is recommended for children over 3 years old and adults to help prevent tooth decay. This concentration offers a balance between effectiveness and safety.

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Fluoride for Children Under 3

Children under 3 years old should use toothpaste with at least 1000ppm fluoride to promote healthy teeth development, but the amount should be no bigger than a smear.

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High-Risk Children Under 3

Children at high risk for cavities under 3 years old can use a toothpaste containing 1350-1500ppm fluoride. However, they must be supervised and taught to spit out the paste.

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Fluoride for Children 7 Years and Older

Children between 7 years and adulthood should typically use toothpaste with 1350-1500ppm fluoride. But if they are at higher risk of cavities, they may be prescribed a stronger toothpaste with 2800ppm fluoride.

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Fluoride for Adults

Adults generally require at least 1350ppm fluoride in their toothpaste for optimal tooth protection. However, individuals with active cavities or root decay may benefit from a higher concentration of 2800ppm or 5000ppm fluoride.

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Supervision for Children Under 7

Children under 7 often lack the manual dexterity to effectively brush their teeth. This makes adult supervision essential to ensure they are properly cleaning their teeth and not swallowing toothpaste.

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Toothpaste: Pros and Cons

Toothpaste provides a convenient and readily available way to deliver fluoride, making it a popular choice for oral health maintenance. However, it is important to ensure users are aware of the fluoride levels present in different toothpastes to select appropriate products.

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Spit Don't Rinse

The term 'Spit don't rinse' refers to the practice of spitting out toothpaste after brushing and avoiding rinsing with water, which can help retain the fluoride on the teeth for longer, maximizing its benefits.

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Children's Dexterity and Oral Hygiene

Children have less developed manual dexterity, meaning they may not be able to brush their teeth effectively. This can lead to plaque buildup and, consequently, an increased risk of cavities.

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Tailoring Fluoride Concentration

When selecting toothpaste, it's crucial to choose a product with a fluoride concentration suitable for the individual's age and risk level. This ensures the proper amount of fluoride is delivered to the teeth for optimal oral health.

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Potentially Lethal Fluoride Dose

A dose of fluoride that is high enough to cause potentially life-threatening effects in a child.

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Sub-Lethal Fluoride Dose

A dose of fluoride that is likely to cause discomfort and symptoms but is not immediately life-threatening.

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Sub-Lethal Toxic Effects of Fluoride

Effects such as vomiting and nausea, that occur after a child has ingested fluoride.

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Lethal Fluoride Dose

The amount of fluoride that can cause death in a child.

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Typical Time for Fluoride Symptoms

The time it takes for symptoms of fluoride poisoning to appear after ingestion. Usually within an hour.

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Emergency Action for Fluoride Overdose

The recommended action to take if a child is suspected of having ingested a potentially lethal dose of fluoride.

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Milk Dilution for Fluoride Poisoning

A common approach to reduce the severity of fluoride poisoning in children by quickly diluting the fluoride.

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Time Frame for Death from Fluoride Poisoning

The time frame in which death from fluoride poisoning can occur after a lethal dose.

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Fluoride Varnish for High-Risk Patients

Fluoride varnish, a topical treatment for tooth decay, is considered the best choice, especially for children who may not use home fluoride products regularly.

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Keeping Home Fluoride Products Safe

Fluoride products for home use, such as toothpaste, should be kept out of reach of young children to prevent accidental ingestions.

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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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