Fluoride and Toothpaste Quiz (ODS Learning Outcomes)

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Questions and Answers

What year did Frederick McKay identify the potential caries-reducing effect of fluoride despite its association with tooth staining?

1916

1931

1932 (correct)

1940

Which report published in 2000 found no evidence linking fluoride with cancer or bone fractures?

York report (correct)

Cochrane review

CDC report

Knox report

At what concentration (ppm) of fluoride is it suggested to optimally reduce caries while preventing mottling?

1.5 ppm

0.5 ppm

1.0 ppm (correct)

2.0 ppm

During which developmental stage does the majority of fluoride absorption occur after tooth eruption?

Post eruptive stage Signup and view all the answers

In the context of fluoride effects, what is indicated by the term 'fluorosis'?

Aesthetic tooth staining Signup and view all the answers

What is the process through which fluoride replaces hydroxyapatite in teeth?

Deposition Signup and view all the answers

What was one conclusion from the Cochrane review conducted in 2015 regarding fluoride use in children?

Fluoride reduces caries incidence by 14%. Signup and view all the answers

Which factor primarily influences the uptake of fluoride during the post-eruptive stage?

Porosity of enamel Signup and view all the answers

What potential effect can excessive fluoride have during the pre-eruptive stage?

Inhibition of ameloblast activity Signup and view all the answers

What is the main source of fluoride during the matrix secretion stage of tooth development?

Systemic sources Signup and view all the answers

What is one of the main antibacterial effects of fluoride on bacteria such as Strep mutans?

It prevents the formation of biofilm. Signup and view all the answers

Which fluoride delivery method is considered a prescription-only option?

Fluoride drops Signup and view all the answers

How does fluoride influence tooth morphology?

Causes shallower pits and reduced fissure depth. Signup and view all the answers

Which score indicates the presence of normal translucency in the enamel when assessing fluorosis severity?

Score 0 Signup and view all the answers

What can result from excess fluoride during the ameloblast activity?

Formation of hypomineralized enamel. Signup and view all the answers

At what fluoride level is it considered dangerous for children under 3 years old?

1000ppm smear Signup and view all the answers

What is the fluoride concentration in Duraphat fluoride varnish?

22,600ppm Signup and view all the answers

What level of fluoride is associated with toxicity in children?

15mg/kg body weight Signup and view all the answers

Which system is affected by fluoride's antibacterial action, inhibiting bacterial uptake of glucose?

Glycolysis system. Signup and view all the answers

Which fluoride delivery method is used for systemic effects?

Fluoridated water Signup and view all the answers

Study Notes

Key Milestones in Fluoride Caries Prevention

1916: Colorado Stain – Frederick McKay observed patients with stained teeth in Colorado Springs, initiating investigation into the cause.
1931: Water Sampling – Churchill McKay discovered children near a mine water source had tooth staining, linked to the water.
1932: Caries Reduction – Frederick McKay suggested that fluoride, although causing staining, could reduce tooth decay.
1930-1940: Shoe Leather/21 Cities Studies – H. Trendley Dean's studies demonstrated a correlation between increasing fluoride in water and mottling, but also a decrease in tooth decay. Optimal level identified as 1 ppm. Led to artificial water fluoridation.
1985: Knox Report – No significant link between fluoride in water and increased cancer risk found.
2000: York Report – Further research confirmed no link between fluoride and cancer or bone fractures.
2015: Cochrane Review – Studies showed a 14% reduction in tooth decay in children from fluoridated water. A 0.7 ppm level in water could result in a 12% chance of fluorosis.

Fluoride Deposition Stages

Pre-Eruptive Stage (Systemic Fluoride)

Matrix Secretion: Fluoride absorbed through the system (swallowed), travels to developing teeth. Deposited as fluoroapatite, replacing hydroxyapetite. Excess fluoride can hinder enamel formation, causing possible mottling (fluorosis).

Maturation Stage

Fluoride Absorption: Fluoride continues to be absorbed after calcification but before eruption. Fluoride deposited further into the enamel.

Post-Eruptive Stage (Topical Fluoride)

Maximum Uptake Period: Most fluoride uptake occurs post-eruption (2-3 years). Demineralized enamel and high porosity enable increased absorption. Fluoride does not penetrate deeply when applied topically.

Modes of Action of Fluoride

Hydroxyapatite Replacement: Fluoride combines with calcium to form fluoroapatite, making enamel and dentin more resistant to acid attack.
Bacterial Inhibition: Fluoride is toxic to bacteria (like Streptococcus mutans). It impacts bacterial enzyme functions, specifically sugar metabolism, reducing their ability to cause decay.
Reduced Surface Energy: Fluoride reduces enamel surface energy, decreasing bacterial attachment and pellicle formation. This makes teeth less susceptible to initial decay. Affects root caries in a similar manner.

Fluorosis: Cause and Assessment

Excess Fluoride: Excessive fluoride intake during tooth development inhibits ameloblast activity, leading to hypomineralized hypolasic enamel formation. This makes the enamel more porous, increasing the risk for staining.
Fluorosis Severity: Fluorosis scores range from 0 (normal) to 9 (severe). Scores 1-4 are characterized by increasing levels of staining without visible enamel loss, whereas scores 5-9 indicate a progressively higher loss of the enamel outer layer. Other factors such as trauma, genetic or disease can also cause this.

Fluoride Delivery Methods and Supplementation

Over-the-Counter Options

Toothpaste (1000-1450 ppm fluoride)
Mouth Rinse (0.05%)
Fluoridated Water (systemic effect)
Fluoridated Salt/Milk (systemic effect)

Prescription Options

Toothpaste (2800, 5000 ppm)
Mouth Rinse (0.2%)
Fluoride Tablets (0.25/0.5%)
Fluoride Drops

Professionally Applied Fluoride

Fluoride Varnish (Duraphat/Profloride - 22,600 ppm) to be applied every 3-6 months (avoid in ulcerative colitis or asthma)
Glass Ionomer Cement
Silver Diamine Fluoride (44,800 ppm)

Dangerous Fluoride Levels for Children and High Risk

Supervision: Children under 7 need supervision with topical fluoride due to dexterity limitations.
Children under 3: Recommended 1000 ppm smear fluoride amount.
Children over 3: 1350-1500 ppm pea-sized applications.
High-Risk Children (any age): Higher fluoride concentrations (1350-1500 ppm for under 3s), up to prescription products (2800 ppm, 5000 ppm), are considered based on risk.
Toxicity: >15 mg/kg body weight is toxic.

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Description

This quiz explores significant historical milestones in fluoride caries prevention, detailing key findings and reports from the early 20th century to recent studies. Test your knowledge about the pivotal events and research that shaped public health policy regarding fluoride use in dental care.