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Questions and Answers
What is the typical concentration of fluoride found in sea water?
What is the primary source of fluoride pollution?
What percentage of ingested fluoride is absorbed from the stomach and duodenum?
What is the average daily intake of dietary fluoride by young children in an optimally fluoridated area?
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Which plant is known to accumulate several hundred parts per million of fluoride?
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What is the highest natural fluoride concentration ever found in water?
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Where is fluoride found in the environment?
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What is the total daily intake of fluoride by adults?
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What is the relationship between fluoride absorption and the pH of the gastric content?
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What is the primary reason for the reduced absorption of fluoride when ingested with food?
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Which of the following fluoride compounds is virtually insoluble?
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What is the typical time frame for peak plasma concentration of fluoride after ingestion?
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What percentage of the body's fluoride burden is associated with calcified tissues?
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What is the primary route of excretion for absorbed fluoride?
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What is the main difference between systemic and topical administration of fluoride?
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Which of the following is an example of systemic administration of fluoride?
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What is the optimum level of fluoride in water fluoridation?
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What is the percentage reduction in caries by water fluoridation?
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What is the concentration of fluoride in salt fluoridation?
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What is the recommended age to start fluoride tablets?
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What is the amount of fluoride in fluoride tablets?
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Who should prescribe fluoride tablets?
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What is the duration of fluoride tablets administration?
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Why is milk a reasonable vehicle for fluoride?
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What is recommended for children below 4 years of age?
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At what age should fluoridated toothpaste be used?
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How much fluoride toothpaste should be used for children?
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What is the recommended method of using fluoride mouth rinses?
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What is the lethal dose of fluoride for adults?
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What are the symptoms of fluoride toxicity?
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What is the treatment for acute fluoride toxicity?
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What is chronic fluoride toxicity known to cause?
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At what age range does the damage to the tooth occur in dental fluorosis?
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Which teeth are least affected by dental fluorosis?
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What is the effect of mild to moderate fluorosis on the risk of dental caries?
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What is the typical appearance of teeth in mild cases of dental fluorosis?
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What is the purpose of Dean's fluorosis index?
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What is the treatment for moderate to severe fluorosis?
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What is the characteristic of dental fluorosis in terms of symmetry?
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What is the treatment for mild fluorosis?
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Study Notes
Fluoride in Environment
- Fluoride is found naturally in the earth's crust and water, chemically bound to minerals and other chemical compounds.
- Sea water contains significant quantities of fluoride at levels of 0.8 – 1.4 mg/lt.
- The highest natural fluoride concentration ever found in water was 2800 mg/lt.
Fluoride Metabolism
- The major sources of fluoride are food, drinking water, beverages, and fluoride-containing dental products.
- The total daily intake of fluoride by adults is 1.7 – 3.3 mg/kg.
- The average daily intake of dietary fluoride by young children whose water supply is optimally fluoridated is approximately 0.5 mg or 0.04 – 0.07 mg/kg per day.
- 75-90% of ingested fluoride is absorbed from the stomach and duodenum by passive diffusion.
- The ingestion of fluoride with food retards its absorption.
- Readily soluble fluoride compounds are completely absorbed.
Fluoride in Plasma
- The fluoride found in plasma is in two forms: ionic (inorganic fluoride or free fluoride) and non-ionic or bound fluoride.
- Peak plasma concentration usually occurs within 30-60 minutes.
- Soft tissues: fluoride from soft tissue could diffuse back into plasma.
- Fluoride in calcified tissues: approximately 99% of the body burden of fluoride is associated with calcified tissues (bone and teeth).
Fluoride Administration
- Systemic administration:
- Provides a low concentration, over a long period of time.
- Examples: water fluoridation, salt fluoride, milk fluoridation, fluoride tablets.
- Topical administration:
- Provides high or low concentrations, over a short period of time.
- Examples: fluoride dentifrices, fluoride mouth rinses.
Fluoride Toxicity
- Lethal dose: adult 34-64mgF/kg, children 5mg/kg.
- Symptoms: salivation, nausea, vomiting, abdominal pain, diarrhea, cramps, cardiac arrhythmia, and coma.
- Acute toxicity: due to excessive ingestion of fluoride over a short period of time.
- Chronic toxicity: due to excessive ingestion of fluoride over a long period of time, causing skeletal fluorosis and dental fluorosis.
Dental Fluorosis
- A cosmetic condition that affects the enamel due to excessive intake of fluoride.
- Damage occurs between the ages of 6 months to 5 years.
- Molars and bicuspids are most frequently affected, followed by upper incisors.
- Fluorosis tends to be bilaterally symmetrical.
- Signs and symptoms:
- Chalk-like discoloration of teeth with white spots or lines on tooth enamel.
- Yellow or brown discoloration in severe cases.
- Pitted tooth surface in extreme cases.
Treatment of Dental Fluorosis
- Mild fluorosis: no treatment is needed.
- Moderate to severe fluorosis: micro abrasion followed by tooth bleaching, conservative composite, porcelain veneer, or crowns.
Dean's Fluorosis Index
- Developed by H. Trendly Dean (father of fluoridation).
- Used to assess the degree and prevalence of dental fluorosis.
- Recording is based on the two most severely affected teeth.
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