Fluoride and Tooth Development PDF

- Dr. Frederick McKay discovered brown stains and fewer cavities in Colorado Springs in early 20th century - H.V. Churchill identified fluorine as the cause in 1931 - Dr. H. Trendley Dean established optimal prevention levels at 1 ppm in 1930s - First community water fluoridation began in 1945 # Fl...

- Dr. Frederick McKay discovered brown stains and fewer cavities in Colorado Springs in early 20th century - H.V. Churchill identified fluorine as the cause in 1931 - Dr. H. Trendley Dean established optimal prevention levels at 1 ppm in 1930s - First community water fluoridation began in 1945 # Fluoride and Tooth Development ## Pre-Eruptive Stage - Primary teeth formation begins in utero - First permanent molars begin mineralization at birth - Fluoride reaches developing teeth through circulation - Hydroxyapatite becomes fluorapatite - Contributes to shallow occlusal grooves ## Post-Eruptive Stage - Rapid uptake on enamel surface in first years after eruption - Uptake continues throughout life through surface exposure - Drinking water provides ongoing topical source # Mechanisms of Action ## Protective Effects - Inhibits demineralization - Enhances remineralization - Inhibits bacterial activity by blocking enolase enzyme - Natural constituent of enamel, dentin, and cementum ## Remineralization Process - Saliva buffers and neutralizes acid - Calcium and phosphorous return to enamel - Fluoride enhances the process - Continuous mineral exchange between biofilm and enamel - Creates more resistant fluorapatite structure # Water Fluoridation - Reduces caries by 27% in adults (excluding other fluoride sources) - Reduces caries up to 40% in primary teeth when used from birth - Current recommended level is 0.7 ppm (updated 2015) - Previously varied from 0.7-1.2 ppm based on climate (1962) # Fluoride Sources ## Natural Sources - Found in meat, eggs, vegetables, cereals, fruits - Higher levels in tea and fish - Fluoridated salt available in Europe - Well water (varies by location) ## Manufactured Sources - Bottled water (varies by source) - Infant formula - Dietary supplements - Professional applications - Consumer products # Professional Applications ## Types and Concentrations - 2.0% Neutral Sodium Fluoride (9,050 ppm) - 1.23% APF (12,300 ppm) - 5% Fluoride Varnish (22,600 ppm) - 38% Silver Diamine Fluoride ## Silver Diamine Fluoride (SDF) - Contains 24.4-28.8% silver and 5-5.9% fluoride - Used for caries arrest and prevention in high-risk patients - Causes permanent black staining of decay - Contraindicated for silver allergies and pregnancy # Self-Applied Fluorides ## Mouth Rinses - Available in prescription and over-the-counter strengths - Not recommended for children under 6 - Suitable for high-risk patients and those with special conditions ## Dentifrices - Contains various fluoride compounds (NaF, SnF2, Na2PO3F) - 1,000-1,100 ppm concentration - Dosage varies by age: - Under 3 years: smear amount - 3-6 years: pea-size - Adults: 1/2 inch # Safety Considerations ## Toxicity - Certainly Lethal Dose: 5-10g sodium fluoride - Safely Tolerated Dose: 1.25-2.5g sodium fluoride - Symptoms of acute toxicity appear within 30 minutes - Emergency treatment includes induced vomiting and fluoride-binding liquids ## Fluorosis - Caused by excessive fluoride during tooth development - Associated with levels over 2ppm - Results in white spots and hypomineralization - Severity varies based on exposure level # Professional Guidelines - Document all fluoride treatments - Obtain permission before application - Follow age-appropriate dosing - Consider patient risk factors - Use appropriate delivery methods based on age and condition ## Classification by Location ### Extrinsic Stains - Located on external surface of tooth - Can be removed through polishing or scaling - Common causes: - Tobacco (primarily on lingual surfaces) - Tea, coffee, cola - Chlorhexidine - Betel nut (common in Eastern countries) - Grape juice - Red wine ### Intrinsic Stains - Located within tooth structure - Cannot be polished off - Causes include: - Trauma/tooth injury with internal hemorrhage - Tetracycline exposure - Fluorosis (during tooth development) - Pulpless teeth ## Types of Stains ### Brown Stains - Associated with: - Tobacco use - Brown pellicle - Stannous fluoride - Beverages (tea, coffee, cola)  - Betel nut - May become incorporated into calculus ### Green Stains - Caused by chromogenic bacteria and fungi - Often includes gingival hemorrhage - Common characteristics: - Found on facial surfaces, cervical 1/3 of anterior teeth - Primarily affects children - May have underlying enamel demineralization ### Black Line Stains - Characteristics: - Caused by gram-positive rods - Forms 1mm wide continuous line near gingival margin - Common on lingual and proximal surfaces of maxillary posterior teeth - More frequent in females - Found in generally clean mouths ### Yellow, Orange, and Red Stains - Associated with plaque - Found on cervical third of teeth - More common on anterior surfaces - Caused by chromogenic bacteria - Orange and red stains are rare ## Metallic Stains ### Drug-Related - Iron: black or brown - Manganese: black - Generally distributed throughout mouth - Prevention: Use tablets/capsules or drink through straw ### Occupational - Copper/brass workers: green or blue/green - Iron workers: brown - Nickel exposure: green - Cadmium exposure: yellow or golden brown - Caused by inhaling dust through mouth ## Endogenous Intrinsic Stains ### Genetic Conditions - Amelogenesis Imperfecta - Dentinogenesis Imperfecta ### Medication-Related - Tetracycline: - Affects developing teeth - Can occur during third trimester of pregnancy - May be generalized or limited to specific areas - Minocycline: - Causes blue-gray staining - Common in acne treatment - Affects permanent teeth post-eruption ### Other Causes - Pulpless teeth: - Due to hemorrhage in pulp chamber - Root canal therapy - Pulp necrosis - Colors: brown, gray, black, reddish brown - Enamel hypoplasia: - Caused by ameloblastic disturbance - Presents as white spots - Can be localized or generalized - Fluorosis: - Known as mottled enamel - Caused by excessive fluoride intake - Results from toxic damage to ameloblasts ## Exogenous Intrinsic Stains - Originally extrinsic stains that become intrinsic - Common causes: - Tobacco - Silver amalgam - Topical stannous fluoride - Endodontic materials - Silver nitrate (blue-black color) ## Treatment Considerations - Some stains can be removed through polishing - Patient concerns may include: - Texture - Taste - Sensitivity - Using straws can help reduce staining - Staining doesn't necessarily indicate disease - Some treatments may be affected by sodium sulfate - Professional cleaning methods vary based on stain type and location ### Historical Context and Prevalence - Early 20th century focused on restorations and tooth removal - 40-60% reduction in caries since 1945 - Current prevalence remains high due to limited care access - Major health issue across demographics ### Types of Dental Lesions #### Noncarious Lesions - Abfraction: V-shaped wedge on buccal surface with microfractures - Abrasion: Mechanical wear - Attrition: Tooth-to-tooth wear (often from bruxism) - Erosion: Chemical wear - Hypoplasia: Incomplete enamel development ### Dental Caries Characteristics #### Nature of Disease - Biofilm-mediated - Diet-modulated - Multifactorial disease requiring: - Susceptible tooth - Acidogenic/aciduric microorganisms - Fermentable carbohydrate substrate - Sufficient time - Non-communicable condition #### Bacterial Involvement - Key bacteria: - Streptococcus mutans - Streptococcus sobrinus - Lactobacillus - Actinomyces - Bifidobacteria (associated with childhood caries) - Transmission occurs person-to-person - Produces formic, lactic, propionic, and acetic acids ### Risk Factors #### Modifiable Factors - Bacterial counts - Visible biofilm - Frequency of between-meal snacks - Saliva flow - Diet composition #### Non-modifiable Factors - Socioeconomic status - Education level - Special needs ### Tooth Structure and Caries Process #### Enamel Composition - 85% mineral, 15% lipids, proteins, and water - Contains hydroxyapatite crystals - Fluorapatite forms when fluoride replaces hydroxyl ions #### Demineralization/Remineralization - Demineralization occurs at pH 5.5 for enamel - Root caries occurs at pH 6.0-6.7 - Process can last up to 20 minutes after carbohydrate consumption - White spot lesions are earliest clinical signs ### Detection and Classification #### Detection Methods - Visual examination - Tactile examination - Radiographic imaging - Advanced technology (laser, computer-aided) #### Classification Systems - G.V. Black Classification - International Caries Classification and Management System - Types of cavities: - Simple (one surface) - Compound (two surfaces) - Complex (more than two surfaces) ### Prevention and Management #### Risk Assessment - Multiple systems available: - AAPD Caries-Risk Assessment Tool - Cariogram - CAMBRA - ICCMS - ADA Caries Risk Assessment #### Saliva's Role - Lubricates oral tissues - Aids food clearance - Buffers acids - Provides minerals - Has antibacterial properties ### Dental Trauma #### Types - Fractures - Luxation (tooth dislocation) - Concussion - Avulsion (complete displacement) #### Pulp Vitality - Testing methods include thermal and electrical - Can indicate reversible or irreversible pulpitis - Important for trauma assessment and treatment planning This comprehensive overview represents the key concepts and information presented in the source material, organized in a logical structure for easy reference and understanding. - Traditional vital signs include temperature, respiration, pulse, and blood pressure - Recent suggestion to add smoking status (including marijuana, vaping, cigarettes) as a vital sign ## Body Temperature ### Measurement Methods - Types of thermometers: oral, temporal, tympanic - Normal range: 97-99°F (average 98.6°F) - Varies throughout day: highest in late afternoon/evening, lowest in early morning/during sleep ### Temperature Classifications - Pyrexia (fever): 99.5°F or higher - Hyperthermia: above 104°F - Hypothermia: below 96°F ### Factors Affecting Temperature - Time of day - Exercise - External heat - Infection - Dehydration - Hyperthyroidism - Hemorrhage/shock ## Pulse ### Basic Information - Measures heartbeats per minute - Adult normal range: 60-100 beats per minute - Children's rates higher, decreasing with age (130 at birth) ### Classifications - Tachycardia: >100 beats per minute - Bradycardia: