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What organ is fluoride mostly excreted by?
The kidneys
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99% of fluoride is located where in the body?
Mineralized tissues
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What are the three stages of tooth development?
- Pre-eruptive Mineralization
- Pre-eruptive Maturation
- Post eruptive
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What are the 4 sources of systemic fluoride?
- Community water
- Supplements
- Foods
- Salts
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Who identified "brown stains" aka dental fluorosis
Dr. F Mckay in the early 20th century
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Fluoridation reaches what percentage of the population
62% more then 144 million people
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What are the 3 sources to get fluoride for fluoridation
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8 States that have naturally fluoridated water
- Texas
- Florida
- Colorado
- Illinois
- California
- South Carolina
- Louisiana
- Arizona
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What is fluoride absorbed as
Hydrogen fluoride
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How is fluoride moved into the bloodstream?
By the passive diffusion from th stomach and small intestines and is distributed by plamsa to all tissues and organs
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Most fluoride is absorbed within how long after ingestion
1 hour
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A small amount of fluoride is excreted by
Sweating and feces
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How many ppm is the recommended range of water fluoridation
0.7 to 1.2 ppm
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By 2006 what percentage of the U.S population had access to fluoridated water
69.2%
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What foods can you get fluoride from
- Raw tea leaves ~3ppm
- Sardines
- Salt Not (U.S)
- Halo/Diffusion
- Bottled water
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What are the sources of topical fluoride
- Toothpaste
- OTC fluoride mouthrinse
- Prescription FL
- Professionally administered FL
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What is the percentage of caries reduction in water fluoridation
18-40%
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What is the percentage of caries reduction in systemic ingestion during tooth formation
20-28%
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What is the percentage of caries reduction in OTC/Prescription rinses
20-25%
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What is the percentage of caries reduction in toothpaste
23-35%
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Toothpaste deliver about how much ppm
1000 to 1300 ppm
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What are the 3 types o fluoride in toothpaste
- Sodium fluoride 0.24%
- Stannous fluoride 0.40%
- Sodium monofluorophosphate 0.76%
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Systemic fluoride delivers how much to enamel
- 1000-2000 ppm to outer enamel
- 20-100 ppm subsurface of enamel
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Topical fluroride provides how much ppm to outer enamel
30,000 ppm
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What is the optimal salivary concentration for high caries risk
0.1ppm
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What is the optimal salivary concentration for low caries risk
0.02-0.04 ppm
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What are the roles of fluoride in caries prevention
- Inhibits demineralization
- Enhances remineralization
- Inhibits bacterial metabolism
- Provides post eruptive maturation
- Has bacteriostatic potential
- During tooth formation modifies tooth morphology
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Fluoride inhibits demineralization by changing
The chemical compositionof enamel from Hydroxyapatite to Fluorapatite or Fluoridated Hydroxyapatite
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Fluoride enhances remineralization
By being absorbed into the tooth surface and attracting calcium to the tooth which then attracts phosphate ions
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Remineralization is best favored by
Daily topical exposure to a combination of fluoride, calcium and phosphate
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Fluoride inhibits bacterial metabolism by
Diffusing into biofilm and some of the fluoride ions bind with the hydrogen ion creating hydrofluoric acid that can pass through the bacterial membrane and acidify the bacterial cytoplasm
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What are the ADA recommendations for professional topical fluoride applcation for patients with moderate caries risk unnder age 6
Fluoride varnish 2xs/yr
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What are the ADA recommendations for professional topical fluoride applcation for patients with moderate caries risk 6 years and older
Flouride gel or varnish 2xs/yr
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What are the ADA recommendations for professional topical fluoride applcation for patients with high caries risk under 6 years old
Fluoride varnish 2-4xs/yr
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What are the ADA recommendations for professional topical fluoride applcation for patients with high caries risk age 6 and older
Fluoride gel or varnish 2-4xs/yr
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What are the 3 professional topical applications
- 1.23% APF Gel & foam
- 2% Sodium fluoride gel and foam
- 5% Sodium varnish paint on resin
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APF Acidulated phosphate Fluoride
- No discoloration on teeth
- Acceptable taste
- Ph 3-4
- 4 minute application
- Rapid uptake into enamel
- Not to be used on composites, porcelain or sealants
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Sodium fluoride 2%
- Neutral ph
- Acceptable taste
- Doesn't discolor teeth
- 4 minute application
- Can be used on porcelain
- Recommened for bulimics, patients with erosion
- Patients with reduced salivary flow
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What is the correct amount of fluoride
- Adults 5ml
- Child over 44lbs 4 ml
- Child over 22lbs 2 ml
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Sodium Fluoride VArnish
- Solution consisting of 22,000 ppm
- Reduced risk of fluoride toxicity
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What is the technique of the sodium fluoride varnish
- 0.5mm thick layer
- Allow resin to set 30-60 seconds
- Do not eat for 1-2 hours
- No bushing for 4-6 hours
- May be applied every 3 months
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If the fluoride concentration in water is less then 0.3ppm patients 6 months to 3 yrs should receive
0.25mg of prescription systemic fluoride
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If the fluoride concentration in water is less then 0.3ppm patients 3-6 yrs should receive
0.50 mg of prescription systemic fluoride
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If the fluoride concentration in water is between 0.3 ppm and 0.6ppm patients 3-6 yrs old should receive
0.25 mg prescription systemic fluoride
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IF the flouride concentration in water is less then 0.3ppm patients 6-16 yrs should receive
1 mg of prescription systemic fluoride
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If the fluoride concentration in water is between 0.3ppm-0.6ppm Patients 6-16 yrs should receive
0.5 mg of prescription systemic fluoride
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What are the 4 liquid prescription fluoride for younger children available as
- Fluradrops
- Luridedrops
- Pediaflor
- Polyviflor
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What are the 3 chewable tablets for older children available as
- Luride
- PharmaFlur
- Flur-A-Day
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What are the 2 prescription fluroride rinses recommened for people with moderate to high caries risk
- 0.63% SnF Stannous fluoride
- 0.20% NaF Sodium fluoride
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What is a prescription fluoride toothpaste for moderate to high caries risk or ortho patients
- 1.1% Sodium Fluoride daily
- 5,000 ppm
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What are some of the syptoms of acute fluoride toxicity
- Acute burning mouth and tongue
- Nausea, vomiting and diarrhea
- Cramping and abdominal pain
- Salivation and thirst
- Hypocalcemia
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What is the medical management of acute fluoride toxicity
- Induce vomiting with Ipecac Syrup or finger
- Call EMS
- Give milk, maalox or lime water
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Flurosis
a hypomineralization of enamel caused by the excessive ingestion of fluoride above 2ppm during tooth development which occurs between the ages of 6 months and 12 years
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What is the most susceptible age for fluorosis
18 months to 3 years
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