DH II Module 8 Fluoride

  1. Fluoride comes from the element _________ which never __________ and only exist _________
    • fluorine
    • occurs in its free state in nature
    • in combination with other elements as a fluoride compound
  2. How are fluoride ions created?
    As water passes over rock formations it dissolves the fluoride compounds creating fluoride ions
  3. _______ rock has a high concentration of fluoride and is used as fluoride additives in the United States _________ and is also used to produce _________
    • —Phosphorite
    • community water systems
    • phosphate fertilizer
  4. Heating the phosphorite rock releases ________ gases. —These gases are captured by vacuum evaporators and condensed to a water-based solution of ___% ______ also referred to as _________with the remainder as water
    • fluoride and silicon tetrafluoride
    • 23% fluorosilicic acid (FSA)
    • hydrofluorosilicate (HFC)
  5. What are the three additives for water fluoridation in the United States
    • 1. Fluorosilicic acid
    • 2. Sodium fluorosilicate (also called Sodium silicofluoride): a dry additive, dissolved into a solution before being added to water
    • 3. Sodium fluoride: a dry additive, typically used in small water systems, dissolved into a solution before being added to water
  6. —The maximum caries inhibiting effect is seen when there is __________  and _________
    • systemic exposure prior to tooth eruption
    • frequent topical fluoride exposure throughout an individual’s life
  7. —Fluoride is absorbed in the _________ and —what is not absorbed will be absorbed by the _________ . —There is less absorption when the fluoride is taken with food and beverages containing __________
    • stomach
    • small intestine
    • calcium (fluoride binds with calcium)
  8. Approximately 99% of fluoride in the body is located in _______ and is essential to the formation of sound teeth and bones, as well as __________
    • the mineralized tissues (bones and teeth)
    • calcium and phosphorus
  9. The fluoride ion (F) is stored as a part of the _______. The teeth store small amounts, with highest levels on ________
    • crystal lattice of teeth and bones
    • the tooth surface
  10. Most fluoride is excreted through the ________ with a small amount excreted by the __________
    • kidneys in the urine
    • sweat glands and in the feces
  11. Fluoride is incorporated directly into the ________ during mineralization to become _______
    • hydroxyapatite crystalline structure
    • fluorapatite, which produces a less soluble apatite crystal (making teeth stronger)
  12. –Much more fluoride is acquired on the outer surface of the tooth during what period
    Maturation stage
  13. –Uptake is most rapid on the enamel surface
    soon after eruption
  14. In erupted teeth foe enamel, fluoride concentration is greatest on the surface ______ . For the dentin, the highest concentration is at the ______ unless there is _________
    • next to the source of fluoride, the oral cavity 
    • pulpal surface
    • recession and the cementum does not reach the CEJ leaving dentin exposed to the oral cavity
  15. —Fluoride inhibits ________ when it is present at the surface of the tooth during an acid attack. —It enhances remineralization by _______. —At high concentrations, fluoride can also ________
    • demineralization
    • attaching to the tooth surface and attracting calcium and phosphate ions
    • interfere with the growth and metabolism of bacteria
  16. The history of fluoridation began with research conducted by _________, a dentist, on naturally occurring fluoride in the water supply around ________
    • Dr. Frederick McKay
    • Pikes Peak, Colorado
  17. It was determined that a fluoride concentration of about _____
    in a water supply was associated with substantially fewer cavities and that it increased fluorosis but only to a level that was of no medical or aesthetic concern
    1 mg/L (1 milligram per liter)
  18. What is currently the most universally accepted classification system for fluorosis?An individual’s fluorosis score is based on the most severe form of fluorosis found on _______
    • Dean’s fluorosis index
    • two or more teeth
  19. What is the description of a fluorosis score of 0
    • Normal
    • Smooth, creamy white enamel surface
  20. What is the description of a fluorosis score of 1
    • Questionable
    • Slight changes from normal translucency is noted
  21. What is the description of a fluorosis score of 2
    • Very mild
    • Small, irregular scattered opaque (paper white) areas over less than 25% of the labial surface
  22. What is the description of a fluorosis score of 3
    • Mild
    • White opaque areas more extensive than category 2 but cover less than 50% of the tooth surface
  23. What is the description of a fluorosis score of 4
    • Moderate
    • The enamel surface shows significant wear and may feature disfiguring brown stains
  24. What is the description of a fluorosis score of 5
    • Severe
    • Widespread, significant hypoplasia, pitting, staining, worn areas, brown staining and/or corroded apperance
  25. In 2015, the US Department of Health and Human Services updated the recommendation for optimal concentration of water fluoridation to _____ ppm for all communities
  26. What is the Halo/Diffusion Effect
    —Occurs when foods and beverages processed in a fluoridated community are imported and consumed in a nonfluoridated community. This can result in increased fluoride intake by individuals living in nonfluoridated communities, providing them some protection against dental caries
  27. What is the prescription guidelines for dietary fluoride supplements
    —264 mg Sodium Fluoride (NaF) (120 mg of fluoride) is to be dispensed per household at one time
  28. —Sodium fluoride supplements are available as ________
    tablets, lozenges, oral drops and a swish and swallow rinse
  29. –Tablets and lozenges are available in _____mg dosages
    0.25 mg, 0.50 mg, and 1.0 mg
  30. —Drops are primarily used for children from
    6 months to 3 years
  31. Infants receiving their total diet from breast feeding need a ___ mg supplement
  32. What are the three Professional Topical Fluoride Applications
    • 2.0% Sodium Fluoride (NaF)
    • 1.23% Acidulated Phosphate Fluoride (Na(PHO4)F)
    • 5% Sodium Fluoride (NaF) varnish
  33. –Sodium fluoride is also called ______ and has a PH and ppm of
    • neutral sodium fluoride or just neutral fluoride
    • 7.0 PH
    • –9,050 ppm or you could say it contains 0.90% F ion
  34. 1.23% Acidulated Phosphate Fluoride (Na(PHO4)F) contains ________ and has a PH and ppm of
    • Sodium Fluoride and Hydrofluoric Acid
    • 3.5 PH
    • 12,300 ppm (1.23% F ion)
  35. The low PH of 1.23% Acidulated Phosphate Fluoride has what effects on the teeth and restorations
    • enhances fluoride uptake but may etch porcelain and composite restorative materials
    • Macro-inorganic filler particles of composite materials demonstrate noticeable etched patterns generated by APF, whereas the more recent micro-filled materials are not sensitive to the APF agent
  36. If a gel is used, no more than __ mL of gel should be placed in each tray for small children, and no more than __ mL for patients with permanent teeth
    • 2
    • 5
  37. Although the most uptake of fluoride is in the _______, research shows that the full _______ provides the best topical benefit
    • first minute
    • 4 minutes
  38. What is the PH and ppm of 5% Sodium Fluoride (NaF) varnish
    • 7 pH (neutral)
    • Concentration: 22,600 ppm, 2.6% F ion
  39. What are some Low-Potency/High-Frequency Rinses, what is the dose and ppm
    • —0.05% NaF (OTC), e.g. ACT 230ppm
    • —0.044% NaF and APF (a sodium fluoride rinse in an acidulated phosphate solution; prescription only) e.g. Phos-Flur® daily 200ppm
    • ◦Child dose 1 teaspoonful (5 mL)
    • ◦Adult dose 10 mL
  40. Name a High-Potency/Low-Frequency Rinse, how often is it used and what is the ppm
    • —0.20% NaF (prescription) e.g. Prevident
    • Weekly
    • 905ppm
  41. —Prescription toothpastes can contain up to ____ ppm fluoride
  42. —Today, over-the-counter dentifrice products in the United States contain between _______ ppm fluoride. —Clinical trials indicate for every ____ ppm fluoride there is a ___% reduction in caries
    • 850 ppm to 1150
    • 500
    • 8.6
  43. What are the —Indications for Use of Self-Applied Fluorides Gels
    • ◦Rampant caries
    • ◦Xerostomia, particularly loss of salivary gland function
    • ◦Exposure to radiation therapy
    • ◦Root surface hypersensitivity
  44. What are some Self-Applied Fluorides Gels
    • –1.1% neutral sodium (NaF) available by prescription
    • –1.1% acidulated phosphate (APF) available by prescription
    • –0.4% stannous (e.g. Gel-Kam) available OTC
  45. Acute toxicity refers to
    rapid intake of an excess dose of fluoride over a short time
  46. Chronic toxicity applies to
    long-term ingestion of fluoride in amounts that exceed the approved therapeutic levels
  47. Signs and symptoms of an acute toxic dose begin within _______ of ingestion and may persist for as long as ______
    • 30 minutes
    • 24 hours
  48. Excess fluoride in the stomach is acted on by the ______ to form ______. Symptoms may include
    • hydrochloric acid
    • hydrofluoric acid
    • –Nausea, vomiting, diarrhea
    • –Abdominal pain
    • –Increased salivation, thirst
  49. What are some systemic involvements of Fluoride toxicity
    • –Systemic calcium can bind with the circulating fluoride causing symptoms of hypocalcemia (not enough calcium in the blood)
    • –Hyperreflexia (over reactive reflexes), convulsions, paresthesias (skin numbness)
    • –If not treated, may lead to death in a few hours from cardiac failure or respiratory paralysis
  50. What is some emergency treatment of fluoride toxicity
    • Induce vomiting
    • –Mechanical: digital (finger) stimulation at the back of the tongue or in the throat
    • –Drug: ipecac syrup
    • If vomiting does not occur, administer a fluoride-binding liquid such as milk, milk of magnesium or limewater
  51. Dental fluorosis is a form of _________ that results from ingestion of an excess amount of fluoride during ________
    • hypomineralization
    • tooth development
  52. Mild and very mild forms of fluoride toxicity appear as
    white opacities in the enamel surface
  53. —Excess fluoride can produce visible fluorosis only when used during the years of development of the crowns of the teeth, namely, from _______ or when the crowns of the 3rd permanent molars are completed
    birth until age 12 or 16 years
  54. Isolated instances of osteosclerosis result from chronic toxicity after long-term ________ use of water with _____ ppm fluoride or from _________
    • (20 or more years)
    • 10 to 25
    • industrial exposure
  55. What is the adult Certainly Lethal Dose (CLD)
    • –5 to 10 g of NaF taken at one time
    • –32-64 mg F/kg
  56. What is the child Certainly Lethal Dose (CLD)
    –Approximately 0.5 to 1.0 g of NaF taken at one time (same as 500 to 1000 milligrams)
  57. The Safely Tolerated Dose (STD) is approximately ________. The adult STD is _____ and the child STD is _______
    • ¼ of the CLD
    • ◦1.25-2.5 g of NaF
    • ◦8-16mg F/kg
    • ◦Depends on the weight of the child as to what is considered a STD
Card Set
DH II Module 8 Fluoride
DH II Module 8 Fluoride