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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
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How are fluoride ions created?
As water passes over rock formations it dissolves the fluoride compounds creating fluoride ions
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_______ 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
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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)
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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
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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
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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)
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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
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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
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Most fluoride is excreted through the ________ with a small amount excreted by the __________
- kidneys in the urine
- sweat glands and in the feces
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Fluoride is incorporated directly into the ________ during mineralization to become _______
- hydroxyapatite crystalline structure
- fluorapatite, which produces a less soluble apatite crystal (making teeth stronger)
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Much more fluoride is acquired on the outer surface of the tooth during what period
Maturation stage
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Uptake is most rapid on the enamel surface
soon after eruption
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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
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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
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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
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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)
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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
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What is the description of a fluorosis score of 0
- Normal
- Smooth, creamy white enamel surface
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What is the description of a fluorosis score of 1
- Questionable
- Slight changes from normal translucency is noted
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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
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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
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What is the description of a fluorosis score of 4
- Moderate
- The enamel surface shows significant wear and may feature disfiguring brown stains
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What is the description of a fluorosis score of 5
- Severe
- Widespread, significant hypoplasia, pitting, staining, worn areas, brown staining and/or corroded apperance
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In 2015, the US Department of Health and Human Services updated the recommendation for optimal concentration of water fluoridation to _____ ppm for all communities
0.7ppm
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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
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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
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Sodium fluoride supplements are available as ________
tablets, lozenges, oral drops and a swish and swallow rinse
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Tablets and lozenges are available in _____mg dosages
0.25 mg, 0.50 mg, and 1.0 mg
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Drops are primarily used for children from
6 months to 3 years
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Infants receiving their total diet from breast feeding need a ___ mg supplement
0.25
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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
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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
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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)
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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
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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
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Although the most uptake of fluoride is in the _______, research shows that the full _______ provides the best topical benefit
-
What is the PH and ppm of 5% Sodium Fluoride (NaF) varnish
- 7 pH (neutral)
- Concentration: 22,600 ppm, 2.6% F ion
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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
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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
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Prescription toothpastes can contain up to ____ ppm fluoride
5000
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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
-
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
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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
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Acute toxicity refers to
rapid intake of an excess dose of fluoride over a short time
-
Chronic toxicity applies to
long-term ingestion of fluoride in amounts that exceed the approved therapeutic levels
-
Signs and symptoms of an acute toxic dose begin within _______ of ingestion and may persist for as long as ______
-
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
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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
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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
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Dental fluorosis is a form of _________ that results from ingestion of an excess amount of fluoride during ________
- hypomineralization
- tooth development
-
Mild and very mild forms of fluoride toxicity appear as
white opacities in the enamel surface
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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
-
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
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What is the adult Certainly Lethal Dose (CLD)
- –5 to 10 g of NaF taken at one time
- –32-64 mg F/kg
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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)
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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
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