Flouride is a _______ ________ mineral found in many forms in the modern world.
naturally occuring
What is the accepted optimal level of fluoride in the drinking water?
.07 mg/L or parts per million (ppm)
consumption of excess fluoride during formation of the teeth may lead to a condition know as what?
fluorosis
What can cause brown staining and pitting of the enamel surface, and is found where high levels (more than 2ppm) of fluoride occur naturally in the drinking water?
fluorosis (4x more than recommendation)
What may create cosmetic concerns for some people by causing opaque white spots or bands on the teeth?
mild or moderate fluorosis (2-3x more than recommendation)
What are 3 possible causes of fluorosis?
main cause is too much fluoride in water
excess fluoride toothpaste swallowd by child
iatrogenic (doctor-induced) factors such as overly prescribed fluoride
tiny mineral crystals thithin a protein/lipid matrix that are present in enamel and dentin
hydroxyapatite
What substance in the crystals makes them much more soluble in acid?
carbonate
When is fluoride's greatest anti-caries benefit gained?
from topicl fluoride exposure after tooth eruption
fluoride in the saliva surrounding the tooth is incorporated into the surface of enamel crystals during _______ to forma a surface veneer containing __________. that has a much lower solubility than the original tooth material.
remineralization
fluorapatite
What is the pH at which tooth mineral dissolves? What is the pH at which a tooth mineral dissolves when the mineral is converted to fluorapatite?
5.5
4.5
There is evidence that fluoride from drinking water, toothpastes, mouth rinses, and some foods remains in the saliva for ______ _______ and has a prolonged ________ effect
several hours
topical
highly acidic foods and beverages such as citrus fruits, sodas, and wine can contribute to loss of tooth mineral that is called what?
erosion
how does erosion differ from caries?
bacteria are not involved, and most of the mineral loss is at the surface
What are 3 midical conditions that can cause erosion by causing stomach acid to enter the mouth?
acid reflux
anorexia (GERD)
bulimia
What is the mechanism of action of fluoride?
it interferes with the enzyme activiey of the bacteria
Fluoride ions do not cross the bacteria cell wall, what do they do?
travel through the bacteria in the form of hydrofluoric acid (HF)
What is the action of fluoride that ultimately causes bacterial cell death?
HF separates into the fluoride and hydrogen ions which disrupt enzyme activies essential to bacterias functioning
fluoride alone is not as effective in managing dental caries as when it is used in conjuction with what?
an antimicrobial mouth rinse
What is one of the most effective mouth rinsing agents for the reduction of plaque (55%) and gingivitis (45%)? And in what concentration is allowed by the FDA in the US?
chlorhexidine
0.12%
How does chlorhexidine kill bacteria?
by binding strongly to bacterial cell membrane, causing it to leak and lose intracellular contents
Chlorhexidines ability to bind vey strongly to many areas in the oral cavity including mucous membranes and plaque, and then release slowly give it what?
a prolonged effect called substantivity
what is the current rinsing regim to control dental caries with the use of chlorhexidine?
rinse twice a day for 30 seconds with 10 ml of 0.12%
use for two weeks, then wait 2 months
if pt is rinsing with chlorhexidine they are on 3 month recall
What are 3 big side effects associated with chlorhexidine?
brown stain on teeth and tongue; and on fillings and artificial teeth
bitter taste, and may affect taste of some foods
alcohol might be harsh for pts with sensitive mucous membranes
What are the longest used antibacterial mouth rinse agents? And what is the best-known product, which has recieved the ADAs seal of acceptance?
phenolic compounds, or essential oils
listerine
What substances make up phenolic compounds/essential oils?
a combination of phenol-related essential oils: thymol, eucalyptol, and menthol) and
methylsalicylate in a 26.9% hydroalcoholic vehicle
What is the antibacterial action of phenolic compounds?
alteration of the bacterial cell wall
What are What are four ways dietary flouride supplements are delivered?
drinking water - natural or supplies
prescribed by dentists in:
tablets
drops
lozenges
fluoride supplements should not be given to school children when the community water supply has a fluoride content that is higher than what?
0.6 ppm
how is systemically ingested fluoride (including drinking water) returned to the oral cavity?
by way of saliva, so it has a topical effect
What are 2 groups of people who are good candidates for professionally applied fluorides?
children with newly erupted teeth
children and adults at high risk for caries
The most commonly used fluorides come in the form of topical _______ or ________ that are applied for ______ minutes in disposable trays
gels
foams
4
Why is the 1 minute fluoride application not recommended by the ADA?
because it delivers approximately only 85% of what the 4 minute delivers
When used one or two times a year, topical fluoride treatments have been shown to produce ____ to_____ % caries reduction
20-26%
What type of fluoride is most often used in children and why?
acidulated phosphate
it contains 12,300 ppm fluoride and has good uptake in enamel
What type of fluoride is more often used with adults and why?
2% neutral sodium fluoride
because it contains 9,000 ppm fluoride, and acidulated phosphate tends to etch the surface of restorations made of porcelain, composite resin, glass ionomer or copomer
What type of fluorides are available in 5.0% sodium fluoride applied directly on the teeth, can remain on teeth for 1-3 days, are useful for direct application to early dental caries that can remineralize, and are quickly replacing foams and gels because they don't have side effects like nausea, vomitting, and gagging
5.0% fluoride varnish
self-applied topical fluoride gels are useful for people under what 3 categories?
individuals at moderate to high risk for dental caries
for orthodontic patients
for elderly patients taking meds that dry their mouth
What are 2 ways that prescription self applied fluoride gels are available?
by prescription:
1.1% neutral sodium fluoride
0.4% stannous fluoride
Why should self applied topical fluoride gels not be used for children under 6?
they tend to swallow too much of the gel
How are over-the-counter fluoride rinses available? How are prescription fluoride rinses available?
0.05% sodium fluoride
0.2% sodium fluoride or 0.63% stannous fluoride
studies have shown that which of the following types of fluoride in toothpaste is more effective?
sodium monofluorophosphate (MFP) and, sodium fluoride, or stannous fluoride
sodium monofluorophosphate and sodium fluoride
a material used as an abrasive in prophylaxis pastes to remove surface stains and plaque; but in the process also remove small amount of the fluoride rich enamel surfaces
pumice
Why is 1.23% APF often added to prophylaxis pastes?
to hopefully regain some lost fluoride from the use of pumice (it has not recieved the ADA seal of acceptance)
What is the lethal dose of sodium fluoride in a child weighing 20 pounds?
700-1500 mg
it is recommended that prescriptions for dietary supplements of fluoride contain no more than _________ to aviod the risk of fatal overdose
120 mg
describe the proper steps to take if it is determined that a child has consumed an excessive amount of fluoride
induce vomitting
give them milk of magnesia or cow's mild
take child to emergency room asap
What is the most common reaction seen in the dental office or shortly after leaving the office when a child has swallowed fluoride gel?
nausea and vomitting
true or false. The use of chlorhexidine can cause increased supragingival calc
true
true or false. listerine containing alcohol has no therapeutic agent, and is contraindicated for pts with xerostomia
true
what are quaternary ammonium compound mouth washes used for?