Identify substances with scientific evidence for caries reduction. What is the most commonly used substance for an anticaries effect?
- fluoridated water
- Fluoride varnish
- xylitol: (gums, mints, toothpaste)
- Chlorhexidine: (the most efficacious antigingivitis agents)
- Fluoride: THE MOST COMMON FOR ANTICARIES
- sodium fluoride (NaF)
Describe the mechanism of action for each anticaries agent.
- Fluoride varnish: anticaries effect
- xylitol: antibacterial and cariostatic
- chlorhexidine: antigingivitis and anticaries
Describe changes in hydroxyapatite when fluoride is ingested during tooth development. Compare changes following topical application of fl2.
Direct effect on the hydroxyapatite crystal of enamel: systemic fluorides consumed during tooth development interact with hydroxyapatite crystals forming clacium fluorideAction of fluoride ion on the individual micro-organisms in biofilm: topically applied fl2 bacterial enzymes are inhibited, thereby altering the pattern of acid production that would result in demineralization
Describe the effect of SnF on biofilm.
Topical fluoride absorbed by dental biofilm alters the usual pattern of microbial acid production, plaque removal is not required prior to topical application for the benefits of fl2 to occur
Describe the signs of acute fluoride toxicity.
- occurs due to a single overdose of fluoride
- intestinal cramping
- profuse salivation
- black stools
- progressive hypotension
- cardiac irregularities (tachycardia, fibrillation
- death is due to repiratory failure and cardiac collapse
Describe the signs of chronic toxicity.
- Fluorosis: color abnormalities from brown to white
- hypoplastic pitting of eneamel
Describe management procedures for acute fluoride toxicity.
- induce vomiting
- call 911
- have pt drink several glasses of milk
- monitor vital signs and prepare for CPR until emergency services arrive
What directions should be provided to the pt for topical home-use fluoride preparations?
make sure to expectorate after use and warn against using in kids under 6
Which product should be used for topical fluoride application when compoites or sealants are present?
topical sodium fluoride (NaF)
Which professionally applied fluoride is safest for the very young child?
5% fluoride varnish
What is the rationale for daily, low-concentration fluoride use?
- NaF at 0.243% providing 1,100 ppm fluoride is present in many fluoride dentifrices with ADA acceptance
- Prescription home-fluoride gels: 1.1% NaF; 0.4% SnF; and a combination of 1/1% NaF in acidulated phosphate - applied for 1-2 mins
- Home fluoride rinses: 0.2% NaF rinse for 1 min every 2 weeks
What is the rationale for the 4-minute professional application of fluoride?
topically applied fluoride must maintain contact with the tooth surface for 4 minutes, the pt should not eat or drink for 30 minutes following treatement
List concentrations of fluoride agents used for professional application and those for at-home application.
- Professional: Sodium 2% (9,050 ppm); Sodium varnish 5% (22,600 ppm); APF 1.23% (12,300 ppm)
- At-home application: daily 0.05% (230 ppm); weekly 0.2% (920 ppm), quarterly 2% (5,000 ppm)
- Dentifrice: kids 250-500 ppm; adult 1,000-1,500 ppm
- NaMFP: 0.76%
- SnF: 0.454% (crest pro-health)
- NaF 0.24% and triclosan 0.3%: (colgate total)
- gels: 1.1% NaF, 0.4% SnF
- rinse: 0.1% SnF, 0.05% NaF
Describe pt instructions following fluoride varnish application.
- Do not eat for approximately 2 hours after application
- do not brush on the day of fluoride application
Describe pt instruction for using xylitol for caries prevention
- Chew xylitol gum with at least 1.55 g xylitol 4-6 times a day
- the goal for bacterial reduction is to have at least 3 exposures to and get a minimum of 5.8 g per day
Describe instructions for using chlorhexidine rinse for caries control.
use 10 mL/day for a 1-week period every 2-3 months
Identify efficacious antigingivitis products and classify them according to efficacy.
- 1. Chlorhexidine 0.12%
- 2. formulations containing cetylpyridinium chloride (CPC)combination of PHENOL-RELATED ESSENTIAL OILS (thymol, eucalyptol, nenthol with methyl salicylate); Listerine
- 3. triclosan
- 4. SnF 0.454%
Describe pt instruction when 0.12% chlorhexidine rinse is prescribed. How does use of most toothpaste influence its use?
- rinse with 15 mL for 30 seconds twice daily for 21 days up to 6 months, and should be discontinued once periodontal disease is controlled
- Sodium laurel sulfate in dentifrice binds to chlorhexidine molecules and reduces the anticaries effect, so allow 30 minutes to an hour between brushing and rinsing
List the side effects of the chlorhexidine rinse.
- tooth and mucosal staining
- bitter taste
- taste alteration
- increased calculus formation
- mucosal ulceration
Discuss the evidence for the risk factors associated with carcinogenicity when rinses contain alcohol.
- Alchohol, particularly in association with tobacco has been recognized as an important risk factor for oral cancer
- Mouth washes may contain alcohol concentrations upt to 26%, but it has been found that there is no support for the hypothesis that use of alcohol-containing mouthwash increases the risk of oral cancer
What dentifrice products are indicated when periodontal inflammation is present?
- Colgate Total is the only product available in the US that is a dentifrice containing 0.3% triclosan, coppolymer, and 0.243% NaF
- 0.454% Stannous Fluoride (SnF) dentifrice
List and describe contributing factors that lead to dentin hypersensitivity.
- severe attrition and gingival recession resulting from:
- abnormal tooth development
- the areas are mostly on buccal/labial surfaces commonly affecting premolars
- Can develop from therapeutic procedures: bleaching agents to whiten teeth
Describe the pathophysiology of DH.
- dentin tubules in sensitive teeth are wider and more numerous than in nonsensitive teeth
- it is a result of outward fluid movement within the dentinopulpal interaface
- 2 phases: gingival recession on root surface, or stimulation of fluid within predisposed dentin tubules provokes pain
- acid erosion associated with GI reflux may expose tubules
- hydrodynamic theory
Describe the hydrodynamic theory of dentin hypersensitivity.
outward movement of fluid within the dentin tubule stimulates nerve endings surrounding the odontoblast at the dentinopulpal interface and generates an impulse transmission interpreted in the brain as pain
List the factors related to natural desensitization.
- sclerosis within tubule as a result of gradual exposure of dentin
- formation of secondary and tertiary dentin
- calculus formation
- smear layer: toothpaste, or burnishing dentin with wood point
Describe recommendations to reduce DH in the pt with GERD.
recommend the use of an alkaline baking soda/salt/lukewarm water mixture (1 tsp baking soda, 1 tsp salt, 1 cup water) to reduce pH of oral fluids
Identify desensitization agents for in-office use, and for home use.
- In-office use: Fl2 (sodium, stannous), adhesives and resins, potassium oxalate (Protect), flutaraldehydes, or calcium phosphates, lasers have worked
- Home use: dentifrice with 5% potassium nitrate, dentifrice containing 0.454% SnF (crest pro-health), dentifrice with strontium chloride (thermodent),
Outline dental hygiene management strategies for using fluorides in clinical practice, including pt instructions following topical applications of fluoride.
- If chronic xerostomia occurs, recommend to use daily anticaries products and give proper instructions for use
- safety precautions about not ingesting product should be provided, and procedure should be monitored
- have pt in upright position
- place saliva ejector at floor of mouth
- use properly sized tray
- provide napkin
- use ribboin of gel or foam to cover no more than half the trays depth
- warn pt not to swallow
- after mnfctrs time remove tray suction fluids and excess fluoride
- wipe teeth with gauze
- have pt spit for 1 minute
- instruct pt not to eat for 30 mins
Outline dental hygiene management strategies for recommending anticaries agents given the age of the pt and individual needs
- Caries prevention: for xerostomia recommend use of daily anticaries products (fl2 toothpaste, lox concentration 0.05% Naf rinse, xylitol gum)
- Kids: parents supervise brushing, store toothpaste out of reach, child size toothbrush w/pea size amt of toothpaste, tell child to spit out toothpaste and not swallow, if water has too much fluoride, drink from different source, use varnish on kids
- Antigingivitis: chlorhexidine warn not to use til 30 mins after brushing
- Desensitization: figure out source, instruct to use alkaline formulation (bakingsoda/salt/water), avoid over instrumentation, inform pt about recession and overbrushing