Fluoride

Question 1

Fredrick McKay

Answer 1

discovered brown stain
coined term “mottled enamel”
determined water was the cause

Question 2

HV Churchill

Answer 2

chemist
fluorine caused enamel change
used McKay’s findings

Question 3

Fluoride

Answer 3

• latin word Fluere meaning flow
• discovered in 1886 by Henri Moissan
• atomic element #9

Question 4

Absorption

Answer 4

GI tract –> passive diffusion, absorbed within 1 hour, less absorption when taken with milk and food
Blood Stream –> plasma is the carrier, maximum levels reached within 30 mins, normal levels are low, levels constantly fluctuating

Question 5

Fluoride Distribution

Answer 5

• 99% of fluoride is in mineralize tisues

- crystal lattice of teeth (small amounds IN teeth, higher amounts ON teeth)

Question 6

Excretion

Answer 6

• most excreted via kidneys in the urine
• small amounts by sweat and feces
• limited transfer from plasma to breast milk for excretion by that route

Question 7

Pre-Eruptive: Mineralization Stage

Answer 7

• fluoride reaches fetus by way of surrounding blood plasma
• risky in that excess fluoride may lead to fluorosis - hypomineralization, stops ameloblasts; only occurs during development
• beneficial in that teeth develop more shallow grooves

Question 8

Pre-Eruptive: Maturation Stage

Answer 8

-absorbed from surrounding tissues

Question 9

Post-Eruptive

Answer 9

• obtained from water, dentifrice, rinses
• prevents caries
• rapid uptake during first years after eruption
• fluorosis is not possible once tooth development is complete

Question 10

Dentin

Answer 10

• fluoride is greater in exposed dentin than in enamel
• higher concentration at pulp where exchange takes place
• newly formed dentin absorbs fluoride rapidly

Question 11

Biofilm/Saliva

Answer 11

• may contain 5-50ppm fluoride
• fluoride remineralizes teeth by attracting calcium and phosphate
• inhibits demineralization (pH < 5.5)

Question 12

Caries Diagnosis and Management

Answer 12

-can be sealed up to moderate lesion ICDAS 3

ICDAS 0 to ICDAS 6

Question 13

Remineralization

Answer 13

• saliva neutralizes acids
• mineral replacement
• arrests caries
• white spots harden/hypermineralize

Question 14

Norfolk

Answer 14

optimal fluoride level 0.90 mg/L

Question 15

Topical Effects of Fluoride Preventing Caries

Answer 15

1. inhibit demineralization
2. enhance remineralization of incipient lesions
3. inhibit bacterial activity by inhibiting enolase, an enzyme needed by bacteria to metabolize carbohydrates

Question 16

Water Levels

Answer 16

• cold: 1.2ppm
• temperate: 1.0ppm
• warm: 0.7ppm

*****0.7ppm everywhere
72% of US population now has fluoridated water

Question 17

Root Caries

Answer 17

-demineralization starts pH 6-6.7

Question 18

Benefits

Answer 18

-increase in alveolar bone density
-less tooth loss and periodontal disease
more well controlled perio

Question 19

Food

Answer 19

• not a good source on its own
• cooking with fluoridated water
• fluoride salt not approved in US, but used in other countries

Question 20

School

Answer 20

• swish programs when no community water fluoride
• overcompensate 4.5x more than recommended
• EPA approved community fluoridated water content
• FDA approves fluoridated bottled water

Question 21

Compounds Used to Fluoridate Water

Answer 21

• sodium fluoride
• sodium silicofluoride
• hydrofluorosilic acid

Question 22

Fluoride in Children Chart

Answer 22

AGE 0.6ppm
0-6mo. none none none
6mo-3yr 0.25mg none none
3-6yr 0.5mg 0.25mg none
6-16yr 1.0mg 0.5mg none

Question 23

Toothpaste

Answer 23

• normally contains 1000-11,000ppm fluoride

- 15-30% reduction in caries

Question 24

Mouthrinse

Answer 24

20-35% caries reduction in children

Question 25

Dentifrice Ingredients

Answer 25

-stannous fluoride 0.45% (1000ppm) [first approved by ADA] -sodium fluoride 0.24% (1100ppm) -sodium monofluorophosphate 0.76% (1000ppm)

Question 26

Prescription Guidelines

Answer 26

- no more than 264mg NaF (120mg Fl2) | - supplements taken with juice or water

Question 27

Sodium Fluoride

Answer 27

``` -5% 22,600ppm -0.3-0.5mL/application -retained 24-48hours after application -2-4x/year -neutral pH 7 -tray method most effective for those with rampant decay ```

Question 28

Acidulated Phosphate

Answer 28

- 12,300ppm - good taste and tissue compatibility - etches composite and porcelain - 1.23% gel and foam - 4min applications 1-2 times/year

Question 29

Stannous Fluoride

Answer 29

- only available in rinse form - 19,360ppm - tin ion - not used regularly - poor taste, very unstable, stains teeth, tissue sloughing

Question 30

Xylitol

Answer 30

- alternative to fluoride - natural sugar found in fruits, vegetable, and trees - our bodies produce 5-15 grams/day - natural carb metabolized in liver - reduces bacterial load - decreases caries - increases oral pH - does not raise glycemic index - 10g/day 5times/day - too much can lead to diarrhea

Question 31

Acute Toxicity

Answer 31

- quick intake of an excessive amount of fluoride | - ingesting fluoride rinses, gels, foams, toothpaste

Question 32

Certainly Lethal Dose

Answer 32

- amount of fluoride ingested with without antidotal therapy can cause death - symptoms begin 30mins-24hours - adult: 5-10g of fluoride - child: 0.5-1g of fluoride - induce vomiting, administer milk of magnesia

Question 33

Safely Tolerated DOse

Answer 33

- one fourth of CLD | - depends on child weight

Question 34

GI

Answer 34

fluoride combines with HCl in stomach to make HFl causing stomach irritation -nausea, vomiting, diarrhea, abdominal pain, increased salivary flow, thirst