Fluoride & desensitizing agents

Question 1

what is fluoride

Answer 1

• naturally occurring mineral

Question 2

what happens with consumption of excess fluoride during tooth formation

Answer 2

• enamel hypoplasia

Question 3

what is the acceptable quantity of fluoride in water

Answer 3

• 0.7-1.2 ppm

Question 4

what is the mechanism of action for fluoride (3)

Answer 4

• inhibits demineralization
• enhances remineralization
• inhibits bacteria in the biofilm

Question 5

how does fluoride inhibit demineralization

Answer 5

• fluoride in fluid of biofilm around enamel crystals and dentin of root
• passes through the diffusion channels with the acids
• increases the fluoride of the subsurface lesion
• prevents the continued dissolution of the minerals in enamel and dentin

Question 6

how does fluoride enhance remineralization

Answer 6

• fluoride absorbs to mineral crystals within the tooth and attracts calcium ions
• fluoride ions incorporate into the remineralizing tooth structure, resulting in the development of fluorapatite-like crystals
• fluoride levels in the mouth from fluoridated water are sufficient to enhance remineralization

Question 7

does topical or systemic have a better benefit for fluoride

Answer 7

• greatest anti-caries benefit from topical exposure after eruption
• fluoride in saliva – incorporated into enamel crystals during remineralization
• evidence of fluoride remaining in saliva several hours – prolonger topical effect

Question 8

what is the pH for tooth minerals and fluorapatite crystals

Answer 8

• tooth minerals dissolve at pH of 5.5

- fluorapatite dissolves at pH of 4.5

Question 9

what causes erosion

Answer 9

• highly acidic foods and beverages

- medical conditions

Question 10

how does erosion differ from caries

Answer 10

1. not bacteria causing erosion - environment

2. minerals of the tooth that are lost

Question 11

how does fluoride cause bacterial inhibition

Answer 11

• fluoride interferes with essential enzyme activity of bacteria
• crosses the bacterial wall (membrane) as hydrofluoric acid
• alkaline cytoplasm - fluoride ion, causes enzyme activity disruption of bacteria = death

Question 12

what is substantivity

Answer 12

• the prolonged effect achieved when a chemical is released slowly over time

Question 13

what are active ingredients in antibacterial rinses

Answer 13

• essential oils
• cetylpyridinium chloride
• triclosan
• ACS = acidified sodium chlorite
• PHMB = polyhaxamethylene biguanine

Question 14

what does chlorhexidine do

Answer 14

• bactericidal
• opens the cell membrane
• recommended to be used in high risk individuals only, 1 min daily for 1 week/month and must be used in conjunction with fluoride remineralization therapy
• chx binds strongly onto many sites: mucous membranes and biofilm
• the bactericidal effect from a single dose is greatest for several hours, could even last as long as 5 days

Question 15

what is chlorhexidine gluconate

Answer 15

• percentage concentration: ~2% in Europe, ~12% in usa and canada
• common names: peridex, periogard, oris chx

Question 16

what is chlorhexidine gluconate the most effective agent for the reduction of

Answer 16

• biofilm = 55%

- gingivitis: 45%

Question 17

what are side effects of chx

Answer 17

1. brown stain on: teeth and tongue; composites, glass ionomer and compomers; acrylic teeth (dentures)
2. bitter taste
3. diet and brushing habits
4. more frequent professional cleanings

Question 18

what are phenolic compounds in essential oil rinses and what are the percentages of the phenolic compounds

Answer 18

1. thymol = 0.063% - Listerine, 0.064% - Personelle
2. eucalyptol = 0.091% - Listerine, 0.092% - Personelle
3. menthol = 0.042% - Listerine, 0.042% - Personelle

Question 19

what are 3 commercial rinses with phenolic compounds

Answer 19

1. listerine

2. personelle and life

Question 20

what are the 3 methods of delivery of topical fluoride

Answer 20

1. drinking water and some beverages
2. self applied: non prescription OTC products, prescription products
3. professionally applied: prescription products

Question 21

what is the fluoride content in over the counter self applied dentifrices

Answer 21

• 1000 ppm fluoride:
• sodium fluoride: crest pro health and Colgate total
• sodium monofluorophosphate (NaMFP)
• stannous fluoride (SnF2)
• 5000 ppm fluoride:
• prevident 1.1% NaF

Question 22

what is the fluoride content in percentage in a weekly vs daily mouthrinse

Answer 22

• weekly: 0.2% NaF

- daily: 0.05% = 230 ppm of NaF, 0.4% SnF2

Question 23

how much does over the counter fluoride rinses help with caries reduction and with what products

Answer 23

• 30-35% caries reduction with:
• daily rinsing (2x/day)
• 0.05% sodium fluoride

Question 24

what are the instructions for fluoride mouth rinses

Answer 24

1. rinse for 30-60 seconds
2. spit out the excess
3. do not eat or drink anything for 30 mins
4. before bed!!!

Question 25

what are 2 examples of weekly rinses and are they otc or prescription

Answer 25

1. 0.63% stannous fluoride: prescription | 2. 0.2% sodium fluoride: non prescription

Question 26

when are self applied topical gel fluoride prescription products recommended

Answer 26

1. moderate/high caries risk 2. orthodontic with decal around brackets 3. elderly - people with xerostomia/root exposure

Question 27

what different types of self applied topical gel fluoride prescription products are available, which are most effective and what is an alternative option

Answer 27

- types available: - 1.1% (5000 ppm) neutral sodium fluoride - 1.23% (5000 ppm) APF - 0.4% (1000 ppm) stannous fluoride = Gelstan - most effective: 4 mins in custom trays/soft disposable trays - alternative option: 1 minute brushing of fluoride gel

Question 28

what are the 2 options of in office fluoride treatments and what is their percentage of uptake

Answer 28

1. 1 min application - 85% | 2. 4 min application - 100%

Question 29

what is a disadvantage of the 1 minute application

Answer 29

- less uptake

Question 30

what are 2 advantages/indications for use for the 1 minute uptake

Answer 30

1. use it on patients like children because it's hard for the to sit still for longer than 1 min 2. good for patients with gag reflexes or a lot of saliva

Question 31

what do fluoride varnishes contain

Answer 31

- contain 5% NaF

Question 32

what is the application like for fluoride varnishes

Answer 32

- isolate and dry - apply directly - allow saliva to harden varnish

Question 33

when is it indicated to apply a varnish to dentin and cementum

Answer 33

1. recession 2. helps with root caries, sensitivity 3. young children if they have abrasion, abfraction or erosion

Question 34

what are post op instructions for fluoride varnishes

Answer 34

1. no brushing for 4-6 hours | 2. no hard, sticky or crunchy foods for the next 4-6 hours

Question 35

what are the 2 reasons children should be supervised when using fluoride

Answer 35

1. don't use too much toothpaste on toothbrush, make sure they are able to spit and not swallow 2. avoid fluorosis on permanent teeth

Question 36

what are the 3 main types of pastes recommended for sensitive teeth

Answer 36

1. sensodyne 2. crest: prohealth 3. prevident: 1.1% sodium fluoride. most effective because stronger dose of fluoride

Question 37

what are the different types of sensodynes

Answer 37

- sensodyne-R (original without fluoride): contains strontium chloride - sensodyne-F: contains potassium nitrate 5%, sodium fluoride 0.254%, detergent SLS (sodium laurel sulphate) - sensodyne repair and protect: contains nova min 5%, sodium monofluorphosphate 0.788% - pronamel: less abrasives, no SLS - more available fluoride

Question 38

what are the active ingredients of crest: prohealth

Answer 38

- stannous fluoride 0.0454% - sodium hexametaphosphate 13%: decreases the ability of stain to adhere to the tooth. used in crest vivid white - has been shown to decrease stain moderately if used 2x/day

Question 39

what is recaldent

Answer 39

- MI paste - vitamins for the teeth - milk derived protein - CPP = casein phsophopeptide - ACP = amorphous calcium phosphate - CPP are naturally occurring molecules which are able to bind to calcium and phosphate ions and stabilize ACP (delivers calcium and phosphate ions into the tooth, repairing and strengthening areas of enamel)

Question 40

how does MI paste work

Answer 40

- adheres to soft tissue, pellicle, biofilm, hydroxyapatite | - under acidic conditions recaldent releases: calcium, phosphate

Question 41

when should you use MI paste

Answer 41

- xerostomia - erosion - hypersensitivity - caries risk - orthodontics (decal)

Question 42

how do you use MI paste in office

Answer 42

- place a generous amount in tray - position in patient's oral cavity for 3 mins - do not rinse, follow fluoride instructions

Question 43

how do you use MI paste at home

Answer 43

- apply by rubbing onto affected area | - leave on overnight

Question 44

what is xylitol, what does it do and how does it work

Answer 44

- other antibacterial therapeutic - looks and tastes like sucrose - inhibits attachment and transmission of bacteria - does the following: - enhances remin - inhibits the transfer of bacteria from person to person - inhibits future decolonization - comes in chewing gum and lozenges - two tabs of gum or lozenges 4-5x/day

Question 45

what is sodium bicarbonate and what does it do

Answer 45

- other antibacterial therapeutic - neutralizes acids produced by acidogenic bacteria and has antibacterial properties - extreme-risk clients = those at high risk plus ry mouth or special needs - delivered in gum, toothpaste or solution (for individuals with low salivary flow)

Question 46

what is dentinal hypersensitivity

Answer 46

- an abnormal condition occurring when vital dentin is exposed to the environment of the oral cavity resulting in painful stimuli that reaches the pulp and is translated as pain - commonly located at the cervical area of the tooth - tooth sensitivity is most common complaint - 1 in 4 patients report some degree of hypersensitivity - 10 million Americans experience long-term hypersensitivity - scores for root sensitivity double following pd surgery

Question 47

what are factors contributing to hypersensitivity

Answer 47

- exposed dentin and open dentinal tubules

Question 48

what causes exposure of dentinal tubules

Answer 48

1. root exposure: due to gingival recession 2. removal of coronal enamel: excessive attrition, abfraction = biomechanics bending due to stress created from grinding or clenching causing a 'flaking off' of enamel at the CEJ

Question 49

what are _ reasons for root exposure

Answer 49

1. gingival recession: result of pathology (disease) 2. aging: results in continuous passive eruption of teeth and a gradual exposure of CEJ and eventually the root surface (2-3-4 mm by age of 55-60) 3. chronic or long lasting PD accompanied by: progressive apical migration of the JE, loss of PDL fibre attachment, crest of alveolar bone destruction = all result in exposed root surfaces 4. tooth positions within dental arch: bucco-version/labio-version may result in excess biofilm accumulation, difficulty in removing biofilm due to difficulty in placement of toothbrush 5. PD surgery 6. bruxism 7. incorrect toothbrushing habits: too much pressure, abrasive tp, too hard a toothbrush 8. root preparation/root debridement: calculus on cementum is impossible to remove without removing cementum too. will initiate a hypersensitive state

Question 50

what are the 3 stimuli that produces hypersensitivity symptoms

Answer 50

1. mechanical: tb bristles, flossing, metal eating utensils, dh instruments, denture clasp 2. chemical: foods high in acids or sugars, bulimic/anorexic individual - acidic vomit residue, acid reflux 3. thermal: hot/cold foods/beverages, cold air

Question 51

what is the hydrodynamic theory of tooth sensitivity

Answer 51

- pain response caused by stimulus causing the dentinal fluid to move - sensitive nerve endings located at the junction of the pulp and the dentin are deformed - this causes the nerve endings to fire, which then produces a quick, localized sharp pain

Question 52

what are desensitizing agents

Answer 52

- material that reduces or eliminates tooth sensitivity

Question 53

how can we stop sensitivity

Answer 53

- block the dental tubules

Question 54

what can cause sensitivity to return

Answer 54

1. acidic foods, beverages 2. toothbrushing 3. scaling/root planing

Question 55

what are some other causes of sensitivity

Answer 55

1. cracked/fractured tooth | 2. microleakages

Question 56

how does desensitizing work

Answer 56

- introducing potassium nitrate chemical - passes through dentinal tubules to pulp - acts directly on the nerve (depolarizes it) - soothing effect on the pulp - desensitizing will create a chemical bond with the dentin which mineralized the openings of the exposed tubules. this creates a mechanical bond with the dentin which mineralizes the openings of the exposed tubules and creates a mechanical occlusion at the beginning of the tubules

Question 57

what are 4 desensitizing agents

Answer 57

- toothpastes - fluoride gel/varnish - inorganic salts - resin agents