Fluoride lecture

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Preventive Dentistry
Third Year

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Fluoride lecture

  1. 1. Preventive dentistry program Fluoride &fissure sealant Third year Heidi Emmerling, RDH, PhD DHYG 104 Pt Ed and Nutrition Fall 2007
  2. 2. Heidi Emmerling, RDH, PhD DHYG 104 Pt Ed and Nutrition Fall 2007
  3. 3. Goals of Fluoride (F) Administration 1) Do not harm the patient. 2) Prevent decay on intact dental surfaces. 3) Arrest active decay. 4) Remineralize decalcified tooth surfaces.
  4. 4. Recommended Optimal Fluoride Level (ppm) in Water Supply depends on temperature and amount already in water Average Daily Air Temperature (°c) Optimal Fluoride Level (ppm) Control Range (ppm) (10-12) (12-15) (15-18) (18-21) (21-26) (26-33) 1.2 1.1 1.0 0.9 0.8 0.7 1.1 to 1.7 1.0 to 1.6 0.9 to 1.5 0.8 to 1.4 0.7 to 1.3 0.6 to 1.2 DHYG 104 Pt Ed and Nutrition Fall 2007
  5. 5. Probable toxic dose: Symptoms: 5 mg F / kg body weight 20 kg 6 year old, PTD= 100 mg F 1. Vomiting 2. Excess salivary and mucous discharge 3. Cold wet skin DHYG 104 Pt Ed and Nutrition Fall 2007 4. Convulsion at higher dose
  6. 6. A serious systemic consequence is binding of F to Ca which needed for heart function. F F Ca Ca DHYG 104 Pt Ed and Nutrition Fall 2007
  7. 7. Counter Measures: 1. Emetics 2. 1% calcium chloride 3. Calcium gluconate 4. milk Divalent cations like Ca cause precipitation, of F and prevent absorbtion in the intestine. DHYG 104 Pt Ed and Nutrition Fall 2007 F Ca F Ca Ca F
  8. 8.  Can be toxic/lethal Chemical burn  Inhibits enzyme systems (protoplasmic poison)  Binds calcium need for nerve action  Hyperkalemia: cardio toxicity  Adult: 2.5-10g (15 mg/kg = lethal)   In industry, skeletal fluorosis, calcification of tendons DHYG 104 Pt Ed and Nutrition Fall 2007
  9. 9. Emergency Treatment  4 actions Immediate treatment:  Induced vomiting  Orally administered calcium or aluminum preparations to protect stomach  Maintenance of blood calcium levels with intravenous calcium  DHYG 104 Pt Ed and Nutrition Fall 2007
  10. 10. 1. Immediate treatment DHYG 104 Pt Ed and Nutrition Fall 2007
  11. 11. First Aid Treatment  2. Milk or milk with eggs  Plenty of fluid including milk should be ingested 3. Lime water (CaOH)  4. Maalox (aluminum preparation)  Protects mucous membranes of upper GI from chemical burns  Contains calcium as a binder  DHYG 104 Pt Ed and Nutrition Fall 2007
  12. 12. DHYG 104 Pt Ed and Nutrition Fall 2007
  13. 13. Fluorosis occurs when teeth are developing. The most critical ages are from 0 to 6 years. After 8 years, risk of fluorosis is essentially past. During the critical ages F intake in excess of 0.1mg/kg body weight/day can lead to fluorosis. This is roughly 1mg/day for a 1 to 2 year old or 1.5 to 2 mg for a 5 year old. Remember that all forms of F intake comprise the daily consumption. This includes water intake (up to 1.5mg/day), foods (0.3 to 1.0mg) and especially significant in young children, swallowed toothpaste. Children under 2 years swallow 50% of toothpaste during tooth brushing and at 5years, 25%, both of which may amount to 1mg F/day.
  14. 14. FLUOROSIS 5 year olds swallow 25% of toothpaste Children under 2 years swallow 50% of toothpaste 1 to 3 grams Toothpaste = 1 mg F / gram (1000 ppmF) “pea” size amount (0.5g) is recommenred for fluorosis susceptible children.
  15. 15. Classification of fluorosis DHYG 104 Pt Ed and Nutrition Fall 2007
  16. 16. Very Mild Small opaque, paper white areas scattered irregularly over the tooth but not involving as much as 25% of the tooth surface. Frequently included in this classification are teeth showing no more than about 1-2 mm of white opacity at the tip of the summit of the cusps of the bicuspids or second molars. Mild The white opaque areas in the enamel of the teeth are more extensive but do not involve as much as 50% of the tooth. Heidi Emmerling, RDH, PhD DHYG 104 Pt Ed and Nutrition Fall 2007
  17. 17. Mild Fluorosis Heidi Emmerling, RDH, PhD DHYG 104 Pt Ed and Nutrition Fall 2007
  18. 18. Moderate All enamel surfaces of the teeth are affected, and the surfaces subject to attrition show wear. Brown stain is frequently a disfiguring feature. Severe Includes teeth formerly classified as "moderately severe and severe." All enamel surfaces are affected and hypoplasia is so marked that the general form of the tooth may be affected. The major diagnostic sign of this classification is discrete or confluent pitting. Brown stains are widespread and teeth often present a corroded-like appearance. Heidi Emmerling, RDH, PhD DHYG 104 Pt Ed and Nutrition Fall 2007
  19. 19. Moderate Fluorosis Heidi Emmerling, RDH, PhD DHYG 104 Pt Ed and Nutrition Fall 2007
  20. 20. DHYG 104 Pt Ed and Nutrition Fall 2007
  21. 21. Severe Fluorosis DHYG 104 Pt Ed and Nutrition Fall 2007
  22. 22. Systemic fluorides   Program began with the younger children should be continued at least until all permanent teeth except third molar erupted Posterior teeth will erupt and need fluoride till post eruption maturation occur
  23. 23. Water fluoridation    Water fluoridation associated with reduced tooth decay 50-60%reduction of caries in communities have water fluoridation between 0.7-1.2 Good cost in comparison to size of population
  24. 24. School water fluoridation    Alternative to community water fluoridation 4-5 times higher that that recommended for community fluoridation Student spent only part of the year on their school also fraction of the daily water intake at school
  25. 25. Salt fluoridation    Salt intake is difficult to determined Research showed that salt contained of 90PPM may be beneficial for reduction of caries May be it is the best method in developing countries where piped water supply is rare
  26. 26. Milk fluoridation   It is not completely supported Milk in the gastrointestinal tract may reduce absorption of ingested fluoride
  27. 27. DHYG 104 Pt Ed and Nutrition Fall 2007
  28. 28. Topical fluoride    Topical fluoride at office every 6 months or for school preventive program (mouth rinsing program at school ) Topical application at home particularaly at high risk activity or handicapped patient or with orthodontic appliance Fluoride rinse 0.2%NaF ,0.4%SnFapplies
  29. 29.    Students rinse for one or two minutes with 710ml Younger children under school age contraindicated Weekly program with 0.2 %Na F is recommended for school age
  30. 30. Methods of topical applications  Cotton application Tray technique
  31. 31. Cotton applicators method Seat patient upright ▪▪Isolate both upper and lower right or left quadrant using cotton roll isolation and saliva evacuation (half mouth technique) ▪▪ Dry isolated teeth with compressed air ▪▪ Keep tooth surfaces continually soaked with fluoride solution for 4-minutes application if active caries present and 1-minutes if caries inactive ▪▪ Repeat procedures on opposite side of the mouth ▪▪ Have the patient expectorate immediately and repeatedly upon completion of the topical treatment ▪▪ Advise patient not to eat ,drink ar rinse for 30 minutes after treatment
  32. 32. Tray technique     Teeth should be dried and free of saliva Patient in upright Place enough gel to fill one third of the trough area of the tray so that they properly fit over each dental arch Avoid overloading to reduce oozing of gel ,which may lead to excessive ingestion
  33. 33.     Place loaded tray over the arch and squeeze the buccual and lingual surfaces forcing gel between teeth With light biting presssure ,allow tray to remain in the mouth for 4- minutes Provide patient with drool bag or saliva ejector to avoid swallowing excessive fluoride After 4- minutes remove trays and use high volume evacuation to thoroughly remove gel that remains on teeth
  34. 34. ▪▪ Have the patient expectorate immediately and repeatedly upon completion of the topical treatment ▪▪ Advise patient not to eat ,drink or rinse for 30 minutes after treatment
  35. 35. APF foams and gels (use trays) DHYG 104 Pt Ed and Nutrition Fall 2007
  36. 36. DHYG 104 Pt Ed and Nutrition Fall 2007
  37. 37. DHYG 104 Pt Ed and Nutrition Fall 2007
  38. 38. FLUORIDE SUPPLEMENTS F in drinking water AGE Birth-6m 6m-3y F <0.3ppm 0 0.30.6ppm 0 >0.6ppm 0 0.25 0 0 3-6y 0.5 0.25 0 6-16y 1.0 0.5 0 Academy of Pediatric Dentistry current recommendations
  39. 39. Fluoride Protection for You    Sensitivity: This condition affects 25% of  most adults. Gum recession and natural wear can cause sensitivity.  Fluoride gels can help strengthen these area to insulate them from hot and cold. Root surface caries: Fluoride can help protect this area from acid- producing bacteria. Cavity control: Fluoride helps to remineralize enamel.  Fluoride blocks cavities by forming a more acidresistant surface layer.   DHYG 104 Pt Ed and Nutrition Fall 2007
  40. 40. Who should receive fluoride varnish?   Children are at risk for developing dental caries. Risk assessment based on the Caries Risk Assessment
  41. 41. Advantages of fluoride varnish:  There is less fluoride ingestion with a fluoride varnish than with conventional office caries treatments because the fluoride adheres to the tooth surface for longer periods of time.  Duraphat releases fluoride for 28 weeks. Twothirds of the fluoride is released by 6 months.**  No special equipment is needed for the application. DHYG 104 Pt Ed and Nutrition Fall 2007
  42. 42. Advantages of fluoride varnish:  Teeth do not need to be professionally cleaned prior to varnish application.  Children can eat and drink immediately after application.  Fluoride varnish can prevent decay in both smooth surface and pit and groove sites. DHYG 104 Pt Ed and Nutrition Fall 2007
  43. 43. Advantages of fluoride varnish:  It is fast and easy and can be done in one appointment with no injections. This varnish is a sticky, yellow semiliquid containing 5% sodium fluoride in a resin base mixed with alcohol to dry quickly after application.  You can leave immediately after application. There are no fluoride trays which prevents gagging.  It can be used as a cavity liner or desensitizer or painted on cervical areas in geriatric patients. It can also be applied to tooth surfaces between teeth for young children. DHYG 104 Pt Ed and Nutrition Fall 2007
  44. 44. Post application instructions for parents     Varnish will set on contact with saliva and look like a yellowish film Child can eat or drink right after application but should try to eat soft foods Instruct parent not to brush their child’s teeth until the next day. The first toothbrushing will remove the yellow film on the teeth.
  45. 45. Epidemiology of pit and fissure caries     Occlusal caries 60%of total caries experience in children and adolescents Morphology of pits and fissures A-shallow,wide v-shaped fissures B-deep,narrow ,I shaped fissures (narrow neck and wide base )like bottle neck DHYG 104 Pt Ed and Nutrition Fall 2007
  46. 46. DHYG 104 Pt Ed and Nutrition Fall 2007
  47. 47. Sealant indications     Deep&retentive pits and fissures Stained pits and fissures No radiographic or clinical evidence of interproximal caries Patient receiving other preventive treatment DHYG 104 Pt Ed and Nutrition Fall 2007
  48. 48. Sealant contraindications      Rampant caries Interproximal caries Low risk patients Well coalesced pits and fissures Uncoapertive patient DHYG 104 Pt Ed and Nutrition Fall 2007
  49. 49. Sealant limitations     Moisture control of utmost importance Patient cooperation for dry field Isolation with rubber dam or cotton rolls Life span of primary tooth DHYG 104 Pt Ed and Nutrition Fall 2007
  50. 50. Heidi Emmerling, RDH, PhD DHYG 104 Pt Ed and Nutrition Fall 2007
  51. 51. Heidi Emmerling, RDH, PhD DHYG 104 Pt Ed and Nutrition Fall 2007
  52. 52. Heidi Emmerling, RDH, PhD DHYG 104 Pt Ed and Nutrition Fall 2007

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