This document describes several school oral health programs from different locations and time periods. It provides details on the goals, implementation, and evaluation of programs in the US, Texas, Minnesota, North Carolina, and globally through the WHO. The programs generally aim to educate children about oral health, develop healthy habits, and reduce dental disease through activities in schools. Evaluation of many programs found reductions in tooth decay and positive changes in knowledge and behaviors.
This presentation is all about the systemic administration of fluorides ,as it is an easier way for the administration of fluorides to prevent dental caries and tooth decay.the aim is to explain the advantages of systemic fluoride ,their present status in India and in other countries and to create awareness among population.Also raising an issue that how these methods of systemic fluoride administration can be improved so that there is better prevention of decay problems
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Remineralization is defined as the process whereby calcium and phosphate ions are supplied from an external source to the tooth thereby, causing ion deposition into crystal voids in demineralized enamel, thus producing net mineral gain.
Remineralization Agents - Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus remineralization occurs.
Fluoride has a long history in dental care and is known to strengthen tooth enamel. Systemic fluorides are ingested or injected forms that allow fluoride to be distributed throughout the body and incorporated into developing teeth and bones. Common systemic fluorides include fluoride tablets, drops, and supplements as well as professionally applied gels and foams.
India has over 1.3 billion people making it the second most populated country. The average diet has changed over time from being grain-based to including more dairy, eggs and sugar. Dental caries is a major public health problem, especially in rural areas, but it is still not considered a priority. Prehistoric man rarely had dental caries, but as diets changed to include more sugars and starches in more recent times, the rate of caries increased substantially.
This document discusses the relationship between diet and dental caries. It defines key terms like diet, nutrition, and dental caries. It classifies foods and describes the food guide pyramid. Diet plays a major role in the development of dental caries as certain carbohydrates are cariogenic. Several studies are summarized that provide evidence of this relationship, like those comparing modern and primitive diets, or studies on sugar intake during World War II. The document also discusses the effects of nutrition on dental caries both before and after tooth eruption.
This document describes several school oral health programs from different locations and time periods. It provides details on the goals, implementation, and evaluation of programs in the US, Texas, Minnesota, North Carolina, and globally through the WHO. The programs generally aim to educate children about oral health, develop healthy habits, and reduce dental disease through activities in schools. Evaluation of many programs found reductions in tooth decay and positive changes in knowledge and behaviors.
This presentation is all about the systemic administration of fluorides ,as it is an easier way for the administration of fluorides to prevent dental caries and tooth decay.the aim is to explain the advantages of systemic fluoride ,their present status in India and in other countries and to create awareness among population.Also raising an issue that how these methods of systemic fluoride administration can be improved so that there is better prevention of decay problems
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Remineralization is defined as the process whereby calcium and phosphate ions are supplied from an external source to the tooth thereby, causing ion deposition into crystal voids in demineralized enamel, thus producing net mineral gain.
Remineralization Agents - Biomimetic approaches to stabilization of bioavailable calcium, phosphate, and fluoride ions and the localization of these ions to non-cavitated caries lesions for controlled remineralization.
Fermentable carbohydrates provide plaque bacteria with substrate for acid production.
This causes a rapid drop in plaque pH and when pH becomes less than 5.5, hydroxyapatite in enamel breaks down and calcium and phosphate ions diffuse out from the enamel.
5.5 is the “critical pH”, the point where equilibrium exists. There is no mineral dissolution and no mineral precipitation.
The plaque remains acidic for about 30-60 minutes after which normal pH is restored gradually.
The calcium and phosphate ions re-enter enamel when normal pH is restored and thus remineralization occurs.
Fluoride has a long history in dental care and is known to strengthen tooth enamel. Systemic fluorides are ingested or injected forms that allow fluoride to be distributed throughout the body and incorporated into developing teeth and bones. Common systemic fluorides include fluoride tablets, drops, and supplements as well as professionally applied gels and foams.
India has over 1.3 billion people making it the second most populated country. The average diet has changed over time from being grain-based to including more dairy, eggs and sugar. Dental caries is a major public health problem, especially in rural areas, but it is still not considered a priority. Prehistoric man rarely had dental caries, but as diets changed to include more sugars and starches in more recent times, the rate of caries increased substantially.
This document discusses the relationship between diet and dental caries. It defines key terms like diet, nutrition, and dental caries. It classifies foods and describes the food guide pyramid. Diet plays a major role in the development of dental caries as certain carbohydrates are cariogenic. Several studies are summarized that provide evidence of this relationship, like those comparing modern and primitive diets, or studies on sugar intake during World War II. The document also discusses the effects of nutrition on dental caries both before and after tooth eruption.
This document provides guidelines for providing anticipatory guidance to parents at different stages of their child's development. It covers topics such as oral development, nutrition, oral hygiene, fluoride use, habits, and injury prevention. Guidelines are provided for prenatal counseling, and ages 6-12 months, 12-24 months, 2-6 years, 6-12 years, and adolescence. The document emphasizes educating parents on establishing good oral health habits and preventing dental injuries at each stage.
This document outlines the Caries Management by Risk Assessment (CAMBRA) protocol, which classifies patients into four caries risk levels - low, moderate, high, and extreme - based on criteria such as dental history, plaque levels, fluoride use, diet, medical conditions, and clinical/radiographic findings. For each risk level, it recommends treatment approaches including frequency of dental visits, fluoride applications and products, xylitol or calcium phosphate use, and salivary testing. The goal of CAMBRA is to implement personalized preventive strategies based on a patient's unique risk factors to prevent new cavities and slow the progression of existing ones.
This document discusses the historical evolution and use of fluorides for dental caries prevention. It begins with early discoveries of fluoride in enamel in 1805 and the isolation of fluorine as an element in 1771. It then covers fluoride chemistry, sources of fluoride intake from water, food, beverages and air. The document discusses fluoride metabolism, distribution in tissues, and excretion. It also addresses water fluoridation, which began in 1945 in Grand Rapids, USA and defines water fluoridation as the controlled adjustment of fluoride in communal water to maximize caries prevention with minimal fluorosis risk.
This document summarizes recent advances in rebuilding lost enamel structure through biomimetics. It discusses the mechanisms of demineralization and remineralization, and the requirements of effective remineralizing agents. Both fluoride and non-fluoride strategies are examined, including casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), nano-hydroxyapatite, bioactive glass, arginine, and tricalcium phosphate. CPP-ACP, which mimics proteins found in saliva, and bioactive glass materials like NovaMin and bioglass, are highlighted as effective remineralizing agents. The document provides details on the compositions and mechanisms of various strategies to promote remin
This document provides a history of fluorides and their discovery and use in dentistry. It discusses how fluorine was first discovered in the 18th century and early observations of fluorides in teeth and bones in the 19th century. In the early 20th century, Dr. McKay first observed mottled enamel in children in Colorado and suspected it was related to fluoride levels in drinking water. Extensive surveys and studies over decades by McKay, Black, Dean and others confirmed high fluoride levels in endemic areas with mottled enamel. They established fluoride's role in preventing dental caries when consumed in optimal levels in drinking water.
This document provides information about stainless steel crowns (SSCs), including their history, objectives, indications, contraindications, types, composition, clinical procedure, and references. Some key points:
- SSCs were first described in the 1950s and became commonly used in the 1960s to restore primary and permanent teeth.
- Objectives are to achieve a biologically compatible restoration that maintains tooth form and function.
- Indications include restoring teeth after pulpotomy/pulpectomy, with large/deep caries, or when 3+ surfaces need restoration.
- Clinical procedure involves evaluating occlusion, selecting correct crown size, tooth preparation to provide space and remove caries, and cementing the crown
INTRODUCTION, METHOD OF ADMINISTRATION,WATER FLUORIDATION,SCHOOL WATER FLUORIDATION,SALT FLUORIDATION,MILK FLUORIDATION,FLUORIDE SUPPLEMENTS,DIETARY SUPPLEMENTS,PRENATAL FLUORIDE SUPPLEMENTS,RECENT STUDY
This document discusses fluoride toxicity and fluorosis. It begins by outlining the learning objectives which are to understand the toxic effects of fluoride, safe dosages, and the pathologies of dental and skeletal fluorosis. It then discusses the classification of fluoride toxicity as either acute or chronic. Acute toxicity occurs with short term excessive intake and can be fatal, while chronic toxicity is from long term excessive intake and causes dental and skeletal fluorosis. The document outlines the signs and symptoms of dental fluorosis, which occurs from intake above recommended levels as a child, and skeletal fluorosis, which is caused by long term intake of higher levels and causes joint and bone pain and stiffness. It also discusses methods for diagnosing and managing fluorosis as
This document discusses antibiotics that are commonly used in pediatric dentistry. It provides formulas for calculating drug dosages for pediatric patients based on their age and weight. It then describes several classes of antibiotics including penicillin, clindamycin, amoxicillin, cephalosporins, and macrolides. For each drug class and individual drug, it discusses indications, contraindications, dosages, side effects, and formulations. The document aims to guide practitioners in appropriately prescribing antibiotics to pediatric patients for odontogenic infections and other dental conditions.
The concept of a dental home, however, is too new to have been studied as a predictor of oral health.In 1999,Nowak described the term in relation to the desired recurrence of preventive oral health supervisory services as propagated by the American Academy of Pediatric Dentistry.
Hi, I am Dr Komal Ghiya, pediatric dentist by profession, I am here to share some of my own presentations for educational purposes. I hope a presentation on DIET AND DENTAL CARIES will be useful for all the dental and medical students. Comments are welcome if you like the presentations and if not please suggest some ways I could make them better for you. All the best
- Preventive dentistry aims to prevent dental diseases before they occur through various levels of prevention including primordial, primary, secondary, and tertiary.
- Primary prevention removes the possibility of disease by targeting the entire population or high-risk groups through health promotion, education, environmental modifications, and specific protective measures like water fluoridation or dental sealants.
- Secondary prevention halts disease progression through early diagnosis and prompt treatment while tertiary prevention focuses on rehabilitation and reducing impairments from existing conditions.
This document discusses the potential for a dental caries vaccine. It begins by defining dental caries and explaining why it is a major public health problem. It then covers how the immune system works and classifications of immunity. Key aspects of the microbiology of dental caries are explained, focusing on Streptococcus mutans and its antigenic determinants. The document discusses the need for a caries vaccine, potential routes of administration including mucosal and systemic routes, and advantages and disadvantages of passive immunization approaches. It concludes by considering the public health perspective on a potential caries vaccine and analyzing whether it could help reduce the global burden of dental caries.
The document discusses various materials used for obturation in root canals of primary teeth. The goals of obturation include maintaining arch length, preserving function, and removing infection. Commonly used materials include zinc oxide eugenol (ZOE), calcium hydroxide, and iodoform-based pastes. ZOE has advantages of antibacterial effects and radiopacity but low resorption. Iodoform provides antibacterial properties and resorbs excess material. Calcium hydroxide is biocompatible with no toxic effects. No single material meets all criteria. Combination materials and addition of substances aim to improve properties. Selection depends on factors like resorption rate and biocompatibility.
This document discusses the history and metabolism of fluorides. It begins with an outline of the topics to be covered, including the history of fluorides, fluoride concentration in tissues, and systemic fluoride sources like water and salt fluoridation. It then covers the chemistry and distribution of fluoride in the environment, foods, and body. The majority of the document discusses fluoride absorption, distribution in serum and tissues like bone and teeth, and excretion through urine, feces, and sweat. It notes that most absorbed fluoride is deposited in mineralizing tissues and the remainder is cleared by the kidneys.
This document provides information about a lingual holding arch space maintainer. It describes the appliance as a bilateral, non-functional, passive mandibular arch appliance used to control anterior-posterior tooth movement and arch perimeter distortion. The key components are a round wire soldered to bands, most commonly on the permanent first molars. Advantages include modifications are possible and it can regain space, while disadvantages are difficult construction and potential for distortion. Fabrication involves adapting bands to the most posterior remaining tooth and soldering a pre-fabricated or custom made wire. The wire should contact the incisor cingulum and rest on the molar. Modifications and patient instructions are also outlined.
This document discusses anterior strip crowns, which are full coverage restorations for primary anterior teeth with large cavities. It defines strip crowns, outlines their purpose and indications, contraindications, placement technique, advantages and disadvantages. Strip crowns provide aesthetic restoration while protecting teeth from further decay, but they can fracture or debond and require careful technique and moisture control. Overall, strip crowns are considered an effective esthetic option for restoring severely decayed primary incisors when more conservative treatments are not sufficient.
This document provides an overview of minimal intervention dentistry. It defines minimal intervention dentistry as an approach focused on early detection and diagnosis of dental caries, followed by minimally invasive treatment. The key principles discussed include early caries diagnosis, classification of caries depth and progression, individual caries risk assessment, reduction of cariogenic bacteria, and remineralization of early lesions. Various methods for caries diagnosis and classification are described. The document also discusses strategies for decreasing caries risk, including remineralizing agents and antimicrobial therapies to arrest active lesions and promote remineralization. Remineralizing agents that are discussed include fluoride, bioactive glasses, CPP-ACP, TCP, ACP
Minimally invasive dentistry aims to control dental disease through early detection and least invasive treatment methods. It focuses on remineralizing early lesions and performing minimal surgical procedures. Recent advances include new cavity classification systems, preparation techniques like tunnels and slots, and caries removal methods like air abrasion, sonoabrasion, and chemomechanical removal. The Atraumatic Restorative Technique and Interim Therapeutic Restoration were developed to provide basic dental care using only hand instruments and restorative materials like glass ionomer cement. Lasers can also be used for caries prevention, removal and cavity preparation with minimal thermal damage to surrounding tooth structure.
This document discusses the history and uses of calcium hydroxide in pediatric dentistry. It describes how calcium hydroxide has been used since the early 20th century for its antibacterial properties and ability to induce hard tissue formation. The document outlines key developments in the understanding and application of calcium hydroxide, including its introduction as a root canal filling material in 1920 and subsequent uses in pulp capping, pulpotomy, apexification, and as an intracanal medicament. The history section covers improved formulations and vehicles for calcium hydroxide from the 1930s-1960s.
This document discusses strategies for protecting children's oral health through the use of fluoride. It describes the three mechanisms by which fluoride prevents dental caries: enhancing remineralization, inhibiting demineralization, and reducing bacterial acid production. It outlines various systemic and topical sources of fluoride, including water, toothpaste, supplements, and varnishes. It provides recommendations on fluoride supplementation based on a child's caries risk and water fluoride levels. The goal of fluoride use is to maximize caries prevention while minimizing enamel fluorosis.
Fluorosis by the Numbers: How Much Is Too Much Fluoride?Molly_Evensen
Fluoride is an essential mineral for oral health. The American Dental Association (ADA) dubbed it as “nature’s cavity fighter.” It helps harden the outer enamel of developing teeth and lessens the risk of dental caries.
This document provides guidelines for providing anticipatory guidance to parents at different stages of their child's development. It covers topics such as oral development, nutrition, oral hygiene, fluoride use, habits, and injury prevention. Guidelines are provided for prenatal counseling, and ages 6-12 months, 12-24 months, 2-6 years, 6-12 years, and adolescence. The document emphasizes educating parents on establishing good oral health habits and preventing dental injuries at each stage.
This document outlines the Caries Management by Risk Assessment (CAMBRA) protocol, which classifies patients into four caries risk levels - low, moderate, high, and extreme - based on criteria such as dental history, plaque levels, fluoride use, diet, medical conditions, and clinical/radiographic findings. For each risk level, it recommends treatment approaches including frequency of dental visits, fluoride applications and products, xylitol or calcium phosphate use, and salivary testing. The goal of CAMBRA is to implement personalized preventive strategies based on a patient's unique risk factors to prevent new cavities and slow the progression of existing ones.
This document discusses the historical evolution and use of fluorides for dental caries prevention. It begins with early discoveries of fluoride in enamel in 1805 and the isolation of fluorine as an element in 1771. It then covers fluoride chemistry, sources of fluoride intake from water, food, beverages and air. The document discusses fluoride metabolism, distribution in tissues, and excretion. It also addresses water fluoridation, which began in 1945 in Grand Rapids, USA and defines water fluoridation as the controlled adjustment of fluoride in communal water to maximize caries prevention with minimal fluorosis risk.
This document summarizes recent advances in rebuilding lost enamel structure through biomimetics. It discusses the mechanisms of demineralization and remineralization, and the requirements of effective remineralizing agents. Both fluoride and non-fluoride strategies are examined, including casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), nano-hydroxyapatite, bioactive glass, arginine, and tricalcium phosphate. CPP-ACP, which mimics proteins found in saliva, and bioactive glass materials like NovaMin and bioglass, are highlighted as effective remineralizing agents. The document provides details on the compositions and mechanisms of various strategies to promote remin
This document provides a history of fluorides and their discovery and use in dentistry. It discusses how fluorine was first discovered in the 18th century and early observations of fluorides in teeth and bones in the 19th century. In the early 20th century, Dr. McKay first observed mottled enamel in children in Colorado and suspected it was related to fluoride levels in drinking water. Extensive surveys and studies over decades by McKay, Black, Dean and others confirmed high fluoride levels in endemic areas with mottled enamel. They established fluoride's role in preventing dental caries when consumed in optimal levels in drinking water.
This document provides information about stainless steel crowns (SSCs), including their history, objectives, indications, contraindications, types, composition, clinical procedure, and references. Some key points:
- SSCs were first described in the 1950s and became commonly used in the 1960s to restore primary and permanent teeth.
- Objectives are to achieve a biologically compatible restoration that maintains tooth form and function.
- Indications include restoring teeth after pulpotomy/pulpectomy, with large/deep caries, or when 3+ surfaces need restoration.
- Clinical procedure involves evaluating occlusion, selecting correct crown size, tooth preparation to provide space and remove caries, and cementing the crown
INTRODUCTION, METHOD OF ADMINISTRATION,WATER FLUORIDATION,SCHOOL WATER FLUORIDATION,SALT FLUORIDATION,MILK FLUORIDATION,FLUORIDE SUPPLEMENTS,DIETARY SUPPLEMENTS,PRENATAL FLUORIDE SUPPLEMENTS,RECENT STUDY
This document discusses fluoride toxicity and fluorosis. It begins by outlining the learning objectives which are to understand the toxic effects of fluoride, safe dosages, and the pathologies of dental and skeletal fluorosis. It then discusses the classification of fluoride toxicity as either acute or chronic. Acute toxicity occurs with short term excessive intake and can be fatal, while chronic toxicity is from long term excessive intake and causes dental and skeletal fluorosis. The document outlines the signs and symptoms of dental fluorosis, which occurs from intake above recommended levels as a child, and skeletal fluorosis, which is caused by long term intake of higher levels and causes joint and bone pain and stiffness. It also discusses methods for diagnosing and managing fluorosis as
This document discusses antibiotics that are commonly used in pediatric dentistry. It provides formulas for calculating drug dosages for pediatric patients based on their age and weight. It then describes several classes of antibiotics including penicillin, clindamycin, amoxicillin, cephalosporins, and macrolides. For each drug class and individual drug, it discusses indications, contraindications, dosages, side effects, and formulations. The document aims to guide practitioners in appropriately prescribing antibiotics to pediatric patients for odontogenic infections and other dental conditions.
The concept of a dental home, however, is too new to have been studied as a predictor of oral health.In 1999,Nowak described the term in relation to the desired recurrence of preventive oral health supervisory services as propagated by the American Academy of Pediatric Dentistry.
Hi, I am Dr Komal Ghiya, pediatric dentist by profession, I am here to share some of my own presentations for educational purposes. I hope a presentation on DIET AND DENTAL CARIES will be useful for all the dental and medical students. Comments are welcome if you like the presentations and if not please suggest some ways I could make them better for you. All the best
- Preventive dentistry aims to prevent dental diseases before they occur through various levels of prevention including primordial, primary, secondary, and tertiary.
- Primary prevention removes the possibility of disease by targeting the entire population or high-risk groups through health promotion, education, environmental modifications, and specific protective measures like water fluoridation or dental sealants.
- Secondary prevention halts disease progression through early diagnosis and prompt treatment while tertiary prevention focuses on rehabilitation and reducing impairments from existing conditions.
This document discusses the potential for a dental caries vaccine. It begins by defining dental caries and explaining why it is a major public health problem. It then covers how the immune system works and classifications of immunity. Key aspects of the microbiology of dental caries are explained, focusing on Streptococcus mutans and its antigenic determinants. The document discusses the need for a caries vaccine, potential routes of administration including mucosal and systemic routes, and advantages and disadvantages of passive immunization approaches. It concludes by considering the public health perspective on a potential caries vaccine and analyzing whether it could help reduce the global burden of dental caries.
The document discusses various materials used for obturation in root canals of primary teeth. The goals of obturation include maintaining arch length, preserving function, and removing infection. Commonly used materials include zinc oxide eugenol (ZOE), calcium hydroxide, and iodoform-based pastes. ZOE has advantages of antibacterial effects and radiopacity but low resorption. Iodoform provides antibacterial properties and resorbs excess material. Calcium hydroxide is biocompatible with no toxic effects. No single material meets all criteria. Combination materials and addition of substances aim to improve properties. Selection depends on factors like resorption rate and biocompatibility.
This document discusses the history and metabolism of fluorides. It begins with an outline of the topics to be covered, including the history of fluorides, fluoride concentration in tissues, and systemic fluoride sources like water and salt fluoridation. It then covers the chemistry and distribution of fluoride in the environment, foods, and body. The majority of the document discusses fluoride absorption, distribution in serum and tissues like bone and teeth, and excretion through urine, feces, and sweat. It notes that most absorbed fluoride is deposited in mineralizing tissues and the remainder is cleared by the kidneys.
This document provides information about a lingual holding arch space maintainer. It describes the appliance as a bilateral, non-functional, passive mandibular arch appliance used to control anterior-posterior tooth movement and arch perimeter distortion. The key components are a round wire soldered to bands, most commonly on the permanent first molars. Advantages include modifications are possible and it can regain space, while disadvantages are difficult construction and potential for distortion. Fabrication involves adapting bands to the most posterior remaining tooth and soldering a pre-fabricated or custom made wire. The wire should contact the incisor cingulum and rest on the molar. Modifications and patient instructions are also outlined.
This document discusses anterior strip crowns, which are full coverage restorations for primary anterior teeth with large cavities. It defines strip crowns, outlines their purpose and indications, contraindications, placement technique, advantages and disadvantages. Strip crowns provide aesthetic restoration while protecting teeth from further decay, but they can fracture or debond and require careful technique and moisture control. Overall, strip crowns are considered an effective esthetic option for restoring severely decayed primary incisors when more conservative treatments are not sufficient.
This document provides an overview of minimal intervention dentistry. It defines minimal intervention dentistry as an approach focused on early detection and diagnosis of dental caries, followed by minimally invasive treatment. The key principles discussed include early caries diagnosis, classification of caries depth and progression, individual caries risk assessment, reduction of cariogenic bacteria, and remineralization of early lesions. Various methods for caries diagnosis and classification are described. The document also discusses strategies for decreasing caries risk, including remineralizing agents and antimicrobial therapies to arrest active lesions and promote remineralization. Remineralizing agents that are discussed include fluoride, bioactive glasses, CPP-ACP, TCP, ACP
Minimally invasive dentistry aims to control dental disease through early detection and least invasive treatment methods. It focuses on remineralizing early lesions and performing minimal surgical procedures. Recent advances include new cavity classification systems, preparation techniques like tunnels and slots, and caries removal methods like air abrasion, sonoabrasion, and chemomechanical removal. The Atraumatic Restorative Technique and Interim Therapeutic Restoration were developed to provide basic dental care using only hand instruments and restorative materials like glass ionomer cement. Lasers can also be used for caries prevention, removal and cavity preparation with minimal thermal damage to surrounding tooth structure.
This document discusses the history and uses of calcium hydroxide in pediatric dentistry. It describes how calcium hydroxide has been used since the early 20th century for its antibacterial properties and ability to induce hard tissue formation. The document outlines key developments in the understanding and application of calcium hydroxide, including its introduction as a root canal filling material in 1920 and subsequent uses in pulp capping, pulpotomy, apexification, and as an intracanal medicament. The history section covers improved formulations and vehicles for calcium hydroxide from the 1930s-1960s.
This document discusses strategies for protecting children's oral health through the use of fluoride. It describes the three mechanisms by which fluoride prevents dental caries: enhancing remineralization, inhibiting demineralization, and reducing bacterial acid production. It outlines various systemic and topical sources of fluoride, including water, toothpaste, supplements, and varnishes. It provides recommendations on fluoride supplementation based on a child's caries risk and water fluoride levels. The goal of fluoride use is to maximize caries prevention while minimizing enamel fluorosis.
Fluorosis by the Numbers: How Much Is Too Much Fluoride?Molly_Evensen
Fluoride is an essential mineral for oral health. The American Dental Association (ADA) dubbed it as “nature’s cavity fighter.” It helps harden the outer enamel of developing teeth and lessens the risk of dental caries.
This document provides information about fluorine and its compounds. It discusses the properties of hydrogen fluoride, sodium fluoride, and fluorosilicic acid. It describes the major uses of inorganic fluorine compounds in industry and for municipal water fluoridation. The document also discusses how fluoride prevents dental caries by enhancing remineralization and inhibiting demineralization of tooth enamel. It provides facts about water fluoridation in the United States.
This document discusses fluoride and the benefits of water fluoridation. It notes that scientific studies have not found links between fluoridation and cancer. Fluoride occurs naturally and is added to drinking water to prevent tooth decay and reduce oral disease by up to 40%. Community water fluoridation is considered a cost-effective public health measure that benefits all individuals regardless of age, race, or socioeconomic status.
Fluoride helps prevent tooth decay through several mechanisms. It inhibits demineralization, promotes remineralization, alters the action of plaque bacteria, and improves enamel crystallinity and reduces solubility. Both pre-eruptive and post-eruptive exposure to fluoride provides caries prevention benefits, with maximal effects seen from high exposure both before and after tooth eruption. Community water fluoridation was first introduced in the 1940s and has been shown to reduce tooth decay rates by 40-59% in both primary and permanent teeth.
This document discusses various ways to prevent dental caries through the use of fluoride. It begins by explaining the role of fluoride in increasing the remineralization of teeth and making enamel more resistant to decay. It then discusses water fluoridation as an effective public health measure for delivering fluoride and preventing cavities at the community level. Finally, it mentions some additional sources of fluoride beyond water, such as toothpaste, mouth rinses, and foods. The overall message is that maintaining adequate fluoride intake through various means can help strengthen tooth enamel and reduce the risk of cavities developing.
This document provides information on the prevention of dental caries through the use of fluoride. It discusses that fluoride can be used systemically by ingesting it or topically by direct application. Fluoride works to prevent dental caries by strengthening enamel, inhibiting bacteria, and enhancing remineralization. Sources of fluoride include water, foods, dental products, and professional treatments. Both optimal levels and methods of delivery are covered.
The document discusses policies and recommendations regarding different methods of fluoride use for preventing dental caries. It states that community water fluoridation is safe, cost-effective and should be introduced where feasible to reduce dental caries. It also supports salt fluoridation as an alternative where water fluoridation is not possible. The use of fluoride toothpaste is endorsed as the most widely used and effective preventive method, and efforts should be made to develop affordable fluoride toothpastes in developing countries.
Fluoride plays an important role in dental health by strengthening tooth enamel and preventing cavities. It is found naturally in water, soil, and plants. Adding fluoride to water reduces tooth decay risk. Fluoride is also available in toothpaste, mouthwash, supplements, and professionally applied gels and varnishes. The document discusses the mechanisms by which fluoride prevents cavities, including affecting bacteria, increasing enamel resistance, and enhancing remineralization. It provides recommendations for fluoride intake from various sources based on age, including using only a smear of toothpaste under age 3 and a pea-sized amount for older children.
Systemic fluoride was used as early as 1874 to prevent dental caries. Fluoride ions are absorbed in the gut and nearly all retained fluoride is incorporated into developing bones and teeth, making enamel crystals larger and more stable. This affects crown morphology by making pits and fissures shallower, less likely to cause decay. Systemic fluoride intake can cause dental fluorosis if intake is too high during tooth development between ages 1-4. Topical fluoride is now recognized as more important for caries prevention than systemic fluoride.
Systemic fluoride was used as early as 1874 to prevent dental caries. Fluoride ions are absorbed in the gut and nearly all retained fluoride is incorporated into developing bones and teeth, making enamel crystals larger and more stable. This affects crown morphology by making pits and fissures shallower, less likely to cause decay. Systemic fluoride includes water fluoridation, supplements, and adding fluoride to salt, milk, mineral water and sugar. Topical fluoride is most important for preventing decay by inhibiting demineralization and promoting remineralization in the mouth. Excessive fluoride can cause dental and skeletal fluorosis.
This document discusses a preventive dentistry program focused on fluoride and fissure sealants presented by Heidi Emmerling. It covers the goals of fluoride administration, recommended fluoride levels in water, potential toxicity of fluoride ingestion, emergency treatment, topical fluoride applications, and fissure sealant indications and limitations. The goals are to prevent decay, arrest active decay, and remineralize teeth using optimal fluoride levels tailored to climate. Potential fluoride toxicity and treatments are also outlined.
1. Fluoride has been used extensively to prevent dental caries since the early 1900s. Both systemic and topical fluoride administration are effective ways to reduce caries risk.
2. Current recommendations include community water fluoridation at 0.7 ppm, fluoride toothpaste in rice-sized amounts for young children, and professionally applied topical fluoride treatments every 3-6 months for those at high risk.
3. New advancements like silver diamine fluoride show promise in arresting cavitated caries lesions and may provide an alternative to conventional restorative techniques.
Study: Water Fluoridation Helps Reduce Tooth Decay among American Children an...mahoneydds
A study published in the Journal of Dental Research shows that children and adolescents in the US with more access to fluoridated drinking water have fewer chances of having tooth decay.
Participants who have access to community water fluoridation presented a 30 percent decrease in tooth decay experience during the primary dentition during a 12 percent decrease in the permanent dentition. These numbers are higher than those who have less access to community water fluoridation.
Fluoride is a naturally occurring mineral ion that strengthens tooth enamel and makes it more resistant to decay. It is added to most toothpastes and many public water supplies in the US to help reduce cavities. While generally safe, fluoride can cause cosmetic fluorosis if consumed in large amounts by young children under 8 years old. The Centers for Disease Control still recommends community water fluoridation for its dental benefits. Anyone with concerns about their fluoride use should consult their dentist.
Water fluoridation involves adding fluoride to public water supplies to reduce tooth decay. It is the most effective public health measure for the prevention of cavities, reducing decay by 20-40%. While it benefits all consumers regardless of socioeconomic status, it aims to help those most at risk. Alternatives to water fluoridation include fluoride toothpaste and other topical treatments, though none are as widespread or cost-effective. Debate continues around potential adverse effects, though major health organizations still support fluoridation as safe and effective.
Presentation on Health and Environmental Impacts of water fluoridation 2012Declan Waugh
This presentation examines why several European countries stopped fluoridating their drinking water supplies. Denmark banned fluoridation when its environmental agency pointed out long-term effects of low fluoride intake were unknown. Sweden also rejected fluoridation on the recommendation of a commission that found combined long-term environmental effects of fluoride were insufficiently known. Studies in Sweden, Germany, and the US have found that excessive fluoride intake can cause dental and skeletal fluorosis, and may increase risks of bone fractures and joint stiffness. Risks are greater for babies and young children, as fluoride is more readily absorbed and retained in developing bones. Total fluoride intake from all sources needs further study to properly assess risks versus benefits.
This document provides an overview of fluorides and oral health in developed and developing countries. It discusses the historical evolution of fluoride and how it relates to reducing dental caries. Different methods of fluoride delivery are examined, including water fluoridation, salt fluoridation, and fluoridated toothpaste. The global scenarios of water fluoridation and excess fluoride in drinking water are also reviewed. The document evaluates the role of fluoride in dental caries prevention, remineralization, periodontal health, and orthodontic anomalies. Both community-based and professionally applied topical fluoride are discussed in relation to developed and developing countries.
Systemic fluoridation through water is effective in reducing dental caries. Excessive fluoride intake during tooth development can cause dental fluorosis. The optimal fluoride level is 1 ppm, reducing caries in 10% of the population with very mild fluorosis. Alternatives to water fluoridation include school water fluoridation, fluoride tablets, drops or lozenges, and fluoridated salt or milk. These provide systemic fluoride benefits when water fluoridation is not available.
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2. 2 www.aap.org/oralhealth/pact
Introduction
Fluoride plays an important role in the prevention of dental caries.
The primary mechanism of action of fluoride in preventing dental
caries is topical. Fluoride acts in the following ways to prevent
dental caries:
1. It enhances remineralization of the tooth enamel. This is the
most important effect of fluoride in caries prevention.
2. It inhibits demineralization of the tooth enamel.
3. It makes cariogenic bacteria less able to produce acid from
carbohydrates.
Used with permission from Lisa Rodriguez
3. 3 www.aap.org/oralhealth/pact
Learner Objectives
Upon completion of this presentation, participants will be able to:
State the 3 mechanisms of action of fluoride in dental caries
prevention
Summarize the available sources of fluoride and their relative
benefits
List strategies to minimize the development of fluorosis
Discuss the fluoride supplementation guidelines
Recognize the various forms of fluorosis and recall their
prevalence
Used with permission from Lisa Rodriguez
4. 4 www.aap.org/oralhealth/pact
Fluoride Facts
Fluoride has been available in the United States since the mid
1940’s.
In 2008, 64.3% of the population served by public water systems
received optimally fluoridated water.
Public water fluoridation practice varies by city and state.
Water fluoridation was recognized by the Centers for Disease
Control and Prevention (CDC) as one of the 10 greatest public
health achievements of the 20th century.
5. 5 www.aap.org/oralhealth/pact
Fluoride Facts, continued
There is strong evidence* that community water fluoridation is
effective in preventing dental caries.
In 2011, the U.S Dept of Health and Human Services proposed
that
community water systems adjust the concentration of fluoride in
drinking water to 0.7 mg/L ppm (change from 0.7-1.2 mg/L).
This proposal has not been finalized.
Water filters may alter the fluoride content of community water.
Activated charcoal filters and cellulose filters have a negligible effect
Reverse osmosis filters and water distillation remove almost all
fluoride from water
6. 6 www.aap.org/oralhealth/pact
Sources of Systemic Fluoride Exposure
Fluoride can be ingested through:
Drinking water (naturally occurring or water system additive)
Other beverages
Foods
Toothpaste
Fluoride dietary supplements
7. 7 www.aap.org/oralhealth/pact
Bottled Water
No one source exists to tell consumers the fluoride content in bottled
waters.
The US Food and Drug Administration (FDA) does not require that
fluoride content be listed on the labels of bottled waters.
It is reasonable to assume that children whose only source of water
is bottled are not receiving optimal amounts of fluoride from that
source.
8. 8 www.aap.org/oralhealth/pact
Commercial Beverages and Foods
Many foods and beverages are made with community fluoridated
water, so may contain fluoride.
Foods such as seafood and certain teas can also have a naturally
high fluoride content.
This must all be taken into account when determining daily fluoride
intake.
9. 9 www.aap.org/oralhealth/pact
Infant Nutrition
Human breast milk contains almost
no fluoride, even when the nursing
mother drinks fluoridated water.
Powdered infant formula contains
little or no fluoride, unless mixed
with fluoridated water. The amount
of fluoride ingested will depend on
the volume of fluoridated water
mixed with the formula.Used with permission from Kathleen Marinelli, MD
10. 10 www.aap.org/oralhealth/pact
Toothpaste
Toothpaste’s effects are mainly topical, but some toothpaste is
swallowed by children and results in systemic fluoride exposure.
Strategies to Minimize Toothpaste Ingestion
Limit the amount of toothpaste on the
toothbrush
Discourage children from swallowing
toothpaste
Encourage spitting of toothpaste
Supervise brushing until spitting can
be ensured
Used with permission from Norman Tinanoff, DDS
11. 11 www.aap.org/oralhealth/pact
Topical Sources of Fluoride
Following are the most common forms of topical fluoride:
Toothpaste
Fluoride mouthrinses
Fluoride gels
Fluoride varnish
12. 12 www.aap.org/oralhealth/pact
Toothpaste
Toothpaste is the most recognizable source of
topical fluoride.
The addition of fluoride to toothpaste began
in the 1950s.
Brushing with fluoridated toothpaste is associated
with a 24% reduction in decayed, missing, and filled tooth surfaces.
The CDC concluded that the quality of evidence for fluoridated
toothpaste in reduction of caries is grade 1. Strength of
recommendation is A for use in all persons.
Used with permission from Rocio B. Quinonez, DMD, MS, MPH;
Associate Professor Department of Pediatric Dentistry, School of
Dentistry University of North Carolina
13. Toothpaste Guidelines
The American Dental Association (ADA), American Academy of
Pediatric Dentistry (AAPD), and the American Academy of Pediatrics
(AAP) have all published the following recommendations:
•Suggest a “smear” or “grain of rice” amount of toothpaste starting at
tooth emergence for all children.
•For children ages 3 to 6, recommend a “pea-sized” amount of
fluoridated toothpaste.
Toothpaste recommendations are no longer “risk-based”.
http://www.aap.org/oralhealth/pact13
15. 15 www.aap.org/oralhealth/pact
Fluoride Mouthrinses
Mouthrinses containing fluoride are recommended in a “swish and
spit” manner for children at least age 6.
Mouthrinses are available over the counter.
• Daily use of a 0.05% sodium fluoride rinse may benefit children over 6 years
who are at high risk for dental caries
• No additional benefit shown beyond daily fluoridated toothpaste use for
children at low risk for caries
The CDC concluded that quality of evidence for fluoride mouthrinses
is Grade 1. Strength of recommendation is A with targeted effort at
populations at high risk for dental caries.
16. 16 www.aap.org/oralhealth/pact
Fluoride Gels
Fluoride gels are professionally applied or prescribed for home
use under professional supervision. They are typically recommended
for use twice per year.
The CDC concluded that the quality of evidence for using fluoride gel
to prevent and control dental caries in children is Grade 1. Strength
of recommendation is A, with targeted effort at populations at high
risk for caries.
17. 17 www.aap.org/oralhealth/pact
Fluoride Varnish
Varnish is a professionally applied,
sticky resin of highly concentrated
fluoride (up to 22,600 ppm).
In the United States, fluoride varnish
has been approved by the FDA for
use as a cavity liner and root
desensitizer, but not specifically as
an anti-caries agent.
For caries prevention, fluoride
varnish is an “off label” product.
Used with permission from Suzanne Boulter, MD
18. 18
Fluoride Varnish
Application frequency for fluoride varnish
ranges from 2 to 6 times per year.
The use of fluoride varnish leads to a
33% reduction in decayed, missing,
and filled tooth surfaces in the primary
teeth and a 46% reduction in the
permanent teeth.
The CDC concluded that the quality of evidence for using fluoride
varnish to prevent and control dental caries in children is Grade 1.
Strength of recommendation is A, with targeted effort at populations
at high risk for dental caries.
Used with permission from Ian VanDinther
19. Fluoride Varnish
The United States Preventive Services Taskforce (USPSTF) in
2014 recommended that primary care clinicians apply fluoride
varnish to the teeth of all infants and children, starting with the
appearance of the first primary tooth through age 5, at least every 6
months.
• Recommendation applies to ALL children; no longer a risk-based
recommendation
• Assigned a “B” grade recommendation
AAP recommends that all children ages 5 and under should receive
a professional fluoride treatment at least every 6 months in the
primary care medical home.
Higher risk children should receive fluoride varnish applicationhttp://www.aap.org/oralhealth/pact19
20. 20 www.aap.org/oralhealth/pact
Community Water Fluoridation
The goal of community water fluoridation is to maximize dental
caries prevention while minimizing the frequency of enamel
fluorosis.
In January 2011, the US Department of Health and Human
Services
proposed 0.7 ppm be considered the optimal fluoride concentration
in drinking water.
Because there is geographic variability in community water
fluoridation, it is important to know fluoride content of the water
children consume.
21. 21 www.aap.org/oralhealth/pact
Water Fluoridation
The US Environmental Protection Agency
requires that all community water supply
systems provide customers an annual
report on the quality of water, including
fluoride concentration. Families or
providers can contact the local water
authority for this information.
Fluoride content of a town’s water can also be determined by
accessing CDC’s My Water's Fluoride Web site.
Used with permission from iSTOCK
22. 22 www.aap.org/oralhealth/pact
Well Water
Wide variations in the natural fluoride concentration of well water
sources exist.
Private wells should be tested for fluoride concentration before
prescribing supplements.
Testing can be done through local and state public health
departments or through private laboratories.
23. 23 www.aap.org/oralhealth/pact
Fluoride Dietary Supplementation
When access to community water
fluoridation is limited, fluoride can
be supplemented in liquid, tablet, or
lozenge form.
Fluoride supplements require a
prescription. Fluoride supplements
should be prescribed only to children
whose community water source has
Suboptimal fluoride levels. Used with permission from Content Visionary
24. 24
Supplementation Dosing Schedule
The AAP, ADA, and AAPD have developed the following
recommendations regarding fluoride supplementation:
1. All sources of fluoride must be considered, including primary
drinking water, other sources of water, prescriptions from the
dentist, fluoride mouthrinse in school, and fluoride varnish.
2. Children who have adequate access to (and are drinking)
appropriately fluoridated community water should NOT be
supplemented.
3. Children younger than 6 months and older than 16 years should
NOT be supplemented.
25. 25 www.aap.org/oralhealth/pact
Fluoride Supplements, continued
CDC Quality of Evidence to Support the Use of Fluoride
Supplements
Children 6 years and younger: Grade II-3. Strength of
recommendation of C with targeted effort at populations at high risk
for dental caries.
Children 6-16 years: Grade 1. Strength of recommendation of A
with targeted effort at populations at high risk for dental caries.
Pregnant women: Quality of evidence against providing fluoride
supplementation to pregnant women to benefit their children is Grade
1. Strength of recommendation of E (good evidence to reject the use
of the modality).
26. 26
Fluoride Supplements, continued
The American Dental Association (ADA) and the American Academy
of Pediatric Dentistry (AAPD) recommend fluoride supplements be
prescribed only to children at high risk for caries.
• Strength of recommendation: B
The United States Preventive Services Task Force (USPSTF) in
2014 recommended fluoride supplementation be prescribed to ALL
children older than 6 months whose primary water source is deficient
in fluoride.
• Strength of recommendation: B.
• The AAP endorses the USPSTF recommendation to prescribe
fluoride supplements to all children ages 6 months to 16 years
who drink sub-optimally fluoridated water.
27. 27 www.aap.org/oralhealth/pact
Fluorosis
Fluorosis is caused by an increased
intake of fluoride during permanent
tooth formation.
Mild forms of fluorosis appear as
chalk-like, lacy markings on the
enamel.
White opacity can be seen on more
than 50% of the tooth in the
moderate form of dental fluorosis.
Severe fluorosis results in brown,
pitted, brittle enamel.
Used with permission from Martha Ann Keels, DDS, PhD; Division Head of Duke
Pediatric Dentistry, Duke Children's Hospital
Fluorosis
28. 28
Fluorosis
Dental fluorosis occurs during tooth
development.
Permanent teeth are more susceptible to
fluorosis than primary teeth.
Most critical ages of susceptibility are 0 to 6
years, especially between the ages of 15 and
30 months.
After 7 or 8 years of age, dental fluorosis
cannot occur because the permanent teeth
are fully developed, although not erupted.
Used with permission from Content Visionary
29. 29 www.aap.org/oralhealth/pact
Prevalence of Fluorosis
The prevalence of dental fluorosis has increased in the United States
from 22.8% in 1986-1987 to 32% in 1999-2002.
This can be attributed to the increased availability and ingestion of
multiple sources of fluoride by young children, including:
Foods
Beverages
Toothpaste
Other oral care products
Dietary fluoride supplements
30. 30 www.aap.org/oralhealth/pact
Prevalence of Fluorosis, continued
Some form of dental fluorosis is found in the following age groups*:
40% of US children ages 6-11 years
48% of 12- to 15-year-olds
42% of 16- to 19-year-olds
Most of this fluorosis is mild and barely noticeable by non-dental
health professionals.
31. 31 www.aap.org/oralhealth/pact
Prevalence of Fluorosis, continued
Although the effects of dental fluorosis are mainly
aesthetic, the increased prevalence mandates that health
professionals be aware of all possible sources of fluoride
before considering supplementation.
32. 32 www.aap.org/oralhealth/pact
Fluorosis and Toothpaste
Ingestion of toothpaste increases
the risk of enamel fluorosis.
If fluoridated toothpaste is used,
strategies to limit the amount
swallowed include limiting the
amount placed on the brush and
observing the child as they brush.
Used with permission from Rocio B. Quinonez, DMD, MS, MPH; Associate Professor
Department of Pediatric Dentistry, School of Dentistry University of North Carolina
33. 33 www.aap.org/oralhealth/pact
Fluorosis and Toothpaste
According to the AAPD, the best way to
minimize a child's risk for fluorosis is to
limit the amount of toothpaste on the
toothbrush.
The AAP suggests a “smear” of
toothpaste for children younger than
3 years of age and a "pea-sized"
amount for children ages 3 and above.
Used with permission from Michael SanFilippo
34. 34 www.aap.org/oralhealth/pact
Fluorosis and Toothpaste
For children younger than 2, the CDC suggests the pediatrician
consider fluoride levels in the community drinking water, other
sources of fluoride, and factors likely to affect susceptibility to dental
caries when weighing the risk and benefits of fluoride toothpaste. For
children younger than 6, the CDC recommends that parents:
1. Limit tooth brushing to 2 times a day.
2. Apply less than a pea-sized amount of toothpaste to the brush.
3. Supervise tooth brushing and encourage children to spit out
excess toothpaste.
4. Keep toothpaste out of the reach of young children to avoid
accidental ingestion.
35. 35 www.aap.org/oralhealth/pact
Question #1
What is the most critical age of susceptibility to fluorosis
of
the permanent teeth?
A. Between 0 and 15 months of age
B. Between 15 and 30 months of age
C. Between 30 and 45 months of age
D. The risk of fluorosis in the permanent teeth is equal across all
ages
E. None of the above
36. 36 www.aap.org/oralhealth/pact
Answer
What is the most critical age of susceptibility to fluorosis
of
the permanent teeth?
A. Between 0 and 15 months of age
B. Between 15 and 30 months of age
C. Between 30 and 45 months of age
D. The risk of fluorosis in the permanent teeth is equal across all
ages
E. None of the above
39. 39 www.aap.org/oralhealth/pact
Question #3
Which of the following is the most important function of
fluoride in caries prevention?
A. Fluoride enhances remineralization of tooth enamel
B. Fluoride inhibits demineralization of tooth enamel
C. Fluoride negatively affects the acid producing capabilities of
cariogenic bacteria
D. Fluoride displaces sugars from the surface of the teeth
E. All of the above are equally important
40. 40 www.aap.org/oralhealth/pact
Answer
Which of the following is the most important function of
fluoride in caries prevention?
A. Fluoride enhances remineralization of tooth enamel.
B. Fluoride inhibits demineralization of tooth enamel.
C. Fluoride negatively affects the acid producing capabilities of
cariogenic bacteria.
D. Fluoride displaces sugars from the surface of the teeth.
E. All of the above are equally important.
43. 43 www.aap.org/oralhealth/pact
Question #5
Which of the following is a symptom of mild fluorosis?
A. A white opacity on more than 50% of the tooth
B. Dark spots on the teeth
C. Brown, pitted, brittle enamel
D. Chalk-like, lacy markings on the enamel
E. None of the above
44. 44 www.aap.org/oralhealth/pact
Answer
Which of the following is a symptom of mild fluorosis?
A. A white opacity on more than 50% of the tooth
B. Dark spots on the teeth
C. Brown, pitted, brittle enamel
D. Chalk-like, lacy markings on the enamel
E. None of the above
45. 45 www.aap.org/oralhealth/pact
References
1. American Academy of Pediatric Dentistry. Guideline on Infant Oral Health Care.
Council on Clinical Affairs. Reference Manual 2011. 33(6): 124-128.
2. American Academy of Pediatric Dentistry. Policy on Early Childhood Caries (ECC):
Classifications, Consequences, and Preventive Strategies. Pediatr Dent 2011,
33(6): 47-49.
3.
3. American Academy of Pediatric Dentistry. Guideline on Fluoride Therapy. Updated
2014. Reference Manual 36(6): 171-74.
4. American Dental Association Council on Scientific Affairs. Professionally applied
topical fluoride. Evidence-based clinical recommendations. JADA. August 1, 2006.
137(8): 1151-1159.
5. American Dental Association Council on Scientific Affairs. Fluoride Toothpaste for
Young Children. J Am Dent Assoc. 2014;145(2):190-1.
6. Berg J, Gerweck C, Hujoel PP, et al. Evidence-Based Clinical Recommendations
Regarding Fluoride Intake from Reconstituted Infant Formula and Enamel
Fluorosis. A Report of the American Dental Association Council on Scientific
Affairs. JAMA. January 2011 vol. 142(1): 79-87.
46. 46 www.aap.org/oralhealth/pact
References, continued
7. Centers for Disease Control and Prevention. Recommendations for using fluoride
to prevent and control dental caries in the United States. MMWR. 2001; 50(RR-14):
1-42. Available online at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm. Accessed November
20, 2006.
8. Centers for Disease Control and Prevention. Surveillance for Dental caries, Dental
sealants, Tooth Retention, Edentulism, and Enamel Fluorosis-United States, 1988-
1994 and 1999-2002. MMWR Surveillance Summaries. 2005. 54(03);1-44.
Available online at: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5403a1.htm.
Accessed November 20, 2006.
9. Centers for Disease Control and Prevention. Using Fluoride to Prevent and Control
Tooth Decay in the United States Fact Sheet, updated Jan 2011.
www.cdc.gov/fluoridation/fact_sheets/fl_caries.htm
10. Department of Health and Human Services. HHS Recommendation for Fluoride
Concentration in Drinking Water for Prevention of Dental Caries. Federal Register.
Vol. 76(9): January 13, 2011.
11. Krol DM. Dental caries, oral health, and pediatricians. Curr Probl Pediatr Adolesc
Health Care. 2003; 33(8):253-270.
12. Lewis CW, Milgrom P. Fluoride. Pediatr Rev. 2003; 24(10):327-336.
47. 47 www.aap.org/oralhealth/pact
References, continued
13. Lewis DW, Ismail AI. Periodic health examination: 1995 update: 2. Prevention of
dental caries. The Canadian Task Force on the Periodic Health Examination. Can
Med Assoc J. 1995; 152(6): 836-46.
14. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride varnishes for preventing
dental caries in children and adolescents. The Cochrane Database of Systematic
Reviews 2002, Issue 1. Art. No.: CD002279. DOI: 10.1002/14651858.CD002279.
This version first published online: 21 January 2002 in Issue 1, 2002.
15. Marinho VCC, Higgins JPT, Logan S, Sheiham A. Topical fluoride (toothpastes,
mouthrinses, gels, or varnishes) for preventing dental caries in children and
adolescents. The Cochrane Database of Systematic Reviews 2003, Issue 1. Art.
No.: CD002782. DOI: 10.1002/14651858.CD002782. This version first published
online: 20 January 2003 in Issue 1, 2003.
16. Oral health in America: A Report of the Surgeon General. Rockville MD: US
Department of Health and Human Services, National Institute of Dental and
Craniofacial Research, National Institutes of Health; 2000. Available online at:
http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral. Accessed November 20,
2006.
17. Rozier RG, Adair S, Graham F, et al. Evidence-Based Clinical Recommendations on
the Prescription of Dietary Fluoride Supplements for Caries Prevention. A Report of
the American Dental Association Council on Scientific Affairs. JADA. December
2010 vol. 141(12): 1480-1489.
48. 48 www.aap.org/oralhealth/pact
References, continued
18. US Environmental Protection Agency. 40 CFR Part 141.62. Maximum contaminant
levels for inorganic contaminants. Code of Federal Regulations 2002:428-9.
19. US Environmental Protection Agency. 40 CFR Part 143.3 National secondary
drinking water regulations. Code of Federal Regulations 2002; 614.
20. United States Preventive Services Task Force. Guide to clinical preventive
services, 2010-2011. Available online at: http://www.ahrq.gov/clinic/pocketgd.htm.
Accessed January 28, 2011.
21. Wright JT, Hanson N, Ristic H, et al. Fluoride toothpaste efficacy and safety in
children younger than 6 years. J Am Dent Assoc. 2014; 145(2):182-9.
22. U.S. Preventive Services Task Force Recommendation Statement. Prevention of
Dental Caries in Children from Birth Through Age 5 Years. May 2014.
www.uspreventiveservicestaskforce.org/uspstf/uspsdnch.htm
23. Clark MB, Slayton RL; AAP Section on Oral Health. Fluoride use in caries
prevention in the primary care setting. Pediatrics. 2014 Sep;134(3):626-33.
Editor's Notes
Notes:
In the human body, fluoride is mainly associated with bones and teeth.
A mineral structure of the tooth that includes fluoride (fluorapatite) is more resistant to demineralization than one without fluoride (hydroxyapatite).
See http://www.aap.org/oralhealth/pact/ch4_intro.cfm for a complete review of the pathogenesis of dental caries.
Notes:
Optimally fluoridated water is defined as 0.7 parts per million.
To learn about the water fluoridation for a particular city, access http://apps.nccd.cdc.gov/MWF/Index.asp.
More information about fluoride recommendations is available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm.
Notes:
*Evidence has been presented by the CDC, the US Task Force on Community Preventive Services, and the Canadian Task Force on Preventive Health Care.
For more information, access the US Preventive Services Task Force Prevention of Dental Caries in Preschool Children Web page at http://www.uspreventiveservicestaskforce.org/uspstf/uspsdnch.htm.
Reference for community water fluoride proposed recommendation: Federal Register. Vol. 76, No. 9. January 13, 2011. pg 2386.
Links:
US Task Force on Community Preventive Services: http://www.uspreventiveservicestaskforce.org/uspstf/uspsdnch.htm
Canadian Task Force on Preventive Health Care: http://www.canadiantaskforce.ca
Notes:
A recent review by the Cochrane Collaboration concluded that regular use of fluoridated toothpaste is associated with a “clear reduction in caries increment.”
The review also found that the effect may be greater for persons with more severe decay.
Related Links:
CDC Grading System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box1
CDC Coding System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box2
Quality of Evidence Table: http://www.uspreventiveservicestaskforce.org/3rduspstf/ratings.htm
Notes:
A recent review by the Cochrane Collaboration concluded that regular use of fluoridated toothpaste is associated with a “clear reduction in caries increment.”
The review also found that the effect may be greater for persons with more severe decay.
Related Links:
CDC Grading System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box1
CDC Coding System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box2
Quality of Evidence Table: http://www.uspreventiveservicestaskforce.org/3rduspstf/ratings.htm
USPSTF Quality of Evidence Grading System used by the CDC:
Grade I - Evidence obtained from one or more properly conducted randomized clinical trials
Grade II-1 - Evidence obtained from one or more clinical trials without randomization
Grade II-3 - Evidence obtained from one or more well-designed cohort or case-control analytic studies
Grade II-4 - Evidence obtained from cross-sectional comparisons between times and places; or dramatic results in uncontrolled experiments
Grade III – Opinions of respected authorities on the basis of clinical experience, descriptive studies or case reports, or reports of expert committees.
The U.S. Preventive Services Task Force (USPSTF) grades its recommendations according to one of five classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms).
A—Strongly Recommended: The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
B—Recommended: The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
C—No Recommendation: The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
D—Not Recommended: The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
I—Insufficient Evidence to Make a Recommendation: The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that the [service] is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.
American Dental Association Council on Scientific Affairs. Fluoride Toothpaste for Young Children. J Am Dent Assoc. 2014;145(2):190-1.
Wright JT, Hanson N, Ristic H, et al. Fluoride toothpaste efficacy and safety in children younger than 6 years. J Am Dent Assoc. 2014; 145(2):182-9.
American Academy of Pediatric Dentistry. Guideline on Fluoride Therapy. Updated 2014. Reference Manual 36(6): 171-74.
Notes:
According to the Cochrane Collaboration, regular fluoride mouthrinse use reduces tooth decay in children, regardless of other fluoride sources, with an average 26% reduction in decayed, missing, and filled tooth surfaces.
Fluoride mouthrinse programs are sometimes utilized in schools.
Related Links:
CDC Grading System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box1
CDC Coding System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box2
Quality of Evidence Table: http://www.uspreventiveservicestaskforce.org/3rduspstf/ratings.htm
Reference: Twetman S, Petersson LG, Axelsson S, et al. Caries preventive effect of sodium fluoride mouthrinses: A systematic review of controlled clinical trials. Acta Odontol Scand 2004;62:233-230
Quality of Evidence Table: http://www.uspreventiveservicestaskforce.org/3rduspstf/ratings.htm
USPSTF Quality of Evidence Grading System used by the CDC:
Grade I - Evidence obtained from one or more properly conducted randomized clinical trials
Grade II-1 - Evidence obtained from one or more clinical trials without randomization
Grade II-3 - Evidence obtained from one or more well-designed cohort or case-control analytic studies
Grade II-4 - Evidence obtained from cross-sectional comparisons between times and places; or dramatic results in uncontrolled experiments
Grade III – Opinions of respected authorities on the basis of clinical experience, descriptive studies or case reports, or reports of expert committees.
The U.S. Preventive Services Task Force (USPSTF) grades its recommendations according to one of five classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms).
A—Strongly Recommended: The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
B—Recommended: The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
C—No Recommendation: The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
D—Not Recommended: The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
I—Insufficient Evidence to Make a Recommendation: The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that the [service] is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.
Notes:
The Cochrane Collaboration concluded that there is a clear evidence of a caries-inhibiting effect of fluoride gels, with an average 21% reduction in decayed, missing, and filled tooth surfaces.Related Links:
CDC Grading System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box1
CDC Coding System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box2
Quality of Evidence Table: http://www.uspreventiveservicestaskforce.org/3rduspstf/ratings.htm
Quality of Evidence Table: http://www.uspreventiveservicestaskforce.org/3rduspstf/ratings.htm
USPSTF Quality of Evidence Grading System used by the CDC:
Grade I - Evidence obtained from one or more properly conducted randomized clinical trials
Grade II-1 - Evidence obtained from one or more clinical trials without randomization
Grade II-3 - Evidence obtained from one or more well-designed cohort or case-control analytic studies
Grade II-4 - Evidence obtained from cross-sectional comparisons between times and places; or dramatic results in uncontrolled experiments
Grade III – Opinions of respected authorities on the basis of clinical experience, descriptive studies or case reports, or reports of expert committees.
The U.S. Preventive Services Task Force (USPSTF) grades its recommendations according to one of five classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms).
A—Strongly Recommended: The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
B—Recommended: The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
C—No Recommendation: The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
D—Not Recommended: The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
I—Insufficient Evidence to Make a Recommendation: The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that the [service] is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.
Notes:
Varnishes have been used extensively in Europe, Scandinavia, and Canada as preventive intervention for dental caries. Related Links:
CDC Grading System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box1
CDC Coding System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box2
Quality of Evidence Table: http://www.uspreventiveservicestaskforce.org/3rduspstf/ratings.htm
Related Videos:
Smiles for Life Application of Fluoride Varnish Video - http://products.talariainc.com/default.aspx?tut=555&pagekey=62948&s1=1193586
Illinois AAP Chapter Bright Smiles from Birth Video - http://illinoisaap.org/2010/08/bright-smiles-from-birth-training-video/
Notes:
Almost all state Medicaid programs have decided to pay medical professionals for the application of fluoride varnish to children’s teeth. Private payers are also beginning to pay for this service. Learn more at http://www2.aap.org/commpeds/dochs/oralhealth/State.html.
The Cochrane Collaboration concluded that fluoride varnishes applied professionally 2 to 4 times a year substantially reduces tooth decay in children.\
Related Links:
CDC Grading System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box1
CDC Coding System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box2
Quality of Evidence Table: http://www.uspreventiveservicestaskforce.org/3rduspstf/ratings.htm
Related Videos:
Applying Fluoride Varnish Video: http://www.aap.org/oralhealth/links-training-oralexamvideo.cfm#varnish
Pediatric Well-Child Visit: Oral Health Exam Video: http://www.aap.org/oralhealth/links-training-oralexamvideo.cfm#exam
Quality of Evidence Table: http://www.uspreventiveservicestaskforce.org/3rduspstf/ratings.htm
USPSTF Quality of Evidence Grading System used by the CDC:
Grade I - Evidence obtained from one or more properly conducted randomized clinical trials
Grade II-1 - Evidence obtained from one or more clinical trials without randomization
Grade II-3 - Evidence obtained from one or more well-designed cohort or case-control analytic studies
Grade II-4 - Evidence obtained from cross-sectional comparisons between times and places; or dramatic results in uncontrolled experiments
Grade III – Opinions of respected authorities on the basis of clinical experience, descriptive studies or case reports, or reports of expert committees.
The U.S. Preventive Services Task Force (USPSTF) grades its recommendations according to one of five classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms).
A—Strongly Recommended: The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
B—Recommended: The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
C—No Recommendation: The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
D—Not Recommended: The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
I—Insufficient Evidence to Make a Recommendation: The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that the [service] is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.
A grade “B” recommendation by USPSTF means that there is “high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial and that practices must offer or recommend this service”. Preventive services given A or B recommendations by the USPSTF must be covered by new and individual insurance plans of all types and by Medicaid and Medicaid-Managed care with no cost sharing.
U.S. Preventive Services Task Force Recommendation Statement. Prevention of Dental Caries in Children from Birth Through Age 5 Years. May 2014. www.uspreventiveservicestaskforce.org/uspstf/uspsdnch.htm
Clark MB, Slayton RL; AAP Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014 Sep;134(3):626-33.
Notes:The HHS press release is available online at http://www.hhs.gov/news/press/2011pres/01/20110107a.html.
Visit the Campaign for Dental Health for more information about water fluoridation – www.ilikemyteeth.org.
Glossary:
Fluorosis: An abnormal condition (as mottled enamel of human teeth) caused by fluorine or its compounds
Notes:Learn more about the fluoridation status of your community’s water system at http://apps.nccd.cdc.gov/MWF/Index.asp.
Notes:
*For more information on the recommendations and decision from the ADA, see Evidence-Based Clinical Recommendations on the Prescription of Dietary Fluoride Supplements for Caries Prevention at http://jada.ada.org/cgi/content/full/141/12/1480.
Notes: American Academy of Pediatrics (AAP), American Dental Association (ADA), and American Academy of Pediatric Dentistry (AAPD)
The AAP/ADA/AAPD dosing schedule is available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#tab1.
Related Links:
CDC recommendations: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm
CDC Grading System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box1
CDC Coding System: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm#box2
Quality of Evidence Table: http://www.uspreventiveservicestaskforce.org/3rduspstf/ratings.htm
Notes:
*Access the American Dental Association guideline at http://jada.ada.org/cgi/content/full/141/12/1480 and the chair side tool at http://ebd.ada.org/ClinicalRecommendations.aspx.
For more about the United States Preventive Services Task Force, visit http://www.ahrq.gov/clinic/uspstf/uspsdnch.htm.
The United States Preventive Services Taskforce (USPSTF) and the American Academy of Pediatrics (AAP) recommend primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for ALL children whose water supply is deficient in fluoride, not a risk-based assessment.
Dietary fluoride supplementation by prescription for children at high caries risk who do not have access to optimally fluoridated water is recommended by the American Academy of Pediatric Dentistry and the American Dental Association (ADA).
U.S. Preventive Services Task Force Recommendation Statement. Prevention of Dental Caries in Children from Birth Through Age 5 Years. May 2014. www.uspreventiveservicestaskforce.org/uspstf/uspsdnch.htm
Clark MB, Slayton RL; AAP Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014 Sep;134(3):626-33. http://pediatrics.aappublications.org/content/134/3/626
Notes:
Dental (enamel) fluorosis is the most common manifestation, but skeletal fluorosis can also occur. Although extremely rare in the United States, skeletal fluorosis is seen in other countries, especially India and China.
Mild forms of fluorosis are difficult to see with the untrained eye.
Glossary:
Fluorosis: An abnormal condition (as mottled enamel of human teeth) caused by fluorine or its compounds
Notes:
Dental fluorosis is less prevalent and less severe in the primary teeth than the permanent dentition.
Source:
Notes:* From Surveillance for Dental caries, Dental sealants, Tooth Retention, Edentulism, and Enamel Fluorosis-United States, 1988-1994 and 1999-2002, available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5403a1.htm.
Beltrán-Aguilar ED, Barker L, Dye BA. Prevalence and severity of dental fluorosis in the United States, 1999-2004. NCHS data brief, no 53. Hyattsville, MD: National Center for Health Statistics. 2010
Notes:Review the AAPD recommendations at http://www.aapd.org/media/Policies_Guidelines/G_CariesRiskAssessment.pdf.
Clark MB, Slayton RL; AAP Section on Oral Health. Fluoride use in caries prevention in the primary care setting. Pediatrics. 2014 Sep;134(3):626-33. http://pediatrics.aappublications.org/content/134/3/626
Notes:Review the CDC recommendations at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm.