Fluoride Modalities in Caries Prevention

Use of fluoride for caries prevention 

Fluoride has been widely used for caries prevention for several decades, and it is considered to be one of the most effective measures in reducing the incidence of dental caries. There are different ways to apply fluoride for caries prevention, including:

1. Topical fluoride: This involves applying fluoride directly to the teeth in the form of a gel, foam, varnish, or mouth rinse. Topical fluoride works by strengthening the tooth enamel and making it more resistant to acid attacks. 

1. Systemic fluoride: This involves ingesting fluoride in the form of fluoridated water, dietary supplements, or fluoride-containing toothpaste. Systemic fluoride works by strengthening the teeth from the inside out as the fluoride is incorporated into the developing tooth structure. 

Fluoride helps to prevent caries by: 

1. Reducing demineralization: Acid-producing bacteria in dental plaque can cause the enamel to lose minerals, a process known as demineralization. Fluoride helps to make the enamel more resistant to demineralization by creating a stronger, more acid-resistant mineral structure.
2. Enhancing remineralization: Fluoride can also enhance the remineralization process, where lost minerals are replaced in the enamel, resulting in stronger and healthier teeth.

Overall, the use of fluoride for caries prevention has been shown to be safe and effective, with numerous studies demonstrating its benefits in reducing the incidence of dental caries in both children and adults. 

 

Reduction of caries incidences due to fluoride use in Australia in children below 12 years of age.

The use of fluoride for caries prevention has been widely implemented in Australia since the 1960s. The Australian government has mandated the fluoridation of community water supplies since the 1970s, and fluoride toothpaste is widely available and recommended by dental professionals for daily use. 

The National Child Oral Health Study, conducted in 2012-2014, found that the prevalence of caries in Australian children aged 5-6 years was 32.7%, while for children aged 9-10 years, it was 43.1%. However, it should be noted that these rates vary across different regions of Australia and are influenced by factors such as socio-economic status, oral health behaviors, and access to dental care. 

Overall, studies have shown that the use of fluoride has led to a significant reduction in caries incidence in Australian children. According to the Australian Dental Association, the prevalence of caries in Australian children has declined by around 50% since the 1970s, with fluoridation of community water supplies being one of the most significant contributors to this reduction. 

Moreover, a systematic review of studies on the effectiveness of water fluoridation in Australia and New Zealand found that water fluoridation led to a 26% reduction in caries in deciduous teeth and a 29% reduction in permanent teeth in children aged 5-12 years. 

In conclusion, the use of fluoride in Australia has contributed significantly to the reduction of caries incidence in children below 12 years of age. Fluoridation of community water supplies, fluoride toothpaste, and other forms of fluoride applications have all played a crucial role in improving the oral health of Australian children. 

Write a detailed note on different preparations of fluoride along with compositions for application on teeth for caries prevention. 

Fluoride is a mineral that is essential for healthy tooth development and has been shown to be effective in preventing dental caries. There are several different preparations of fluoride available for use in dental care, including:

 

5. Fluoride toothpaste: Fluoride toothpaste is the most commonly used fluoride preparation for caries prevention. It typically contains 1000 to 1500 parts per million (ppm) of fluoride and is recommended for twice-daily use. The fluoride in toothpaste works by remineralizing the tooth enamel and making it more resistant to acid attacks.

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6. Fluoride mouthwash: Fluoride mouthwash is another form of topical fluoride application that is used to prevent caries. It typically contains 0.05% sodium fluoride and is used once or twice daily after brushing. The fluoride in mouthwash helps to strengthen the tooth enamel and prevent demineralization. 

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7. Fluoride varnish: Fluoride varnish is a topical fluoride application that is applied directly to the teeth by a dental professional. It typically contains 22,600 ppm of fluoride and is recommended for use every 3 to 6 months. The fluoride in varnish works by strengthening the tooth enamel and making it more resistant to acid attacks. 

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8. Fluoride gel: Fluoride gel is a topical fluoride application that is applied directly to the teeth by a dental professional. It typically contains 1.23% fluoride and is recommended for use every 3 to 6 months. The fluoride in gel works by remineralizing the tooth enamel and making it more resistant to acid attacks.

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9. Fluoride foam: Fluoride foam is a topical fluoride application that is applied directly to the teeth by a dental professional. It typically contains 1.23% fluoride and is recommended for use every 3 to 6 months. The fluoride in foam works by remineralizing the tooth enamel and making it more resistant to acid attacks.

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10. Fluoride tablets: Fluoride tablets are a form of systemic fluoride application that are ingested by individuals. They typically contain 0.25 to 1.0 mg of fluoride and are recommended for use in children who do not have access to fluoridated water. The fluoride in tablets works by strengthening the teeth from the inside out and making them more resistant to acid attacks.

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Overall, fluoride is an essential mineral for healthy teeth, and its use in dental care has been shown to be effective in preventing caries. Different forms of fluoride preparations are available for use, and the choice of preparation depends on individual needs and preferences. Consultation with a dental professional can help determine the most appropriate fluoride preparation for an individual's oral health needs. 

SBQ

Scenario: Sarah is a 2-year-old child living in Australia where the potable water contains 2 ppm fluoride. Her parents are concerned about her dental health and want to prevent dental caries. 

Question: What is the most effective way to prevent dental caries in Sarah? 

A) Giving her fluoride supplements

B) Using fluoride toothpaste twice a day

C) Using a fluoride mouthwash once a day

D) Taking her to the dentist every 6 months for fluoride varnish application

E) All of the above 

Correct Answer: B) Using fluoride toothpaste twice a day. 

Explanation:

For a 2-year-old child living in an area where the potable water contains 2 ppm fluoride, using fluoride toothpaste twice a day is the most effective way to prevent dental caries. Fluoride supplements are not recommended for children under the age of 3, and a fluoride mouthwash may be difficult for a young child to use properly. While taking Sarah to the dentist every 6 months for fluoride varnish application can be helpful, it is not the most effective means of preventing caries at home. Therefore, option B is the most probable correct answer for this scenario.

Do more SBQ practice in Iridium course.

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Fluoride as Anti-Caries

Clinical context

Water fluoridation is a safe, effective and ethical way to help reduce tooth decay across the population and has long standing support of peak public health and dental authorities.

Water fluoridation

Water fluoridation is a proven method for reducing the prevalence of tooth decay in communities.

Surveys of tooth decay and dental fluorosis must be undertaken regularly, taking into account all fluoride sources and patterns of consumption in a community, in order to confirm the most appropriate water fluoridation concentration for that community or region.

The optimal fluoride concentration of community water supplies will normally be in the range of 0.6 to 1 milligram per litre (mg/Litre) of water (commonly known as parts per million or ppm).

The fluoride content of bottled water should be clearly stated on the label.

Fluoride supplements

Fluoride drops or tablets should only be taken (swallowed) under the direction of a dentist.

Fluoridated toothpaste

From the time that teeth first erupt (about six months of age) to the age of 17 months, children’s teeth should be cleaned by a responsible adult, but not with toothpaste unless the tooth decay risk is deemed to be high, as assessed by a dentist.

For children aged 18 months to five years (inclusive), the teeth should be cleaned twice a day with toothpaste containing 0.5–0.55 mg/g of fluoride (500–550 ppm). Toothpaste should always be used under supervision of a responsible adult. A small pea-sized amount should be applied to a child-sized soft toothbrush and children should spit out, not swallow, and not rinse. Young children should not be permitted to lick or eat toothpaste. If risk of tooth decay is increased, concentrations of fluoride greater than 550 ppm may be used as recommended by a dentist.

For people aged six years or more, the teeth must be cleaned twice a day or more frequently with standard fluoride toothpaste containing 1 - 1.5 mg/g fluoride (1000–1500 ppm). People aged six years or more should spit out, not swallow, and not rinse. Standard toothpaste is not recommended for children under six years of age unless on the advice of a dentist.

For children who do not consume fluoridated water or who are at elevated risk of developing tooth decay for any other reason, guidelines about toothpaste usage must be varied, as needed, based on dental professional advice. Variations could include more frequent use of fluoridated toothpaste, commencement of toothpaste use at a younger age, or earlier commencement of use of standard toothpaste containing 1mg/g fluoride (1000ppm). This guideline may apply particularly to preschool children at high risk of tooth decay.

For teenagers, adults and older adults who are at elevated risk of developing tooth decay, dental professional advice should be sought to determine if they should use toothpaste containing a higher concentration of fluoride (i.e. greater than 1000- 1500 ppm up to 5000 ppm of fluoride).

Manufacturers must avoid flavours that imitate too closely popular food tastes to avoid accidental ingestion of large amounts of paste by very young children.

Application of topical fluoride

Concentrated forms of fluoride should only be routinely applied by suitably qualified dental practitioners and should only be used after taking into account an assessment of an individual’s tooth decay risk conducted by a dentist.

Fluoride varnish should be used for people who have elevated risk of tooth decay.

High concentration fluoride gels and foams (those containing more than 1.5 mg/g fluoride ion) may be used for patients who have an increased risk of tooth decay.

Fluoride mouth rinses

Fluoride mouth rinses must not be used by children under the age of six years due to the possibility that they will ingest some of the product and increase their risk of dental fluorosis.

Fluoride mouth rinses may be used by people over the age of six years under the direction of a dentist where it is considered an appropriate choice for preventing tooth decay in high risk individuals and where there is certainty that the individual will understand that the product should be rinsed as directed and spat out, not swallowed.

Fluoride, diet and cleaning routines

The beneficial effects of fluorides must be understood in conjunction with all the major risk factors for tooth decay.

A person’s inappropriate dietary and other habits have the potential to overcome the beneficial effect of fluoride, with poor oral hygiene habits, and high frequency or prolonged exposure to dietary sugars and acidic foods and beverages, posing the highest risk.

Scenario Based Question

Scenario: Sarah is a 7-year-old healthy girl who lives in an area in Australia where potable water contains 0.3 ppm fluoride. Her parents are concerned about her dental health and are wondering if she needs any additional sources of fluoride.

Question: What is the recommended daily fluoride intake for a 7-year-old healthy girl who lives in an area in Australia where potable water contains 0.3 fluoride?

a) No additional sources of fluoride are needed

b) 0.25 mg

c) 0.5 mg

d) 1 mg

Correct answer: b) 0.25 mg

This question is testing the knowledge of the recommended daily fluoride intake for a 7-year-old healthy girl who lives in an area in Australia where potable water contains 0.3 to 0.5 ppm fluoride, based on the Australian Dental Association guidelines.