Week 9 - Colgate presentation/fluoride

What is fluoride?

Fluoride is a natural mineral found in food, water, plants, and toothpastes.

How does fluoride work? (4 marks)

Fluoride protects and strengthens teeth through several key mechanisms:

• Inhibits Demineralization: It lowers the critical pH threshold required for enamel dissolution, making tooth enamel significantly more resistant to acid attacks from plaque bacteria and sugars.

• Enhances Remineralization: It lowers the energy needed to reform apatites, helping to repair and reverse early, non-cavitated tooth decay (such as white-spot lesions) by replenishing lost minerals.

• Acts as a Reservoir: It forms calcium fluoride globules on the tooth surface and in plaque, creating a sustained protective reservoir.

• Inhibits Bacteria: It limits the ability of harmful mouth bacteria to produce decay-causing acids.

What does the evidence say about the use of fluoride?

Dental caries remains a highly prevalent oral disease for both children and adults in Australia, and fluorides serve as the cornerstone of caries prevention. There is strong international and national consensus that widespread fluoride use has been the major driving factor behind the decline in caries prevalence and severity across developed countries. This is heavily supported by contemporary expert consensus, including the ARCPOH Guidelines published in the Australian Dental Journal.

Fluoride toothpaste recommendations - describe the frequency and concentration of fluoride toothpaste for patients both low risk and high risk aged 0 to 13 years and older.

• 0-17 months - Low risk = no toothpaste is necessary / High risk = use a smear of low-flouride toothpaste (500ppm) when first tooth erupts

• 18 months - 6 years - Low risk = low flouride toothpaste (500pm) / High risk = Standard fluoride toothpaste (1000-1500ppm)

• 6 years - 12 years - Low risk = Standard fluoride toothpaste (1000-1500ppm) / High risk = Standard fluoride toothpaste (1000-1500ppm), brush more frequently than twice daily

• 13 years and over - Low risk = Standard fluoride toothpaste (1000-1500ppm) / High risk = Standard fluoride toothpaste (1000-1500ppm), brush more frequently than twice daily OR on professional advice: Use high concentration fluoride toothpaste (5000ppm) twice daily.

What defines a low-risk caries patient?

• Reside in community water fluoridation region

• Child: No new cavitated or non-cavitated lesion themselves or parent/carer and siblings

• Adult: good diet, good oral hygiene, adequate saliva flow ect.

What defines a ‘high-risk caries patient? (8 marks)

• Active caries

• Inadequate fluoride exposure

• High sugar diet

• Poor-fair oral hygiene

• Low saliva flow

• Individual or Family history of untreated caries

• Orthodontic/dental appliances

• Other individual factors such as hypomineralised teeth, multiple medications, special health care needs.

Who are mouthrinses recommended for? Should this replace brushing and flossing?

Mouthrinses are recommended to high-risk caries patients and should not replace twice daily toothbrushing. Use at a different time of day than twice daily toothbrushing. CAUTION - not for children under 6 years.

Give three examples of professionally-applied fluoride products and the fluoride concentration in each. Which of these are recommended for low-risk caries patients?

1. Fluoride Varnish (22,600 ppm F)

2. Fluoride Gel (1500- 12,300ppm F)

3. Silver Diamine Fluoride (38%)

According to clinical guidelines from ADA, professionally applied topical fluoride treatments are not recommended for low-risk caries patients as:

• Lack of Added Benefit: Low-risk patients (such as those who reside in a community with fluoridated tap water and consistently brush twice daily with standard fluoride toothpaste) already receive optimal baseline protection

• Minimizing Unnecessary Ingestion: While professional treatments like varnishes are safe when used selectively, avoiding unnecessary clinical procedures for low-risk individuals reduces avoidable exposure and potential side effect

• Resource and Cost Efficiency: Guidelines recommend targeting clinical resources toward individuals at moderate-to-high risk

List the max. dosage limit of fluoride varnishes for primary, mixed, and permanent dentition.

• Primary dentition: Up to 0.25ml

• Mixed dentition: Up to 0.4ml

• Permanent dentition: Up to 0.75ml

How often can you apply a fluoride varnish and what type of patient can you use this on?

• Apply up to 4 times per year.

• All people at moderate to high risk of caries

In what situation would you apply a fluoride gel and what type of patient can you use this on?

• Use where other forms of fluoride are not available or suitable e.g. Fluoride varnish is number one if available

• Moderate to high caries risk - Not for children under 10 years. For children over 10 years to adults.

Describe the application protocol for fluoride application. (5 marks)

1. Clean the teeth and remove healthy plaque - isolate quadrants to control excessive saliva

2. Dry thoroughly with triplex

3. dispense the measured amount onto a mixing/dosage pad

4. using a brush, probe, or cotton applicator, paint and dab a thin layer across high-risk or susceptible tooth surfaces

5. the varnish sets instantly upon contact with saliva