prevention: fluoride, oral hygiene, and sealants

lecture given 8/10/2026

fluoride

a mineral, is naturally present in many foods and available as a dietary supplement

the ionic form of the element fluorine, and it inhibits or reverses the initiation and progression of dental caries (tooth decay) and stimulates new bone formation

soil, water, plants, and foods contain trace amounts

most that people consume comes from fluoridated water, foods and beverages prepared with fluoridated water, and toothpaste and other dental products containing fluoride

approximately 80% or more of orally ingested fluoride is absorbed in the gastrointestinal tract

in adults, about 50% of absorbed fluoride is retained in the body, with all but 1% stored in bones and teeth

the other 50% is excreted in urine

in young children, up to 80% of absorbed fluoride is retained because more is taken up by bones and teeth than in adults

what does the AAPD recommend when it comes to fluoride?

the use of fluoride for the prevention and control of caries as it is both safe and highly effective in reducing dental caries prevalence

consumption of optimally-fluoridated community water as a cost-effective method to prevent and controlcaries at the population level

toothbrushing at least twice daily with an age-appropriate amount of over-the-counter fluoride- containing toothpaste to prevent caries as first line for caries prevention

professionally-applied topical fluoride treatments such as five percent NaFV or 1.23 percent F gel preparations at least twice per year to reduce incidence of dental caries

38% SDF be used to arrest cavitated caries lesions in primary teeth and permanent teeth as part of a comprehensive caries management program

prescription-strength home-use 0.5 percent F gels and pastes and 0.02-0.09 percent F mouth rinses to reduce dental caries in high-risk patients over six years of age

decisions concerning the administration of fluoride be based on the unique needs of each patient, including the risks and benefits (e.g., risk of mild or moderate fluorosis versus the benefits of decreasing caries increment and, in some cases, preventing devastating dental disease)

fluoride dietary supplements be cautiously considered for children at caries risk who drink less than optimally fluoridated water as supplementation, in the face of all other sources of fluoride, could exceed the recommended amount of daily fluoride intake.

what are the mechanisms of action of fluoride?

topical (most important)- promotes remineralization, inhibits demineralization, antibacterial

systemic- incorporated into teeth and bones as children develop

community water fluoridation

the process of adjusting the amount of fluoride in drinking water to a level recommended for preventing cavities

0.7mg per liter of water

bathes teeth in a low level of fluoride throughtout the day, this helps to strengthen a tooth’s surface, making it more resistant to decay

benefits all members of a community by preventing cavities, reducing oral health disparities, and saving money for everyone

one of the 10 great public health achievements of the 20th century

has a halo effect

what are the recommended types of fluoridated toothpaste that should be recommended?

OTC sodium fluoride, sodium monofluorophosphate, stannous fluoride

has 1000-1500 ppm fluoride OTC

take age into considerations for amount and supervision

ADA seal of approval is important

oral hygiene at home for prenatal counseling

review oral health with expectant parents

oral hygiene at home for infants (0-1 yo)

cleaning gums with moist cloth at bedtime after feeding before teeth erupt

introduce toothbrushing when teeth start erupting

oral hygiene at home for toddlers (1-3 yo)

toothbrush can be introduced with a smear amount of toothpaste

parents must perform brushing

positioning of the child is important

oral hygiene at home for toddlers (2-3 yo)

children enjoy modeling parent’s behavior

children may start to take a turn brushing but adult must complete

positioning may start to differ

oral hygiene at home for preschool (3-6 yo)

children have greatly improved manual dexterity and visual coordination

parents are still responsible for ensuring complete job

introduce a pea sized amount of toothpaste

oral hygiene at home for school aged (6-12 yo)

start to have child assume responsibility

disclosing agents can be helpful

parents still need to supervise/check

orthodontic treatment considerations

oral hygiene at home for adolescents (12-19 yo)

fully capable of independence OH

difficulty with compliance

stress increased responsibility- may consider appealing to concerns regarding personal apperance

fluoride varnish

FDA device for treatment of hypersensitivity- off label use for caries prevention

prevents caries and can stop decay from worsening

typically 5% NaF

resin based or shellac

plaque removal not needed for application

gel and foam fluoride varnish

1.23% APF, 2% NaF

need prolonged contact time

existing research is on gels- need 3 min of contact time

t/f fluoride in prophy paste is enough to be considered a fluoride application

false- not enough

silver diamine fluoride (SDF)

FDA device for treatment of hypersensitivity, off label use is caries arrest

arrests or slows progression of a carious lesion & promotes remineralization- recommended 2x a year for caries arrest

esp useful for populations that may not be able to tolerate dental treatment or that may not be able to access treatment

what are the benefits of silver in SDF?

antimicrobial; deactivates enzymes

what are the benefits of fluoride in SDF?

promote remineralization

what are the pros of SDF?

fast and easy to use

painless

relieves sensitivity

remineralizes your natural tooth structure

prevents biofilm adhesion

avoid or delay more invasive restorations

arrests 80% of cavities when applied twice yearly

what cons of SDF?

stains black

cavities (holes) that trap food may still require restoration

not an option for deep cavities

20% of cavities continue to grow

treatment for cavities, not a cure

what are contraindications to SDF?

silver/metal allergy

symptomatic teeth

pulpally involved teeth (can cause irritation)

low caries risk caries management pathway for children 0-5 yo

recall every 6 to 12 mo, radiographs every 12 to 24 mo

drink optimally fluoridated water, twice daily brushing with fluoridated toothpaste

dietary counseling indicated

sealants indicated

surveillance

low caries risk caries management pathway for children > 6 yo

recall every 6 to 12 mo, radiographs every 12 to 24 mo

drink optimally fluoridated water, twice daily brushing with fluoridated toothpaste

dietary counseling indicated

sealants indicated

surveillance

moderate caries risk caries management pathway for children 0-5 yo

recall every 6 mo, radiographs every 6 to 12 mo

drink optimally fluoridated water (alternatively take fluoride supplements with fluoride-deficient water supplies), twice daily brushing with fluoridated toothpaste, professional topical treatment every 6 mo

dietary counseling indicated

sealants indicated

active surveillance of non-cavitated (white spot) caries lesions, restore cavitated or enlarging caries lesions

moderate caries risk caries management pathway for children > 6 yo

recall every 6 mo, radiographs every 6 to 12 mo

drink optimally fluoridated water (alternatively take fluoride supplements with fluoride-deficient water supplies), twice daily brushing with fluoridated toothpaste, professional topical treatment every 6 mo

dietary counseling indicated

sealants indicated

active surveillance of non-cavitated (white spot) caries lesions, restore cavitated or enlarging caries lesions

high caries risk caries management pathway for children 0-5 yo

recall every 3 mo, radiographs every 6 mo

drink optimally fluoridated water (alternatively take fluoride supplements with fluoride-deficient water supplies), twice daily brushing with fluoridated toothpaste, professional topical treatment every 6 mo, SDF on cavitated lesions

dietary counseling indicated

sealants indicated

active surveillance of non-cavitated (white spot) caries lesions, restore cavitated or enlarging caries lesions, interim therapeutic restorations (ITR) may be used until permanent resotrations can be placed

high caries risk caries management pathway for children > 6 yo

recall every 3 mo, radiographs every 6 mo

drink optimally fluoridated water (alternatively take fluoride supplements with fluoride-deficient water supplies), brushing with 0.5% fluoride gel/paste, twice daily brushing with fluoridated toothpaste, professional topical treatment every 6 mo, SDF on cavitated lesions

dietary counseling indicated

sealants indicated

active surveillance of non-cavitated (white spot) caries lesions, restore cavitated or enlarging caries lesions, interim therapeutic restorations (ITR) may be used until permanent resotrations can be placed

fluorosis

tooth hypomineralization resulting in a change in the appearance of teeth

occurs as a result of elevated amounts of fluoride during enamel formation before the tooth is erupted

*for a child birth to 6mo, how much fluoride should be supplemented if their water at home has less than 0.3ppm F?

0

*for a child birth to 6mo, how much fluoride should be supplemented if their water at home has 0.3 to 0.6 ppm F?

0

*for a child birth to 6mo, how much fluoride should be supplemented if their water at home has over 0.6 ppm F?

0

*for a child 6mo to 3 yrs, how much fluoride should be supplemented if their water at home has less than 0.3ppm F?

0.25mg

*for a child 6mo to 3 yrs, how much fluoride should be supplemented if their water at home has 0.3 to 0.6 ppm F?

0

*for a child 6mo to 3 yrs, how much fluoride should be supplemented if their water at home has more than 0.6ppm F?

0

*for a child 3 to 6 yo, how much fluoride should be supplemented if their water at home has less than 0.3ppm F?

0.5mg

*for a child 3 to 6 yo, how much fluoride should be supplemented if their water at home has 0.3 to 0.6 ppm F?

0.25mg

*for a child 3 to 6 yo, how much fluoride should be supplemented if their water at home has more than 0.6ppm F?

0

*for a child 6 to 16 yo, how much fluoride should be supplemented if their water at home has less than 0.3ppm F?

1.00 mg

*for a child 6 to 16 yo, how much fluoride should be supplemented if their water at home has 0.3 to 0.6 ppm F?

0.50 mg

*for a child 6 to 16 yo, how much fluoride should be supplemented if their water at home has more than 0.6ppm F?

0

*how many mg of fluoride are in one drop of fluoride drops?

0.125 mg

*there is a 18 mo child living in fluoride deficient community (less than 0.3 ppm), what should you prescribe?

sodium fluoride solution, 2 drops into the mouth before bedtime

*there is a 7 yo child living in suboptimally fluoridated community (0.3 to 0.6 ppm), what should you prescribe?

sodium fluoride tablet, 1 per night, chew/swish/swallow

*how much fluoride is in one sodium fluoride tablet?

0.5 mg

what is the estimated probable toxic dose of fluoride?

5 mg/kg

what is the most common symptom of unintentional fluoride overdose?

GI upset

dental sealants

thin protective coating on chewing surfaces of posterior teeth

prevent 80% of cavities over 2 yrs in posterior teeth, where 90% of cavities occur

can be used as treatment for inital caries

dental prophylaxis

fundamental component of pediatric oral health care

facilitates the conduct of a high-quality comprehensive oral examination

facilitates education and demonstration of home oral hygiene techniques

introduces dental procedures to the pt

how can supragingival plaque, extrinsic stains, and calculus be removed from pts teeth?

toothbrush, dental floss, rotary rubber cup, hand instruments, ultrasonic scalers, and air polishers

little effect on reducing gingivitis without the OHI component

dental home

the dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a safe, culturally-sensitive, individualized, comprehensive, continuous, accessible, coordinated, compassionate, and patient- and family centered way regardless of race, ethnicity, religion, sexual or gender identity, medical status, family structure, or financial circumstances

should be established no later than 12 months of age to help children and their families institute a lifetime of optimal oral health

addresses anticipatory guidance and preventive, acute, and comprehensive oral health care and includes referral to dental specialists when appropriate

anticipatory guidance / counseling

the process of providing practical and developmentally appropriate information about children’s healthto prepare parents for significant physical, emotional, and psychological milestones

what should be discussed (tailored to an individual) at each visit?

oral hygiene practices

oral/dental development and growth

speech/language development

nonnutritive habits

diet & nutrition

injury prevention

tobacco/nicotine product use

substance misuse

intraoral/perioral piercing and oral jewlry/accessories