DMT W4 Preventive and Desensitizing Materials

Define Fluorapatite

Tooth mineral that results when fluoride is incorpated into the tooth

Define Substantivity

Proper of a material that has prolonged therapeutic effect after its initial use.

What are the 4 main preventive measure for caries management?

1. Fluoride

2. ANtibacterial mouth rinse

3. Sealants

4. SIlver diamine fluoride

What is CAMBRA?

Caries Management by Risk Assessment → common practice in many dental offices; evidence-based approach to preventing and managing cavities at the earliest stages

OTC toothpaste with fluoride 2x daily is recommended for which level of risk based on CAMBRA?

Low Risk

• OTC fluoridated toothpaste 2x daily

• OTC fluoride rinse (0.05% NaF) daily

• Xylitol candy/gum 4x daily

Is the recommended treatment for this level of risk based on CAMBRA?

Moderate Risk

What is CAMBRA’s alternate recommendation for Moderate risk?

Xylitol candies 4x daily with Rx 5000ppm fluoride toothpaste 2x daily (PreviDent5000)

What is the CAMBRA recommendation for individuals with High risk?

1. Xylitol candies or gum 4x daily

2. Rx 5000ppm fluoride toothpaste 2x daily

3. Chlorohexidine gluoconate (0.12%) rinse 1x daily for 1 week and then monthly until next oral evaluation for reassessment

4. Fluoride varnish applied at initial appt and then at each re-call

What is CAMBRA’s recommended treatment for Extreme risk individuals?

1. Xylitol candies/gum 4x daily

2. Rx 5000ppm fluoride toothpaste 2x daily

3. Chlorohexidine gluconate rinse (0.12%) 1x daily for 1 week and then monthly until next recall for reassessment

4. Fluoride varnish at initial appt and then at recall

5. Baking soda rinse 2tsp in 8oz of water 4-6x daily

Which statement is false about Fluoride?

1. Fluoride is a naturally occuring mineral

2. Fluoride occurs naturally in almost all foods and water supplies

3. Fluoride is safe and effective when used appropriately

4. Fluoride contributes to demineralization of the teeth making the teeth more resistant to acid attacks.

4 is FALSE - it contributes to RE-mineralization

What component of tooth crystals make them soluble in acid?

carbonate in tooth crystals

• tooth crystals composed mainly of hydroxyapatite but not purely.

At 5.5 pH tooth mineral dissolves. What is the pH needed to dissolve tooth mineral converted to fluorapatite?

4.5 - Fluoride makes it more difficult for acids to demineralize tooth strucutre

What is the difference between the acid attacks on teeth from erosion versus fermemnted CHOs

Erostion acid attacks are not caused by bacteria, medical conditions or highly acidic food/drink cause erosion

Canned fish has high ____?

Fluoride

What are the 2 types of Fluoride?

1. Acidulated Phosphate fluoride (APF 1.23%)

2. Stannous fluoride (SNF2)

3. Sodium Fluoride (NaF 2%)

How much fluoride is given to a child/adult?

Child = 2ml per tray (total 4ml)

Adult = 2.5ml per tray (total 5ml)

Self adminstered fluoride is recommended for who?

1. clients who are moderate to high-risk for dental caries

2. Elderpatients on medications that cause xerostomia

3. Patients under active ortho treatment

In cases of acute fluoride poisoning, what can be done?

1. induce vomitting

2. protect the stomach using milk

3. maintain blood calcium by administering IV/orally (CaCl or Calcium gluconate)

What is the recommended daily intake for fluoride?

0.05-0.07mg per kg per day

5mg per kg of fluoride causes ?

Probably toxic dose

What is the certain lethal dose of fluoride?

32-64 mg per kg

Acceptable levels of fluoride in drinking water is ___

0.7mg/L or ppm

T or F - Prophylaxis paste containing fluoride (APF 1.23%) is an adequate replaecment for fluoride treatment

FALSE - it does not have ADA approval as an effective preventative against caries.

T or F Chlorhexidine rinses can be used occaisionally to prevent bacterial colony growth.

FALSE - it must be used consecutively for 2-weeks. After a 2 week treatment, the bacterial colonies will not regrow for 4-6 weeks

Why does Chlorohexidine rinse have the greatest substantivity?

It can be retained on oral structures and continue to be released over an extendedperiod of tiem without losing its potency and effectiveness

• reduces plaque by 55% and gingivitis by 45%

What are some side effects of Chlorohexidine rinses?

1. allergy

2. staining teeth, restorations and tongue

3. increased supragingival calc due to increasing thickness of pellicle

4. lingering taste of the rinse may alter taste perception

5. not recommended for pregnant or nursing clients

What is the antibacterial component of Listerine?

Phenolic compound that alters the bacterial cell wall

• reduces plaque scores by 25% and gingivitis by 50%

Where can you find pits and fissures?

• occlusal surfaces of posterior teeth max and mand

• buccal of mand molars

• lingual of max molars

• lingual of max incisors

What are some contraindications for sealants?

1. proximal caries present

2. carious pits and fissures

3. poorl oral hygiene, cariogenic diet

4. well fused enamel so that pits and fissures are shallow or non existent

bis-GMA (Bisphenol A-glycidyl methacrylate) is a monomer found in the resin component of ____?

Sealant

What contributes to an unsuccessful sealant? (3)

1. Inadequate isolation (rubber dam, cotton rolls)

2. Contamination by moisture, saliva, air/water syringe, patients breath

3. part of the fissure is left uncovered → repair is recommended

How does aggressive brushing contribute to tooth hypersensitivity?

Aggressive/excessive pressure applied when brushing wears away enamel or cementum and causes dentin to be exposed

How does gum recession contribute to tooth hypersensitivity?

Gums moving away from the tooth will exposure root surface

How does gum disease contribute to tooth hypersensitivity?

inflamed and sore gum tissue may cause sensitivity due to the loss of supporting ligaments exposing root surface

How does cracked teeth contribute to tooth hypersensitivity?

Chipped or cracked teeth may fill up with bacterial from plaque and enter the pulp causing an inflammatory reaction

How does bruxism (grinding teeth) contribute to tooth hypersensitivity?

Grinding/clenching wears down enamel and exposes underlying dentin

How does plaque contribute to tooth hypersensitivity?

Presence of plaque on the root surface can cause sensitivity

What are 6 common causes of root sensitivity?

1. root caries

2. tooth brush abrasion

3. erosion by acids

4. abfraction associated with bruxism

5. scaling and root planing

6. leaing restorations on the root

What professional treatments can be done to help reduce tooth sensitivity?

1. white fillings to cover exposed root

2. Fluoride varnish to exposed root

3. dentin sealer applied to exposed root surfaces

Potassium nitrate, strontium chloride, zinc chloride are all ______ agents.

desensitizing agents