DH Theory II - “Fluoride Products: In-Office”

What is the effectiveness of fluoride txs in dental clinics/offices?

Reduce decay by 25-35%

What is required for fluoride tx in dental offices?

A prophy is not 100% required, but it is needed if calculus is present

Why are foams better than gels for some pts?

- foams better for pts with high gag reflex

- more easily suctioned

- allow for better interproximal tooth coverage without overflow

What is the most common fluoride tx used in dental offices?

Acidulated phosphate fluoride (APF), 1.23% is the most common tx

What is the fluoride concentration in Acidulated phosphate fluoride (APM)?

12,300 ppm

What is the pH level of Acidulated phosphate fluoride (APF)?

3.0-4.0

How long should Acidulated phosphate fluoride (APF) be applied?

1 to 4 minutes on a semi-annual basis

What is a contraindication for using Acidulated phosphate fluoride (APF)?

- APF etches or dulls porcelain, composite restorations, and titanium implants

- should be avoided by pts who cannot tolerate an acidic environment (ex. Xerostomia, bulimics)

What is the fluoride concentration in Neutral Sodium Fluoride (NSF)?

9040 ppm

What is the pH level of neutral sodium fluoride (NSF)?

7

What fluoride regiment was recommended for neutral sodium fluoride?

The recommended regimen was four weekly applications (ages 3, 7, 11, and 13), but NSF is now often used as an alternative to APF

What is the recommended application time for neutral sodium fluoride (NSF)?

4 minutes

Who should use NSF?

- Pts with extensive porcelain or composite restorations

- those who cannot tolerate acidic fluorides

- reduced salivary flow

What is the fluoride concentration in stannous fluoride?

19,360 ppm

What are the adverse effects of stannous fluoride?

- staining of demineralized enamel, grooves, and restoration margins

- bitter taste

- gingival irritation

What is the ideal tray feature for fluoride application?

- completely cover all tooth surfaces

- have anatomical contours to direct gel/foam into interproximal areas

- adequate distal damage to prevent ingestion

- soft edges

- non-flimsy construction to prevent gel/foam overflow

What is the correct procedure for fluoride tx?

- seat the pt upright

- instruct them not to swallow

- dry the teeth

- place the correct amount of gel or foam in the tray

- insert the tray

- use a saliva ejector

- close the pts mouth gently

- use a timer

What should be done after fluoride trays are removed from the pts mouth?

- pt should expectorate several times

- excess gel should be wiped off with gauze or suction

- Pt should bee instructed not to rinse, eat, drink, or brush for at least 30 mins

Since when has fluoride varnish been used in Canada and Europe?

Since the 1970s

True or false: is fluoride varnish FDA approved in the US?

True

Can fluoride varnish be used for caries prevention in the US?

Yes, but it cannot be marketed as such

What is the fluoride concentration in fluoride varnish?

5% sodium fluoride; 22,600 ppm

How is fluoride varnish applied to the teeth?

Teeth are dried and a thin layer of varnish is painted on the surfaces

What should you do before applying fluoride varnish?

Always read the directions before applying the varnish

What is a common brand of fluoride varnish?

- vanish

Duraphat

Does fluoride varnish require a full professional cleaning before application?

It is not required unless calculus is present

What is the primary action of fluoride varnish once applied?

It forms a non-water-soluble layer that provides a slow release of fluoride into the tooth

How does fluoride varnish set?

Rapidly in the presence of saliva

Can fluoride varnish be applied to specific sites or the entire mouth?

Both

What should pts avoid after fluoride varnish application?

Brushing or flossing for 4-6 hrs after application

What dietary restrictions should be followed after fluoride varnish application?

Pts should follow a soft food diet for approx 2 hours and avoid hard or crunchy foods

How often is fluoride varnish typically applied?

Research still ongoing: 2 times per year, 4 times per year, 3 times per week once per year

What is silver diamond fluoride made of?

- ionic silver

- fluoride

- ammonia

What is the concentration of silver diamond fluoride?

38%

How often is silver diamine fluoride applied for high caries risk with active lesions?

Typically applied annually

What FDA-approved use does silver diamine fluoride have?

Reduction of dentinal hypersensitivity

What are the off-label uses of silver diamine fluoride?

- arresting carious lesions

- serving as a diagnostic indicator

What is a notable drawback of silver diamine fluoride?

It stains defects in the tooth structure

What is the appearance of silver diamine fluoride before and after application?

It is colorless and odor less before application

What is a benefit of silver diamine fluoride for patients?

Cost-effective and beneficial for pts who cannot tolerate traditional dental txs

What psychological benefit does silver diamine fluoride offer?

It saves time and alleviates anxiety for pts

What are the do's before applying silver diamine fluoride?

- read instructions carefully/research chemistry

- educate pts

- protect pts

- use caution

What are the don'ts when applying silver diamine fluoride?

- don't let pedo pts taste products

- do not use in the same manner as fluoride varnish

- do not use as a restorative product

What code is used for interim caries arrestin medicament application?

D1354

What code is used for topical application of fluoride?

D1208

What code is used for the application of a desensitizing medicament?

D9910

What is the code for unspecified preventive procedures?

D1999