DHED 316- exam 3 (lecture 1)

4 fluoride mechanisms of action

1. remineralization

2. seals dentinal tubules

3. interferes with micro-organisms

4. reduced solubility of enamel

which mechanism of action is most significant, and reverses the caries process

remineralization

_________ enamel is more resistant to decay due to larger crystals

remineralized

_________ applications of ______ concentration of fluoride is key to remineralization

frequent; low

which mechanism of action Reduces ability of plaque organisms to form acid

interferes with micro- organisms

which mechanism of action was Once thought to be most significant mechanism of action, is Pre-eruptive, and Converts hydroxyapatite to fluorapatite

reduced solubility of enamel

which is more resistant to caries, hydroxyapatite or fluorapatite?

fluorapatite

two ways of aquiring fluoride

systemic and topical

aquiring fluoride systemically DURING mineralization =

Circulation to developing enamel

aquiring fluoride systemically After mineralization, before eruption=

Deposited in surface enamel

uptake of fluoride depends on (2 things)

Amount of fluoride ingested

Length of time of exposure

t/f- ways of aquiring fluoride systemically is through either water or dietary supplements

true

t/f : topical fluoride causes fluorosis

false ; Excessive intake does not result in fluorosis

t/f - No difference in effectiveness of naturally fluoridated vs adjusted fluoridation

true

FORMER recommendation of fluoride was ___, ______range from ____ ppm (warmer climates) to ___ppm (cooler climates)

1ppm; WITH; 0.7-1.2ppm

Current recommendation (as of January 2011) is ____ppm; _________ range

0.7ppm; NO RANGE

EPA considers________ to be maximum contaminant level (noticeable fluorosis) ; defluoridate

4ppm

main benefit of water fluoridation =

caries reduction

water fluoridation caries reduction in adults =

• decrease of about 35 - 50% in coronal and root decay

water fluoridation caries reduction in kids

=

Early studies showed 60% decrease in permanent teeth; now about 20-40% due to widespread use of fluorides

water fluoridation prevents

infection, pain, suffering, and increase in quality of life

water fluoridation savings

saves money on future restorative care; beneficial for smooth surfaces!

decrease in benefits of water fluoridation due to use of other fluoride products

dilution effects ; basically saying water fluoridation isnt the only thing responsible for caries reduction and we cannot give it all the credit

extension of benefits of water fluoridation to residents of non-fluoridated communities (kids that dont have fluoridated water get it from other sources)

diffusion effect (halo effect)

benefits of water fluoridation - APPEARANCE

at 1 ppm : teeth are whiter, shiny, opaque, clean

above 2-4 ppm : during time of enamel formation (birth to age 8), noticeable fluorosis

benefits of water fluoridation- partial exposure

*Dependent upon amount and length of exposure

• Dental decay increases if fluoridation is discontinued for one year or more

Benefits of water fluoridation- PRENATAL

Does cross placenta and enter fetal circulation

Research is inconclusive about benefits

fluorisis is a ______ problem in the US

cosmetic

most cases (22%) of fluoride are what stage?

very mild to mild

is fluorosis increasing or decreasing in US?

Recent increase in U.S. due to inappropriate use of supplements and ingestion of fluoride TOOTHPASTE

Average cost of fluoride per person , per year

1 dollar

Cost varies within a range based on:

▪ Size of city

▪ Labor costs

▪ Amount and type of equipment

▪ Amount and type of fluoride

types of fluoride compounds

Fluorosilicic acid - liquid (most expensive)

▪ Sodium fluorosilicate - solid

▪ Sodium fluoride - solid* (most common)

type of compound depends on

Size of water facility

Type of water facility

Preference of water supply engineer

Types of fluoridation systems

- saturators

-dry feeders

- solution/ liquid feeder

what do all the fluoridation systems do?

All limit amount of added fluoride

two methods of defluoridating water supply

1. additive

2. absorbative

type of defluoridation that adds chemicals to precipitate the fluoride (makes it solid and sink to bottom so you can scoop it out)

additive

type of defluoridation that fluoride is removed by ion exchange or chemical reaction (deactivates fluoride)

absorbative

t/f: defluoridation is more expensive than fluoridation

true ; 2 dollars per person instead of 1

EPA requirement is to defluoridate H2O at ______or higher

4ppm

Decision to fluoridate is usually __________, not professional

political

Three ways to approve water fluoridation:

1. administrative decision (approved by local governing bodies, usually city council)

2. referendum (approved by vote of the people)

3. state legislative action (mandate passed by state legislators)

Adoption of fluoridation has_______ in recent years

slowed/ decreased

why has Adoption of fluoridation slowed (4 reasons)

public and professional apathy

issue is percieved as controversal by legislators

low voter turn out

fear, confusion

vocal group opposed to fluoride for various reasons

antifluoradationists

rationale for not fluoridating

1. violation of persoanl liberty/ individual rights

2. violates religious beliefs

3. environmental sensitivity

4. Antiregulatory attitudes / government mistrust

5. health concerns

6. Dental health is improving anyway so why take the additional "risk" of fluoridating???

*these have been disproven

how has violation of persoanl liberty/ individual rights be disproven by supreme court

Supreme Court = two legal arguments:

• Fluoride is a nutrient, not a medication, and is present in environment

• No one is forced to drink fluoridated water

how has violation of religious beliefs been disproven

Court has ruled that there is a difference between freedom to believe certain religious beliefs (absolute) and freedom to practice those beliefs.

how has environmental sensitivity been disproven

fluoride is a natural element

steps in introducing fluoride to a community

1. Need organized community support*

2. Engagement of community leaders

3. Institute low pressure education program based on evidence based scientific studies

4. Educate both public and legislators

5. Develop long range plan for community education and action

issue with bottled water

Most do not contain optimal levels of fluoride

issues with Home water treatment systems

▪ Can decrease fluoride content

▪ Should have fluoride level tested

overall advantages of water fluoridation

• Cost

• Benefits everyone regardless of income, race, & age

• No individual effort needed to realize benefit

• Saves $ for the individual and for the US Health Care system

overall barriers of water fluoridation

• Can be political, controversial

• Need central water supply

school water fluoridation was Developed and tested in 1960s for use in rural schools with _________________

independent, non-fluoridated water supply

School water fluoridation was More effective on

late erupting teeth due to both systemic and topical effects

Optimal concentration of school fluoridated water =

4.5 ppm

advantages of school water fluoridation

Benefits school children and adults in the building regardless of income or age

No individual effort needed to realize benefi

disadvantages of school water fluoridation

• Benefits begin late, then are accrued only intermittently

• Consolidated school systems should not have school water fluoridation

• Only school children benefit

• Requires frequent monitoring

• Not many studies on effectiveness (few studies done indicate 20 to 30% effectiveness)

• CDC no longer promotes due to some spills and safety problems

High concentration of fluoride in salt =

250 ppm

Especially good for developing countries where there is no piped water

fluoride salt

Caries reduction is similar to that for water fluoridation in fluoride salt (t/f)

true

concerns for fluoride salt

* hypertension

• Individual variations in salt intake

• Does not take fluoride in water into account

fluoridated milk

▪ Not very common in U.S.

▪ Limited milk intake with age

▪ Monitoring is difficult because there are so many more dairies than there are water systems

____________ should be used in conjunction with fluoride

sealants (pit and fissure for sealants, smooth surface for fluoride)

sealants are usually targeted towards _________due to cost

undeserved

Helps prevent 80% of cavities over 2 yrs in the molars

sealants

School-age kids (ages 6 to 11) without sealants have almost 3x as many cavities in the first molars compared to those with sealants (t/f)

true

advantages of sealants

• Can be school-based using mobile/portable equipment

• Effective if correctly applied and fully retained

• Huge savings in future dental tx

disadvantages of sealants

• Need dental professional and adequate equipment

• Can be costly unless use volunteers

school based programs of periodontal disease prevention

• Tooth brushing

• Education

• Episodic, not usually comprehensive

advantages of periodontal disease prevention

• Raises awareness of dental health

• May be only contact some children have with dental care system

disadvantages of periodontal disease prevention

Wide range in costs

Minimal studies regarding effectiveness

Lack of teacher support

Messy

Lack of adequate facilities

Storage of supplies

injury prevention programs should be supported by dental/dental hygiene professions... examples

drinking and driving prevention

seatbelts

mouthguards

helmets

Fall prevention equipment

t/f : there is a Lack of public awareness of oral cancer

true

School-based intervention programs for oral cancer

cigarettes and tobacco

stars as early as 3rd grade

Adult intervention programs for oral cancer

oral cancer screenings in high risk populations

ORAL CANCER PREVENTION

-school based intervention
-adult intervention
-decrease tobacco sales to minors

FUTURE
DIRECTIONS:
Public

▪ Educate!
▪ Importance of fluoride in
preventing decay
▪ Sources of acquiring
fluoride
▪ Purpose of dental sealants
▪ Signs and symptoms of
gum disease
▪ Risk factors, signs and
symptoms of oral cancer
▪ Need for routine oral
exams