Fluorides and Fissure Sealants
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What is the most common childhood disease worldwide?
Dental caries
What does prevention of dental caries depend on?
Control of dietary sugar
What 2 things can improve ease of prevention of dental caries?
• Optimal levels of fluoride is orally available 2. Good salivary function
How does fluoride facilitate the easier prevention of caries?
Fluoride promotes remineralisation and prevents demineralisation of tooth surface by exerting a topical effect at tooth surface promoting uptake of calcium and phosphate ions
What can occur if excess fluoride is consumed during period of tooth formation?
• White spots to severe defects of enamel can occur • Excess fluoride interferes with secretion and maturation of dental enamel of the crown • Can cause fluorosis
Describe the fluoridation of toothpaste
• Added largely in 1970s • Widespread introduction • Use of fluoride toothpastes led to significant improvements in child dental health
What studies were carried out by Cochrane in 2003 with regards to fluoride?
International evidence synthesis of clinical benefit of fluoride toothpastes
What was the main outcome of the Cochrane studies in 2003?
The effect of fluoride toothpaste increased with higher baseline DMFS values and supervised brushing
What studies were carried out by Cochrane in 2019 with regards to fluoride?
International evidence synthesis on benefits of different strengths of fluoride toothpaste
Describe the 3 main outcomes of the Cochrane studies in 2019
• In permanent teeth of children and adolescents, less new decay was found as strength of fluoride increased • In permanent teeth of adults 1000 ppm toothpaste reduced decay • PHE recommended children use fluoridated toothpaste containing no less than 1000 ppm fluoride
Name 4 advantages of fluoridating toothpastes for community prevention of caries
• Accepted as routine part of personal hygiene • Relatively low cost • No need for specialists • Higher strength fluoride can be prescribed for high risk adults
Name 2 disadvantages of fluoridating toothpastes for community prevention of caries
• Cost barrier 2. Needs to be used twice daily every day for maximum benefit
Describe Colorado Brown Stain
• 1915 • Local dentist in USA reported defects on teeth and low caries • Excess fluoride in drinking water
Describe Trendly Dean’s discovery in 1933
When fluoride was at 1 ppm, prevalence of caries was low and fluorosis was mild
Describe the fluoride related experiment in Grand Rapids, Michigan
• 1945 • First town to have level of fluoride in water artificially adjusted to 1ppm • Nearby city of Muskegon acted as control • In 6 years, caries reduced by 50% in Grand Rapids
From 2000, how has the attitude to water fluoridation changes in Europe?
• Many reviews on safety and effectiveness • No new schemes in Europe with some reversals • Cochrane Review (2015) raised doubts on quality and age of studies supporting water fluoridation
What are 4 advantages of water fluoridation for community prevention of caries?
• Reaches all communities • Passive prevention • Low cost per person • Potential to reduce health inequalities
What are 3 disadvantages of water fluoridation for community prevention of caries?
• Environmental opposition on a matter of personal freedom • Based on systemic need than topical mechanism of fluoride • As fluoride toothpastes are now widely used, potential for over-consumption
How may fluoride be administered other than in toothpastes and water?
Fluoride varnishes
Describe the application and effectiveness of fluoride varnishes
• Application 2-4 times per year • Caries preventive effect • 2.2% NaF used
Name 2 programmes which are made up partly of fluoride varnishes
• Childsmile (Scotland) 2. Designed to Smile (Wales)
What is NICE guidance and PHE recommendation on fluoride varnish?
Used in children aged 3 years and older at high caries risk
What are 3 advantages of fluoride varnish use for community prevention of caries?
• Easy to apply • Well accepted • Relatively low cost for use in community programmes
What are 2 disadvantages of fluoride varnish use for community prevention of caries?
• High risk individual or population strategy needs professional application twice a year • Does not address underlying causes of caries