The University of Louisiana at Monroe Fluoride Dental Hygiene Clinic Discussion

Fluoride Discussion

Please discuss the questions regarding fluoride.

1. A patient comes into the dental hygiene clinic and refuses fluoride treatment. How would you explain and encourage the benefits of fluoride to this patient?

2. Explain the clinical procedures of a topical (tray) and fluoride varnish application on a patient.

Fluoride Jordan Anderson, RDH, MDH Objectives  Identify fluoride as a method of preventing dental caries  Describe the importance of the proper level of fluoride in a water system  List three types of fluoride used for professional applications.  List the types of self-applies fluorides  Compare percentages of fluoride in self applied and topical professional applications.  Designate the recommended amount of fluoride in sub optimally fluoridated communities and with patients who are susceptible to caries. Key Terms  PPM- parts per million, measure designate the amount of fluoride used for optimum level in fluoridated, dentifrice, and other fluoride containing preparations.  Fluoride- a salt of hydrofluoric acid, the ionized form of fluoride that occurs in many tissues and is stored primarily in bones and teeth  Systemically- by way of the circulation to developing teeth (preeruptive exposure)  Topically- directly to the exposed surfaces of erupted teeth (posteruptive exposure)  Fluoridation- the adjustment of natural fluoride ion content in a water supply that will maximize caries prevention and limit enamel fluorosis Key Terms  Xerostomia- dryness of the mouth due to a diminished quality of saliva  Rampant Caries- widespread formation of chalky white areas and incipient lesions that may increase in size over a short time  Fluorosis- form of enamel hypomineralization due to excessive ingestion of fluoride during the development and mineralization of the teeth; depending on length and exposure and ppm of fluoride; the fluorised area may appear as a white spot or as severe brown staining with pitting (over 2 ppm) Historical Aspects  Early 20th century Dr. Frederick McKay observed people in Colorado Springs, CO. They had mottled enamel (dental fluorosis) and less dental caries. He associated this with drinking water.  1930’s- Dr. H Trendley Dean and US Public Health Service concluded that the optimum level of fluoride for dental caries prevention is 1 ppm in moderate climates.  1945- the first communities were fluoridated Fluoride Level  In 2011, US Dept of Health and Human Services updated recommendation for the optimal concentration of water fluoridation to 0.7 ppm for all communities.  The decision based on fact that Americans have access to many more sources of fluoride today than they did when water fluoridation was introduced. Effects/Benefits of Fluoridation  Appearance of teeth (optimum- white/opaque less caries; slightly over optimum- mild fluorosis)  Reduction in dental caries in primary/permanent teeth  Slow progression of dental caries  Less tooth loss  Desentization  Remineralization of Demineralized areas School Fluoridation  Adding 1 ppm of fluoride to school water supply because of intermittent use of school water and time there  Has been phased out in several states. Professional Topical Fluoride Indications  Based on caries risk assessment for the individual patient  Low caries risk: use professional judgement, application may not provide additional benefit.  Moderate caries risk: ( presence of at least one risk factor) application at 6 month intervals or more frequent.  High caries risk: (multiple risk factors, xerostomia or suboptimal fluoride exposure) application at 6 month or 3 month intervals Professional Topical Fluoride Applications  Ages 6 or younger, fluoride varnish is the only topical application recommended.  Also come in gels or foams delivered in trays for all ages and levels of caries risk except ages 6 and under Types of Professionally Applied Fluoride  2 % sodium fluoride (NaF) gel or foam in trays  1.23 acidulated phosphate fluoride as a gel or foam in trays  5% sodium fluoride as a varnish brushed on teeth Clinical Procedures of topical tray fluoride  Determine need and type of fluoride for patient  Patient should be seating upright, head tilting forward and no swallowing. Procedure lasts 4 minutes  Choose appropriate size of tray for full coverage  Fill tray 1/3 full of gel or foam  Dry Teeth  Insert trays with suction in between  Don’t leave patient unattended  Remove tray after 4 minutes ask patient to expectorate and not drink, eat or rinse for 30 minutes Procedure for Varnish Application  Determine need based on caries risk  Explain procedure and prepare patient  Lightly Dry teeth  Apply varnish in a thin layer  Instruct patient there will be a thin covering and to leave on at least 4-6 hours after Self- Applied Fluorides  Tray technique  Mouthrinses  Brush on gel and dentifrices Tray Technique-Home Application  Indicated for patient with xerostomia, rampant caries  Custom tray is made for the patient  Instruction is provided for the use of this tray and gel used Fluoride Mouthrinses for home application  Indicated for adolescent and pre-teen, patients with demineralization, and prevention of caries  Children under 6 years of age and those of any age that cannot rinse because of oral and/or facial musculature problem should not use a fluoride rinse  Mouthrinses is a practical and effective means for selfapplication of fluoride for individual at moderate or high risk Fluoride home applying gel/dentifrice  SnF, NaF, APF Na monofluorophoshate, and amine fl  Fluoride dentifrice are available as gels or pastes  Approved by ADA as an integral part of a complete preventive program and is a basic caries prevention intervention for all patients. Patient Instructions  Select accepted ADA Fluoride –containing toothpaste  Place a small amt of dentifrice on toothbrush  Spread dentifrice over teeth with light brushing  Proceed with correct brushing technique  Keep dentifrice out of reach of children  Rinse minimally with water after brushing to retain fluoride Recommended amounts of dentifrice per age Age Amount of Dentifrice Instruction Child (less than 2 yo) “Smear”- less than ½ size of small pea Twice daily brushing with minimal amt of dentifrice swallowed Older Child (3-5 yo) Small pea size Twice daily brushing spreading over filaments explaining not to swallow large amounts. Adults ½ inch or less Twice daily brushing References  Wilkins, E. (2013) Clinical Practice of the Dental Hygienist. 11th edition. P. 517-541