Week 4

• Preventive & Desensitizing Materials


  Materials used to prevent dental disease and reduce tooth sensitivity
• This is Chapter 7 of a Dental Materials course, updated in August 2023
• Lesson Overview


  • Fluoride and Caries Control
  • Sealants
  • Desensitizing Agents
  • Remineralization Products
• CAMBRA


  Caries Management by Risk Assessment - an evidence-based approach to preventing and managing cavities at the earliest stages

  
• Fluoride


  A naturally occurring mineral that is effective and safe in preventing dental decay
• Fluoride may occur naturally or by supplement

  
• Fluoride is a naturally occurring mineral

  
• Fluoride occurs naturally in almost all foods and water supplies

  
• Fluoride is safe and effective when used appropriately

  
• Fluoride contributes to demineralization of the teeth making them more resistant to acid attacks
• Demineralization


  The process where minerals are removed from the tooth surface, usually where the minerals entering the surface balance the minerals coming out
• Remineralization


  The process of replacing minerals lost from the tooth surface, forming a surface veneer containing fluorapatite with lower solubility
• The enamel and dentin of the tooth are composed of tiny mineral crystals called hydroxyapatite, which contain carbonate making them more soluble in acid
• Demineralization occurs when acids remove more mineral than the amount of mineral coming into the tooth from saliva
• Fluorapatite


  The mineral formed when fluoride is incorporated into the surface of enamel crystals during remineralization, which has a lower pH at which it dissolves compared to hydroxyapatite

  
• Anti-cariogenic


  The ability of fluoride to make it more difficult for acids produced by cariogenic bacteria in plaque to demineralize tooth structure and cause dental caries
• Systemic fluoride


  Dietary fluorides that are ingested and become incorporated into forming tooth structure
• Dietary fluoride sources


  • Fruit, milk, eggs
  • Grains, vegetables
  • Meat, poultry, fish fillet
  • Canned fish (in oil with bones)
  • Tea (brewed)
• Topical fluoride


  Fluoride applied in direct contact with the teeth through mouth rinses, fluoridated toothpaste and topical fluoride applications, strengthening teeth and making them more decay resistant
• Types of topical fluoride

  • Acidulated phosphate fluoride (APF 1.23%)
  • Stannous fluoride (SnF2)
  • Sodium fluoride (NaF 2%)

  
• Do not overfill fluoride trays - 2ml for children, 2.5ml for adults
• In-office fluoride


  Professionally applied fluoride gels, foams, rinses and varnishes for high caries risk patients
• Fluoride varnishes (5.0% NaF) are highly effective
• Beware of allergies when using fluoride flavours
• Topical fluoride application


  1. Apply hydrophilic fluoride gel/foam/rinse for 4 minutes in trays

  2. Apply hydrophobic fluoride varnish
• Self-applied fluoride


  Recommended for moderate to high caries risk patients, including elderly with dry mouth and orthodontic patients

  
• Follow manufacturer's instructions, use judiciously, carefully monitor, maximize suction, never leave patient unattended when applying fluoride
• Fluorosis


  An enamel condition caused by consumption of excess fluoride during tooth formation, ranging from mild white spots to severe brown staining and pitting
• Fluorosis occurs due to high water fluoride concentration, swallowing fluoride toothpaste, or over-prescribed fluoride supplements

  
• Recommended daily fluoride intake is 0.05-0.07 mg/kg, probable toxic dose is 5 mg/kg, and certain lethal dose is 32-64 mg/kg

  
• Fluorosis classification


  • Normal
  • Questionable
  • Very Mild
  • Mild
  • Moderate
  • Severe
• Fluoride delivery methods


  • Dietary fluoride supplements
  • In-office topical fluoride application
  • Self-applied topical gels and pastes
  • OTC fluoride rinses
  • Fluoride-containing toothpaste
  • Fluoride-containing prophylaxis pastes
• Children under 6 need supervision when brushing with fluoride toothpaste, using only a pea-sized amount
• Fluoride dentifrice


  Toothpaste containing 1000 ppm fluoride, usually as monofluorophosphate or sodium fluoride, more stable than stannous fluoride
• Fluoride prophylaxis paste


  Contains pumice as an abrasive to remove stains and plaque, can remove a small amount of fluoride-rich enamel surface which can be regained through the fluoride additive of 1.23% APF
• OTC fluoride rinses


  Contain 0.5% (225 ppm) fluoride, reduce caries by 28% when used daily, should be used before bedtime
• Prescription fluoride rinses


  Contain 0.2% sodium fluoride or 0.63% stannous fluoride

  
• Chlorhexidine


  A prescribed oral rinse (0.12% chlorhexidine gluconate) that reduces plaque by 55% and gingivitis by 45%
• Prophylaxis


  Removal of surface stains and plaque from the teeth
• Fluoride-rich enamel surface


  A small amount is removed during prophylaxis