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Preventive Agents/Products
Board Review DH227Concorde Career College
Lisa Mayo, RDH, BSDH
Fluoride• Fluoride in average topical treatment
– 45mg for NaF– 61.5mg for APF
• Toxic Dose– Induce emesis– F ion can bind to a liquid of MILK or LIME JUICE– Call 911
• Safe Dose– Adult: 1.25-2.5G– Child: 0.5G
• Lethal Dose F– 32-64mg of PURE fluoride per Kg body weight– Adult: 5-10G– Child: 0.5-1.0G
Fluoride: Toxicity
• Symptoms being within 30min – 24hrs• GI: hydrochloric acid acts on F ion to form hydrofluoric
acid – irritates stomach lining– Nausea, vomit, diarrhea, abdominal pain, increase salivation,
thirst• Systemic Involvement– Symptoms of hypocalcemia– Hyper-reflexia, convulsions, parasthesia– Cardiac failure, resp. paralysis
• Treatment– Induce vomiting (emesis)– Administer F-binding agents
Fluoride: Toxicity
• Skeletal fluorosis– Results after long-term use of water with 10-
25ppm for industrial exposure• Dental fluorosis– When excess F is in drinking water during the
years of tooth development– Birth til 12-16yrs or when crowns of permanent 3rd
molars are completed
Amt F Ingested Emergency Tx
≤5mg/kg 1. Admin fluoride-binding agent
≥5mg/kg 1. Induce vomiting (emesis)2. Admin fluoride-binding agent3. Seek medical tx
≥15mg/kg 1. Seek medical tx2. Induce vomiting3. Cardiac monitoring
Question
What is the first measure that should be taken when a child ingests a toxic amount of topical fluoride?
a. Drink milkb. Induce vomitingc. Seek medical attentiond. Administer fluoride-binding agent
Answer
What is the first measure that should be taken when a child ingests a toxic amount of topical fluoride?
a. Drink milkb. Induce vomitingc. Seek medical attentiond. Administer fluoride-binding agent
Question
How long can acute fluoride toxicity last?a. 1 hourb. 10 hoursc. 10 minutesd. Up to 24 hours
Answer
How long can acute fluoride toxicity last?a. 1 hourb. 10 hoursc. 10 minutesd. Up to 24 hours
Question
What is the safely tolerated dose of topical fluoride?
a. >5mg/kgb. >15mg/kgc. ¼ the certainly lethal dosed. The amount of drug likely to cause death if not
intercepted by antidotal therapy
Answer
What is the safely tolerated dose of topical fluoride?
a. >5mg/kgb. >15mg/kgc. ¼ the certainly lethal dosed. The amount of drug likely to cause death if not
intercepted by antidotal therapy
Fluoride Absorption In Body
• Begins in stomach as hydrogen fluoride– Rate depends on solubility of F compound &
gastric activity– ↓ when taken with milk/food– Most absorbed in 60min
• Whatever not absorbed by stomach – small intestine– Plasma in blood carries it through body– Max blood levels reached in 30min after intake
Fluoride Distribution In Body
• Strong affinity for calcified tissues – 99% located in mineralized tissues
• Highest concentration in surfaces closest to the source supplying F: Highest level is on the tooth surface
• Stored in crystal lattice of teeth and bones• Amount stored varies w/ intake amt, exposure
time, age/stage of development• Exposed dentin F concentrations < enamel
Fluoride Excretion In Body• Kidneys by urine• Small amts in sweat and feces• Limited transfer via breast milk• Pre-Eruptive Stage
– Deposited during formation of enamel starting at DEJ– Incorporated in crystals during mineralization– New crystals = fluoroapatite = less soluble then hydroxyapatite– Results = shallower grooves, less fissures
• Post-Eruptive Stage– F benefits from topical application only– Uptake most rapid on enamel surface during 1st 2yrs after eruption– Topical = fluorhydroxyapatite (Free F ion moves into crystal & forms)– Mature enamel reacts with fluoride to primarily form CaF– Demin: CaF dissolves 1st, then hydroxyapatite, then
fluorhydroxyapatite
Fluoride: Role in Caries Process
• Reacts with hydroxyapatite to form FLUORAPATITE• Interferes with bacterial metabolism
– High concentrations: bactericidal– Low concentrations: bacteriostatic– Has substantivity: ability to be bound to pellicle and tooth
surface and be released over a period of time with retention of potency
• Aids in accelerated maturation– At time of tooth eruption, enamel not fully calcified and
undergoes post-eruptive period during which enamel calcification continues
– F will be rapidly absorbed into the enamel
Fluoride Therapy
• Methods– Systemic: water, supplements, food– Topical: toothpaste, rinse, in-office
• Systemic– Most F absorbed by stomach and intestines and
stored in the bone as fluoroapatite– Most efficient from 6mo-14yrs– Excreted by kidneys
Fluoride Therapy
Systemic– Fluoridation: adjustment of F ion content of
domestic water supply to the optimum physiologic concentration that will provide max. protection against caries and enhance appearance of the teeth with min. possibility of producing objectionable enamel fluorosis
– 1965: 1st communities fluoridated– Avg cost: $0.13 - $5.48 per person/year– Most cost effective way to bring F to a community
Fluoride Therapy
Community Fluoridation– Levels range 0.7-1.2ppm mg/L– Warmer climate = lower– Colder climate = higher– EPA monitors– Compounds used:
1. Sodium fluoride2. Sodium silicofluoride3. Hydrofluosilic acid
NBQ
To deliver water to a community through water fluoridation. If a person lives in a colder climate, what ppm fluoride would be expeted?
a. 0.7ppmb. 0.9ppmc. 1.2ppmd. 1.4ppm
NBQ
To deliver water to a community through water fluoridation. If a person lives in a colder climate, what ppm fluoride would be expeted?
a. 0.7ppmb. 0.9ppmc. 1.2ppmd. 1.4ppm
Fluoride Therapy
Community Fluoridation– Most effective in reducing caries smooth surface– Least effective in reducing caries pit and fissures– Ant teeth have better protection then post– Adv:
1. Decrease caries by 25% in post eruptive teeth2. Cost effective3. Safe4. Benefits kids and adults
Fluoride Therapy
Community Fluoridation– Disadv.
1. Have to drink community water
– Reasons why not universal1. Controversial effects of systemic F2. Public not informed of benefits of F3. Powerful Lobbyist's
- Courts have upheld the legality of water fluoridation
Fluoride Therapy
• Tooth colored restorations: NaF• Topical– APF: Acidulated Phosphate F– NaF: Sodium F– SnF: Stannous F– MFP: monofluorophosphate
Fluoride Therapy: Topical• Stannous F
– Unpleasant taste, Unstable solution– Stains teeth in demin areas– Gingival sloughing– Discoloration restorations
• APF– Not for tooth colored restorations: acid will etch glass components - pits
and roughens material• Varnish
– 5% NaF (22,600ppm)– ADA recommended– Desen roots, Caries (14% more effective than other topicals)– Retained for 24-48HRS during which time F released for reaction
w/enamel– 2 to 4 times per year
Fluoride TherapyNaF APF SnF2
Concentration 2% 1.23% 8%
ppm F 9,050 12,300 19,360
Efficacy 29% 28% 32%
pH 9.2 3.0-3.5 2.1-2.3
Adverse Rxns None May etch rest materials
Brown staining, gingiva rxn
Application Freq 4x/yr ages 3,7,10,13 1-2x/yr 1-2x/yr
Fluoride Therapy: Topical
• Safety– Under 6yrs – no rinses (swallow)
• Self-Applied F– Tray, rinse, toothbrush– Frequent, low concentrations F to promote remin. – Bacteriostatic
At-Home Fluoride
• Application: tray, rinse, toothbrush• Low concentration, frequent application• Promote remin (bacteriostatic effect)• Ex:
1. Rinse: 0.05% NaF, 225ppm2. Dentifrice: 400-1500ppm3. Gels: 0.4% Stannous (1,000ppm) pH2.8-5.0 or
1.1% NaF (5,000ppm)
Question
Which of the following topical fluoride delivery systems is BEST for an individual with rampant caries?
a. Trayb. Rinsec. Paintingd. Toothbrushing
Answer
Which of the following topical fluoride delivery systems is BEST for an individual with rampant caries?
a. Trayb. Rinsec. Paintingd. Toothbrushing
Question
Self-applied fluoride rinses are:a. Rarely suggested for adultsb. Available by prescription onlyc. Are effective in caries prevention and controld. Too expensive to be considered cost-effective
Answer
Self-applied fluoride rinses are:a. Rarely suggested for adultsb. Available by prescription onlyc. Are effective in caries prevention and controld. Too expensive to be considered cost-effective
Question
In what percentage is professional strength, in-office sodium fluoride gel?
a. 2%b. 5%c. 1.2%d. 1.23%
Answer
In what percentage is professional strength, in-office sodium fluoride gel?
a. 2%b. 5%c. 1.2%d. 1.23%
Dietary Fluoride Supplements
• Recommended for kids who live in areas with inadequate water fluoridation
• NOT recommended for pregnant women• Fluoride in foods: tea/fish contain large amounts• Includes tablets, lozenges, drops, liquids, F-vitamin
preparations containing NaF (most common) or APF• Tablets intended to be chewed, swished and swallowed• Drops are used on infants• Daily use better at caries reduction then systemic F• Not recommended on infants who are breastfed (breast milk
contains 0.0004ppm)• School-based F supplement programs yield 30%↓ caries
Question
What is the best method of fluoride application for caries prevention?
Concentration Frequencya. Low Lowb. Low Highc. High Lowd. High High
Question
What is the best method of fluoride application for caries prevention?
Concentration Frequencya. Low Lowb. Low Highc. High Lowd. High High
ADA Table
Age Concentration of Fl Ion in Drinking Water
≤0.3ppm 0.3-0.6ppm ≥0.6ppm
Birth-6mo None None None
6mo-3yrs 0.25mg/day None None
3-6yrs 0.5mg/day 0.25mg/day None
6-16yrs 1.0mg/day 0.5mg/day None
Board Question
What agency monitors the amount of fluoride in community water supply?
a. Bureau of Land Managementb. Food and Drug Administrationc. Environmental Protection Agencyd. Occupational Health and Safety Administration
Board Question
What agency monitors the amount of fluoride in community water supply?
a. Bureau of Land Managementb. Food and Drug Administrationc. Environmental Protection Agencyd. Occupational Health and Safety Administration
Board Question
All of the following are added to the water for community water fluoridation, EXCEPT one.
a. Sodium fluorideb. Sodium silicofluoridec. Hydrofluorosilic acidd. Acidulated phosphate fluoride
Board Question
• All of the following are added to the water for community water fluoridation, EXCEPT one.a. Sodium fluorideb. Sodium silicofluoridec. Hydrofluorosilic acidd. Acidulated phosphate fluoride
Systemic Fluoride Pre-Eruptive
• Circulates in the bloodstream and is incorporated into the enamel of developing teeth
• Rapidly absorbed in stomach and small intestine• Effective for 6mo-14 years of age• Amount not used is excreted through kidneys• Once thought to be primary action, now understood to be a
minor effect compared with the post-eruptive action of fluoride
• F incorporated into the mineralized tooth structure during tooth development by the replacement of hydroxyapatite w/fluorapatitie during enamel formation
Demineralization
• Dissolution of the Calcium and Phosphate ions from the hydroxyapatite crystal of the tooth that are lost into the plaque and saliva
• Occurs when pH drops below – 4.5-5.5 enamel– 6.0-7.0 cementum
• Prevention1. Good plaque control2. Fluoride uptake3. Restricted sugar intake
Remineralization
• Calcium, phosphate, other ions in saliva and plaque are re-deposited into previously demin. areas
• When pH rises above “critical levels”• Remin. areas tend to be stronger and more
acid resistant then original structure– Fluoroapatite has been formed
• Requirements same as demin.
NBQ
Prevention and control of smooth surface dental caries if MOST effectively managed by:
a. Biannual dental hygiene recall visitsb. Early radiographic detectionc. Dental sealant applicationd. Diet rich in fermentable carbohydratese. Fluoride therapy
NBQ
Prevention and control of smooth surface dental caries if MOST effectively managed by:
a. Biannual dental hygiene recall visitsb. Early radiographic detectionc. Dental sealant applicationd. Diet rich in fermentable carbohydratese. Fluoride therapy
NBQ
Acidulated phosphate fluoride (APF)a. Is an acidic preparation of stannous fluorideb. Is difficult to use because of its instability in
solutionc. Should be applied every 6 monthsd. Is not recommended for childrene. Is commonly recommended for OTC preparation
NBQ
Acidulated phosphate fluoride (APF)a. Is an acidic preparation of stannous fluorideb. Is difficult to use because of its instability in
solutionc. Should be applied every 6 monthsd. Is not recommended for childrene. Is commonly recommended for OTC preparation
Chemotherapeutics• Definition: Treatment of disease by means of chemical substances or
pharmaceutical agents• Purposes
In-Office1. Pretx rinse to reduce org.2. Pretx rinse to reduce aerosol contamination3. Facilitate impressions4. Rinse and fresh breathe5. Replace surface F removed during tx6. F rinse as part of caries prevention pgrm
At Home1. Vigorous rinsing to aid in oral cleansing2. Saline rinse after nonsurgical perio therapy3. Caries prevention
Chemotherapeutics• Commercial Mouthrinses
1. Oxygenating AgentsCleanse via effervescent actionAntimicrobialActive ingredients: H2O2, Na perorbate, Urea peroxide
Concerns: black hairy tongue, sponginess of tissues, hypersensitivity of exposed roots, demin. tooth surface
2. AntimicrobialTo reduce oral microbial countInhibit bacterial activityActive ingredients: Chlorahexidine, iodine, iodophores,
fluorides, phenol, essential oils, cetylpyridinum chloride, sanguinarine
Chemotherapeutics: CHX
• Mechanism of Action– Bactericidal: active against wide range Gram (+) & Gram (-)– Alters cell wall so that lysis occurs – cell destroyed– Substantivty: rapidly absorbed into teeth and pellicle and
is released slowly• Clinical Uses– Preprocedural rinse, decrease supragingivial bacteria,
inhibits gingivitis, short-term adjunct following SRP, implants, suppresses S.mutans (may aid in prevention caries)
• Side effects (next slide)
Chemotherapeutics
Side Effects– Temp loss of taste– Bitter taste– Burning sensation of mucosa– Dryness– Epithelia desquamation– Discoloration of teeth, tongue, restorations– Slight increase supragingival calculus formation
(related to dead bacteria that remin. as a result of bactericidal action)
CHX• RX• Most effective ant-plaque/gingivitis
chemotherapeutic agent• Broad specturm bacterio-static/cidal• Kills gram (+)(-) microbes• US only 0.12%• Mode of action: binds to hydroxyapatite and glycoPRO thus ↓
pellicle formation• Absorbs into bacterial cell surface & interferes with
cell attachment• Prevents bact accumulation • Inactivated by SLS detergents• 8-12 active hours
Antimicrobials• Tobacco User
– Advise to use non-alcohol– Alcohol + tobacco = synergistic effect, increase risk of cancer
• Cancer Pt– Rinse baking soda/saline followed by H2O/CHX, avoid alcohol
mouthrinses• Acute Perio Disease
– Warm water or weak saline solution, CHX• Alcohol Condition
– Avoid alcohol rinses, if being treated with DISULFIRAM can have medical emergency
Xylitol
• Used in food/snack items as a noncariogenic sweetner
• Evidence of anticariogenic and cariostatic properties• Control dental caries in people with moderate to high
risk for caries• Reduced S.mutans • Makes plaque biofilm less adhesive• Allows enamel surface to remin.
Novamin
• Ca and Phosphate ions in ACP will seek out areas of demin and enhance enamel remin., occlude dentinal tubules, increase F uptake, prevent caries progression
• High risk caries groups should use• People w/ sensitivity should use• Should be used in combo with F• Toothpaste, polish paste, sealant
Recaldent / Casein Phosphopeptides
• Enhance the effects of F & provides a supersaturated environment of Ca and P for remin.
• Not a F substitute• High caries risk, sensitivity issues• Caries prevention• Gum, pastes, professional application
Oral Irrigation
• Effective method of delivery for Chemotherapeutic agents
• Disrupts loosely adherent microbial colonization• Point tip perpendicular to long axis of toothBOARDS: GOOD FOR GINGIVITIS REDUCTION
Oral Irrigator Indications
• Delivery of liquid antimicrobial agent• Presence of gingival inflammation and
bleeding• Disruption of loosely adherent plaque• Ortho• Least effective method of removing plaque
when compared to other oral physiotherapy aids
NBQ
What is the purpose of an oral irrigator?a. To remove subgingival plaque that is adherent to
the toothb. To remove supragingival plaque that is adherent
to the toothc. To disrupt loosely adherent plaque in the sulcusd. To disrupt tightly adherent plaque in the sulcus
NBQ
What is the purpose of an oral irrigator?a. To remove subgingival plaque that is adherent to
the toothb. To remove supragingival plaque that is adherent
to the toothc. To disrupt loosely adherent plaque in the sulcusd. To disrupt tightly adherent plaque in the sulcus
Supplemental Aids• Disclosing agents• Floss and tape• Floss threader• Tufted floss, yarn, gauze: embrasures, pontics, ortho, implants• End Tuft • Interproximal: embrasures, pontics, FPD, ortho, perio splints, proximal
cavities, class V furcation’s, delivering chemotherapeutics• Wooden/plastic/triangular wedges/sticks: embrasures• Toothpicks, perio aid, rubber tip: embrasures, concavities, furcation's,
ortho, apply chemotherapeutics, biofilm removal at/below gum line• Tongue cleaners• Power brush• Oral Irrigation
Denture/Partial Care1. Rinse under water2. Brush: water, soap, non-abrasives (toothpaste, paste,
powders)3. Immersion: solvent, detergent, prevent drying them out,
use mouthrinse for pleasant taste, daily Alkaline Hypochlorite: bleach, loosen debris and stains,
dissolve plaque matrix Alkaline Peroxide: loosen debris, stains, not for heavy stains Dilute Aids: dissolve inorganic components of deposits Enzymes: break down plaque PRO Disinfectants: NaCl - antimicrobial agent, not use metal
dentures, good stain remover, soak 10-15min4. Mechanical cleanser: ultrasonic, magnetic, sonic
Denture/Partial Oral Lesions
• Reactive / Traumatic– Acute or chronic– Ulcers, focal hyperkeratosis, denture-induced fibrous
hyperplasia, redness• Infectious Lesions
– Denture stomatitis, angular cheilitis, candidiasis/thrush• Mixed Reactive
– Etiology: Trauma and infection– Root caries, papillary hyperplasia
Denture/Partial Oral Lesions
• Systemic-Disease Related– Paget’s Disease: rapid resorption and deposition of bone,
enlarged jaw bones, fuzzy-looking on radiographs, etiology unknown
– Acromegaly: overproduction growth hormone, enlarged mandible, lips, tongue, hands, feet
– Oral Cancer– Pernicious Anemia: vitamin deficiency (B12)
Power Toothbrush Indications
• People with manual dexterity problems• Caregivers providing oral care• Implants
Interdental Brushes Indications
• Open embrasure spaces• Diastema’s• Implants – only if plastic wire• Mild arthritis• Accessible Class III or IV furcation areas
Tufted Brushes Indications
• Rotated teeth• Hard to access third molars• Accessible Class III or IV furcations
Toothpick Indications
• Accessible furcation areas• Shallow pockets• Normal sulcus depths• Patient who already uses toothpicks
Floss Threader Indications
• Fixed bridges• Ortho• Use in conjunction w/dental floss
Floss Holder Indications
• People who are physically / dexterity challenged to use dental floss with fingers
• Those with large hands• Gag reflex
Tufted Floss Indications
• Bridges• Ortho• Does not need floss (bridge) threader
Dental Floss
• Indicated for use proximal surfaces• Aids in min interprox decay• Should start flossing child’s teeth when
proximal surfaces contact each other
NBQ
Powered toothbrushes may be:a. Indicated for individuals who are physically or mentally
challengedb. Effective tools for subgingivial plaque control in pocket
depths up to 4mmc. More traumatic to gingiva and cementum that manual
toothbrushesd. Contraindicated for individuals with mitrovalve
prolapsee. More difficult to use and require increased instructions
time
NBQ
Powered toothbrushes may be:a. Indicated for individuals who are physically or mentally
challengedb. Effective tools for subgingivial plaque control in pocket
depths up to 4mmc. More traumatic to gingiva and cementum that manual
toothbrushesd. Contraindicated for individuals with mitrovalve
prolapsee. More difficult to use and require increased instructions
time
NBQ
Which of the following home care armamentariums is the LEAST effective plaque control tool for a client with dental implants and a fixed prosthesis?
a. Tapered end tuft toothbrushb. Soft bristled, multi-tufted nylon toothbrushc. Rubber tip stimulatord. Mild abrasive, ADA approved toothbrushe. Unwaxed dental floss
NBQ
Which of the following home care armamentariums is the LEAST effective plaque control tool for a client with dental implants and a fixed prosthesis?
a. Tapered end tuft toothbrushb. Soft bristled, multi-tufted nylon toothbrushc. Rubber tip stimulatord. Mild abrasive, ADA approved toothbrushe. Unwaxed dental floss
NBQ
Interdental cleaning devisesa. Conform to the anatomy of the proximal tooth
surfaceb. May result in the loss of interdental papillaec. Are selective on the architecture and position of
the gingivad. Compare favorably with toothbrushing for
interdental bacterial plaque removale. Require excellent manual dexterity to manipulate
NBQ
Interdental cleaning devisesa. Conform to the anatomy of the proximal tooth
surfaceb. May result in the loss of interdental papillaec. Are selective on the architecture and position of
the gingivad. Compare favorably with toothbrushing for
interdental bacterial plaque removale. Require excellent manual dexterity to manipulate
Oral Deposits
• Acquired Pellicle– Amorphous, acellular, unstructured– Reforms w/in min. after removal– Composed of salivary glycoPRO
• Materia Alba– Loosely adherent mass of bact and cellular debris– Unstructured– Resembles cottage cheese in appearance– Forms over plaque in neglected mouths– Can be removed by oral irrigation or water spray
Oral Deposits• Food Debris
– Unstructured, loosely attached– Collects at cervical 1/3 and interprox– Can be removed by oral irrigation/water spray
• Plaque (Biofilm)– Dense, nonmineralized mass of bacteria– Organized and closely adherent– Caries and perio d. are infectious d. caused by biofilm– Not caused by single microorganism– Pellicle – Biofilm - Calculus
Biofilm
Formation Stages1. Pellicle formation• Absorption of glycoPRO from saliva
2. Bacterial colonization• Colonies form and coalesce
3. Maturation• Bact multiply and may increase thickness
4. Matrix formation• Supragingival biofilm: saliva• Subgingival biofilm: sulcular fluid• Both contain polysaccharied (adherence properly)
Biofilm CompositionDays Biofilm Composition
1-2 Cocci, aerobic, gram (+)S.mutans, S.sanguis, Actinomyces
2-4 Cocci, may see filaments and rodsColonization occurs in stratified layers against the tooth surface, matrix
4-7 Filamentous forms ↑, fusobacteria appearBiofilm thicken at margin
7-14 Vibrios and spirochetes appear, gram (-), aerobic, ↑WBCSign of inflammation begin
14-21 Densely packed vibrios, spirochetes, filamentous bact.Biofilm blooms into mushroom shape attached by a narrow base that incorporates channel to capitalize on fluid movementGingivitis
Biofilm
• 80% water• 20% inorganic/organic elements– 70-80% microbes– Inorganic: Ca, phosphorous, fluoride– Organic: CHO, PRO, Lipids
Calculus
• Mineralized plaque• Formation
24-48 hours Centers grow and coalesce Ave time for detectable calculus = 12 days
• Pellicle – Plaque biofilm – Mineralization• Sub-g vs Supra: sub harder and darker in color (pigments
from blood breakdown)– Attach supra via acquired pellicle– Attach sub directly to cementum
• Significance Allows for bact attachment DOES NOT cause pocket formation!!!
Calculus Composition
• 10-30% water and organic elementsMicrobesCells
• 70-90% inorganicCa, phosphorous, carbonate, sodium, magnesium,
potassium, trace elements, fluoride• Rapid formers: greater Ca-phosphate• Slow formers: greater pyrophosphate
Calculus• Supra– Nutrient is saliva– Color often white, yellow, gray– Most commonly found near opening of salivary
gland ducts• Sub-g– Nutrient source crevicular fluid & inflammatory
exudate– Color dark brown, dark green, black
Calculus Detection
• Explorers – 11/12 and pigtail for posteriors– Orban-type for ant and cervical 1/3 of post
• Dry teeth w/ compressed air• Radiographs (not always show calculus)
Question
From which of the following is calculus most easily removed?
a. Pellicleb. Enamelc. Cementumd. Restorative material
Answer
From which of the following is calculus most easily removed?
a. Pellicleb. Enamelc. Cementumd. Restorative material
Stain Color Cause Extrinsic Intrinsic
Yellow/Brown Biofilm, food pigments, CHX, SnF x
Orange, Red Chromogenic bact in plaquePoor OH, ant teeth
x
Green Chromogenic bact, poor OHFungi, Decomposed hemoglobin
x x
Black Line Bact (gram +), iron1/3 of F/L
x
Brown Tobacco, SnF, CHX, Cetylpyridinium, Food Source, Betel Nut
x
Blue-Green Mercury, Lead Dust (occupational exposure), poro OH, dark beverages
x
Gray, Black Metallic Ions from amalgam x
Gray, Brown Caries x
Question
What kind of stain does stannous fluoride cause?
a. Brownb. Greenc. Blackd. Orange
Answer
What kind of stain does stannous fluoride cause?
a. Brownb. Greenc. Blackd. Orange
Stain
Intrinsic (endogeneous)– Not removable– Possible causes
1. Pulpal necrosis2. Internal resorption3. Excessive systemic fluoride 4. Tetracycline
Question
Which of the following stains is not caused by poor oral hygiene or smoking?
a. Brownb. Orangec. Bluish-greend. Yellow-brown
Answer
Which of the following stains is not caused by poor oral hygiene or smoking?
a. Brownb. Orangec. Bluish-greend. Yellow-brown
Question
An industrial worker presented to the dental office with a bluish-green stain on his teeth. The inhalation of which type of metallic dust from occupational exposure caused this stain?
a. Goldb. Coalc. Nickeld. Copper
Answer
An industrial worker presented to the dental office with a bluish-green stain on his teeth. The inhalation of which type of metallic dust from occupational exposure caused this stain?
a. Goldb. Coalc. Nickeld. Copper
Toothbrushing
• Review Methods HandoutRollBass SulcularModified BassStillmanModified StillmanFones(circular)Horizontal (scrub)Leonard (Vertical)Occlusal
Question
• If your patient was a child with limited dexterity what method of brushing would you recommend?
Answer
• Roll or Fones– Fones 1st technique for kids prior to dexterity
development– Roll: good as a technique prior to being able to
use sulcular
Question
• What method of brushing is recommended for a 12 year old patient in full orthodontics?
Answer
• Charters– Filaments 45 degree angle toward occlusal– Enough pressure to force filaments between teeth– Vibrate back and for 10sec 2-3x/teeth– Heel/toe for anterior lingual’s
Question
A 14-yr old girl presents to the office with swollen, bleeding gingiva. Which of the following would you recommend?
a. Oral irrigatorb. End-tuft toothbrushc. Soft toothbrushd. Disclosing solution
Answer
A 14-yr old girl presents to the office with swollen, bleeding gingiva. Which of the following would you recommend?
a. Oral irrigatorb. End-tuft toothbrushc. Soft toothbrushd. Disclosing solution
Question
A patient presents with misaligned mandibular anterior teeth. Which of the following oral physiotherapy aids would be BEST to recommend to clean these teeth at home?
a. Dental tapeb. End-tuft toothbrushc. Interdental brushd. Toothpick holder
Answer
A patient presents with misaligned mandibular anterior teeth. Which of the following oral physiotherapy aids would be BEST to recommend to clean these teeth at home?
a. Dental tapeb. End-tuft toothbrushc. Interdental brushd. Toothpick holder
Dentifrices
• ↓ Caries • ↓ Biofilm formation • ↓gingivitis• ↓ Supragingivial calculus• ↓ tooth sensitivity• Remove stains• Whitening
Dentifrices• Abrasives (20-40%)
– Clean and polish– Physically remove biofilm and stain– Smooth teeth: resists bact. accumulation & stains– Factors that affect: particle hardness, size, shape, toothpaste pH, water and
glycerin content, salivary characteristics• Humectants (20-40%)
– Retain moisture– Prevent hardening when exposed to air– Stabilize preparation
• Detergents (1-2%)– Loosen debris– Surfactant (↓ surface tension)– Foaming and emulsify debris
Dentifrices• Binders (1-2%)– Thickener– Prevent separation of solid and liquid ingredients
• Sweeteners (1-2%)– Create a favorable taste– Xylitol, glycerine, manitol, sorbitol, saccharine
• Coloring agents – Attractiveness but may cause mucosal rxns– Vegetable dyes, tartrazine
Dentifrices• Flavoring agents– Mask other ingredients and present a pleasant
taste and after-taste– Essential oils, peppermint, cinnamon, spearmint,
clove, wintergreen, menthol• Preservatives (2-3)– Prevent bact growths, formaldehyde,
dichlorinated phenols– Prolong shelf life– Alcohols, benzoate
Specialty Dentifrices• Whitening: some use hydrogen peroxide and others use carbamide
peroxide• Tooth sensitivity: occlude dentinal tubules
– Potassium nitrate/citrate/chloride; strontium chloride, sodium citrate, SnF
• Gingivitis reduction– SnF, triclosan, zinc citrate + NaMFP
• Calculus reduction– Tetrapotassium pyrophosphate– Tetrasodium hexametaphosphate– Zinc chloride, zinc citrate, triclosan/copolymer
Specialty Dentifrices
• Caries Prevention– NaF, Na-monofluorophosphate, stannous, xylitol
• Halitosis– Essential oils, chlorine dioxide,
triclosan/copolymer, stannous fluoride, sodium hexametaphosphate
Mouthrinses• Cosmetic/Breath-Freshner or Therapeutic
– ↓ biofilm, bact, inflammation
• General Functions– Oxygenation, astringent, buffering, deodorizer, anodyne(pain relief),
bacterio-static/cidal• Ingredients
1. Water: largest amt of volume2. Alcohol: ↑ stability essential oils, ↓ surface tension, 15-30%3. Flavoring agents: essential oils, eucalyptus oil, oil of wintergreen4. Aromatic waters: peppermint, spearmint, wintergreen5. Coloring: must not discolor tissues6. Sweetening agents7. Astringents: zinc chloride, zinc acetate, alum tannic, acetic acids, citric
acids
Question
Which of the following is the cause of dentinal hypersensitivity?
a. Irritation to the pulpb. Aggressive toothbrushingc. Use of abrasive toothpasted. Movement of fluid within the dentinal tubule
Answer
Which of the following is the cause of dentinal hypersensitivity?
a. Irritation to the pulpb. Aggressive toothbrushingc. Use of abrasive toothpasted. Movement of fluid within the dentinal tubule
Which of the following is a TRUE statements regarding fluoride? (there is more then one right answer)
a. Fluorine, the precursor to fluoride, is a naturally occurring element in air & water
b. Fluoride is the end result of sodium bicarbonate mixing underground with clean well water
c. The practice of civilized water fluoridation in populated areas is supported by scientific research to help prevent widespread tooth decay in children
and adults.d. Persons who are at risk for developing early gum disease in their teens are
recommended to buy meat and dairy with products injected with antibiotics to support their immune system.
e. The level of fluoride recommended in drinking water for optimal dental health is 10.0ppm
f. Fluoridation of city water systems has been common practice in the US since WWIg. Young children who ingest too much fluoride early in life develop teeth with short
roots.
Correct Answers: A, C, F
• B = derived from hydrofluoric acid• D= person at risk for tooth decay are to brush
2x/day with fluoride toothpaste• E= Should be 1.0ppm• G= would develop white spots on enamel
Order the following 1-4 to show the most reasonable steps in conducting a periodontal exam:
Collect samples from the pockets to conduct a bacterial evaluation by microscope
Do a visual inspections of the gums, connective tissues, lips, tongue
Measure the distance ranging between 1-12mm of the gum tissue from the tooth
Grow a culture of the bacteria collected to exactly identify strain and variety.
Answer
2, 3, 1, 4
For each symptoms, match correct disorder
Symptom Disorder
1. Migraine Headache a. Oral Cancer
2. Canker sore, aphthous ulcer b. Lichen Planus
3. Bright red, smooth area c. Sutton’s Disease
4. Lines of lesions that form lacey-looking patterns
d. TMD
5. Black tongue e. Sjogren’s Syndrome
Answer
1. D2. C3. A4. B5. E
Symptom Disorder1. Migraine Headache a. Oral Cancer2. Canker sore, aphthous ulcer b. Lichen Planus3. Bright red, smooth area c. Sutton’s Disease4. Lines of lesions that form lacey-looking patterns d. TMD 5. Black tongue e. Sjogren’s Syndrome
