Dental Fluorosis

Front 1

the fluoride story

Back 1

detrimental effects of fluoride on tooth appearance-->scientific invesitgation-->discovery of anticaries benefits

Front 2

The Fluroide Story

Back 2

References to fluorosis throughout history:
-dating back to 1st century greeks

Anticariogenic properties:
-europe, late 19th centruy
-Fl powders and pills to fight caries
-very little scientific basis

Front 3

Who Identify the scientific basis for fluoride in caries prevention

Back 3

-Frederick McKay
-H. Trendley Dean

Front 4

George McKay:
When did he graduate:
where did he work?
what did he observe?
what did he note?
impact on him?

Back 4

-1901
-Worked Colorado
-Observed "Colorado Brown Stain"
-Later noted no reference to brown stain in dental literature
-piqued his curiosity

Front 5

McKay 1909:
who did he consult?
what kind of sutdies did he conduct
end result?

Back 5

-GV black, enamel expert; but orignally he thought it was unimportnat

-Epi studies by McKay in Colorado: 90% of children affected w/ fluross

-Histological study by Black;

Front 6

Blacks contribution?
puzzle by?

Back 6

-black raised profile of ottled enamel in research community

-mottled enamel was hypocalcified, should have high susceptibilit yot decay but didn't

Front 7

colorado-like teeth?
localized to?
suspected what issue?

Back 7

-other states and countries

-children born in specific geographic

-McKay suspected water supply as etiologic factor

-kids with brown stained teeth were clustered in certain geographical areas

Front 8

Mckay tests his theory when and where?

Back 8

-1923
-Oakley Idaho

Front 9

CO Brown teeth in oakley idaho
-appeared after?
-what did he recommend?
-the result?

Back 9

-new water pipelin built in 1908
-1923: Mckay recommends finding an alternate water source
-ten years late rproblem gone

Front 10

Another city?
-situation?
-flurorisis situation
-water samples?
-chemist finds?

Back 10

-owned by Aluminum Company of America-everyone in town employed by company

-bauxite kids-mottled enamel, kids 5mi away-normal enamel

-Mckay's Bauxite water samples-normal

-ALCOA chemist analysis: high fluoride content

Front 11

H.T. Dean/USPHS

job?

found?

Back 11

-traveled U.S. recoridng prevalence and severity of mottled enamel relative to Fl in water

-IDed clear dose-response relationship between fluroide in water and decay ppl would get

-For Fl up to 1 ppm, extend and severity of mottling is of no public health concern


-For Fl

Front 12

Findings of McKay, Dean and USPHS

Back 12

-foundation for research confirming caries prevention efficacy of community and water fluoridation:
fluoride in right amounts is good at prevneting caries

Front 13

Normal Enamel Formation

Back 13

1. Pre-eruption enamel is initially
-protein-rich
-20% mineralized
-seeded with HA crystals

2. Matrix Proteins break down, replaced by Ca & PO4 precipitating onto growing crystal surfaces

3.Matures slowly inot highly(96%) mineralized tiusse via crystal growth-->very little organic protein remains

Front 14

fluorosis pathogensis

Back 14

-excess fluoride probably:
-slows down breakdown of matrix proteins
-slows removal of protein by-products:toom much protein hanging around for too long, HA can't replace it.
-Retarded crystal growth
-hypomineralized enamel

Front 15

What does flurosis produce?

Back 15

-hypomineralized enamel in an otherwise normal enamel matrix
-enamel matrix just doesn't go away fast enough, everything else is normal(ameloblasts, matrix proteins

Front 16

Has Fl been shown to cause hypoplastic changes?

then why does pitting and enamel occur?

Back 16

-no

-occurs posteruptively

Front 17

Why isn't hypomineralized enamel decayed?

Why is fluorsis teeth not soft?

Why is there brown decay in fluorosis

Back 17

-antibacterial effect
-post eruption enamle maturation
-calcium and phosphate uptake from saliva post-eruption which leans to enamel increase in density

-fluoride retards enamel matrix removal, once erupts through, nothing preventing enamel from taking up Ca, PO4 in saliva-->get harder skin on tooth

-Exogenous sources: foods, uptake into porous enamel prior to post-eruption maturation

-teeth do not reupt with brown stains

Front 18

Fluorosis index?

White areas are...?

occur in?

Back 18

thylstrup Fejerskov index

-not limited to areas of plaque accumulation(as in white sport caries lesions)

-areas of non-plaque accumualtion areas

Front 19

Treatment of Flurosis?

Back 19

-enamel microabrasion
-remineralization

Front 20

enamel Microabrasion
inventor?
uses ___ to ___

purpose?

Back 20

Dr. Theodore Croll

-abrasive paste: pumice + HCL
-controlled removal of outer enamel

-remove brown discoloration on out levels of enamel, hypomineralization is most severe at surface

Front 21

Enamel Microabrasion:
Products:
-Opalustre
-Prema

Back 21

-Opalustre(ultradent)
-Prema(practicon)

Front 22

Enamel Microabrasion:
Technique:

Back 22

-eye protection for patient
-rubber dam
-prophy cup, LOW RPM
-Apply for sec. rinse
-assess for contour change: convexity, stop or continue knowing can fill convexity with composite
-repeat
-topical fluroide application to return teeth to normal mineralization

Front 23

Common area with flurosis?

Back 23

Zacatecas, Aguacalientes Mexico

Front 24

Minimally Invasive treatments for white spot lesions

only used when?

Back 24

-remineralize lesion rather than remove superficial area

-can be applied to fluorissi and incipient carious white spots only when surface is intact

Front 25

Amorphous calcium phosphate stabilized by?

Back 25

Casein Phosphopeptides, CPP-ACP

Front 26

Remineralized enamel with 1000ppm fluroide

translucency?
mineral?

Back 26

-densifies outer surface but doesn't penetrate deep enough to restore mienral underneth

-makes surface more resistant to acid dilution

-changes translucency slightly at surface

-+7% mineral

Front 27

Remineralised enamel with 2% CPP-ACP

fxnatliy?
penetrates through?
mineral?

Back 27

-Ca, PO4 can penetrate deeper and restore translucency

-remineralisation throguh body of lesion

-+13% mineral

Front 28

Remineralised with enamel 2% CPP-ACPF

reminerlisation through?

mineral?

Back 28

Ca, PO4 and fluroide working togehter can penetrate deeper

-remineralisation through body of lesion, enamel is now also more acid resistant

+21% mineral

Front 29

Mild Fluorosis
Fluoride rich where?
need to ___ via?
then?

Back 29

enamel surface

break seal via acid etching to remove pumus

now much able to absorb Fl, Ca, PO4

Front 30

Fluoridation of water supplies

ideal fluoride concentration

is fluoridinated water necessary?

Back 30

-controversial, when safe effectivness is overwhelming

-.7-1.2ppm considered ideal fluoride, not changed to .7

-increased in other sources of fluoride