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** Calculations part (of the pre.

Lecture )
The doctor said : " there are 10 examples you must practice on them at home " Basically the amount of fluoride in any product is calculated from the molecular weight so we should know it.

Fluoride content =

Atomic weight of F Molecular weight of compoud

Atomic weight of elements : Na = 22.98 ---- 23 Sn = 118.9 ---- 11 F = 18.19 ---- 19 O = 15.99 ---- 16 P = 30.97 ---- 31 Conversion factors 1 ppm = 1 mg/L ( 1L = 1000 mL ) 1 % = 1x 10^4 ppm = 10000 ppm 1% = 1 gm/100 mL = 1 gm/100 gm = 1000 mg/100 mL

g/1000 mL = 40 mg/ mL

So according to the equation we can find F conten

SnF2 = 2xF = [ 2 x 19 ]
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SnF2 [ 119 + (19x2) ]

Na2PO3F = F 13% = .13 Na2PO3F

19

[ (23X2)+31+(16X3)+19]

NaF = F = NaF

19 [23+19]

= 45% = .45

** NOTE : APF : is only the product that manufacturer is actually giving you the Fluoride concentration not the product itself. Sometimes the amount is by grams not in ml , For example if I have a tooth pastethat contains 500 pm fluride , this means it contains 0.5 mg of fluride per each g of the tooth paste ( 0.5mg/g) so if the toothpaste is 60 mg then I have totally half of it fluride which is 30 mg. read the example on Slide #46. Slide 52, Page 26, Example 7: -You have a child who ingested 10 mL of 5% NaF, how much did he ingest? - First of all you have to know how much fluoride is in 10mls of 5% NaF - We said that we change the percentage to ppm by multiplying it by 10^4

%5 X 10^4 ppm = 50,000 mg/L .. because 1 ppm =1 mg/L 550555 =


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mg/L = 50,000 mg/1000ml .. because 1 L = 1000 mL 550555 Which equals to 50 mg/ml That means 5% = 50,000 ppm = 50,000 mg/L = 50,000 mg/1000ml = 50 mg/ml

50 mg/mL x 10 mL = 500 mg NaF the percentage of F in NaF = 0.45 so 500 x 0.45 = 225 mg F Is this toxic ? is this lethal ? how do we know? Let's suppose that the child is 10 kilos so we say ? The toxic dose is 5 mg/kg 10 x 5 = 50 So the toxic dose is 50

we have 225 mg F , so is the dose toxic ? definitely, because it's more than 50 Is the dose lethal? 32 mg/kg is the lethal dose, so 32 x 10 = 320 255 is less than 320 so its not lethal - Finally, we can say it's toxic but it's not lethal, but it so close to lethal dose. - Symptoms may be quite severe if they are not managed immediately.

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Chemotheraputic agents

The final lecture of the prevention lectures is going to be about Chemotheraputics agents and vaccination . We are going to talk about Caries Balance: its a consept that you should have a balance between the factors that cause caries (bacteria , salivary flow when its abnormal , frequent eating and drinking of sugar) and protective factors that protect us from caries and make them more such as (increase the salivary flow and its components like by: chewing gum, or by floride remineralize the tooth and make them stronger or by xylitol , or tooth brushing) all of these in order to reach the[no caries status].

Tooth caries doesnt have a single cause it has many causes and many predisposing factors , so the cause of caries in one patient is not necessarily the same cause of other different patient m in terms of this factors . Most of the time what causes caries is the bacteria and its acidic products but sometime its the same amount of microorganisims and nearly the same lifestyle of two persons while in one of them it causes caries and it doesnt in the other one .

This is because the different predisposing factors and risk factors among people : 1. Medical histocy is a risk factor 2. Enamel hypo-plasia is a risk factor 3. the amount of the saliva
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4. the salaivary flow 5. salaivary contants , even the minerals in the saliva is different from one person to another 6. any medication taken 7. family history 8. and so many others factors The first agent we are going to talk about is

Chlorohexidene : it's actually termed as chlorohexidine gluconate which is a salt. At Ph 7 it dissociate to give +ve charged molecule . You can find it in the markets as two products : - 0.2% CHX (Savacol,Plaqacide) , or - 0.12% CHX ( Difflam,Dental solutn , savacol freshmint , Peridex)
The dr. only read the slide and this is what I understood from it

Its positively charged molecule and its activity results from: 1) Its electrostatic interaction the negatively charged bacterial cell membrane so it means that it can bind to anything negative, like Bacterial cell wall. 2) At higher concentration CHX also induces coagulation of cytoplasmic material and then cause cell death How do we prescribe it? It depends on CHX concentration In Savocal m/rinse:
The doctor didnt mention the names of the products

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Regular type:

2mg/ml = 0.2% CHX Or

(the 10ml of Savocal regular CHX must be rinsed for 1 minute in the mouth)
it reacts as 15 ml for 1 min

Freshmint type:

1.2mg/ml ,12%CHX

( the 15 ml of Savocal Freshmint CHX must be rinsed for 1 minute in the mouth )

CHX gel (1%) Another type of CHX comes as a tube that contains Gel and this is also can be found in the markets , it is called Periokin in Jordan. 1- it doesnt contain alcohol that means it doesnt irritate the mucosa which is good for children *Advantage 2- Bactericidal : Reduces dental plaque . *Advantage 3- Reduces discomfort of mouth ulcer . * Advantage 4- it has a good taste. *Advantage 5- very slight after taste from sustained release. *Advantage 6- it doesnt give much staining to the teeth like other mouth rinses. *Advantage 7- it has a fairly low cost compared with Mouth flurid rinses for example . *Advantage 8- and excellent patient compliance ( conformity , ). *Advantage 9- it can be used as once weekly to achieve suppression of cariogenic bacteria. 10- it is usually described for young patients especially( before GA's / or if Gingivitis / or high bacterial counts)

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11- 60 sec treatment causes reduction in MO with recolonisation to baseline within 4-6 weeks 12- it can be given to infants , children and even adults 13- it is good for medically compromised patient who undergoes Radiotherapy or [Chemotherapy or patients with Epedermolysis Bullosa] , because all of these patients are suffering from mucosal irritation and it would be better and milder to their soft tisssues to take a non-alcohol product . 14- We can use it also before we put composite filling with children whose high risk carries . # slide 8 :This used to be a CHX Gel , called perioGard , Its not used now anymore , in Jordan we have PerioKen #Slide 9 : CHLOROFLOUR gels: This product contains CHX and fluride together , but they stop producing it nowadays.

*Characteristics: - The ability to adsorb to anionic substances, ex; hydroxyapatite ,pellicle ,salivary glycoproteins, mucous membranes and polysaccharide coats of bacteria, all these are negatively charged , and when adhering to them , the action is prolonged - Then and after a while It causes a slow release that gives a prolonged bacterial effect we call it "substantivity " - And this give 80% reduction in plaque when used as adjunct in oral hygiene " HIGLY EFFECTIVE " 1234Caries preventiom and plaque control In physaccily and mentally handicapped and special needs High caries risk patiens Removable and fixed ortho appliances

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Others : denture stomatitis , post surgery , In periodontal or gingival cases , recurrent oral ulcesr.

Before we use CHX we should do scaling ( remove all dental plaque and calculus ) and polishing to be effective and allow te drug a fair start.

Actions: 1- As we said bactericidal, binds to ve charged bacteria 2- anti-plaque, but it's not effective against the lacto bacilli, it works against the Strep. Mutans. Side effects : 1- staining that can be removed by convential TP ( yellow brown gingival and interproximal sites ) 2- Dulling of taste 3- Increase calculus formation of the soft tissue of the epithelium 4- Desquamation of the epithelium because it contains alcohol

xylitol: -Its a non-cariogenic sugar, it cannot casue caries. -Non sugar sweetener; it tastes sweets but its not a sugar. -it's produced from xylan-beech wood.

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Characteristic of xylitol:

1)Not cariogenic 2)Chewing gum is anti cariogenic ; they found that 93% of children who chew Xylitol gum got a caries reduction. Its either because Chewing process itself stimulate salivary flow and washes away the bacteria and the plaque or other said that it is a protective factor from Xystol itself. 3) Also it inhibit mother-child transmission of bacteria, so if a pregnant mother or a mother that has a baby will reduce bacterial count in her mouth which means it will reduce the transmission to the child. In a research that had made for this it shows that (7175%) caries reduction in 5 children that their moms chew Xylitol regularly for 21 months ( Children age was from 3-24 months ) , plus that children didnt chew it for sure . 4) The explanation for this is that maternal use of xylitol had effected children's probability of being colonized by S.mutans., and that children mostly earn bacteria from their mothers . 5) Its considered more effective in caries reduction than sorbitol and sucrose. 6) Xylitol maybe used in preventive program to reduce caries.

Xylitol disadvantages :

1.The biggest disadvantage of Xylitol is osmotic diarrhea if eaten in large amount, which is 20g per day.(threshold levels would be lower for children. 2. hypoglycemia ( NO EVIDENCE IN HUMANS)
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3.Hyperic-acidic levels in blood which can cause kidney stones 4.Allergies to xylitol which is rare cases. The recommended amount is 6-8 gram per day for dental benefit

Proposed actions of xylitol:

-Plaque: usually affects the MO, reduces plaque quantity,


Strep.mutans reduced, and strains with reduced virulence, participate in futile metabolic cycle. reduce adhesion of plaque flora, and also reduce transmission of bacteria from mother to her baby. -On saliva: it changes the quality and the quantity of it. - On enamel: aid in remineralization.

Xylitol has two mechanisims in reducing the MO :

-The non-specific meshanisim : Because xylitol is mom-fermentable , it doesnt encourage bacterial growth - The specific mechanesims : 1. when MO exposed to xylitol they develop to mutan xylitolresistantstrain which is less virulent 2. it increases the soncentrations of amino acids and ammonia in plaque , and these neutralize plaque acids.

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3. It can act as a bacteriostatic way , some S,M take up xylitol and convert it to xylitol-5-P and expell it out the cell as xylitol which means that it enters a cycle that the bacteria cant make any use of it and this is called "FUTILE CYCLE"

casein phosphopeptide ( CPP ) It is produced by prof Eric Rrynold , and his first product was RECALDENT . -Recaldent (CCP ACB = casein phosphopeptide amorphous calcium phosphate) , derived from casein part of the protein found in cow's milk.

CPP mechanisim of action - each molecue binds to 25 Ca , 15 P and 5 F ions - CPP-ACP increase levels of Ca and P in plaque up to 5 folds , that means ; it increases the level of calcium and phosphate in saliva and concentrate them in ionic form and can adsorb by the tooth into the enamel.. The prposed mecanisim of their anticarioginity is that they act as calcium-phosphate reservoir , helping tp make the saliva supersaturated with Calcium-phosohate which mak it easy to the enamel to adsorb calcium and phosphate , so it is a Demineralizing agent .

Slide #28:

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CPP- Recaldent chewing gum , the ability of it in sugar free gum is to remineralize enamel subsurface lesions , and tis was hsown by Shen . Chewing this gum immediately after brushing with a TP that contains fluride or after apllyiing fluride by the dental profession enhances the reminealizaton activity of the fluride .

Tooth Mousse This was produced in 2005 , you cant find it in pharmacies you can only order it from companies , you can distribute it to patients in your clinic . It is a white product that comes in a different flavors , that can be used as a topical cream on the teeth or you can apply it with a tooth brush . Tooth mousse uses : 1. Its an anticaries agent 2. Remeniralize hypoplastic molars 3. remineralize erosion areas 4. remineralize white spot lesions associated with ortho tx or flurosis . 5. and it can be used in dentine hyper sensitivity . 6. induced into GIC restorations The good thing in It that it can be used in any age , and the dose is not a big deal , it is only contraindicated in patients who has milk allergy ( because all casein products are from milk ) There are two types of it, the first type doesnt contain fluoride then they developed a new type which is called MI paste which contain fluoride (F added to the tooth mousse) and its contraindicated for children under the age of 6 years because of fluride content .

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So the idea is that it will provide the teeth with calcium and phosphate in its ionic form to get adsorbed to tooth surface, its easier for the enamel to adsorb to their ionic forms in the salivary flow ( Ca+2 .. etc )

** Please go back to the slides to read the Instructions and Immunization , the dr only read the slides **

Sundos M. Abuzaid

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