Card Set Information
What did McKay do?
observed "CO brown stain" (90% fluorosis)
consulted GV Black
: Mottled enamel: developmental imperfection
other reports seemed geograpically localized
McKay suspected H20
Oakley, Idaho - new pipeline coincided w/ fluorosis (1908), 1923 McKay suggest new H2O source 10 years later no more fluorosis (still didn't know it was Floride though)
What was the initial dilemna of mottled enamel?
Hypocalcified yet not susceptible to decay
What happened in Bauxite, Arizona?
ALCOA, Bauxite kids w/ mottled enamel, 5 miles away normal
ALCOA chemist-> HIGH FLORIDE CONTENT (seemed normal to McKay)
What did Dean do?
recorded prevalence and severity of mottled enamel relative to [F] in H2O
discovered dose-response relationship
[F] up to 1ppm, mottling isn't a concern
What did they do in Grand Rapids, MI?
1945: adjust it's water supply [F]
What are some dental controversies?
Hg in amalgam
Bis-Phenol A in sealants
What does scientific evidence say about Floridated water?
safe & effective
single most effective public health measure to prevent decay
benefits everyone espicially w/o access
What is optimal Fluoride range?
ok for environment and people
mild to very mild fluorosis, cosmetic concern
severe and moderate is rare (well water, outside US)
What is fluorosis prevalence in 6-49 yr olds?
less than 1/4
prevelence in younger is higher(multiple F sources) yet still mild/very mild
What are the issues with Fluoridated Water?
Ethics, safety, efficacy
compulsory mass meds
brain damage/ reduced IQ
inc fracture, bone CA
topical not systemic
What is the pathogenesis of fluorosis?
Normal pre-eruption enamel:
1. protein rich, 20% mineralized, seeded w HA crystals
2. matrix proteins break down->replaced by Ca & PO4
3. Matures slowly into highly (96%) mineralized tissue via crystalization (years)
1. slows breakdown of matrix proteins or removal of proteins by by-products
2. Retards crystal growth
3. Hypomineralized enamel (normal ameloblasts & proteins)
4. NO HYPOPLASTIC CHANGES (pitting occurs post-eruption)
Porosity in outer zones of enamel
How does hypomineralized enamel resist decay?
: enamel takes up additional Ca & PO4 fromsaliva
Fluoroapatite is more resistant to dissolution than HA
Why is Fluorisis brown?
exogenous (foods/porous enamel stain prior to post-eruption maturation)
What is the difference between fluorosis and white spot caries lesions?
NOT limited to areas of plaque accumulation
What is the THylstrup Fejerskov (TF) index?
ID the spectrum of mildest(TF1) to most severe(TF9) fluorosis.
What are the CDC descriptors?
Very mild & mild
: scattered white flecks, occasional white spots, frosty edges, barely noticeable
: large white spots
: roug, pitted(brown) spots
What are some treatments for Fluorosis?
What is the enamel Microabrasion process?
: pumice & HCL
controlled removal of outer enamel
: Opalustre (Ultradent), Prema (Practicon)
: patient eye protection, rubber dam, prophy cup (low RPM), 60 sec, rinse, assess contour, repeat
Zacatecas Mx patient
(brighter when dehydrated)
How does demineralization affect optical properties of enamel?
less transluscent & more reflective = white spot
What is MI paste?
Amorphous Calcium Phospate stabilized by Casein Phosphopeptides (CPP-ACP)
drives minerals deep into white spot to regain natural coloring/optical properties
may be used with microabrasion