Caries Prevention and Advice: 

See preventative pathway flowchart In 'Paediatric Pathways' 

Fluoride 

Fluoride overdose in a child: 

• The following shows the concentration of fluoride in water supply, in order of increased risk of mottling (1). 
  • <0.9 ppm 
  •  0.9 ppm 
  • 2 ppm 
  • 2+ ppm 
• Safe dose =  1mg/kg body weight. 
• Unsafe dosage which can be lethal =  5mg/kg body weight 
  • Requires hospital admission.  
  • If <5mg/kg - given milk 
  • If 5mg+/kg - gastric levage 
• Lethal dose = 32-64mg/kg body weight. 
• Primarily, we aim to provide a safe amount of fluoride without causing fluorosis or systemic effects.

Doses: 

• Toothpaste: 1000ppm F = 1mgF/ml 
• Toothpaste: 1500ppm F = 1.5mg F/ml 
• Daily fluoride mouth rinse  0.05% NaF = 0.023% F = 0.23mg F/ml (note weekly mouthrinse = 0.2% NaF) 
• Fluoride varnish 22,600ppm  5% NaF = 2.26% F = 22.6mg/ml 
• High Fluoride toothpastes: 
  • 2800ppm = 0.619% NaF 
  • 5000ppm = 1.1% NaF  (2)

Other Advancing Treatments: 

ICON

• This is a clear resin composite or resin infiltrate.  
  •  ICON is recommended to treat carious white spot lesions reaching up to the outer third of dentine. 
  • Consists of 15% HCl acid, ICON dry (99% ethanol) and ICON infiltrate (methacrylate-based resin) (3)

SDF

• SDF = silver diamine fluoride 
  • Contains ionic silver, fluoride and ammonium. 
• Alternative to fluoride varnish – used as a preventative measure.  
• Can be used to arrest early carious lesions and help treat dentine hypersensitivity.  
• Is thought to make a fluoride reservoir within tooth structure and help promote remineralisation.  
• Disadvantage: may cause staining of lesion.  

CPP-ACP

• CPP-ACP is more commonly known as 'Tooth mousse'. It is a calcium phosphate topical cream.
• Therefore, it does not contain fluoride- so some patients may prefer this.
• It not available on prescription in the UK and can be expensive.
• Can be used at home - applied daily with finger post brushing. 
• There is some evidence for the use of CPP-ACP.
  • Some evidence that is good for use in orthodontics for treatment of white spot lesions.
  • It anecdotally reduces sensitivity also and supposedly increases mineralisation.