● Woodbury rubber dam frame provides more retraction of soft tissue .

When placing rubber dam

● Always isolate at least 3 teeth
● For a tooth bearing a clamp the hole should be one size larger than the holes over teeth
without a clamp.
● To prevent seepage of saliva use a floss to inverte rubber dam into gingival sulcus.

Sealants
● decreased progression of preexisting lesions.
● Retention rate for chemically cured and light cured sealants are similar.
● Low viscosity sealants wet the best.
● Sealants most retained on max and mand premolars
● Most teeth benefit from sealants are max and mand 1st molar

Component of sealants
● Bis-GMA diluted with TEGDMA
● Initiator :benzoyl (self cured) or Diketone (light cured)
● Accelerator: amine
● Opaque filler :titanium oxide(TiO2)

● If topical fluoride is used in conjunction with sealants the fluoride is applied after the
sealants.

When applying sealants:

● Don't use anything contain fluoride when cleaning .

Fluoride:
● To prevent caries at least 0.7ppm of fluoride be present in water,maximum is 1.2ppm.
● The optimal concentration of Fluoride for community water depends on air temperature .
● Fluoride added to water are:
● 1-sodium fluoride
● 2-sodium silicofluoride
● 3-hydrofluosilicic acid.

Professional applied topical fluorides:

● Applied 2 times a year
● 2% sodium fluoride ,advantages are basic ph 9.2 ,more acceptable taste than stannous
fluoride ,no adverse effect on restorative materials .
● 8% stannous fluoride advantages it does not etch porcelain restoration and requires
single visit disadvantages are ,bad taste,stain silicate restorations,acidic ph 2.1-2.3
● Stannous fluoride is not used in any approved dentifrices in the US.
 ● 1.23% acidulated phosphate fluoride has more acceptable taste,it may damage
porcelain restorations,applied by dentist!! ,acidic ph-3-3.5,contraindicated on porcelain
and composite restoration,cause pitting and etching,avoided on implant patients can
corrode the surface of titanium implants.
● Fluoride mouth rinses are shown to have greatest effect on newly erupted teeth .
● Fluoride rinses are most beneficial to smooth tooth surfaces .
● Systemic fluorides are least effective on root surfaces.
● The greatest concentration of fluoride ions exist on the outermost layer of enamel.
● Dicalcium Phosphate,calcium carbonate,silica (abrasives in toothpaste) inactivate
fluoride ions.

Acute fluoride toxicity symptoms may appear 30 mint of ingestion and persist for up to 24hrs
● Symptoms
○ Nausea
○ Vomiting
○ Diarrhea
○ Abdominal cramping
● Fluoride mainly eliminated via kidneys
● Deposited in skeletal muscles .
Acute fluoride poisoning is rare but most common cause of death are cardiac failure respiratory
paralysis.
Lethal dose
● Child
○ 15 mg/kg can be lethal
○ Lethal dose range 20-50mg/kg
● Adult
○ 4-5 gram
○ Range 2.5-10gram
Fluoride supplement are recommended if water fluoride content is <0.7ppm
● Fluoride supplement are normally not indicated after age 13 .
● School water fluoridation optimal concentration is 4.5X that of the city water supplies.
● A child should stop taking fluoride supplement at 16-18 years old.
● Elementary school children have high interproximal caries rate so fluoride mouth rinses
are recommended .
● In communities without fluoridated water ,,school water fluoridation is the best option .
● Fluorides are recommended to protrct cancer patients from post irradiation caries as
toothpaste fluoride not adequate .
● Sodium fluoride past for root sensitivity contains:
○ Sodium fluoride
○ Kaolin
○ Glycerin
●