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