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Correct Answer: all calculus must be removed from her teeth prior to fluoride application.
to provide a detailed explanation of the question presented, let's break down the situation and the options provided. the patient in question has significant calculus (tartar) on her teeth and seeks a professionally applied fluoride treatment. understanding the relationship between calculus, plaque, fluoride, and the efficacy of fluoride treatment is crucial in determining the correct approach.
calculus is a hard deposit that forms on the teeth when plaque is not removed and mineralizes over time. it is primarily composed of calcium phosphate and calcium carbonate, and its presence can lead to gum diseases and provide a rough surface that attracts more plaque. because calculus is calcified and hard, it acts as a barrier, preventing topical agents such as fluoride from penetrating and reaching the underlying enamel or dentin surfaces where they are most needed.
fluoride treatments are used to strengthen tooth enamel, making it more resistant to decay. for fluoride to be effective, it needs direct contact with the teeth's surfaces. therefore, any barrier, such as calculus, can significantly diminish the effectiveness of the fluoride treatment. this is because fluoride cannot penetrate the hard layers of calculus, and thus cannot reach the enamel or dentin to exert its protective effects.
looking at the options provided:
- **she may have fluoride applied immediately.** this statement would not be entirely correct since the presence of significant calculus can hinder the effectiveness of the fluoride treatment. immediate application without removing calculus would not be ideal.
- **all calculus must be removed from her teeth prior to fluoride application.** this is the most accurate and appropriate option. removing calculus ensures that fluoride can directly contact the tooth surfaces, allowing for maximum efficacy of the fluoride treatment. this option recognizes the barrier that calculus forms and addresses the need to eliminate this barrier for effective treatment.
- **all calculus and all plaque must be removed from her teeth prior to fluoride application.** while removing both calculus and plaque would ideally prepare the teeth for fluoride application, focusing on calculus is particularly crucial because unlike plaque, calculus is a solid barrier that fluoride cannot penetrate. plaque, although undesirable, is a softer deposit that fluoride can penetrate more easily.
- **this patient should not have professionally applied fluoride treatment.** this option is incorrect as the presence of calculus does not contraindicate the use of fluoride; it only necessitates prior removal of calculus.
in conclusion, the best practice for a patient with significant calculus seeking fluoride treatment is to first undergo a thorough dental cleaning to remove all calculus. this allows the fluoride to contact the teeth directly, thereby working effectively to strengthen the enamel and prevent dental caries. therefore, the correct answer is "all calculus must be removed from her teeth prior to fluoride application."
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