Effect of 5% fluoride varnish application on caries among school children in rural Brazil: a randomized controlled trial
ABSTRACT To determine the efficacy of 5% sodium fluoride (NaF) varnish application in reducing caries increments in the permanent dentition of rural Brazilian school children over the course of 12 months.
A double-blind, randomized, placebo-controlled trial was conducted with 379 children aged 7-14 years who attended three schools in Brazil between January 2006 and December 2007. During this period, each school was visited four times at 6-month interval for recruitment, dental examinations, and fluoride varnish applications. Recruited children were randomly assigned to either a treatment (5% NaF varnish, n = 198) or a control group (placebo, n = 181). Trained interviewers collected data on oral health habits and sociodemographic characteristics from the children. Information on the child's diet was collected through a 7-day food frequency diary. Caries examinations were conducted using the International Caries Detection and Assessment System (ICDAS). The efficacy of fluoride varnish application on caries prevention was reported as a preventive fraction (PF). Crude caries increments of decayed and filled surfaces (DFS) were compared between fluoride varnish and placebo groups. A generalized linear model (GLM) was constructed to test the differences in DFS increments between the groups after accounting for confounding factors.
Of the total sample (N = 379), 210 (55.4%) children had completed 12 months of follow-up including one or two applications of fluoride varnish or placebo. At the baseline examination, the children in the treatment and control groups presented on average 6.2 and 5.6 DFS, respectively (P < 0.001). After 12 months of follow-up, the children in the varnish group showed significantly lower DFS increments than did children in the control group (10.8 versus 13.3; P < 0.007), with PF of 40% (95% CI: 34.3-45.7%; P < 0.0001).
The results of this study suggest that applications of 5% NaF varnish can be recommended as a public health measure for reducing caries incidence in this high-caries-risk population.
SourceAvailable from: Hatem El-Damanhoury[Show abstract] [Hide abstract]
ABSTRACT: Objective: To assess the feasibility of teaching International Caries Detection and Assessment System (ICDAS) II and its e‑learning program as tools for occlusal caries detection to freshmen dental students in comparison to dental graduates with 2 years of experience. Materials and Methods: Eighty‑four freshmen and 32 dental graduates examined occlusal surfaces of molars/ premolars (n = 72) after a lecture and a hands‑on workshop. The same procedure was repeated after 1 month following the training with ICDAS II e‑learning program. Validation of ICDAS II codes was done histologically. Intra‑ and inter‑examiner reproducibility of ICDAS II severity scores were assessed before and after e‑learning using (Fleiss’s kappa). Results: The kappa values showed inter‑examiner reproducibility ranged from 0.53 (ICDAS II code cut off ≥ 1) to 0.70 (ICDAS II code cut off ≥ 3) by undergraduates and 0.69 (ICDAS II code cut off ≥ 1) to 0.95 (ICDAS II code cut off ≥ 3) by graduates. The inter‑examiner reproducibility ranged from 0.64 (ICDAS II code cut off ≥ 1) to 0.89 (ICDAS II code cut off ≥ 3). No statistically significant difference was found between both groups in intra‑examiner agreements for assessing ICDAS II codes. A high statistically significant difference (P ≤ 0.01) in correct identification of codes 1, 2, and 4 from before to after e‑learning were observed in both groups. The bias indices for the undergraduate group were higher than those of the graduate group. Conclusions: Early exposure of students to ICDAS II is a valuable method of teaching caries detection and its e‑learning program significantly improves their caries diagnostic skills.European journal of dentistry 10/2014; 8(4):493. DOI:10.4103/1305-7456.143631
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ABSTRACT: Contributing Author: June 2nd-5th, 2013- Participated 25 hours as a nationally elected member for King’s College London workshop that inaugurated the Global Collaboratory for Caries Management (GCCM). International Caries Classification and Management System (ICCMS™), Manual of Clinical Recommendations for Caries Management for Practitioners and Educators, 2013.King’s College London workshop that inaugurated the Global Collaboratory for Caries Management (GCCM), London, England; 06/2013
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ABSTRACT: Objectives To evaluate approximal caries increment among 12- to 16-year-olds in a low caries prevalence area in Sweden after a 3.5-year school-based fluoride (F) varnish programme with Bifluorid 12 and Duraphat. Methods The design was a RCT study with 1365 adolescents, divided into following four groups: Group 1 Bifluorid 12 two applications/year; Group 2 Duraphat two applications/year; Group 3 Bifluorid 12 four applications/year and Group 4 no F varnish at school. 1143 children (84%) completed the study. Approximal caries was registered on bitewing radiographs. ResultsThere were no statistically significant differences in caries prevalence among the groups either at baseline or after 3.5years . The caries increment for Group 1 was 1.342.99 (mean +/- SD), 1.24 +/- 2.84 for Group 2, 1.07 +/- 2.66 for Group 3 and 1.25 +/- 2.75 for Group 4, with no statically significant differences either between Bifluorid 12 and Duraphat with the same frequency of F varnish applications or between the F groups and the control group. Conclusions In an area with low caries prevalence in Sweden, the supplementary caries-preventive effect of school-based F varnish applications, to regular use of F toothpaste at home and to regular caries prevention given at the Public Dental Clinics, appears to be nonsignificant regarding approximal caries increment.Community Dentistry And Oral Epidemiology 05/2014; 42(5). DOI:10.1111/cdoe.12108 · 1.94 Impact Factor