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.
- Cochrane Database of Systematic Reviews, 07/2013;
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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: Declarative Title Improving the efficacy of fluoride therapies reduces dental caries and lowers fluoride exposure. Background Fluoride is delivered to the teeth systemically or topically to aid in the prevention of dental caries. Systemic fluoride from ingested sources is in blood serum and can be deposited only in teeth that are forming in children. Topical fluoride is from sources such as community water, processed foods, beverages, toothpastes, mouthrinses, gels, foams, and varnishes. The United States Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA) have proposed changes in their long standing recommendations for the amount of fluoride in community drinking water in response to concerns about an increasing incidence of dental fluorosis in children. Current research is focused on the development of strategies to improve fluoride efficacy. The purpose of this update is to inform the reader about new research and policies related to the use of fluoride for the prevention of dental caries. Methods Reviews of the current research and recent evidence based systematic reviews on the topics of fluoride are presented. Topics discussed include: updates on community water fluoridation research and policies; available fluoride in dentifrices; fluoride varnish compositions, use, and recommendations; and other fluoride containing dental products. This update provides insights into current research and discusses proposed policy changes for the use of fluoride for the prevention of dental caries. Conclusions The dental profession is adjusting their recommendations for fluoride use based on current observations of the halo effect and subsequent outcomes. The research community is focused on improving the efficacy of fluoride therapies thus reducing dental caries and lowering the amount of fluoride required for efficacy.Journal of Evidence Based Dental Practice 06/2014; DOI:10.1016/j.jebdp.2014.02.004