Slow-release fluoride devices for the control of dental decay
ABSTRACT Slow-release fluoride devices have been investigated as a potentially cost-effective method of reducing dental caries in those with high risk of disease.
To evaluate the effectiveness of different types of slow-release fluoride devices on preventing, arresting, or reversing the progression of carious lesions on all surface types of deciduous and permanent teeth.
We searched (up until February 2005) multiple electronic databases (Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE), bibliographic references of identified randomised controlled trials (RCTs), textbooks, review articles, and meta-analyses. Letters were sent to authors of identified RCTs asking for clarifications and unpublished or ongoing research. Relevant journals were handsearched for more recent reports than those obtained from databases.
Randomised or quasi-randomised controlled trials (RCTs) comparing slow-release fluoride devices with an alternative fluoride treatment, placebo, or no intervention in all age groups. The main outcomes measures sought were changes in numbers of decayed, missing, and filled teeth or surfaces (DMFT/DMFS in permanent teeth or dmft/dmfs in primary teeth) and progression of carious lesions through enamel and into dentine.
Abstracts of all reports identified were considered independently by two review authors and full reports obtained of any potentially relevant articles to allow further assessment for relevance and validity. Data extraction and quality assessment were conducted independently by two and three review authors respectively, with arbitration by the fourth. Where uncertainty existed, authors were contacted for additional information.
Only one trial involving 174 children fully met the criteria for inclusion in this review. Although 132 children were still included in the trial at the 2-year completion point, examination and statistical analysis was performed on only the 63 children who had retained the beads. Thirty-one of these were in the intervention group and 32 in the control group. Amongst these 63 children, caries increment was reported to be statistically significantly lower in the intervention group than in the placebo group (mean difference: -0.72 DMFT, 95% confidence interval -1.23 to -0.21 and -1.52 DMFS, 95% confidence interval -2.68 to -0.36)
There is some evidence of a caries-inhibiting effect of slow-release fluoride glass beads. This evidence is regarded as weak and unreliable because the results were from participants selected on the basis of bead retention rather than an intention-to-treat analysis.
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ABSTRACT: Although the prevalence of caries has decreased dramatically over the past decades, it has become a polarised disease, with most of subjects presenting low caries levels and few individuals accounting for most of the caries affected surfaces. Thus it become evident for the need of clinical approaches directed at these high-risk patients, in order to overcome problems related to compliance and low attendance at dental care centres. Slow-release fluoride devices were developed based on the inverse relationship existing between intra-oral fluoride levels and dental caries experience. The two main types of slow-release devices - copolymer membrane type and glass bead - are addressed in the present review. A substantial number of studies have demonstrated that these devices are effective in raising intra-oral F concentrations at levels able to reduce enamel solubility, resulting in a caries-protective effect. Studies in animals and humans demonstrated that the use of these devices was able to also protect the occlusal surfaces, not normally protected by conventional fluoride regimens. However, retention rates have been shown to be the main problem related to these devices and still requires further improvements. Although the results of these studies are very promising, further randomised clinical trials are needed in order to validate the use of these devices in clinical practice. The concept of continuously providing low levels of intra-oral fluoride has great potential for caries prevention in high caries-risk groups.Journal of applied oral science: revista FOB 09/2008; 16(4):238-46. DOI:10.1590/S1678-77572008000400003 · 0.80 Impact Factor
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ABSTRACT: Porous-wall hollow glass microspheres (PW-HGMs) are a novel form of glass material consisting of a 10- to 100-microm-diameter hollow central cavity surrounded by a 1-microm-thick silica shell. A tortuous network of nanometer-scale channels completely penetrates the shell. We show here that these channels promote size-dependent uptake and controlled release of biological molecules in the 3- to 8-nm range, including antibodies and a modified single-chain antibody variable fragment. In addition, a 6-nm (70-kDa) dextran can be used to gate the porous walls, facilitating controlled release of an internalized short interfering RNA. PW-HGMs remained in place after mouse intratumoral injection, suggesting a possible application for the delivery of anticancer drugs. The combination of a hollow central cavity that can carry soluble therapeutic agents with mesoporous walls for controlled release is a unique characteristic that distinguishes PW-HGMs from other glass materials for biomedical applications. FROM THE CLINICAL EDITOR: Porous-wall hollow glass microspheres (PW-HGMs) are a novel form of glass microparticles with a tortuous network of nanometer-scale channels. These channels allow size-dependent uptake and controlled release of biological molecules including antibodies and single-chain antibody fragments. PW-HGMs remained in place after mouse intratumoral injection, suggesting a possible application for the delivery of anti-cancer drugs.Nanomedicine: nanotechnology, biology, and medicine 08/2009; 6(1):127-36. DOI:10.1016/j.nano.2009.06.004 · 5.98 Impact Factor
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ABSTRACT: To present the evidence summarized in the Cochrane fluoride reviews. An overview of the results of selected systematic reviews. Relevant systematic reviews published in the Cochrane Database of Systematic Reviews (CDSR) were identified by searching 'The Cochrane Library issue 4, 2008', using the terms 'Fluoride' and 'Caries'. Complete Cochrane reviews assessing the effectiveness of any fluoride-based intervention for preventing caries were selected, and their main features and findings were reviewed. 14 papers were identified of which 11 were relevant full-text reviews. The results were assessed of 7 reviews published from 2002 to 2004 concerning the relative effectiveness of 4 topical fluoride treatments (toothpastes, gels, varnishes and mouthrinses) in preventing caries in children and adolescents. Comparisons in these reviews were made against non-fluoride controls, against each other, and against different combinations. Findings from 4 reviews published between 2004 and 2006, assessing other fluoride modalities (slow release devices, milk), specific comparison/site (fluoride varnishes versus sealants in occlusal surfaces), and particular population and caries outcome (fluorides for white spot lesions in orthodontic patients) were also assessed. The 7 reviews confirm a clear and similar effectiveness of topical fluoride toothpastes, mouthrinses, gels and varnishes for preventing caries, and show that additional caries reduction can be expected when another topical fluoride is combined with fluoride toothpaste. Evidence is insufficient to confirm the effectiveness of slow release fluoride devices and fluoridated milk. The comparative effectiveness of other modes of delivering fluoride, such as to orthodontic patients is also as yet unclear. Fissure sealants appear more effective than fluoride varnish for preventing occlusal caries but the size of the difference is unclear. The benefits of topical fluorides are firmly established based on a sizeable body of evidence from randomized controlled trials. The size of the reductions in caries increment in both the permanent and the primary dentitions emphasizes the importance of including topical fluoride delivered through toothpastes, rinses, gels or varnishes in any caries preventive program. However, trials to discern potential adverse effects are required, and data on acceptability. Better quality research is needed to reach clearer conclusions on the effects of slow release fluoride devices, milk fluoridation, sealants in comparison with fluoride varnishes, and of different modes of delivering fluoride to orthodontic patients.European Archives of Paediatric Dentistry. Official Journal of the European Academy of Paediatric Dentistry 09/2009; 10(3):183-91. DOI:10.1007/BF03262681