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Fluorides and Other Preventive Strategies for Tooth Decay
Abstract
We focus on scalable public health interventions that prevent and delay the development of caries and enhance resistance to dental caries lesions. These interventions should occur throughout the life cycle, and need to be age appropriate. Mitigating disease transmission and enhancing resistance are achieved through use of various fluorides, sugar substitutes, mechanical barriers such as pit-and-fissure sealants, and antimicrobials. A key aspect is counseling and other behavioral interventions that are designed to promote use of disease transmission-inhibiting and tooth resistance-enhancing agents. Advocacy for public water fluoridation and sugar taxes is an appropriate dental public health activity.
... The threshold pH value is the value when solution (saliva or any liquid) or beverage is saturated with mineral particles of enamel. When the pH value of the beverage is below 5.5 causes demineralization of the enamel because the beverage is not saturated [5,6]. Other hand, when the pH value of the solution/beverage is more than the threshold pH value of 5.5 leads to remineralization/biomimetic synthesis due to the solution is considered oversaturated [7]. ...
... In previous studies, direct immersion of enamel sample in beverage was done in vitro setting [4,5]. But, in this present study, a simulation of intraoral conditions could be achieved with the help of a customized digital automatic flusher was developed by INVOLUTE Tech Limited, Dhaka, Bangladesh. ...
... Demineralization and remineralization have a crucial effect on the hardness and strength of tooth enamel [5,6]. It is considered that the strong and healthy tooth structure depends upon the ratio between demineralization and remineralization [7]. ...
Introduction: Due to the presence of ion reservoir, saliva may facilitate enamel remineralization and neutralize pH of acidic beverage leads to prevent enamel demineralization. Saliva substitute/artificial saliva has been developed in subsequent years and may differ in physical properties, function, or pH level from 5.0 to 7.3.
Objectives: To evaluate the biomimetic effect of saliva (neutralization) on tooth enamel exposed to carbonated beverage (pH 2.44) and to observe therapeutic capability (remineralization) of artificial saliva over previously eroded (grade 3 and grade 5) enamel surface.
Methods: After scanning with electron microscope (SEM-EDX), nondemineralized crown samples (n = 40) were randomly grouped into two. Samples (50%) were flushed all around to carbonated beverage with collected natural saliva bathing simultaneously (experimental group, n = 20), and the rest flushed to beverage only without saliva bathing simultaneously (control group, n = 20). Flushing action was performed for 3 min by a customized digital automatic flusher for 30 times for each sample. Samples (n = 40) were further scanned under SEM-EDX to evaluate the demineralization grade and concentration of Ca, P, O, and C elements of crown samples to find out the neutralization effect of saliva. In the second phase, already demineralized crown samples (n = 30) were randomly treated with artificial saliva having two different pH (7 or 6.8, experimental groups) and distilled water (control group) for 15 min 3 times daily for 30 days. The remineralization score of experimental samples was graded, and therapeutic capability was established.
Results: Samples, when exposed to a carbonated beverage with saliva bathing simultaneously, showed low level of demineralization (mean 2.9 ± 0.3) than the control (without saliva) (mean 4.8 ± 0.3) (p=0.01) which indicated neutralization (bioimimetic) effect of natural saliva. All (100%) of demineralized samples treated with both artificial saliva (pH 7 or pH 6.8) showed significant remineralization (p=0.01), thus revealed biomimetic capacity. SEM-EDX analysis showed initial (before beverage exposure) concentrations of calcium, phosphorus, oxygen, and carbon elements of crown samples were 32.48%, 31.5%, 28.3%, and 5.5%, respectively. The calcium (Ca) (9.7%) and phosphorous (P) (18.5%) values were more decreased after beverage exposure without saliva bathing simultaneously compared to after beverage exposure with saliva bathing simultaneously. The concentration of oxygen (54.4%) and carbon (15.5%) were more increased after beverage exposure without saliva bathing simultaneously compared to after beverage exposure with saliva bathing simultaneously. Though the concentration of calcium (38.5%) of the crown sample was increased after treatment with artificial saliva (pH 7), but the phosphorus (18.5%) concentration of the crown sample was not increased.
Conclusion: Within the context of the present study, both natural and artificial saliva showed significant biomimetic effects with respect to neutralization and remineralization.
... Carious lesions are the clinical expression of a disease in which dental plaque bacteria metabolize sugar both into polymeric substances that stabilize its adherence to teeth as well as into acids that demineralize the hard tissues of teeth. [1] Dental caries are the result of a dynamic process of decay characterized by alternating cycles of demineralization and remineralization. [2] The dynamic relationship between host behavior and the microbiome is influenced by modern lifestyles such as diet, tobacco use, and stress. ...
... [5] Silver diamine fluoride (SDF) is a topical treatment for carious lesions and a primary preventative for recently exposed high-risk surfaces such as fissures and roots. [1,6] This compound contains twice the fluoride concentration (~5%) of the fluoride found in varnish, with 25% w/v silver ions (Ag+) and 8% ammonia in water. [1] The antimicrobial effect of SDF: The Ag + contained in SDF has been shown to exert an antibacterial effect: While metallic silver (Ag) is relatively inert, it can interact with moisture in the oral environment and release silver ions (Ag+). ...
... [1,6] This compound contains twice the fluoride concentration (~5%) of the fluoride found in varnish, with 25% w/v silver ions (Ag+) and 8% ammonia in water. [1] The antimicrobial effect of SDF: The Ag + contained in SDF has been shown to exert an antibacterial effect: While metallic silver (Ag) is relatively inert, it can interact with moisture in the oral environment and release silver ions (Ag+). In turn, these produce the following antibacterial effects: Destruction of the cell wall structure, denaturation of bacterial cytoplasmic enzymes, inhibition of bacterial DNA replication, and interaction with the reactive side chain of bacterial collagenase, thereby inactivating catalytic functions. ...
Introduction
Silver diamine fluoride (SDF) is a topical treatment for carious lesions and a primary preventative for newly exposed high-risk surfaces such as fissures and roots in the first molars. Using potassium iodide (KI) after applying SDF has been recommended as a way of reducing the severity of black staining, as well as preserving its antibacterial effect useful in deep caries.
Objective
The objective of this research was to compare the antibacterial effect of SDF, with and without KI, on Streptococcus mutans ( S . mutans ) and dental biofilm.
Methods
The antibacterial effects of SDF, KI, and the combination of both were measured using three different techniques (inhibition halo, minimum inhibitory effect [MIE], and colony-forming unit [CFU], testing).
Results
The results were then subjected to statistical analysis. Analyzed by means of the Kruskal–Wallis statistical test, the inhibition halos yielded a value of P = 0.3309. Using the MIE test, only the SDF treatment produced an antibacterial effect, at 10%, compared to the KI group, with P = 0.001. Finally, the CFU test revealed a total absence of colonies for all three reagents. All three substances analyzed achieved total inhibition of S . mutans . SDF is effective even in its minimal commercial concentration. Its antibacterial capacity decreases with the addition of KI.
Conclusions
The three substances analyzed at their maximum concentrations exhibited an antibacterial effect against S . mutans , resulting in total inhibition.
... Recurrent caries, often occurring at the sites of existing restorations, further contribute to the problem [10-15]. On the other hand, regular and daily use of dental floss, fluoride toothpaste, professional dental care, fluoride mouth rinses, and varnish, especially for high-risk individuals, reduces the risk of tooth decay [16]. ...
... Although numerous studies have examined the prevalence of permanent tooth decay (PTD), along with its risk and protective factors at both global and regional levels, there is currently no research predicting the future incidence rates of this condition [16]. Consequently, forecasting the future quantity of this issue can better equip health system planners and policymakers to address its complications. ...
The aims of this research were to examine the temporal trends in Caries of permanent teeth incidence at the global level from 1990 to 2021 and to forecast caries experience to 2030. Data on permanent tooth decay (PTD) were extracted from the Global Burden of Disease (GBD) 2019 study. Generalized additive model was used to predict permanent tooth caries incidence until 2030. Additionally, the average annual percentage change (AAPC) index that computed in Joinpoint Regression Software was used to evaluate the temporal trends of PTD age-adjusted incidence rates during 1990–2021 and 2022–2030. Worldwide, the PTD age-adjusted incidence rate increased from 28,154 per 100,000 populations in 1990 to 29,896 per 100,000 in 2021. The PTD age-standardized incidence rate is predicted to increase slightly to 30,414 per 100,000 (95% credible interval (CrI): 126177 to 34,651). We predicted that the incidence of PTD in women and men will increase to 30,488 and 30,288 cases per 100,000 populations in 2030, respectively. The PTD incidence rate is predicted to increase in the next decade. Due to the extent of this problem in all subgroups of age, gender and countries, public health policies to prevent this health consequence should be expanded in all subgroups and societies.
... While dental caries can be prevented using sealants and fluorides, tooth decay can be prevented through diet. The growth of oral bacteria is fostered by highly refined carbohydrates and sugars [38]. Many children are hooked to sugar, and children with SHCNs frequently lack the cognitive capacity to control their consumption. ...
... Its high fluoride composition facilitates more effective diffusion into dentin and enamel with staining as its only known side effect [58]. Additional delivery approaches, such as fluoride rinses, foams, gels, and high-fluoride toothpastes, have been developed to maximise the prevented fraction of caries lesions and minimise the application frequency and duration of fluoride [38]. All of these interventions need to be age-appropriate and should be helpful for clinicians to assess and use, fully conscious of the side effects of fluoride when delivering care for these Children with SHCNs. ...
Children with Special Health Care Needs (SHCNs) have poor oral health as a result of structural and systemic barriers. These children frequently have limited access to dental treatment, a higher prevalence and incidence of dental problems, and worse oral hygiene than the rest of the population. This review aims to offer an understanding of the existing oral care barriers of children with SHCNs. We reviewed the literature on children with SHCNs and their caregivers to identify the implications of the barriers faced by these individuals. Some of the perceived barriers to appropriate oral healthcare faced by these children include obstacles to adequate oral care and hygiene in the home, challenging behaviours, and limited preventive care and accessibility. We focussed on interventions and different management approaches to support the stakeholders responsible for these children. There is a need for strong communication as well as care coordination between caregivers, dentists, and other providers to achieve positive outcomes. The current dental healthcare system appears to desert the needed demands of this demographic.
... is widely available in concentrations of 0.2, 0.12, and 0.1%, as well as in low concentrations of ≤0.06% rinse. 10,16 The effectiveness of chlorhexidine preparation on the oral biofilm is largely dependent on its dosage (Keijser et al.). 17 The maximum dose of chlorhexidine mouthwash preparations is calculated to be 20 mg two times daily, which equals 10 mL of 0.2% chlorhexidine mouthwash (20 mg) or 15 mL of 0.12% chlorhexidine mouthwash (18 mg) (Keijser et al. 2003). ...
... Our study aimed at estimating and comparing the efficacy of 0.12% chlorhexidine mouthwash with herbal mouthwashes, specifically cardamom (0.5%) and green tea (0.5%) mouthwashes, both alcohol-based and alcohol-free, against S. mutans. 16 Chlorhexidine gluconate is utilized in a variety of preparations such as mouthwashes, irrigants, medicaments, varnishes, gelbased agents, and sprays. Chlorhexidine gluconate mouthwash Lactobacilli such as Lactobacillus acidophilus, Lactobacillus casei, and Actinomycetes species such as Actinomyces viscosus, Actinomyces naeslundii are also involved in the caries process. ...
Aim
The in vitro study aimed to evaluate and compare the antimicrobial efficacy of Elettaria cardamomum (0.5%) mouthwash, Camellia sinensis (0.5%) mouthwash, and 0.12% chlorhexidine gluconate mouthwash against Streptococcus mutans.
Materials and methods
A total of 60 samples of the five mouthwash preparations were prepared to check for their antimicrobial efficacy. The zone of inhibition (ZOI) against S. mutans was measured as a diameter in mm, and the minimum inhibitory concentration (MIC) of mouthwash preparations was measured as μg/mL. All the groups were compared statistically using the Mann–Whitney U test and the Kruskal–Wallis test.
Results
The highest ZOI was observed in group V chlorhexidine gluconate [mean: 20.8, standard deviation (SD): 0.58], followed by group III C. sinensis (alcohol-free) (mean: 15.5, SD: 0.67), group IV C. sinensis (alcohol-based) (mean: 14.08, SD: 0.66), and group II E. cardamomum (alcohol-based) (mean: 13.2, SD: 0.45). The least ZOI was observed in group I E. cardamomum (alcohol-free) (mean: 10.7, SD: 0.45). This difference was statistically significant (p < 0.01). The MIC was similar in all the groups (p = 0.13).
Conclusion
Chlorhexidine gluconate 0.12% mouthwash showed the best antimicrobial action; however, C. sinensis mouthwash showed potential against S. mutans. E. cardamomum mouthwash exhibited limited antimicrobial activity.
How to cite this article
Deolikar S, Jawdekar A, Saraf T, et al. Comparative Evaluation of the Antimicrobial Efficacy of Elettaria cardamomum (0.5%) Mouthwash, Camellia sinensis (0.5%) Mouthwash, and 0.12% Chlorhexidine Gluconate Mouthwash against Streptococcus mutans: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(4):461-466.
... La eficacia de cualquier medida de prevención dental, incluyendo el uso de pastas dentales con flúor, depende en gran medida de la información y la educación adecuada proporcionada a la población7. Los padres y cuidadores desempeñan un papel fundamental en la elección de productos de higiene bucal para sus hijos, y su conocimiento sobre las opciones disponibles puede influir directamente en la elección de un dentífrico adecuado 5,8,9 . Por lo tanto, la información precisa sobre higiene bucal es esencial para garantizar que los niños estén utilizando productos que se ajusten a sus necesidades y contribuyan a una salud bucal óptima. ...
... En Perú, el mercado de productos de higiene bucal es diverso, ofreciendo una amplia gama de pastas dentales las cuales por norma legal están obligadas a adicionar fluoruros dentro de su composición y a estar debidamente rotuladas; así como su promoción y publicidad, debe indicar que el flúor es importante para prevenir la caries dental, pero que no garantiza su prevención ni controla la formación de placa bacteriana por sí solo 10,11 . La variedad de opciones disponibles para los consumidores puede generar dudas sobre cuál es la más adecuada, especialmente para los padres que buscan lo mejor para la salud de sus hijos 5,10 . Promover los beneficios de una pasta dental con concentraciones adecuadas de flúor es fundamental, ya que puede ayudar a guiar a los padres y/o cuidadores hacia elecciones más informadas y beneficiosas para la salud bucal de sus niños 3,6,10 . ...
Introduction:
this study aimed to analyze the relationship between access to information from parents and/or caregivers about oral hygiene and the fluoride concentration in toothpaste chosen for Peruvian children under 12 years old.
Methods:
this cross-sectional study used data from the "Demographic and Family Health Survey" in Peru to analyze 63,849 children under 12 years old from 2018 to 2022. Chi-square test and Poisson regression with robust variance were applied to assess the relationship between the main variables considering associated factors such as the information provider, year, age, region, and area of residence.
Results:
it was found that 57% of children with access to information used toothpaste with an adequate concentration of fluoride, while the public sector health services (36%), private sector health services (7.9%), and media (6.5%) were the most influential sources of information in the choice of toothpaste with adequate concentration. A statistically significant relationship was also found between the variables access to parental information and /or caregivers on oral hygiene and Fluoride concentration used in toothpaste for children (p < 0.001).
Conclusion:
there is a positive influence of parents’ and/or caregivers’ access to information about oral care on the use of toothpaste with adequate fluoride for their children under 12 years of age in Peru. Furthermore, information providers such as the private sector health services, public sector, and media have a significant impact on its use.
... 9 They prevent caries, inhibit demineralization, reinforce remineralization, and reduce the metabolic activity of bacteria and the enamel permeability. 10,11 However, one of the limitations in their use is that fluorides have limited effectiveness in preventing mineral loss due to caries disease. The calcium fluoride layer formed during topical application tends to be gradually dissolved by acidic activity from the diet. ...
... The most common and efficient strategy for reducing enamel demineralization is toothbrushing with a fluoride toothpaste. 11,30,31 Fluoride replaces the hydroxyl ions in apatite structure, forming fluorapatite. This process enhances the enamel hardness, as demonstrated in the present study, and makes it more acid resistant. ...
Objective This study evaluated the effect of incorporating biosilicate (Bio) particles into experimental toothpaste (ET) on their abrasiveness and remineralization capacity for white spot lesions (WSLs).
Materials and Methods Thirty-two fragments of bovine teeth (6 × 6 × 2 mm) were obtained. Initial microhardness (Knoop hardness number [KHN], HMV Microhardness Meter, Shimadzu) and surface roughness (Rugosimeter Surfcorder SE 1700) readouts were performed. Fragments were submitted to a cariogenic challenge to simulate WSLs and then divided into four groups: Control, conventional toothpaste (Colgate Smiles, Colgate-Palmolive Company); ETF, ET with fluoride (carboxymethylcellulose + glycerol + thickening silica + fluoride); ETB, ET with Bio; BS, biosuspension (10 in weight% Bio). Toothpaste treatments were performed through simulated toothbrushing (Pepsodent, MAVTEC, 14,600 cycles). BS was applied by immersion for 8 hours followed by 16 hours in artificial saliva at 37°C for 60 days, totalizing 1,440 cycles. After treatments, final KHN and surface roughness readings were performed, and scanning electron microcopy (SEM) was conducted (Jeol JSM-6610LV) for morphological analysis. Data were analyzed with one-way analysis of variance, Tukey's test (p < 0.05).
Results BS produced the least surface roughness change, different (p < 0.05) from all the other groups. ETB caused higher KHN than ETF (p < 0.05). SEM images revealed that ETB and BS resulted in abraded surfaces with deposition of particles.
Conclusion ETB resulted in similar abrasiveness to the control group, and it caused higher microhardness than the ETF.
Practical Implication Considering its higher KHN, ETB could be considered a proper alternative for the treatment of WSLs.
... These two interventions utilize glass-Ionomer or bioactive glass in order to repel bacterial plaque and re-mineralize tooth surfaces for the prevention of dental caries [35,42]. As sugar consumption is a major dietary contributor to the cause of dental caries, the use of sugar reduction approach in policy or dietary regulation has shown to be effective in reducing the caries incidence [12,13,43]. Public health resources should therefore be prioritized to the prevention of dental decay among children and adolescents with evidenced-based approaches [43]. ...
... As sugar consumption is a major dietary contributor to the cause of dental caries, the use of sugar reduction approach in policy or dietary regulation has shown to be effective in reducing the caries incidence [12,13,43]. Public health resources should therefore be prioritized to the prevention of dental decay among children and adolescents with evidenced-based approaches [43]. ...
Background
In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children.
Methods
The study uses a hypothetical South African population of school aged learners aged 5–15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective.
Results
The results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively.
Conclusion
Based on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.
... Primary prevention aims at the initial stages, whereas secondary aims to stop disease progression. [ 4] Interception is done best at earliest or initial stages. Dental plaque can be prevented by reducing dietary sugar exposure and improving the resilience of the teeth. ...
... HA NPs closely resemble the mineral structure of teeth, making them effective in binding to demineralized enamel and promoting the formation of a uniform apatite layer that restores enamel integrity and reduces sensitivity [42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. ...
... Notably, these methods offer the advantage of preserving tooth structure while being more economical and eliminating the need for specialized and costly equipment (14,15). Various laboratory and clinical studies have demonstrated that different products containing topical fluoride yield positive outcomes in the prevention of tooth decay (16,17). The effects of fluoride can be categorized into local and systemic influences. ...
Background: Caries causes progressive demyelination in the tooth structure. This study was conducted to address concerns regarding the decay of milk teeth, which are important for children's growth and nutrition. Therefore, the aim of this study is to compare the effects of fluoride varnish and GC tooth mousse on the enamel hardness of milk teeth.
... 26 Trials involving young permanent teeth have demonstrated this benefit of fluoride, showing a 20-30% decrease in caries prevalence in the population that uses fluoridated toothpaste. 27 Smoking was also found to influence caries occurrence. Data show that among those who smoke daily, 52.1% had a higher caries experience. ...
Although caries is a preventable disease, it is still a health burden in all countries in all age categories. This study aimed to identify the determinants associated with caries risk factors in Indonesian adults. This secondary analysis used 2018 National Health Survey data, which included 37,057 respondents aged ≥ 15 years. The sampling design was based on census blocks selected using linear systematic sampling with probability proportional to size (PPS). The survey included an interview to collect data on sociodemographic characteristics, oral health practice, and health behavior. An oral examination was conducted to measure the DMFT (decayed, missing, filled- teeth) index. Multivariable models were generated to estimate the odds ratio (OR) and confidence intervals (95% CI) using caries as the dependent variable. The highest average DMFT index was seen in those respondents aged over 45 years, those from rural areas, individuals with low formal education, those who consumed sweets and sugary beverages at least once a day, those who did not brush their teeth regularly, and those who smoked. The multivariable analysis showed the potential risk of caries: risk of 19.51 times for older adults, 74% for male, 94% for those living in rural areas, 1.62 times for those with lower formal education, 78% for those with no dental visits, 1.18 times for those who eat sweets often, 1.37 times for those who drink sugary beverages often, 1.48 times for those who do not brush their teeth regularly, and 1.3 times for those who smoke. The multifaceted nature of caries in the Indonesian adult population highlights the influence of various factors, ranging from lifestyle habits and oral hygiene practices to access to dental services, age, and educational level.
... Preventive dental health strategies, such as community fluoride programs, regular dental check-ups and educational initiatives for caregivers, could substantially mitigate the risks of early childhood caries. Considering the age group studied, educational programs should be designed to engage both the children and their caregivers, emphasizing the importance of early dental care and proper feeding practices [18]. The results support the need for on-going study and observation to monitor early childhood caries trends and assess the success of adopted tactics. ...
Early Childhood Caries (ECC) poses a major challenge to young children's oral health worldwide. Therefore, it is of interest to explore the prevalence of Early Childhood (between 3-6 years) Caries in Bhubaneswar, Odisha. An oral examination of 460 children, chosen via random sampling, revealed a 54.78% prevalence of early childhood caries. Early childhood caries rates were high among children. The findings underscore the need for community-based prevention, public health education targeting parents and caregivers and integrating oral health promotion into primary healthcare to combat early childhood caries effectively in Bhubaneswar.
... El Sistema Internacional para el Diagnóstico y Detección de Caries(ICDAS), constituye una técnica de diagnóstico de lesiones cariosas, propuesta para reducir la subjetividad e incrementar la especificidad y sensibilidad, permitiendo la reproductividad de la inspección visual táctil del diagnóstico de caries (4). ...
Introducción: El presente artículo se realizó para identificar y evaluar el uso del sistema Internacional para la Detección y Evaluación de Caries (ICDAS) en la determinación del tratamiento de caries dental en molares temporales, destacando su eficacia sobre los métodos convencionales. Objetivos: Evaluar la efectividad del sistema ICDAS en la determinación del tratamiento de caries dental en molares temporales en niños, para mejorar la precisión diagnóstica y la eficacia del tratamiento. Materiales y Métodos: Dentro de la presente investigación se implementará una metodología basada en la sistematización bibliográfica de veinte artículos científicos, seleccionados por su relevancia en el estudio y tratamiento de las caries en molares temporales utilizando el sistema ICDAS. Resultados y Conclusiones: Los estudios revisados confirman su capacidad para detectar caries en diferentes etapas de desarrollo, lo que permite un tratamiento más preciso y oportuno. Se debe integrar el ICDAS en los protocolos de atención dental en instituciones educativas, para que los niños reciban una evaluación continua y adecuada desde temprana edad, lo que facilitaría la prevención y tratamiento oportuno de las caries.
... OHE interventions for this group should cover: Proper Oral Hygiene Practices: Demonstrating correct brushing and flossing techniques using micromodels and audiovisual aids can help children learn and practice proper oral hygiene [28]. Fluoride Application: Educating children about the importance of fluoride application at home and during dental appointments can promote its acceptance and adoption [29]. Fissure Sealants: Explaining the benefits of fissure sealants and the need for regular reassessment can encourage their utilization for caries prevention [30]. ...
The prevalence of oral diseases has escalated to a global scale, warranting acknowledgment as critical public health issues. With an estimated 3.5 billion individuals worldwide affected by oral diseases, the implications extend far beyond mere dental concerns, encompassing the fundamental health, well-being, and socio-economic productivity of billions. Among these, certain demographic subsets, such as pregnant women, school-aged children, adolescents, the elderly, and physically challenged children, stand out as particularly vulnerable groups prone to oral diseases and associated detrimental habits. Notably, personal behaviours including inadequate oral hygiene practices, tobacco use, excessive alcohol consumption, and consumption of nutritionally deficient diets represent modifiable risk factors significantly impacting oral health outcomes within these populations. Addressing these factors requires a multifaceted approach that integrates preventive strategies, education, and targeted interventions tailored to the unique needs and challenges faced by these special groups. The overarching rationale for this literature review stems from the pressing need to comprehensively understand the multifaceted challenges and opportunities surrounding oral health within special groups. By synthesizing existing knowledge, identifying gaps, and critically evaluating current interventions and strategies, this review aims to provide a robust foundation for informed decision-making and evidence-based practices in oral health education and promotion. In this context, the pivotal role of oral health education emerges as a cornerstone in promoting positive health behaviours and fostering sustainable oral health practices. By empowering individuals and communities with knowledge and skills related to oral hygiene, healthy lifestyle choices, and preventive measures, we can affect substantial improvements in oral health outcomes and overall quality of life. Thus, advocating for innovative, culturally sensitive, and cost-effective strategies that prioritize oral health education within social and cultural frameworks becomes imperative. Such approaches not only hold promise for mitigating the burden of oral diseases but also contribute significantly to enhancing broader health outcomes and fostering inclusive, healthier communities.
... • Scenario 1 -Application of universal interventions with a decrease in caries progression rates by 30% across each deprivation quintile. The 30% decrease in dental caries progression rate was considered conservative, given that the majority of dental caries is preventable via a range of effective public health interventions, such as community water fluoridation, salt fluoridation, reduced sugar consumption (via the implementation of, for example, SSB taxes or enhanced food labelling) and twice daily brushing with fluoridated toothpaste and fluoride varnish (frequency dependent on risk of caries) [48]. • Scenario 2 -A 'levelling-up' , or proportionate universalism approach, with the scale of prevention and management interventions proportional to the degree of need across deprivation quintiles. ...
Background
The recent World Health Organization (WHO) resolution on oral health urges pivoting to a preventive approach and integration of oral health into the non-communicable diseases agenda. This study aimed to: 1) explore the healthcare costs of managing dental caries between the ages of 12 and 65 years across socioeconomic groups in six countries (Brazil, France, Germany, Indonesia, Italy, UK), and 2) estimate the potential reduction in direct costs from non-targeted and targeted oral health-promoting interventions.
Methods
A cohort simulation model was developed to estimate the direct costs of dental caries over time for different socioeconomic groups. National-level DMFT (dentine threshold) data, the relative likelihood of receiving an intervention (such as a restorative procedure, tooth extraction and replacement), and clinically-guided assumptions were used to populate the model. A hypothetical group of upstream and downstream preventive interventions were applied either uniformly across all deprivation groups to reduce caries progression rates by 30% or in a levelled-up fashion with the greatest gains seen in the most deprived group.
Results
The population level direct costs of caries from 12 to 65 years of age varied between US10.2 billion in Italy to US22,910 and the lowest in Indonesia at US3,948 in Indonesia to US$17,728 in the UK.
Conclusion
Our exploratory analysis shows the disproportionate economic burden of caries in the most deprived groups and highlights the significant opportunity to reduce direct costs via levelling-up preventive measures. The healthcare burden stems from a higher baseline caries experience and greater annual progression rates in the most deprived. Therefore, preventive measures should be start early, with a focus on lowering early childhood caries and continue through the life course.
... Preventive strategies, including the use of fluoridated water, toothpaste, and mouthwash, have been demonstrated to be significantly effective in reducing the likelihood of cavitation [21]. Fluoride enhances the strength of tooth enamel and contributes to the mitigation of decay. ...
Introduction: Dental caries continues to represent one of the most widespread oral health challenges on a global scale, particularly in adolescents. This cross-sectional investigation examines the impact of demographic, clinical, and preventive factors on caries susceptibility and cavitation in children aged six to 15 years, thereby offering a thorough analysis of risk patterns and preventive strategies.
Materials and methods: This prospective, cross-sectional study was conducted on 2,000 schoolchildren, aged six to 15 years. Demographic and clinical data and data on preventive factors were gathered using the American Academy of Pediatric Dentistry (AAPD) Caries-Risk Assessment Tool (CAT). Based on clinical assessments and self-reported behaviors, participants were classified into high-, medium-, and low-risk groups. Statistical methodologies, including chi-square analyses and odds ratios (OR), were employed to evaluate the significance of the relationships among the variables.
Results: The associations between gender, educational attainment, and caries risk were statistically significant (p = 0.001), demonstrating that females exhibited a greater vulnerability than their male counterparts. Individuals enrolled in higher education levels showed an increased prevalence of high-risk categorization. Notable variations among communities were also observed, with specific demographics presenting a heightened susceptibility to caries. The frequency of tooth brushing, sugar intake, and regular dental examinations exhibited strong correlations with caries risk, whereas cavitation was recorded in 65.50% of the subjects. Key predictors included visible plaque, diminished salivary flow, and use of orthodontic appliances (p = 0.001). Preventive strategies, such as the application of fluoridated products and daily tooth brushing, have been found to significantly mitigate the risk of cavitation.
Conclusion: This investigation emphasizes the complex, multifaceted nature of caries susceptibility, accentuating the critical role of demographic, clinical, and preventive factors.
... Fluoride is applied in water fluoridation, toothpaste, mouthwash, dietary supplements, and professionally applied fluoride compounds like gels and varnishes. Fluoride can slow down the metabolism of bacteria found in dental plaque and speed up the remineralization of demineralized enamel (3) . ...
... Este posee altas concentraciones de ion fluoruro (44.800 ppm), el doble comparado con la de un barniz. 14 ...
Se reconoce la caries dental como una de las enfermedades con mayor prevalencia la cual afecta a la población sin distinguir género, razas y edades, por lo cual es considerado un problema de salud pública a nivel mundial, se sabe que existen diferentes medidas para controlar y revertir dicho proceso en los cuales se incluye la aplicación tópica de fluoruro, clorhexidina, barniz de fluoruro y fluoruro de diamino de plata, entre otras. El fluoruro diamino (FDP) de plata es un material cuyo uso ha cobrado auge durante los últimos años gracias a sus propiedades remineralizantes se puede detener el progreso de la caries, además muestra ventajas sobre otros tratamientos para estas lesiones, ya que, es mínimamente invasivo y más conservador, compuesto de iones de plata, fluoruro y amonio. Su uso se ha visto documentado desde finales de los años sesenta y fue aprobado por la Food And Drugs Administration de los Estados Unidos en el 2014. El propósito del presente trabajo es describir las principales propiedades y características esenciales para el correcto uso del FDP para el control de la caries dental.
Palabras clave: caries dental, remineralización, fluor, Fluoruro diamino de plata.
... Early diagnosis and treatment of oral health conditions can prevent many complications in later life. Primary prevention aims at the initial stages, whereas secondary prevention aims to stop disease progression [1]. Preventing dental plaque at its earliest stage is most effective when it occurs at its initial stage. ...
Background
Parents play a vital role in modeling good oral hygiene practices for their children; thus, their attitude, knowledge, and awareness toward preventive dentistry can be one of the major factors contributing to children’s oral health.
Objectives
The objective of this study is to determine the parental knowledge and attitudes toward the modalities of preventive dentistry for their children in Al Qassim, Saudi Arabia.
Materials and methods
A cross-sectional study was carried out using an online self-administered questionnaire designed for parents living in the Al Qassim region. The questionnaire included demographic data, parent knowledge and attitude toward preventive dentistry, and awareness of preventive dentistry procedures. The data collected were analyzed using RStudio.
Results
Data were collected from 392 Saudi parents (male: n = 190 (48.5%), female: n = 202 (51.5%)). The majority of participants (n = 336, 85.7%) considered the importance of primary teeth for general body health, while 320 participants (81.6%) believed that primary dentition influences permanent teeth. Awareness regarding special preventive measures like using toothpaste with fluorides comprised 87.5% (n = 343), and that of the benefits of early dental visits was 77.3% (n = 303). However, there was marked unawareness and use of preventive procedures such as serial extraction (n = 226, 57.7% of respondents unaware) and silver diamine fluoride (n = 276, 70.4% unaware). The higher levels of education and income were positively related to better knowledge and attitudes about preventive dentistry.
Conclusions
The current paper highlights the importance of educational interventions for enhancing parental knowledge and awareness about preventive dentistry. Community-based educational programs and increased availability of preventive dentistry services might be helpful in eliminating the knowledge gap among parents about good oral health practice.
... Public health programs should focus on the effective use of sealants and topical fluorides, considering cost-effectiveness and clinical outcomes. Monitoring sealant retention alone may not fully capture their effectiveness in preventing caries lesions, necessitating a shift toward evaluating actual caries prevention (61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73). ...
Background: Dental caries remains a significant public health issue, manifesting in various forms such as early childhood caries (ECC), primary caries, and root surface caries. It results from bacterial metabolism of dietary sugars leading to tooth enamel demineralization. While various preventive interventions, including fluoride and non-fluoride agents, have been employed, their efficacy varies and remains a subject of extensive research. Aim: This systematic review aims to evaluate the effectiveness of fluoride and other preventive measures in reducing dental caries and improving oral health outcomes across different populations and age groups. Methods: The review synthesizes evidence from clinical trials, observational studies, and public health reports on the effectiveness of fluoride varnishes, supplements, community fluoridation, sugar substitutes, sealants, and antimicrobial agents in caries prevention. Key variables include intervention types, dosage, application methods, and demographic variables. Results: Fluoride-based interventions, such as varnishes and water fluoridation, have demonstrated varying levels of effectiveness. Water fluoridation shows a 35% reduction in carious lesions in primary dentition and 26% in permanent teeth. Fluoride varnishes and supplements provide modest benefits, with fluoride toothpaste achieving a 24% reduction in caries. Antimicrobial agents and sealants also contribute to caries control, although their effectiveness is often context-dependent.
... No entanto, vale ressaltar que na cavidade bucal há sucessivos ciclos de desmineralização e remineralização dentária (DES-RE) com uma frequência considerável de perda de minerais no tecido do esmalte dentário, decorrendo a aparição das lesões (HORST et al., 2018). A aplicação tópica do verniz de flúor deve ser realizada no ambiente do consultório, administrado pelo profissional, esse produto apresenta uma grande eficácia nos scores 1 e 2, tendo como maior vantagem o tempo de contato prolongado entre o flúor e a superfície do dente, apresentando uma concentração de 22.600 ppm, onde favorece a absorção lenta dos íons na superfície dentária (GUPTA et al., 2020). ...
A cárie dentária continua sendo prevalente na cavidade oral. Sua progressão é multifatorial, resultante da combinação de vários elementos bactérias cariogênicas, ingestão de alimentos, higiene oral inadequada e fatores salivares. A odontologia vem caminhando para uma detecção, diagnóstico e escolha de tratamento mais conservador, com a utilização do fluoreto para meios preventivos e terapêuticos nas lesões iniciais, proporcionando uma paralisação destas. O objetivo dessa revisão de literatura é destacar a importância do flúor na prevenção e controle das lesões de cárie iniciais, promovendo a remineralização rápida e eficaz da estrutura dentária. A busca de estudos foi realizada a partir de um banco de dados científicos, “Google Acadêmico” , “Scielo” (Scientific Eletronic Library Online) e ‘‘Pubmed’’ utilizando uma associação de descritores no DeCS/MeSH. Os critérios de inclusão foram: artigos publicados de estudos clínicos e revisão de literatura em inglês e português publicados entre 2016-2024, e salvo os mais antigos que tivessem grande revelância no assunto, disponibilizados online. Nesse sentindo, destaca-se nessa pesquisa a importância do uso do flúor como forma eficaz no controle da doença cárie dentária e demonstrando uma efetividade na prevenção e no tratamento frente as lesões cariosas em fases iniciais.
... 13,14 Also, some studies state that, besides roughening the enamel surface mechanically, the air abrasion technique also opens up fissures and removes caries before sealant placement. 4 This technique, therefore, is less techniquesensitive and eliminates various steps that are required in the traditional technique, thereby reducing working time. Although many studies in the past have mentioned the use of the acidetching technique as a crucial requisite for the effective bonding of the sealant to the tooth surface, the literature also states that the air abrasion technique performed before sealant application is equally fulfilling. ...
Purpose
The purpose of our study was to perform a systematic review to assess and compare the effectiveness of the air abrasion technique with that of the conventional acid-etching technique performed before the placement of pit and fissure sealants.
Materials and methods
A search of studies was conducted in May 2021 using PubMed, Cochrane Library, and Google Scholar databases. Clinical trials in the English language between 1997 and 2019 were included. The quality of the studies was analyzed using the Cochrane Collaboration tool.
Results
The search retrieved 276 references, out of which seven studies were included for a qualitative analysis. In these seven studies, the risk of bias across the Cochrane tool's domains varied from low to high. All the included studies considered acid-etching as a comparator to air abrasion technique either used alone or as an adjunct to acid-etching technique.
Conclusion
When coverage of sealants or their retentivity was compared at different time intervals, it was more in the acid-etching group than in the air abrasion group. Similarly, carious lesions were seen more in the air abrasion group than in the acid-etching group. The air abrasion technique followed by acid-etching brought superior retention properties of sealants than the acid-etching technique alone.
How to cite this article
Bhadule SN, Kalaskar R, Kalaskar A, et al. Clinical Effectiveness of Air Abrasion When Compared to Conventional Acid-etching Technique in Enhancing the Retention of Pit and Fissure Sealants: A Systematic Review. Int J Clin Pediatr Dent 2024;17(3):377–384.
... The preventive measures for the prevention of caries are -the application of fissure sealant, use of remineralizing agents, fluoride, oral hygiene instructions, motivation and reinforcement to children regarding maintenance of oral hygiene and regular visits to the dentist. [19][20][21] The study was conducted at Chitwan Medical College, thus the results obtained cannot be generalized. ...
Background: Dental caries currently represents the most common chronic disease among children. Early detection of caries is very important as it helps in the prevention and control of carious diseases. This study was aimed to assess the prevalence of dental caries on permanent first molars among children of age group 6-14 years. Methods: This descriptive cross–sectional study was conducted among 270 children coming to Department of Pedodontics of Chitwan Medical College. The children of age 6-14 years were included in the study. Caries status was noted using DMFT index and the data was presented using descriptive statistical tool. This was analysed using SPSS version 26. Results: A total of 270 children of age group 6-14 years (Mean ± SD: 9.84 ± 2.24 years, median 10 years) participated in the study. The prevalence of dental caries of left mandibular first permanent molar was high 108 (40%) among the studied teeth. The prevalence of dental caries was high in mandibular arch. Conclusions: Among the permanent first molars, prevalence of dental caries was higher in mandibular arch than maxillary arch.
... Pit and fissure caries constitute approximately 90% of caries in permanent posterior teeth and 44% in primary teeth among children and teenagers [4]. The overall reduction in caries prevalence is largely attributed to the adoption of preventive measures like topical fluoride treatment, plaque management, community water fluoridation, and dietary sugar control [5]. These approaches have been notably successful in diminishing carious lesions on smooth surfaces. ...
Background/Objectives
Pit and fissure caries constitute a predominant portion, approximately 90% in permanent posterior teeth and 44% in primary teeth among children and adolescents. Among various preventive modalities, pit and fissure sealants play a pivotal role in safeguarding these vulnerable areas. Categorized by materials such as glass ionomer, composites, and polyacid-modified glass ionomers, these sealants offer effective protection. This study aims to evaluate the efficacy of glass ionomer-based pit and fissure sealants in terms of retention rate at 12-month post-procedure period in permanent first molars.
Methodology
This study was conducted at the Department of Operative Dentistry, Nishtar Institute of Dentistry, Multan, Pakistan. Fifty-six children, aged 7 to 12 years, presenting with pit and fissure caries in permanent first molar teeth were enrolled. Glass ionomer sealant was meticulously applied to the affected pits and fissures. The efficacy was assessed after 12 months based on predefined criteria.
Results
The age of participants ranged from 7 to 12 years, with a mean age of 9.24 ± 1.38 years. Among the 56 patients, 23 (41.2%) were male and 33 (58.8%) were female. Sealant retention was noted in 31 (55.35%) patients, while 25 (44.65%) experienced sealant loss. In the 7 to 9-year age group, 19 demonstrated complete sealant retention, whereas in the 10 to 12-year age group, 12 exhibited complete retention. Concerning gender distribution, 17 males and 14 females exhibited complete sealant retention.
Conclusion
Glass ionomer-based sealants demonstrate excellent properties for pit and fissure sealing owing to their low technique sensitivity, cost-effectiveness, and favorable retention rates. Therefore, they represent an optimal choice for this preventive dental procedure.
... The 30% decrease in the caries progression rate was considered conservative, given that the majority of dental caries is preventable via a range of effective public health interventions, such as public water fluoridation, salt fluoridation, reduced sugar consumption (via the implementation of, for example, sugar taxes or enhanced food labelling) and twice daily brushing with fluoridated toothpaste. 46 • Scenario 2 -A 'levelling-up', or proportionate universalism approach, with the scale of prevention and management interventions proportional to the degree of need across deprivation quintiles. In this scenario, the caries progression rate of the least deprived quintile was applied across all quintiles. ...
Background
The recent World Health Organization (WHO) resolution on oral health urges pivoting to a preventive approach and integration of oral health into the non-communicable diseases agenda. This study aimed to: 1) explore the healthcare costs of managing dental caries between the ages of 12 and 65 years across socioeconomic groups in six countries (Brazil, France, Germany, Indonesia, Italy, UK), and 2) estimate the potential reduction in direct costs from non-targeted and targeted oral health-promoting interventions.
Methods
A cohort simulation model was developed to estimate direct costs of over time for different socioeconomic groups. National-level DMFT (dentine threshold) data, the relative likelihood of receiving an intervention (such as a restorative procedure, tooth extraction and replacement), and clinically-guided assumptions were used to populate the model. A hypothetical group of upstream and downstream preventive interventions were applied either uniformly across all deprivation groups to reduce caries progression rates by 30% or in a levelled-up fashion with the greatest gains seen in the most deprived group.
Results
The population level direct costs of caries from 12 to 65 years of age varied between US10.2bn in Italy to US22,910 and the lowest in Indonesia at US3,948 in Indonesia to US$17,728 in the UK.
Conclusion
Our exploratory analysis shows the disproportionate economic burden of caries in the most deprived groups and highlights the significant opportunity to reduce direct costs via levelling-up preventive measures. The healthcare burden stems from a higher baseline caries experience and greater annual progression rates in the most deprived. Therefore, preventive measures should be primarily aimed at reducing early childhood caries, but also applied across all ages.
... 6 Most oral health conditions can be prevented or treated in their early stages. 7 Parents who make decisions about their child's health have a significant influence on the dental health of their offspring. ...
Background: Usually, parents are less aware that preventive oral
health and dental procedures may have an impact on the general
health and well-being of the children. Parental negligence may result
in unfavourable dental and general health consequences. Parental
knowledge of preventive measures towards oral health is important
for proper oral hygiene maintenance, control of caries, care of primary
teeth in children.
Aim: To analyse the attitude and awareness towards preventive dentistry
among parents of Anganwadi children in Chennai.
Methodology: This was a questionnaire-based cross-sectional study
conducted among 316 participants. The study included the parents
of Anganwadi children residing in Zone-4 Chennai. A questionnaire
was prepared and distributed to seven Anganwadi centres which was
then given to participants and responses were collected after two
days. The data were collected systematically and analysed using the
SPSS software version 20.
Results: 316 study subjects participated in the study. The study revealed
a significant difference statistically in knowledge, attitude and awareness
among parents in various categories. About 81% of the participants
were aware that sugar and sugar-containing diet can cause dental decay
whereas, only 25% of them had the understanding that fluorides can
help prevent dental decay.
Conclusion: Awareness about preventive dental practices such as the
appropriate duration of brushing, the influence of dietary sugars on
dental decay, the impact of oral health on the general health of children
existed among the parents. At the same instant, participants were found
to be less aware of the role of fluorides in caries control, eruption time
of permanent dentition, timely dental visits and trauma care.
Keywords: Preventive Dentistry, Parental Awareness, Anganwadi
... The utilization of fluoride helps in preventing the occurrence of cavities showcasing an effect on the effectiveness of the material. Nevertheless, differences, in the rate and composition of saliva can impact the speed at which ions are released and subsequently affect the properties of the material (15,16). The connection between saliva, the oral microbiome and dental restorative materials also applies to amalgam restorations. ...
Saliva and the oral microbiome play critical roles in the performance and longevity of dental restorative materials. Saliva's buffering capacity, pH regulation, and remineralization impact the durability and stability of materials. Variations in saliva composition among individuals can influence wear resistance and surface degradation of these materials. This review explores the intricate relationship between saliva, the oral microbiome, and restorative dental materials, emphasizing their mutual influences and the implications for dental practice. The oral microbiome, consisting of diverse microorganisms, further complicates this interaction. Bacterial adhesion, biofilm formation, and microbial metabolism significantly affect the integrity of restorative materials. For example, the degradation of composite resins by oral bacteria and their acidic byproducts can compromise the mechanical properties of these materials. Clinical manifestations of these interactions include deterioration of composite resin restorations, biofilm formation, and corrosion of amalgam restorations. Recognizing these manifestations is crucial for dentists to implement timely interventions and personalized management strategies. Regular monitoring and timely intervention, coupled with advancements in biomaterials, are key to enhancing the durability and effectiveness of restorative dental treatments.
... Previous clinical and epidemiological data suggests that fluoride implements its topical preventive action against caries primarily through reducing the rate of enamel demineralization and remineralization of the initial caries lesions. 4,10 Fluoride toothpastes are the most convenient, ethnically accepted and cost-effective methods towards the accomplishment of the goal for prevention. 2 "Fluoride dentifrice is a wise investment, as an ounce of prevention is worth a pound of cure" 11 Review from Cochrane database show that in the developed countries, amplified use of fluoridated tooth pastes has reduced the prevalence of dental caries and so has been anticipated as the method of choice for dental caries prevention. 12 In developed countries, well-controlled clinical trials have investigated the desirable data in relation to the caries controlling efficacy of tooth pastes but there has been no such data reported in our part of the world indicating that this topic remains unexplored. ...
Objective: To investigate the change in dental caries status on provision of high fluoridated tooth paste after 24 months. Study Design: Triple Blind Randomized Clinical and Controlled. Setting: Private School of Gulshan Town, Karachi. Period: January 2018 to January 2020. Material & Methods: A cohort of regular school children aged 12-15 years studying in classes 6-9 were included. Through simple random sampling, 412 subjects were purposively allocated to Group A (n=202, intervention group) and Group B (n=210, control group). A pre-trial market survey was conducted to identify the fluoridated toothpastes available followed by the laboratory testing of fluoride concentration through Atomic Absorption Spectrometry. Dental examination was performed by a single examiner on mobile dental units under sunlight in the school ground using sterilized dental mirror, probe and tweezers at baseline and then after 8, 16 and 24 months employing the World Health Organization recommended Decayed Missing Filled Teeth index. Results: The mean age of the recruited participants was 12.91±0.82 having 209 males and 203 females. The mean DMFT scores observed over 24 months were 1.25 in group A and 1.42 in group B. At baseline it was 1.10 ±1.50 and 1.11±1.43 which gradually increased to 1.32±1.57 and 1.59±1.96 in group A and B respectively at last follow-up examination. Conclusion: This trial has identified no significant change in the overall dental caries status; however, the mean decayed score in both the interventional groups decreased on provision of high fluoridated tooth paste.
... Community water fluoridation (CWF) is the practice of adjusting the level of fluoride in public water supplies to a concentration optimal for the prevention of tooth decay [1]. This public health initiative is backed by numerous studies that underscore its efficacy; even amid widespread use of fluoride-containing dental products, such as toothpastes and mouthwashes, CWF contributes an additional reduction in dental decay by over 25%, which translates to significant cost savings in dental health expenditures, with estimates placing the per capita savings at over thirty dollars [2,3]. The robust evidence supporting the benefits of fluoridation has garnered endorsements from a spectrum of authoritative health organizations. ...
Objective: This study reports on the number and percentage of community water systems (CWSs) meeting fluoride concentration standards set by the U.S. Department of Health and Human Services (DHHS). The study also explored changes in the population exposed to optimally fluoridated water in these systems between 2006 and 2020. Methods: This study analyzed U.S. Centers for Disease Control and Prevention data from 2006 to 2020, tabulating state-specific CWS fluoridation rates, ranking them, and calculating the percent change. Results: In 2020, 72.7% of the US population received CWS water, with 62.9% of those individuals served by a CWS system meeting DHHS fluoridation standards. This compares to 69.2% receiving CWS water in 2006 and 74.6% in 2012. The overall change in those receiving fluoridated water was 1.4%, from 61.5% in 2006 to 62.9% in 2020. State-specific percentages ranged from 8.5% in Hawaii to 100% in Washington DC in 2020 (median: 76.4%). Conclusions: Although endorsed by the American Dental Association, the percentage of individuals receiving fluoridated water did not increase substantially from 2006 to 2020, indicating that there has not been much progress toward meeting the Healthy People 2030 goal that 77.1% of Americans receive water with enough fluoride to prevent tooth decay.
... Overall, this solution seems to be understudied, which is probably due to its propensity to cause extrinsic stains and its bad taste. 17 This has been overcome by new formulations of SnF 2 -dentifrices, for example, Colgate TotalSF, containing 0.454% SnF 2 and 1% zinc phosphate, which provides statistically significantly higher stain reduction compared to a competitor paste (26%) and SnF 2 gel (35%). 21 Further, using sodium hexametaposphate with SnF 2 formulations also removes extrinsic stains and provide longlasting inhibition of new-stain chromogen adsorption. ...
Purpose:
The aim of this in-vitro study was to investigate the antimicrobial efficacy of identical experimental toothpastes with different stannous sources.
Materials and methods:
Streptococcus mutans biofilms were grown on protein-coated glass disks in static conditions for 24 h and thereafter exposed to toothpaste slurries or physiological saline (negative control; n = 15) for 30 s. Four experimental toothpastes were applied in this study, containing either stannous chloride (SnCl2; B: 3500 ppm Sn2+, and D: 3600 ppm Sn2+) or stannous fluoride (SnF2; C: 3500 ppm Sn2+, and E: 3600 ppm Sn2+). Marketed toothpaste meridol® (A: 3300 ppm SnF2) served as control. All five toothpastes contained amine fluoride (AmF). The biofilms were placed on agar surface and their metabolic activity was assessed by isothermal microcalorimetry over 96 h. The heat flow data was analysed for growth rate and lag time using grofit package in software R. Additionally, reduction of active biofilm compared to untreated control was calculated.
Results:
All toothpastes significantly prolong the lag time of treated biofilms in comparison to negative control (p < 0.05). Toothpastes containing SnF2 (C and E) prolonged the lag time statistically significantly compared to toothpastes containing SnCl2 (B and D) (p < 0.05). The maximum growth rate was statistically significantly reduced by all tested toothpastes compared to the untreated control group (p < 0.05). Toothpastes containing SnF2 (A, C and E) reached 59.9 ± 7.8, 61.9 ± 7.7, and 55.6 ± 7.0% reduction of active biofilm, respectively. Thus, they exhibit statistically significantly better results than toothpastes B (52.9 ± 9.9%) and D (44.7 ± 7.6%). Toothpaste D, which contains a slightly higher concentration of Sn2+, was the least effective in reducing active biofilm.
Conclusion:
The toothpastes containing SnF2 combined with AmF had the highest antimicrobial efficacy in this study.
... 6 Most oral health conditions can be prevented or treated in their early stages. 7 Parents who make decisions about their child's health have a significant influence on the dental health of their offspring. ...
... • Scenario 1 -Application of universal interventions with a decrease in caries progression rates by 30% across each deprivation quintile. The 30% decrease in dental caries progression rate was considered conservative, given that the majority of dental caries is preventable via a range of effective public health interventions, such as community water fluoridation, salt fluoridation, reduced sugar consumption (via the implementation of, for example, SSB taxes or enhanced food labelling) and twice daily brushing with fluoridated toothpaste and fluoride varnish (frequency dependent on risk of caries) [48]. • Scenario 2 -A 'levelling-up' , or proportionate universalism approach, with the scale of prevention and management interventions proportional to the degree of need across deprivation quintiles. ...
... In order to increase the efficiency of biofilm reduction, the use of antiseptic agents is recommended as a complement. However, because of the restless nature of children it is most prudent to determine a dentifrice that in its composition presents components with proven clinical efficiency in combating Streptococcus mutans (Horst et al., 2018). The word dentifrice was probably first used in 1558, whose meaning comes from the Latin dentifricium, denti (tooth) and fricare (to rub) (Katz, 2000). ...
The cultural bridge in the use of toothpastes with fluoride and xylitol in the reduction of Streptococcus mutans and the prevention of cavities is not clear. The antibacterial effect of pediatric toothpastes on Streptococcus mutans was compared. Each toothpaste was dissolved in different concentrations, and placed in Petri dishes with Streptococcus mutans ATCC 25175 and observed at 24 and 48 hours. The results show that there is variability in sensitivity depending on the concentration and exposure time. The toothpaste that had the greatest inhibitory effect on Streptococcus mutans was the one that had fluoride and xylitol.
... Furthermore, it is worth noting that sealing materials are compared to another method of prevention-fluoridation. Nonetheless, the application of fluoride usually considers full dentition present in the oral cavity of the patient instead of selected teeth surfaces. It should be emphasized that properly applied sealing does not have to be repeated as regularly as fluoridation [87]. ...
The scope of this paper is to compare different dental sealants and flow materials indicated for sealing pits and fissures considering their chemical formula. The narrative review aims to address the following questions: What is the essence of different dental sealants’ activity, how does their chemical formula affect their mechanisms of caries prevention, and what makes a dental sealant efficient mean of caries prevention? Another vital issue is whether the sealants that contain fluoride, or any other additions, have potentially increased antimicrobial properties. An electronic search of the PubMed, Cochrane, Web of Science, and Scopus databases was performed. The following keywords were used: (dental sealants) AND (chemical composition). Additionally, information about composition and indications for clinical use provided by manufacturers were utilized. All of the considered materials are indicated for use both in permanent and primary dentition for sealing fissures, pits, and foramina caeca. The selection of suitable material should be made individually and adjusted to conditions of the sealing procedure and patient’s needs. Cariostatic mechanisms increasing sealants’ effectiveness such as fluoride release are desired in modern dentistry appreciating preventive approach. The review aims are to find crucial elements of sealants’ composition which affect their cariostatic mechanisms.
... Findings using PLM supported the previous results revealing decrease in optical reflectivity and the positive birefringent area which was about to appear broad positively birefringent body after demineralization and disappear after remineralization indicating a great mineral content recovery at all the three groups. effective tool for caries prevention, F agents such as toothpaste, gel, foam, mouth rinse, solution, varnish and tablets, has been used for the prevention of dental caries over the past 25 years [8]. ...
Aim
To evaluate and compare initial enamel caries treated by ozone gel with or without nanohydroxyapatite paste or fluoride gel.
Materials and methods
30 intact, noncarious freshly extracted human premolars, were collected, cleaned from all soft debris and/or calculus and polished using prophy polishing paste. Each tooth was sectioned first at cement enamel junction (CEJ) to separate crown after removal of root. Each crown was mesiodistally sectioned to a thickness of 1–2 mm then stored in artificial saliva which was periodically changed. All the specimens were exposed to demineralizing solution at occlusal surface only (the surface of the study) for creation of enamel lesions. All the specimens were examined with, EDX and tested under PLM to evaluate enamel surface. After demineralization the specimens were divided randomly into three equal groups I, II and III consist of 10 specimens of each group. For group I Ozonized olive oil gel was used alone on occlusal surface for 1 min once daily, group II was treated as group I followed by application of 5% nanohydroxyapatite paste, while all specimens in group III were treated as group I followed by fluoride gel application. All the procedures at the three groups were repeated daily for 21 days.
Result
It was found that nonsignificant difference among the mean wt % values of mineral contents (Ca, P, and Ca/P ratio) between the three treatment groups at baseline and after demineralization ( P ≥ 0.5), by using ANOVA test at remineralization stage it was found that (group II) recorded the highest mineral content with a mean value of 69.58 ± 1.54 followed by (group III) with a mean value of 69.36 ± 1.04 while the lowest mineral content mean value was 67.43 ± 0.92 which related to (group I). Also, highly statistically significant difference between the three groups was recorded ( P = 0.001). Findings using PLM supported the previous results revealing decrease in optical reflectivity and the positive birefringent area which was about to appear broad positively birefringent body after demineralization and disappear after remineralization indicating a great mineral content recovery at all the three groups.
A BSTRACT
Aim
The study focused to determine the microleakage of various materials using the dye penetration method.
Materials and Methods
The study samples consisted of 45 healthy human mandibular premolar teeth removed for orthodontic therapy without caries. The samples were categorized into three groups of 15 each. All the samples were etched for 20 seconds with 37% phosphoric acid gel before being sealed with a glass ionomer cement (GIC) sealant (Fuji—VII GIC), light-cure glass ionomer composite cement (Prevest Fusion I), or flowable nanocomposite sealants (Prevest Fusion Flo), respectively. Every sample were thermocycled and immersed for one day in methylene blue (5%) solution to dye diffusion between the gaps present among the tooth and restoration. The teeth were sectioned and analyzed using image analysis software beneath a stereomicroscope at 10x magnification.
Results
The marginal microleakage was found lowest in flowable nanocomposites (1.06 ± 0.98), then light-cure glass ionomer composite cement (2.44 ± 1.42), and GIC (4.07 ± 1.54). A statistically significant variance was noted.
Conclusion
Current investigation evaluated that reduced marginal leakage was seen in flowable nanocomposites when compared to other two groups.
Introduction: Early childhood caries is one of the most prevalent chronic dental disorders affecting children in their early developmental stages. The negative consequence of caries would impact the child's overall quality of life. The mother or other primary caregiver is ultimately responsible for making the decisions concerning a child's nutrition, upbringing, and care in order to promote good health and impart healthy habits in them. Aims and Methodology: To investigate the knowledge and awareness of parents towards the child’s feeding, oral hygiene practices and its impact on the dental tissues in the oral cavity represented using the ICDAS scores. In phase I a preformed closed ended questionnaire in Malay language was distributed to 100 parents that recorded the Knowledge, practices and awareness of parent’s feeding and oral hygiene measures followed in their children. In Phase II their kids were examined at to record the ICDAS scores. Results: The parameters in the parent’s questionnaire form and the ICDAS scores of the deciduous and young permanent molars in the children were tabulated and statistically analyzed by using Spss software. There was ambiguity among the parent’s knowledge, awareness and practice of feeding and oral hygiene methods they followed for their children. Besides, there was statistical significance difference in the molar teeth affected by caries and their ICDAS scores (p < 0.001) in the subjects upon clinical examination. Conclusion: The clinical outcomes for treatment of early childhood caries are not always favorable with high relapse. Hence, this study recommends to investigate the cultural norms that are associated with knowledge, practice and attitude of feeding and oral hygiene practices followed in community and modify their practices in a wise and strategical trajectories to promote health, thereby reducing the burden of oral health in the society.
Fluoride in excess of the World Health Organisation limit of 1.5mg/L in drinking water can cause dental fluorosis (DF) in developing teeth. DF is a significant problem in the Hai District of Northern Tanzania, where there is limited access to safe piped water and groundwater is high in fluoride. A door-to-door prevalence survey of residents of Tindigani village was undertaken to assess current prevalence and severity of DF in the Hai District, and the effectiveness of previous interventions to promote low-fluoride drinking water, following a prevalence survey in 2009. DF was graded by trained assessors, utilising dental photography, and drinking water sources were sampled for chemical analysis. DF was endemic in the 563 people assessed, with a prevalence of 79.4% (CI=76.1-82.7%). Prevalence and severity were found to be higher in permanent teeth than deciduous teeth. Fluoride concentrations in non-piped water sources ranged from 2.5-38.6mg/L. Despite more households reporting the use of low-fluoride, piped water sources, compared to 2009 (82.8% versus 62%), DF remains a significant problem in Tindigani and other such communities where low-fluoride drinking water is not easily and reliably accessible. Policy makers must prioritise reliable access to low-fluoride water, especially for children as their permanent dentition develops.
Background: Dental caries is a major problem in the field of oral and dental health and its prevention is more important than its treatment. Fluoride plays a significant role in prevention of caries, improving oral and dental health. One of the common ways of fluoride use is the use of a fluoride- containing mouthwash, the most important of which in use is 0.2% sodium fluoride mouthwash. Aim: The aim of the present study was to assess the efficiency of 0.2% sodium fluoride mouthwash in prevention of dental caries according to DMFT index. Material and Method: The study included a control group and an experimental group. For each group, 10 children were selected randomly. The two groups were assessed by means of intra-oral examination. Data was recorded using DMFT index. Results: The decrease in DMFT value of the control group and experimental group from baseline to 30 days was statistically significant (p<0.001). A statistically insignificant difference between the two groups (p=0.7022) was seen. Conclusion: According to this study results, the daily use of 0.2% sodium fluoride mouthwash has been successful in the improvement of oral and dental health by preventing dental caries among children of school age. Key words: Dental caries, Incipient enamel lesions, DMFT index, Varnish, Fluoride mouthwash.
This study focuses on the effects of different fluoride-releasing restorative materials on dentin microhardness. The process involves demineralization and remineralization cycles with topical fluoride application, with the hypothesis that these materials affect the mineral content and thereby the microhardness of dentin. Four groups were established based on the type of restorative material used. Group 1 used Conventional Glass Ionomer Cement (GIC), Group 2 used Resin Modified Glass Ionomer Cement (RMGIC), Group 3 employed Equia Forte and Group 4 used Cention N. Each group consisted of 30 samples. The methodology included applying dentin conditioner, restoration and light curing. The microhardness of root dentin was measured at distances of 100µm, 200µm, and 300µm from the restoration interface after pH cycling using a Knoop indenter. Results: The results showed a significant difference in dentin microhardness among the groups. For instance, at 100µm from the restoration interface, Group 1 showed a microhardness of 45 KHN, Group 2 showed 50 KHN, Group 3 showed 60 KHN, and Group 4 showed 48 KHN. Similar trends were observed at 200µm and 300µm, indicating varying levels of remineralization efficacy among the materials.Conclusion: Equia Forte exhibited superior anticariogenic potential compared to the other materials. The use of topical fluoride agents was found to enhance the efficacy of these restorative materials, with GC Tooth Mousse Plus out performing Colgate Total. The study underscores the importance of selecting appropriate restorative materials in caries-prone individuals but also highlights the need for further in-vivo research to simulate more complex oral conditions.
There is a growing shift from the use of conventional pharmaceutical oral care products to the use of herbal extracts and traditional remedies in dental caries prevention. This is attributed to the potential environmental and health implications of contemporary oral products. This comprehensive review aims at the analysis of plant-derived compounds as preventive modalities in dental caries research. It focuses on data collected from 2019 until recently, trying to emphasize current trends in this topic. The research findings suggest that several plant-derived compounds, either aqueous or ethanolic, exhibit notable antibacterial effects against Streptococcus mutans and other bacteria related to dental caries, with some extracts demonstrating an efficacy comparable to that of chlorhexidine. Furthermore, in vivo studies using plant-derived compounds incorporated in food derivatives, such as lollipops, have shown promising results by significantly reducing Streptococcus mutans in high-risk caries children. In vitro studies on plant-derived compounds have revealed bactericidal and bacteriostatic activity against S. mutans, suggesting their potential use as dental caries preventive agents. Medicinal plants, plant-derived phytochemicals, essential oils, and other food compounds have exhibited promising antimicrobial activity against oral pathogens, either by their anti-adhesion activity, the inhibition of extracellular microbial enzymes, or their direct action on microbial species and acid production. However, further research is needed to assess their antimicrobial activity and to evaluate the cytotoxicity and safety profiles of these plant-derived compounds before their widespread clinical use can be recommended.
Food quality assessment is becoming a global priority due to population growth and the rise of ionic pollutants derived from anthropogenic sources. However, the current methods used to quantify toxic ions are expensive and their operation is complex. Consequently, there is a need for affordable and accessible methods for the accurate determination of ion concentrations in food. Electrochemical sensors based on potentiometry represent a promising approach in this field, with the potential to overcome limitations of the currently available systems. This review summarizes the current advances in the electrochemical quantification of heavy metals and toxic anions in the food industry using potentiometric sensors. The healthcare impact of common heavy metal contaminants (Cd2+, Hg2+, Pb2+, As3+) and anions (ClO4−, F−, HPO4−, SO42−, NO3−, NO2−) is discussed, alongside current regulations, and gold standard methods for analysis. Sensor performances are compared to current benchmarks in terms of selectivity and the limit of detection. Given the complexity of food samples, the percentage recovery values (%) and the methodologies employed for ion extraction are also described. Finally, a summary of the challenges and future directions of the field is provided. An overview of technologies that can overcome the limitations of current electrochemical sensors is shown, including new extraction methods for ions in food.
We are currently engaged in the development of models and simulations to assess the impact of environmental factors on water systems in the upcoming years. Our focus is on utilizing the PHREEQ C tool to analyze how various determinants will influence water chemistry and subsequently impact the individuals who rely on it. Our primary objective is to address the critical question of whether the water supply will remain safe for consumption in the foreseeable future.
A BSTRACT
Background
This research sought to assess the impact of polyhexamethylene guanidine hydrochloride (PHMGH) and 1,3,5-triacryloyl hexahydro-1,3,5-triazine (TAT) on the antibacterial activity of an experimental resin sealant.
Materials and Methods
The two experimental sealants were formulated based on previous research, and Streptococcus mutans (S. mutans) was tested for biofilm and planktonic bacteria’s antibacterial properties. In 48 hours, 300 L of frozen S. mutans in skim milk was stored in an oven at 37°C in a microaerophilic atmosphere with 5% of CO2 and put on a petri plate containing brain–heart infusion (BHI) broth with agar at 15 g/L. By combining 100 mL of the subculture broth with 900 mL of a sterile saline solution (0.9%) in an Eppendorf tube, the initial inoculum used for the experiments was evaluated. The colonies were measured in colony-forming units per milliliter (CFU/mL) after being counted visually. To measure the antibacterial activity, log CFU/mL was used to express the number of bacteria in the broth that had been in contact with the samples for 24 hours.
Results
Outcomes of antibacterial activity against planktonic bacteria and against biofilm development on polymerized materials. The two innovative sealant materials were found to differ significantly from one another, while group 2’s mean and standard deviation values were larger.
Conclusion
Dental sealants designed with PHMGH and TCPTAT for anticaries application showed less bacterial growth throughout time the cavity prevention properties of the resin sealant.
This study evaluated the efficacy of incorporating different concentrations of bioactive glass-ceramic (Biosilicate) into coconut oil on the remineralizing potential and surface roughness of white spot lesions. Fragments (6 x 6 x 2mm) of bovine teeth were sectioned and initial microhardness (KHN) and surface roughness (Ra) readings were obtained. The samples were submitted to cariogenic challenge to form white spot lesions and were separated into six groups (n=13): 1) Artificial Saliva (AS); 2) Coconut Oil (CO); 3) CO+2% Biosilicate (CO+2%Bio); 4) CO+5% Biosilicate (CO+5%Bio); 5) 2% Biosilicate Suspension (2% Bio) and 6) 5% Biosilicate Suspension (5% Bio). The treatments for 1 cycle/day were: immersion into the treatments for 5 minutes, rinsing in distilled water, and storage in artificial saliva at 37ºC. After 14 days, KHN and Ra readings were taken. The surface roughness alteration ((Ra) was analyzed (Kruskal-Wallis, Dunn’s post-test, p<0.05). CO+2%Bio had higher (p = 0.0013) (Ra followed by CO+5%Bio (p = 0.0244) than AS. The relative KHN and remineralization potential were analyzed (ANOVA, Tukey, p<0.05), and 5% Bio treatment presented a higher relative microhardness than all other groups (p>0.05). The remineralizing potential of all the treatments was similar (p > .05). When Biosilicate was added, the pH of the suspensions increased and the alkaline pH remained during the analysis. Biosilicate suspension is more efficient than the incorporation of particles into coconut oil at white spot lesion treatment. In addition to the benefits that coconut oil and Biosilicate present separately, their association can enhance the remineralizing potential of Biosilicate.
TITATNIUM AND ITS USES IN DENTISTRY
Dental disease is widespread among various groups, as tooth decay ranks
second after the common cold, as it is widespread and as soon as the child
reaches the age of five. Among the most important causes of tooth decay
are carbohydrates, bacteria, susceptibility to caries, and the time factor, it
divides tooth decay into the type of chronic caries and acute decay. The type
of bacteria associated with decay is Staphylococcus Spp. Streptococcus
pyogenes, Bacillus cereus, Escherichia coli and Proteus Spp
The oral route is the most common route of administration of drugs. Over 90% of all the available marketed pharmaceutical products are oral formulations. Oral drugs are used in different courses of treatment including the prevention of tooth decay. Tooth decay is the permanent damage of the enamel which leads to the formation of cavities. It can be prevented with good oral hygiene and enough fluorides in the body. Fluorides can be administered both topically (toothpastes) and systemically (supplements). Fluoride supplements fall under oral drug delivery systems. They come in the form of tablets, lozenges, and liquids. However, challenges are faced when it comes to oral drug delivery in children. The development of paediatric drugs is a difficult undertaking since many pharmaceutically active compounds have low water solubility, instability, or an unpleasant taste. Children are unable to tolerate bitter or unpleasant-tasting formulations, as well as huge pills and capsules. Due to various biological, biochemical, and physical barriers faced by oral drug delivery systems, new approaches have been developed to address these challenges such as the application of nanotechnology in drug development. Jellies for oral administration on the other hand are a new approach for the delivery of drugs with bitter tastes as well as for age groups such as children and elders. They are clear, translucent, or non-greasy semisolid products that can be used both externally and internally. In-depth, aspects of these factors will be discussed in this review paper including oral dosage forms for paediatrics, tooth decay and its pathogenesis, preventive measures and setbacks of each measure as well as the future perspectives.
Background
Fissure sealant (FS) and fluoride varnish (FV) have been shown to be effective in preventing dental caries when tested against a no-treatment control. However, the relative clinical effectiveness and cost-effectiveness of these interventions is unknown.
Objective
To compare the clinical effectiveness and cost-effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- and 7-year-olds and to determine their acceptability.
Design
A randomised controlled allocation-blinded clinical trial with two parallel arms.
Setting
A targeted population programme using mobile dental clinics (MDCs) in schools located in areas of high social and economic deprivation in South Wales.
Participants
In total, 1016 children were randomised, but one parent subsequently withdrew permission and so the analysis was based on 1015 children. The randomisation of participants was stratified by school and balanced for sex and primary dentition baseline caries levels using minimisation in a 1 : 1 ratio for treatments. A random component was added to the minimisation algorithm, such that it was not completely deterministic. Of the participants, 514 were randomised to receive FS and 502 were randomised to receive FV.
Interventions
Resin-based FS was applied to caries-free FPMs and maintained at 6-monthly intervals. FV was applied at baseline and at 6-month intervals over the course of 3 years.
Main outcome measures
The proportion of children developing caries into dentine (decayed, missing, filled teeth in permanent dentition, i.e. D 4–6 MFT) on any one of up to four treated FPMs after 36 months. The assessors were blinded to treatment allocation; however, the presence or absence of FS at assessment would obviously indicate the probable treatment received. Economic measures established the costs and budget impact of FS and FV and the relative cost-effectiveness of these technologies. Qualitative interviews determined the acceptability of the interventions.
Results
At 36 months, 835 (82%) children remained in the trial: 417 in the FS arm and 418 in the FV arm. The proportion of children who developed caries into dentine on a least one FPM was lower in the FV arm (73; 17.5%) than in the FS arm (82, 19.6%) [odds ratio (OR) 0.84, 95% confidence interval (CI) 0.59 to 1.21; p = 0.35] but the difference was not statistically significant. The results were similar when the numbers of newly decayed teeth (OR 0.86, 95% CI 0.60 to 1.22) and tooth surfaces (OR 0.85, 95% CI 0.59 to 1.21) were examined. Trial fidelity was high: 95% of participants received five or six of the six scheduled treatments. Between 74% and 93% of sealants (upper and lower teeth) were intact at 36 months. The costs of the two technologies showed a small but statistically significant difference; the mean cost to the NHS (including intervention costs) per child was £500 for FS, compared with £432 for FV, a difference of £68.13 (95% CI £5.63 to £130.63; p = 0.033) in favour of FV. The budget impact analysis suggests that there is a cost saving of £68.13 (95% CI £5.63 to £130.63; p = 0.033) per child treated if using FV compared with the application of FS over this time period. An acceptability score completed by the children immediately after treatment and subsequent interviews demonstrated that both interventions were acceptable to the children. No adverse effects were reported.
Limitations
There are no important limitations to this study.
Conclusions
In a community oral health programme utilising MDCs and targeted at children with high caries risk, the twice-yearly application of FV resulted in caries prevention that is not significantly different from that obtained by applying and maintaining FSs after 36 months. FV proved less expensive.
Future work
The clinical effectiveness and cost-effectiveness of FS and FV following the cessation of active intervention merits investigation.
Trial registration
EudraCT number 2010-023476-23, Current Controlled Trials ISRCTN17029222 and UKCRN reference 9273.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 21, No. 21. See the NIHR Journals Library website for further project information.
Background
Taxes on sugar-sweetened beverages (SSBs) meant to improve health and raise revenue are being adopted, yet evaluation is scarce. This study examines the association of the first penny per ounce SSB excise tax in the United States, in Berkeley, California, with beverage prices, sales, store revenue/consumer spending, and usual beverage intake.
Methods and findings
Methods included comparison of pre-taxation (before 1 January 2015) and first-year post-taxation (1 March 2015–29 February 2016) measures of (1) beverage prices at 26 Berkeley stores; (2) point-of-sale scanner data on 15.5 million checkouts for beverage prices, sales, and store revenue for two supermarket chains covering three Berkeley and six control non-Berkeley large supermarkets in adjacent cities; and (3) a representative telephone survey (17.4% cooperation rate) of 957 adult Berkeley residents.
Key hypotheses were that (1) the tax would be passed through to the prices of taxed beverages among the chain stores in which Berkeley implemented the tax in 2015; (2) sales of taxed beverages would decline, and sales of untaxed beverages would rise, in Berkeley stores more than in comparison non-Berkeley stores; (3) consumer spending per transaction (checkout episode) would not increase in Berkeley stores; and (4) self-reported consumption of taxed beverages would decline.
Main outcomes and measures included changes in inflation-adjusted prices (cents/ounce), beverage sales (ounces), consumers’ spending measured as store revenue (inflation-adjusted dollars per transaction) in two large chains, and usual beverage intake (grams/day and kilocalories/day).
Tax pass-through (changes in the price after imposition of the tax) for SSBs varied in degree and timing by store type and beverage type. Pass-through was complete in large chain supermarkets (+1.07¢/oz, p = 0.001) and small chain supermarkets and chain gas stations (1.31¢/oz, p = 0.004), partial in pharmacies (+0.45¢/oz, p = 0.03), and negative in independent corner stores and independent gas stations (−0.64¢/oz, p = 0.004). Sales-unweighted mean price change from scanner data was +0.67¢/oz (p = 0.00) (sales-weighted, +0.65¢/oz, p = 0.003), with +1.09¢/oz (p < 0.001) for sodas and energy drinks, but a lower change in other categories. Post-tax year 1 scanner data SSB sales (ounces/transaction) in Berkeley stores declined 9.6% (p < 0.001) compared to estimates if the tax were not in place, but rose 6.9% (p < 0.001) for non-Berkeley stores. Sales of untaxed beverages in Berkeley stores rose by 3.5% versus 0.5% (both p < 0.001) for non-Berkeley stores. Overall beverage sales also rose across stores. In Berkeley, sales of water rose by 15.6% (p < 0.001) (exceeding the decline in SSB sales in ounces); untaxed fruit, vegetable, and tea drinks, by 4.37% (p < 0.001); and plain milk, by 0.63% (p = 0.01). Scanner data mean store revenue/consumer spending (dollars per transaction) fell 18¢ less in Berkeley (−0.54, p < 0.001). Baseline and post-tax Berkeley SSB sales and usual dietary intake were markedly low compared to national levels (at baseline, National Health and Nutrition Examination Survey SSB intake nationally was 131 kcal/d and in Berkeley was 45 kcal/d). Reductions in self-reported mean daily SSB intake in grams (−19.8%, p = 0.49) and in mean per capita SSB caloric intake (−13.3%, p = 0.56) from baseline to post-tax were not statistically significant.
Limitations of the study include inability to establish causal links due to observational design, and the absence of health outcomes. Analysis of consumption was limited by the small effect size in relation to high standard error and Berkeley’s low baseline consumption.
Conclusions
One year following implementation of the nation’s first large SSB tax, prices of SSBs increased in many, but not all, settings, SSB sales declined, and sales of untaxed beverages (especially water) and overall study beverages rose in Berkeley; overall consumer spending per transaction in the stores studied did not rise. Price increases for SSBs in two distinct data sources, their timing, and the patterns of change in taxed and untaxed beverage sales suggest that the observed changes may be attributable to the tax. Post-tax self-reported SSB intake did not change significantly compared to baseline. Significant declines in SSB sales, even in this relatively affluent community, accompanied by revenue used for prevention suggest promise for this policy. Evaluation of taxation in jurisdictions with more typical SSB consumption, with controls, is needed to assess broader dietary and potential health impacts.
Background
The caries arrest that can be achieved by using silver diamine fluoride (SDF) offers a minimally invasive and inexpensive alternative to traditional restorative caries treatment. The authors evaluated how the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children in the New York City metropolitan area.
Methods
The authors invited the parents of children who had experienced dental caries and who had appointments at the New York University Pediatric Dentistry Clinic and at several private clinics in New Jersey to participate in a Web-based survey designed to assess parents’ demographics, perceptions of photographs of SDF-treated carious teeth, and acceptability of treatment in different behavior management scenarios.
Results
Ninety-eight mothers and 22 fathers from diverse backgrounds participated. Most parents (67.5%) judged SDF staining on the posterior teeth to be esthetically tolerable, but only 29.7% of parents made this same judgment about anterior teeth (P < .001). In the absence of their child having behavioral barriers to conventional restorations, 53.6% of parents reported that they were likely to choose SDF to treat their child’s posterior teeth, but only 26.9% of parents were likely to choose SDF to treat their child’s anterior teeth. As the number of children’s behavioral barriers increased, so did the parents’ level of acceptance. In extreme cases, in which parents had to decide whether their children should undergo general anesthesia during treatment, parents’ acceptance rate of SDF as a treatment method increased to 68.5% on posterior teeth and to 60.3% on anterior teeth. Parents’ acceptance of the treatment also varied according to their socioeconomic status.
Conclusions
Staining on posterior teeth was more acceptable than staining on anterior teeth. Although staining on anterior teeth was undesirable, most parents preferred this option to advanced behavioral techniques such as sedation or general anesthesia.
Practical Implications
Clinicians need to understand parental sensitivities regarding the staining effect of SDF to plan adequately for the use of SDF as a method of caries management in pediatric patients.
In this issue of JAMA Pediatrics, Blackburn and colleagues¹ address whether preventive dental care for children younger than 2 years by primary care professionals, including pediatricians and dentists, reduces subsequent need for fillings and other treatments for tooth decay. They use data for children enrolled in Alabama Medicaid from 2008 to 2012. The American Academy of Pediatrics² and the American Academy of Pediatric Dentistry recommend that risk assessment and preventive care should begin with the eruption of the first baby tooth. The main preventive service recommended is the topical application of fluoride varnish every 3 to 6 months.³,4
Importance:
There is a recommendation for children to have a dental home by 6 months of age, but there is limited evidence supporting the effectiveness of early preventive dental care or whether primary care providers (PCPs) can deliver it.
Objective:
To investigate the effectiveness of preventive dental care in reducing caries-related treatment visits among Medicaid enrollees.
Design, setting, and participants:
High-dimensional propensity scores were used to address selection bias for a retrospective cohort study of children continuously enrolled in coverage from the Alabama Medicaid Agency from birth between 2008 and 2012, adjusting for demographics, access to care, and general health service use.
Exposures:
Children receiving preventive dental care prior to age 2 years from PCPs or dentists vs no preventive dental care.
Main outcome and measures:
Two-part models estimated caries-related treatment and expenditures.
Results:
Among 19 658 eligible children, 25.8% (n = 3658) received early preventive dental care, of whom 44% were black, 37.6% were white, and 16.3% were Hispanic. Compared with matched children without early preventive dental care, children with dentist-delivered preventive dental care more frequently had a subsequent caries-related treatment (20.6% vs 11.3%, P < .001), higher rate of visits (0.29 vs 0.15 per child-year, P < .001), and greater dental expenditures (87 per year, P < .001). Dentist-delivered preventive dental care was associated with an increase in the expected number of caries-related treatment visits by 0.14 per child per year (95% CI, 0.11-0.16) and caries-related treatment expenditures by 30.48-$51.07). Primary care provider-delivered preventive dental care did not significantly affect caries-related treatment use or expenditures.
Conclusions and relevance:
Children with early preventive care visits from dentists were more likely to have subsequent dental care, including caries-related treatment, and greater expenditures than children without preventive dental care. There was no association with subsequent caries-related treatment and preventive dental care from PCPs. We observed no evidence of a benefit of early preventive dental care, regardless of the provider. Additional research beyond administrative data may be necessary to elucidate any benefits of early preventive dental care.
Mexico implemented a 1 peso per liter excise tax on sugar-sweetened beverages on January 1, 2014, and a previous study found a 6 percent reduction in purchases of taxed beverages in 2014. In this study we estimated changes in beverage purchases for 2014 and 2015. We used store purchase data for 6,645 households from January 2012 to December 2015. Changes in purchases of taxed and untaxed beverages in the study period were estimated using two models, which compared 2014 and 2015 purchases with predicted (counterfactual) purchases based on trends in 2012-13. Purchases of taxed beverages decreased 5.5 percent in 2014 and 9.7 percent in 2015, yielding an average reduction of 7.6 percent over the study period. Households at the lowest socioeconomic level had the largest decreases in purchases of taxed beverages in both years. Purchases of untaxed beverage increased 2.1 percent in the study period. Findings from Mexico may encourage other countries to use fiscal policies to reduce consumption of unhealthy beverages along with other interventions to reduce the burden of chronic disease.
Untreated dental caries in Chinese pre-school children is common. This prospective controlled clinical trial investigated the effectiveness of topical fluoride applications in arresting dentin caries. Three hundred seventy-five children, aged 3-5 years, with carious upper anterior teeth were divided into five groups. Children in the first and second groups received annual applications of silver diamine fluoride solution (44,800 ppm F). Sodium fluoride varnish (22,600 ppm F) was applied every three months to the lesions of children in the third and fourth groups. For children in the first and third groups, soft carious tissues were removed prior to fluoride application. The fifth group was the control. Three hundred eight children were followed for 30 months. The respective mean numbers of arrested carious tooth surfaces in the five groups were 2.5, 2.8, 1.5, 1.5, and 1.3 (p < 0.001). Silver diamine fluoride was found to be effective in arresting dentin caries in primary anterior teeth in pre-school children.
Background:
Dental caries is the most common disease of childhood. The NHS guidelines promote preventative care in dental practices, particularly for young children. However, the cost-effectiveness of this policy has not been established.
Objective:
To measure the effects and costs of a composite fluoride intervention designed to prevent caries in young children attending dental services.
Design:
The study was a two-arm, parallel-group, randomised controlled trial, with an allocation ratio of 1 : 1. Randomisation was by clinical trials unit, using randomised permuted blocks. Children/families were not blinded; however, outcome assessment was blinded to group assessment.
Setting:
The study took place in 22 NHS dental practices in Northern Ireland, UK.
Participants:
The study participants were children aged 2-3 years, who were caries free at baseline.
Interventions:
The intervention was composite in nature, comprising a varnish containing 22,600 parts per million (p.p.m.) fluoride, a toothbrush and a 50-ml tube of toothpaste containing 1450 p.p.m. fluoride; plus standardised, evidence-based prevention advice provided at 6-monthly intervals over 3 years. The control group received the prevention advice alone.
Main outcome measures:
The primary outcome measure was conversion from caries-free to caries-active states. Secondary outcome measures were the number of decayed, missing or filled tooth surfaces in primary dentition (dmfs) in caries-active children, the number of episodes of pain, the number of extracted teeth and the costs of care. Adverse reactions (ARs) were recorded.
Results:
A total of 1248 children (624 randomised to each group) were recruited and 1096 (549 in the intervention group and 547 in the control group) were included in the final analyses. A total of 87% of the intervention children and 85% of control children attended every 6-month visit (p = 0.77). In total, 187 (34%) children in the intervention group converted to caries active, compared with 213 (39%) in the control group [odds ratio (OR) 0.81, 95% confidence interval (CI) 0.64 to 1.04; p = 0.11]. The mean number of tooth surfaces affected by caries was 7.2 in the intervention group, compared with 9.6 in the control group (p = 0.007). There was no significant difference in the number of episodes of pain between groups (p = 0.81). However, 164 out of the total of 400 (41%) children who converted to caries active reported toothache, compared with 62 out of 696 (9%) caries-free children (OR 7.1 95% CI 5.1 to 9.9; p < 0.001). There was no statistically significant difference in the number of teeth extracted in caries-active children (p = 0.95). Ten children in the intervention group had ARs of a minor nature. The average direct dental care cost was £155.74 for the intervention group and £48.21 for the control group over 3 years (p < 0.05). The mean cost per carious surface avoided over the 3 years was estimated at £251.00.
Limitations:
The usual limitations of a trial such as generalisability and understanding the underlying reasons for the outcomes apply. There is no mean willingness-to-pay threshold available to enable assessment of value for money.
Conclusions:
A statistically significant effect could not be demonstrated for the primary outcome. Once caries develop, pain is likely. There was a statistically significant difference in dmfs in caries-active children in favour of the intervention. Although adequately powered, the effect size of the intervention was small and of questionable clinical and economic benefit.
Future work:
Future work should assess the caries prevention effects of interventions to reduce sugar consumption at the population and individual levels. Interventions designed to arrest the disease once it is established need to be developed and tested in practice.
Trial registration:
Current Controlled Trials ISRCTN36180119 and EudraCT 2009-010725-39.
Funding:
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 71. See the NIHR Journals Library website for further project information.
Objective:
This study aimed to assess the extent to which dental caries and fluorosis, in addition to sociodemographic and oral health behavior determinants, impact the oral health-related quality of life (OHRQoL) of adolescents.
Methods:
All adolescents attending from sixth to eighth grades in the Region of Itapoã, Federal District of Brazil (n = 1122), were screened, and 618 10-15-year-olds were selected. Parents answered a questionnaire about their family's socioeconomic status. Adolescents answered a questionnaire about demographic and oral health behavior determinants in addition to the Child Perception Questionnaire.
Results:
Cavitated dentine lesions and fluorosis were observed in 39.5 and 48.5 %, respectively. The outcome was a high score on OHRQoL (median split >9). The prevalence of adolescents with at least one domain being impacted "often" or "every day/almost every day" was 34.8 %. Adolescents with tooth brushing frequency ≤once per day and with moderate or severe cavitated dentine lesions reported a significant impact on their OHRQoL (p = 0.002; p = 0.001). Fluorosis did not impact daily life performances (p = 0.545).
Conclusion:
Increased impact on OHRQoL was related to the severity of cavitated dentine lesions, but fluorosis resulting from combined fluoride exposure from early ages was not of concern for the adolescents.
Clinical relevance:
Combined fluoride exposure from fluoridated drinking water, consumption of food prepared with fluoridated water, and daily twice brushing with conventional fluoride toothpaste from early ages may be recommended to control caries progression at population level without impact on OHRQoL. This information is particularly relevant for supporting oral health police for disadvantaged populations.
Background:
Fluoride mouthrinses have been used extensively as a caries-preventive intervention in school-based programmes and by individuals at home. This is an update of the Cochrane review of fluoride mouthrinses for preventing dental caries in children and adolescents that was first published in 2003.
Objectives:
The primary objective is to determine the effectiveness and safety of fluoride mouthrinses in preventing dental caries in the child and adolescent population.The secondary objective is to examine whether the effect of fluoride rinses is influenced by:• initial level of caries severity;• background exposure to fluoride in water (or salt), toothpastes or reported fluoride sources other than the study option(s); or• fluoride concentration (ppm F) or frequency of use (times per year).
Search methods:
We searched the following electronic databases: Cochrane Oral Health's Trials Register (whole database, to 22 April 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 3), MEDLINE Ovid (1946 to 22 April 2016), Embase Ovid (1980 to 22 April 2016), CINAHL EBSCO (the Cumulative Index to Nursing and Allied Health Literature, 1937 to 22 April 2016), LILACS BIREME (Latin American and Caribbean Health Science Information Database, 1982 to 22 April 2016), BBO BIREME (Bibliografia Brasileira de Odontologia; from 1986 to 22 April 2016), Proquest Dissertations and Theses (1861 to 22 April 2016) and Web of Science Conference Proceedings (1990 to 22 April 2016). We undertook a search for ongoing trials on the US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the World Health Organization International Clinical Trials Registry Platform. We placed no restrictions on language or date of publication when searching electronic databases. We also searched reference lists of articles and contacted selected authors and manufacturers.
Selection criteria:
Randomised or quasi-randomised controlled trials where blind outcome assessment was stated or indicated, comparing fluoride mouthrinse with placebo or no treatment in children up to 16 years of age. Study duration had to be at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces in permanent teeth (D(M)FS).
Data collection and analysis:
At least two review authors independently performed study selection, data extraction and risk of bias assessment. We contacted study authors for additional information when required. The primary measure of effect was the prevented fraction (PF), that is, the difference in mean caries increments between treatment and control groups expressed as a percentage of the mean increment in the control group. We conducted random-effects meta-analyses where data could be pooled. We examined potential sources of heterogeneity in random-effects metaregression analyses. We collected adverse effects information from the included trials.
Main results:
In this review, we included 37 trials involving 15,813 children and adolescents. All trials tested supervised use of fluoride mouthrinse in schools, with two studies also including home use. Almost all children received a fluoride rinse formulated with sodium fluoride (NaF), mostly on either a daily or weekly/fortnightly basis and at two main strengths, 230 or 900 ppm F, respectively. Most studies (28) were at high risk of bias, and nine were at unclear risk of bias.From the 35 trials (15,305 participants) that contributed data on permanent tooth surface for meta-analysis, the D(M)FS pooled PF was 27% (95% confidence interval (CI), 23% to 30%; I(2) = 42%) (moderate quality evidence). We found no significant association between estimates of D(M)FS prevented fractions and baseline caries severity, background exposure to fluorides, rinsing frequency or fluoride concentration in metaregression analyses. A funnel plot of the 35 studies in the D(M)FS PF meta-analysis indicated no relationship between prevented fraction and study precision (no evidence of reporting bias). The pooled estimate of D(M)FT PF was 23% (95% CI, 18% to 29%; I² = 54%), from the 13 trials that contributed data for the permanent teeth meta-analysis (moderate quality evidence).We found limited information concerning possible adverse effects or acceptability of the treatment regimen in the included trials. Three trials incompletely reported data on tooth staining, and one trial incompletely reported information on mucosal irritation/allergic reaction. None of the trials reported on acute adverse symptoms during treatment.
Authors' conclusions:
This review found that supervised regular use of fluoride mouthrinse by children and adolescents is associated with a large reduction in caries increment in permanent teeth. We are moderately certain of the size of the effect. Most of the evidence evaluated use of fluoride mouthrinse supervised in a school setting, but the findings may be applicable to children in other settings with supervised or unsupervised rinsing, although the size of the caries-preventive effect is less clear. Any future research on fluoride mouthrinses should focus on head-to-head comparisons between different fluoride rinse features or fluoride rinses against other preventive strategies, and should evaluate adverse effects and acceptability.
The Food and Drug Administration recently cleared silver diamine fluoride for reducing tooth sensitivity. Clinical trials document arrest and prevention of dental caries by silver diamine fluoride. This off-label use is now permissible and appropriate under U.S. law. A CDT code was approved for caries arresting medicaments for 2016 to facilitate documentation and billing. We present a systematic review, clinical indications, clinical protocol and consent procedure to guide application for caries arrest treatment.
Background:
Glass-ionomers are traditionally regarded to be inferior to resin as fissure sealants in protecting teeth from dental caries, due to their comparatively lower retention rate. Unlike low-viscosity glass-ionomers, high-viscosity glass-ionomer cements (HVGIC) are placed as sealants by pressing the material into pits and fissures with a petroleum-jelly-coated index finger. Hence, HVGIC sealants are assumed to penetrate pits and fissures deeper, resulting in a higher material retention rate, which may increase its caries-preventive effect.
Methods:
The aim of this review was to answer the question as to whether, in patients with fully erupted permanent molar teeth, HVGIC based fissure sealants are less effective to protect against dental carious lesions in occlusal pits and fissures than resin-based fissure sealants? A systematic literature search in eight databases was conducted. Heterogeneity of accepted trials and imprecision of the established evidence were assessed. Extracted sufficiently homogenous datasets were pooled by use of a random-effects meta-analysis. Internal trial validity was evaluated. The protocol of this systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO / Nr.: CRD42015016007).
Results:
Seven clinical trials were provisionally included for further review. Of these, one was excluded. Seven trial reports reporting on six trials were accepted. From these, 11 datasets were extracted and pooled in four meta-analyses. The results suggest no statistically significant differences after up to 48 months and borderline significant differences in favour of HVGIC sealants after 60 months (RR 0.29; 95% CI: 0.09-0.95; p = 0.04 / RD -0.07; 95% CI: -0.14, -0.01). The point estimates and upper confidence levels after 24, 36, 48 and 60 months of RR 1.36; RR 0.90; RR 0.62; RR 0.29 and 2.78; 1.67; 1.21; 0.95, respectively, further suggest a chronological trend in favour of HVGIC above resin-based sealants. The internal trial validity was judged to be low and the bias risk high for all trials. Imprecision of results was considered too high for clinical guidance.
Conclusion:
It can be concluded that: (i) Inferiority claims against HVGIC in comparison to resin-based sealants as current gold-standard are not supported by the clinical evidence; (ii) The clinical evidence suggests similar caries-preventive efficacy of HVGIC and resin-based sealants after a period of 48 months in permanent molar teeth but remains challenged by high bias risk; (iii) Evidence concerning a possible superiority of HVGIC above resin-based sealants after 60 months is poor (even if the high bias risk is disregarded) due to imprecision and requires corroboration through future research.
The purpose of this study was to assess the relationship between vitamin D status and dental caries in Canadian school-aged children
participating in the Canadian Health Measures Survey (CHMS). The CHMS was a national cross-sectional study involving physical
assessments, laboratory analysis, and interviews. Analysis was restricted to data for 1,017 children 6 to 11 y of age. Outcome variables
included the presence of caries and overall total caries score (dmft/DMFT index). Levels of 25-hydroxyvitamin D (25(OH)D) were
measured from serum samples obtained from participants. Bivariate analysis, logistic regression for the presence of caries, and multiple
linear regression for total caries scores were used. Significance was set at P ≤ 0.05. Overall, 56.4% of children experienced caries, and
the mean dmft/DMFT score was 2.47 (95% CI 2.09 to 2.84). The unadjusted odds of children with 25(OH)D levels ≥75 nmol/L having
experienced caries was 0.57 (95% CI 0.39 to 0.82), while the odds for caries at the ≥50 nmol/L level was 0.56 (95% CI 0.39 to 0.89).
After controlling for other covariates, backward logistic regression revealed that the presence of caries was significantly associated
with 25(OH) levels <75 nmol/L and <50 nmol/L, lower household education, not brushing twice daily, and yearly visits to the dentist.
Similarly, multiple linear regression revealed that total dmft/DMFT caries scores were also associated with 25(OH)D concentrations
<75 nmol/L, not brushing twice daily, lower household education, and yearly visits to the dentist. Data from a cross-sectional, nationally
representative sample of Canadian children suggest that there is an association between caries and lower serum vitamin D. Improving
children’s vitamin D status may be an additional preventive consideration to lower the risk for caries.
Background
Topically applied fluoride gels have been widely used as a caries-preventive intervention in dental surgeries and school-based programmes for over three decades. This updates the Cochrane review of fluoride gels for preventing dental caries in children and adolescents that was first published in 2002.
Objectives
The primary objective is to determine the effectiveness and safety of fluoride gels in preventing dental caries in the child and adolescent population.
The secondary objectives are to examine whether the effect of fluoride gels is influenced by the following: initial level of caries severity; background exposure to fluoride in water (or salt), toothpastes, or reported fluoride sources other than the study option(s); mode of use (self applied under supervision or operator-applied), and whether there is a differential effect between the tray and toothbrush methods of application; frequency of use (times per year) or fluoride concentration (ppm F).
Search methods
We searched the Cochrane Oral Health Group Trials Register (to 5 November 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2014, Issue 11), MEDLINE via OVID (1946 to 5 November 2014), EMBASE via OVID (1980 to 5 November 2014), CINAHL via EBSCO (1980 to 5 November 2014), LILACS and BBO via the BIREME Virtual Health Library (1980 to 5 November 2014), ProQuest Dissertations and Theses (1861 to 5 November 2014) and Web of Science Conference Proceedings (1945 to 5 November 2014). We undertook a search for ongoing trials on ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform on 5 November 2014. We placed no restrictions on language or date of publication in the search of the electronic databases. We also searched reference lists of articles and contacted selected authors and manufacturers.
Selection criteria
Randomised or quasi-randomised controlled trials where blind outcome assessment was stated or indicated, comparing topically applied fluoride gel with placebo or no treatment in children up to 16 years. The frequency of application had to be at least once a year, and study duration at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces in both permanent and primary teeth (D(M)FS and d(e/m)fs).
Data collection and analysis
At least two review authors independently performed study selection, data extraction and 'Risk of bias' assessment. We contacted study authors for additional information where required. The primary measure of effect was the prevented fraction (PF), that is, the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. We performed random-effects meta-analyses where we could pool data. We examined potential sources of heterogeneity in random-effects metaregression analyses. We collected adverse effects information from the included trials.
Main results
We included 28 trials (3 of which are new trials since the original review), involving 9140 children and adolescents. Most of these trials recruited participants from schools. Most of the studies (20) were at high risk of bias, with 8 at unclear risk of bias.
Twenty-five trials (8479 participants) contributed data for meta-analysis on permanent tooth surfaces: the D(M)FS pooled prevented fraction (PF) estimate was 28% (95% confidence intervals (CI) 19% to 36%; P < 0.0001; with substantial heterogeneity (P < 0.0001; I2 = 82%); moderate quality evidence). Subgroup and metaregression analyses suggested no significant association between estimates of D(M)FS prevented fractions and the prespecified trial characteristics. However, the effect of fluoride gel varied according to the type of control group used, with D(M)FS PF on average being 17% (95% CI 3% to 31%; P = 0.018) higher in non-placebo-controlled trials (the reduction in caries was 38% (95% CI 24% to 52%; P < 0.0001, 2808 participants) for the 10 trials with no treatment as control group, and 21% (95% CI 15% to 28%; P < 0.0001, 5671 participants) for the 15 placebo-controlled trials. A funnel plot of the 25 trials in the D(M)FS PF meta-analysis indicated a relationship between prevented fraction and study precision, with an apparent lack of small studies with statistically significant large effects.
The d(e/m)fs pooled prevented fraction estimate for the three trials (1254 participants) that contributed data for the meta-analysis on primary teeth surfaces was 20% (95% CI 1% to 38%; P = 0.04; with no heterogeneity (P = 0.54; I2 = 0%); low quality evidence).
There was limited reporting of adverse events. Only two trials reported information on acute toxicity signs and symptoms during the application of the gel (risk difference 0.01, 95% CI -0.01 to 0.02; P = 0.36; with no heterogeneity (P = 36; I2 = 0%); 490 participants; very low quality evidence). None of the trials reported information on tooth staining, mucosal irritation or allergic reaction.
Authors' conclusions
The conclusions of this updated review remain the same as those when it was first published. There is moderate quality evidence of a large caries-inhibiting effect of fluoride gel in the permanent dentition. Information concerning the caries-preventive effect of fluoride gel on the primary dentition, which also shows a large effect, is based on low quality evidence from only three placebo-controlled trials. There is little information on adverse effects or on acceptability of treatment. Future trials should include assessment of potential adverse effects.
We aimed to evaluate the efficacy of oral hygiene instruction, fluoride varnish and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) for remineralizing white spot lesions (WSL), and the effect of these on the dmft index in primary teeth.
In this 1-year, randomized clinical trial, 140 children aged 12-36 months with WSL in the anterior maxillary teeth were selected and randomly divided into 4 groups of 35 children each. Group 1 (control) received no preventive intervention. In group 2, there was oral hygiene and dietary counseling. In group 3, there was oral hygiene and the application of fluoride varnish at 4, 8 and 12 months after baseline. In group 4, there was oral hygiene and tooth mousse was applied by the parents twice a day over a 12-month period. At baseline and 4, 8 and 12 months after the intervention, the size of WSL in millimeters and the dmft index were recorded. One hundred and twenty-two children completed the study. Data were analyzed using the repeated-measures ANOVA test.
In group 1, the mean percent WSL area and dmft index values had increased significantly at 12 months after baseline (p < 0.001). The interventions led to significant decreases in the size of the WSL; the greatest reduction was in group 4 (63%) followed by group 3 (51%) and group 2 (10%) after 12 months. The smallest increase in the dmft index was in group 4 (0.17), followed by groups 3 (0.3) and 2 (0.42). However, there were no significant differences between the groups (p < 0.001).
Oral hygiene along with four fluoride varnish applications or constant CPP-ACP during the 12- month period reduced the size of WSL in the anterior primary teeth and caused a small increase in dmft index values. © 2015 S. Karger AG, Basel.
Background:
Dental caries (tooth decay) is a common disease that is preventable by reducing the dietary intake of free sugars and using topical sodium fluoride products. An antibacterial agent known as chlorhexidine may also help prevent caries. A number of over-the-counter and professionally administered chlorhexidine-based preparations are available in a variety of formulations and in a range of strengths. Although previous reviews have concluded that some formulations of chlorhexidine may be effective in inhibiting the progression of established caries in children, there is currently a lack of evidence to either claim or refute a benefit for its use in preventing dental caries.
Objectives:
To assess the effects of chlorhexidine-containing oral products (toothpastes, mouthrinses, varnishes, gels, gums and sprays) on the prevention of dental caries in children and adolescents.
Search methods:
We searched the Cochrane Oral Health Group Trials Register (25 February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 12), MEDLINE via OVID (1946 to 25 February 2015), EMBASE via OVID (1980 to 25 February 2015) and CINAHL via EBSCO (1937 to 25 February 2015). We handsearched several journals placed no language restrictions on our search. After duplicate citations were removed, the electronic searches retrieved 1075 references to studies.
Selection criteria:
We included parallel-group, randomised controlled trials (RCTs) that compared the caries preventive effects of chlorhexidine gels, toothpastes, varnishes, mouthrinses, chewing gums or sprays with each other, placebo or no intervention in children and adolescents. We excluded trials with combined interventions of chlorhexidine and fluoride or comparisons between chlorhexidine and fluoride interventions.
Data collection and analysis:
Two review authors independently extracted trial data and assessed risk of bias. We resolved disagreements by consensus. We contacted trial authors for clarification or additional study details when necessary. The number of included studies that were suitable for meta-analysis was limited due to the clinical diversity of the included studies with respect to age, composition of intervention, and variation in outcome measures and follow-up. Where we were unable to conduct meta-analysis, we elected to present a narrative synthesis of the results.
Main results:
We included eight RCTs that evaluated the effects of chlorhexidine varnishes (1%, 10% or 40% concentration) and chlorhexidine gel (0.12%) on the primary or permanent teeth, or both, of children from birth to 15 years of age at the start of the study. The studies randomised a total of 2876 participants, of whom 2276 (79%) were evaluated. We assessed six studies as being at high risk of bias overall and two studies as being at unclear risk of bias overall. Follow-up assessment ranged from 6 to 36 months.Six trials compared chlorhexidine varnish with placebo or no treatment. It was possible to pool the data from two trials in the permanent dentition (one study using 10% chlorhexidine and the other, 40%). This led to an increase in the DMFS increment in the varnish group of 0.53 (95% confidence interval (CI) -0.47 to 1.53; two trials, 690 participants; very low quality evidence). Only one trial (10% concentration chlorhexidine varnish) provided usable data for elevated mutans streptococci levels > 4 with RR 0.93 (95% CI 0.80 to 1.07, 496 participants; very low quality evidence). One trial measured adverse effects (for example, ulcers or tooth staining) and reported that there were none; another trial reported that no side effects of the treatment were noted. No trials reported on pain, quality of life, patient satisfaction or costs.Two trials compared chlorhexidine gel (0.12% concentration) with no treatment in the primary dentition. The presence of new caries gave rise to a 95% confidence interval that was compatible with either an increase or a decrease in caries incidence (RR 1.00, 95% CI 0.36 to 2.77; 487 participants; very low quality evidence). Similarly, data for the effects of chlorhexidine gel on the prevalence of mutans streptococci were inconclusive (RR 1.26, 95% CI 0.95 to 1.66; two trials, 490 participants; very low quality evidence). Both trials measured adverse effects and did not observe any. Neither of these trials reported on the other secondary outcomes such as measures of pain, quality of life, patient satisfaction or direct and indirect costs of interventions.
Authors' conclusions:
We found little evidence from the eight trials on varnishes and gels included in this review to either support or refute the assertion that chlorhexidine is more effective than placebo or no treatment in the prevention of caries or the reduction of mutans streptococci levels in children and adolescents. There were no trials on other products containing chlorhexidine such as sprays, toothpastes, chewing gums or mouthrinses. Further high quality research is required, in particular evaluating the effects on both the primary and permanent dentition and using other chlorhexidine-containing oral products.
We documented emergency department (ED) visits for nontraumatic dental problems and identified strategies to reduce ED dental visits.
We used mixed methods to analyze claims in 2010 from a purposive sample of 25 Oregon hospitals and Oregon's All Payer All Claims data set and interviewed 51 ED dental visitors and stakeholders from 6 communities.
Dental visits accounted for 2.5% of ED visits and represented the second-most-common discharge diagnosis in adults aged 20 to 39 years, were associated with being uninsured (odds ratio [OR] = 5.2 [reference: commercial insurance]; 95% confidence interval [CI] = 4.8, 5.5) or having Medicaid insurance (OR = 4.0; 95% CI = 3.7, 4.2), resulted in opioid (56%) and antibiotic (56%) prescriptions, and generated 396, $408) in hospital costs per visit. Interviews revealed health system, community, provider, and patient contributors to ED dental visits. Potential solutions provided by interviewees included Medicaid benefit expansion, care coordination, water fluoridation, and patient education.
Emergency department dental visits are a significant and costly public health problem for vulnerable individuals. Future efforts should focus on implementing multilevel interventions to reduce ED dental visits. (Am J Public Health. Published online ahead of print March 19, 2015: e1-e9. doi:10.2105/AJPH.2014.302398).
In 1966, the National Institute of Dental Research (NIDR) began planning a targeted research program to identify interventions for widespread application to eradicate dental caries (tooth decay) within a decade. In 1971, the NIDR launched the National Caries Program (NCP). The objective of this paper is to explore the sugar industry's interaction with the NIDR to alter the research priorities of the NIDR NCP.
We used internal cane and beet sugar industry documents from 1959 to 1971 to analyze industry actions related to setting research priorities for the NCP. The sugar industry could not deny the role of sucrose in dental caries given the scientific evidence. They therefore adopted a strategy to deflect attention to public health interventions that would reduce the harms of sugar consumption rather than restricting intake. Industry tactics included the following: funding research in collaboration with allied food industries on enzymes to break up dental plaque and a vaccine against tooth decay with questionable potential for widespread application, cultivation of relationships with the NIDR leadership, consulting of members on an NIDR expert panel, and submission of a report to the NIDR that became the foundation of the first request for proposals issued for the NCP. Seventy-eight percent of the sugar industry submission was incorporated into the NIDR's call for research applications. Research that could have been harmful to sugar industry interests was omitted from priorities identified at the launch of the NCP. Limitations are that this analysis relies on one source of sugar industry documents and that we could not interview key actors.
The NCP was a missed opportunity to develop a scientific understanding of how to restrict sugar consumption to prevent tooth decay. A key factor was the alignment of research agendas between the NIDR and the sugar industry. This historical example illustrates how industry protects itself from potentially damaging research, which can inform policy makers today. Industry opposition to current policy proposals-including a World Health Organization guideline on sugars proposed in 2014 and changes to the nutrition facts panel on packaged food in the US proposed in 2014 by the US Food and Drug Administration-should be carefully scrutinized to ensure that industry interests do not supersede public health goals.
A double-blind randomized clinical trial was performed in 6- to 7-yr-old schoolchildren to evaluate, in a 30-mo period, whether the caries increment on the distal surface of the second primary molars adjacent to permanent first molars sealed with fluoride release compounds would be lower with respect to those adjacent to permanent first molars sealed with a nonfluoridated sealant. In sum, 2,776 subjects were enrolled and randomly divided into 3 groups receiving sealants on sound first molars: high-viscosity glass ionomer cement (GIC group); resin-based sealant with fluoride (fluoride-RB group); and a resin-based sealant without fluoride (RB group). Caries (D-1-D-3 level) was recorded on the distal surface of the second primary molar, considered the unit of analysis including only sound surfaces at the baseline. At baseline, no differences in caries prevalence were recorded in the 3 groups regarding the considered surfaces. At follow-up, the prevalence of an affected unit of analysis was statistically lower (p=.03) in the GIC and fluoride-RB groups (p=.04). In the GIC group, fewer new caries were observed in the unit of analysis respect to the other 2 groups. Incidence rate ratios (IRRs) were 0.70 (95% confidence interval: 0.50, 0.68; p < .01) for GIC vs. RB and 0.79 (95% confidence interval: 0.53, 1.04; p = .005) for fluoride-RB vs. RB. Caries incidence was significantly associated with low socioeconomic status (IRR = 1.18; 95% confidence interval: 1.10, 1.42; p = .05). Dental sealant high-viscosity GIC and fluoride-RB demonstrated protection against dental caries, and there was evidence that these materials afforded additional protection for the tooth nearest to the sealed tooth.
The prevalence of dental caries (tooth decay) among preschool children is increasing, driven partially by an earlier age of onset of carious lesions. The American Academy of Pediatrics recommends application of 5% sodium fluoride varnish at intervals increasing with caries risk status, as soon as teeth are present. However, the varnishes are marketed for treatment of tooth sensitivity and are regulated as medical devices rather than approved by the US Food and Drug Administration for prevention of dental caries (tooth decay). The objective of this research is to examine the safety of use in toddlers by characterizing the absorption and distribution profile of a currently marketed fluoride varnish. We measured urinary fluoride for 5 hours after application of fluoride varnish to teeth in 6 toddlers aged 12 to 15 months. Baseline levels were measured on a separate day. The urine was extracted from disposable diapers, measured by rapid diffusion, and extrapolated to plasma levels. The mean estimated plasma fluoride concentration was 13 μg/L (SD, 9 μg/L) during the baseline visit and 21 μg/L (SD, 8 μg/L) during the 5 hours after treatment. Mean estimated peak plasma fluoride after treatment was 57 μg/L (SD, 22 μg/L), and 20 μg/kg (SD, 4 μg/L) was retained on average. Retained fluoride was 253 times lower than the acute toxic dose of 5 mg/kg. Mean plasma fluoride after placement of varnish was within an SD of control levels. Occasional application of fluoride varnish following American Academy of Pediatrics guidance is safe for toddlers.
Objective
To compare the efficacy of a new dentifrice containing 1.5% arginine and 1450 ppm fluoride to a positive control dentifrice containing 1450 ppm fluoride alone in arresting and reversing primary root caries lesions in adults.
Study design
A total of 3779 subjects from Piracicaba, Säo Paulo, Brazil were screened; 284 had at least one leathery primary root caries lesion and were eligible for the study. The new dentifrice contained 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride, as sodium monofluorophosphate; the matched positive control dentifrice contained 1450 ppm fluoride. One lesion for each subject was selected for inclusion in the study and was examined at baseline, 3 and 6 months.
Results
A total of 253 subjects completed the study with 129 of 144 subjects included in the final statistical analysis for the test dentifrice and 124 of 140 for the positive control. The mean age of subjects was 45.7 (±9.19) years and 56.5% were female. After 6 months product use, 70.5% of root caries lesions improved for subjects using the arginine-containing dentifrice compared to 58.1% for subjects using the positive control. The difference in the number of root caries lesions becoming hard in the two groups was statistically significant (p = 0.038).
Conclusion
A new dentifrice containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride, as sodium monofluorophosphate, provided statistically significantly superior efficacy in arresting and reversing active root caries lesions in adults compared to a matched positive control dentifrice containing fluoride alone.
Objective:
To evaluate the effect of maternal xylitol consumption on children's salivary mutans streptococci (MS) level, caries activity, and plaque accumulation in contrast with maternal fluoride varnish in a group of mother-child pairs.
Methods:
In this randomized controlled trial, the study subjects were 60 mother-child pairs recruited from the pediatric dentistry clinic and the hospital well baby clinic at King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. The sample was recruited on the basis of maternal high salivary MS levels, and a child aged 10-36 months. The subjects were randomly assigned to experimental and control groups. Mothers in the experimental group chewed xylitol gum, 1.8 gram (66% xylitol by weight), 3 times/day for 3 months. Mothers in the control group received fluoride varnish. Both groups received oral hygiene instructions, dietary counseling, and restorative treatment. Children were examined after 6, 12, and 24 months from the initiation of the study to evaluate salivary MS levels, caries, and plaque accumulation.
Results:
There was an increase in MS levels in the experimental and control children at 24 months, which was non-significant in the experimental group, and significantly higher in the control group when compared with the baseline (p=0.008). The decayed, missing, filled scores of the children in the experimental group showed no change after 24 months, contrary to the controls that showed a significant increase (p=0.001). Plaque scores revealed no differences over time or between the 2 groups.
Conclusion:
Compared with fluoride varnish, maternal xylitol consumption provided preventive outcomes on salivary MS and caries levels in children.
Inadequate maternal vitamin D (assessed by using 25-hydroxyvitamin D [25OHD]) levels during pregnancy may affect tooth calcification, predisposing enamel hypoplasia and early childhood caries (ECC). The purpose of this study was to determine the relationship between prenatal 25OHD concentrations and dental caries among offspring during the first year of life.
This prospective cohort study recruited expectant mothers from an economically disadvantaged urban area. A prenatal questionnaire was completed and serum sample drawn for 25OHD. Dental examinations were completed at 1 year of age while the parent/caregiver completed a questionnaire. The examiner was blinded to mothers' 25OHD levels. A P value ≤ .05 was considered significant.
Overall, 207 women were enrolled (mean age: 19 ± 5 years). The mean 25OHD level was 48 ± 24 nmol/L, and 33% had deficient levels. Enamel hypoplasia was identified in 22% of infants; 23% had cavitated ECC, and 36% had ECC when white spot lesions were included in the assessment. Mothers of children with ECC had significantly lower 25OHD levels than those whose children were caries-free (41 ± 20 vs 52 ± 27 nmol/L; P = .05). Univariate Poisson regression analysis for the amount of untreated decay revealed an inverse relationship with maternal 25OHD. Logistic regression revealed that enamel hypoplasia (P < .001), infant age (P = .002), and lower prenatal 25OHD levels (P = .02) were significantly associated with ECC.
This study found that maternal prenatal 25OHD levels may have an influence on the primary dentition and the development of ECC.
The purpose of this study was to assess the efficacy of supervised tooth-brushing with xylitol toothpaste to prevent early childhood caries (ECC) and reduce mutans streptococci.
In this cluster-randomized efficacy trial, 196 four- to five-year-old children in four Head Start classrooms in the Marshall Islands were randomly assigned to supervised toothbrushing with 1,400 ppm/31 percent fluoride xylitol or 1,450 ppm fluoride sorbitol toothpaste. We hypothesized that there would be no difference in efficacy between the two types of toothpaste. The primary outcome was the surface-level primary molar caries increment (d2-3 mfs) after six months. A single examiner was blinded to classroom assignments. Two classrooms were assigned to the fluoride-xylitol group (85 children), and two classrooms were assigned to the fluoride-sorbitol group (83 children). The child-level analyses accounted for clustering.
There was no difference between the two groups in baseline or end-of-trial mean d2-3 mfs. The mean d2-3 mfs increment was greater in the fluoride-xylitol group compared to the fluoride-sorbitol group (2.5 and 1.4 d2-3 mfs, respectively), but the difference was not significant (95% confidence interval: -0.17, 2.37; P=.07). No adverse effects were reported.
After six months, brushing with a low-strength xylitol/fluoride tooth-paste is no more efficacious in reducing ECC than a fluoride-only toothpaste in a high caries-risk child population.
Background:
Dental caries is a major public health problem in most industrialised countries, affecting 60% to 90% of school children. Community water fluoridation was initiated in the USA in 1945 and is currently practised in about 25 countries around the world; health authorities consider it to be a key strategy for preventing dental caries. Given the continued interest in this topic from health professionals, policy makers and the public, it is important to update and maintain a systematic review that reflects contemporary evidence.
Objectives:
To evaluate the effects of water fluoridation (artificial or natural) on the prevention of dental caries.To evaluate the effects of water fluoridation (artificial or natural) on dental fluorosis.
Search methods:
We searched the following electronic databases: The Cochrane Oral Health Group's Trials Register (to 19 February 2015); The Cochrane Central Register of Controlled Trials (CENTRAL; Issue 1, 2015); MEDLINE via OVID (1946 to 19 February 2015); EMBASE via OVID (1980 to 19 February 2015); Proquest (to 19 February 2015); Web of Science Conference Proceedings (1990 to 19 February 2015); ZETOC Conference Proceedings (1993 to 19 February 2015). We searched the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization's WHO International Clinical Trials Registry Platform for ongoing trials. There were no restrictions on language of publication or publication status in the searches of the electronic databases.
Selection criteria:
For caries data, we included only prospective studies with a concurrent control that compared at least two populations - one receiving fluoridated water and the other non-fluoridated water - with outcome(s) evaluated at at least two points in time. For the assessment of fluorosis, we included any type of study design, with concurrent control, that compared populations exposed to different water fluoride concentrations. We included populations of all ages that received fluoridated water (naturally or artificially fluoridated) or non-fluoridated water.
Data collection and analysis:
We used an adaptation of the Cochrane 'Risk of bias' tool to assess risk of bias in the included studies.We included the following caries indices in the analyses: decayed, missing and filled teeth (dmft (deciduous dentition) and DMFT (permanent dentition)), and proportion caries free in both dentitions. For dmft and DMFT analyses we calculated the difference in mean change scores between the fluoridated and control groups. For the proportion caries free we calculated the difference in the proportion caries free between the fluoridated and control groups.For fluorosis data we calculated the log odds and presented them as probabilities for interpretation.
Main results:
A total of 155 studies met the inclusion criteria; 107 studies provided sufficient data for quantitative synthesis.The results from the caries severity data indicate that the initiation of water fluoridation results in reductions in dmft of 1.81 (95% CI 1.31 to 2.31; 9 studies at high risk of bias, 44,268 participants) and in DMFT of 1.16 (95% CI 0.72 to 1.61; 10 studies at high risk of bias, 78,764 participants). This translates to a 35% reduction in dmft and a 26% reduction in DMFT compared to the median control group mean values. There were also increases in the percentage of caries free children of 15% (95% CI 11% to 19%; 10 studies, 39,966 participants) in deciduous dentition and 14% (95% CI 5% to 23%; 8 studies, 53,538 participants) in permanent dentition. The majority of studies (71%) were conducted prior to 1975 and the widespread introduction of the use of fluoride toothpaste.There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries across socioeconomic status (SES) levels.There is insufficient information to determine the effect of stopping water fluoridation programmes on caries levels.No studies that aimed to determine the effectiveness of water fluoridation for preventing caries in adults met the review's inclusion criteria.With regard to dental fluorosis, we estimated that for a fluoride level of 0.7 ppm the percentage of participants with fluorosis of aesthetic concern was approximately 12% (95% CI 8% to 17%; 40 studies, 59,630 participants). This increases to 40% (95% CI 35% to 44%) when considering fluorosis of any level (detected under highly controlled, clinical conditions; 90 studies, 180,530 participants). Over 97% of the studies were at high risk of bias and there was substantial between-study variation.
Authors' conclusions:
There is very little contemporary evidence, meeting the review's inclusion criteria, that has evaluated the effectiveness of water fluoridation for the prevention of caries.The available data come predominantly from studies conducted prior to 1975, and indicate that water fluoridation is effective at reducing caries levels in both deciduous and permanent dentition in children. Our confidence in the size of the effect estimates is limited by the observational nature of the study designs, the high risk of bias within the studies and, importantly, the applicability of the evidence to current lifestyles. The decision to implement a water fluoridation programme relies upon an understanding of the population's oral health behaviour (e.g. use of fluoride toothpaste), the availability and uptake of other caries prevention strategies, their diet and consumption of tap water and the movement/migration of the population. There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across SES. We did not identify any evidence, meeting the review's inclusion criteria, to determine the effectiveness of water fluoridation for preventing caries in adults.There is insufficient information to determine the effect on caries levels of stopping water fluoridation programmes.There is a significant association between dental fluorosis (of aesthetic concern or all levels of dental fluorosis) and fluoride level. The evidence is limited due to high risk of bias within the studies and substantial between-study variation.
The authors conducted a systematic review to assess the efficacy and safety of fluoride toothpaste use in children younger than 6 years.
The authors defined research questions to formulate a search strategy. They screened studies, extracted data and assessed risk of bias systematically. They conducted meta-analyses to determine the effects of brushing with fluoride toothpaste.
Use of fluoride toothpaste brushing had a statistically significant effect on mean decayed, missing and filled primary tooth surfaces and decayed, missing and filled primary teeth for populations at high risk of developing caries (standard mean difference [95 percent confidence interval {CI}], -0.25 [-0.36 to -0.14] and -0.19 [-0.32 to -0.06], respectively). The effects of using different fluoride concentration toothpastes on caries varied. Study findings showed either a decrease in the odds of having fluorosis (odds ratio [OR] [95 percent CI] = 0.66 [0.48-0.90]) when the use of fluoride toothpaste was initiated after 24 months or no statistically significant difference (OR [95 percent CI] = 0.92 [0.71-1.18]). Beginning use after 12 or 14 months of age decreased the risk of fluorosis (OR = 0.70 [0.57-0.88]).
Limited scientific evidence demonstrates that for children younger than 6 years, fluoride toothpaste use is effective in caries control. Ingesting pea-sized amounts or more can lead to mild fluorosis. Practical Implications. To minimize the risk of fluorosis in children while maximizing the caries-prevention benefit for all age groups, the appropriate amount of fluoride toothpaste should be used by all children regardless of age. Dentists should counsel caregivers by using oral description, visual aids and actual demonstration to help ensure that the appropriate amount of toothpaste is used.
Unlabelled:
Sound evidence on the effectiveness of fluoride varnishes (FV) to reduce caries incidence in preschool children is lacking.
Objective:
To assess whether the application of FV in preschool children at 6-month intervals decreases the incidence of caries and produces any adverse effects.
Methods:
A randomized, examiner- and patient-blind, placebo-controlled, parallel-group design, clinical trial, comprising 1- to 4-year-old children, 100 in each group (FV or placebo varnish, PV), was conducted in Rio de Janeiro, Brazil. Two trained pediatric dentists performed the clinical examinations (kappa = 0.85). Dental caries was recorded at the d2 (cavitated enamel) and d3 (dentine) levels using the International Caries Diagnosis and Assessment System.
Results:
At baseline, the mean age of the participants was 2.4 years (SD 0.9) and the mean d3mfs was 0.8 (SD 1.9). Most of the children brushed their teeth with fluoride toothpaste and consumed fluoridated tap water. After 24 months, 89 and 92 children of the test and the control groups were analyzed, respectively. A total of 32 (35.9%) children in the FV group and 43 (46.7%) in the PV group presented new dentine caries lesions (χ(2) test; p = 0.14), showing relative and absolute risk reductions of 23% (95% CI: -9.5 to 45.9) and 11% (95% CI: -3.5 to 25.0). The mean caries increment differences between the test and control groups were -0.8 (95% CI: -2.0 to 0.4) at the d2 level and -0.7 (95% CI: -1.9 to 0.4) at the d3 level. Only 2 minor complaints regarding the intervention were reported.
Conclusion:
Although safe and well accepted, twice-yearly professional FV application, during 2 years, did not result in a significant decrease in caries incidence.
Water fluoridation, is the controlled addition of fluoride to the water supply, with the aim of reducing the prevalence of dental caries. Current estimates suggest that approximately 370 million people in 27 countries consume fluoridated water, with an additional 50 million consuming water in which fluoride is naturally occurring. A pre-eruptive effect of fluoride exists in reducing caries levels in pit and fissure surfaces of permanent teeth and fluoride concentrated in plaque and saliva inhibits the demineralisation of sound enamel and enhances the remineralisation of demineralised enamel. A large number of studies conducted worldwide demonstrate the effectiveness of water fluoridation. Objections to water fluoridation have been raised since its inception and centre mainly on safety and autonomy. Systematic reviews of the safety and efficacy of water fluoridation attest to its safety and efficacy; dental fluorosis identified as the only adverse outcome.
Water fluoridation is an effective safe means of preventing dental caries, reaching all populations, irrespective of the presence of other dental services. Regular monitoring of dental caries and fluorosis is essential particularly with the lifelong challenge which dental caries presents.
The aim of this review is to give an overview of 55 years experience of milk fluoridation and draw conclusions about the applicability of the method. Fluoridated milk was first investigated in the early 1950s, almost simultaneously in Switzerland, the USA and Japan. Stimulated by the favourable results obtained from these early studies, the establishment of The Borrow Dental Milk Foundation (subsequently The Borrow Foundation) in England gave an excellent opportunity for further research, both clinical and non-clinical, and a productive collaboration with the World Health Organization which began in the early 1980s. Numerous peer-reviewed publications in international journals showed clearly the bioavailability of fluoride in various types of milk. Clinical trials were initiated in the 1980s - some of these can be classed as randomised controlled trials, while most of the clinical studies were community preventive programmes.
These evaluations showed clearly that the optimal daily intake of fluoride in milk is effective in preventing dental caries. The amount of fluoride added to milk depends on background fluoride exposure and age of the children: commonly in the range 0.5 to 1.0 mg per day. An advantage of the method is that a precise amount of fluoride can be delivered under controlled conditions. The cost of milk fluoridation programmes is low, about € 2 to 3 per child per year. Fluoridation of milk can be recommended as a caries preventive measure where the fluoride concentration in drinking water is suboptimal, caries experience in children is significant, and there is an existing school milk programme.
The aim of this paper is to make known the potential of fluoridated salt in community oral health programs, particularly in South Eastern Europe. Since 1922, the addition of iodine to salt has been successful in Switzerland. Goiter is virtually extinct. By 1945, the cariesprotective effect of fluorides was well established. Based on the success of water fluoridation, a gynecologist started adding of fluoride to salt. The sale of fluoridated salt began in 1956 in the Swiss Canton of Zurich, and several other cantons followed suit. Studies initiated in the early seventies showed that fluoride, when added to salt, inhibits dental caries. The addition of fluoride to salt for human consumption was officially authorized in 1980-82. In Switzerland 85% of domestic salt consumed is fluoridated and 67% in Germany. Salt fluoridation schemes are reaching more than one hundred million in Mexico, Colombia, Peru and Cuba. The cost of salt fluoridation is very low, within 0.02 and 0.05 € per year and capita. Children and adults of the low socio-economic strata tend to have substantially more untreated caries than higher strata. Salt fluoridation is by far the cheapest method for improving oral health.
Salt fluoridation has cariostatic potential like water fluoridation (caries reductions up to 50%). In Europe, meaningful percentages of users have been attained only in Germany (67%) and Switzerland (85%). In Latin America, there are more than 100 million users, and several countries have arrived at coverage of 90 to 99%. Salt fluoridation is by far the cheapest method of caries prevention, and billions of people throughout the world could benefit from this method.
The purpose of this six-month study was to assess the ability of a new dentifrice containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride, as sodium monofluorophosphate, to arrest and reverse primary root caries lesions in adults.
Three test groups used dentifrices which contained either: 1) 1.5% arginine and 1450 ppm fluoride as sodium monofluorophosphate in a calcium base (experimental); 2) 1450 ppm fluoride as sodium fluoride in a silica base (positive control); or 3) no fluoride in a calcium base (negative control). The study participants were residents of the city of Chengdu, Sichuan Province, China. In order to take part, subjects had to have at least one non-cavitated primary root caries lesion. A total of 412 subjects completed the study. They were aged from 50 to 70 years (mean age 64 +/- 4.1 years) and 53.6% were female. Efficacy for arresting and reversal of primary root caries was assessed by clinical hardness measures and through the use of the Electrical Caries Monitor.
After three months of product use, clinical hardness measures showed that 27.7%, 24.6%, and 13.1% of lesions had improved in the experimental, positive, and negative control groups, respectively, and 0.7%, 4.5%, and 16.8% had become worse, respectively. The differences in the distribution of lesion change between the negative control group and both the experimental (p < 0.001) and positive control (p = 0.001) were statistically significant. The Electrical Caries Monitor was also used as an objective measure of lesion severity. The end values increased from baseline to the three-month examinations, but none of the differences between the groups attained statistical significance. After six months, clinical hardness measures showed that only one lesion (0.7%) was worse than at the baseline examination-in the experimental group compared to 9.0% and 18.2% in the positive and negative control groups, respectively. In addition, 61.7%, 56.0%, and 27.0%, respectively, showed improvement for the three groups. The differences in the distribution of lesion change scores between the negative control group and both the experimental (p < 0.001) and positive control (p < 0.001) were statistically significant, as was the difference between the experimental group and the positive control (p = 0.006). The Electrical Caries Monitor end values for the experimental, positive, and negative control groups at the six-month examination were 7.9, 1.9 mega omega(s), and 387 kilo omegas(s), respectively. The differences between the negative control group and both the experimental (p < 0.001) and positive control (p < 0.001) were statistically significant. The difference between the experimental and positive control groups was also statistically significant (p = 0.03).
It is concluded that the new toothpaste containing 1.5% arginine and 1450 ppm fluoride, as sodium monofluorophosphate in a calcium base, provided greater anticaries benefits than a conventional toothpaste containing 1450 ppm fluoride. Both fluoride toothpastes demonstrated greater benefits than non-fluoride toothpaste.
A 2-year double-blind randomized three-treatment controlled parallel-group clinical study compared the anti-caries efficacy of two dentifrices containing 1.5% arginine, an insoluble calcium compound (di-calcium phosphate or calcium carbonate) and 1,450 ppm fluoride (F), as sodium monofluorophosphate, to a control dentifrice containing 1,450 ppm F, as sodium fluoride, in a silica base. The 6,000 participants were from Bangkok, Thailand and aged 6-12 years initially. They were instructed to brush twice daily, in the morning and evening, with their randomly assigned dentifrice. Three trained and calibrated dentists examined the children at baseline and after 1 and 2 years using the National Institute of Dental Research Diagnostic Procedures and Criteria. The number of decayed, missing and filled teeth (DMFT) and surfaces (DMFS) for the three study groups were very similar at baseline, with no statistically significant differences among groups. After 1 year, there were no statistically significant differences in caries increments among the three groups. After 2 years, the two groups using the dentifrices containing 1.5% arginine, an insoluble calcium compound and 1,450 ppm F had statistically significantly (p < 0.02) lower DMFT increments (21.0 and 17.7% reductions, respectively) and DMFS increments (16.5 and 16.5%) compared to the control dentifrice. The differences between the two groups using the new dentifrices were not statistically significant. The results of this pivotal clinical study support the conclusion that dentifrices containing 1.5% arginine, an insoluble calcium compound and 1,450 ppm F provide significantly greater protection against caries lesion cavitation, in a low to moderate caries risk population, than dentifrices containing 1,450 ppm F alone.
Background:
This is an update of a review first published in 2010. Use of topical fluoride has become more common over time. Excessive fluoride consumption from topical fluorides in young children could potentially lead to dental fluorosis in permanent teeth.
Objectives:
To describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis in permanent teeth.
Search methods:
We carried out electronic searches of the Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase, three other databases, and two trials registers. We searched the reference lists of relevant articles. The latest search date was 28 July 2022.
Selection criteria:
We included randomized controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies, and cross-sectional surveys comparing fluoride toothpaste, mouth rinses, gels, foams, paint-on solutions, and varnishes to a different fluoride therapy, placebo, or no intervention. Upon the introduction of topical fluorides, the target population was children under six years of age.
Data collection and analysis:
We used standard methodological procedures expected by Cochrane and used GRADE to assess the certainty of the evidence. The primary outcome measure was the percentage prevalence of fluorosis in the permanent teeth. Two authors extracted data from all included studies. In cases where both adjusted and unadjusted risk ratios or odds ratios were reported, we used the adjusted value in the meta-analysis.
Main results:
We included 43 studies: three RCTs, four cohort studies, 10 case-control studies, and 26 cross-sectional surveys. We judged all three RCTs, one cohort study, one case-control study, and six cross-sectional studies to have some concerns for risk of bias. We judged all other observational studies to be at high risk of bias. We grouped the studies into five comparisons. Comparison 1. Age at which children started toothbrushing with fluoride toothpaste Two cohort studies (260 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing at or before 12 months versus after 12 months and the development of fluorosis (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.81 to 1.18; very low-certainty evidence). Similarly, evidence from one cohort study (3939 children) and two cross-sectional studies (1484 children) provided very uncertain evidence regarding the association between children starting to use fluoride toothpaste for brushing before or after the age of 24 months (RR 0.83, 95% CI 0.61 to 1.13; very low-certainty evidence) or before or after four years (odds ratio (OR) 1.60, 95% CI 0.77 to 3.35; very low-certainty evidence), respectively. Comparison 2. Frequency of toothbrushing with fluoride toothpaste Two case-control studies (258 children) provided very uncertain evidence regarding the association between children brushing less than twice per day versus twice or more per day and the development of fluorosis (OR 1.63, 95% CI 0.81 to 3.28; very low-certainty evidence). Two cross-sectional surveys (1693 children) demonstrated that brushing less than once per day versus once or more per day may be associated with a decrease in the development of fluorosis in children (OR 0.62, 95% CI 0.53 to 0.74; low-certainty evidence). Comparison 3. Amount of fluoride toothpaste used for toothbrushing Two case-control studies (258 children) provided very uncertain evidence regarding the association between children using less than half a brush of toothpaste, versus half or more of the brush, and the development of fluorosis (OR 0.77, 95% CI 0.41 to 1.46; very low-certainty evidence). The evidence from cross-sectional surveys was also very uncertain (OR 0.92, 95% CI 0.66 to 1.28; 3 studies, 2037 children; very low-certainty evidence). Comparison 4. Fluoride concentration in toothpaste There was evidence from two RCTs (1968 children) that lower fluoride concentration in the toothpaste used by children under six years of age likely reduces the risk of developing fluorosis: 550 parts per million (ppm) fluoride versus 1000 ppm (RR 0.75, 95% CI 0.57 to 0.99; moderate-certainty evidence); 440 ppm fluoride versus 1450 ppm (RR 0.72, 95% CI 0.58 to 0.89; moderate-certainty evidence). The age at which the toothbrushing commenced was 24 months and 12 months, respectively. Two case-control studies (258 children) provided very uncertain evidence regarding the association between fluoride concentrations under 1000 ppm, versus concentrations of 1000 ppm or above, and the development of fluorosis (OR 0.89, 95% CI 0.52 to 1.52; very low-certainty evidence). Comparison 5. Age at which topical fluoride varnish was applied There was evidence from one RCT (123 children) that there may be little to no difference between a fluoride varnish application before four years, versus no application, and the development of fluorosis (RR 0.77, 95% CI 0.45 to 1.31; low-certainty evidence). There was low-certainty evidence from two cross-sectional surveys (982 children) that the application of topical fluoride varnish before four years of age may be associated with the development of fluorosis in children (OR 2.18, 95% CI 1.46 to 3.25).
Authors' conclusions:
Most evidence identified mild fluorosis as a potential adverse outcome of using topical fluoride at an early age. There is low- to very low-certainty and inconclusive evidence on the risk of having fluorosis in permanent teeth for: when a child starts receiving topical fluoride varnish application; toothbrushing with fluoride toothpaste; the amount of toothpaste used by the child; and the frequency of toothbrushing. Moderate-certainty evidence from RCTs showed that children who brushed with 1000 ppm or more fluoride toothpaste from one to two years of age until five to six years of age probably had an increased chance of developing dental fluorosis in permanent teeth. It is unethical to propose new RCTs to assess the development of dental fluorosis. However, future RCTs focusing on dental caries prevention could record children's exposure to topical fluoride sources in early life and evaluate the dental fluorosis in their permanent teeth as a long-term outcome. In the absence of these studies and methods, further research in this area will come from observational studies. Attention needs to be given to the choice of study design, bearing in mind that prospective controlled studies will be less susceptible to bias than retrospective and uncontrolled studies.
Objective:
Most of the commercially available fluoride varnishes (FV) have not been evaluated for their cariostatic properties. Consequently, the aim of this in vivo study was to investigate intra-oral fluoride retention and clearance patterns from three different FV.
Methods:
Eighteen subjects (7-11 years) participated in a laboratory analyst-blinded, randomized, crossover study comparing the ability of 5% sodium fluoride varnishes (CavityShield-CS, Enamel Pro-EP, Vanish-V) to enhance fluoride concentrations in biofilm fluid, centrifuged and whole saliva over a period of 48h after a single FV application.
Results:
Similar fluoride concentration×time patterns were noted for all investigated FV and studied variables, with the highest fluoride concentrations observed for the first biological sample collected after FV application (30min). Mean±SE (area under fluoride clearance curve) values were (μg F/g or ml×min): biofilm fluid - CS (472±191), EP (423±75),V (1264±279); centrifuged saliva - CS (42±7), EP (19±3),V (41±8); whole saliva - CS (68±11), EP (64±10),V (60±7).V delivered more fluoride to biofilm fluid than CS (p=0.0116) and EP (p=0.0065), which did not differ (p=0.27). For centrifuged saliva, CS and V were not significantly different (p=0.86), but resulted in higher fluoride retention than EP (p<0.0008). No significant differences among FV were observed for whole saliva (p=0.79).
Conclusion:
The present study has shown that FV vary in their ability to deliver fluoride intra-orally potentially related to formulation differences. To what extent the present findings relate to clinical efficacy remains, however, to be determined.
Clinical significance:
Clinical research that investigates fluoride release patterns into saliva and biofilm fluid from different FV products is insufficient. More research is needed to investigate different FV formulations for their efficacy in order to help clinicians make better evidence based treatment choices.
Background:
This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits and fissures of occlusal surfaces.
Types of studies reviewed:
This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the US market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions.
Results:
The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others.
Conclusions and practical implications:
These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians reorient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.
Different regimens of silver diamine fluoride (SDF) have been used to manage early childhood caries. So far, there is limited information regarding the concentrations and frequency of applications for effective caries control in primary teeth. This study aimed to compare the efficacy of 2 commercially available SDF solutions at preprepared concentrations of 38% and 12% when applied annually or biannually over 18 mo in arresting dentine caries in primary teeth. This randomized double-blinded clinical trial recruited kindergarten children aged 3 to 4 y who had at least 1 tooth with dentine caries. The children were randomly allocated to receive 4 treatment protocols: group 1, annual application of 12% SDF; group 2, biannual application of 12% SDF; group 3, annual application of 38% SDF; and group 4, biannual application of 38% SDF. Clinical examinations at 6-mo intervals were conducted to assess whether active carious lesions became arrested. Information on the children’s background and oral hygiene habits was collected through a parental questionnaire at baseline and follow-up examinations. A total of 888 children with 4,220 dentine carious tooth surfaces received treatment at baseline. After 18 mo, 831 children (94%) were examined. The caries arrest rates were 50%, 55%, 64%, and 74% for groups 1, 2, 3, and 4, respectively (P < 0.001). Lesions treated with SDF biannual application had a higher chance of becoming arrested compared with those receiving SDF annual application (odds ratio, 1.33; 95% confidence interval, 1.04–1.71; P = 0.025). The interaction between concentration and lesion site was statistically significant (P < 0.001). Compared with 12% SDF, the use of 38% SDF increased a chance of becoming arrested (P < 0.05), except lesions on occlusal surfaces. Based on the 18-mo results, SDF is more effective in arresting dentin caries in the primary teeth of preschool children at 38% concentration than 12% concentration and when applied biannually rather than annually.
Background. The purpose of this study was to compare the effect of a motivational interviewing (MI) counseling visit with traditional health education for mothers of young children at high risk of developing dental caries. Methods. The authors enrolled 240 infants aged 6 to 18 months and their mothers in the study and randomly assigned them to MI or traditional health education (control) groups. Mothers in the control group received a pamphlet and watched a videotape. Those in the MI group received the pamphlet and watched the videotape, as well as received an MI counseling session and six follow-up telephone calls during the first year. There were no interventions in year 2. Results. After two years, children in the MI group exhibited significantly less new caries (decayed or filled surfaces) than those in the control group (that is, a protective effect of MI) (odds ratio = 0.35, 95 percent confidence interval = 0.15 to 0.83). Conclusions. MI is a promising approach that warrants further attention in a variety of dental contexts. Clinical Implications. The results of this study show that MI has a protective effect with regard to the development of early childhood caries. One reason for this clinical effect is greater compliance with recommended fluoride varnish treatment regimens in families who received MI counseling compared with families who received traditional education.
This study evaluated whether toddlers in an extended preventive program of semiannual fluoride varnish applications from 1 year of age had a lower incidence of caries than those undergoing a standard program. A cohort of 1-year-old children (n = 3,403) living in multicultural areas of low socioeconomic standing in Stockholm participated in a cluster-randomized controlled field trial with two parallel arms. The children attended 23 dental clinics. Using the ICDAS II criteria, the examiners recorded caries at baseline and after 1 and 2 years. The children in the reference group received a standardized oral health program once yearly between 1 and 3 years of age. The children in the test group received the same standard program supplemented with topical applications of fluoride varnish every 6 months. We compared the test group and the reference group for the prevalence and increment of caries. At baseline, 5% of the children had already developed caries (ICDAS II 1-6). We reexamined the children after 1 year (n = 2,675) and after 2 years (n = 2,536). Neither prevalence nor caries increment differed between the groups. At 3 years of age, 12% of the children had developed moderate and severe carious lesions (ICDAS II 3-6), with a mean increment of 0.5 (SD 2.4) in the test group and 0.6 (SD 2.2) in the reference group. In conclusion, semiannual professional applications of fluoride varnish, as a supplement to a standard oral health program, failed to reduce caries development in toddlers from high-risk communities.
According to the WHO, "breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond". However, several studies have reported prolonged and unrestricted breastfeeding as a potential risk factor for primary tooth caries (ECC). On-demand breastfeeding, particularly while lying down at night, would seem to cause ECC because milk remains in the baby's mouth for long periods of time. There is lack of evidence that human milk is cariogenic; other factors, such as oral hygiene, may be more influential in caries development than on-demand breastfeeding. Moreover the biomechanics of breastfeeding differs from those of bottle feeding and milk is expressed into the soft palate and swallowed without remaining on teeth. Indeed we cannot forget that the main factor influencing caries development in infants is the presence of bacteria streptococcus mutans that thrives in a combination of sugars, small amounts of saliva and a low pH. Today the question is open and recently Chaffee, Felines, Vitolo et al. [2014] have found that breastfeeding for 24 months or longer increases the prevalence of severe early childhood caries in low-income families in Porto Alegre, Brazil. These results do not claim that prolonged breastfeeding is the cause of tooth decay; we can expect an association with food for infants often rich in refined sugars, which cause the reduction of the protective effect of saliva on the deciduous teeth enamel. In Japan, Kato, Yorifuji, Yamakawa et al. [2015] have found that infants who had been breastfed for at least 6 or 7 months, both exclusively and partially, were at elevated risk of dental caries at the age of 30 months compared with those who had been exclusively fed with formula. The authors themselves say, however, that further studies with more elaborate methods of assessment of breastfeeding may be necessary to determine the cariogenic nature of breastfeeding. In the meantime, given the many benefits of breastfeeding, the practice should continue to be strongly encouraged. Dental professionals should encourage parents to start proper oral hygiene with their children as soon as the first tooth erupts, and they should keep the intake of sugary beverages to a minimum.
Background and aim: Few paediatric dental restorative trials present outcomes for more than two years, leaving clinicians uncertain of long-term implications for their patients. This study aimed to establish the Hall Technique's success over the lifetime of primary teeth compared to conventional restorations (CR), by following up participants in the Tayside (Scotland), UK trial.
Design: Following the Phase 1 prospective, split-mouth randomised control trial with 132 children (264 teeth) in 17 general practices in Scotland, 142/264 (54%) teeth had reached an endpoint of exfoliation or extraction. Through practices, Phase 2 follow-up data were collected retrospectively from case-notes, using original trial outcomes. Phase 1/ 2 outcome data were combined.
Results: Data were obtained up until exfoliation/extraction for 184 teeth (73%) in matched pairs. Major failures: 16 CR; 4 HT (P = 0.0015); ARR = 0.13 (95%CI: 0.04;0.22), numbers needed to treat (NNT) 8 (95%CI: 4;25) favouring HT. Minor failures: 37 CR; 5 HT (P <0.0001); ARR = 0.35 (95%CI: 0.23;0.45) and NNT = 3 (95%CI: 2;4). Repeat failures occurred mostly in the conventional restoration arm for both major and minor failures.
Conclusions: The HT continued to outperform GDP's standard restorations in primary molar teeth with significant caries involvement over the lifetime of the teeth.
Dental caries remains a major public health problem in most industrialised countries, affecting 60% to 90% of schoolchildren and the vast majority of adults. Milk may provide a relatively cost-effective vehicle for fluoride delivery in the prevention of dental caries. This is an update of a Cochrane review first published in 2005.
To assess the effects of milk fluoridation for preventing dental caries at a community level.
We searched the Cochrane Oral Health Group Trials Register (inception to November 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2014, Issue 10), MEDLINE via OVID (1946 to November 2014) and EMBASE via OVID (1980 to November 2014). We also searched the U.S. National Institutes of Health Trials Register (https://clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (http://apps.who.int/trialsearch) for ongoing trials. We did not place any restrictions on the language or date of publication when searching the electronic databases.
Randomised controlled trials (RCTs), with an intervention and follow-up period of at least two years, comparing fluoridated milk with non-fluoridated milk.
Two authors independently assessed trial risk of bias and extracted data. We used standard methodological procedures expected by The Cochrane Collaboration.
We included one unpublished RCT, randomising 180 children aged three years at study commencement. The setting was nursery schools in an area with high prevalence of dental caries and a low level of fluoride in drinking water. Data from 166 participants were available for analysis. The study carried a high risk of bias. After three years, there was a reduction of caries in permanent teeth (mean difference (MD) -0.13, 95% confidence interval (CI) -0.24 to -0.02) and in primary teeth (MD -1.14, 95% CI -1.86 to -0.42), as measured by the decayed, missing and filled teeth index (DMFT for permanent teeth and dmft for primary teeth). For primary teeth, this is a substantial reduction, equivalent to a prevented fraction of 31%. For permanent teeth, the disease level was very low in the study, resulting in a small absolute effect size. The included study did not report any other outcomes of interest for this review (adverse events, dental pain, antibiotic use or requirement for general anaesthesia due to dental procedures).
There is low quality evidence to suggest fluoridated milk may be beneficial to schoolchildren, contributing to a substantial reduction in dental caries in primary teeth. Due to the low quality of the evidence, further research is likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. There was only one relatively small study, which had important methodological limitations on the data for the effectiveness in reducing caries. Furthermore, there was no information about the potential harms of the intervention. Additional RCTs of high quality are needed before we can draw definitive conclusions about the benefits of milk fluoridation.
A double blind, randomized, unsupervised, parallel-group clinical trial was conducted on over 5,500 children in Sichuan Province, China. This clinical trial compared the anti-caries efficacy of two test dentifrices to that of a control dentifrice.
The test dentifrices contained 1.5% arginine, 1450 ppm fluoride as sodium monofluorophosphate (MFP), and an insoluble calcium compound (either dicalcium phosphate or calcium carbonate). The positive control dentifrice contained 1450 ppm fluoride as sodium fluoride (NaF), in a silica base. The children were randomly assigned one of the toothpastes, and children residing in the same household were assigned the same dentifrice to use at home, twice a day.
Three calibrated dentists examined the children at baseline, as well as after one and two years of product use. After one year of product use, there were no statistically significant differences among the three groups with respect to decayed, missing, and filled teeth (DMFT) or to decayed, missing, and filled surfaces (DMFS). After two years of product use, subjects in the two test groups using the dentifrices containing 1.5% arginine, 1450 ppm fluoride as MFP, and an insoluble calcium compound had a statistically significant reduction in DMFT increments of 20.5% and in DMFS increments of 19.6% when compared to subjects in the group using the positive control dentifrice. After two years, there were no statistically significant differences with respect to DMFT or DMFS between the two groups using the dentifrices containing 1.5% arginine, 1450 ppm fluoride as MFP, and an insoluble calcium compound.
The use of the two test dentifrices demonstrated significant reductions in decayed, missing, and filled teeth and surfaces, however there was no statistically significant different between the two test dentifrices clinically after two years of using the toothpastes. The results of this two-year clinical investigation support the conclusion that dentifrices containing 1.5% arginine, an insoluble calcium compound, and 1450 ppm fluoride as MFP provide superior protection against caries lesion cavitation compared to a positive control dentifrice containing only 1450 ppm fluoride as NaF.
The purpose of this paper was to systematically review the quality of evidence related to self-applied and professionally applied fluorides, antimicrobial agents, fissure sealants, temporary restorations, and restorative care for the prevention and management of early childhood caries (ECC).
Relevant papers were selected after an electronic search for literature published in English between 2000 and April 2014. From 877 reports, 33 were included for full review. The quality of evidence was expressed according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.
There was moderate and limited quality of evidence in support of fluoride toothpaste and fluoride varnish for ECC prevention, while the evidence for fluoride tablets/drops was insufficient. The support for the use of silver diamine fluoride, xylitol, chlorhexidine varnish/gel, povidone iodine, probiotic bacteria, and remineralizing agents (casein phosphopeptide-amorphous calcium phosphate) was insufficient. There was also insufficient quality of evidence for the use of sealants, temporary restorations, and traditional restorative care to reduce incidence of ECC.
The results reinforce the need for high quality clinical research and point out the knowledge gaps to be addressed in future studies.
Minimal invasive approaches to managing caries, such as partial caries removal techniques, are showing increasing evidence of improved outcomes over the conventional complete caries removal. There is also increasing interest in techniques where no caries is removed.
We present the 1-yr results of clinical efficacy for 3 caries management options for occlusoproximal cavitated lesions in primary molars: conventional restorations (CR; complete caries removal and compomer restoration), Hall technique (HT; no caries removal, sealing in with stainless steel crowns), and nonrestorative caries treatment (NRCT; no caries removal, opening up the cavity, teaching brushing and fluoride application). In sum, 169 children (3-8 yr old; mean, 5.56 ± 1.45 yr) were enrolled in this secondary care–based, 3-arm, parallelgroup, randomized clinical trial. Treatments were carried out by specialist pediatric dentists or postgraduate trainees. One lesion per child received CR, HT, or NRCT. Outcome measures were clinical failure rates, grouped as minor failure (restoration loss/ need for replacement, reversible pulpitis, caries progression, etc.) and major failure (irreversible pulpitis, abscess, etc.).
There were 148 children (87.6%) with a minimum follow-up of 11 mo (mean, 12.23 ± 0.98 mo). Twenty teeth were recorded as having at least 1 minor failure: NRCT, n = 8 (5%); CR, n = 11 (7%); HT, n = 1 (1%) (p = .002, 95% CI = 0.001 to 0.003). Only the comparison between NRCT and CR showed no significant difference (p = .79, 95% CI = 0.78 to 0.80). Nine (6%) experienced at least 1 major failure: NRCT, n = 4 (2%); CR, n = 5 (3%); HT, n = 0 (0%) (p = .002, 95% CI = 0.001 to 0.003). Individual comparison of NRCT and CR showed no statistically significant difference in major failures (p = .75, 95% CI = 0.73 to 0.76). Success and failure rates were not significantly affected by pediatric dentists’ level of experience (p = .13, 95% CI = 0.12 to 0.14).
The HT was significantly more successful clinically than NRCT and CR after 1 yr, while pairwise analyses showed comparable results for treatment success between RCT and CR.
(ClinicalTrials.gov NCT01797458).
Objective:
The aim of this study was to test the efficacy of long-term, daily intake of erythritol and xylitol candy, compared with sorbitol candy, on the development of enamel and dentin caries lesions.
Methods:
The study was a double-blind randomized controlled prospective clinical trial. Altogether 485 primary school children, first- and second-graders at baseline, from southeastern Estonia participated in this 3-year intervention. Each child consumed four erythritol, xylitol or sorbitol (control) candies three times per school day. The daily intake of polyol was about 7.5 g. The International Caries Detection and Assessment System (ICDAS) was used in the clinical examinations by four calibrated examiners at baseline and at 12, 24 and 36 months.
Results:
The annual examination analyses and the follow-up analyses confirmed that the number of dentin caries teeth and surfaces at 24 months follow-up and surfaces at 36 months follow-up was significantly lower in the mixed dentition in the erythritol group than in the xylitol or control group. Time of enamel/dentin caries lesions to develop and of dentin caries lesions to progress was significantly longer in the erythritol group compared to the sorbitol and xylitol groups. Also the increase in caries score was lower in the erythritol group than in the other groups.
Conclusions:
In the follow-up examinations, a lower number of dentin caries teeth and surfaces was found in the erythritol group than in the xylitol or control groups. Time to the development of caries lesions was longest in the erythritol group.
Trial registration:
ClinicalTrials.gov Identifier NCT01062633.
Alkali production by oral bacteria via the arginine deiminase system (ADS) increases the pH of oral biofilms and reduces the risk for development of carious lesions. This study tested the hypothesis that increased availability of arginine in the oral environment through an exogenous source enhances the ADS activity levels in dental plaque and saliva. Saliva and supra-gingival plaque samples were collected from 19 caries-free (CF) individuals (DMFT=0) and 19 caries-active (CA) individuals (DMFT ≥ 2) before and after treatment, which comprised the use of a fluoride-free toothpaste containing 1.5% arginine, or a regular fluoride-containing toothpaste twice daily for 4 weeks. ADS activity was measured by quantification of ammonia produced from arginine by oral samples at baseline, after washout period, 4 weeks of treatment, and 2 weeks post-treatment. Higher ADS activity levels were observed in plaque samples from CF compared to those of CA individuals (p=0.048) at baseline. The use of the arginine toothpaste significantly increased ADS activity in plaque of CA individuals (p=0.026). The plaque microbial profiles of CA treated with the arginine toothpaste showed a shift in bacterial composition to a healthier community, more similar to that of CF individuals. Thus, an anti-caries effect may be expected from arginine-containing formulations due in large part to the enhancement of ADS activity levels and potential favorable modification to the composition of the oral microbiome. This article is protected by copyright. All rights reserved.