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One topical fluoride (varnishes, or gels, or rinses, or toothpastes) versus another for preventing dental caries in children and adolescents
Abstract
Background:
Topical fluorides in the form of toothpaste, mouthrinse, varnish and gel are effective caries preventive measures. However, there is uncertainty about the relative value of these interventions.
Objectives:
To compare the effectiveness of one form of topical fluoride intervention with another when used for the prevention of dental caries in children.
Search strategy:
We searched the Cochrane Oral Health Group's Trials Register (May 2000), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers.
Selection criteria:
Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste with each other in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS).
Data collection and analysis:
Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the 'experimental' and 'control' groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled.
Main results:
There were 17 studies included, and 15 contributed data for the meta-analyses. Fluoride toothpaste was not significantly different from mouthrinse (pooled DMFS PF 0%; 95% CI, -18% to 19%; p = 0.94), or gel (pooled DMFS PF 0%; 95% CI, -21% to 21%; p = 1), or both gel and mouthrinse (pooled DMFS PF 1%; 95% CI, -13% to 14%; p = 0.94); heterogeneity was substantial. Results from the single trial comparing toothpaste with varnish (in deciduous teeth) were inconclusive (dfs PF 5%; CI not obtainable). The pooled results from the comparisons of fluoride varnish with mouthrinse was a non-significant difference favouring varnish (DMFS PF 10%; 95% CI, -12% to 32%; p = 0.40), but this result was not robust to sensitivity analysis performed, and heterogeneity was considerable. Results from the single trial comparing varnish with gel (14%, 95% CI, -12% to 40%; p = 0.30) and the single trial comparing gel with mouthrinse (-14% DMFS PF; 95% CI, -40% to 12%; p = 0.30) were inconclusive (favoured varnish and mouthrinse respectively).
Reviewer's conclusions:
Fluoride toothpastes in comparison to mouthrinses or gels appear to have a similar degree of effectiveness for the prevention of dental caries in children. There is no clear suggestion that fluoride varnish is more effective than mouthrinses and the evidence for the comparative effectiveness of fluoride varnishes and gels, and mouthrinses and gels is inconclusive. No conclusions about adverse effects could be reached, because no data were reported on in the trials. Acceptance is likely to be greater for fluoride toothpaste.
... In communities where fluoride exists in water, either naturally or artificially, the use of PATF has been restricted to people with moderate and high risk of caries [8]. Most research worldwide has focused on the effectiveness of fluoride in its different presentations in caries prevention [9][10][11][12][13][14][15] following the premise of PATF in selected patients is generally recommended to prevent dental caries. This preventive maneuver is not as thoroughly used as it should be. ...
... These figures are lower, however, than reports from developed countries, where percentages close to 75% are reported in children between 7 and 9 years of age [22] or up to 66% in children from 4 to 6 years of age [21]. This low utilization in our study setting ought to give pause because PATF helps prevent caries in children and adolescents [9][10][11][12][13][14]. PATFs should not be applied routinely; patient's caries susceptibility must first be determined, and based on that information, an appropriate preventive care plan must be designed for each individual [36]. ...
... It is necessary to highlight that we found lower caries experience among children who had PATF in the previous year, a finding consistent with other reports supporting that the benefits of topical fluorides have been firmly established on a sizeable body of evidence. On the other hand, other preventive interventions have been found to improve oral health in schoolchildren [9][10][11]. It could be convenient to implement caries prevention programs aiming at reducing caries incidence encompassing not only mouthwashes, but also other technologies shown to have an impact on oral health. ...
The objective of the present study was to characterize socioeconomic inequalities in the patterns of professionally applied topical fluoride (PATF) in Mexican schoolchildren. A cross-sectional study was carried out on 3029 Mexican schoolchildren. A questionnaire was administered to caregivers to determine sociodemographic, socioeconomic, and behavioral variables. The dependent variable was prevalence of PATF, coded as 0 = without PATF and 1 = with PATF, at any point in life, and separately, in the previous year. Various indicators of socioeconomic position were included. Logistic regression was used in the final multivariate analysis. The prevalence of PATF any time in life was 33.8%, while in the previous year it was 11.4%. The variables associated (p < 0.05) with PATF any time in life were child's older age (OR = 1.12), older age when tooth brushing started (OR = 1.57), higher brushing frequency (OR = 1.60), having health insurance [public (OR = 1.61) or private (OR = 1.45)], if family owned a car (OR = 1.29) and better socioeconomic position [parents' education, second (OR = 1.48) and third (OR = 1.75) tertile]. For PATF in the previous year, the variables associated were older age of mother (OR = 1.03), older age when tooth brushing started (OR = 1.99), higher brushing frequency (OR = 1.68), having health insurance [public (OR = 1.62)] and better socioeconomic position (parents' education, second (OR = 1.57) and third (OR = 1.97) tertile). This study suggests the existence of socioeconomic inequalities in PATF, manifested through socioeconomic position, access to health insurance and household having a car. Identifying and addressing PATF inequalities would improve oral health in the child population.
... Fluoride in toothpaste has significantly influenced dental caries reduction since the 1970s. 1 Systematic reviews and Cochrane reviews showed evidence of the role of fluoride in caries prevention. [2][3][4][5][6][7] In addition, a Cochrane review supported the benefits of fluoridated toothpaste compared to non-fluoridated toothpaste in preventing caries. 8 Fluoridated toothpaste may be used alone or in combination with other fluoridated products such as fluoride varnish, gels, and mouthwashes for caries prevention. ...
... 8 Fluoridated toothpaste may be used alone or in combination with other fluoridated products such as fluoride varnish, gels, and mouthwashes for caries prevention. 6,7 Using such preventive practices is more cost-effective than treating dental caries. 9 It was reported that fluoride could be toxic when ingested excessively. ...
Purpose:
To evaluate and compare the attitude, practice, and knowledge of individuals who use fluoridated and non-fluoridated toothpaste in Jeddah city, Saudi Arabia.
Methods:
A digital questionnaire composed of 43 questions were formulated. The questionnaire was divided into five sections: eligibility questions, demographic data, attitude, practice, and knowledge. Content and face validation were done, and convenience sampling was used. The inclusion criteria were any citizen and resident who lives in Jeddah city, Saudi Arabia. Descriptive statistics, Chi-square, and Fischer's tests were conducted to compare fluoridated and non-fluoridated toothpaste users (α=0.05).
Results:
A total of 473 completed participants' responses were collected. Attitude: 41.8% of fluoridated toothpaste users reported that it was "very important" to rinse to remove the toothpaste compared to non-fluoridated toothpaste users (58.3%) (P-value<0.001). Healthy teeth were the most important to fluoridated toothpaste users (69.1%) (P <0.001). Practice: 28.6% of non-fluoridated toothpaste users have been using non-fluoridated toothpaste for >1 year, and 35.7% of them <2 years. 73.8% of fluoridated toothpaste users used whitening toothpaste. Significantly higher non-fluoridated toothpaste users (29%) used organic toothpaste (P<0.001).
Knowledge:
57% of fluoridated toothpaste users believed that a good diet, tooth brushing, and fluoridated toothpaste are important to prevent caries, and the fluoride would strengthen the teeth (P<0.001). Approximately 60% of non-fluoridated toothpaste users did not know the proper age to start using fluoridated toothpaste (P<0.001). Also, 47.6% of non-fluoridated toothpaste users avoid using fluoride because it is toxic.
Conclusion:
Significantly higher number of Jeddah residents that used fluoridated toothpaste had a better attitude and knowledge than non-fluoridated toothpaste users. Nonetheless, most residents had similar oral hygiene practices. It is suggested to execute educational campaigns to explain the importance of fluoridated toothpaste to the population. Also, individuals should take caution from the source of obtaining their dental information and consult their dentist.
... [8] At low concentration of fluoride found in toothpaste, acceptable results were obtained. [9,10] Varnish fluoride, in addition to the inhibitory effect on the adhesion of S. mutan, causes biofilm acidogenicity to change, these results could be due to the release of fluoride ions. [11] Fluoride mouth rinse leads to demineralizationremineralization balance toward remineralization and has an inhibitory effect on the tooth decay. ...
... [29,30] Further, Marinho et al. compared the effectiveness of two types of topical fluorides in preventing dental caries and reported no significant difference between fluoride varnish and mouth rinse 0.2%, which is contrary to the results of this study. [9] The reason for the higher effect of fluoride varnish may be because salivary fluoride concentration is more durable and lasts longer after using varnish. [31] In the present study, there was no significant difference in early biofilm formation of S. mutans between the two types of orthodontic adhesive resins Transbond XT (3M Unitek, Monrovia, Calif, USA) and Lightbond (Reliance Orthodontic Products, Itasca, Ill, USA). ...
Background: The aim of the present study is to compare the antibacterial effect of fluoride mouth rinse and fluoride varnish on the primary biofilm formation of Streptococcus mutans (S. mutans) in two types of orthodontic adhesives.
Materials and Methods: This is an in vitro study in which forty composite discs of Transbond XT and Lightbond were divided randomly into 4 groups: Group 1: Control group (not treated with fluoride), Group 2: Rinsed by 0.2% fluoride mouth rinse, Group 3: Rinsed by 0.05% fluoride mouth rinse, and Group 4: Treated by varnish fluoride. Then each group was placed in S. mutans suspension. Bacterial suspension from each treatment was subcultured onto the surface of Mueller–Hinton agar plates, and bacterial growth was assessed. The results were analyzed by analysis of variance test and Scheffé test was run to compute the binary groups (P < 0.05).
Results: There was a statistically significant reduction in the viability of S. mutans in treated groups by fluoride but no significant difference between two types of composites.
Conclusion: The results of this study demonstrated that S. mutans colonies were sensitive to fluoride and their most effective form was varnish. There was no significant difference in early biofilm formation of S. mutans in two types of orthodontic adhesive resins Transbond XT and Lightbond.
... Low but slightly elevated levels of fluoride in saliva and plaque provided from topical fluoride help to prevent and reverse caries by the above mechanisms. 3 According to a recent literature review, the level of fluoride incorporated into dental mineral by systemic ingestion is insufficient to play a significant role in caries prevention. 3 Method of topical fluoride application are in the form of toothpastes, mouthrinses, gels. ...
... 3 According to a recent literature review, the level of fluoride incorporated into dental mineral by systemic ingestion is insufficient to play a significant role in caries prevention. 3 Method of topical fluoride application are in the form of toothpastes, mouthrinses, gels. Another review stated that there was moderate quality evidence of a large caries-inhibiting effect of fluoride gel in the permanent dentition. ...
Introduction: Fluoride is a known caries preventive agent. According to previous literature, a school based preventive program using fluoride gel could be effective in reducing the level of dental caries in children. There are very few studies that have been done in India in this regard. So, a retrospective study was planned to evaluate the preventive program of application of Acidulated phosphate fluoride (APF) gel on permanent teeth of school going children of 10-11 years till 15-16 years for 5 years.
... Marinho et al. also compared the effectiveness of fluoride varnish and mouthwash for remineralization, favoring varnish over mouthwash, potentially due to its ability to maintain prolonged contact time with the tooth surface. Insoluble globules of calcium fluoride formed on the tooth surface after topical fluoride application act as a reservoir for fluoride over an extended period [29,30]. ...
Background: Extrinsic discoloration is treated with bleaching which increases enamel porosity and roughness. Remineralizing materials is applied to avoid the bleaching side effects. The current study aimed to evaluate time dependent safety of bleaching materials on enamel surfaces roughness, and to assess the remineralizing potential of whey extract as a natural product and to compare it with the commercially available fluoride varnish and fluoride mouthwash after maximum bleaching time (30 min.). Methods: Extracted human incisor teeth without cracks or any enamel defects were used in this study. Teeth were cleaned and decoronated at the level of the cementoenamel junction. A nail varnish was used to cover the entire surface of the crowns of each tooth, leaving a window measuring 4 mm × 4mm. Bleaching material was applied to the enamel of all teeth specimens. The Application of bleaching material was repeated 2 more times, each time for 10 minutes, which amounted in total to 30 min. The specimens in group 1 were soaked in artificial saliva, the specimens in group 2 were soaked in whey extract, the specimens in group 3 were treated with fluoride varnish and group 4 specimens were soaked in fluoride mouthwash. Results: The mean value of the surface roughness of all the teeth specimens was increased significantly after bleaching for 10 minutes, 20 minutes and 30 minutes (p=0.000) when compared with baseline mean value. As well, there was significant direct correlation between application time of bleaching material and mean value of surface roughness (r= 0.94). There were no significant differences (p>0.05) between the specimens of the 4 groups when the mean value of surface roughness compared at baseline and after bleaching. But, after treatment, there was significant difference (p≤0.05) between the 4 groups, with the best result obtained from whey extract and fluoride varnish. Conclusions: The enamel surface roughness is significantly and directly correlated with prolonged application time of bleaching material. Remineralizing materials; whey extract, fluoride varnish and fluoride mouth wash had significantly decreased enamel surface roughness caused by bleaching. Whey extract has statistically the same effect as fluoride varnish on decreasing the surface roughness of bleached enamel surface.
... Many studies, including a review by Cooper et al., recommend brushing in school [5]. In addition, a large body of evidence demonstrates the effectiveness of fluoride delivered in various forms such as varnish, gel, toothpaste, etc. to prevent dental caries [6,7]. The guidelines recommend that supervised toothbrushing should start from approximately 6 months of age up to the age of 7 [8]. ...
Promoting schoolchildren's oral health is important, particularly in developing countries. This study was conducted to monitor the oral health of schoolchildren aged 6-7 years old following the implementation of an oral health promotion program in Tehran, Iran. The protocol was registered in the Iranian Registry of Clinical Trials (Code: IRCT20090307001749N4). A cluster random sampling method was applied, and the schools were randomly allocated to intervention and control groups. An intervention package consisting of a one-day workshop for parents and supervised toothbrushing for children was employed. In both groups, the Caries Assessment Spectrum and Treatment (CAST) and Oral Hygiene Index Simplified (OHI-S) were evaluated at baseline and at one-year follow-up in addition to the questionnaire data. Clinical data were collected by calibrated examiners at both intervals (Kappa = 89.8%, 87.68%) and analyzed using the SPSS software ver. 22.0. Of 739 children included at baseline, 593 were re-examined after one year (response rate = 74%). According to the Generalized Estimating Equation (GEE) analysis, considering the confounding effect of time, significantly more children in the control group had deciduous molars with a score of 3 and higher compared to the intervention group (OR = 1.79; 95% CI:1.17-2.73, p = 0.007). The oral hygiene status of the children significantly improved in the intervention group compared to the controls (B = -0.27; 95% CI: -0.45 --0.08, p = 0.005). After one year, the improvement in the oral health-related attitude of parents and children's oral health behavior was marginally significant in the intervention group compared to the control group [0.2 (0.17) vs. -0.13 (0.05), p = 0.096] and [0.06 (0.06) vs. -0.05 (0.04), p = 0.09], respectively. However, the impact on the oral health-related knowledge and self-reported behavior of the parents was not significant. In the intervention group, children had less caries and a better oral hygiene status compared to the controls after one year.
... Toothpastes are the most common topical fluoride sources, and a review (15) found that no definite conclusions could be drawn about side effects that may arise from the application of topical fluoride. Nevertheless, people who are concerned about the amount of fluoride they are exposed to from other sources may prefer using alternatives to fluoride-containing toothpastes, such as fluoride-free herbal toothpastes that are widely available. ...
Objective: Objective: Pregnant women may be vulnerable to dental caries due to their inability to fully implement oral hygiene practices. Toothpastes are main component of oral hygiene and the most important tool for the primary prevention of caries. The study aimed to examine the knowledge and attitudes of pregnant women with children (PC) and without children (PNC) about fluoride and herbal toothpastes. Methods: A self-administered and validated 20-item questionnaire was completed by a total of 219 pregnant participants, 85 PC and 134 PNC. Statistical analyses were performed using the SciPy v1.2.3. program. Results: Most of the PC (57.65%; 69.41%) and PNC (72.39%; 47.76%) participants responded with “no idea” when asked about fluoride sources and the optimal amount of fluoride added to tap water by local health authorities (p= .006). The majority of the PC (62.4%) and the PNC (47.0%) had no preference for herbal toothpastes during pregnancy (p= .03). In addition, 86.6% of the PNC showed low knowledge about the nonfluoride content of herbal toothpastes (p= .023). While 51.5% of the PNC responded with “no idea” about a preference for herbal toothpastes for their children, 56.47% of the PC stated that they might not prefer using herbal toothpastes for their children’s routine oral hygiene. Conclusion: The findings show that both PC and PNC participants had little knowledge of toothpastes and their contents. Considering that toothpastes are the most common self-applied oral hygiene tools, knowledge and awareness of fluoride and herbal toothpastes should be raised via antenatal programs.
... Al respecto, algunos autores señalan que ese tipo de situación puede ser revertida o prevenida si se aplican medidas de higiene (22) de conjunto con el uso de sustancias remineralizantes. (23) La educación de niños y niñas sobre medidas de higiene y conservación dental debe realizarse por padres y educadores (24) desde las primeras etapas de vida, lo que constituye la principal estrategia para conservar la salud bucal en los primeros molares definitivos y la armonía oclusal. (25) La principal limitación del estudio estuvo dada por el número de variables sociodemográficas y de exploración de causalidad, para lograr resultados más profundos alrededor del proceso de caries por su naturaleza dinámica y de etiología multifactorial. ...
An observational, descriptive and cross-sectional research was carried out; with the participation of 492 students between the 6 and 12 years of age, enrolled in primary schools in the town of Alangasí, Pichincha province and in the town of Puerto Baquerizo Moreno in the city of San Cristóbal, Galapagos Islands, Ecuador; whose legal guardians gave the respective consent. The International Caries Detection and Assessment System (ICDAS) was used to assess the state of the first molars (16, 26, 36 and 46). The presence of the female gender predominated among the study population, as well as the category that implies caries lesions in dental enamel or in healthy teeth. Based on the means, greater affectation was observed in the first molars of the participants from Quito (1.51-2.37) compared to those ones from San Cristóbal (1.18-1.46); not observing important differences according to gender. However, during the analysis of the data between school types, it was found that the population of the fiscal school had more affectation (1.91-2.37). In addition, there were associations between categories of the variables involved.
... The effectiveness of fluoride varnishes (5% NaF) was demonstrated in numerous studies. 43,44 Another 2016 review by Bonetti et al. from 200 trials with more than 80,000 participants confirmed the effectiveness of fluoride varnish, used as indicated 2-4 times/year, to prevent dental caries in both primitive and permanent teeth. 45 However, one study found that the use of fluoride varnish twice yearly, although safe and accepted, did not significantly reduce the incidence of dental caries. ...
Aim: To investigate the status of dental caries and assess the effectiveness of dental caries prevention interventions in children from
3 to 5-year-old in Hue City, Vietnam. Materials and methods: The subjects were 464 children and their direct caregivers at some kindergartens in Hue City from June 2020 to October 2021. The study included two consecutive phases: the first one was a cross-sectional study to identify the rate of dental caries and related factors in the studied kindergartens, and phase 2 was a controlled comparative interventional study for a period of 12 months. Results: The mean of decayed, missing, filled, and DMFT index was 8.25, 0.09, 0.48, and 8.82, respectively, with no statistically significant difference in these figures between the living areas. The multivariable logistic regression model revealed some factors related to dental caries, including age, frequency of toothbrushing per day, parent-assisted toothbrushing, and eating and drinking sweets. Results showed the effectiveness of a community-based intervention for preventing dental caries, gingivitis, and plaque in the intervention group, compared to the control group. Conclusion: The rate of dental caries among Vietnamese children was remarkably high. A comprehensive intervention to prevent early childhood dental caries was effective and might be considered a necessary program in healthcare prophylaxis. Clinical significance: This intervention was consistent with the guidelines of WHO and based on evidences of related factors of dental caries identified in a previous cross-sectional study.
Keywords: Comprehensive intervention, Early dental caries, Kindergarteners
... The success of topical fluorides (varnishes, mouthrinses and prescription toothpastes) are well documented. 43 Based upon a caries risk assessment and the child's age, a tailored oral health plan can be created to encompass appropriate preventative interventions and recall frequency. ...
In the wake of the COVID-19 pandemic the UK dental workforce is facing a national health crisis as we address the vast
amount of untreated dental disease. This is ever more pressing for our child dental patients for whom early detection
and intervention is key to maintaining quality of life. A pragmatic, cost-effective, dental team-based approach, grounded
in the philosophy of Minimal Intervention Dentistry (MID) is needed to address the increasing burden of disease and
the worsening of health inequalities. Although not exhaustive, this article offers a brief overview of evidence relating to
minimally invasive techniques for the management of dental caries in paediatric dentistry.
... Most of the clinical trials which reported the caries-preventive effect of professionally-and self-applied topical fluorides in primary teeth have compared only two or three types of interventions. Similarly, various systematic reviews of randomized clinical trials showing scientific evidence of the caries-preventive effect of many forms of fluorides have been published [6][7][8][9][10][11][12][13][14][15][16]. However, these reviews have only provided direct evidence, but no indirect comparisons among the trials have been performed. ...
Objectives: To summarize the evidence on prevention of early childhood caries (ECC) by professionally or self-applied topical fluorides using network meta-analysis.
Data: Randomized-controlled trials with minimum 1-year follow-up assessing caries-preventive effect among children younger than six years.
Sources: Eight electronic databases and grey literature.
Study selection: After screening and data extraction, risk of bias assessment using Cochrane risk of bias tool 2.0 was done. Twenty-four trials were included, among which 17 were assessed as “high risk” and remaining as “low risk”. Fifteen studies evaluated professionally-applied, and the other nine used self-applied topical fluorides. Ten studies on professionally-applied fluorides reporting the net caries increment (dmfs increment) at 2-years follow-up were included in Network meta-analysis (NMA). NMA and ranking the interventions were conducted using a frequentist random-effects approach and surface under the cumulative ranking command, followed by assessing the certainty of evidence using an extension of GRADE approach with CINeMA framework. Among the eight included interventions of professionally-applied fluorides, only two, i.e., 3-monthly 0.9% difluorosilane (DFS) and 6-monthly 5% sodium fluoride varnish were effective in preventing ECC compared to control with 3-monthly DFS application ranking higher than 6-monthly sodium fluoride varnish application.
Conclusion: Among all the professionally-applied topical fluoride interventions reviewed, very low to moderate evidence was found with 0.9% DFS application at 3-monthly intervals, which was ranked highest in prevention of ECC. Among the included studies on self-applied topical fluorides, the evidence was inconclusive due to heterogeneity among studies.
Clinical significance: The 0.9% DFS varnish applied every 3 months is most effective for preventing early childhood caries. The review recommends that good quality studies be conducted in future, comparing two or more interventions for both self- as well as professionally-applied topical fluoride agents with adequate follow-up.
... Although fluoride interventions seem to have the most consistent benefit in preventing caries development and decreasing the progression of initial lesions [55][56][57][58], caries still develop in high risk individuals [59]. For this reason, it has been recommended that individuals at high caries risk need additional preventive measures [26,60,61]. ...
Objectives
The aim of this randomized, double-blind, two-arm crossover in situ study was to investigate whether nano-hydroxyapatite (nanoHAP) dental lotion (Apagard Deep Care) applied immediately after tooth-brushing with nanoHAP toothpaste (Apagard M-plus) enhances the remineralization promotion and the demineralization inhibition efficacies of nanoHAP toothpastes.
Methods
64 sound enamel blocks and 64 blocks bearing artificially-produced initial caries were produced from human permanent molar teeth. During each treatment period, lasting 14 days per arm, two blocks, one sound and one lesion-bearing, were exposed to either 5% nanoHAP-containing or placebo dental lotion after tooth-brushing with 5% nanoHAP toothpaste, via an intra-oral appliance worn by 30 adults in each of the study groups. Baseline and post-test mineral loss were quantified using transverse microradiography (TMR). One-sided t-test of one group mean was used for intragroup comparison, while two-sided t-test of two independent means was used to compare the two dental lotions.
Results
Pairwise comparison (baseline vs. post-test) indicated significant (p<.001) remineralization by nanoHAP toothpaste in both groups. However, when compared against each other, there was a significantly (p<.001) greater percentage of remineralization with nanoHAP lotion [58.4(±1.8)%] than with placebo lotion [37.7(±2.2)%]. TMR examination showed absolute demineralization inhibition in sound enamel blocks exposed to either lotions.
Conclusions
Toothpaste containing 5% nanoHAP effectively remineralized initial caries and inhibited demineralization of healthy enamel; however, the application of a dental lotion containing 5% nanoHAP after brushing resulted in superior remineralization compared to a placebo lotion.
Clinical Significance
Dental lotion containing 5% nanohydroxyapatite used immediately after toothbrushing with 5% nanohydroxyapatite toothpaste can serve as an adjunct to enhance the clinical benefits of the toothpaste.
... Recent studies stated that SDF is effective in arresting caries in permeant teeth too as well as root caries in the elderly 4 . SDF has several mechanisms of action; anti-microbial action by inhibiting biofilm formation and matrix metalloproteinase activities, and remineralization of demineralized tooth structure reducing loss of calcium and phosphate ions as well as collagen damage 1,[5][6][7][8][9][10] . SDF has different features that are beneficial in clinical dentistry; control of caries, simplicity of use, affordability, minimal training needed, and being minimallyinvasive 6 . ...
Examine the effect of dental curing light and laser treatments applied after Silver Diamine Fluoride (SDF) on dentin hardness in carious primary molars. This in-vitro study consisted of 30 extracted primary molars with caries extending into dentin without pulpal involvement. The collected teeth were randomly divided into three groups: group 1: received SDF then Sub-ablative low-energy of Er,Cr:YSGG laser, group 2: received SDF followed by application of curing light for 40 s, group 3: had SDF treatment only. In all groups, 38% Ag (NH3)2F SDF was used. Vickers hardness test was performed on sound dentin below carious lesion. Kruskal–Wallis Test was used to determine the mean difference in dentin hardness of the groups at 5% Significance level using SPSS software. Surface hardness of sound dentin below the carious lesion was statistically significantly higher in the laser + SDF group (891.24 ± 37.33 kgf/mm ² ) versus the two other groups (Light cure + SDF = 266.65 ± 90.81 kgf/mm ² and SDF only = 117.91 ± 19.19 kgf/mm ² ) with p -value ≤ 0.001. Although Photopolymerization of SDF increases the surface hardness of sound dentin below the carious lesion, applying laser after SDF has the highest surface hardness due to the laser’s sub-ablation of dentin.
... This fluoride therapy is low-cost and is an easily operated treatment that is used to arrest active dental caries [17]. This fluoride is incorporated with the tooth structure in the form of fluorapatite crystals thereby making the surface more resistant to acid dissolution [18]. Fluoride inhibits the process of demineralisation, and enhances the speed of enamel remineralisation along with increase in the mineral content of affected teeth [19]. ...
Introduction: Topical fluoride application helps in preventing tooth erosion and prevents caries. This fluoride is incorporated with the tooth structure in the form of fluorapatite crystals thereby making the surface more resistant to acid dissolution. Fluoride helps in restricting plaque metabolism, alters plaque composition and reduces the activity of plaque to produce large amounts of acid from carbohydrates. Materials and Method: the current study was done under a university setting of Saveetha Dental College as a retrospective study. The total sample size after eliminating bias is 917. Inclusion criteria includes patients with an age group 13-17 years who all underwent topical fluoride application while exclusion criteria includes unclear photographs of fluoride application and error data. SPSS software is used for statistical data analysis with the Chi-square test. Results and Discussion: The results of the current study shows that parents of both male and female pediatric patients prefer topical fluoride gel (99%) application over varnish (0.9%). There was no difference in the preference based on gender of the patient (p-value > 0.05). Conclusion: The current study concludes that parents of both male and female paediatric permanent dentition patients prefer the usage of topical fluoride gel due to its effective post-treatment action.
... Reducing the amount and frequency of sugar consumption, including the "hidden sugars" in many processed foods, continues to be important for patients at high risk for caries. Consuming foods or snacks that do not promote carious lesion formation or progression would be ideal for patients at risk for dental caries 91 . Hard cheese has been shown to coat teeth with a lipid layer, protecting surfaces from acid attack. ...
... Moreover, S. mutans interacts with other microorganisms in dental plaque, including Candida albicans, to increase the pathogenicity of the biofilms (Kreth et al., 2005;Metwalli et al., 2013). Fluoride interventions have been the most effective towards the prevention of dental; however, caries still develops in high-risk individuals (Bader et al., 2013), which justifies the search for alternate strategies that could be used to eradicate dental caries (Marinho, 2008(Marinho, , 2009Marinho et al., 2003Marinho et al., , 2004. As a microbial disease, the quest towards an effective antimicrobial against cariogenic pathogens and pathogenic dental biofilms with minimal toxicity is considered a search in the right direction. ...
Objective: Zinc is a potent antimicrobial against cariogenic bacteria and effective anti-plaque agent. The present study investigated the efficacy of zinc oxide nanoparticles (ZnO-NP) varnish to inhibit S. mutans growth, biofilm, acid production, and its antioxidant potential and cytotoxicity. Design: Green synthesized ZnO-NP were characterized using ultraviolet-visible spectroscopy, x-ray diffraction spectroscopy, and transmission electron microscopy. Secondary metabolites were assessed using fourier transform infrared spectroscopy. Anti-oxidant potential was ascertained using 2,2-diphenyl-2-picrylhydrazyl hydrate (DDPH) assay and cytotoxicity of synthesized nanoparticles was evaluated on human liver cancer (Hep G2) and human embryonic kidney 293 (HEK-293T) cell lines. Results: Synthesized ZnO-NP showed excellent antimicrobial properties against S. mutans, as the minimum inhibitory and bactericidal concentrations were 0.53 μg/mL, and 1.3 μg/mL respectively. ZnO-NP at 0.1 mg/μl concentration had the greatest zone of inhibition (24 mm), followed by 0.05 mg/μl ZnO-NP (23 mm) and 0.05 mg/μl ampicillin (21 mm). Further, 0.1 mg/μl ZnO-NP varnish inhibited 90 % of S. mutans biofilms and reduced 24 h acid production closest to that of baseline and it also exhibited antioxidant capacity in a dose dependent manner (94 % inhibition-100 μg/mL). Biocompatibility of ZnO-NP varnish was evaluated on Hep G2 and HEK-293T cell lines; and the highest concentration of 0.1 mg/μl ZnO-NP used caused very low cytotoxicity to Hep G2 cells and was non-cytotoxic to HEK-293T cells. Conclusions: Within the limits of this study, ZnO-NP varnish was effective in inhibiting S. mutans and holds great potential as an effective anticaries agent.
... Revisões sistemáticas com base na evidência científica confirmaram a informação disponível relativamente aos mecanismos de acção e aos efeitos preventivos da cárie dentária obtidos pela exposição à água fluoretada de forma contínua, que os benefícios dos fluoretos tópicos estão bem estabelecidos, que a escovagem com dentífricos fluoretados é eficaz na prevenção da cárie dentária, que a utilização de fluoretos tópicos em adição à utilização de dentífrico fluoretado proporciona uma efeito sinérgico modesto relativamente ao que se obtém com a utilização de dentífrico fluoretado de forma isolada e que a comparação dos efeitos na prevenção da cárie dentária das diferentes formas de apresentação dos fluoretos tópicos é inconclusiva [50][51][52][53][54][55] . ...
The relationship between dental caries and the beneficial effects of fluorides are recognized by the scientific community since the beginning of the twentieth century.
The first interpretations of the preventive effects of fluorides in dental caries were made based on data from the communities in which it was implemented artificial fluoridation ofpublic water supply.
A first interpretation of the scientific community, based on available information about fluoride and dental caries, did believe that the effect of fluorides in dentistry was directly and strictly linked to a mechanism of action of preventive dental pre-eruptive effect through of systemic fluoride incorporated during tooth maturation.
Currently the scientific community, based on scientific evidence, acknowledges that the mechanisms of action of fluorides for prevention of dental caries is effected by inhibiting demineralization of tooth tissues, increasing the remineralization of dental tissue and the inhibition of bacterial plaque activity and that these mechanisms of action are post-eruptive topical effect by or for children or for adults.
Key words: fluoride, mechanisms of action, prevention,dental caries
... The role of fluoride in the prevention of dental caries and the mechanisms through which this preventative effect is achieved have been well described; however, the vast majority of studies investigating the effects of fluoride interventions have been carried out in children. 8,9 Studies including adults have shown that fluoride is an effective caries preventative measure across all age groups, whilst a review of fluoride interventions to prevent root caries in adults found that the regular application of topical fluoride was effective in achieving this. 10 Older people residing in LTCFs represent a group with distinct characteristics including multiple comorbidities, xerostomia, polypharmacy and limited self-care abilities. 11 Given the obvious differences between the groups involved, difficulties exist in simply extrapolating the results of previous studies on fluoride efficacy to older adults residing LTCFs. ...
Background:
The oral health status of older adults within Long Term Care Facilities (LTCFs) is significantly worse than their community living peers. Whilst evidence suggests an important role for fluoride varnish in preventing caries in this population very few studies have evaluated this intervention.
Objective:
To evaluate the effectiveness of professionally-applied fluoride varnish on the incidence of dental caries amongst older adults resident in LTCFs in Northern Ireland.
Methodology:
A quality improvement project was undertaken with dentate residents (n=190) in nine LTCFs who had fluoride varnish applied by Dental Care Professionals on two separate occasions during a 12-month period (intervention group). Nine LTCFs were chosen as matched controls (control group) with comparable numbers of residents of similar medical status (n=217). For the intervention group, oral hygiene training was also provided for the care home staff.
Results:
A total of 407 patients (n=271 female) were included in the analyses (mean age [SD]: 84.1 [6.6] years). After 12-months, the intervention group recorded a significant reduction in mean number of carious teeth (mean [95% CI]: -0.85 [-1.12, -0.58]; P<0.001). Patients in the control group had significant increases in the mean number of carious teeth (mean [95% CI]: 0.21 [0.05, 0.37]; P=0.012), mean plaque score (mean [95% CI]: 1.16 [0.28, 2.04]; P=0.010) and mean DMFT score (mean [95% CI]: 0.13 [0.04, 0.22]; P=0.004).
Conclusions:
This study demonstrates the potential role of fluoride varnish in combination with oral hygiene training for staff in the prevention and arrest of carious lesions among older adults in LTCFs.
... In this systematic review, no significant difference was observed between participants receiving FV + RFT and RFT alone in d(m/e)fs increment, incidence of caries or changes in prevalence of caries. Over 5000 children were included, and for all of them, the professional fluoride regimen used in all included studies was FV. [5,11,27,[38][39][40][41][42]. All six included studies reported caries increment data at tooth level with d(m/e)fs and contributed to the overall pooled estimate. ...
Objective
To assess whether professional fluoride application (PFA) used in addition to regular fluoride toothpaste (RFT, ≥ 1,000 ppm) is more effective than RFT alone in children.
Materials and methods
A systematic search was conducted using the PubMed, Embase, Google Scholar and CENTRAL databases. Randomized controlled trials (RCTs) comparing the effectiveness of RFT + PFA and RFT alone were included. Meta-analyses with random-effects models were performed. The certainty of evidence was assessed using the GRADE approach.
Results
A total of 2,729 records were identified from electronic and manual searches, which were screened by two reviewers independently and in duplicate. Six RCTs (5,034 participants) were included, of which four had high risk of bias and two had unclear risk of bias. The PFA used in all these trials was fluoride varnish (FV). In meta-analyses, no significant difference was observed between participants receiving FV + RFT and RFT alone of d(m/e)fs increment (mean difference (MD) − 0.17, 95% confidence interval (CI) − 0.60 to 0.26, P = 0.43, I² = 38%; 6 trials, 5,034 participants, moderate certainty evidence), incidence of caries (risk ratio (RR) 0.91, 95% CI 0.80 to 1.05, P = 0.21, I² = 41%; 4 trials, 4,487 participants, moderate certainty evidence) or changes in prevalence of caries (RR 0.89, 95% CI 0.78 to 1.01, P = 0.07, I² = 0%, 4 trials, 4,189 participants, low certainty evidence).
Conclusions
Low to moderate certainty evidence suggests that FV does not have significant additional caries-preventive benefit for children (under 8 years old) when provided as an adjunct to daily tooth brushing with RFT (≥ 1,000 ppm). There is insufficient evidence regarding the additional benefit of other PFA interventions.
Clinical relevance
The decision to apply FV to children needs to be made in light of their actual usage of RFT.
Trial registration
PROSPERO (CRD42020165270)
... The search for preventive and restorative interventions for dental referral yielded 10 high-quality systematic reviews. [550][551][552][553][554][555][556][557][558][559] Fifty-six articles addressing prevalence, burden of disease, disease risk and access to care in immigrant populations were selected for detailed review. ...
Clinical preventive care should be informed by the person's region or country of origin and migration history (e.g., forced versus voluntary migration).• Forced migration, low income, and limited proficiency in English or French increase the risk of a decline in health and should be considered in the assessment and delivery of preventive care. Vaccination (against measles, mumps, rubella, diphtheria, tetanus, pertussis, polio, varicella, hepatitis Band human papillomavirus) and screening (for hepatitis B, tuberculosis, HIV, hepatitis C, intestinal parasites, iron deficiency, dental pain, loss of vision and cervical cancer) should be routinely provided to at-risk immigrants.• Detecting and addressing malaria, depression, post-traumatic stress disorder, child maltreatment, intimate partner violence, diabetes mellitus and unmet contraceptive needs should be individualized to improve detection, adherence and treatment outcomes
... Prevention of oral diseases like caries, gingivitis, and periodontitis strongly depends on the efficiency of daily oral hygiene (Gibson and Williams 1999;Marinho et al. 2003;Marinho et al. 2004;Lam 2014). Beginning with the emergence of the first tooth, it is necessary to remove plaque deposits on a daily basis (Ismail 1998;Sgan-Cohen 2005). ...
Objectives:
Nationwide prevention programs in Germany aim to promote oral health. The group prevention program starts in kindergarten and ends when the children are about 12 y old. While in a recent study, toothbrushing behavior of 12-y-old children was analyzed, the present study's objective was to examine the children's ability to achieve oral cleanliness and to analyze how toothbrushing behavior and compliance with the toothbrushing recommendations taught in the group prevention programs predict oral cleanliness.
Methods:
Twelve-year-old randomly selected children (N = 174) were asked to brush their teeth to the best of their abilities, and simultaneously a video was recorded for behavioral analyses. Plaque levels were measured before and immediately after toothbrushing. In addition, dental status and gingival bleeding were assessed.
Results:
After brushing to the best of their abilities, there was plaque on 50% (±24.72%) of all measured sites at the gingival margin (Marginal Plaque Index). Regression analyses revealed approximately 22% of the variance of marginal plaque on the outer surfaces to be explained by the time brushed by circular movements (β = -0.41;P < 0.001) and the number of sextants brushed for at least 7.5 s (β = -0.171; P < 0.05). Circular movements explained most additional variance (ΔR2 = 0.113; P < 0.001). With respect to inner surfaces, none of the behavioral aspects explained any variance of oral cleanliness.
Conclusion:
Despite regular group prevention measures, 12-y-old children show limited skills to clean their teeth adequately. Furthermore, none of the recommended behaviors relates to oral cleanliness after toothbrushing at inner surfaces. As a consequence, it is necessary to explore further which behavioral sequences effectively improve oral cleanliness.
Knowledge transfer statement:
This study illustrates that children's compliance to toothbrushing recommendations is not necessarily related to toothbrushing effectiveness. Clinicians should therefore assess the effectivity of recommendations individually and provide individual guidance for improvement.
... First, the silver component works as an antimicrobial agent, killing bacteria and, at the same time, impeding the development of new biofilm, [2][3][4][5] while the fluoride component acts to prevent demineralization and improve remineralization, which leads to a stronger tooth structure. [6][7][8] SDF has five characteristics that makes it advantageous, which include control of caries infection, simplicity of use, affordability, minimal requirement for training, and being a minimally invasive treatment. 4 Although previously not approved in the United States (U.S.), SDF has been used in other countries, including Japan, China, Australia, and Argentina, since 1970. ...
Purpose: To determine the effect of a dental curing light on the penetration depth of silver diamine fluoride (SDF), dentin hardness, and
silver and fluoride ion precipitation into cavitated carious lesions. Methods: SDF was applied on 16 primary incisors extracted due to caries
extending into dentin. Teeth were divided into two groups: (1) control group, was not light-cured; and (2) test group, was light-cured. A scanning
electron microscope, and OmniMet software were used to measure penetration depth, dentin hardness, and ion precipitation. Wilcoxon’s ranksum test was used for statistical analysis. Results: All samples in both groups showed SDF penetration beyond the carious lesion and into sound
dentin. The penetration depth into sound dentin was 70 µm further without the dental curing light it (P<0.001). Silver precipitation in infected
dentin with the dental curing light was approximately 2.6 times greater than without it (P=0.02). Dentin hardness of infected dentin was
26 percent more with the dental curing light (P=0.04). Conclusions: Applying a dental curing light during silver diamine fluoride treatment of
carious lesions induces more silver ion precipitation in infected dentin, increases its hardness, and, perhaps because more silver stays in the
infected dentin, less SDF penetrates into sound dentin.
... 15 Second, the extent to which PFA in addition to the regular use of fluoride toothpaste provides extra protection against caries is unclear; this issue is of clear importance and needs to be formally investigated. 16 Additionally, the Cochrane library contains only six systematic reviews and meta-analyses regarding fluoride use [16][17][18][19][20][21] ; however, only one review, published in 2004, mentioned a combination of toothpaste and PFA. 16 That article did not take the concentration of fluoride in toothpaste into consideration, and its evidence remains to be updated. ...
Introduction:
Regular toothbrushing with fluoride toothpaste is a fundamental intervention for caries prevention. Professional fluoride application (PFA) is widely considered a beneficial supplement to the routine use of fluoride toothpaste. However, some recent studies have failed to demonstrate the preventive effect of PFA. In addition, an increasing number of studies have highlighted the potential adverse effects of fluoride. However, little information exists on the effectiveness of additional PFA. The objective of this review is to systematically analyse the efficacy of PFA in addition to regular fluoride toothpaste among children under the age of 16.
Method and analysis:
We will search the PubMed, Embase, Google Scholar and Cochrane Central Register of Controlled Trials databases for randomised controlled trials without language or publication date restrictions. Additional studies will be identified by manually searching the reference lists of the included studies and relevant reviews. At least two authors will carry out the selection of studies independently and in duplicate. The Cochrane Risk of Bias tool will be used to assess the risk of bias of the included studies. The random effects model will be used for meta-analyses. The data synthesis will be conducted using Review Manager software (RevMan V.5.3). The Grading of Recommendation, Assessment, Development and Evaluation will be used to assess the quality of supporting evidence for each major comparison.
Ethics and dissemination:
There is no need for ethical approval. The results of this review will be disseminated through peer-reviewed publications and social networks.
Prospero registration number:
CRD42020165270.
... Resistance to dental caries may be enhanced by the application of topical fluorides [63,64]; fluoride toothpaste has been demonstrated to provide significant benefit in preventing and remineralising root caries in patients undergoing radiation for head and neck cancer [65]. The efficacy of fluoride in these patients may be limited by the lack of calcium and phosphate secondary to hyposalivation [66]. ...
Radiotherapy, often with concomitant chemotherapy, has a significant role in the management of head and neck cancer, however, radiotherapy induces adverse events include oral mucositis, hyposalivation, loss of taste, dental caries, osteoradionecrosis, and trismus, all of which have an impact on patients' quality of life. Therefore, it is necessary to implement oral management strategies prior to the initiation of radiotherapy in patients with head and neck cancer. Since 2014, the National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines) have enumerated the "Principles of Dental Evaluation and Management (DENT-A)" in the section on head and neck cancers, however, oral management was not explained in detail. Oral management has not been achieved a consensus protocol. The aim of this literature is to show that oral management strategy include removal infected teeth before the start of radiotherapy to prevent osteoradionecrosis, oral care for preventing severe oral mucositis to support patient complete radiotherapy during radiotherapy, and prevent of dental caries followed by osteoradionecrosis after radiotherapy.
... Among the preventive strategy, toothbrushing (with fluoridated toothpaste) is the most cost-effective tool in preventing dental caries. [15] The World Health Organization continues to emphasize the effective use of fluoride for the prevention of dental caries as an important public health measure and highly recommends the introduction of affordable fluoride toothpastes in developing countries. [16] Oral health behavior of an individual is greatly reflected by his/her own experiences, cultural perceptions, familial beliefs, and other life situations. ...
... Toothpaste containing fluoride to prevent tooth decay in children and adolescents [132] The combination of topical fluorides with fluoride toothpaste reduces dental caries more than 10%. [133] Combinations of topical fluoride (toothpaste, mouth rinse, gels, varnishes) versus single topical fluoride for preventing dental caries. ...
Human oral cavity (mouth) hosts a complex microbiome consisting of bacteria, archaea, protozoa, fungi and viruses. These bacteria are responsible for two common diseases of the human mouth including periodontal (gum) and dental caries (tooth decay). Dental caries is caused by plaques, which are a community of microorganisms in biofilm format. Genetic and peripheral factors lead to variations in the oral microbiome. It has known that, in commensalism and coexistence between microorganisms and the host, homeostasis in the oral microbiome is preserved. Nonetheless, under some conditions, a parasitic relationship dominates the existing situation and the rise of cariogenic microorganisms results in dental caries. Utilizing advanced molecular biology techniques, new cariogenic microorganisms species have been discovered. The oral microbiome of each person is quite distinct. Consequently, commonly taken measures for disease prevention cannot be exactly the same for other individuals. The chance for developing tooth decay in individuals is dependent on factors such as immune system and oral microbiome which itself is affected by the environmental and genetic determinants. Early detection of dental caries, assessment of risk factors and designing personalized measure let dentists control the disease and obtain desired results. It is necessary for a dentist to consider dental caries as a result of a biological process to be targeted than treating the consequences of decay cavities. In this research, we critically review the literature and discuss the role of microbial biofilms in dental caries.
... Toothpastes are known as the best source of fluoride as they effectively protect both deciduous and permanent teeth from demineralization. 1 Oral healthcare for pre-school children is a main concern, as their oral health will determine the oral health status of future generations. Therefore, a healthy mouth with a full balanced set of teeth should be the goal for all children. 2 The decline in the prevalence of dental caries in many developing countries is mainly attributed to the use of fluoridated toothpaste. ...
BACKGROUND
A variety of toothpastes are available in the market, however proper knowledge and choice of fluoride toothpastes to be used
is important in children for better oral health care. Parents especially mothers should be aware of type, frequency and quantity
of toothpastes which has to be used by children.
METHODS
This is a cross sectional questionnaire-based study conducted randomly among mothers of preschool children of both sexes in
the 3-5 years age group who visited different private dental clinics in Srinagar city (Kashmir J & K). 10 self-administered
questions were used for interviewing mothers that included frequency of tooth brushing by their child, use and knowledge of
fluoride toothpaste by their children.
RESULTS
Overall knowledge with regard to recommended fluoride concentration in the child’s toothpaste among mothers was found to
be less. 96% of the mothers did not know the advantages and disadvantages of fluoride. And overall poor knowledge was found
among mothers regarding the toothpaste use for their children.
CONCLUSIONS
Based on the findings of this study, it shows that there is lack of awareness regarding dental health issue among parents.
Emphasis should be made towards educating the mothers regarding importance of oral hygiene practices.
... Plaque removal on a regular basis is a central part of oral health prophylaxis. Without proper oral hygiene (including fluoride toothpaste) there is a high risk for caries and gingivitis [1][2][3][4]. Accordingly, there is wide consent that oral hygiene behavior is essential for everyone and should begin with the first tooth of a child [5,6]. As this health behavior has to be performed on a daily basis [6], it is important to educate children to take up the responsibility for their own oral health. ...
Background:
Many countries offer systematic group prevention programs in kindergarten and school in order to promote children's oral health. Little is known, however, about the actual toothbrushing abilities of children when group prevention programs end.
Methods:
In Germany, all children take advantage from a nationwide group prevention program (called "Gruppenprophylaxe") lasting from kindergarten up to sixth grade (12 years of age). Standardized recommendations are given concerning brushing systematics and brushing movements. N = 174 children at the age of 12 were thus randomly selected from two German towns and were asked to perform toothbrushing to the best of their abilities in front of a mirror which also served as a camera. Brushing behavior was analyzed by video analysis.
Results:
Children brushed their teeth for an average of 200 s ± 80.48 s (mean ± SD). Still, more than 55% missed at least one sextant when brushing inner surfaces, 16% missed them all. Only 7.5% of the children brushed both inner and outer surfaces by the intended movements (vertical movements on the inner surfaces and circular movements on the outer surfaces) for at least 90% of the respective brushing time. Instead, horizontal brushing was very common on the lateral surfaces.
Conclusions:
The present analysis indicates that children have low efficiency to adopt the tooth-brushing recommendations given in prevention programs. This is surprising as great endeavors are made to help children internalize the recommendations. Future research is needed to better understand which factors impede adoption of toothbrushing recommendations in children and which efforts are necessary to improve their toothbrushing abilities.
Purpose
This study is to conduct a comprehensive scoping review to map scientific evidence and clarify concepts regarding the commonly recommended preventive and restorative dental treatments for patients diagnosed with head and neck cancer (HNC) and subjected to radiotherapy.
Material and methods
This systematic scoping review was performed under the PRISMA-ScR guidelines. The study’s experimental design was registered in the Open Science Framework. In vitro studies that evaluated preventive and restorative dental treatment over 50 Gy radiation doses were included. The search was conducted in November 2023 in five electronic databases (PubMed, Scopus, Web of Science, Cochrane Library, and Embase) without language or date restriction. A search strategy was applied based on keywords, MeSh terms, or synonyms. A descriptive analysis was conducted.
Results
A total of 49 studies, out of 3679 original articles identified, were included and reviewed. Of the included studies, three evaluated saliva stimulants and 35 evaluated fluoride-based preventive materials: gel (n = 18) toothpaste (n = 11) mouth rinse (n = 8) and varnish (n = 5) while 14 evaluated restorative materials: resin composite (n = 12) glass ionomer cement (n = 6) and amalgam (n = 1) Of those studies, 36 were clinical trials and 13 were in vitro studies.
Conclusion
Fluoride gel was the most frequently recommended preventive material for preventing radiation caries with supportive clinical evidence. Resin composite and glass ionomer were the most frequently used restorative materials, respectively. However, there is not yet clinical evidence to support the use of resin composite in irradiated teeth.
Dental caries is a prevalent chronic disease among adolescents. Caries activity increases significantly during adolescence due to an increase in susceptible tooth surfaces, immature permanent tooth enamel, independence in pursuing self-care, and a tendency toward poor diet and oral hygiene. Dental caries in permanent teeth is more prevalent among adolescents in low-income families and racial/ethnic minority groups, and these disparities in adolescent dental caries experience have persisted for decades. Several conceptual and data-driven models have proposed unidirectional mechanisms that contribute to the extant disparities in adolescent dental caries experience. Our objective, using a literature review, is to provide an overview of risk factors contributing to adolescent dental caries. Specifically, we map the interactive relationships of multilevel factors that influence dental caries among adolescents. Such interactive multilevel relationships more closely reflect the complex nature of dental caries experience among the adolescent population. The methods that we use are two-fold: (1) a literature review using PubMed and Cochrane databases to find contributing factors; and (2) the system dynamics approach for mapping feedback mechanisms underlying adolescent dental caries through causal loop diagramming. The results of this study, based on the review of 138 articles, identified individual, family and community-level factors and their interactions contributing to dental caries experience in adolescents. Our results also provide hypotheses about the mechanisms underlying persistence of dental caries among adolescents.
Conclusions
Our findings may contribute to a deeper understanding of the multilevel and interconnected factors that shape the persistence of dental caries experience among adolescents.
Background and objective: The study aims to assess the correlation between degree of monomer conversion (DC) and shear bond strength (SBS) of the different adhesives. The objective of the present study was to determine the efficiency of four orthodontic adhesives regarding shear bond strength (SBS), debonding characters and degree of conversion (DC) and to correlate SBS to the DC. Methods: Forty human upper first premolars, divided into four Groups (n = 10) were bonded with metal brackets using four different adhesives. Brackets were debonded in shear on an Instron universal testing machine with a crosshead speed of 1 mm per minute. The mode of bond failure was determined by the adhesive remnant index (ARI) index and the DC was determined by Fourier transform infrared spectroscopy (FTIR) analysis. Result: There was a statistically significant difference between the SBS of only Transbond XT and Orthobond plus color change adhesive while the two remaining adhesives showed no significant difference. All groups of adhesives showed a cohesive type of bond failure according to the ARI results. A statistically significant lower percentage of DC was noted for Orthobond plus (63 %) than Transbond XT (70.2 %) but it was within the accepted range reported in the literature (55-75%). Pearson’s correlation was significantly positive between SBS and DC for Smart Ortho, Heliosit Orthodontic and Orthobond Plus adhesives and insignificantly positive for Transbond XT. Conclusion: Within the limitations of this in vitro study it can be concluded that the Transbond plus color change has significantly higher fluoride release as well as recharge properties when compared to other ortho-adhesive materials. Keywords: Orthodontic Adhesive, Shear Bond Strength, Degree of conversion
Objective
This study was aimed at comparing the performance of light-cured (LC) silver diamine fluoride (SDF) to non-LC SDF in dental applications, in terms of various properties.
Methods
Articles published until April 2023 were retrieved from electronic databases (PubMed, Scopus and Science Direct) according to Boolean operators, and the reference lists of the included articles were manually searched. The included articles were all full-text, original studies in English that assessed the effects of LC SDF compared with SDF alone. The risk of bias in the in vitro studies on dental materials was evaluated with the modified Consolidated Standards of Reporting Trials (CONSORT) checklist.
Results
Six studies (five in vitro and one ex vivo) were included in qualitative analysis after a comprehensive manual search and electronic database search. Every study compared LC SDF versus non-LC SDF in terms of properties such as penetration depth, silver ion precipitation, dentine hardness, surface morphology and anti-bacterial characteristics. Four studies were categorised as low quality with a high risk of bias, whereas the remaining two studies were considered high quality with a low risk of bias.
Conclusion
In this investigation, LC SDF, compared with non-LC SDF, was found to be an efficacious approach for enhancing SDF properties. Future high-quality studies, particularly randomised clinical trials, remain necessary to verify these findings.
Clinical significance
The use of light curing with SDF can be a beneficial strategy that enhances SDF's clinical use. This review comparing various properties of LC SDF and non-LC SDF may help clinicians enhance clinical use and patient acceptance of LC SDF.
Purpose
To adapt an evidence-based clinical practice guideline (CPG) for risk-based management of caries in 18–55 year-old Iranian adults.
Methods
A multidisciplinary adaptation team reviewed evidence-based guidelines such as the NICE, SIGN, and ADA according to the defined clinical questions. In addition, databases such as the PubMed and Google Scholar were searched and CPGs were screened and appraised using the AGREE II (Appraisal of Guidelines for Research and Evaluation II) tool. Clinical scenarios were developed and their level of evidence, clinical advantage and adaptability were assessed. Following a two-round ranking by experts, the final recommendations were selected using the RAND-UCLA appropriateness method.
Results
Of 17 CPGs, 5 were selected as the source guidelines for adaptation. To assess the risk of caries in the adult population, reduced Cariogram (without saliva tests) and CAMBRA were suggested as diagnostic tools. In addition, 53 risk-based recommendations on the preventive care (including the use of fluoride toothpaste, fluoride, and chlorhexidine mouthwash, at home and in-office fluoride gel, fluoride varnish, mouth buffering, and sealant), operative intervention threshold, and follow-up interval were adapted for Iranian adults.
Conclusions
A guideline was adapted for risk-based management of dental caries in Iranian adults. This helps local dentists in decision making and promoting oral health of adults. Further research is needed to assess the external validity and feasibility of the adapted guideline in the Iranian population.
Background
Dental caries is the most common global childhood disease. To control caries, the Centers for Disease Control and Prevention recommends school-based caries prevention, and the World Health Organization lists glass ionomer cement and silver diamine fluoride as essential dental medicines. The Caried Away trial tested the comparative effectiveness of these essential medicines when used in a school-based dental care program.
Methods
This cluster-randomized non-inferiority pragmatic trial was conducted in children from 2018 to 2022. Subjects were randomized at the school level to receive either silver diamine fluoride (”simple care”) or an active comparator of glass ionomer sealants and atraumatic restorations (”complex care”). All subjects received tooth brushes, fluoride toothpaste, and fluoride varnish. We assessed caries arrest and incidence at two years using mixed-effects multilevel models and two-sample proportion tests with clustering adjustment.
Results
1398 subjects received treatment and completed follow-up observations after two years. The proportion of subjects with arrested caries in simple and complex groups was 0.56 and 0.46, respectively (difference = -0.11, 95% CI = -0.22, 0.01). Prevention rates for no new caries were 0.81 and 0.82 (difference = 0.01, 95% CI = -0.04, 0.06).
Conclusions
Over a two-year, non-intervention period, simple care was non-inferior to complex care for both caries arrest and prevention. Results support the utilization of silver diamine fluoride as an arresting and preventive agent in school-based oral health programs and questions the periodicity of current caries prevention recommendations.
: To evaluate the antimicrobial efficacy of three commercially available toothpastes which are non-fluoridated, fluoridated and the one containing prebiotic ingredient on s and .
: Antimicrobial activities of prebiotic, fluoridated, non-fluoridated toothpastes were assessed at different concentrations (100ug, 200ug, 300ug and 400ug). Since prebiotic toothpaste had other proven antimicrobial agents, 100% inulin extract from chicory (prebiotic) was assessed for its antimicrobial efficacy at varying concentrations. Antimicrobial property was evaluated by determining the zone of inhibition using agar well diffusion method on Luria Bertani (LB) broth media for and MRS broth media forL.plantarum. 100ul of inoculums of S.mutans and L.plantarum was poured on to the agar plates respectively. Five wells measuring 0.5cm was made, dentifrice at varying concentration i.e; 100ug, 200ug, 300ug and 400ug was loaded into respective wells. 50ul of DMSO was loaded in the well at the centre as control and incubated at 37°C for 24hrs.
: All the three tested toothpastes had significant antimicrobial activity against S.mutans and L.plantarum. The highest antimicrobial activity was exhibited by toothpaste containing prebiotic ingredient with mean zone of inhibition of (18.5+/-0.5) and (20.0+/-1) at 400ug against S.mutans and L.plantarum. There was no significant difference in antimicrobial activity of fluoridated and non-fluoridated toothpastes against S.mutans at 400ug (P=1), but there was a significant difference for L.plantarum at 400ug (P<0.001). Antimicrobial activity increased at higher concentrations for all the three tested toothpastes and for 100% Inulin extract.
: All the three tested toothpaste were effective against S.mutans and L.plantarum at varying concentrations, but toothpaste containing prebiotic ingredient was most effective in inhibition of both the micro-organisms.
Purpose: The purpose of this project is to compare the dental services by national hospital of three areas in Chin state, Myanmar.Materials and Methods: Demographic statistics were collected form Township health profile of every township stocked in municipal office. Number of patients who attended at the dental clinic within four national hospitals was summarized by month and year. The diagnosis and contents of treatment were summarized by year. In addition, fluoride concentration of tap water was measured. Results: Number of the patients who visited for the national hospital is fluctuated by month because of the school dental health checkups and landslide that prevent the people in local area to the national hospital. The most of the dental disease diagnosed were dental caries and pulpitis. More than seventy percent of the treatment was filling and extraction.Conclusion: The primary health care is not sufficient in Chin sate. In addition, health promotion is important especially health education. To promote these concepts, there still existed many obstacles in Chin state in Myanmar.
Dalmatian Sage(Salvia officinalis L., Lamiaceae) is known in the Middle East for its therapeutic properties, and is widely used in folk medicine, cosmetics, flavoring and preservative for food products. It’s essential oil possess antimicrobial, antiviral, antifungal and antioxidant properties so that it is widely used to treat gingivitis and laryngitis. The present study has formulated a semi-solid pharmaceutical form (tooth paste) that contains essential oil extracted from the leaves of common sage and conducted the necessary observations and further control tests, in preface for preparation at the industrial level at the later stage. The Sage leaves were harvested from al-Qadmus area, in Tartous province, Syria, dried and extracted for essential oil by hydro-distillation. The extraction yield was estimated to formulate the toothpaste and observational tests for quality control (sensory tests, the absence of solid and sharp particles, spread ability, pH, moisture content, bacterial tests and stability test on shelf) were performed. Our formulated toothpaste characteristics were identical to the commercial toothpaste specifications from the following respect: Sensory tests, spread ability, pH, moisture content and stability on shelf, also the microbial parameters values were within permissible limits. Our study suggest using this formula to prepare a tooth paste with sage essential oil and perform further studies to evaluate its efficacy on dental cavities and gingivitis.
Objective:
To understand the oral health status of children aged 3-12 in Shaoshan area of Hunan province and to evaluate the role of oral health educations based on community such as fluoride varnish, oral hygiene introduction in improving the oral health of children in the area so as to gain expe-rience.
Methods:
The study used cluster sampling to select 3 kindergartens and 2 primary schools in different economic development areas of Shaoshan. Oral health status survey and interventions were conducted in December 2014 and September 2016, respectively. The average debris index, decayed missing filled teeth (deciduous teeth: dmft; permanent teeth: DMFT), and caries prevalence rate of children aged 3-6 years and 6-12 years were compared. At the same time, children aged 5 and 12 were used as representative populations to compare the indices as listed before and the caries prevalence rate of the first permanent molar in 12-year-old children was compared as well. Finally, health economic analysis was carried out based on the 2 years' result.
Results:
In this study, 992 children and 896 children in 2014 and 2016 were included respectively. As for children aged 3-6 years, the average debris index and dmft in 2016 were significantly less than that in 2014 (P < 0.001, P < 0.001), and the difference of DMFT was not significant (P=0.419). Children aged 6-12 years showed the same result, the average debris index and dmft in 2016 were significantly less than those in 2014 (P < 0.001, P=0.013), and the difference in DMFT was not significant (P=0.674). 173 and 179 5-year-old children were included in 2014 and 2016 respectively, and the dmft showed significant difference (P=0.038); the caries prevalence rate was 75.7% and 71.5%, respectively, which was also not significant (P=0.370). With respect to the 12-year-old children, 65 and 104 children were included and the differences in dmft and DMFT were not significant (P=0.133, P=0.171). The caries prevalence of the first permanent molar in the 12-year-old children was 36.9% and 26.9%, whose difference was not significant (P=0.171).
Conclusion:
The application of fluoride varnish and oral health education can significantly reduce the dmft of children aged 3-12 years in Shaoshan area and significantly improve the oral hygiene status. DMFT, the caries prevalence rate of 5-year-old children's deciduous teeth and 12-year-old children's first permanent molar showed a decline.
Endometriosis is a gynecological condition recognized by the existence of ectopic endometrial tissue outside the uterus.
It is predominantly present in females of reproductive age group and is one of the main causes of infertility. Even with a
predictable prevalence of 11% in females and considerable historical explanations adopted from the seventeenth century,
the diagnosis of endometriosis still remains doubtful. The conventional concepts on histological basis of endometriosis
are explained by a number of theories. Medical signs of endometriosis contain prolonged pelvic ache, dyspareunia, repeated
menstrual discomfort and chronic pelvic pain which can severely affect the excellence of life and health of the patient. In
this review we will discuss the prevalent theories for the diagnosis of endometriosis and suggestions to identify the condition
well in time for better control and management.
Key words: Endometriosis, Endometriotic lesion, angiogenesis, vascularization, vasculogenesis, endothelial progenitor
cells
With the dramatic increase in the amount of scientific information available about oral health, an evidence‐based approach to oral health care and the practice of dentistry is necessary. There is a need to summarize, critique, and disseminate scientific evidence and to translate the evidence into a practical format that is used easily by dentists. The evidence‐based clinical recommendations in this report were developed by an expert panel established by the American Dental Association Council on Scientific Affairs that evaluated the collective body of scientific evidence on the effectiveness of professionally applied topical fluoride for caries prevention. The recommendations are intended to assist dentists in clinical decision making. MEDLINE and the Cochrane Library were searched for systematic reviews and clinical studies of professionally applied topical fluoride—including gel, foam, and varnish—through October 2005. Panelists were selected on the basis of their expertise in the relevant subject matter. The recommendations are stratified by age groups and caries risk and indicate that periodic fluoride treatments should be considered for both children and adults who are at moderate or high risk of developing caries. Included in the clinical recommendations is a summary table that can be used as a chairside resource. The dentist, knowing the patient's health history and vulnerability to oral disease, is in the best position to make treatment decisions in the interest of each patient. These clinical recommendations must be balanced with the practitioner's professional expertise and the individual patient's preferences.
Objective:
To ascertain the preferred method of teaching among 4th and 5th year M.B.B.S students of Al-Tibri Medical College, Karachi, Pakistan
Materials/Methods:
All medical students of 4th and 5th year were enrolled for this study from May 2018 to June 2018. All students of both classes were included in the study and none excluded. A questionnaire was distributed amongst the students, asking them about the best teaching options with regarding academic institutional and clinical institutional teaching. Data was collected and analysed by trained professionals. Descriptive statistics included gender and year of M.B.B.S. Frequency and percentages were calculated and presented.
Results:
A total of 166 of students, 82 from 4th year and 84 from 5th years were reviewed. For 4th year student preferred method of academic teaching was equal between white boards and multimedia and about preferred mode of clinical teaching, the most preferred method was through Out Patient Department (OPD) clinics. Among 5th year medical students inquired about preferred method of academic teaching, multimedia was most preferred by the students. And about preferred mode of clinical teaching, the most preferred method was through disease discussion..
Conclusion:
Our study concluded that white board and multimedia, bed side teaching and disease discussion were highly preferred method of teaching among both 4th and 5th year medical students. Therefore, strategies for improvement of the preferred method and establishing better facilities for students can aid in improving both knowledge attainment and skills development of students.
Key words: Learning styles, preferences, academic teaching, clinical teaching
Aims:
To evaluate the effectiveness of 5% sodium fluoride varnish on caries in first permanent molars and to assess the suitability of using this method to control caries among children in rural areas of Guangxi province, China.
Methods:
A total of nine schools with 32 classes were selected by simple random sampling. There were 999 students in the experimental group and 1,004 in the control group. The experimental group received oral health education and topical application of 5% sodium fluoride varnish, while the control group received oral health education only. Dental examinations were performed in November 2014 and November 2017, and the modified International Caries Detection and Assessment System (ICDAS-II) was used to record the caries status of the first permanent molars. The data were entered into SPSS 22 for statistical analysis.
Results:
A total of 1,748 students (853 in the experimental group and 895 in the control group) completed the study. After 3 years of intervention, the experimental group had a lower prevalence of caries, a lower caries increment, a lower decayed, missing and filled teeth (DMFT) index and a lower decayed, missing and filled surfaces (DMFS) index compared with the control group (respectively: 58.9% vs 65.5%, 34.8% vs 42.1%, 1.38 vs 1.59 and 2.06 vs 2.38). All the differences were statistically significant (P < 0.05).
Conclusion:
In this study population, twice-yearly application of 5% sodium fluoride varnish and oral health education were more effective for preventing caries in first permanent molars than oral health education alone. The implementation of fluoride varnish application as a public health measure in schools in rural areas is recommended.
Background:
Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). Regular toothbrushing with fluoride toothpaste is the principal non-professional intervention to prevent caries, but the caries-preventive effect varies according to different concentrations of fluoride in toothpaste, with higher concentrations associated with increased caries control. Toothpastes with higher fluoride concentration increases the risk of fluorosis (enamel defects) in developing teeth. This is an update of the Cochrane Review first published in 2010.
Objectives:
To determine and compare the effects of toothpastes of different fluoride concentrations (parts per million (ppm)) in preventing dental caries in children, adolescents, and adults.
Search methods:
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 August 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 7) in the Cochrane Library (searched 15 August 2018); MEDLINE Ovid (1946 to 15 August 2018); and Embase Ovid (1980 to 15 August 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (15 August 2018). No restrictions were placed on the language or date of publication when searching the electronic databases.
Selection criteria:
Randomised controlled trials that compared toothbrushing with fluoride toothpaste with toothbrushing with a non-fluoride toothpaste or toothpaste of a different fluoride concentration, with a follow-up period of at least 1 year. The primary outcome was caries increment measured by the change from baseline in the decayed, (missing), and filled surfaces or teeth index in all permanent or primary teeth (D(M)FS/T or d(m)fs/t).
Data collection and analysis:
Two members of the review team, independently and in duplicate, undertook the selection of studies, data extraction, and risk of bias assessment. We graded the certainty of the evidence through discussion and consensus. The primary effect measure was the mean difference (MD) or standardised mean difference (SMD) caries increment. Where it was appropriate to pool data, we used random-effects pairwise or network meta-analysis.
Main results:
We included 96 studies published between 1955 and 2014 in this updated review. Seven studies with 11,356 randomised participants (7047 evaluated) reported the effects of fluoride toothpaste up to 1500 ppm on the primary dentition; one study with 2500 randomised participants (2008 evaluated) reported the effects of 1450 ppm fluoride toothpaste on the primary and permanent dentition; 85 studies with 48,804 randomised participants (40,066 evaluated) reported the effects of toothpaste up to 2400 ppm on the immature permanent dentition; and three studies with 2675 randomised participants (2162 evaluated) reported the effects of up to 1100 ppm fluoride toothpaste on the mature permanent dentition. Follow-up in most studies was 36 months.In the primary dentition of young children, 1500 ppm fluoride toothpaste reduces caries increment when compared with non-fluoride toothpaste (MD -1.86 dfs, 95% confidence interval (CI) -2.51 to -1.21; 998 participants, one study, moderate-certainty evidence); the caries-preventive effects for the head-to-head comparison of 1055 ppm versus 550 ppm fluoride toothpaste are similar (MD -0.05, dmfs, 95% CI -0.38 to 0.28; 1958 participants, two studies, moderate-certainty evidence), but toothbrushing with 1450 ppm fluoride toothpaste slightly reduces decayed, missing, filled teeth (dmft) increment when compared with 440 ppm fluoride toothpaste (MD -0.34, dmft, 95%CI -0.59 to -0.09; 2362 participants, one study, moderate-certainty evidence). The certainty of the remaining evidence for this comparison was judged to be low.We included 81 studies in the network meta-analysis of D(M)FS increment in the permanent dentition of children and adolescents. The network included 21 different comparisons of seven fluoride concentrations. The certainty of the evidence was judged to be low with the following exceptions: there was high- and moderate-certainty evidence that 1000 to 1250 ppm or 1450 to 1500 ppm fluoride toothpaste reduces caries increments when compared with non-fluoride toothpaste (SMD -0.28, 95% CI -0.32 to -0.25, 55 studies; and SMD -0.36, 95% CI -0.43 to -0.29, four studies); there was moderate-certainty evidence that 1450 to 1500 ppm fluoride toothpaste slightly reduces caries increments when compared to 1000 to 1250 ppm (SMD -0.08, 95% CI -0.14 to -0.01, 10 studies); and moderate-certainty evidence that the caries increments are similar for 1700 to 2200 ppm and 2400 to 2800 ppm fluoride toothpaste when compared to 1450 to 1500 ppm (SMD 0.04, 95% CI -0.07 to 0.15, indirect evidence only; SMD -0.05, 95% CI -0.14 to 0.05, two studies).In the adult permanent dentition, 1000 or 1100 ppm fluoride toothpaste reduces DMFS increment when compared with non-fluoride toothpaste in adults of all ages (MD -0.53, 95% CI -1.02 to -0.04; 2162 participants, three studies, moderate-certainty evidence). The evidence for DMFT was low certainty.Only a minority of studies assessed adverse effects of toothpaste. When reported, effects such as soft tissue damage and tooth staining were minimal.
Authors' conclusions:
This Cochrane Review supports the benefits of using fluoride toothpaste in preventing caries when compared to non-fluoride toothpaste. Evidence for the effects of different fluoride concentrations is more limited, but a dose-response effect was observed for D(M)FS in children and adolescents. For many comparisons of different concentrations the caries-preventive effects and our confidence in these effect estimates are uncertain and could be challenged by further research. The choice of fluoride toothpaste concentration for young children should be balanced against the risk of fluorosis.
Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Västra Götaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the “low” subgroup, those with 1–3 into the “moderate” subgroup and those with ≥4 into the “high” subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12.
This in-vitro study investigated the effect of different natural and synthetic products on the remineralization capabilities of eroded enamel surface. A total of 45 extracted human upper first premolar teeth were used for this study: 5 of them were placed in distilled water (C-ve) and the remaining 40 specimens were placed in Coca-Cola soft drink 3 times per day for 3 days to reach demineralization, then 5 of them were taken to repesent (C+ve) after demineralization. After which, 35 of the demineralized specimens were divided into 7 subgroups: Milk (A-I), Green tea (A-II), Mouthwash (B-I), Toothpaste (B-II) (applied with soft toothbrush), Toothpaste with electric toothbrush (B-III), Fluoride varnish (B-IV) and Fluoride varnish with electric toothbrush (B-V). Each subgroup were socked in their products consecutively whether brushed or coated for 5 minutes 3 times daily for 6 days. All specimens were subjected to measurement of surface microhardness in Vickers hardness tester using a digital microhardness tester at base line. Then, specimens were examined using scanning electron microscopy (SEM) and Energy Dispersive X-Ray Analysis (EDX). Data was then recorded, tabulated and statistically analyzed. The mean microhardness recorded for B-III was the highest, while that for B-I was the lowest. The lowest mean percentage of change in microhardness recorded was for C+ve, while the highest was that for B-III. SEM results for C-ve group showed the surface was devoid of any surface deposits. While the C+ve group demonstrated deep changes in enamel structure due to demineralization. As for all other remineralizing groups, they have showed different areas of mineralized white spots with different morphological changes according to the medium used. The EDX analysis results showed that C+ve had the lowest Calcium wt% and Phosphorus wt%, while showed the highest Carbon content. Whereas A-I showed the highest Calcium wt% and Phosphorus wt% and the lowest Carbon wt%. In conclusion, the use of commercially available toothpaste containing fluoride with a manual toothbrush and milk consumption on daily basis enhances the defensive mechanism against the different acidic beverages.
Background:
Effective oral hygiene measures carried out on a regular basis are vital to maintain good oral health. One-to-one oral hygiene advice (OHA) within the dental setting is often provided as a means to motivate individuals and to help achieve improved levels of oral health. However, it is unclear if one-to-one OHA in a dental setting is effective in improving oral health and what method(s) might be most effective and efficient.
Objectives:
To assess the effects of one-to-one OHA, provided by a member of the dental team within the dental setting, on patients' oral health, hygiene, behaviour, and attitudes compared to no advice or advice in a different format.
Search methods:
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 10 November 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 10) in the Cochrane Library (searched 10 November 2017); MEDLINE Ovid (1946 to 10 November 2017); and Embase Ovid (1980 to 10 November 2017). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were also searched for ongoing trials (10 November 2017). No restrictions were placed on the language or date of publication when searching the electronic databases. Reference lists of relevant articles and previously published systematic reviews were handsearched. The authors of eligible trials were contacted, where feasible, to identify any unpublished work.
Selection criteria:
We included randomised controlled trials assessing the effects of one-to-one OHA delivered by a dental care professional in a dental care setting with a minimum of 8 weeks follow-up. We included healthy participants or participants who had a well-defined medical condition.
Data collection and analysis:
At least two review authors carried out selection of studies, data extraction and risk of bias independently and in duplicate. Consensus was achieved by discussion, or involvement of a third review author if required.
Main results:
Nineteen studies met the criteria for inclusion in the review with data available for a total of 4232 participants. The included studies reported a wide variety of interventions, study populations, clinical outcomes and outcome measures. There was substantial clinical heterogeneity amongst the studies and it was not deemed appropriate to pool data in a meta-analysis. We summarised data by categorising similar interventions into comparison groups.Comparison 1: Any form of one-to-one OHA versus no OHAFour studies compared any form of one-to-one OHA versus no OHA.Two studies reported the outcome of gingivitis. Although one small study had contradictory results at 3 months and 6 months, the other study showed very low-quality evidence of a benefit for OHA at all time points (very low-quality evidence).The same two studies reported the outcome of plaque. There was low-quality evidence that these interventions showed a benefit for OHA in plaque reduction at all time points.Two studies reported the outcome of dental caries at 6 months and 12 months respectively. There was very low-quality evidence of a benefit for OHA at 12 months.Comparison 2: Personalised one-to-one OHA versus routine one-to-one OHAFour studies compared personalised OHA versus routine OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis, plaque or dental caries (very low quality).Comparison 3: Self-management versus professional OHAFive trials compared some form of self-management with some form of professional OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis or plaque (very low quality). None of the studies measured dental caries.Comparison 4: Enhanced one-to-one OHA versus one-to-one OHASeven trials compared some form of enhanced OHA with some form of routine OHA.There was little evidence available that any of these interventions demonstrated a difference on the outcomes of gingivitis, plaque or dental caries (very low quality).
Authors' conclusions:
There was insufficient high-quality evidence to recommend any specific one-to-one OHA method as being effective in improving oral health or being more effective than any other method. Further high-quality randomised controlled trials are required to determine the most effective, efficient method of one-to-one OHA for oral health maintenance and improvement. The design of such trials should be cognisant of the limitations of the available evidence presented in this Cochrane Review.
Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30
A meta-analysis was performed on published data on the caries-inhibiting effect of fluoride gel treatment in 6- to 15-year-old children. The purposes of this meta-analysis were: (1) to calculate the overall caries-inhibiting effect of clinical fluoride gel treatment studies, based on explicit selection criteria, and (2) to explore factors potentially modifying the effect of fluoride gel treatment in caries prevention, concerning the baseline caries prevalence of the target population, the general fluoride regimen, and application features. The caries-inhibiting effect of fluoride gel application was assessed by the prevented fraction and the 'number needed to treat'. The overall prevented fraction of the fluoride gel treatment studies, indicating the reduction of caries incidence by fluoride gel treatment relative to the incidence in the control group, was 22% (95% CI = 18-25%). Multiple regression analysis showed no significant influence on the prevented fractions for the variables 'baseline caries prevalence', 'general fluoride regimen', 'application method', and 'application frequency'. The 'number needed to treat' (NNT), indicating the number of patients that need to be treated in order to prevent 1 DMFS, estimated the efficiency of fluoride gel treatment according to the caries incidence of the target population, including cost/effect relations. It was found that the NNT = 18 in a population with caries incidence 0.25 DMFS per year, and NNT = 3 in a population with caries incidence = 1.5 DMFS per year (treatment duration 1 year). From the standpoint of cost-effectiveness, the additional effect of fluoride gel treatment in current low and even moderate caries incidence child populations must be questioned.
Caries reduction has been observed in certain parts of the western world. The reduction coincides with the timing of the introduction of fluoride-containing toothpastes and no other factors can explain the caries reduction. It is possible that improved oral hygiene and use of fluoride have a synergistic effect.
376 three-year old children were divided into four experimental groups and exposed to different combinations of preventive programs for a period of two years. All the groups were given the same basic prophylactic information. Additionally Group I received fluoride tablets (FLUDENT) for daily sucking twice a day plus a placebo dentifrice free of fluoride. Group II was given a fluoride dentifrice containing 0.025% F, (ACTA). Group III was given a placebo dentifrice plus fluoride varnish (Duraphat) twice a year. Group IV a fluoride dentifrice containing 0.025% F (ACTA) plus fluoride varnish (Duraphat) twice a year. No statistically significant difference in caries increment during the two experimental years was found between the groups. A tendency to lower caries increment was found in Group IV, i.e. in the children using the low fluoride dentifrice and treated twice a year with fluoride varnish.
Exploring the possible reasons for heterogeneity between studies is an important aspect of conducting a meta-analysis. This paper compares a number of methods which can be used to investigate whether a particular covariate, with a value defined for each study in the meta-analysis, explains any heterogeneity. The main example is from a meta-analysis of randomized trials of serum cholesterol reduction, in which the log-odds ratio for coronary events is related to the average extent of cholesterol reduction achieved in each trial. Different forms of weighted normal errors regression and random effects logistic regression are compared. These analyses quantify the extent to which heterogeneity is explained, as well as the effect of cholesterol reduction on the risk of coronary events. In a second example, the relationship between treatment effect estimates and their precision is examined, in order to assess the evidence for publication bias. We conclude that methods which allow for an additive component of residual heterogeneity should be used. In weighted regression, a restricted maximum likelihood estimator is appropriate, although a number of other estimators are also available. Methods which use the original form of the data explicitly, for example the binomial model for observed proportions rather than assuming normality of the log-odds ratios, are now computationally feasible. Although such methods are preferable in principle, they often give similar results in practice. Copyright © 1999 John Wiley & Sons, Ltd.
Exploring the possible reasons for heterogeneity between studies is an important aspect of conducting a meta-analysis. This paper compares a number of methods which can be used to investigate whether a particular covariate, with a value defined for each study in the meta-analysis, explains any heterogeneity. The main example is from a meta-analysis of randomized trials of serum cholesterol reduction, in which the log-odds ratio for coronary events is related to the average extent of cholesterol reduction achieved in each trial. Different forms of weighted normal errors regression and random effects logistic regression are compared. These analyses quantify the extent to which heterogeneity is explained, as well as the effect of cholesterol reduction on the risk of coronary events. In a second example, the relationship between treatment effect estimates and their precision is examined, in order to assess the evidence for publication bias. We conclude that methods which allow for an additive component of residual heterogeneity should be used. In weighted regression, a restricted maximum likelihood estimator is appropriate, although a number of other estimators are also available. Methods which use the original form of the data explicitly, for example the binomial model for observed proportions rather than assuming normality of the log-odds ratios, are now computationally feasible. Although such methods are preferable in principle, they often give similar results in practice. Copyright © 1999 John Wiley & Sons, Ltd.
Exploring the possible reasons for heterogeneity between studies is an important aspect of conducting a meta-analysis. This paper compares a number of methods which can be used to investigate whether a particular covariate, with a value defined for each study in the meta-analysis, explains any heterogeneity. The main example is from a meta-analysis of randomized trials of serum cholesterol reduction, in which the log-odds ratio for coronary events is related to the average extent of cholesterol reduction achieved in each trial. Different forms of weighted normal errors regression and random effects logistic regression are compared. These analyses quantify the extent to which heterogeneity is explained, as well as the effect of cholesterol reduction on the risk of coronary events. In a second example, the relationship between treatment effect estimates and their precision is examined, in order to assess the evidence for publication bias. We conclude that methods which allow for an additive component of residual heterogeneity should be used. In weighted regression, a restricted maximum likelihood estimator is appropriate, although a number of other estimators are also available. Methods which use the original form of the data explicitly, for example the binomial model for observed proportions rather than assuming normality of the log-odds ratios, are now computationally feasible. Although such methods are preferable in principle, they often give similar results in practice. Copyright © 1999 John Wiley & Sons, Ltd.
Caries prevalence data from recent studies in all European countries showed a general trend towards a further decline for children and adolescents. However, in several countries with already low caries prevalence in primary teeth, there was no further decrease. Regarding the permanent dentition, further reductions were observed in the 12-year age group, these being even more evident at the ages of 15–19 years. In some Central and Eastern European countries, caries prevalence in children and adolescents was still high. Few data were available on young adults, but the benefits of prevention are becoming manifest. The available data on the use of toothbrushes, fluorides and other pertinent items provided few clues as to the causes of the decline in caries prevalence.
Abstract 251 9–12-yr-old children completed a 3-yr, double-blind, clinical trial of two caries preventive fluoride programs. Caries increments and progression patterns were compared in two groups of children who rinsed every fortnight with a 0.2% NaF solution or received biannual topical applications with a fluoride varnish (Fluor-Protector). Clinically recorded mean DPS increments were 3.3 ± 0.2 (SE) in the rinse group and 3.5 ± 0.2 in the varnish group. In both groups nearly half of these increments were recorded in the occlusal surfaces of second molars. The mean incremental DPS recorded radiographically on approximal surfaces of posterior teeth were 1.1 ± 0.2 and 1.5 ± 0.2 in the rinse and varnish group, respectively. None of the inter-group differences were statistically significant (p>0.05). Detailed analyses of the radiographic scores revealed a similar and extremely slow caries progression in the two study groups and they strengthened the conclusion of equal clinical efficacy of the two treatments. None of the fluoride programs had been able to change pre-established patterns of caries development among the children.
Within the last 20 years there has been a decrease in the caries prevalence of US schoolchildren, a change in the intraoral caries pattern, and a slowing of the progress of lesions. Simultaneously, the prevalence of enamel fluorosis has increased. The increase principally is in the milder, cosmetically acceptable forms and is more noticeable in fluoride-deficient communities than those with optimal or above-optimal water fluoride concentrations. Circumstantial evidence indicates that a principal contributor to the caries decline is the extensive use of fluoride dentifrices. Conversely, although use of a fluoride dentifrice can add to the total daily amount of ingested fluoride in preschool children, there is little evidence to suggest that dentifrice ingestion is a principal factor causing the fluorosis increase. The value of fluoride methods may be assessed in relative or absolute terms. The relative, or percentage, caries reduction attributed to fluoride mouthrinses and gels appears to be a property intrinsic to the methods themselves and generally is little affected by the caries activity of the population being treated. Conversely, the absolute, or numerical, caries reduction is dependent upon the level of disease in the population. Thus, the reported caries decline reduces the number of surfaces prevented from developing caries, even though the percentage reduction remains substantially unchanged. Although inadvertent ingestion of fluoride can result from the use of mouthrinses and gels, there is little evidence to suggest that they have contributed to the fluorosis increase. When using topical methods, prudence should prevail to avoid ingestion of fluoride. Fluoride dentifrices should continue to be used routinely, and although lower potency dentifrices may be considered, the literature does not provide strong support for their need. Use of fluoride mouthrinses and gels for individual patients should be predicated upon their caries activity or risk. Use of these methods in public health programs is a matter of cost-effectiveness, which will be influenced by the caries prevalence of the target population.
The study groups using a dentifrice and mouthrinse both containing fluorides, a dentifrice containing stannous fluoride and a mouthrinse containing sodium fluoride, or a mouthrinse containing sodium fluoride with a placebo dentifrice had a 20.7% to 29.0% lower DMF increment than the control group after 30 months. These differences were significant. The study groups using a dentifrice containing amine fluorides and a placebo mouthrinse, a mouthrinse containing amine fluorides and a placebo dentifrice, or a dentifrice containing stannous fluoride and a placebo mouthrinse had a 13.6% to 22.4% lower DMF increment than the control group. These differences were not statistically significant. There was no significant difference in effectiveness against caries between the use of the organic or inorganic fluoride products.
Recent studies have shown a high fluorine uptake in the enamel and a considerable caries reduction following the application of varnished containing fluoride. As the application is easy to carry out it may in certain situations serve as an alternative to other topical fluoride school programmes. The aim of the present study, therefore, was to compare the caries increment in schoolchildren exposed to a fluoride varnish (Duraphat) every six months and in children receiving the conventional weekly fluoride mouthrinsing programme with 0.2 per cent sodium fluoride over a two-year period. Two hundred 14-year-old children, divided into one test and one control group took part in the study. They were clinically and radiographically examined every year. Preexperimental data revealed no differences between the groups. During the experimental period the children in the fluoride varnish group developed a statistically significant lower number of new carious lesions compared with those in the mouthrinsing group. The difference in caries increment was about 30 per cent. Further clinical studies to compare the effects of various topical fluoride programmes are recommended.
A study to test the efficacy of two amine fluoride products in reducing the extent of plaque and the degree of gingivitis was conducted with 6th-grade school children in Pensacola, Florida. The treatment regimens consisted of a daily supervised mouthrinse at school and the ad libitum home use of a dentifrice. Examinations were conducted at 12-week and 20-week intervals after the treatment had begun. There was no recognizable difference between the plaque and gingival reductions achieved with the use of the amine fluoride dentifrice or mouthrinse when compared either with their inorganic counterparts or with placebo treatment vehicles
This report describes a clinical study carried out to compare the cariesinhibiting effect of the unsupervised home use of a sodium-monofluorophosphate-calcium-carbonate-based toothpaste formulation and an acidulated phospho-fluoride (APF) gel professionally applied semi-annually, used singly and together. The study was of 3 years’ duration, involving 1,718 boys and girls aged 11–12 years at the time of the initial examinations, living in two sectors, London and the Isle of Wight. There were five treatment groups: control group – non-fluoride paste and non-fluoride gel; paste A group -fluoride paste A and non-fluoride gel; paste B group – fluoride paste B and non-fluoride gel; gel group – non-fluoride paste and APF gel, and paste A/gel group – fluoride paste A and APF gel. Paste A and paste B differed in their flavour systems. The study was of double-blind design and included annual clinical and radiographic examinations. After 3 years, there were statistically significant reductions in caries increments when the test and control groups were compared. However, the unsupervised use of sodium monofluorophosphate dentifrice was as effective in reducing caries as twice annual, professionally applied, treatments of APF gel. Further, the reductions in caries obtained by the combined use of fluoride dentifrice and gel applications were not significantly greater than the use of fluoride dentifrice or gel applications alone. Detailed analysis of the data revealed disparities in the effect of treatment related to sex and sector.Copyright © 1978 S. Karger AG, Basel
Dental caries reduction was studied in 414 children 1 year following F-year primary caries prevention with the use of sodium fluoride solution, fluorine lacquer, and Ca phosphate-containing gels. Essential reduction of the intensity of carious involvement of the teeth was seen in the examinees as against children not administered specific prophylactic treatment.
The aim of this study was to assess the caries incidence and plaque accumulation in schoolchildren at caries risk, after brushing the teeth fortnightly with gels containing 0, 0.4% F, 1.25% F as amine fluoride (AmF) or the common amine fluoride toothpaste containing 0.125% F. The study was conducted double blind over an 18-month period, and after 6 months discontinuation of brushing. Only the group that brushed with the 1.25% AmF gel showed a significant decrease in caries development compared to the group that brushed with the 0.125% AmF toothpaste. During the 6-month discontinuation period, the incidence of caries increased in all groups; the differences in caries development between all groups were not significant. Plaque indices were significantly lower in the AmF-treated groups. The highest fluoride concentration in the gel reduced the development of caries to zero, probably due to increased fluoride levels in the oral milieu of caries risk children. In order to maintain a positive effect of fluoride over an extended time period, caries-prone subjects should continue an initiated fluoride programme.
There is ample evidence documenting that simultaneous use of several fluoride application techniques results in an enhanced cariostatic effect. A formula is presented which estimates the combined cariostatic efficacy of such multiple usage. For simultaneously applied topical fluorides, the formula seems to overestimate the combined efficacy. Both higher frequency of use and higher concentration result in increased topical fluoride efficacy. Within narrower limits, higher concentrations of fluoride in water or salt also enhance efficacy. The rapid and substantial decline of caries prevalence in some highly industrialized countries may, in part, be attributed to multiple fluoride usage, but other factors must also have exerted a beneficial effect.
A total of 857 7-year-old children were examined, divided into 9 groups. A certain prophylactic agent was used in every group. Caries augmentation intensity and reduction indexes, determined in a year after prophylactic treatment, evidence that 2% sodium fluoride solution was the most effective caries inhibiting agent. 1% fluoride gel and fluoride varnish were also found effective means of caries prevention.
Stomatologic examinations of 1370 children aged 7, 12, and 15, determination of hygienic indexes in them, and anonymous questionnaires distributed among 154 parents and 64 pupils, as well as study of the efficacies of fluorine lacquer and gel have lead the authors to a conclusion that the level of dental caries intensity is low in children, but shows a tendency to growth. This necessitates introduction of a program of measures for the prevention of dental diseases and local administration of fluoride drugs, fluoride gel being the most effective of them.
The caries-preventive effect of Duraphat® lacquer versus fluoride mouthrinses was evaluated in a 5-year clinical trial. The lacquer group received Duraphat application every 6th month and a placebo rinse every 2nd week during the school year. The fluoride rinse group received a 0.2% sodium fluoride rinse every 2nd week during the school year and a placebo lacquer every 6th month. All children received regular dental examination and treatment in clinics established by the municipality in which the study took place. Fluoride content of the drinking water varied between 0.1 and 0.2 ppm F––. Caries was recorded clinically and radiographically and increments calculated after 3 and 5 years. On teeth erupted at baseline the clinical caries increment after 5 years was 2.96 DMF-S in the lacquer group and 2.77 DMF-S in the fluoride rinse group, evaluated for the 248 3rd grades completing the study. Caries increment in teeth erupting during the trial was 2.20 DMF-S in the lacquer group and 2.30 DMF-S in the fluoride rinse group. The corresponding figures for radiographic caries increment were 1,01 and 0.82 DMF-S for teeth erupted at baseline, and 0.59 and 0.45 DMF-S for teeth erupting during the trial. None of the differences were statistically significant. Mean time needed to apply the lacquer was approximately 4 min, when working with a chairside assistant and 6 min, when working without a chairside assistant.Copyright © 1986 S. Karger AG, Basel
The aim of this study was to compare the effect of fortnightly rinsing with a 0.2% fluoride solution and two fluoride varnishes. A total of 204 ten- to 13-year-old children, in 24 school classes, participated in the study. The school classes were randomly divided into three groups. The first group rinsed with the fluoride solution every second week during the school year, and the second and third groups received semiannual applications of Duraphat® or Fluor Protector®, respectively. Clinical and radiographical examinations were performed at the baseline and after 2 years. The mean caries increments were adjusted for initial DMFS values and age. The increment in the Duraphat group was significantly lower than that in the rinsing group (p < 0.01) and in the Fluor Protector group (p < 0.05). The difference between the rinsing and Fluor Protector group was not statistically significant. The results suggest that the replacement of teacher-supervised fluoride rinses by semiannual application of Duraphat is worth considering.Copyright © 1987 S. Karger AG, Basel
The purpose of this study was to evaluate the separate effect of fluoride dentifrice, fluoride mouthrinsing and fluoride varnish on approximal dental caries. All 252 13-14-yr-old children at an elementary school were selected at random and divided among four groups for a 3-yr longitudinal study. Group 1 received a fluoride dentifrice for home care and a fluoride mouthrinse once a week. Group 2 received a fluoride dentifrice for home care and a placebo mouthrinse once a week. Group 3 received a fluoride dentifrice for home care and a fluoride varnish once every 3 months. Group 4 received a placebo dentifrice for home care and a fluoride rinse once a week. Fluoride rinsing did not give any additional effect compared with placebo-rinsing when a fluoride dentifrice was used for home care. Fluoride varnish gave a significant caries reduction compared with fluoride rinsing.
751 14- and 15-year old children completed a 3-year, double-blind, caries preventive program. The effects of daily, supervised toothbrushing with an 0.76% sodium monofluorophosphate dentifrice, rinsing with a 0.05% sodium fluoride mouthrinse, and the combined effects of the two treatments were investigated. Both the dentifrice and mouthrinse reduced the incidence of dental caries, but their combined use at the same time had no greater effect than either used alone.
The clinical effects of different preventive regimens provided for young people in their early and middle teens were studied during a 2-year period. The regimens studied during the 1st year of the trial were professional tooth-cleaning plus fluoride mouth-rinsing every 3rd week versus fluoride varnish treatment every 6 months. During the 2nd year, the preventive measures were given in accordance with the estimated needs of each individual. The results were related to the individuals' previous experience with dental prevention to determine whether this had a significant influence. The results showed that fairly good or excellent effects on the individuals' oral hygiene and gingival status were readily achieved and maintained with a professional tooth-cleaning plus fluoride mouth-rinsing regimen. The study failed to demonstrate any superior caries-preventive effect of the fluoride varnish treatments. Subsequent individualized prevention produced similar average end results in all groups. Differences in the results in accordance with the individuals' previous experience with dental prevention indicate a superior and prolonged influence on dental health of professional tooth-cleaning plus fluoride mouth-rinsing in comparison with a fluoride-based program alone.
A clinical trial was conducted in a non-fluoridated water, high-caries community in which school children (average age = 13.04yr) were randomly assigned to one of four groups subjected to two different fluoride procedures. Clinical and radiographic examinations were conducted at baseline, 12, 24 and 36 months. After 12 months, there was a small but significant rinse effect and a small gel effect which fell short of significance. The effects were additive, and subjects who received both forms of fluoride treatment experienced a 19 per cent reduction in decayed + filled (DF) surface increment. The pattern of incremental findings at the end of 24 months was similar to that at 12 months. Both gel and rinse effects were significant and of similar size; subjects receiving both treatments experienced a 31 per cent reduction in DF surface increment. The incremental findings after 24–36 months 2 yr and 1 yr were similar. The effects were reduced relative to those seen at 24 months; the gel effect was still statistically significant, but the rinse effect was not. Possible mechanisms underlying the treatment effects include deposition of CaF2 and fluorapatite, and suppression of microbial flora.
The 1993 national survey report shows encouraging evidence of general improvements in children's dental health compared with earlier surveys in 1973 and 1983. There have been dramatic declines in dental caries at all ages and this is evident in the different parts of the United Kingdom and in all social classes. However, among 5-year-old children average caries levels have remained unchanged since 1983, although a higher proportion now have no known decay experience. The amount of decay treated by restoration as a proportion of total caries experience has fallen in all age groups and the disease appears to be becoming concentrated at higher levels in a diminishing number of children who are not obtaining dental care. A disturbing finding was the high prevalence of dental erosion, particularly in the primary dentition. Other findings included more than half of children in Scotland and Northern Ireland having fissure sealants, improved parental knowledge about preventing dental disease, reduced numbers of orthodontic extractions and a reduction of one-third in the rate of traumatised permanent incisors. Children must be regarded as the number one priority for dental services in order to safeguard the dental health of rising generations, and renewed efforts must be made to further reduce their disease levels through population based preventive measures.
The first Swiss studies of DMFT counts were undertaken in the late 1950s and showed values of 7.7-11.3 for children of 12 years of age and 12.6-18.6 for children of 15 years of age. Although these studies did not use current statistical sampling methods, and so are not directly comparable, the results of the most recent surveys do present a startling contrast. In 1992, DMFT figures had fallen to an average of 1.12 and 2.22 DMFT in 12- and 15-year-olds respectively. Reasons for these sharp declines are discussed, as are the available figures for adults over the same period of time. Predictions are made for DMFT levels for the year 2008 and their likely impact on dental services.
In a nonfluoridated community of Finland, where fortnightly fluoride rinsing with 0.2% sodium fluoride has been used for nearly two decades, a total of 313 children 7-8 yr old were recruited and randomly divided into two groups. 206 children completed the 3-yr trial. The control group (n = 94) participated in the rinsing program which included supervised toothbrushings, while the test group (n = 112) received a new fluoride toothpaste tube (0.15% F) for home use every second month. Annual dental recordings, treatment plannings and the treatment itself were all carried out by one clinician. At the end of the study the number of caries-free children of the toothpaste group was lower (P < 0.01) and the caries increment higher (P < 0.05) than that of the mouthrinse group. Out of the mean of four dental visits per child and year some 1.5 were prophylactic by nature. No differences were found between the number of treatment visits, time or prophylactic care of the two groups. Unsupervised use of fluoride toothpaste may not be a sufficient substitute for the school-based fortnightly fluoride rinses and supervised toothbrushings in caries prevention of children with erupting permanent teeth.
The aim of this trial was to compare the caries-preventive effect of sodium fluoride varnish and acidulated phosphate fluoride (APF) gel. A total of 254 children aged 12-13 years with high past caries experience were randomly divided into two groups. The participants received semi-annual applications of either fluoride varnish or APF gel for 3 years. During the study, the mean (+/- SD) total DMFS increments of the varnish and gel groups were 6.8 +/- 5.6 and 7.7 +/- 6.4, respectively, when initial caries was included, and 3.1 +/- 3.7 and 3.6 +/- 4.6 when initial caries was excluded. The difference was most evident on the approximal surfaces (varnish: 1.4 +/- 2.4; gel: 1.9 +/- 3.1). However, this difference was not statistically significant. Although larger studies are needed for firm conclusions about the comparative effect of the two fluoride measures, the results suggest that fluoride varnish is as effective as fluoride gel at least in preventing approximal caries. Taking into account the shorter treatment time, using fluoride varnish for professional applications seems justified.
The contribution of health services to improvements in health is contentious. The main aim of the present study was to assess the relative contribution that dental services may have made to the changes in dental caries (decayed, missing or filled permanent teeth) level of 12-year-old children in some industrialized countries in the 1970s and early 1980s. A secondary aim was an analysis of the association of the changes in caries levels with broad socioeconomic factors. In this study aggregate (ecological) data from 18 industrialized countries were analyzed at a national level. Data were obtained from published papers and official publications and included 3 kinds of variables: caries, presence of dental service and broad socioeconomic factors (including fluoridated toothpastes). Dental services explained 3% of the variation in changes in 12-year-old caries levels in the 1970s and early 1980s period whereas broad socioeconomic factors (including or excluding fluoridated toothpastes) explained 65%. The findings suggest that dental services were relatively unimportant in explaining the differences in changes in 12 year-old caries levels in the 1970s and early 1980s in the 18 countries. The view that fluoride in toothpaste was the only important cause of the declines in decayed, missing or filled permanent teeth in industrialized countries was questioned. A possible important contribution of the dental services to the declines was a change in the diagnostic and treatment criteria of caries.
The aim of this paper was to describe what experts of today believe are the main reasons explaining the caries decline seen in many westernized countries over the past 3 decades. We have collected the views of a number of international experts, trying to answer the specific question "What are the main reasons why 20-25-year-old persons have less caries nowadays, compared to 30 years ago?". A questionnaire was mailed to 55 experts with a number of thinkable explanations to be scored according to a predetermined scale. The 25 items were divided into main groups under the heading of diet, fluorides, plaque, saliva, dentist/dental materials and other factors. The experts were asked to think of a specific country or area, and also to specify whether the chosen area had water fluoridation or not. The main finding of our study, based on a 95% response rate, was that there is a very large variation in how the experts graded the impact of various possible factors. For the use of fluoride toothpaste, there was a clear agreement of a definite positive effect.
A dental health survey was included as part of a large scale study of nutrition in preschool children. The survey was carried out in 1992/93 and was published in spring 1995. Information on dental health status and on dietary intake was gathered from a total of 1658 children from 100 geographical sectors in the United Kingdom. This article summarises the main findings and highlights some of the most important findings regarding dental health and its relationship to dietary factors. Seventeen per cent of children had some caries experience and in 83% of cases this was untreated. Dental decay was most strongly related to social background. The factors most strongly related to caries prevalence were: receipt of income benefits, in the 1.5-2.5-year-old children; the educational status of the mother in the 2.5-3.5-year-old children and social class of the head of household in the 3.5-4.5-year-old children. Consumption of sugary drinks at bedtime, children being left to brush their teeth themselves, household expenditure on confectionery and geographical region were also strongly associated with caries prevalence.