European Academy of Paediatric Dentistry. Guidelines on the use of fluoride in children: an EAPD policy document

Video game playing and oral health in school-age children: A cross-sectional study in Turkey

AIM

The aim of this study is to evaluate the relationship of video game playing with oral/dental health and harmful oral habits in school-age children.

METHODS

The daily video gamer (n = 77) and occasional video gamer (n = 77) children between 6 and 12 years old were included in the study. A questionnaire inquiring socio-demographic characteristics, video gaming and abnormal oral habits of the children was filled by parents. The children were examined intraorally and decayed-missing-filled tooth, the International Caries Detection and the Assessment-II System scores, dental plaque and gingival indices were recorded.

RESULTS

Of the children; 42.9% daily video gamers played video games for between 1 and 2 h and 57.1% played for ≥2 h while all of the occasional video gamers spent for between 1 and 2 h on video game per day. The daily video gamer and occasional video gamer children were not different in terms of socio-demographic characteristics, frequency of having daily tooth brushing habit, using children's toothpaste and having regular dental checkup (P > 0.05). No statistically significant difference was present between the groups in terms of frequencies of abnormal oral habits and having at least one abnormal oral habit (P > 0.05). Severe gingivitis and advanced caries lesions were more common in daily video gamer group (14.2% vs. 3.9%, P = 0.025 and 90.9% vs. 70.9%, P = 0.026, respectively). Daily video gaming time was weakly correlated with plaque index (r = 0.26, n = 77, P = 0.024). Daily video gaming for ≥2 h increased the risk for severe gingivitis (odds (95% confidence interval) = 4.53 (1.07-19.23), P = 0.041) while daily video gaming for between 1 and 2 h decreased the risk for having abnormal oral habit (odds (95% confidence interval) = 0.39 (0.16-0.93), P = 0.034).

CONCLUSION

In school age, daily video gaming may worsen oral and dental health compared with occasional video gaming. Particularly, an excessive video gaming time seems to be associated with poor oral health in school children.

The Safety of Fluoride Compounds and Their Effect on the Human Body-A Narrative Review

Fluoride is one of the elements commonly present in the human environment. Due to its characteristics, it is very widely used in medicine, dentistry, industry or agriculture. On the other hand, its universality possesses a real threat to the human body in the form of acute and chronic poisoning. The aim of this paper is to characterize the properties of fluoride and its effects on the human body, as well as the sources of its occurrence. Particular emphasis is placed on the safety of its use and optimal dosage intake, which prevents accumulation and reduces its potential side effects. The positive effect of proper fluoride supply is widely described. In order to avoid overdose, it is best to consult a specialist to properly select the dosage.

Revisiting Fluoride in the Twenty-First Century: Safety and Efficacy Considerations

Over 100 years of scientific literature is available which describes the long relationship between dentistry and the many possible applications of fluoride anion (F−) as successful therapeutic strategies. To date, systemic introduction of fluoride via water, milk and salt fluoridation, and fluoride-containing tablets, has been employed. Post-eruption topical fluoride products have also been introduced, such as fluoridated toothpaste, along with fluoride-containing rinses and varnishes. Importantly, a recent addition to the available armamentarium of fluoride therapeutics now exists in the form of metal ion-fluorido adducts, most especially silver(I)-diammine fluoride (SDF). In view of its high level of therapeutic success, very recently this agent was added to the World Health Authority's (WHO's) list of essential medicines available for the treatment and prevention of tooth decay. Overall, this current state of affairs merits a major review of all these fluoride-containing therapeutic compounds, together with their risks and benefits, both individually and collectively. In this study, a simple graphical tool has been developed for the rapid “on-site” evaluation of fluoride intake with respect to a range of oral healthcare products and body mass index is presented as a gauge of safety for the risk of fluoride toxicity in individual patients. This exposition commences with (a) an account of the history and value of fluoride therapeutics in clinical dentistry, including applications of monofluorophosphate and stannous fluoride; (b) an evaluation of the toxicological activities of fluoride, together with a summary of any reports, albeit very rare ones, arising from its clinically-driven overuse; (c) a history of the development, molecular structure, mechanisms of action, and therapeutic applications of SDF, including a summary of any possible toxic activities and effects arising from silver(I) ion rather than fluoride itself; and (d) the establishment of a working relationship between fluoride exposure and toxicity, with special reference to the instigation of newly-developed tabular/graphical reference guidelines for use by dental clinicians who employ fluoride-rich products in their practices. Particular attention is given to the oral care and treatment options of pediatric patients. In conclusion, applications of this unique monitoring tool may serve as a valuable toxicity guide for dental practitioners.

Association between Demographic Factors Parental Oral Health Knowledge and their Influences on the Dietary and Oral Hygiene Practices followed by Parents in Children of 2-6 Years in Buraidah City Saudi Arabia: A Pilot Study

Background

Preschool children's oral hygiene maintenance is greatly prejudiced by their parent's knowledge and understanding regarding oral health. When parents are devoid of the basic awareness of caries-associated factors, the significance of primary teeth, and oral healthcare, it is challenging to program disease prevention strategies and apply them effectively.

Aims and objectives

This pilot study aimed to assess the knowledge regarding oral health, its effects, and the influence of demographic values on the parental practices among the parents of 2-6-year-old children by using a self-administered pretested questionnaire.

Materials and methods

The questionnaire was randomly distributed among parents of 2-6-year-old children who visited Buraidah Central Hospital. The sample size taken for this pilot study was 1,000. The questionnaire included 26 questions associated with the parent's knowledge about the oral health of the child, hygiene maintenance, and dietary habits. The collected data was analyzed using SPSS software.

Results

In the present research, a total of 1,000 parents participated in the study. It was observed that parental knowledge and hygiene practices increased as the educational status increased. It was also observed that as the number of children decreased in the family, the dietary practices and hygiene practices improved. All these observations were found to be statistically significant (p < 0.05).

Conclusion

Parent's education and knowledge reflect in their child's development of healthy practices. Thus the parents need to know about oral health, which can be put into practice in their children.

Clinical significance

This research helps us to understand the significance of parental knowledge and education in the oral health practices and maintenance among the children inculcated by parents, which can help in bringing down the oral health diseases in children in future.

How to cite this article

Al Mejmaj DI, Nimbeni SB, Alrashidi RM. Association between Demographic Factors Parental Oral Health Knowledge and their Influences on the Dietary and Oral Hygiene Practices followed by Parents in Children of 2-6 Years in Buraidah City Saudi Arabia: A Pilot Study. Int J Clin Pediatr Dent 2022;15(4):407-411.

[Oral health trends in children : Results from the epidemiological surveys accompanying group prophylaxis in Germany]

Für die Beschreibung der aktuellen epidemiologischen Trends der Karieserfahrung bei Kindern in Deutschland wurden die Mundgesundheitsdaten primär anhand der Epidemiologischen Begleituntersuchungen zur Gruppenprophylaxe (DAJ-Studie) für das Schuljahr 2015/2016 dargestellt. Hier standen Kariesdaten von 301.684 Kindern verteilt auf 3 verschiedene Altersgruppen zur Verfügung. Für die Trends in der Kariesentwicklung wurden zudem weitere in Deutschland durchgeführte nationale und regionale Studien herangezogen.

Karies an Milchzähnen tritt schon sehr früh auf (bereits 10–17 % der 3‑Jährigen sind betroffen) und ist auch unter 6‑ bis 7‑Jährigen noch weitverbreitet (ca. 40–60 %). Sehr hoch ist dabei der Anteil nicht sanierter kariöser Milchzähne (3-Jährige: 73,9 %, 6‑ bis 7‑Jährige: 42,5 %). Bei den 6‑ bis 7‑Jährigen sind in den letzten 10 Jahren außerdem kaum noch Verbesserungen zu verzeichnen. Die Karieswerte der erstmals im Rahmen der DAJ-Studie national untersuchten 3‑Jährigen liegen in dem Bereich der Werte aus bisherigen lokalen Studien der letzten Jahrzehnte, bei den 6‑ bis 7‑Jährigen konvergieren die Werte regional. Bei den 12-Jährigen ist die mittlere Karieserfahrung im bleibenden Gebiss in den letzten knapp 20 Jahren um etwa 80 % gesunken. Damit liegt Deutschland hinsichtlich der Mundgesundheit dieser Altersgruppe weltweit im Spitzenbereich.

Bezüglich der Mundgesundheit im Milchgebiss besteht in Deutschland dennoch ein deutliches Optimierungspotenzial. Kürzlich implementierte präventive Maßnahmen adressieren dieses Problem bereits, sodass weitere Verbesserungen ähnlich den Erfolgen im bleibenden Gebiss realistisch erscheinen und zu erwarten sind.

Influence of a programme for prevention of early childhood caries on early orthodontic treatment needs

OBJECTIVES

The aim of this prospective birth cohort study was to evaluate the effect of the programme for prevention (PP) of early childhood caries and the resulting need for orthodontic treatment in 8-year-old German children.

MATERIAL AND METHODS

Children who had been enrolled in a caries-risk-related recall system with continuous dental care starting at the time of birth (prevention group, PG) were compared with children of the same birth cohort whose parents decided not to participate in the programme (control group, CG). All children (n = 289) participating in the last PP evaluation at the age of 5 years were invited again and examined by blinded clinicians. Dental caries was scored using the WHO diagnostic criteria expanded to d1-level without radiography. Impressions were taken of children with premature tooth loss to analyse space conditions.

RESULTS

Two hundred twenty-seven children (mean age 8.4 ± 0.6 years; 46.7% female) were examined. Children in the PG (n = 127) showed significantly lower caries prevalence and experience (3.1%, 0.4 ± 1.0 d3-4mft) than children in the CG (37.3%, 3.9 ± 3.5 d3-4mft). Orthodontic analysis found a higher prevalence of premature tooth extraction, followed by a greater extent of space loss in the CG (41.0%; 3.3 ± 4.4 mm) vs. PG (7.9%; 0.4 ± 1.9 mm) and an increase in early orthodontic treatment need (KIG P3, IOTN 5).

CONCLUSIONS

The PP was an effective approach for preventing caries-related premature tooth loss in children and conserving relevant arch length.

CLINICAL RELEVANCE

Children who received continuous dental care starting at the time of birth showed better oral health with less premature loss of deciduous teeth and lower need for orthodontic treatment at the age of 8 years.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438.

Program for Dental Health Advancement in Children "Dental Passport"

Objective

The need for improving oral health in the Republic of Croatia was based on health indicators and poor oral health status and resulted in the implementation of measures to improve the use of dental health care for schoolchildren through the national program called “Dental Passport”, which began in the 2017/2018 school year.

Purpose

The aim of this study was to present the content and results of its implementation and to analyse them with emphasis on the sustainability and inclusion of the program and its implementation in preventive activities and procedures.

Material and Methods

The data were collected from the completed “Dental Passport” forms from September 2017 to August 2018. The dental examinations and diagnostic-therapeutic procedures were recorded in The Central Health Information System of Croatia.

Results

In the school year 2017/2018, 24,729 6^th grade elementary school students visited a dentist. The response rate in the Republic of Croatia was 68%. According to the CEZIH data, in the period from September 1 to December 31 2017, an increase in the number of first examinations and diagnostic-therapeutic procedures was observed in children aged 12 years, compared to the same period in 2015. The least reported preventive procedures in preschool children and 6^th grade students were fissure sealing and sealing restorations, while motivating and instructing children on oral hygiene were the most common reported procedures.

Conclusion

Good organization of work in school medicine provides the basis for the implementation of dental programs involving schoolchildren. However, greater motivation of the dental health care provider in the implementation of preventive procedures and motivation of parents and patients for a more active involvement in the “Dental Passport” program are important determinants in further implementation and improvement of oral health in children.

Amount of Dentifrice and Fluoride Concentration Influence Salivary Fluoride Concentrations and Fluoride Intake by Toddlers

The present study evaluated fluoride (F) concentrations in saliva of toddlers after brushing with dentifrices containing different F concentrations, applied in different quantities, and estimated F intake from toothbrushing. The study comprised a double-blind, crossover protocol, in which toddlers (n = 18, 2-3 years old) were randomly assigned into six groups, according to possible combinations of dentifrices (0/550/1,100 ppm F, as NaF) and amounts (rice grain, pea size, and transverse technique). Volunteers used a F-free dentifrice during 1 week. On the 7th day, saliva samples were collected before (baseline), and at 5/15/30/60 min after toothbrushing. All dentifrice expectorated after brushing was collected. F concentrations (saliva and expectorate) were determined with an ion-specific electrode. Data were submitted to ANOVA or Kruskal-Wallis test, followed by Fisher's LSD or Student-Newman-Keuls' tests (p <0.05). Brushing with 550 ppm F dentifrice (pea size or transversal technique) increased the area under the curve (AUC) at similar levels compared to 1,100 ppm F (rice grain). The highest AUC and salivary F at 5 min after brushing were achieved by 1,100 ppm F (pea size), followed by 550 ppm F (transversal technique). Regarding F intake, the highest values were observed for 550 ppm F (transversal technique), followed by 1,100 ppm F (pea size). It is possible to conclude that the amount of dentifrice and F concentration in the product significantly affected both salivary F concentrations and F intake during toothbrushing.

Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document

AIM

To update the exisitng European Academy of Paediatric Dentistry (EAPD) 2009 fluoride guidelines.

METHODS

Experts met in Athens, Greece duirng November 2018 for the following groups: I Fluoride toothpastes, II Fluoride gels, rinses and varnishes, III Fluoridated milk, fluoridated salt, tablets/lozenges and drops, IV Water fluoridation. Systematic reviews and meta-analyses were reviewed and discussed for each of the groups. The GRADE system was used to assess the quality of evidence which was judged as HIGH, MODERATE, LOW or VERY LOW based on the assessment of eight criteria which can influence the confidence of the results. Following the quality assessment, GRADE was then used to indicate the strength of recommendation for each fluoride agent as STRONG or WEAK/CONDITIONAL.

RESULTS

Parents must be strongly advised to apply an age-related amount of toothpaste and assist/supervise tooth brushing until at least 7 years of age. The EAPD strongly endorses the daily use of fluoride as a major part of any comprehensive programme for the prevention and control of dental caries in children. Regardless of the type of programme, community or individually based, the use of fluoride must be balanced between the estimation of caries-risk and the possible risks of adverse effects of the fluorides. Fluoride use is considered safe when the manufacturer's instructions are followed. Preventive programmes should be re-evaluated at regular intervals and adapted to a patient's or population's needs and risks.

CONCLUSIONS

For the majority of European Countries, the EAPD recommends the appropriate use of fluoride toothpaste in conjunction with good oral hygiene to be the basic fluoride regimen.

Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis

The aim of this study was to assess the effectiveness of fluoride varnish (FV) in reducing dentine caries at the patient, tooth, and surface levels as well as caries-related hospitalizations in preschoolers. We performed a systematic review of clinical trials of FV, alone or associated with an oral health program, compared with placebo, usual care, or no intervention. Bibliographical search included electronic searches of seven databases, registers of ongoing trials, and meeting abstracts, as well as hand searching. We performed random-effects meta-analyses and calculated confidence and prediction intervals. The search yielded 2,441 records; 20 trials were included in the review and 17 in at least one meta-analysis. Only one study had low risk of bias in all domains. We found no study reporting on caries-related hospitalizations. At the individual level, the pooled relative risk was 0.88 (95% confidence interval [CI] 0.81, 0.95); this means that in a population of preschool children with 50% caries incidence, we need to apply fluoride varnish in 17 children to avoid new caries in one child. At the tooth level, the pooled weighted mean difference was –0.30 (95% CI –0.69, 0.09) and at the surface level –0.77 (95% CI –1.23, –0.31). Considering the prediction intervals, none of the pooled estimates were statistically significant. We conclude that FV showed a modest and uncertain anticaries effect in preschoolers. Cost-effectiveness analyses are needed to assess whether FV should be adopted or abandoned by dental services.

Caries Trends in the Primary Dentition of 6- to 7-Year-old Schoolchildren in Germany from 1994 to 2016: Results from the German National Oral Health Surveys in Children

Long-term nationally representative caries data in the primary dentition are rare, but nonetheless central to assess needs in caries prevention and treatment. This study evaluated the prevalence and trends of caries levels in the primary dentition of 6- to 7-year-olds in Germany as a whole and its federal states individually. In 2016, employing a randomized cluster selection, 6- to 7-year-old first graders were included in the National German Oral Health Survey performed regularly since 1994/95. Children were examined by 482 calibrated dentists in all 17 German regions using the WHO criteria for the decayed, missing, and filled teeth (dmft) including the assessment of initial carious lesions (it). In total, 151,555 6- to 7-year-olds were examined. Caries prevalence in the primary dentition dropped from 65% in 1994 to 44% in 2016, while the mean caries experience dropped from 2.89 to 1.73 dmft (dt = 0.74, mt = 0.19, ft = 0.80). When initial lesions were included, the mean caries experience increased to idmft = 2.12 (it = 0.38). In 2016, 49.7% of the examined 6- to 7-year-olds were caries-free including initial lesions. The Care Index at the tooth level was 57.5%, and the Significant Caries Index was 4.84 dmft. Depending on the German region, the mean dmft varied considerably, ranging from 1.37 to 2.31. In conclusion, despite the overall caries decline in 6- to 7-year-olds in Germany, only minor caries reductions were observed over the last decade, with a still existing high proportion of untreated dental decay. This calls for more effective preventive and restorative efforts with focus on the primary dentition in Germany.

Economic evaluation of an expanded caries-preventive program targeting toddlers in high-risk areas in Sweden

OBJECTIVE

To economically evaluate a caries-preventive program "Stop Caries Stockholm" (SCS) where a standard program is supplemented with biannual applications of fluoride varnish in toddlers and compared it with the standard preventive program.

MATERIAL AND METHODS

Data from the cluster randomized controlled field trial SCS including 3403 children, conducted in multicultural areas with low socioeconomic status was used. The difference in mean caries increment between the examinations; when the toddlers were 1 and 3 years old, was outcome measure of the intervention. The program was evaluated from a societal as well as a dental health care perspective. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental cost for each defs prevented.

RESULTS

Average dental health care costs per child at age 3 years were EUR 95.77 for the supplemental intervention and EUR 70.52 for the standard intervention. The ICER was EUR 280.56 from a dental health care perspective and EUR 468.67 and considered high.

CONCLUSIONS

The supplemental caries intervention program was not found to be cost-effective. The program raised costs without significantly reducing caries development. A better alternative use of the resources is recommended.

TRIAL REGISTRATION

www.controlled-trials.com (ISRCTN35086887).

Fluoride Exposure Induces Inhibition of Sodium-and Potassium-Activated Adenosine Triphosphatase (Na+, K+-ATPase) Enzyme Activity: Molecular Mechanisms and Implications for Public Health

In this study, several lines of evidence are provided to show that Na + , K + -ATPase activity exerts vital roles in normal brain development and function and that loss of enzyme activity is implicated in neurodevelopmental, neuropsychiatric and neurodegenerative disorders, as well as increased risk of cancer, metabolic, pulmonary and cardiovascular disease. Evidence is presented to show that fluoride (F) inhibits Na + , K + -ATPase activity by altering biological pathways through modifying the expression of genes and the activity of glycolytic enzymes, metalloenzymes, hormones, proteins, neuropeptides and cytokines, as well as biological interface interactions that rely on the bioavailability of chemical elements magnesium and manganese to modulate ATP and Na + , K + -ATPase enzyme activity. Taken together, the findings of this study provide unprecedented insights into the molecular mechanisms and biological pathways by which F inhibits Na + , K + -ATPase activity and contributes to the etiology and pathophysiology of diseases associated with impairment of this essential enzyme. Moreover, the findings of this study further suggest that there are windows of susceptibility over the life course where chronic F exposure in pregnancy and early infancy may impair Na + , K + -ATPase activity with both short- and long-term implications for disease and inequalities in health. These findings would warrant considerable attention and potential intervention, not to mention additional research on the potential effects of F intake in contributing to chronic disease.

Knowledge, attitudes and behaviour towards preventive oral care in early childhood among paediatricians in Trinidad and Tobago: findings of a national survey

OBJECTIVE

To determine paediatrician's knowledge and attitudes about oral health in Trinidad and Tobago.

DESIGN AND METHOD

A pre-tested questionnaire was sent out via survey monkey to 70 out of 75 paediatricians registered with the Medical Board of Trinidad and for whom email addresses were available. Hard copies of the questionnaires were delivered to the paediatric departments of the Eric Williams Medical Sciences complex. Paediatricians that were unable to complete the questionnaire online were asked to complete hard copies.

RESULTS

Forty-nine paediatricians responded, yielding a response rate of 70%. Most (95.9%) of the participants had positive views about routine dental visits, but yet only 28.6% advised a first dental visit between the ages 6 months and 1 year. Although the majority (91.8%) had positive views on fluoride supplementation, knowledge of appropriate fluoride dosages was not in keeping with current guidelines. Mixed views on the role of breastfeeding as a risk factor for developing decay were seen among respondents; 63.3% of the paediatricians indicated that they did not receive any education on the oral health of young children during their specialty training, and most felt they required additional training in this area.

CONCLUSIONS

Paediatricians in Trinidad and Tobago demonstrated positive attitudes toward oral health. However, their knowledge with respect to oral disease prevention including the use of fluoride, and timing of the first dental visit appear to be lacking. Paediatricians may benefit from continuing education with regards to the oral health of children.

Sociodemographic factors associated with oral health in 12-year-old adolescents: hygiene behaviours and health appointments. A cross-sectional national study in Portugal

OBJECTIVES

The aim of this study was to characterise the daily oral hygiene behaviours and the frequency of, and reasons for, oral health appointments, among 12-year-old adolescents in Portugal. We also investigated whether there were any associations between these behaviours and sociodemographic factors.

METHODS

We conducted an observational descriptive study based on 1,309 Portuguese adolescents from rural, peri-urban and urban populations. Data were drawn from the III National Prevalence Study of Oral Health Diseases. After descriptive analyses, binary logistic regression models were used.

RESULTS

In this study, 70.6% (n = 924) of adolescents reported that they brushed 'twice a day or more', and this behaviour was associated with all sociodemographic variables. Multivariate analysis revealed that male gender [odds ratio (OR) = 2.124; 95% confidence interval (95% CI): 1.616-2.793], rural residence (OR = 1.647; 95% CI: 1.169-2.321), peri-urban residence (OR = 1.926; 95% CI: 1.319-2.812), low level of maternal educational (OR = 2.139; 95% CI: 1.446-3.164) and father's unemployment (OR = 1.671; 95% CI: 1.127-2.478) were associated with not brushing at least twice a day (P < 0.05). Approximately 94% (n = 1,217) of participants had already visited an oral health professional, and 74.5% (n = 860) did so in the last 12 months.

CONCLUSION

Our results are in agreement with the literature; the oral health behaviours of 12-year-old Portuguese adolescents can be regarded as satisfactory, although there are important variations across different subpopulations. The influence of sociodemographic factors suggests that tailored strategies must be developed for specific subpopulations, at both individual and community levels.

Early Childhood Caries: Epidemiology, Aetiology, and Prevention

Early childhood caries (ECC) is one of the most prevalent diseases in children worldwide. ECC is driven by a dysbiotic state of oral microorganisms mainly caused by a sugar-rich diet. Additionally, poor oral hygiene or insufficient dental plaque removal leads to the rapid progression of ECC. ECC leads not only to dental destruction and pain with children, but also affects the quality of life of the caregivers. Children with extensive ECC are at high risk to develop caries with the permanent dentition or will have other problems with speaking and/or eating. To prevent ECC, several strategies should be taken into account. Children should brush their teeth with toothpastes containing gentle ingredients, such as mild surfactants and agents showing antiadherent properties regarding oral microorganisms. Parents/caregivers have to help their children with brushing the teeth. Furthermore, remineralizing and nontoxic agents should be included into the toothpaste formulation. Two promising biomimetic agents for children's oral care are amorphous calcium phosphate [Ca_x(PO₄)_yn H₂O] and hydroxyapatite [Ca₅(PO₄)₃(OH)].

Oral health training, knowledge, attitudes and practices of primary care paediatricians: a European survey

Oral health is an essential component of children's general health. The aim of this study is to evaluate the training, knowledge, attitudes and practices of primary care paediatricians in oral health in Europe. Paediatricians were invited to complete a survey on the web. There was a 54.3% response rate. The oral health education of the responders was received mainly through continuing medical education and practical experience (51%) rather than in medical school or during paediatric residency training (33%). Twenty-four percent of the responders did not know that the first signs of caries were white spots on the surfaces of teeth. Although 98.8% of paediatricians check the oral health status of children, only 52% feel confident enough to identify dental caries. A large proportion of the paediatricians (43%) recommended a first dental visit for children above the age of 3 years and only 7% under 1 year of age.

CONCLUSIONS

Paediatricians are familiar with some aspects of the oral health but are not confident in identifying the risk factors. The current postgraduate curriculum in Paediatrics should incorporate training on basic oral healthcare. In addition, continuous educational programmes are needed to keep the knowledge of the paediatrician up to date. What is Known: • Oral health is an essential component of general health that influences the functional, psychological and social dimensions of a child's well-being. • Paediatricians are the leading providers of primary healthcare for children. What is New: • Paediatricians are familiar with some aspects of the oral health of children but are not confident in identifying the risk factors responsible for oral disease. • The current postgraduate curriculum in Paediatrics should incorporate training on basic oral healthcare in children.

Paediatric dentistry- novel evolvement

Pediatric dentistry provides primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, together with special health care needs. This specialty encompasses a variety of skills, disciplines, procedures and techniques that share a common origin with other dental specialties however these have been modified and reformed to the distinctive requirements of infants, children, adolescents and special health care needs. Disciplines comprise of behavior guidance, care of the medically and developmentally compromised and disabled patient, supervision of orofacial growth and development, caries prevention, sedation, pharmacological management, and hospital dentistry including other traditional fields of dentistry. The skills apply to the ever-changing stages of dental, physical, and psychosocial development for treating conditions and diseases distinctive to growing individuals. Hence with the changing scope of practice it is imperative that the clinician stays updated with the current evidence based trends in practice, collaborates with other disciplines and Imparts quality oral health care tailored to the specific needs of every child.

Stability of chemically available fluoride in Chilean toothpastes

BACKGROUND

Storage time may reduce the amount of soluble fluoride (F) in toothpastes. Although we previously studied the type and concentration of F in fresh samples of commercial Chilean toothpastes, their stability was not determined.

AIM

To evaluate the stability of soluble F in Chilean toothpastes after 1 year of storage.

DESIGN

All the toothpastes (n = 30) previously used were re-analyzed after 1 year of storage time at room temperature (±22°C). Total F (TF = soluble F + insoluble F) and total soluble F (TSF = F ion + MFP ion) were assessed using an ion-specific electrode, through a validated methodology. Data were expressed in ppm of F (mg F/kg).

RESULTS

Mean (±SD; n = 30) TF and TSF concentrations after storage were 1049 ± 427 and 987 ± 411 ppm F, respectively. Five toothpastes showed between 30% and 50% of insoluble F, four of them formulated with MFP/calcium-based abrasive. In two products, there was a reduction in TSF below the evidence-based anticaries effectiveness threshold of 1000 ppm F.

CONCLUSIONS

Although most of the toothpastes tested kept their original TSF content after 1 year of storage, some products evidenced an important reduction, which may compromise their anticaries efficacy. Reductions in TSF may be explained by an incorrect F salt-abrasive formulation.

The history of public health use of fluorides in caries prevention

AIM

The aim of our study was to chronologically analyse various public health measures of fluoride use in caries prevention.

METHODS

We systematically searched the PubMed database on the preventive role of fluorides in public health, published from 1984 to 2014. The search process was divided into four steps, where inclusion and exclusion criteria were defined. Qualitative methodology was used for the article analysis. In the research process, the described forms of F use, diversity of the described F agents, and the observed population group were analysed.

RESULTS

In our systematic review, 40 relevant reviews were revealed. Fluorides have been used in many different forms, but only a few studies showed their significant role in public health. Water fluoridation was the most important public health measure. In the recent decades, the number of studies on topical fluorides is constantly rising. The most extensively described topical forms of fluorides are professionally applied fluoride agents and fluoride toothpaste for home-use. The use of fluoride containing toothpaste in caries prevention is a safe and successful public health measure (PHM) if their use is widespread, and it is recommended for all. The results on other topical forms of fluorides are insufficient to be suggested as an important PHM.

CONCLUSIONS

The role of fluorides in public health prevention has changed in accordance with the knowledge about the fluoride cariostatic mechanism. Previously the most important pre-eruptive effect of fluorides was supplemented by the post eruptive effect. Abundant evidence exists to show the effectiveness of systemic and topical fluorides.

The efficiency of child formula dentifrices containing different calcium and phosphate compounds on artificial enamel caries

OBJECTIVES

Fluoride toothpaste has been extensively used to prevent dental caries. However, the risk of fluorosis is concerning, especially in young children. Calcium phosphate has been an effective remineralizing agent and is present in commercial dental products, with no risk of fluorosis to users. This in vitro study aimed to compare the effects of different calcium phosphate compounds and fluoride-containing dentifrices on artificial caries in primary teeth.

MATERIALS AND METHODS

Fifty sound primary incisors were coated with nail varnish, leaving two 1 mm² windows on the labial surface before immersion in demineralizing solution for 96 hours to produce artificial enamel lesions. Subsequently, one window from each tooth was coated with nail varnish, and all 50 teeth were divided into five groups (n = 10); group A - deionized water; group B - casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste (Tooth Mousse); group C - 500 ppm F (Colgate Spiderman^®); group D - nonfluoridated toothpaste with triple calcium phosphate (Pureen^®); and group E - tricalcium phosphate (TCP). Polarized light microscopy and Image-Pro^® Plus software were used to evaluate lesions.

RESULTS

After a 7-day pH-cycle, mean lesion depths in groups A, B, C, D, and E had increased by 57.52 ± 10.66%, 33.28 ± 10.16%, 17.04 ± 4.76%, 32.51 ± 8.99%, and 21.76 ± 8.15%, respectively. All data were processed by the Statistical Package for the Social Sciences (version 16.0) software package. Comparison of percentage changes using one-way analysis of variance and Fisher's least squares difference tests at a 95% level of confidence demonstrated that group A was significantly different from the other groups (P < 0.001). Lesions in groups B and D had a significant lesion progression when compared with groups C and E.

CONCLUSIONS

All toothpastes in this study had the potential to delay the demineralization progression of artificial enamel caries in primary teeth. The fluoride 500 ppm and TCP toothpastes were equal in the deceleration of enamel caries progression and better than CPP-ACP paste and TCP toothpaste.

Variation in fluorosis and caries experience among Lithuanian 12 year olds exposed to more than 1 ppm F in tap water

AIM

The aim of the present study was to analyze caries experience in relation to the occurrence of fluorosis in 12 year olds in a natural fluoride area.

METHODS

This cross-sectional study was conducted among 12-year-old lifetime residents (n = 301) of Klaipeda, Lithuania, where the natural fluoride content is 1.7-2.2 ppm F. Data collection included a clinical dental examination and an inquiry about toothbrushing habits. Dental caries was diagnosed according to the World Health Organization criteria and described in terms of decayed, missing, and filled teeth (DMFT)/decayed, missing and filled surfaces (DMFS) indices and decayed, filled surfaces (DFS) on selected proximal surfaces. Dental fluorosis was diagnosed according to the Thylstrup-Fejerskov (TF) index and categorized as none (TF = 0), mild (TF = 1-2), moderate (TF = 3-7), or severe (TF = 8-9). The χ(2)-, Kruskal-Wallis, and Mann-Whitney tests, Pearson's correlation, and linear regression served for statistical analyses.

RESULTS

A total of 34% of the 12 year olds studied had no signs of fluorosis, while the rest had mild (42%) or moderate (24%) fluorosis. Caries experience was negatively related to the presence of fluorosis. When present (TF > 0), the mean DMFT was 1.8 (standard deviation [SD]: 1.7) versus 2.6 (SD: 2.3) in the absence of fluorosis (TF = 0, P = 0.008). The corresponding mean DMFS values were 2.6 (SD: 3.1) versus 3.8 (SD: 4.3, P = 0.014).

CONCLUSION

The presence of fluorosis associates with lesser caries experience in 12-year-old lifetime residents of an area with moderately-elevated natural fluoride.

Dentifrices for children differentially affect cell viability in vitro

Objectives

Child dentifrices vary in their composition, with possible differential impacts on cells in the oral soft tissue. While cytotoxicity studies have been performed on adult dentifrices, no respective studies have thus far been reported on child dentifrices.

Material and methods

Seventeen commercial dentifrices for children up to 12 years of age were evaluated with respect to their in vitro cytotoxicity on gingival fibroblasts, oral squamous cell carcinoma HSC-2 cells, and L929 mouse fibroblasts. Proliferation was analyzed and live-dead staining was performed.

Results

Ten child dentifrices greatly reduced cell viability with LC50 values below 5 %. Four dentifrices showed a moderate cytotoxicity with LC50 values between 5 and 20 %. Three child dentifrices showed almost no cytotoxicity with LC50 values above 95 %. The results of the assays for proliferation and live-dead staining supported these findings.

Conclusions

The different composition of the child dentifrices translated into a broad spectrum of in vitro cytotoxicity on cells of the oral cavity.

Clinical relevance

The in vitro data provide the scientific foundation for further in vivo research testing the clinical relevance of the present findings.

FLUORIDE: A REVIEW OF USE AND EFFECTS ON HEALTH

INTRODUCTION

Appropriate oral health care is fundamental for any individual's health. Dental caries is still one of the major public health problems. The most effective way of caries prevention is the use of fluoride.

AIM

The aim of our research was to review the literature about fluoride toxicity and to inform physicians, dentists and public health specialists whether fluoride use is expedient and safe.

METHODS

Data we used in our review were systematically searched and collected from web pages and documents published from different international institutions.

RESULTS

Fluoride occurs naturally in our environment but we consume it in small amounts. Exposure can occur through dietary intake, respiration and fluoride supplements. The most important factor for fluoride presence in alimentation is fluoridated water. Methods, which led to greater fluoride exposure and lowered caries prevalence, are considered to be one of the greatest accomplishments in the 20th century`s public dental health. During pregnancy, the placenta acts as a barrier. The fluoride, therefore, crosses the placenta in low concentrations. Fluoride can be transmitted through the plasma into the mother's milk; however, the concentration is low. The most important action of fluoride is topical, when it is present in the saliva in the appropriate concentration. The most important effect of fluoride on caries incidence is through its role in the process of remineralization and demineralization of tooth enamel. Acute toxicity can occur after ingesting one or more doses of fluoride over a short time period which then leads to poisoning. Today, poisoning is mainly due to unsupervised ingestion of products for dental and oral hygiene and over-fluoridated water.

CONCLUSION

Even though fluoride can be toxic in extremely high concentrations, it`s topical use is safe. The European Academy of Paediatric Dentistry (EAPD) recommends a preventive topical use of fluoride supplements because of their cariostatic effect.

Factors influencing caries incidence in permanent teeth in children/adolescents under and after anti-neoplastic treatment

AIM OF THE STUDY

To determine reasons for the increase in caries among children/adolescents treated for neoplasms.

MATERIAL AND METHODS

Health promoting behaviour, oral hygiene (PLI), gingiva (GI), dentition (DMFt/DMFs), number of teeth with white spot lesions (WSL), and enamel defects (ED) were assessed in three groups of 60 patients each. The three groups were as follows: under chemotherapy (CH), after chemotherapy (PCH), and generally healthy (CG). Medical files supplied information on neoplasm type, chemotherapeutic type and dose, age at treatment start, chemotherapy duration, and complications. Statistical analysis was performed with Mann-Whitney U test and Spearman's rho test.

RESULTS

The age at which chemotherapy was started/its duration was 5.9 ±4.0/1.3 ±0.5 years in PCH and 9.12 ±4.44/0.8 ±0.3 years in CH; PCH completed treatment 4.9 ±3.4 years ago. Chemotherapy most often included vincristine (VCR), etoposide (VP-16), adriamycin (ADM), cyclophosphamide (CTX), cisplatin (CDDP), and ifosphamide (IF). Mucositis occurrence was 28.33% in PCH and 45.00% in CH; vomiting occurrence was 43.33% and 50.00%, respectively. Nutrition and prophylaxis mistakes occurred more often in CH/PCH than in CG; PLI, GI, caries incidence and severity, and the number of teeth with WSL were higher. Correlation between caries incidence and chemotherapeutic type and dose, age at treatment start and treatment duration, mucositis, emesis, PLI, GI, ED, no fluoride prophylaxis, and nutritional mistakes was established. Ifosphamide and mucositis treatment played a major role in chemotherapy; after chemotherapy - ED and CTX, ADM, IF, and VP-16.

CONCLUSIONS

Caries in permanent teeth in children/adolescents undergoing chemotherapy result from nutritional mistakes, poor prophylaxis, and indirectly from chemotherapy complications (first mucositis and emesis, and later developmental ED).

Preventive strategies in oral health for special needs patients

As regards to the most common oral disease in pediatric patients, intellectual disability is not a risk factor for caries disease itself, but it rather reduces the individual capability to self-care and therefore to his own oral care. Children suffering of systemic pathologies and/or with different stages of disability are to be considered at high risk for dental caries development. According to recent guidelines for oral health prevention in childhood, individual additional strategies for a preventive care should be applied for these patients. All the health providers, family and caregivers should be involved with the aim of being aware, motivated and informed on oral health issues, and a better access system to the dental care structure, both logistic, professional and economical should be assured.

Evaluation of an interdisciplinary preventive programme for early childhood caries: findings of a regional German birth cohort study

OBJECTIVES

The aim of this prospective birth cohort study was to evaluate the effect of the interdisciplinary preventive programme (PP) for early childhood caries in 3-year-old children in Germany.

MATERIAL AND METHODS

From July 2009 to October 2010, all parents of newborns (n = 1162) were visited after birth by the communal newborn visiting service of Jena, Thuringia, and advised on general and dental health. In the first year of life, children were invited to a dental examination in Jena University Hospital. Participating children were included in a risk-related recall system with continuous oral care over 3 years. Caries-risk assessment tool of the AAPD was used for risk categorizing. High-risk children received fluoride varnish biannual. In 2013, the total birth cohort (participants and non-participants) was invited to evaluate the PP. Dental caries was scored using WHO diagnostic criteria expanded to d1-level without radiography. Data were analysed statistically (multivariate logistic regression).

RESULTS

Seven hundred fifty-five children (mean age 3.26 ± 0.51 years) were examined. Children in the PP (n = 377) showed significantly lower caries prevalence and experience than non-participants (15.6 vs. 37.8 %, 0.9 ± 3.3 d_1-4mfs vs. 2.6 ± 5.2 d_1-4mfs). Lack of vitamin D supplements (OR = 1.9, CI 0.99-3.51), familial caries experience (OR = 2.2, CI 1.27-3.73) and visible plaque on teeth (OR = 6.5, CI 4.41-9.43) were significant risk factors for caries development, whereas regular dental care (OR = 0.5, CI 0.38-0.79) had a protective effect.

CONCLUSIONS

The PP was an effective interdisciplinary approach for preventing early childhood caries in small children.

CLINICAL RELEVANCE

Early dental visits with caries-risk-related preventive dental care are necessary to prevent early childhood caries (ECC).

TRIAL REGISTRATION

German Clinical Trials Register DRKS00003438, https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00003438.

Recent advancements in fluoride: A systematic review

To review advancements of fluoride in dentistry, a search of 21 electronic databases and World Wide Web was conducted. Relevant journals were hand searched and further information was requested from authors. Inclusion criteria were a predefined hierarchy of evidence and objectives. Study validity was assessed with checklists. Two reviewers independently screened sources, extracted data, and assessed validity. Fluoride has become an important tool in preventive dentistry. Current research is focused on the development of strategies to improve fluoride efficacy. Fluoride therapy in the form of varnish, gel, mouth rinse, or toothpaste has been used extensively as a caries-preventive intervention for over three decades. The purpose of this review is to inform the reader about new research related to the use of fluoride for the prevention of dental caries.

WHY DO YOU NEED TO USE A CARIES RISK ASSESSMENT PROTOCOL TO PROVIDE AN EFFECTIVE CARIES PREVENTIVE REGIME?

BACKGROUND

Clinical guidelines recommend an individual is given a caries risk status based on analysis of defined clinical and social criteria before implementing a tailored preventive plan.

AIMS

Improve documentation of caries risk assessment (CRA) in a general dental practice setting, using a systems-based approach to quality improvement methods. Investigate the impact of quality improvement efforts on subsequent design and delivery of preventive care. Identify barriers to delivery of CRA and provision of preventive care.

DESIGN

Data for patients aged 0-16 years was collected over two cycles using standard audit methodology. The first cycle was a retrospective analysis (n = 400) using random sampling. The second cycle a prospective analysis (n = 513) using consecutive sampling over a 15-week period. Five staff meetings with feedback occurred between cycles.

RESULTS

In cycle one, no specific CRA system was identified. CRA status was not stated widely, risk factors were not analysed and there was variation with respect to the prescription and delivery of preventive strategies. These discrepancies were demonstrable for all four participating dentists and at all ages. In cycle two, 100% recorded CRA. All risk factors were analysed and individual caries risk was correctly annotated. There was 100% compliance with the protocol for preventive plans.

CONCLUSIONS

The use of CRA improved documentation of caries risk status. This has improved subsequent prescription of age specific evidence-based preventive care appropriate to the risk status of that individual. Barriers were identified to the delivery of CRA and the provision of comprehensive preventive care by the dentists and other healthcare professionals.

Timetable for oral prevention in childhood-a current opinion

Dental caries in young children remains a public health problem particularly for children whose families are socioeconomically deprived. A child's first dental visit should be at approximately 12 months of age and this should facilitate the provision of anticipatory guidance concerning oral health and dental development to the child's parents/guardians. Compliance with dietary advice is of key importance and motivational interviewing shows promise in relation to parents adopting good oral health practices for their children. Twice daily toothbrushing using toothpaste that contains in the range of 1000- 1500ppmF is a most important preventive measure. It is important to use a minimal amount of toothpaste, insure that it is not swallowed, have parental or adult supervision during toothbrushing and avoid rinsing with water following brushing with toothpaste. The professional application of topical fluoride varnish twice yearly is a proven caries preventative measure. The application of pit and fissure sealants to teeth with deep pits and fissures is recommended.

Does early establishment of favorable oral health behavior influence caries experience at age 5 years?

OBJECTIVE

The purpose was to study associations between tooth brushing frequency, use of fluoride lozenges and consumption of sugary drinks at 1.5 years of age and having caries experience at 5 years of age.

METHODS

This study was based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and by the Public Dental Services. A total of 1095 children were followed from pregnancy to the age of 5 years. Questionnaires regarding oral health behavior were completed by the parents at 1.5 and 5 years of age. Clinical and radiographic examination of the children was performed at the age of 5 years.

RESULTS

In multiple logistic regression, having caries experience at 5 years of age was associated with; at 1.5 years of age having the teeth brushed less than twice daily (OR = 2.1, CI = 1.3-3.6) and being offered sugary drinks at least once a week (OR = 1.8, CI = 1.1-2.9) when controlled for family characteristics and oral health behavior at 5 years of age.

CONCLUSIONS

Tooth brushing frequency and consumption of sugary drinks in early childhood were related to caries development during pre-school age, independent of family characteristics and oral health behavior at 5 years of age. The results indicate that early established habits regarding tooth brushing and consumption of sugary drinks have long-term effects on caries development. Parents encountering difficulties in establishing favorable oral health behavior in children's first years of life should receive special attention from health personnel.

Fluoride varnish applications and caries incidence in pre-schoolers

DESIGN

A two year placebo-controlled, double-blind, randomised control trial in 1-4-year-old children.

INTERVENTION

Children were recruited from low income families in Rio de Janeiro, Brazil, with access to a fluoridated public water supply. Both groups received oral hygiene instruction along with provision of toothbrushes and 1450 ppm F- toothpaste. The control group had a placebo fluoride varnish applied every six months. The intervention group had 22,600 ppm F- varnish applied every six months. Clinical examinations for the presence of caries were conducted at baseline and at each subsequent six monthly visit.

OUTCOME MEASURE

The primary outcome was the proportion of children in each group that went on to clinically develop any new carious surfaces using the ICDAS criteria. The number of new carious surfaces was assessed as a secondary outcome, both at the enamel and dentine level. The study also reported on the safety and acceptability of the varnish.

RESULTS

Two hundred children participated in the trial, 91% were followed up at two years and adherence to the six-monthly applications was 84% in the intervention and 85% in control groups. The results did not show a significant difference for the development of new lesions between the two groups. In the fluoride varnish group 36% had developed new dentinal lesions compared to 47% in the placebo group, a difference of -10.8% (95% CI -24.9 to 3.3, p = 0.14). In relation to caries increment, at the enamel level, this was a mean of 2.0 teeth in the fluoride varnish group and 2.8 teeth in the placebo group, a difference of -0.8 (95% CI -2.0 to 0.4, p = 0.19). At the dentine level, caries increment was a mean of 1.8 teeth in the fluoride varnish group and 2.5 in the placebo group, a difference of -0.7 (95% CI -1.9 to 0.4, p = 0.23). Two minor complaints related to taste and appearance of the varnish were recorded and no safety events were reported.

CONCLUSIONS

Whilst no significant difference was found, the authors note that this does not indicate ineffectiveness of fluoride varnish. Re-assessment of the power calculation following study completion demonstrated that a significantly larger sample size would have been indicated, preventing the drawing of any direct conclusions from the results of this study. The use of fluoride varnish amongst this group appears to be safe and overall well tolerated.

Pediatricians' oral health recommendations for 0- to 3-year-old children: results of a survey in Thuringia, Germany

Background

German societies of pediatricians and dentists disagree about oral health-related preventive recommendations (use of fluoride supplements, fluoride-containing toothpaste) for children aged 0–3 years. After failure to reach a consensus, there is no study that has evaluated the guidelines that pediatricians use in daily practice.

Methods

A standardized questionnaire was sent to all 167 practicing pediatricians in the state of Thuringia, Germany, to assess the current oral health-related preventive recommendations. Data were analyzed using descriptive statistics.

Results

The response rate was 52.0%. More than 9.0% of the pediatricians advise parents with regard to diet, use of baby bottles, oral hygiene and dental visits. The majority of pediatricians recommend to start tooth-brushing after the 1st birthday and recommend the use of toothpaste and a 1st dental visit after the 2nd birthday (78.0%). Additionally, 23.3% (n = 20) of pediatricians prescribe solely vitamin D, and 20.9% (n = 18) prescribe vitamin D combined with fluoride. Fluoride supplements are given as required by 37.2% (n = 32) of pediatricians, primarily between the 1st and 6th birthdays. The guidelines of the Pediatric Society were used by 1.2% of the pediatricians, the guidelines of the dentists were used by 5.8%, and a mix of both was used by 93.0%. The simultaneous use of fluoride supplements and fluoride toothpaste in the first three years was recommended by 45.9% of the pediatricians.

Conclusions

Pediatricians’ oral health recommendations are based on a mix of the guidelines from the German societies of pediatricians and dentists and led to no use or possible overdose of fluoride. Against the background of early childhood caries and dental fluorosis, there is a need for uniform guidelines.

Tooth brushing frequency and use of fluoride lozenges in children from 1.5 to 5 years of age: a longitudinal study

OBJECTIVES

The purpose of the analyses was to study development, stability and changes in oral health behaviour - tooth brushing frequency, use of fluoride lozenges and fluoridated toothpaste in children from 1.5 to 5 years of age - and to study associations between oral health behaviour and family characteristics.

METHODS

This study was based on data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health and data from the Public Dental Services. A total of 771 children were followed from 1.5 to 5 years of age. Questionnaires regarding oral health behaviour in children were completed by the parents three times during preschool age.

RESULTS

More than half of the children (52%) had their teeth brushed twice daily at 1.5 years of age, increasing to 61% at 3 years and 76% at 5 years of age. At 1.5 years of age, 37% of the children used fluoride lozenges daily, increasing to 74% at 3 years and 75% at 5 years of age. The majority of the children who had started brushing twice daily and used fluoride lozenges daily at 1.5 years of age continued these behaviours until the age of 5 years. At 1.5 years of age, children who brushed twice daily were more likely to use fluoride lozenges daily than children who brushed less frequently (P = 0.03). Multiple logistic regression showed that the probability of a child having its teeth brushed twice daily continuously during preschool age was higher when both parents were of western origin [odds ratios (OR) 4.0, confidence intervals (CI) 1.3-11.9] than when one or both parents were of non-western origin. Children with one older sibling brushed more frequently (OR 1.4, CI 1.0-1.9) and used fluoride lozenges more often (OR 1.6, CI 1.1-2.2) during preschool age than children without older siblings.

CONCLUSIONS

Oral health behaviour established in early life was stable during preschool age. The results indicate that tooth brushing frequency and use of fluoride lozenges were not in accordance with the present recommendations based on the scientific literature. The teeth of Norwegian preschoolers were brushed less frequently than recommended, and more children than recommended were using fluoride lozenges.

Fluoridated toothpaste: usage and ingestion of fluoride by 4- to 6-yr-old children in England

Fluoridated toothpaste is effective for dental caries control, yet may be a risk factor for dental fluorosis. This study aimed to quantify fluoride ingestion from toothpaste by children and to investigate the effects of age, gender, and social class on the amount of fluoride ingested per toothbrushing session. Sixty-one children, 4-6 yr of age, were recruited: 38 were from low socio-economic (LSE) areas of Newcastle, UK, and 23 were from high socio-economic (HSE) areas of Newcastle, UK. All expectorated saliva, rinse water (if used), and residual toothpaste were collected after brushing at home and were analysed for fluoride. Of the children, 74% and 69% from HSE and LSE areas, respectively, claimed that they brushed twice per day. The mean (SD) weight of toothpaste dispensed was 0.67 (0.36) g. The mean (SD) amount of fluoride ingested per toothbrushing session and per day was 17.0 (14.7) and 29.3 (32.8) μg kg(-1) of body weight, respectively. Daily fluoride intake per kilogram of body weight did not differ significantly between children from LSE and HSE areas. Fluoride intake per toothbrushing session was significantly influenced by weight of toothpaste, its fluoride concentration, and the child's age. Whilst the average amount of toothpaste used per toothbrushing session was more than twice the recommended amount (of 0.25 g), only one child had a daily fluoride intake that exceeded the tolerable upper intake level of 0.1 mg kg(-1) of body weight for this age group.

Comparison of the remineralizing potential of child formula dentifrices

BACKGROUND

Although child formula fluoridated dentifrices can be used safely by young children their remineralizing capability remains questionable.

AIMS

To evaluate the remineralizing potential of child formula dentifrices on primary teeth.

DESIGN

In vitro single-section technique utilizing a 7 days pH-cycling model.

METHODS

Primary teeth were placed in demineralizing solution for 96 h to produce artificial carious lesions 100 μm deep, and then cut longitudinally into 50 sections 100-150 μm thick and randomly assigned to five groups. Sections in Groups A to D were treated with dentifrices containing 500 ppm AmF, 500 ppm MFP, 500 ppm MFP and xylitol, or 500 ppm NaF, respectively. Group E sections were treated with a nonfluoridated dentifrice.

OUTCOME MEASUREMENTS

Lesions were evaluated using polarized light microscopy and microradiography.

RESULTS

Group D (500 ppm NaF) sections exhibited a significant decrease in lesion depth, whereas those in Group E (nonF) showed a significant increase in depth (P<0.05, paired t-test). Decrease in lesion progression was observed in Groups A, B and C.

CONCLUSIONS

The 500 ppm NaF dentifrice demonstrated remineralization of carious lesions by virtue of a significant decrease in lesion depth; whereas dentifrices that contained AmF, MFP and MFP with xylitol decelerated the progression of demineralization.