Caries prevention with fluoride toothpaste in children: an update

Tooth brushing with fluoridated toothpaste and associated factors among Chinese adolescents: a nationwide cross-sectional study

BACKGROUND

Tooth brushing with fluoridated toothpaste has become the most important way to provide the anti-caries effect of fluoride around the world. China has promoted the use of fluoridated toothpaste since 1989. However, there are few studies on the national profile of use of fluoridated toothpaste and related factors in Chinese adolescents. We carried out this study to investigate oral hygiene behaviours, especially the status of tooth brushing with fluoridated toothpaste and its correlates among adolescents, based on data from the latest Nation Oral Health Survey in mainland China.

METHODS

This cross-sectional study recruited 118,601 participants aged 12-15 years using multistage stratified sampling. Questionnaires were completed by students at school. Data employed in analyses were extracted from the questionnaire, including information on tooth brushing, fluoridated toothpaste, dental floss, sociodemographic factors, fluoride knowledge and attitude towards regular dental check-ups. A binary logistic regression was performed to compute the odds ratios (OR). Tooth brushing twice daily with fluoridated toothpaste was the dependent variable. Sociodemographic factors, fluoride knowledge, attitude towards regular dental check-ups, dental visit experience and perceived oral health were the independent variables. P < 0.05 was considered statistically significant.

RESULTS

A total of 32.6% of participants brushed their teeth twice daily, 7.4% used fluoridated toothpaste, and 3.9% cleaned their teeth twice daily with fluoridated toothpaste. The logistic regression showed the probability of twice-a-day tooth brushing with fluoridated toothpaste was higher among these groups: females (OR: 1.141; 95%CI: 1.072-1.214), 15-year-olds (OR: 1.786; 95%CI: 1.634-1.952), from urban areas (OR: 1.389; 95%CI: 1.288-1.497), without siblings (OR: 1.351; 95%CI: 1.259-1.450), with an educated father (OR: 1. 605; 95%CI: 1.442-1.788) and mother (OR: 1.706; 95%CI: 1.530-1.903), having dental visit experiences (OR: 1.702; 95%CI: 1.589-1.823), rating one's oral health as good (OR: 2.341; 95%CI: 2.083-2.631), having fluoride knowledge (OR: 4.345; 95%CI: 4.034-4.678) and having a positive attitude towards regular dental check-ups (OR: 1.589; 95%CI: 1.460-1.729).

CONCLUSIONS

The oral hygiene behaviours of Chinese adolescents were undesirable. Twice daily tooth brushing with fluoridated toothpaste was significantly associated with sociodemographic factors, fluoride knowledge, and attitudes towards regular dental check-ups.

Amount of toothpaste used by dental students

PURPOSE

This study analyzed associations of cumulative learning, demographic characteristics, fluoride content, and toothbrush head size with the amount of toothpaste used by dental students.

METHODS

Students in the third and fifth year of dental school were recruited. Each participant was asked to dispense three toothpastes (pediatric, regular fluoride, and high fluoride) on five toothbrushes (rotation-oscillation, sonic, manual pediatric, and two manual adult toothbrushes). The length and weight of the toothpaste dispensed were recorded. The data were evaluated by nonparametric correlation analysis (P < 0.05).

RESULTS

Eighty-one students (third year = 42; fifth year = 39; mean age: 26.2 ± 5.3 years) participated in the study. More toothpaste was dispensed by third-year students than by fifth-year students (weight: P = 0.014; length: P = 0.037). Men dispensed more toothpaste than did women (weight: P < 0.001; length: P = 0.042). Participants with higher educational attainment dispensed less toothpaste (weight: P < 0.001; length: P < 0.001). The type of toothbrush was associated with the weight of toothpaste dispensed (P < 0.001). Toothbrush head size was inversely associated with the length of toothpaste dispensed (P < 0.001).

CONCLUSION

The amount of toothpaste used by dental students was associated with cumulative learning, educational attainment, sex, and toothbrush head size but not with the fluoride content of the toothpaste.

Clinical practice guideline adaptation for risk-based caries management in 18-55 year-old Iranian adults

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.

Attitude, Practice, and Knowledge Regarding Fluoridated Toothpaste, Brushing, and Rinse Usage Among Residents of Jeddah City in Saudi Arabia

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.

Risk factors for and prevention of caries and dental erosion in children and adolescents with asthma

There are many studies and reviews of the relationship between the asthma disease in young individuals on the one hand and caries and dental erosion on the other. The causes of caries and dental erosion might be related to the asthmatic drugs, low pH and the sweeteners that the inhaled drug contains and perhaps even the lifestyle of children and adolescents with asthma. The main focus of this review is therefore to describe various preventive strategies, based on long experience of preventive dental care in Sweden. Two fact boxes are presented, one on fluoride toothpaste as a population-based intervention for different ages and one on diet counselling in children and adolescents with asthma. The most important thing is to introduce fluoride toothpaste early in the child's life and that the parents brush the child's teeth twice a day, in the morning after breakfast and at night before bedtime, up to the age of 10. Moreover, a high-risk approach with an additional fluoride supply at home is presented, together with the application of fluoride varnish at the clinic. Regarding diet counselling, it is important to make sure that the child has regular meals during the day, maximum five to six times a day, to allow the teeth to rest between meals and restrict sweets and soft drinks to once a week. It is important to identify children and adolescents with asthma as early as possible and to refer them to a dental team for preventive treatment.

Barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools: a systematic review

Background

Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools.

Methods

Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines.

Results

A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers.

Conclusion

The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02270-7.

Salivary fluoride concentration following toothbrushing with and without rinsing: a randomised controlled trial

Background

Caries prevalence has declined significantly since the introduction of fluoridated toothpaste. There have been several developments regarding specific active fluoride ingredients but not enough evidence to support one over the other. The purpose of this double-blind randomized controlled trial was to compare salivary fluoride concentrations of different fluoride formulations in the form of toothpaste with and without post-brushing water rinsing in adults.

Methods

The study included 120 participants who were randomly assigned to one of 12 groups (10 participants/group). The toothpaste formulas investigated included (1) fluoride-free (0 ppmF); (2) sodium fluoride (1450 ppmF); (3) sodium monofluorophosphate (1450 ppmF); (4) sodium fluoride and monofluorophosphate combined (1450 ppmF); (5) stannous fluoride and sodium fluoride combined (1450 ppmF); and (6) amine fluoride (1400 ppmF). Block randomisation was used to assign each participant to one of the 12 groups. Participants brushed with 1.0 g of one of the six different toothpaste formulations either with or without post-brushing water rinsing. Saliva was collected at six different times (baseline and at 1, 15, 30, 60, and 90 min/s post-brushing). Samples were analysed using a fluoride ion-specific sensitive electrode connected to an ion analyser.

Results

The demographic characteristics of the participants were not significantly different among the groups (P > 0.05). Time, toothpaste formulation, and post-brushing rinsing routines had significant effects on saliva fluoride retention (P < 0.05). Amine fluoride-containing toothpaste was the only formula that showed statistically significantly higher concentrations of salivary fluoride at 90 min in both the rinsing and non-rinsing groups. Sodium monofluorophosphate toothpaste did not result in a significant difference compared to the control group at any time point, in both rinsing and non-rinsing groups.

Conclusions

Based on the results from this study, no rinsing after toothbrushing in adults can be recommended when sodium monofluorophosphate containing toothpaste formula is used. It also concludes that amine fluoride resulted in a significantly higher saliva fluoride concentration at 90 min in both the rinsing and non-rinsing groups compared to other fluoride toothpaste formulations.

Registry: Protocol Registration and Results System (ClinicalTrials.gov).

Clinical trial registration number: NCT02740803 (15/04/2016).

Impact of a novel oral health promotion program on routine oral hygiene among socioeconomically disadvantaged smokers: results from a randomized semi-pragmatic trial

Smokers are at high risk of oral disease and report sub-optimal oral hygiene. Improving smokers’ oral hygiene could reduce their future disease risk. The purpose of this study is to assess the effects of a novel, multi-modal oral health promotion program (Oral Health 4 Life; OH4L) targeted to socioeconomically disadvantaged smokers and delivered through state-funded tobacco quitlines. Smokers (n = 718) were randomized to standard quitline care or standard care plus OH4L. OH4L recipients received a comprehensive behavioral intervention and were advised of the benefits of routine oral hygiene, encouraged to brush and floss daily (for better oral health and to manage cigarette cravings), and provided a toothbrush and floss. Participants were followed for 6 months to assess the intervention effects on routine oral hygiene (brushing and flossing) and changes in motivation and self-efficacy. Data were collected between 2015 and 2017. At 2-month follow-up, OH4L participants were more likely to meet the American Dental Association (ADA) recommendations for brushing twice daily (adjusted RR = 1.15 [1.04, 1.27], p = .006), flossing daily (adjusted RR = 1.20 [1.03, 1.39], p = .02), and for both brushing and flossing (adjusted RR = 1.33 [1.10, 1.61], p = .003). Daily flossing was more likely at 6-month follow-up (adjusted RR = 1.21 [1.04, 1.42], p = .02) among OH4L participants. The change in self-efficacy and motivation for daily flossing from baseline to 2 months was significantly greater among OH4L participants and mediated the intervention effect on flossing at 6 months. Integrating oral hygiene promotion with standard tobacco quitline services improved oral health self-care.

A study of 84 homemade toothpaste recipes and the problems arising from the type of product

Objective Growing consumer mistrust of a number of ingredients used in industry has led to the development of a trend for homemade products. This now affects all types of sectors, but particularly the hygiene sector for shampoo and toothpaste products. The aim of this work is therefore to study recipes found on the internet for these types of products in order to assess risks associated with their use.Materials and methods Eighty-four recipes were collected from the internet and their composition was analysed.Results None of the 84 formulas analysed contained any fluoride salts, well known for their oral health benefits. Eighty percent did not contain a foaming agent either, which is very useful in the cleaning function of toothpastes. Furthermore, the quantities of substances to be used were usually expressed in tablespoons or teaspoons, measures which are imprecise and could, for example, lead someone to use large quantities of an abrasive agent such as calcium carbonate.Conclusions Attention should be drawn to homemade toothpaste recipes that contain no fluoride and whose abrasivity, purity and microbial contamination cannot be verified.

Exogenous Intake of Fluorides in Caries Prevention: Benefits and Risks

Caries incidence and prevalence have decreased significantly over the last few decades due to widespread use of fluoride. However, an increase in the prevalence of dental fluorosis has been reported in both fluoridated and non-fluoridated communities. Care must be taken to ensure that a balance between the optimal fluoride preventive effect at the individual and community level and minimal risk of dental fluorosis is maintained. This review describes the main sources of fluoride intake that have been identified: fluoridated drinking water, dietary fluoride supplement, and topical forms comprising toothpastes, rinses, gels and varnishes. The cited data were taken from meta-analytic studies and reports from Cochrane database systematic reviews up to December 2019. Efficiency, but safety, of topically applied fluorides in individual home care is dependent on the degree of compliance of individuals/parents and on the level of competence of providers of preventive counselling. The broad spectrum of these resources allows individualization of fluoride prevention based on risk analysis of caries attack and taking into consideration other preventive measures.

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.

Personalized Dental Caries Management in Children

This article reviews dental caries management in children. The goal is to help clinicians recognize common patterns of dental caries in primary dentition and make appropriate decisions regarding management of carious lesions in children, taking into account the best available evidence, clinician expertise and experience, and a child's treatment needs, age, medical history, and ability to tolerate treatment as well as caregiver preferences. It also is important to protect the developing psyche of the child, stabilize or restore the dentition to health and natural esthetics when possible, and maintain space for the eruption of the future permanent dentition.

Global oral health in the framework of the Global Charter for the Public's Health

Oral diseases are a neglected epidemic affecting all ages globally and can substantially impact overall health and well-being. Even though most oral diseases are preventable and share major risk factors with other non-communicable diseases, integration of oral health into public health systems is still limited in both clinical and health policy perspectives. This Viewpoint aims to highlight oral health from a global health perspective, calling for all public health leaders to advocate for oral health of all. We strongly recommend oral health as an essential part of public health policy and oral health-related activities to be aligned with the Global Charter for the Public's Health Framework.

The oral health behaviours and fluid consumption practices of young urban Aboriginal preschool children in south-western Sydney, New South Wales, Australia

ISSUE ADDRESSED

Australian Aboriginal children have a higher risk of dental caries yet there is limited focus on oral health risk factors for urban Aboriginal preschool children. This study examined the oral health behaviours and fluid consumption practices of young children from an urban Aboriginal community in south-western Sydney, Australia.

METHODS

In total, 157 Aboriginal children who were recruited to the "Gudaga" longitudinal birth cohort participated in this study. A survey design was employed and parents responded to the oral health questions when their child was between 18 and 60 months.

RESULTS

Few parents (20%) were concerned about their child's oral health across the time period. By 60 months, only 20% of children had seen a dentist while 80% were brushing their teeth at least once daily. High levels of bottle use were seen up to 30 months. Consumption of sugary drinks was also very high in the early years, although this was replaced by water by 36 months.

CONCLUSIONS

While there are some encouraging findings, such as the rates of tooth brushing and increasing rates of water consumption, the findings do highlight the poor uptake of dental services and high levels of bottle usage among urban aboriginal children during their early years. SO WHAT?: Targeted oral health promotional programs are needed in the urban Aboriginal community to better support parents understanding of good oral health practices in the early years and engagement with dental health services.

Ethics Rounds: Death After Pediatric Dental Anesthesia: An Avoidable Tragedy?

Early childhood caries (ECC) is the single most common chronic childhood disease. In the treatment of ECC, children are often given moderate sedation or general anesthesia. An estimated 100 000 to 250 000 pediatric dental sedations are performed annually in the United States. The most common medications are benzodiazepines, opioids, local anesthetics, and nitrous oxide. All are associated with serious adverse events, including hypoxemia, respiratory depression, airway obstruction, and death. There is no mandated reporting of adverse events or deaths, so we don't know how often these occur. In this article, we present a case of a death after dental anesthesia and ask experts to speculate on how to improve the quality and safety of both the prevention and treatment of ECC.

Managing Early Childhood Caries with Atraumatic Restorative Treatment and Topical Silver and Fluoride Agents

Early childhood caries (ECC) is a significant global health problem affecting millions of preschool children worldwide. In general, preschool children from families with 20% of the lowest family incomes suffered about 80% of the ECC. Most, if not all, surveys indicated that the great majority of ECC was left untreated. Untreated caries progresses into the dental pulp, causing pain and infection. It can spread systemically, affecting a child's growth, development and general health. Fundamental caries management is based on the conventional restorative approach. Because preschool children are too young to cope with lengthy dental treatment, they often receive dental treatment under general anaesthesia from a specialist dentist. However, treatment under general anaesthesia poses a life-threatening risk to young children. Moreover, there are few dentists in rural areas, where ECC is prevalent. Hence, conventional dental care is unaffordable, inaccessible or unavailable in many communities. However, studies showed that the atraumatic restorative treatment had a very good success rate in treating dentine caries in young children. Silver diamine fluoride is considered safe and effective in arresting dentine caries in primary teeth. The aim of this paper is to review and discuss updated evidence of these alternative approaches in order to manage cavitated ECC.

Comparison of Antimicrobial Activity of Child Formula Dentifrices at different Concentrations: An in vitro Study

Aim

The aim of the present in vitro study is to evaluate and compare antimicrobial efficacy of commercially available child’s dental formulas in reduced concentrations containing different forms of fluoride against Streptococcus mutans activity.

Materials and methods

The selected dentifrices were prepared in dilutions of 1:1, 1:2, 1:4, 1:8, and 1:16 using sterile pyrogen-free distilled water. Various dilutions of the selected toothpaste slurries were incubated in the agar plate containing pure strains of S. mutans, and antimicrobial activity of each was assessed by measuring the diameter of zones of inhibition (in mm). Agar well plate diffusion method and minimum inhibitory concentration (MIC) determination were the methods used in this study. The inhibitory circle of each dentifrice was measured and MIC was achieved by considering the value of diameter of the circle.

Results

The results of the study showed that even at a lower concentration of fluoride, inhibition halos were obtained for all the formulations at different dilutions.

Conclusion

The kid’s formulations having lower fluoride concentration show antimicrobial activity even after dilutions. Thus, commercially, the fluoride concentrations can be further lowered down in the dentifrices, thereby reducing the risk associated with fluoride.

How to cite this article

Malhotra R, Singla S, Shashikiran ND. Comparison ofAntimicrobial Activity of Child Formula Dentifrices at different Concentrations: An in vitro Study. Int J Clin Pediatr Dent 2017;10(2):131-135.

Effect of supervised brushing with fluoride gel during primary school, taking into account the group prevention schedule in kindergarten

OBJECTIVES

In one region of Germany, a group of children took part in regular fluoride gel applications during primary school following intensified prevention in kindergarten. This observational study aimed to ascertain whether the dental health of primary school children can be improved by introducing a group prevention program based on applications of fluoride gel.

MATERIALS AND METHODS

The subjects were distributed among six groups with varying preventive measures in kindergarten and at school. The basis for determining caries experience and calculating the caries increment consisted of dental findings gathered in the second and fourth grade.

RESULTS

While second graders without professionally supported daily toothbrushing in kindergarten exhibited an average d_3-6mft of 2.17, in those who had enjoyed intensive dental prevention, the corresponding value was 19% lower (d_3-6mft = 1.74). The caries increment was significantly lower mainly among children who had received the maximum of group prevention (intensive prevention in kindergarten and gel program at school).

CONCLUSIONS

The results show that intensified preventive programs in kindergartens and schools, based mainly on supervised toothbrushing, have a positive effect on the dental health of primary school children.

CLINICAL RELEVANCE

Such programs are efficient in reducing caries experience especially in socially deprived areas.

The Special Needs of Preterm Children - An Oral Health Perspective

Preterm births are defined as those before 37 weeks of gestation. With advances in fertility medicine and neonatal medicine, the numbers of preterm children in the community have significantly increased. Developmental delays and complications among preterm children are well recognized. Much less consideration is given to the dental complications of preterm children. Manifestations include palatal deformations, enamel defects, tooth size variations and tooth shape deformities, malocclusions, and increased risks of early childhood caries and tooth wear. This article explores orodental risks and orodental needs of preterm children and suggests preventive and management strategies for optimizing the oral health of special needs children.

Laser fluorescence in monitoring the influence of targeted tooth brushing on remineralization of initial caries lesions on newly erupted molar teeth - RCT

OBJECTIVE

This study aimed to monitor mineralization changes in initial caries lesions on newly erupted second molars using laser fluorescence (LF) scanning after a 1-month targeted tooth brushing intervention.

METHODS

Altogether, 124 13- to 14-year-old school children were invited to participate. Of those who fulfilled the clinical criteria (at least one initial lesion with LF value >10 in second molars), 51 gave their written consent to participate. Laser fluorescence values were registered at baseline and after 1-month follow-up period. All participants were individually taught targeted tooth brushing of their second molars and randomly provided tooth paste with 0 or 1500 ppm fluoride. Brushing frequency was investigated at baseline and after the follow-up. Change in LF values was compared considering the tooth, content of fluoride in the paste and brushing frequency.

RESULTS

In lesions with LF values ≤30 at baseline, change in LF values demonstrated improvement. Improvement was detected especially in upper molars. In lesions with LF values >30 at baseline, improvement was least detected. Brushing frequency increased slightly during the intervention.

CONCLUSIONS

Laser fluorescence is a simple method and useful in monitoring remineralization of incipient lesions even in weeks. Targeted tooth brushing seems to induce remineralization even in weeks. Laser fluorescence could be a valuable motivating tool in promoting patients' self-care.

A randomized clinical study to assess ingestion of dentifrice by children

This study investigated whether there was a difference in amounts of dentifrice ingested by children based on age using pea-sized instructions. The study had a randomized, single-blinded, 3-period, crossover design modelled after Barnhart et al. (1974) with one regular-flavored and two specially-flavored dentifrices used ad libitum. Subjects were enrolled in three groups: 2-4, 5-7, and 8-12 years. They were instructed to brush at home as they would normally with each dentifrice for 3 weeks (9 weeks total). On weekly study-site visits, subjects brushed with the assigned dentifrice containing a lithium marker to measure the amount of dentifrice ingested and used. Averaging across dentifrices, amounts ingested were: 0.205 g (2-4 yr), 0.125 g (5-7 yr) and 0.135 g (8-12 yr), demonstrating 2-4 year-olds ingested significantly more than older children (p ≤ 0.002). Averaging across dentifrices, amounts used were: 0.524 g (2-4 yr), 0.741 g (5-7 yr) and 0.978 g (8-12 yr) suggesting an age-related effect (p < 0.01). Findings also showed that ingestion amount for specially-flavored dentifrices may increase relative to regular-flavored dentifrice for children 2-7 years-old. This research demonstrated that dentifrice ingestion amount decreased significantly with age while usage amount increased with age. Importantly, ingestion and usage levels in younger children reflect "pea-sized" direction and were numerically lower than historical levels reported prior to this direction.

The development and validation of a new technology, based upon 1.5% arginine, an insoluble calcium compound and fluoride, for everyday use in the prevention and treatment of dental caries

OBJECTIVE

This paper briefly discusses caries prevalence, the multi-factorial nature of caries etiology, caries risk and the role and efficacy of fluoride. The paper also highlights research on bacterial metabolism which provided understanding of the mouth's natural defenses against caries and the basis for the development of a new technology for the everyday prevention and treatment of caries. Finally, evidence that the technology complements and enhances the anti-caries efficacy of fluoride toothpaste is summarized.

CONCLUSIONS

Global data show that dental caries is a prevalent disease, despite the successful introduction of fluoride. Caries experience depends on the balance between consumption of sugars and oral hygiene and the use of fluoride. Three scientific concepts are fundamental to new measures to detect, treat and monitor caries: (1) dental caries is a dynamic process, (2) dental caries is a continuum of stages from reversible, pre-clinical to irreversible, clinically detectable lesions, and (3) the caries process is a balance of pathological and protective factors that can be modulated to manage caries. Fluoride functions as a protective factor by arresting and reversing the caries process, but fluoride does not prevent pathological factors that initiate the process. A novel technology, based upon arginine and an insoluble calcium compound, has been identified which targets dental plaque to prevent initiation of the caries process by reducing pathological factors. As the mechanisms of action of arginine and fluoride are highly complementary, a new dentifrice, which combines arginine with fluoride, has been developed and clinically proven to provide superior caries prevention.

Lactotransferrin Gene Polymorphism Associated with Caries Experience

Dental caries is a common multifactorial disease, resulting from the interaction of biofilm, cariogenic diet and host response over time. Lactotransferrin (LTF) is a main salivary glycoprotein, which modulates the host immune-inflammatory and antibacterial response. Although a genetic component for caries outcome has been identified, little is known over the genetic aspects underlying its susceptibility. Thus, the aim of this study was to investigate the association between LTF polymorphisms and caries susceptibility. Six hundred seventy seven 12-year-old students were selected: 346 with (DMFT ≥ 1) and 331 without caries experience (DMFT = 0). Also, individuals concentrating higher levels of disease (polarization group, DMFT ≥ 2, n = 253) were tested against those with DMFT ≤ 1 (n = 424). Along with clinical parameters, three representative LTF tag SNPs (rs6441989, rs2073495, rs11716497) were genotyped and the results were evaluated using univariate and multivariate analyses. Allele A for tag SNP rs6441989 was found to be significantly less frequent in the polarization group, conferring a protective effect against caries experience [AA + AG × GG (OR: 0.710, 95% CI: 0.514-0.980, p = 0.045)], and remained significantly associated with caries protection in the presence of gingivitis (p = 0.020) and plaque (p = 0.035). These results might contribute to the understanding of the genetic control of caries susceptibility in humans.

Inequalities in dental caries experience among 6-year-old German children after the caries decline

OBJECTIVE

As in many other countries, caries decline in Germany has left pockets of persisting caries prevalence. This study aims to assess the benefit of a 10-year community-based prophylaxis program, focused on regular toothbrushing with fluoridated toothpastes or gels and involving institutions noted as having the highest caries levels.

MATERIALS AND METHODS

The caries data (d3mft/D3MFT) was extracted from the results of the compulsory school entry examinations in Greifswald/Germany (2003/2004-2012/2013) involving ∼280 6-7-year-olds each year. Data from schools that include children with the highest caries levels and coming from low-SES families were analyzed independently and used for comparisons. Additionally, caries trends from Greifswald were compared to data from representative national surveys (2004-2009).

RESULTS

Data from 2871 children were available for analysis. The baseline d3mft value (2003/2004) was 3.2±3.8; the d3-component corresponded to 70% of the index. The latest caries data (2012/2013) showed a strong reduction (43.8%) in caries prevalence (d3mft=1.8±2.5). Similarly, the SiC-Index declined significantly from 2003/2004 (7.9±2.3) to 2012/2013 (4.8±2.3; p<0.001). Nevertheless, in all analyzed years the d3mft values and the SiC-Index were significantly higher in the institutions that included children coming from lower-SES families (p<0.05). The amount of caries reduction between 2004 and 2009 corresponded to 38% in Greifswald as compared to 13% in Germany.

CONCLUSIONS

This strategy involving a combination of regular toothbrushing and fluoride application has achieved an overall substantial caries reduction, thereby indicating that caries-control strategies for heterogeneous risk groups can be highly successful as setting approach. However, activities targeting high risk groups still need to be strengthened.

Non-surgical treatment of dentin caries in preschool children--systematic review

Background

Untreated dentin caries in primary teeth is commonly found in preschool children worldwide. Recently, the use of simple non-surgical approaches to manage the situation has been advocated.

The aim of the study was to systematically review and evaluate the literature on effectiveness of non-surgical methods in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children.

Methods

A systematic search of the main electronic databases (Pubmed, Cochrane Collaboration, EMBASE) was conducted to identify peer reviewed papers published in English in the years 1947–2014. Keywords and MeSH terms used in the search were “dental caries”, “primary dentition” and various non-surgical treatments (fluoride, sealant, resin infiltration, xylitol, chlorhexidine, CPP-ACP, ozone, etc.). The inclusion criteria were clinical studies conducted in children under 6 years old, and reported findings on caries arrest or caries progression in primary teeth. Retrieved papers were read by two reviewers independently to assess suitability for inclusion, and the final decision was made by consensus. Quality of the included studies was assessed and data were extracted for analysis.

Results

The search identified 323 papers for screening. Among these, 290 papers did not satisfy the study inclusion criteria. Consequently, 33 full papers were retrieved and reviewed. Finally, 4 studies were included. Three studies reported that topical applications of silver diammine fluoride (SDF) solution could arrest dentin caries in preschool children. One study supported that having a daily toothbrushing exercise in kindergarten using toothpaste with 1000 ppm fluoride could stabilize the caries situation in young children.

Conclusions

There is limited evidence to support the effectiveness of SDF applications or daily toothbrushing with fluoride toothpaste in arresting or slowing down the progression of active dentin caries in primary teeth in preschool children. More well-designed randomized controlled trials are required to confirm these findings.

In vitro assessment of a toothpaste range specifically designed for children

OBJECTIVE

To evaluate the ability of a range of low abrasivity experimental toothpastes designed for use by children at different stages of their development (typically ages 0-2 years, 3-5 years and 6+ years) to promote fluoride uptake and remineralisation of artificial caries lesions.

METHODS

pH cycling study: demineralised human permanent enamel specimens were subjected to a daily pH cycling regime consisting of four 1-minute treatments with toothpaste slurries, a 4-hour acid challenge and remineralisation in pooled whole human saliva. Surface microhardness (SMH) was measured at baseline, 10 days and 20 days, and the fluoride content determined at 20 days. Enamel Fluoride Uptake (EFU): these studies were based on Method #40 described in the US Food and Drug Administration (FDA) testing procedures. Abrasivity: relative enamel abrasivity (REA) and relative dentine abrasivity (RDA) were measured using the Hefferren abrasivity test. Bioavailable fluoride: the bioavailable fluoride was determined for all experimental toothpastes from slurries of one part toothpaste plus 10 parts deionised water.

RESULTS

Enamel remineralisation measured by changes in SMH correlated with enamel fluoride content. A statistically significant fluoride dose response was observed for all toothpastes tested across all age groups (P < 0.05). The fluoride content of specimens in the pH cycling model correlated with the EFU testing results. The enamel and dentine abrasivities were low and the level of bioavailable fluoride was high for all experimental toothpastes.

CONCLUSION

A series of low abrasivity experimental toothpastes were developed which were effective at promoting fluoride uptake and remineralisation of artificial caries lesions.

Shades of Decay: The Meanings of Tooth Discoloration and Deterioration to Mexican Immigrant Caregivers of Young Children

The objective of this article is to investigate parental understanding of tooth discoloration and decay and their related care seeking for young, Mexican-American children. The research design entailed semi-structured, face-to-face interviews conducted in Spanish with a convenience sample of 37 Mexican immigrant mothers of young children in a low-income urban neighborhood. Five major color terms - white, off-white, yellow, brown, and black - were used to describe tooth discoloration, the causes of which were mainly unrecognized or attributed to poor oral hygiene and exposure to sweet substances. Mothers also described three major levels of deterioration of the structural integrity of teeth due to caries, from stains to decayed portions to entirely rotten. A trend was observed between use of darker discoloration terms and extensive carious lesions. Teeth described as both dark in color and structurally damaged resulted in seeking of professional care. The paper concludes with the finding that Spanish terms used to describe tooth discoloration and carious lesions are broad and complex. Mexican immigrant mothers' interpretations of tooth discoloration and decay may differ from dental professionals' and result in late care seeking. Increased understanding between dental practitioners and caregivers is needed to create educational messages about the early signs of tooth decay.

Associations between Caries among Children and Household Sugar Procurement, Exposure to Fluoridated Water and Socioeconomic Indicators in the Brazilian Capital Cities

The objective of this ecological study was to investigate the association between caries experience in 5- and 12-year-old Brazilian children in 2010 and household sugar procurement in 2003 and the effects of exposure to water fluoridation and socioeconomic indicators. Sample units were all 27 Brazilian capital cities. Data were obtained from the National Surveys of Oral Health; the National Household Food Budget Survey; and the United Nations Program for Development. Data analysis included correlation coefficients, exploratory factor analysis, and linear regression. There were significant negative associations between caries experience and procurement of confectionery, fluoridated water, HDI, and per capita income. Procurement of confectionery and soft drinks was positively associated with HDI and per capita income. Exploratory factor analysis grouped the independent variables by reducing highly correlated variables into two uncorrelated component variables that explained 86.1% of total variance. The first component included income, HDI, water fluoridation, and procurement of confectionery, while the second included free sugar and procurement of soft drinks. Multiple regression analysis showed that caries is associated with the first component. Caries experience was associated with better socioeconomic indicators of a city and exposure to fluoridated water, which may affect the impact of sugars on the disease.

Desarrollo y validación de una nueva tecnología, basada en arginina al 1.5%, un compuesto de calcio insoluble y fluoruro, para el uso diario en la prevención y tratamiento de la caries dental

OBJETIVO

este artículo discute brevemente la prevalencia de caries, la naturaleza multifactorial de su etiología, el riesgo de caries y el papel y eficacia del fluoruro. Resalta también la investigación sobre el metabolismo bacteriano, que ha aportado conocimientos sobre la defensa natural oral contra la caries y la base para el desarrollo de una nueva tecnología para la prevención diaria y el tratamiento de la caries. Por último, se resume la evidencia que respalda que la tecnología complementa y mejora la eficacia anti-caries de la crema dental con fluoruro.

CONCLUSIONES

los datos globales muestran que a pesar de la exitosa introducción del fluoruro, la caries dental es una enfermedad prevalente. La experiencia de caries depende del balance entre el consumo de azúcares, la higiene oral y el uso del fluoruro. Hay tres conceptos científicos que son fundamentales en las nuevas mediciones para detectar, tratar y monitorear la caries: (1) la caries dental es un proceso dinámico, (2) la caries dental es un proceso continuo de etapas que van desde reversible (pre-clínica) hasta irreversible (lesiones clínicamente detectables), y (3) el proceso de la caries es un balance de factores patológicos y protectores que pueden modularse para el manejo de la caries. El fluoruro funciona como factor protector al detener y revertir el proceso de la caries, pero el fluoruro no previene los factores patológicos que inician el proceso. Se ha identificado una tecnología novedosa, basada en arginina y un compuesto insoluble de calcio, que está dirigida a la placa dental para prevenir la iniciación del proceso de caries al reducir los factores patológicos. Como los mecanismos de acción de la arginina y el fluoruro son altamente complementarios, se ha desarrollado un nuevo dentífrico que combina la arginina y el fluoruro, y se ha probado clínicamente que brinda una prevención superior contra la caries.

A systematic review on fluoridated food in caries prevention

OBJECTIVE

This paper aims to provide a systematic review of the caries-prevention effect of fluoridated food, excluding water. The main aim of this review was to evaluate the presence of scientific evidence relating to the effects of fluoride intake via food on the occurrence of carious lesions. The outcome was defined as a clinical outcome, so only papers evaluating a decrease in caries indices were included.

MATERIALS AND METHODS

Relevant databases (Medline®, Embase®, The Cochrane Library) were searched. The date range was set from 01.01.1966 to 03.31.2011. One hundred and thirty-nine reports were identified and assessed. Only three papers fulfilled the inclusion criteria and were discussed in detail.

RESULTS

No paper related to the use of fluoridated salt in caries prevention fulfilled the inclusion criteria. The use of milk as a vehicle for providing additional fluoride in a dental public health programme was evaluated in two papers. The consumption of fluoridated milk was an effective measure to prevent caries in the primary teeth. The use of fluoridated sugar demonstrated a reduction in caries increment in the permanent dentition in one paper.

CONCLUSIONS

Literature on the effectiveness of fluoridation in foods in caries prevention is scant and almost all the studies have been conducted in children. There is low evidence that the use of milk fluoridation is effective in reducing the caries increment.

Sodium fluoride induces apoptosis in odontoblasts via a JNK-dependent mechanism

Sodium fluoride (NaF) is widely used for the treatment of dental caries and dentin hypersensitivity. However, its pro-apoptotic effect on odontoblasts may lead to harmful side-effects. The purpose of this study was to evaluate the pro-apoptotic effects of NaF in odontoblasts and elucidate the possible underlying molecular mechanisms. NaF generated cytotoxic effects in odontoblast-lineage cell (OLC) in a dose- and time-dependent manner. Exposure of cells to 4mM NaF for 24h induced caspase-3 activation, ultrastructural alterations, and resulted in the translocation of Bax to the mitochondria and the release of cytochrome c from the mitochondrial inter-membrane space into the cytosol, indicating that fluoride-mediated apoptosis is mitochondria-dependent. Fluoride treatment also increased phosphorylation of JNK and ERK, but not p38, and apoptosis induced by fluoride was notably or partly suppressed by treatment with JNK or ERK inhibitors, respectively. Taken together, these findings suggest that NaF induces apoptosis in OLC odontoblasts through a JNK-dependent mitochondrial pathway.

Cárie dentária, disponibilidade de açúcar e fatores associados nas capitais brasileiras em 2003: um estudo ecológico

INTRODUÇÃO: A associação entre a disponibilidade de açúcar e a cárie dentária, utilizando-se dados populacionais, ainda não foi testada na população brasileira. OBJETIVO: Investigar a associação entre a experiência de cárie em crianças e a disponibilidade domiciliar de açúcar no Brasil, em 2003. Buscou-se ainda testar a provável influência de indicadores socioeconômicos e do acesso à água fluoretada. MATERIAL E MÉTODO: Este estudo ecológico analisou dados das 27 capitais brasileiras sobre cárie em crianças de cinco e 12 anos, e abastecimento de água fluoretada, obtidos do levantamento nacional de saúde bucal de 2003. Os dados sobre disponibilidade domiciliar de açúcar foram obtidos da Pesquisa de Orçamento Familiar (POF) de 2003 e, sobre indicadores socioeconômicos, do Programa das Nações Unidas para o Desenvolvimento em 2000. Na análise estatística, foram utilizados testes de correlação e regressão linear simples e múltipla. RESULTADO: Não houve associação significativa entre a experiência de cárie em crianças de cinco anos e as variáveis independentes. Na idade de 12 anos, menor experiência de cárie foi correlacionada à maior aquisição de refrigerantes, ao maior tempo de fluoretação e ao IDH e à renda per capita mais elevados. O resultado da regressão linear múltipla, ajustado pelo tempo de fluoretação das águas, indicou que esta variável explica os níveis de cárie mais baixos. Após o ajuste pelos demais fatores, nenhuma variável foi associada à cárie. CONCLUSÃO: Não houve associação entre a experiência de cárie em crianças e a disponibilidade domiciliar de açúcar nas capitais brasileiras em 2003, quando indicadores socioeconômicos e presença de água fluoretada foram considerados na análise.

Caries Clinical Trial Methods for the Assessment of Oral Care Products in the 21st Century

Traditionally, caries clinical trials of oral care products have focused on the prevention of caries in children and adolescents at the “cavitation” level. Because of a general reduction in caries incidence and the use of positive control comparators, studies have grown both in size and duration to improve statistical power. Currently, they tend to be of 2 to 3 years’ duration, with up to 2,000 high-risk individuals per group. During the past decade, there has been a shift in emphasis from a restorative approach to the treatment of dental caries to a therapeutic approach focused on the remineralization of early caries lesions. However, caries clinical trials of oral care products have not often reflected this paradigm change. This manuscript reviews alternative caries clinical trial methods for oral care products. It is concluded that methods focused on the detection and monitoring of enamel caries and root caries, by visual approaches such as ICDAS and instrumental methods such as QLF, Diagnodent, and Electrical Caries Monitors, provide viable alternatives to traditional methods. In particular, such approaches more accurately reflect the modes of action of many therapeutic agents and formulations and may reduce the cost and duration of product innovation.

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.

Is the use of fluoride toothpaste optimal? Knowledge, attitudes and behaviour concerning fluoride toothpaste and toothbrushing in different age groups in Sweden

OBJECTIVES

The most effective method to prevent caries is the regular use of fluoride toothpaste. The aim of this study was to evaluate self-care routines in a population by identifying knowledge, attitudes and behaviour relating to fluoride toothpaste and toothbrushing habits.

METHODS

A questionnaire was sent to 3200 individuals in two municipalities in Sweden. Four age groups representing different life stages were chosen: 15-16, 31-35, 61-65 and 76-80 years of age. The participants were selected from the population register by random selection of birth dates.

RESULTS

Totally 2023 (63%) individuals answered the questionnaire. The majority (84-94%) in all age groups brushed their teeth twice a day or more often. Good toothpaste behaviour identified as brushing at least twice a day, using at least 1 cm toothpaste, brushing 2 minutes or longer and using a small amount of water when rinsing was reported by only 10% of the respondents. The factors that increased the odds for having good caries-preventive behaviour were: (i) being female, (ii) being younger than 35 years, (iii) having knowledge about fluoride, (iv) finding use of fluoride toothpaste important and (v) rating own oral health as good.

CONCLUSIONS

The population seems to have embraced regular toothbrushing with fluoride toothpaste to a large extent. However, regarding techniques for using fluoride toothpaste effectively, there was great potential for improvement, especially among the older respondents.

Combination of high-fluoride toothpaste and no post-brushing water rinsing on enamel demineralization using an in-situ caries model with orthodontic bands

OBJECTIVE

To compare the effects on enamel demineralization and fluoride (F) retention of two different brushing–rinsing regimens.

MATERIAL AND METHODS

An in-situ caries model with orthodontic bands was used for 8–9 weeks. A total of 20 orthodontic patients participated. They were randomized into two groups: (1) a test group using 5000 ppm F (n = 10) with no post-brushing water rinsing; and (2) a control group using 1450 ppm F (n = 10) with three sessions of post-brushing water rinsing. Orthodontic stainless-steel bands were applied to the two upper first premolars, leaving 2–3 mm of space away from the exposed buccal surface in order to accumulate plaque and provoke initial caries development. The teeth were extracted after 8 and 9 weeks, then analysed using quantitative light-induced fluorescence (QLF). Additionally, oral F retention was compared for the two groups.

RESULTS

In comparison to the control group, the test regimen resulted in a non-significant smaller QLF lesion area and a significantly lower average QLF loss of fluorescence (P < 0.05). The highest F retention concentration under the band was found in the test group (P < 0.001).

CONCLUSIONS

The combination of using a 5000 ppm F toothpaste and no post-brushing water rinsing had a greater anti-caries potential and resulted in elevated oral F retention compared to a 1450 ppm F toothpaste with three sessions of post-brushing water rinsing.