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Ruff RR, Godín TB, Niederman R. The effectiveness of medical nurses in treating children with silver diamine fluoride in a school-based caries prevention program. Community Dent Oral Epidemiol 2024; 52:398-405. [PMID: 37873685 DOI: 10.1111/cdoe.12925] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The sustainability of school-based oral health programs depends on the utilization of effective, efficient treatments and the availability of a trained clinical workforce. The objective of this study was to determine whether registered nurses are comparable to dental hygienists in the application and effectiveness of silver diamine fluoride (SDF) and fluoride varnish (FV) for the prevention of dental caries. METHODS CariedAway was a school-based study of SDF and FV versus dental sealants and atraumatic restorations. Within the SDF + FV arm, participants were treated by either a licensed dental hygienist or a registered nurse, both under the supervision of a paediatric dentist. Although initial treatment assignment in CariedAway was randomized, assignment to provider was not. The proportion of children who remained caries free after 2 years was assessed for non-inferiority using two-group proportion tests, adjusting for the clustering effect of schools. RESULTS A total of 417 children with no untreated caries at baseline were analysed including 298 treated by hygienists and 119 by nurses. The proportion of children who remained caries free after 2 years was 0.81 and 0.80 for those treated by hygienists and nurses, respectively, for a difference of 0.01 (95% CI = -0.07, 0.098) and within the pre-determined non-inferiority margin. CONCLUSIONS Nurses may be effective in treating children with silver diamine fluoride and other fluoride varnishes in school-based oral health programs.
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Affiliation(s)
- Ryan Richard Ruff
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, New York City, USA
| | - Tamarinda Barry Godín
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, New York City, USA
| | - Richard Niederman
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, New York, New York City, USA
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Sun IG, Duangthip D, Chai HH, Luo BW, Lo ECM, Chu CH. Postoperative instructions for silver diamine fluoride therapy: A scoping review of current evidence and practice. J Dent 2024; 145:105029. [PMID: 38679132 DOI: 10.1016/j.jdent.2024.105029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVES Silver diamine fluoride (SDF) has gained popularity in dentistry as an anti-hypersensitive and anti-caries agent. This study aims to review the postoperative instructions for SDF therapy and examine the evidence supporting these instructions in treating dentine hypersensitivity and caries control. DATA AND SOURCES Two independent reviewers searched three electronic databases (EMBASE, PubMed, and Web of Science) to identify clinical studies that used SDF to treat dentine hypersensitivity and dental caries. Additionally, they searched Google Chrome for information from manufacturers, the department of health, national dental organisations, authoritative dental organisations, and universities regarding SDF therapy for these conditions. Data on postoperative instructions were extracted, and their impact on the treatment of dentine hypersensitivity and caries control was investigated. STUDY SELECTION This review included 74 clinical studies, 11 sets of instructions from SDF manufacturers, and six recommendations from national dental organisations, departments of health and universities. Amongst the included records, 50 clinical studies, two manufacturers, and one department of health mentioned postoperative instructions for SDF therapy. The recommendations varied, from suggesting no specific instructions, immediate rinsing, refraining from eating or drinking for 30 to 60 min, and even avoiding brushing until the next day after SDF therapy. Notably, no clinical studies reported the effects of these postoperative instructions on the SDF treatment of dentine hypersensitivity or dental caries. CONCLUSIONS This scoping review highlights the presence of inconsistent postoperative instructions for SDF therapy in the treatment of dentine hypersensitivity and caries control. Furthermore, there is a lack of evidence supporting the effectiveness of these instructions. CLINICAL SIGNIFICANCE No evidence supports the postoperative instructions for SDF therapy for managing dentine hypersensitivity and dental caries. Studies are necessary to provide guidance for clinicians using SDF in their clinical practice.
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Affiliation(s)
- Ivy Guofang Sun
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Duangporn Duangthip
- Division of Pediatric Dentistry, The Ohio State University, Columbus, United States
| | | | - Bella Weijia Luo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | | | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Muntean A, Mzoughi SM, Pacurar M, Candrea S, Inchingolo AD, Inchingolo AM, Ferrante L, Dipalma G, Inchingolo F, Palermo A, Bordea IR. Silver Diamine Fluoride in Pediatric Dentistry: Effectiveness in Preventing and Arresting Dental Caries-A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:499. [PMID: 38671716 PMCID: PMC11049537 DOI: 10.3390/children11040499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Tooth decay is considered a global scourge by the World Health Organization (WHO) starting at an early age. In recent years, silver diamine fluoride (SDF) has regained interest, particularly in pediatric dentistry, used to prevent the development of carious lesions or arrest their progression. OBJECTIVE The aim of this study was to assess, through a systematic review of the literature, the effectiveness of SDF, used in pedodontics, in temporary teeth, in preventing or arresting dental caries. MATERIAL AND METHODS An electronic search was conducted on PubMed, Web of Science and Scopus. The effect of SDF on both temporary and permanent teeth has been considered. RESULTS The inclusion criteria identified 16 randomized controlled trials involving patients aged 18 months to 13 years and followed over a period of 12-30 months. CONCLUSIONS SDF is a practical, accessible and effective non-invasive way to prevent and arrest caries in temporary and permanent teeth. Its application requires regular monitoring. The resulting black spot is diminished by immediate application of potassium iodide but this may affect its effectiveness.
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Affiliation(s)
- Alexandrina Muntean
- Department of Paediatric Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, 31 A. Iancu Street, 400083 Cluj-Napoca, Romania; (A.M.); (S.M.M.); (S.C.)
| | - Soundouss Myriam Mzoughi
- Department of Paediatric Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, 31 A. Iancu Street, 400083 Cluj-Napoca, Romania; (A.M.); (S.M.M.); (S.C.)
| | - Mariana Pacurar
- Department of Orthodontics, Faculty of Dental Medicine, University of Medicine, Pharmacy Science and Technology “G. E. Palade” Targu Mures Romania, Gheorghe Marinescu Street, nr. 38, 540139 Târgu Mureș, Romania;
| | - Sebastian Candrea
- Department of Paediatric Dentistry, Iuliu Hatieganu University of Medicine and Pharmacy, 31 A. Iancu Street, 400083 Cluj-Napoca, Romania; (A.M.); (S.M.M.); (S.C.)
| | - Alessio Danilo Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.M.I.); (L.F.); (G.D.)
| | - Angelo Michele Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.M.I.); (L.F.); (G.D.)
| | - Laura Ferrante
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.M.I.); (L.F.); (G.D.)
| | - Gianna Dipalma
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.M.I.); (L.F.); (G.D.)
| | - Francesco Inchingolo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.D.I.); (A.M.I.); (L.F.); (G.D.)
| | - Andrea Palermo
- College of Medicine and Dentistry, Birmingham B4 6BN, UK;
| | - Ioana Roxana Bordea
- Department of Oral Health, Iuliu Hatieganu University of Medicine and Pharmacy, 15 V. Babes Street, 400012 Cluj-Napoca, Romania;
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Baghlaf K, Sindi AE, Almughalliq FA, Alarifi NK, Alquthami R, alzahrani RA, Alhaid S. Effectiveness of silver diamine fluoride in indirect pulp capping in primary molars: A systematic review and meta-analysis. Heliyon 2023; 9:e19462. [PMID: 37809634 PMCID: PMC10558611 DOI: 10.1016/j.heliyon.2023.e19462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/08/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Recently, clinical trials have assessed the effectiveness of Silver Diamine Fluoride (SDF) as an indirect pulp capping material (IPC) in primary teeth. This systematic review aimed to assess the evidence presented in these trials. Data sources A comprehensive search identified relevant studies through five electronic databases (PubMed, Scopus, ClinicalTrials.gov, ScienceDirect, and Cochrane). Search strategies were designed using the PICO model to identify all studies that investigated SDF as an IPC compared to calcium hydroxide (CaOH) or mineral trioxide aggregate (MTA). Quality assessment and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were used to assess the level of evidence. Study selection Four clinical trials were found to be suitable for inclusion in the qualitative synthesis and three studies were included in the quantitative analysis. Three studies compared SDF with CaOH and only one study compared SDF, CaOH, and MTA. Only one randomized controlled trial (RCT) had a low risk of bias, and the non-RCT study had a moderate risk of bias. The level of evidence based on the GRADE was low. Three out of four studies showed higher clinical and radiographic outcomes with SDF than with CaOH. One non-RCT study showed that SDF resulted in the least reparative dentin at the 6-months follow-up. The meta-analysis showed a non-significant difference between the SDF and CaOH groups (P = 0.36). Conclusion There is little evidence showing a higher clinical and radiographic outcome of SDF compared to CaOH as an IPC material in primary molars. Clinical significance This systematic review updates pediatric dentists regarding the effectiveness of using SDF as indirect pulp caping in primary teeth.
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Affiliation(s)
- Khlood Baghlaf
- Pediatric Dentistry Department -King Abdulaziz University, Jeddah, Saudi Arabia
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Gadallah LK, Safwat EM, Saleh RS, Azab SM, Azab MM. Effect of silver diamine fluoride/potassium iodide treatment on the prevention of dental erosion in primary teeth: an in vitro study. BDJ Open 2023; 9:24. [PMID: 37414762 DOI: 10.1038/s41405-023-00153-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023] Open
Abstract
INTRODUCTION Dental erosion has a great effect on oral health, when diagnosed it is irreversible, this sets the importance of different preventive measures being investigated against dental erosion. AIM This in vitro study aims to evaluate the effectiveness of silver diamine fluoride and Potassium iodide (SDF-KI) in comparison to casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) varnish, sodium fluoride (NaF) varnish, silver diamine fluoride (SDF) alone and deionized water as a control group in the prevention of dental erosion in primary teeth and assessing its staining effect. MATERIALS AND METHODS Forty deciduous teeth enamel specimens were randomly allocated into the five study groups. Tested materials were applied. An erosive challenge was done by immersing the specimens in a citric acid-containing soft drink with pH 2.85, for 5 min, 4 times/day, for 5 days. Changes in surface microhardness, mineral loss, and color change were evaluated besides recording of the surface topography and surface roughness for selected specimens. RESULTS The highest decrease in surface microhardness was recorded in the control group (-85.21 ± 10.60%), with a statistically significant difference (p = 0.002). SDF-KI group (-61.49 ± 21.08%) showed no statistically significant difference when compared to CPP-ACPF, NaF, and SDF groups. For calcium and phosphorous loss, control group was statistically significantly higher compared to the treatment groups (p = 0.003) and (p < 0.001) respectively, while there was no statistically significant difference between the tested treatment groups. The highest mean value for color change was recorded in SDF group (26.26 ± 10.31), followed by SDF-KI group (21.22 ± 12.87) with no statistically significant difference between groups. CONCLUSIONS SDF-KI is as effective as CPP-ACPF, NaF varnishes and SDF in the prevention of dental erosion in primary teeth, there was no statistically significant difference regarding its staining potential.
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Affiliation(s)
- Lamia Khairy Gadallah
- Orthodontics and Pediatric Dentistry Department, National Research Centre, Giza, Egypt
| | - Engie Mohamed Safwat
- Restorative and Dental Materials Department, National Research Centre, Giza, Egypt
| | - Reham Sayed Saleh
- Restorative and Dental Materials Department, National Research Centre, Giza, Egypt
| | - Shereen Musa Azab
- Pharmaceutical Chemistry, Egyptian Drug Authority (EDA) (previous NODCAR), Giza, Egypt
| | - Maha Moussa Azab
- Department Pediatric Dentistry, Faculty of Dentistry, Fayoum University, Fayoum, Egypt.
- Department of Pediatric Dentistry, School of Dentistry, New Giza University NGU, Giza, Egypt.
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Sun IG, Duangthip D, Lo ECM, Chu CH. The Caries-Arrest Effectiveness of Silver Diamine Fluoride Treatment with Different Post-Treatment Instructions in Preschool Children: A Study Protocol for a Randomized Controlled Trial. Dent J (Basel) 2023; 11:145. [PMID: 37366668 DOI: 10.3390/dj11060145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/03/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
In this 12-month randomized active-controlled clinical trial, we compare two post-treatment instructions for silver diamine fluoride (SDF) therapy in arresting dentine caries. The trial will include at least 254 kindergarten children with active dentine caries. The children will be randomized into two groups and receive a 38% SDF solution applied topically to their carious lesions. Children in Group A will rinse immediately, whereas those in Group B will refrain from rinsing, eating, and drinking for 30 min. One trained examiner will perform the dental examination at baseline and every six months. The primary outcome measurement will be the proportion of caries lesions that become arrested at the 12-month examination. Potential confounding factors and parents' satisfaction with SDF therapy at baseline and after 12 months will be collected using parental questionnaires. This trial will provide evidence-based information for clinical practitioners to give post-treatment instructions for SDF therapy. This study is registered at ClinicalTrial.gov (USA) (registration number: NCT05655286).
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Affiliation(s)
- Ivy Guofang Sun
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | | | | | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Bonifácio CC, Hesse D. Is silver diammine fluoride effective in arresting dental caries in cavitated primary molars? Evid Based Dent 2023; 24:50-51. [PMID: 37130922 DOI: 10.1038/s41432-023-00874-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 05/04/2023]
Abstract
CLINICAL QUESTION To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dental caries in cavitated caries lesions in primary molars. DATA SOURCES A systematic search was carried out in PubMed, Scopus, and Embase. Furthermore, cross-referencing was performed using the references lists of full-text articles and grey literature was also retrieved for eligible studies. Two independent reviewers were responsible for study selection and data extraction. STUDY SELECTION Randomized and non-randomized clinical studies that evaluated the caries arrest rate of SDF compared to no treatment or any other type of non-invasive or minimally-invasive treatment were included. Only publications in the English, Italian and French language and with a minimum follow-up of 6 months were considered for study eligibility. DATA EXTRACTION AND SYNTHESIS The characteristics of the included studies-age, sex, type of study, sample size, caries at baseline, setting, operator, blinding, intervention, outcomes and assessment of any confounders-were extracted from the included papers. The quality assessment was carried out using the Cochrane risk of bias tool. The success rate and odds ratios were chosen to calculate the effect size for the meta-analysis. RESULTS A total of nine publications were included for qualitative review and five of them were included in the meta-analysis. Around half of lesions that received annual or biannual application SDF ≥ 38% were arrested. CONCLUSIONS SDF 38% application was found to be effective in arresting dental caries progression in cavitated primary molars.
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Affiliation(s)
- C C Bonifácio
- Paediatric Dentistry, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands.
| | - D Hesse
- Paediatric Dentistry, Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
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Xie Z, Yu L, Li S, Li J, Liu Y. Comparison of therapies of white spot lesions: a systematic review and network meta-analysis. BMC Oral Health 2023; 23:346. [PMID: 37264364 DOI: 10.1186/s12903-023-03076-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/25/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE White spot lesions (WSLs), the earliest evidence of enamel demineralization, are considered amenable to intervention to achieve a remineralized or arrested state of caries. The management of WSLs is quite challenging, and there is no definitive cure as yet. We performed a network meta-analysis to assess the efficacy of seven therapies for WSLs and gave a hierarchy of them. MATERIALS AND METHODS We systematically searched the PubMed, EMBASE, Cochrane, and Web of Science databases (last search: July 2022) to identify all relevant studies. We limited our search to studies published in English. Randomized controlled designed in vitro/clinical trials related to the efficacy of the seven therapies for WSLs were included. Data extraction was performed independently by two reviewers. The risk of bias (ROB) 2.0 tool from Cochrane and a previous in vitro methodological tool will be used for the quality assessment. Variations in quantitative light-induced fluorescence (QLF), laser fluorescence (LF), and lesions area were the primary outcome measures. Standard mean difference (SMD) was used as the effect size for the Network meta-analysis (NMA). Consistency and inconsistency tests were conducted. The hierarchy of 7 treatment effects was evaluated using surface probabilities under cumulative ranking (SUCRA). Publication bias was evaluated using a bias plot. RESULTS Forty-two articles were included in the systematic review. Thirty-one of them, with a total of 1906 participants, were included in the network meta-analysis. The studies owned a low and moderate risk of bias. This analysis does not suffer from significant inconsistency. The difference between 4 groups 'self-assembled peptide (SAP) P11-4', 'P11-4 + Fluoride Varnish (FV)', 'Resin Infiltration (RI)', 'casein phosphor peptides-amorphous calcium fluoride phosphate (CPP-ACFP)' and the 'Control' group was found to be statistically significant. Compared to the 'FV' and 'casein phosphor peptides-amorphous calcium phosphate (CPP-ACP)' groups, the 'P11-4 + FV" group and 'RI" group made a significant difference. The hierarchy was evident in the SUCRA values of 7 therapies. P11-4 + FV and RI were considered effective therapies compared to the control group or the FV group (gold standard group). CONCLUSIONS The available evidence suggests that resin infiltration and P11-4 in combination with fluoride varnish had advantages over gold standard (FV). The effect of tricalcium phosphate-based drugs and fluoride is not very noticeable. Overall, drugs based on P11-4 and resin infiltration will be better therapies. Using more than two drugs in combination also would increase efficacy.
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Affiliation(s)
- Zunxuan Xie
- Department of Endodontics, Hospital of Stomatology, Jilin University, Jilin, China
| | - Lei Yu
- Department of Orthodontics, Hospital of Stomatology, Jilin University, Jilin, China
| | - Sining Li
- Department of Prosthodontics, Hospital of Stomatology, Jilin University, Jilin, China
| | - Jianing Li
- Department of Endodontics, Hospital of Stomatology, Jilin University, Jilin, China
| | - Yuyan Liu
- Department of Endodontics, Hospital of Stomatology, Jilin University, Jilin, China.
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Ruff RR, Barry-Godín T, Niederman R. Effect of Silver Diamine Fluoride on Caries Arrest and Prevention: The CariedAway School-Based Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2255458. [PMID: 36757696 PMCID: PMC9912124 DOI: 10.1001/jamanetworkopen.2022.55458] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
IMPORTANCE Dental caries is the most common global childhood disease. To control caries, the Centers for Disease Control and Prevention recommends school-based caries prevention, and the World Health Organization lists glass ionomer cement and silver diamine fluoride as essential medicines for oral disease. OBJECTIVE To determine the noninferiority of silver diamine fluoride with fluoride varnish vs traditional glass ionomer sealants with fluoride varnish after 2 years when provided to children via a school-based health care program. DESIGN, SETTING, AND PARTICIPANTS The CariedAway study is an ongoing single-blind, cluster randomized, noninferiority trial conducted between February 1, 2019, and June 1, 2023, among 2998 children in 47 New York City primary schools. Children aged 5 to 13 years of any race and ethnicity were recruited from block-randomized schools. Inclusion criteria for schools were a student population of at least 50% Hispanic or Latino or Latina ethnicity and/or Black race and at least 80% of students receiving free or reduced-cost lunch. Statistical analysis is reported through March 2022. INTERVENTIONS Children received a single application of silver diamine fluoride with fluoride varnish or an active comparator of glass ionomer sealants and atraumatic restorations with fluoride varnish. MAIN OUTCOMES AND MEASURES Primary outcomes were caries arrest and incidence after a 2-year follow-up, assessed using mixed-effects multilevel models and clustered 2-sample proportion tests. The noninferiority margin was 10%. Intention-to-treat analysis was performed using multiple imputation. RESULTS A total of 2998 children (1566 girls [52.2%]; mean [SD] age at baseline, 6.6 [1.2] years; 1397 Hispanic or Latino or Latina children [46.6%]; 874 [29.2%] with untreated dental caries) were recruited and treated from September 16, 2019, to March 12, 2020. Follow-up observations were completed for 1398 children from June 7, 2021, to March 2, 2022. The mean (SE) proportion of children with arrested caries was 0.56 (0.04) after experimental treatment and 0.46 (0.04) after control treatment (difference, -0.11; 95% CI, -0.22 to 0.01). The mean (SE) proportion of patients without new caries was 0.81 (0.02) after experimental treatment and 0.82 (0.02) after control treatment (difference, 0.01; 95% CI, -0.04 to 0.06). Analysis of imputed data for the full sample did not deviate from per-protocol analyses. There were no adverse events. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, silver diamine fluoride with fluoride varnish was noninferior to sealants and atraumatic restorations with fluoride varnish for caries arrest and prevention. Results may support the use of silver diamine fluoride as an arresting and preventive agent in school-based oral health programs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03442309.
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Affiliation(s)
- Ryan Richard Ruff
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, New York
| | - Tamarinda Barry-Godín
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, New York
| | - Richard Niederman
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, New York
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Survival Analysis and Cost Effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and ART Occlusal Restorations in Primary Molars: a randomized controlled trial. J Dent 2023; 128:104379. [PMID: 36460236 DOI: 10.1016/j.jdent.2022.104379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/03/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To evaluate and compare the clinical performance and cost effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and Atraumatic Restorative Treatment (ART) restorations in primary molars over 12 months follow up period. MATERIALS AND METHODS Sixty-seven children, aged 5-9 years old having at least one asymptomatic primary molar with active caries, were randomly assigned to either the test arm (SMART) or the control arm (ART). Clinical performance was assessed after 6 and 12-months using the modified United States Public Health Services criteria. The trial was registered at Clinical Trial.gov with a registration number (NCT03881020). Treatment time for each restoration was recorded, Kaplan-Meier survival analysis and the log-rank test were performed (p<0.05) and cost effectiveness was measured at the end of the study. RESULTS Both techniques showed comparable clinical performance and the mean survival time was 11.8 and 11.6 months for SMART and ART restorations respectively with no detected significant differences (p=0.416). Mean treatment time for SMART restorations (7.8 min.), however, was significantly lower than ART (15 min.) (p < 0.001). SMART technique, also, showed statistically significant lower mean total cost per restoration (p <0.001). CONCLUSIONS Though SMART and ART have comparable clinical performance and survival in single-surface occlusal restorations in primary molars, SMART is less time consuming and more cost effective. CLINICAL SIGNIFICANCE Using SMART technique could change paradigms in caries management. Being a patient friendly and cost-effective approach, it could be adopted as a superior treatment option when dealing with young children, those with behavioral and medical challenges and for promoting access to oral care among the underprivileged.
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Aly MM, Yousry YM. Potential discolouration of silver diamine fluoride versus silver diamine fluoride/potassium iodide in primary teeth: a randomised clinical study. Br Dent J 2022:10.1038/s41415-022-5272-9. [PMID: 36473976 PMCID: PMC9734755 DOI: 10.1038/s41415-022-5272-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/29/2022] [Indexed: 12/12/2022]
Abstract
Aim This study aimed to evaluate the potential discolouration and carious lesion arresting effect of silver diamine fluoride (SDF) and silver diamine fluoride/potassium iodide (SDF/KI) in the treatment of carious primary teeth.Materials and method A total of 30 carious primary canines were randomly assigned to treatment groups where Group I was treated with SDF while Group II was treated with SDF/KI. Caries arrest was assessed based on consistency and stability of lesion size while the discolouration of treated lesions was assessed digitally using a VITA Easyshade spectrophotometer.Results Both treatments demonstrated 100% efficacy in arresting active caries lesions. Regarding discolouration, the total colour difference represented by delta E (ΔE) was 16.45 ± 5.69 for Group I compared to 9.54 ± 3.09 for Group II immediately post-operative, with a statistically significant difference (p = 0.003). Both groups showed similar values at 1, 3, 6 and 12 months after the treatment, with no statistically significant difference. No incidence of serious adverse effects related to either treatment and the majority of parents/guardians were satisfied with both treatments compromising their child's aesthetic appearance.Conclusions Both SDF and SDF/KI are effective in arresting carious lesions in primary teeth but in terms of the discolouration potential, the use of KI significantly reduced the discolouration caused by SDF immediately post-operatively. Unfortunately, marked discolouration was recorded in the subsequent follow-up visits, compromising the aesthetic outcome.
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Affiliation(s)
- Mariam M Aly
- Lecturer of Paediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Egypt.
| | - Yasmin M Yousry
- Lecturer of Paediatric Dentistry and Dental Public Health, Faculty of Dentistry, Cairo University, Egypt
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Zaffarano L, Salerno C, Campus G, Cirio S, Balian A, Karanxha L, Cagetti MG. Silver Diamine Fluoride (SDF) Efficacy in Arresting Cavitated Caries Lesions in Primary Molars: A Systematic Review and Metanalysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12917. [PMID: 36232217 PMCID: PMC9566773 DOI: 10.3390/ijerph191912917] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
A systematic review and meta-analysis were carried out to evaluate the efficacy of silver diamine fluoride (SDF) in controlling caries progression in cavitated primary molars. A search for randomized and non-randomized trials with follow-up > 6 months was performed using PubMed, Scopus and Embase. The Cochrane risk of bias tools were used for the quality assessment. The success rate and odds ratios were chosen to calculate the effect size for the meta-analysis. A total of 792 papers were identified and 9 were selected. A high variability regarding SDF application protocol was found; otherwise, caries arrest was always recorded using visual/tactile methods. Two studies were judged at low risk of bias, six at moderate risk and one at high risk. Data from five studies were aggregated for meta-analysis. Heterogeneity was found moderate (I2 = 35.69%, p = 0.18). SDF application was found to be overall effective (fixed effect model) in arresting caries progression (ES = 0.35, p < 0.01). In a total of 622 arrested lesions, out of 1205 considered, the caries arrest rate was 51.62% ± 27.40% (Confidence = 1.55) using SDF ≥ 38% applied annually or biannually. In conclusion, when applied to active cavitated caries lesions in primary molars, SDF appears to be effective in arresting dental caries progression, especially if applied biannually.
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Affiliation(s)
- Luciano Zaffarano
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Claudia Salerno
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012 Bern, Switzerland
- Department of Pediatric, Preventive Dentistry and Orthodontics, School of Dentistry, Sechenov University, 119991 Moscow, Russia
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Viale San Pietro 3/c, 07100 Sassari, Italy
| | - Silvia Cirio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Araxi Balian
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Lorena Karanxha
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
| | - Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy
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Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2022; 128:248-330. [PMID: 36096911 DOI: 10.1016/j.prosdent.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022]
Abstract
The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.
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Brunet‐Llobet L, Auría‐Martín B, González‐Chópite Y, Cahuana‐Bartra P, Mashala EI, Miranda‐Rius J. The use of silver diamine fluoride in a children's hospital: Critical analysis and action protocol. Clin Exp Dent Res 2022; 8:1175-1184. [PMID: 35869630 PMCID: PMC9562575 DOI: 10.1002/cre2.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives The present critical analysis aims to propose an action protocol for the use of silver diamine fluoride (SDF) in pediatric patients in a hospital setting, especially for those who are currently awaiting hospital dental treatment under general anesthesia. Material and Methods A literature search was performed in the PubMed/MEDLINE from 2009 to 2021 using the search terms “silver diamine fluoride”, “pediatrics silver diamine fluoride”, “application silver diamine fluoride”, and “AND” ‐ combined with terms: “potassium iodide”, “properties”, “adverse effects”, “early childhood caries”, “patient with disability”, “management”, “special health care needs patient”. Articles that recorded the type of teeth, application protocol, the concentration of the product, and possible complications of the treatment were selected. Results Four hundred and sixteen related articles were obtained, of which 13 were finally chosen on the basis of the search criteria. The age at which the use of SDF was recommended ranged from the first year of life to 12 years, in most cases in primary teeth. The study populations varied in size from 53 to 799 patients. An analysis of the characteristics of SDF and its use in pediatric patients with dental caries was performed. The recommended concentration was 38% SDF, applied twice yearly. The main complication reported was staining. A decision algorithm was designed including SDF as an agent for caries control in patients attending the specific population of our hospital (divided into two groups: healthy children aged 0−4 years and patients with special health care needs (SHCNs) aged 0−18 years). Conclusions SDF therapy appears to be effective in the control of caries in pediatric patients. We propose an action protocol for patients with early childhood caries to reduce risk, complications, and the progression of lesions. The protocol is aimed especially at pediatric patients who also have some systemic pathology, disability, SHCNs, and/or behavioral difficulties.
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Affiliation(s)
- Lluís Brunet‐Llobet
- Department of Pediatric Dentistry, Hospital Sant Joan de DéuUniversity of BarcelonaBarcelonaSpain
- Hospital Dentistry, Clinical Orthodontics and Periodontal Medicine Research Group (HDCORPEMrg)Institut de Recerca Sant Joan de Déu (IRSJD)BarcelonaSpain
| | - Beatriz Auría‐Martín
- Department of Pediatric Dentistry, Hospital Sant Joan de DéuUniversity of BarcelonaBarcelonaSpain
| | - Yndira González‐Chópite
- Department of Pediatric Dentistry, Hospital Sant Joan de DéuUniversity of BarcelonaBarcelonaSpain
- Hospital Dentistry, Clinical Orthodontics and Periodontal Medicine Research Group (HDCORPEMrg)Institut de Recerca Sant Joan de Déu (IRSJD)BarcelonaSpain
| | - Pau Cahuana‐Bartra
- Department of Pediatric Dentistry, Hospital Sant Joan de DéuUniversity of BarcelonaBarcelonaSpain
- Hospital Dentistry, Clinical Orthodontics and Periodontal Medicine Research Group (HDCORPEMrg)Institut de Recerca Sant Joan de Déu (IRSJD)BarcelonaSpain
- Department of Odontostomatology, Faculty of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
| | - Elias Isaack Mashala
- Doctoral Programme in Medicine and Translational Research, Line of Odontostomatology. Faculty of Medicine and Health Sciences, Hospital Sant Joan de DéuUniversity of BarcelonaBarcelonaSpain
| | - Jaume Miranda‐Rius
- Hospital Dentistry, Clinical Orthodontics and Periodontal Medicine Research Group (HDCORPEMrg)Institut de Recerca Sant Joan de Déu (IRSJD)BarcelonaSpain
- Department of Odontostomatology, Faculty of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
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García-Bernal D, Pecci-Lloret MP, López-García S. The Cytocompatibility of Silver Diamine Fluoride on Mesenchymal Stromal Cells from Human Exfoliated Deciduous Teeth: An In Vitro Study. MATERIALS 2022; 15:ma15062104. [PMID: 35329556 PMCID: PMC8954535 DOI: 10.3390/ma15062104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
Silver diamine fluoride (SDF) has been used for many years for the treatment of caries, and minimally invasive dentistry concepts have made it popular again. The fact that its application does not require the administration of anesthesia makes its use in children more desirable. The aim of this study was to determine the cytotoxicity of two new commercial SDF products: Riva Star (SDI Dental Limited) and e-SDF (Kids-e-Dental) on mesenchymal stromal cells from human exfoliated deciduous teeth (SHEDs). SHEDs were exposed to SDF products at different concentrations (0.1%, 0.01% and 0.005%). Then different assays were performed to evaluate their cytocompatibility on SHEDs: IC50, MTT, cell migration (wound healing), cell cytoskeleton staining, cell apoptosis, generation of intracellular reactive oxygen species (ROS), and ion chromatography. Statistical analyses were performed using one-way ANOVA and Tukey’s post hoc test (p < 0.05). Riva Star Step 2 showed the same cell metabolic activity when compared to the control condition at any time and concentration. Meanwhile, e-SDF displayed high cytotoxicity at any time and any concentration (*** p < 0.001), whereas Riva Star Step 1 displayed high cytotoxicity at any time at 0.1% and 0.01% (*** p < 0.001). Only e-SDF showed a statistically significant decreased cell migration rate (*** p < 0.001) at all times and in all concentrations. At 0.1%, e-SDF and Riva Star Step 1 only showed 4.37% and 4.47% of viable cells, respectively. These results suggest that Riva Star has better in vitro cytocompatibility on SHEDs than does e-SDF. Riva Star Step 1 was found to be as cytotoxic as e-SDF, but it had better biological properties when mixed with Riva Star Step 2. Our findings suggest that Riva Star is more suitable when used in deciduous teeth due to its lower cytotoxicity compared to e-SDF.
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Affiliation(s)
- David García-Bernal
- Biochemistry, Molecular Biology and Immunology Department, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain;
| | - Maria Pilar Pecci-Lloret
- Gerodontology and Special Care Dentistry Unit, Morales Meseguer Hospital, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
- Correspondence: ; Tel.: +34-8688-8575
| | - Sergio López-García
- Department of Stomatology, Faculty of Medicine and Dentistry, Universitat de Valencia, 46003 Valencia, Spain;
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Cleary J, Al-Hadidi R, Scully A, Yahn W, Zaid Z, Boynton JR, Eckert GJ, Yanca E, Fontana M. A 12-Month Randomized Clinical Trial of 38% SDF vs. Restorative Treatment. JDR Clin Trans Res 2022; 7:135-144. [PMID: 35120408 DOI: 10.1177/23800844211072741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this 2-arm, parallel-group, 12-mo randomized clinical trial was to compare the effectiveness of semiannual application of 38% silver diamine fluoride (SDF) versus restorative treatment (RT) to manage cavitated caries lesions in primary teeth in a diverse population of children in Michigan. METHODS Children aged 2 to 10 y with at least 1 soft cavitated lesion (International Caries Detection and Assessment System 5 or 6) with no pain or signs/symptoms of irreversible pulpitis were recruited and randomly assigned to 2 intervention groups. One random lesion per child received 38% SDF (twice, at a 6-mo interval) or RT. All interventions and assessments were done by calibrated dentists. Primary outcome measures were clinical failure rates: minor (e.g., reversible pulpitis, active/soft lesion or progression, restoration loss or need for replacement/repair, secondary caries) and major (e.g., irreversible pulpitis, abscess, extraction). Parent, child, and provider acceptability was also assessed. RESULTS Ninety-eight children were enrolled and randomized, with a mean (SD) age of 4.8 y (1.8); 46% were female and their mean dmft + DMFT was 6.3 (3.9). Sixty-nine children were assessed at 12 mo (sample was within the planned 30% attrition rate). There were significantly more teeth with minor failures (SDF = 65%, RT = 23%, P ≤ 0.001) and major failures (SDF = 13%, RT = 3%, P ≤ 0.001) in the SDF group than the RT group; 74% of SDF-treated lesions were hard at 12 mo vs. 57% at 6 mo. Providers stated that SDF was easier, faster, and more preferable than RT (P ≤ 0.001). No significant differences were found in parental satisfaction and acceptability. At 12 mo, children in the RT arm felt significantly (P < 0.05) happier with their tooth appearance and stated that their visit to the dentist hurt less. CONCLUSION At 12 mo, SDF-treated lesions had significantly more minor and major failures than RT, suggesting that SDF-treated teeth need to be closely monitored in a population at high caries risk (ClinicalTrials.gov NCT02601833). KNOWLEDGE OF TRANSFER STATEMENT The results of this study can be used by clinicians when deciding whether to restore or apply silver diamine fluoride to cavitated lesions in primary teeth. Information on treatment outcomes and parent, child, and provider acceptability can help guide appropriate treatment decisions and need for monitoring.
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Affiliation(s)
- J Cleary
- Private practice, East Lansing, MI, USA
| | - R Al-Hadidi
- Private practice, Grosse Pointe and Novi, MI, USA
| | - A Scully
- Department of Pediatric Dentistry, School of Dentistry, Indiana University, Indianapolis, IN, USA
| | - W Yahn
- Private practice, Saginaw, MI, USA
| | - Z Zaid
- Private practice, Westminster, CO, USA
| | - J R Boynton
- Division of Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - G J Eckert
- Department of Biostatistics and Health Data Science, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA
| | - E Yanca
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - M Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
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Ali AM, Abdellatif HM, Baghdady SI, Abdelaziz WE, Elkateb MA. Child discomfort and parental acceptability of silver diamine fluoride and alternative restorative treatment: A randomized controlled clinical trial. J Dent 2021; 114:103811. [PMID: 34530059 DOI: 10.1016/j.jdent.2021.103811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/22/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To compare pain perception of young children treated with SDF and ART, as well as their parents' acceptability of both modalities. METHODS Eighty, 3 to 8-years old children, having at least one deciduous asymptomatic tooth with active caries, as defined by the ICDAS II scores 4, 5, 6 were randomly assigned into two groups; SDF for caries arresting in the test group, and ART for caries removal in the control group. Pain perception was assessed using Sound, Eye, Motor scale (SEM), whereas parental acceptability was assessed using a self-administered questionnaire. RESULTS Patients treated with SDF reported significantly less discomfort and pain compared to the ART group, with a mean SEM of 3.70 ± 1.47 and 6.18 ± 3.06, respectively (p < 0.001). A significantly higher mean parental acceptability score was detected for SDF treatment (31.85 ± 2.30) than ART treatment (26.75 ± 3.60), p < 0.001, with regard to the treatment duration, child comfortability and quality of treatment (p < 0.001). The only dimension showing more satisfaction for the ART treatment was esthetics of anterior teeth (p= 0.01). CONCLUSIONS Parental acceptability was higher for the SDF caries treatment of primary teeth compared to ART treatment, especially in relation to the shorter intervention time, child comfortability and acceptance as well as quality of treatment. CLINICAL SIGNIFICANCE The shorter average time needed and the ease of application of SDF on cavitated primary lesions, in addition to parental acceptability, place SDF in an advantageous position over the ART on clinical level.
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Affiliation(s)
- Amel Mahmoud Ali
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt and College of Dentistry, Preventive Dental Sciences Department, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hoda Mahmoud Abdellatif
- College of Dentistry, Preventive Dental Sciences Department, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sarah Ibrahim Baghdady
- Faculty of Dentistry, Alexandria University, Champollion Street, Azaritah, Alexandria, Egypt.
| | | | - Mona Abdallah Elkateb
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt and College of Dentistry, Preventive Dental Sciences Department, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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