High fluoride dentifrice for preventing and arresting root caries in community-dwelling older adults: A randomized controlled clinical trial

Hagfish-inspired hydrogel for root caries: A multifunctional approach including immediate protection, antimicrobial phototherapy, and remineralization

Root caries is the main cause of oral pain and tooth loss in the elderly. Protecting root lesions from environmental disturbances, resisting pathogens, and facilitating remineralization over time are essential for addressing root caries, but are challenging due to the irregular root surface and the complex oral environment. Hagfish secretes slime when facing danger, which converts into gels upon contact with seawater, suffocating the predators. Inspired by hagfish's defense mechanism, a fluid-hydrogel conversion strategy is proposed to establish a mechanical self-regulating multifunctional platform for root caries treatment. The fluid system (silk fibroin-tannic acid-black phosphorene-urea, ST-BP-U), in which urea disrupts the hydrogen bonds between silk fibroin and tannic acid, can easily spread on the irregular root surface and permeate into dentinal tubules. Upon contact with the surrounding water, urea diffuses, prompting the hydrogel re-formation and creating intimate attachments with micromechanical inlay locks. Meanwhile, BP increases the crosslinking of the re-formed hydrogel network, resulting in reinforced cohesion for robust wet adhesion to the tooth root. This process establishes a structured platform for effective antimicrobial phototherapy and dentin remineralization promotion. This water-responsive fluid-hydrogel conversion system adapts to the irregular root surface in the dynamic wet environment, holding promise for addressing root caries. STATEMENT OF SIGNIFICANCE: Root caries bring a heavy burden to the aging society, but the irregular root surface and dynamic moist oral environment always hinder non-surgical therapeutic effects. Here, we propose a water-responsive fluid-hydrogel conversion strategy aimed at mechanical self-regulation on the irregular and wet root interface to construct a functional structural platform. The liquid system (ST-BP-U) that prebreak intermolecular hydrogen bonds can easily spread on irregular surfaces and dentin tubules. When encountering water, hydrogen bonds re-form, and BP increases the crosslinking of the hydrogel formed in situ. Based on this firm wet-adhesion platform, it provides powerful phototherapy effects and promotes dentin remineralization. This fluid-hydrogel conversion system turns the disadvantages of wet environment into advantages, offering a promising strategy for root caries.

Use of oral health care services among older home care clients in the context of an intervention study

BACKGROUND

An increasing number of care-dependent older people living at home need external support to receive regular dental care.

OBJECTIVES

To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self-care and nutrition.

MATERIALS AND METHODS

This study employed data from the multidisciplinary Nutrition, Oral Health and Medication (NutOrMed) intervention study with a population-based sample of 245 home care clients (74% female) aged 75 or more divided in intervention (n = 140) and two control groups (n = 105). The data were collected through interviews at baseline and 6-month follow-up.

RESULTS

At baseline, 43% of participants reported visits to oral health care within the previous year. At 6-month follow-up, this proportion was 51%. In the intervention group, the corresponding figures were 46% and 53%, and in the controls 39% and 48%. Adjusted regression analyses showed that this change was statistically significant (p = 0.008). In addition, higher education and toothache or other discomfort related to teeth or dentures at baseline were associated with increased use after the 6-month follow-up (OR = 1.1, 95% CI = 1.0-1.2; OR = 3.4, 95% CI = 1.5-7.9) but being edentulous indicated the opposite (OR = 0.2, 95% CI = 0.1-0.4). Belonging to the intervention group was not associated with increased use.

CONCLUSIONS

In older adults, any efforts to raise awareness of oral health are of great potential to increase use of services.

Oral health and healthy ageing: a scoping review

BACKGROUND

Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people.

METHODS

A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O'Malley's scoping review framework.

RESULTS

The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride.

CONCLUSION

There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.

Prevention of oral diseases for the older person (Part 1)

Older adults often experience poorer levels of oral health than younger adults, especially if they have become dependent on a third party to support their daily oral care routine. However, the deterioration of oral health does not need to be a part of the ageing process. Most oral diseases are largely preventable with the daily removal of dental plaque that forms on teeth and dentures, using a fluoride toothpaste, eating a healthy diet and reducing any tobacco consumption. The dental team have a duty of care to ensure that older people receive evidence-based oral health preventative advice tailored to the individual, taking into account individual risk factors that can increase with age. This can include the clinical application of topical fluoride and minimally invasive dentistry. Older people at an increased risk of poor oral health include those with cognitive conditions, physical impairments and certain medical conditions. Care home residents face particular barriers to attaining a satisfactory standard of oral care which are discussed herein. Good oral health preventative routines must be established early after the diagnosis of progressive chronic conditions and will help to prevent the need for dental intervention later in life when treatment can be more difficult to tolerate. Inclusion of oral health prevention within health policy and legislation is necessary to improve the oral health for older people living in all health and care settings.

Immediate and Sustained Root Caries Prevention of Fluoride Varnish Combined with Toothpastes

The aim of this study was to determine the immediate and sustained effect of a fluoride varnish and its combinations with toothpastes in preventing root caries development using a salivary microcosm in vitro model. Human root dentin specimens (n = 150) were randomly divided into 5 experimental protocols (n = 30): (1) Fluoride Varnish (V); (2) V followed by Paste One (V + PO); (3) V followed by Paste Plus (V + PP); (4) V followed by PO and PP (V + PO + PP); and (5) No treatment (control). One varnish layer was applied on the specimens (except for the control group) and kept for 18 h. Then, the varnish was removed and toothpaste treatments were initiated according to experimental groups. For the short-term incubation model (n = 15), the specimens were also immediately subjected to 7-day cariogenic challenge. For that, human saliva was used as bacterial inoculum and McBain artificial saliva containing 2% sucrose as growth medium. The other half of the specimens (n = 15) were used to study the varnish's sustained effect by long-term incubation (8 weeks) before cariogenic challenge. The protocols' anti-caries properties were evaluated by dentin porosity (rhodamine intensity; RI) and mineral density, while their anti-biofilm effects were evaluated using biofilm's biomass and viability assays. For short- and long-term incubation models, all experimental regimens resulted in statistically significant decreases (p < 0.05) in the RI (up to 180 μm and 120 μm, respectively) as well as higher mineral density compared to No treatment (p < 0.001). V + PO + PP and/or V + PO resulted in statistically lower RI compared to V for some depths (p < 0.05) in both models. There were changes in RI and mineral density within groups over time. All experimental treatments exhibited anti-biofilm effects. All prevention protocols exhibited immediate and sustained anti-caries effect against root caries development. The combination of a fluoride varnish with PO resulted in superior additional anti-caries effects.

Salivary fluoride levels after daily brushing with 5000 ppm fluoride toothpaste: A randomised, controlled clinical trial

This study explored salivary fluoride levels following toothbrushing with 5000 and 1450 ppm fluoride toothpaste and determined the decline in salivary fluoride levels following the return from 5000 to 1450 ppm fluoride toothpaste. The study was a randomised, controlled double-blind parallel clinical trial (n = 24/group) measuring salivary fluoride five times during a 3-week trial phase involving 2×/day use of 5000 or 1450 ppm fluoride toothpaste, and five times during an ensuing 2-week wash-out phase where all participants used 1450 ppm toothpaste. Salivary fluoride was measured using a fluoride electrode and data were analysed using multilevel mixed-effects linear regression. Baseline salivary fluoride geometric means were 0.014 and 0.016 ppm for the 1450 and 5000 ppm groups, while the values at the end of the trial phase were 0.023 and 0.044 ppm, respectively. During the trial phase, except at baseline, differences between groups were statistically significant. The salivary fluoride levels for the 5000 ppm group remained statistically significantly higher than for the 1450 ppm group only at the first measurement in the wash-out phase (≈30 h after the last 5000 ppm brushing), indicating that higher salivary fluoride levels resulting from use of 5000 ppm are sustained only as long as the brushing habit continues.

Dental Care for Older Adults

There is a global increase in the older population. Unfortunately, dental conditions in the older population can sometimes be poor as a result of worsened physical conditions and the cumulative damage caused by dental diseases in the past. Many suffer from oral diseases such as dental caries and periodontal disease but receive no regular dental care. Oral conditions and systemic problems are interrelated. Chronic medical problems and polypharmacy are common among them. These conditions may lead to xerostomia with or without a decrease in saliva output. Additionally, many older adults have deteriorated masticatory function associated with physical health issues such as frailty. Preventive measures are crucial to stop oral diseases from progressing and the replacement of missing teeth is needed when masticatory function is impaired. Older adults also suffer a higher risk of oral cancer because of their less resilient but more permeable oral mucosa. With the increasing need for elderly dental care, dentists should equip themselves with knowledge and skills in geriatric dentistry. They should help older adults to develop and maintain the functional ability that enables well-being in older age. This communication article aims to discuss the relevant medical conditions, common dental diseases, and dental care for older adults.

Nonrestorative Caries Treatment: A Systematic Review Update

Caries is the most prevalent chronic noncommunicable disease. Strategies to prevent its onset and early interventions to arrest the progression of early lesions have been emphasised throughout recent decades to avoid or delay the restorative spiral of the tooth. More individuals are retaining their natural teeth into old age, thereby necessitating ongoing restorative dentistry intervention for their maintenance. The aim of this systematic review was to update the state of the art regarding clinical studies reporting the effectiveness of different nonrestorative caries treatment options in the 5-year period from 2017 to 2022. Relevant articles were retrieved from 2 electronic databases, including randomised clinical trials (RCTs) published from January 2017 until April 2022, assessing effectiveness and secondary effects of at least one nonrestorative caries treatment option, carried out with adults and/or children with noncavitated or cavitated carious lesions on either primary or permanent teeth and diagnosed by radiographs or visual/tactile assessment. All 35 included articles presented the results of RCTs with a follow-up period ranging from 6 to 84 months. Most of these studies were considered high-quality articles with a low risk of bias. Sealants and fluoride gels and varnishes were mentioned in 12 studies as effective strategies to prevent the onset of caries lesions and to arrest them in the early stages. Resin infiltration reported high caries arresting rates in noncavitated proximal lesions in 10 publications. Silver diammine fluoride presented high caries-arresting rates in open dentin lesions, both in primary and permanent dentitions as well as in root caries lesions that were accessible for cleansing. New evidence has been published between 2017 and 2022 as the result of numerous clinical studies providing further evidence of the effectiveness of nonrestorative caries treatment options.

Caries Management in Special Care Dentistry

The objective of this article is to provide a summary of the current evidence-based recommendations for caries management in patients with special health care needs (SHCNs). Considerations regarding caries risk assessment and preventive measures are also discussed with the goal of helping clinicians to manage the caries disease process using a person-centered approach and risk-based interventions. Importantly, most of the evidence is still based on the general population, because the evidence for those with SHCNs is still limited.

Ultrasonic measurement of dentin remineralization effects of dentifrices and silver diamine fluoride

OBJECTIVE

This study investigated the dentin remineralization effect of the application of a functionalized tri-calcium phosphate (fTCP) dentifrice and a silver diamine fluoride (SDF) solution.

MATERIAL AND METHODS

The materials used were: a fluoride-containing dentifrice with fTCP (fTCP＋), a fluoride-containing dentifrice without fTCP (fTCP-) and a 38% SDF solution. Following treatment, the dentin slabs were immersed in a 0.1-M lactic acid buffer solution and then placed in artificial saliva. This procedure was repeated three times daily for 28 days. The propagation time of longitudinal ultrasonic velocities (UV) and the Knoop hardness (KH) of the samples were measured. The samples were also observed using scanning electron microscopy.

RESULTS

The SDF and fTCP＋ groups showed higher UV than the fTCP - group regardless of the application method. The F-SDF group at 28 days showed significantly higher UV (4121 ± 102 m/s) than the F-fTCP + group (3731 ± 65 m/s) (p < .05). The F-SDF group at 28 days showed significantly higher KH (47.4 ± 2.2) than the F-fTCP＋ group (43.3 ± 1.0) and the F-fTCP - group (42.9 ± 2.1) (p < .05). Closure of the dentinal tubules and crystal precipitation was detected on the surface of the fTCP＋ group to a greater extent than the fTCP - group.

CONCLUSIONS

The fTCP-containing dentifrice and SDF solution effectively enhanced bovine dentin remineralization.

Proposal for a Conceptual Framework for the Development of Geriatric Dentistry

Demographic changes with an increasingly higher proportion of older adults worldwide and an epidemiologic transition resulting in more teeth retained and higher demand and expectations set up new scenarios for the oral health of the older population. Thus, geriatric dentistry must be reconfigured, transitioning from the traditional focus on prosthesis to a more holistic discipline, actively incorporating geriatric and gerontologic aspects. We describe some situations that provide the rationale for a new conceptual framework for the advancement of geriatric dentistry as a clinical specialty. On the basis of scientific evidence and our academic experience, we propose 4 concepts that should steer the discipline during the following years and become its structural pillars: minimal intervention dentistry, oral functionality, patient-centered care, and interdisciplinary teamwork. Since data and evidence are limited, a special focus on poor and developing countries is incorporated. Adjusting clinical guidelines and public health policies around these concepts will increase access to oral care for older people, including those with physical or social barriers, and will ensure better oral health-related quality of life and well-being. These concepts have deep consequences in the education and training of new dentists and specialists, at the public and private levels.

The Current Strategies in Controlling Oral Diseases by Herbal and Chemical Materials

Dental plaque is a biofilm composed of complex microbial communities. It is the main cause of major dental diseases such as caries and periodontal diseases. In a healthy state, there is a delicate balance between the dental biofilm and host tissues. Nevertheless, due to the oral cavity changes, this biofilm can become pathogenic. The pathogenic biofilm shifts the balance from demineralization-remineralization to demineralization and results in dental caries. Dentists should consider caries as a result of biological processes of dental plaque and seek treatments for the etiologic factors, not merely look for the treatment of the outcome caused by biofilm, i.e., dental caries. Caries prevention strategies can be classified into three groups based on the role and responsibility of the individuals doing them: (1) community-based strategy, (2) dental professionals-based strategy, and (3) individual-based strategy. The community-based methods include fluoridation of water, salt, and milk. The dental professionals-based methods include professional tooth cleaning and use of varnish, fluoride gel and foam, fissure sealant, and antimicrobial agents. The individual-based (self-care) methods include the use of fluoride toothpaste, fluoride supplements, fluoride mouthwashes, fluoride gels, chlorhexidine gels and mouthwashes, slow-release fluoride devices, oral hygiene, diet control, and noncariogenic sweeteners such as xylitol. This study aimed to study the research in the recent five years (2015–2020) to identify the characteristics of dental biofilm and its role in dental caries and explore the employed approaches to prevent the related infections.

Management of dental caries lesions in Latin American and Caribbean countries

Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.

The burden of root caries: Updated perspectives and advances on management strategies

BACKGROUND

Root caries has gained much attention in the last few years. As the world's population is ageing and people currently tend to retain more teeth compared with older generations, there is an increased prevalence of periodontal disease and gingival recession, which may accelerate the onset of root caries.

OBJECTIVE

This review aims to summarise recent findings related to the diagnosis, prevention and treatment of root caries.

MATERIALS AND METHODS

MEDLINE (OVID) and Scopus (Elsevier) searches were performed to identify and discuss articles that address the pathogenicity and clinical management of root caries.

RESULTS

Root caries is a multifactorial disease. Cariogenic species involved in root caries are less dependent on carbohydrates since collagen degradation inside the dentinal tubules can provide nutrients and microcavities for the invading microorganisms. Furthermore, the root surface has fewer minerals in comparison with enamel, which may accelerate the onset of demineralisation. Root caries could be prevented by patient education, modification of risk factors, and the use of in-office and home remineralisation tools. The use of non-invasive approaches to control root caries is recommended, as the survival rate of root caries restorations is poor. When plaque control is impossible and a deep/large cavity is present, glass ionomer or resin-based restorations can be placed.

CONCLUSION

The assessment of root carious lesions is critical to determine the lesion activity and the required intervention. Dental practitioners should also be aware of different prevention and treatment approaches to design optimum oral health care for root caries-affected patients.