The Role of Fluoride in the Prevention of Tooth Decay

Caries preventive potential of professionally deliverable fluoride-containing agents with incorporated arginine: A scoping review

The scoping review objectives were to: 1) investigate the caries preventive potential of professionally deliverable fluoride (F)-containing agents with incorporated arginine (Arg); and 2) identify the future scope of research on Arg-F interventions for caries prevention. Of 150 identified records, 7 articles (6 in vitro investigations and 1 scoping review) were included for a complete review; with no clinical studies with/without appraisal. Arginine variants (L-Arg/Arg.HCl at 1% to 10% w/v.) were examined for a potential professional application aimed at caries prevention, as reported with in vitro studies. Of the included articles, four in vitro studies explored L-Arg enriched 5% NaF varnish (Duraphat®) as a promising caries preventive agent, while only one considered incorporating L-Arg in MI varnish®/nanohydroxyapatite and one investigated glass ionomer cement for primary/secondary and tertiary caries prevention. The scoping review highlighted the scope for incorporating Arg to professionally deliverable F-containing agents. No clinical data are available to make conclusive recommendations about the caries preventive potential of professionally deliverable F-containing agents with incorporated Arg. With Arg-F varnish being investigated predominantly through in vitro studies, the data so far suggest that Arg was incorporated exclusively in Duraphat®, while the potential of Arg to prevent caries in other F-containing varnishes remains unexplored.

Changes in the surface texture of pre-polymerized acrylic resin pediatric crowns following acidulated phosphate fluoride application

This study aimed to investigate the effect of acidulated phosphate fluoride (APF) application on filler-free polymethyl methacrylate (PMMA)-based resin blocks for computer-aided design/computer-aided manufacturing (CAD-CAM), focusing on their use in pediatric crowns. Three types of PMMA-based blocks for CAD-CAM were evaluated, and a composite resin block for CAD-CAM was used as a control. Statistical analysis (p<0.05) of the data revealed that all PMMA-based blocks showed significantly higher gloss levels than the composite resin blocks. Two PMMA-based blocks also demonstrated significantly lower Ra and Sa values. SEM images showed no irregular changes in the surface properties of the PMMA-based blocks compared to those of the composite resin block. These results are significant in meeting the increasing demand for esthetic restorative treatments in pediatrics, where APF is commonly used for caries prevention. PMMA-based resin blocks for CAD-CAM are an effective alternative to prevent esthetic degradation from gloss reduction and plaque accumulation.

Incorporating an artificially synthesized fluoride complex into urethane-acrylate-based 3D printing resin: Effects on mechanical properties, cytotoxicity, antimicrobial actions, and its long-term fluoride-releasing properties

OBJECTIVES

To synthesize a 3D printing resin with antibacterial and long-term fluoride-releasing properties.

METHODS

(4,4-Bis-4-[2‑hydroxy-3-(2-methacryloyloxy)propoxy]-phenyl-pentanol-amine)-N,N-diacetic acid zirconium (IV) fluoride complex was synthesized from 4,4-bis-(4-hydroxyphenyl)-pentanoic acid and monitored using proton nuclear magnetic resonance spectroscopy. The synthesized complex was incorporated into a urethane-acrylate-based (UA) resin at 5 wt% and 10 wt% (5F-UA and 10F-UA groups, respectively). The UA resin without the synthesized complex was considered as the control group. All groups were 3D printed using a DLP printer, followed by 10 min of washing and 20 min of curing. Surface characteristics were observed using scanning electron microscopy. The mechanical properties were assessed by measuring its flexural strength and Vickers hardness. The antibacterial property was investigated with direct and indirect contact tests and a WST-8 metabolic activity assay. The suspension was fully mixed and diluted for counting the number of colony-forming units. The cell viability test was performed using a cell proliferation assay. The amount of fluoride released was measured daily for 28 days using ion chromatography. One-way analysis of variance was performed for statistical analyses using SPSS software.

RESULTS

The amount of fluoride released increased with the concentration of fluoride complex in the resin. The fluoride ions were constantly released at a low concentration from the 3D printed specimens (5F-UA: around 0.13 ppm daily; 10F-UA: around 0.22 ppm daily). The antibacterial efficacy was acceptable in both the 5F-UA and 10F-UA groups, and higher in the latter. No cytotoxicity of the resin was detected. The mechanical properties were significantly influenced by the addition of the fluoride-releasing complex.

CONCLUSIONS

The present 3D printing UA resin incorporating a fluoride complex effectively inhibited the growth of S. mutans and demonstrated the ability to slowly release fluoride over an extended period of time.

CLINICAL SIGNIFICANCE

This study provided informative composition of a fluoride-releasing UA-based 3D printing resin, ideal for dental applications such as crowns, bridges, removable partial dentures, and orthodontic appliances, which can benefit from sustained fluoride release and antimicrobial properties. Further modifications to the resin composition can be easily achieved to enhance the resin qualities.

Socioeconomic vulnerability and access to community water fluoridation in Washington

BACKGROUND

The aim of the authors was to determine whether socioeconomic vulnerability is associated with community water fluoridation (CWF).

METHODS

The authors used US Census Bureau data to create 4 county-level vulnerability markers (percentages non-White, Hispanic or Latino, below the federal poverty threshold, education below high school), obtained county-level CWF data from the Washington State Department of Health, and evaluated associations using Spearman rank correlation coefficient and the Kruskal-Wallis rank sum test. The authors then interviewed 122 community members in Washington (December 2022-March 2023) and analyzed the interview data inductively.

RESULTS

A higher percentage of non-White people at the county level was associated with a significantly higher level of CWF (Spearman rank correlation coefficient, 0.55; 95% CI, 0.29 to 0.82; P < .001), whereas county-level poverty was associated with significantly lower CWF (Spearman rank correlation coefficient, -0.36; 95% CI, -0.70 to -0.03; P = .02). High school completion was not associated with county-level CWF. Significantly larger proportions of Hispanics and Latinos lived in counties with higher CWF (P < .05). From the interviews, more participants thought tap water was healthy than unhealthy, but 41% had mixed feelings. Similarly, more participants thought CWF was acceptable than unacceptable, with 35% reporting mixed feelings. Negative views about tap water and CWF were more common among non-White participants.

CONCLUSIONS

People in racially and ethnically diverse communities in Washington appear to have greater access to CWF, whereas those in lower-income communities have poorer access.

PRACTICAL IMPLICATIONS

CWF is an important population-level strategy to prevent caries. Additional work is needed to improve access to CWF, especially for people from low-income communities.

Oral health needs of Wampanoag elders on Martha's Vineyard: A comprehensive assessment

OBJECTIVES

Evaluate oral health care access and utilisation, while identifying the specific oral health needs of the Native American Elders within the Wampanoag Tribe of Gay Head (WTGH) on Martha's Vineyard Island.

BACKGROUND

Elders, particularly the WTGH face notable issues in obtaining oral health care. This study addressed the oral health gaps within the WTGH Elders through a comprehensive community needs assessment.

METHODS

Employing a mixed-methods approach, qualitative concept mapping interviews with stakeholders and tribe members, a quantitative survey was conducted, and deidentified billing codes were analysed.

RESULTS

Concept mapping revealed limited availability of services, accessibility and transportation, insurance challenges, lack of a centralised database, tribal/national policy and health-related self-sufficiency. Quantitative data indicated that 65% of Elders faced challenges in accessing oral health care, and 48% reported experiencing an oral health issue in the last 12 months. Additionally, 23% did not receive oral health care during this period, with a significant portion having previously utilised services at the Martha's Vineyard Hospital Oral Health Clinic.

CONCLUSION

Establishing a formal relationship between the WTGH and an academic institution for creating a portable oral health clinic supervised by faculty and developing a structured referral system is essential. This initiative aims to dismantle barriers to oral health care, improve access, and meet the oral health needs among Elders while offering valuable educational experiences for students regarding diverse patient populations and access-to-care factors.

Cross-sectional study of association between caries and fluoridated water among third-grade students in Pennsylvania

BACKGROUND

Caries is the most common chronic disease among children. In Pennsylvania, a comprehensive oral health Basic Screening Survey and assessment of the association between caries and community water fluoridation (CWF) among children have not been conducted.

METHODS

From 2021 through 2022, the first Basic Screening Survey was conducted among third-grade students in Pennsylvania. Oral health and demographic data were collected. CWF data were provided by the Pennsylvania Department of Environmental Protection. The relative risk of developing caries in association with CWF was assessed using the GENMOD procedure in SAS, Version 9.4 (SAS Institute) in this cross-sectional study.

RESULTS

Caries prevalence was 59.7% among 4,120 screened students. Participation in the free or reduced lunch program and CWF were each significantly associated with risk of developing caries after adjustment for age, sex, and race and ethnicity. The risk of developing caries was 33% higher among students who participated in the free or reduced lunch program than those who did not participate (relative risk, 1.33; 95% CI, 1.24 to 1.42). Students with the highest CWF coverage had a nearly 16% lower risk of developing caries than those without CWF coverage (relative risk, 0.84; 95% CI, 0.75 to 0.94).

CONCLUSIONS

CWF was significantly associated with a reduced risk of developing caries. Efforts are needed to increase CWF coverage, along with promotion of oral health education and healthy dietary habits among Pennsylvania children.

PRACTICAL IMPLICATIONS

Increasing CWF coverage will reduce caries burden among Pennsylvania children. Although Pennsylvania has no state laws to regulate CWF, these findings are persuasive for local municipalities to consider expanding CWF coverage.

In vitro effect of TiF4/NaF solution on the development of radiation-induced dentin caries

OBJECTIVE

To evaluate the protective effect of an experimental solution containing TiF4/NaF on the development of radiation-induced dentin caries lesions.

METHODOLOGY

bovine root samples were irradiated (70Gy) and distributed as following (n=12/group): Commercial Saliva (BioXtra), NaF (500 ppm F-), TiF4 (500 ppm F), TiF4/NaF (TiF4: 300 ppm F-, NaF: 190 ppm F-), and Phosphate buffer solution (PBS, negative control). Biofilm was produced using biofilm from irradiated patients and McBain saliva (0.2% of sucrose, at 37oC and 5% CO2) for five days. The treatments were applied 1x/day. Colony-forming units (CFU) were counted and demineralization was quantified by transversal microradiography. The ANOVA/Tukey test was applied for all parameters.

RESULTS

All treatments reduced CFU for total microorganisms. TiF4 reduced Lactobacillus sp. (7.04±0.26 log10 CFU/mL) and mutans streptococci (7.18±0.28) CFU the most, when compared to PBS (7.58±0.21 and 7.75±0.17) and followed by NaF (7.12±0.31 and 7.34±0.22) and TiF4/NaF (7.16±0.35 and 7.29± 0.29). TiF4 and Commercial saliva showed the lowest integrated mineral loss (ΔZ-vol%.mm) (1977±150 and 2062±243, respectively) when compared to PBS (4540±335), followed by NaF (2403±235) and TiF4/NaF (2340±200). Commercial saliva was the only to significantly reduce mineral loss (LD-µm) (111±25) compared to PBS (153±24).Mean mineral loss (R-vol%) decreased by 35.2% for TiF4 (18.2±3.3) when compared to PBS (28.1±2.9) Conclusion: TiF4/NaF has a comparable anti-cariogenic effect to TiF4 and Commercial saliva under the model in this study.

The factors associated with the knowledge of brushing teeth with fluoridated toothpaste among high school students in Al-Madinah, Saudi Arabia

Objective

The use of fluoridated toothpaste (FT) is essential for controlling caries. This analytical cross-sectional study aimed to determine the proportion of students who brushed their teeth with fluoridated toothpaste/or do not know the content at least once a day and to determine the factors associated with the knowledge of brushing teeth with FT.

Methods

An anonymous questionnaire was distributed during the academic year 2019-2020 among 439 high school students. The data collected included sociodemographic characteristics and oral-health-related variables [e.g., brushing teeth, knowledge of the effect of fluoride on caries (KEFC) and dental service utilisation (DSU)]. The dependent variable was the knowledge of using FT when brushing teeth (Yes or do not know). Descriptive, bivariate, and logistic regression analysis were performed.

Results

The response rate was 98% (n = 432) and usable data was 88% (n = 385). The median (IQR) age of the students was 16.00 (1) years, and 190 (47%) were males. Eighty eight percent of the students brushed their teeth with toothpaste daily with no knowledge of toothpaste content and only 86 (21.8%) knew the content of the toothpaste used for brushing their teeth i.e., FT. The multivariable analyses revealed an association of family income and KEFC with brushing teeth with FT [adjusted odds ratio (AOR): 1.98, 95% confidence interval (CI): 1.14-3.43, p = 0.015 and AOR = 6.11, 95% CI: 3.45-10.83, p < 0.001, respectively].

Conclusions

While the brushing and use of toothpaste among high school students was common, the knowledge of the content of toothpaste used for brushing teeth was less common and was associated with family income and KEFC.

Examination of cytotoxic and antimicrobial effect of whitening toothpastes: an in vitro study

OBJECTIVE

Toothpastes are widely used to protect oral and teeth health. This study aims to examine the cytotoxic and antimicrobial effects of whitening toothpastes.

METHODS

In this study, extracts were prepared according to ISO 10993-12:2021 standard (0.2 g/mL) using whitening and conventional toothpastes. The prepared extracts were added to human gingival fibroblast cell lines (HGF-1) in different dilutions (1:1, 1:2, 1:4, 1:8, 1:16, and 1:32) and a cytotoxicity test was performed. Antimicrobial analysis of toothpastes was performed on Streptococcus mutans, Staphylococcus aureus, and Candida albicans using the hole-plate diffusion method. Cell viability and microbial analysis data were examined using two-way analysis of variance (ANOVA) and Tukey post-hoc test (p < 0.05).

RESULTS

Toothpastes with sodium lauryl sulfate (SLS) in their composition showed statistically more toxic effects (p < 0.05). The activated carbon toothpastes without SLS showed over 90% cell viability after dilution. Although the dilution rate of toothpastes containing SLS increased, cell viability remained below 70%. All toothpastes used in the study showed antimicrobial effects on S. mutans, S. aureus, and C. albicans. Toothpaste containing hydrogen peroxide and SLS produced more antibacterial effects than activated carbon, blue covarine, microparticles, and conventional toothpaste.

CONCLUSIONS

SLS-containing toothpastes showed more toxicity on HGF-1 cells. Toothpaste containing hydroxyapatite did not show toxic effects on HGF-1 cells. SLS, sodium lauryl sarcosinate and hydrogen peroxide in toothpastes increase antimicrobial effects.

Study on the mechanical and aging properties of an antibacterial composite resin loaded with fluoride-doped nano-zirconia fillers

Preventing the occurrence of secondary caries serves as one of the significant issues in dental clinic, thus make it indispensable to improving the properties of conventional composite resin (CR) by developing a novel CR. In present study, two groups of experimental CRs loaded with different contents of fluoride-doped nano-zirconia fillers (25 wt% and 50 wt%) were fabricated. The surface topography, mechanical performance, fluoride release, antibacterial effect, aging property and cytotoxicity of the experimental CRs were evaluated subsequently. A uniform distribution of the F-zirconia fillers over the whole surface of resin matrix could be observed. The experimental CRs showed continuous fluoride release within 28 days, which was positively correlated with the content of F-zirconia fillers. Moreover, the amount of fluoride release increased in the acidic buffer. Addition of F-zirconia fillers could improve the color stability, wear resistance and microhardness of the experimental CRs, without reducing the flexure strength. Furtherly, the fluoride ions released continuously from the experimental CRs resulted in effective contact and antibacterial properties, while they showed no cytotoxicity. As a consequence, considerations can be made to employ this new kind of composite resin loaded with fluoride-doped nano-zirconia fillers to meet clinical requirements when the antimicrobial benefits are desired.

Uncovering a pseudoscience: an analysis of 'biological dentistry' Instagram posts

OBJECTIVE

This infodemiology study aimed to analyze characteristics of English-language Instagram posts on 'Biological Dentistry'.

MATERIALS AND METHODS

Using CrowdTangle, we analyzed 500 'Biological Dentistry' posts published on Instagram from May 2017 to May 2022. Two researchers assessed each post for facticity, motivation, author's profile, sentiment, and interaction metrics. Statistical analysis was employed to compare interaction metrics between dichotomized categories of posts' characteristics and determine predictors of misinformation and user engagement.

RESULTS

Over half of the posts (58.4%) were from health-related authors, and a considerable number contained misinformation (68.2%) or were financially motivated (52%). Sentiment was mostly negative or neutral (59.8%). Misinformation was associated with financial motivation (OR = 2.12) and health-related authors (OR = 5.56), while non-health-related authors' posts associated with higher engagement (OR = 1.98). Reliable content, non-health-related authorship, and positive sentiment were associated with increased user interaction.

CONCLUSION

Misinformation about 'Biological Dentistry' on Instagram is mainly spread by financially incentivized health-related authors. Yet, non-health-related authors' posts resonate more with audiences, highlighting a nuanced relationship between content facticity, authorship, and engagement.

Decoding Early Childhood Caries: A Comprehensive Review Navigating the Impact of Evolving Dietary Trends in Preschoolers

This comprehensive review delves into the intricate relationship between evolving dietary trends in preschoolers and the prevalence of early childhood caries (ECC). The investigation meticulously analyzes ECC epidemiology, etiology, and preventive strategies. The review unveils the multifaceted nature of ECC, highlighting microbial, dietary, and environmental factors contributing to its development. Significantly, the study explores the global prevalence of ECC and its substantial implications for the overall health, nutrition, and development of preschool-aged children. The implications for public health and policy are deliberated, advocating for targeted interventions and collaborative efforts among healthcare professionals, policymakers, educators, and parents. The conclusion presents a compelling call to action, urging collective engagement to mitigate the impact of ECC and prioritize the well-being of preschoolers. This review offers valuable insights for healthcare professionals, policymakers, educators, and parents to inform evidence-based strategies for addressing ECC and promoting early childhood oral health.

An In Vitro Study to Evaluate the Antimicrobial Activity of a Zinc Citrate, Sodium Fluoride, Alum and Xylitol-Based Toothpaste Formulation

INTRODUCTION

Periodontitis is a prevalent condition significantly affecting oral health. Comorbid conditions, such as diabetes, can heighten the severity of periodontal disease and overall oral health. Therefore, to enhance oral health and manage comorbid conditions, comprehensive periodontal care is essential. This approach could involve using toothpaste containing antimicrobial ingredients in routine oral care. This paper presents the results of an in vitro study analysing the antimicrobial properties of the test formulation containing zinc citrate, alum, sodium fluoride, and xylitol-based toothpaste (Stolin-R). These ingredients work together to help in providing comprehensive oral care by controlling growth of bacteria majorly responsible for periodontal disease and thus maintaining optimal oral hygiene.

AIM

To determine the antimicrobial properties of zinc citrate, alum, sodium fluoride, and xylitol-based toothpaste formulation against key periodontal pathogens through in vitro analyses.

MATERIALS AND METHODS

The antimicrobial efficacy of test formulation is evaluated through minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and time-dependent antibacterial assessment against key periodontal pathogens, including Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, Streptococcus mutans, and Bacteroides fragilis.

RESULTS

The test formulation demonstrated potent antimicrobial effectiveness against Bacteroides fragilis, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Streptococcus mutans, and Tannerella forsythia, by exhibiting low MIC and MBC. Additionally, significant bacterial reduction, exceeding 99.99%, was observed within five minutes, emphasising its potential as an effective adjunct in combating periodontal infection.

CONCLUSION

Zinc citrate, alum, sodium fluoride, and xylitol-based toothpaste formulation demonstrates significant antimicrobial activity against key periodontal pathogens, suggesting its potential as an effective agent for maintaining oral health and combating gingival infection.

The fluorosis conundrum: bridging the gap between science and public health

Fluorosis, a chronic condition brought on by excessive fluoride ingestion which, has drawn much scientific attention and public health concern. It is a complex and multifaceted issue that affects millions of people worldwide. Despite decades of scientific research elucidating the causes, mechanisms, and prevention strategies for fluorosis, there remains a significant gap between scientific understanding and public health implementation. While the scientific community has made significant strides in understanding the etiology and prevention of fluorosis, effectively translating this knowledge into public health policies and practices remains challenging. This review explores the gap between scientific research on fluorosis and its practical implementation in public health initiatives. It suggests developing evidence-based guidelines for fluoride exposure and recommends comprehensive educational campaigns targeting the public and healthcare providers. Furthermore, it emphasizes the need for further research to fill the existing knowledge gaps and promote evidence-based decision-making. By fostering collaboration, communication, and evidence-based practices, policymakers, healthcare professionals, and the public can work together to implement preventive measures and mitigate the burden of fluorosis on affected communities. This review highlighted several vital strategies to bridge the gap between science and public health in the context of fluorosis. It emphasizes the importance of translating scientific evidence into actionable guidelines, raising public awareness about fluoride consumption, and promoting preventive measures at individual and community levels.

Antibacterial Effects of Silver Diamine Fluoride with and without Potassium Iodide against Streptococcus mutans

Introduction

Silver diamine fluoride (SDF) is a topical treatment for carious lesions and a primary preventative for newly exposed high-risk surfaces such as fissures and roots in the first molars. Using potassium iodide (KI) after applying SDF has been recommended as a way of reducing the severity of black staining, as well as preserving its antibacterial effect useful in deep caries.

Objective

The objective of this research was to compare the antibacterial effect of SDF, with and without KI, on Streptococcus mutans (S. mutans) and dental biofilm.

Methods

The antibacterial effects of SDF, KI, and the combination of both were measured using three different techniques (inhibition halo, minimum inhibitory effect [MIE], and colony-forming unit [CFU], testing).

Results

The results were then subjected to statistical analysis. Analyzed by means of the Kruskal-Wallis statistical test, the inhibition halos yielded a value of P = 0.3309. Using the MIE test, only the SDF treatment produced an antibacterial effect, at 10%, compared to the KI group, with P = 0.001. Finally, the CFU test revealed a total absence of colonies for all three reagents. All three substances analyzed achieved total inhibition of S. mutans. SDF is effective even in its minimal commercial concentration. Its antibacterial capacity decreases with the addition of KI.

Conclusions

The three substances analyzed at their maximum concentrations exhibited an antibacterial effect against S. mutans, resulting in total inhibition.

Clinical performance of sealants under different humidity control conditions: a split-mouth 1-year randomized trial

PURPOSE

Sealants are an effective method of prevention and treatment for early caries lesions. This study analyzed the 1-year clinical performance of resin-based and ionomeric sealants applied to permanent teeth under different humidity conditions.

METHODS

The investigation was a triple-blind randomized clinical trial (RCT) with a four arms split-mouth design, divided according to the sealant protocol: (1) Resin-based sealant applied with rubber dam isolation, (2) Resin-based sealant applied with cotton rolls isolation, (3) Ionomeric sealant applied with rubber dam isolation and (4) Ionomeric sealant applied with cotton rolls isolation. Fifty-eight patients started the study (232 teeth), and 47 (188 teeth) remained until the 1-year recall. The modified USPHS criteria were used in the analyzes to investigate surface texture, retention and the presence of secondary caries lesions around the sealants; in the following periods: baseline, after 3, 6, 9, and 12 months by two calibrated examiners. Data were analyzed by the Mann-Whitney and Friedman tests.

RESULTS

There was no difference between the types of sealants (p > 0.05). The type of humidity control influenced the superficial texture (p = 0.0012) and the retention of sealants (p = 0.0023). The sealant displacement was greater under cotton rolls isolation. Only one active caries lesion in enamel was found in the 9th month.

CONCLUSION

It may be concluded that sealants effectively prevented caries, even when they were partially or totally lost, regardless of the material. The rubber dam isolation with a rubber dam promoted lower surface roughness and improved the retention rates. International Clinical Trials Registry Platform: #1111-1215-2832 (07/26/2018).

Toothpaste use in Peruvian children during COVID-19 pandemic: results from a National Demographic and Health Survey

PURPOSE

To determine the impact of COVID-19 pandemic on use of toothpaste in Peruvian children.

METHODS

A national database of Peruvian children from 0 to 11 years old was used to develop a cross-sectional study, with a final sample of 51, 013 subjects. Data were obtained of results of the Demographic and Family Health Survey (ENDES); the questionnaire was self-reported. The use of toothpaste and fluoride concentration in toothpaste were dependent variables, and for the independent variable, the year was considered; in addition, other covariates were included. The statistical analyses applied were descriptive, bivariate, and multivariate tests.

RESULTS

Use of toothpaste was 98.99% (n = 50,134), while fluoride toothpaste with < 1000 ppm was used by 77.29% (n = 27,366). For bivariate analysis, use of toothpaste was associated with place and area of residence, altitude, natural region, and age; for use of fluoride toothpaste with minimum 1000 ppm, there was an association with place and area of residence, natural region, wealth index, and age. In a multivariate manner, year only presented a positive association with use of fluoride toothpaste < 1000 ppm (RPa:1.04; 95%CI 1.01-1.07).

CONCLUSIONS

Year 2020 of COVID-19 pandemic had a positive impact on the use of < 1000 ppm fluoride toothpaste in Peruvian children.

Leveraging School Health Programs in Africa: Integrated Screening for Rheumatic Heart Disease and Dental Caries

Background

Rheumatic heart disease (RHD) and dental caries (DC) disproportionately affect children and young adults in sub-Saharan countries, with major impact on schoolchildren's health and education. DC in children with RHD constitutes an important risk for fatal complications. Our study aimed at assessing the feasibility of simultaneous RHD and DC screening in school environment.

Methods

March 20-24, 2022, we performed an observational descriptive study of schoolchildren in a public school in Maputo City, Mozambique. RHD screening involved two stages: first, a physical examination (including cardiac auscultation and direct observation of the oral cavity), and second, an abbreviated echocardiography performed by a cardiologist. Rapid testing for group A Streptococcus (GAS) was done to every eighth child in the classroom and for those with signs suggesting recent infection, in accordance with the study protocol developed for screening. A multidisciplinary team collected the data. Data were analyzed using descriptive statistics.

Findings

A total of 954 students (median age 9; range 6-15) were screened. One hundred and twenty-five participants were eligible for a rapid antigen test, of which 6 (4.8%) tested positive. On clinical evaluation 52 children (5.3%) presented a heart murmur. Echocardiography on 362 children showed borderline RHD in 35 children and definite RHD in 2 (0.6%); 1 child had a ventricular septal defect. Dental cavities were present in 444 (48.4%), despite 904 out of 917 students reporting brushing of their teeth once to three times daily (98.6%).

Conclusion

School-based integrated oral and cardiovascular screenings and use of rapid tests for GAS carriage provide crucial information to create customized preventive strategies for rheumatic fever (RF) and RHD in low- and middle-income countries (LMICs), in addition to detecting children at very high risk of bacterial endocarditis. The sustainability of such interventions and acceptability by health providers needs to be assessed.

Topical fluoride impact in future restorative dental procedures: A claim study

BACKGROUND

Caries is one of the most prevalent diseases affecting children. Topical fluoride is used to decrease the incidence of caries. The purpose of this study was to investigate the impact of fluoride varnish and gel applications on future restorative dental treatment claims.

METHODS

The data were obtained in conjunction with a dental data warehouse through a partnership agreement. A retrospective analysis of dental claims made from 2010 through 2018 was completed. Data were extracted for patients aged 1 through 8 years with topical fluoride application and its subsequent impact on restorative dental claims.

RESULTS

Data for 672,889 patients were included in the analysis. Patients who received topical fluoride had significantly lower numbers (P < .001) of restorative procedures and extractions per year and significantly increased time (P < .001) to their first restorative procedure or extraction after the index visit than patients who did not receive topical fluoride.

CONCLUSIONS

The application of fluoride varnishes and gels increased the time to future restorative and extraction dental claims and decreased the number of future restorative and extraction dental claims.

PRACTICAL IMPLICATIONS

This study is important because it found that the use of topical fluoride decreased the number of future restorative and extraction dental claims.

Improving anion sensing ability of the indolocarbazole-based fluorescence turn-on sensor by increasing salicylaldehyde response unit

Detection abilities on tested subjects of sensors should be closely connected to the sensing unit numbers. Herein, two anion sensors ICZ-o-1S and ICZ-o-2S were synthesized by using indolo (2,3-a) carbazoles as fluorescent chromophore and salicylaldehyde as recognition site. Though UV-Vis and fluorescent ways, it demonstrated that F^- can induce the sensor solutions becoming colored from colorless to yellow green, and can endow them with bright green turn-on fluorescence, proving their sensitive and selective sensing on F^-. Accordingly, the F ion sensing studies including anti-interference abilities against to other anions on fluorescence response, stoichiometric ratios of sensor-F^- in 1 : 1 and 1 : 2, -OH deprotonation sensing mechanism confirmed by ¹H NMR titration and theoretical calculation were fully covered. Most importantly, fluoride ion detection limits achieved by ICZ-o-1S and ICZ-o-2S were 1.8 × 10^-7 M and 6.0 × 10^-8 M, respectively, the latter with two sensing units exhibited 3 times lower detection limit outcompeted to the former with only one sensing unit, rendering the sensor design strategy of improving detecting ability by increasing sensing unit number was rational. The practical application of F^- detection in water-containing environment calibrated from the standard curve between the fluorescence intensity of sensor-F^- system and the changing F^- concentration was conducted. In addition, the accuracy of the sensor on detecting F^- was evaluated by the spiked recovery experiment, therefore, the fast and convenient F^- concentration detection based on the fluorescence color RGB values of the tested sensor-sample mixture was investigated. Consequently, the results obtained by these two sensors should deliver effective supports on designing high-performance sensors featuring naked-eye and fluorescence turn-on anion sensing by altering the response unit numbers.

Relationships between dental fluorosis and fluoride concentrations in bottled water and groundwater in low-income children in Mexico

Introduction

The aim of the current study was to investigate associations between dental fluorosis in children living in low socioeconomic areas in Mexico, and fluoride concentrations in tap water, fluoride concentrations and in bottled water, and body mass index (BMI).

Methods

A cross-sectional study involving 585 schoolchildren aged 8-12 years was conducted in communities in a southern state of Mexico with >0.7 parts per million (ppm) fluoride in the groundwater. The Thylstrup and Fejerskov index (TFI) was used to evaluate dental fluorosis, and the World Health Organization growth standards were used to calculate age-adjusted and sex-adjusted BMI Z-scores. A BMI Z-score ≤ -1 SD was used as the cut-off point for thinness, and multiple logistic regression models for dental fluorosis (TFI ≥ 4) were constructed.

Results

The mean fluoride concentration in tap water was 1.39 ppm (SD 0.66), and the mean fluoride concentration in bottled water was 0.32 ppm (SD 0.23). Eighty-four children (14.39%) had a BMI Z-score ≤ -1 SD. More than half (56.1%) of the children presented with dental fluorosis in TFI categories ≥ 4. Children living in areas with higher fluoride concentrations in the tap water [odds ratio (OR) 1.57, p = 0.002] and bottled water (OR 3.03, p < .001) were more likely to have dental fluorosis in the severe categories (TFI ≥ 4). BMI Z-score was associated with the probability of dental fluorosis (TFI ≥ 4; OR 2.11, p < 0.001), and the effect size was 29.3%.

Discussion

A low BMI Z-score was associated with a higher prevalence of dental fluorosis in the severe category. Awareness of the fluoride concentrations in bottled water may help prevent dental fluorosis, particularly in children exposed to several high fluoride content sources. Children with a low BMI may be more vulnerable to dental fluorosis.

Association between fluoride exposure and blood pressure in children and adolescents aged 6 to19 years in the United States: NHANES, 2013-2016

To examine the association between fluoride exposure and childhood blood pressure (BP), we used data involving 3260 subjects participating in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2016. Both plasma and water fluoride concentrations were measured using the ion-specific electrode. Outcome variables were systolic blood pressure (SBP) and diastolic blood pressure (DBP). For a 1-mg/L increase in water fluoride concentration, the participants' SBP decreased by 0.473 mm Hg (95% CI: -0.860, -0.087). Specifically, inverse associations were found between water fluoride and SBP in girls (β= -0.423, 95% CI: -0.886, -0.021), adolescents (β= -0.623, 95% CI: -0.975, -0.272), and non-Hispanic whites (β= -0.694, 95% CI: -1.237, -0.151). Also, every 1-μmol/L increase in plasma fluoride concentration was associated with a 1.183 mm Hg decrease in SBP among other races (95% CI: -2.258, -0.108). This study suggested that fluoride exposure may affect childhood blood pressure.

Oral health behavior and oral health service utilization among cancer patients in China: A multicenter cross-sectional study

Purpose

Oral health plays an important role in overall health. But there is scarce information available on oral health behavior and oral health service utilization among cancer patients. This study aimed to evaluate oral health behavior and oral health service utilization among different population groups of cancer patients in China.

Methods

A multicenter cross-sectional study in three tertiary hospitals was conducted to explore the oral health behaviors and oral health service utilization of 162 cancer patients in China.

Results

We investigated a total of 162 cancer patients, 81 from urban and rural areas, respectively. The participant’s ages ranged from 18 and 82 years, mean age was 44.62 years (SD = 15.72). Overall, cancer patients have poor oral health behaviors and limited oral health service utilization. There were statistically significant differences (p &lt; 0.05) between urban and rural cancer patients in terms of oral health behaviors, including brushing methods, the use of fluoride toothpaste, the use of dental floss, dental caries, and bleeding gums while brushing teeth. As for oral health service utilization, there were significant differences (p &lt; 0.05) between urban and rural cancer patients on regular dental cleaning, the reasons for visiting a dental clinic, and whether they took the initiative to learn about oral health.

Conclusion

The study findings suggest that cancer patients had poor oral health behaviors and limited oral health service utilization, and rural patients perform poorer than their urban counterparts. Oral health education should be provided to cancer patients to improve their oral health behaviors and oral health service utilization.

Novel bioactive dental restorations to inhibit secondary caries in enamel and dentin under oral biofilms

OBJECTIVE

To provide the first review on cutting-edge research on the development of new bioactive restorations to inhibit secondary caries in enamel and dentin under biofilms. State-of-the-art bioactive and therapeutic materials design, structure-property relationships, performance and efficacies in oral biofilm models.

DATA, SOURCES AND STUDY SELECTION

Researches on development and assessment new secondary caries inhibition restorations via in vitro and in vivo biofilm-based secondary caries models were included. The search of articles was carried out in Web of Science, PubMed, Medline and Scopus.

CONCLUSIONS

Based on the found articles, novel bioactive materials are divided into different categories according to their remineralization and antibacterial biofunctions. In vitro and in vivo biofilm-based secondary caries models are effective way of evaluating the materials efficacies. However, new intelligent and pH-responsive materials were still urgent need. And the materials evaluation should be performed via more clinical relevant biofilm-based secondary caries models.

CLINICAL SIGNIFICANCE

Secondary caries is a primary reason for dental restoration failures. Biofilms produce acids, causing demineralization and secondary caries. To inhibit dental caries and improve the health and quality of life for millions of people, it is necessary to summarize the present state of technologies and new advances in dental biomaterials for preventing secondary caries and protecting tooth structures against oral biofilm attacks. In addition, suggestions for future studies are provided.

Prevalence of malocclusions under conditions of prolonged introduction of systemic fluorides in variable concentrations: Literature review

The pathogenesis of malocclusions, which are common among the population of  all  countries, is  well represented in the professional literature. The occurrence of  malocclusions is associated with genetic and various environmental factors. Among the latter, fluorides which affect the prevalence of some dental diseases are of particular interest. However, there are few publications reflecting the frequency of malocclusion among the population in the regions with different levels of fluoride in drinking water. This problem seems to be significant in the context of the increasing impact of fluorine compounds on human health, including dental health.

The aim of the study. To analyze the literature on the frequency of malocclusion among the population living in conditions of variable fluoride content in drinking water. A manual search of domestic and foreign literature was performed in the search databases PubMed, Medline and Google Scholar. From the initial list of publications, eighteen articles that met the inclusion criteria for the study were selected for analysis. We revealed significant variability of the research results. Some authors note a higher prevalence of malocclusions among the population under conditions of increased fluoride intake, others note a lower one, and still others did not reveal any differences between the values obtained in both samples. Most of the assessed publications did not methodologically meet modern international standards, and therefore were of little evidence.

The literature data do not provide grounds for an unambiguous assessment of fluorine compounds as an environmental factor that indirectly affects the process of occlusion formation in humans and animals.

The review did not allow to make a definitive conclusion on the possible impact of  systemic fluorides on the prevalence and pattern of malocclusion in humans and animals. It requires the implementation of studies that comply with the principles of evidence-based medicine. 

Caries risk assessment-related knowledge, attitude, and behaviors among Chinese dentists: a cross-sectional survey

OBJECTIVES

To investigate caries risk assessment (CRA)-related knowledge, attitudes, and practices among dentists in China, to describe their subjective ratings of the significance of specific caries risk factors and to identify factors associated with the level of knowledge, attitudes, and use of CRA in routine clinical practice.

MATERIALS AND METHODS

A cross-sectional anonymous online questionnaire survey was performed. The questionnaire was distributed via WeChat (Tencent, Shenzhen, China) to practicing dentists between November 25 and December 25, 2021. For participant recruitment, we employed purposive and snowball sampling techniques. Data were collected using a specialized web-based survey tool ( www.wjx.cn ) and analyzed with descriptive statistics and regression analyses.

RESULTS

A total of 826 valid questionnaires were collected. Only 292 (35.4%) respondents used CRA in routine practice, among whom a majority (243, 83.2%) did not use a specific CRA tool. The routine use of CRA was associated with the type of practicing office, attendance of caries-related lectures, the habit of reading caries-related literature, geographic location, and the total knowledge score. The mean total knowledge score was 3.13 (score range: 0 to 6). Knowledge levels were related to several sociodemographic characteristics, including geographic location, the type of practicing office, attendance of caries-related lectures and the habit of reading caries-related literature. The risk factor deemed most important was "current oral hygiene."

CONCLUSIONS

Caries risk assessment has not widely entered clinical practice in China. The level of CRA-related knowledge among dentists was generally suboptimal.

CLINICAL RELEVANCE

Strengthening CRA-related education may allow practitioners to develop a better understanding of caries risk assessment and hence promote its implementation.

Maintaining and Improving the Oral Health of Young Children

Oral health is an integral part of the overall health of children. Dental caries is a common and chronic disease process with significant short- and long-term consequences. The prevalence of dental caries remains greater than 40% among children 2 to 19 years of age. Although dental visits have increased in all age, race, and geographic categories in the United States, disparities continue to exist, and a significant portion of children have difficulty accessing dental care. As health care professionals responsible for the overall health of children, pediatricians frequently confront morbidity associated with dental caries. Because the youngest children visit the pediatrician more often than they visit the dentist, it is important that pediatricians be knowledgeable about the disease process of dental caries, prevention of disease, interventions to maintain and restore health, and the social determinants of children's oral health.

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.

Assessment of the oral health literacy and oral health behaviors among nurses in China: a cross-sectional study

PURPOSE

Oral health is important for general health; nurses are expected to possess good oral health awareness and work together for public oral health promotion. The purpose of this study is to investigate oral health literacy (OHL)and oral health behaviors of nurses, and explore the association between oral health literacy with demographic variables and oral health behaviors.

METHODS

A cross-sectional study in a tertiary hospital was conducted using a short-form Health Literacy in Dentistry-14 (HeLD-14) and a 16-items oral health behaviors questionnaire. Information about the subjects' demographic details including age, gender, place of residence, marital status, marital status, education level, monthly household income, working experience, etc. were collected. Independent sample t- test, One- way ANOVA, and multivariable regression were used to identify the association of oral health literacy with demographic variables and oral health behaviors.

RESULTS

A total number of 317 nursing nurses participated in the survey, with a mean OHL score of 36.72, SD10.531, 21.8% were categorized as good, 34.1% medium and 44.2% poor oral health literacy; monthly household income, self-rated oral health, brushing time, use of fluoride toothpaste, and regular oral examination were signficantly associated with OHL scores.

CONCLUSION

The overall oral health literacy of the nurse population is at a moderate to low level. These findings may help to map and design an oral health education intervention to improve oral health literacy amongst nurses, especially nurses with low monthly household income and poor self-assessed oral health status. Nursing administrators and nursing educators should pay more attention to the oral health status of the nurse population.

Deterministic and probabilistic human health risk assessment for fluorides in drinking groundwater from Lukavac, Bosnia and Herzegovina

Although fluorides are essential for dental health, there are growing health concerns regarding the risk-benefit ratio of fluoride exposure. The objectives of the study were to obtain data on the amount and human health risks of fluoride in drinking groundwater, as well as to compare and evaluate the differences in the outputs obtained by two different approaches in health risk assessment (deterministic vs probabilistic). From a densely populated industrial area of north-eastern Bosnia and Herzegovina, a total of 54 groundwater samples were collected. Fluoride concentrations varied from 1.69 to 3.52 mg/L. The WHO's threshold value for fluoride in drinking water was exceeded in all the samples analysed, indicating an increased daily intake of fluoride from groundwater. Deterministic and semi-probabilistic techniques were used for exposure assessment and health risk quantification. Generally, the deterministic approach resulted in acceptable health risks in most adult exposure scenarios. However, the Monte Carlo simulation revealed that 20.6, 20.8, and 99.8% of adult males, females, and children, respectively, were above the tolerable upper intake level, indicating that both adults and children face a significant health risk. Nevertheless, small children are more vulnerable to environmental hazards than youth and adults. Hence, a more in-depth risk-benefit analysis is required to reduce/or optimize fluoride content in drinking water to prevent tooth decay and fluorosis at all ages. Considering that optimal daily intake of fluorides is a crucial factor for preserving human health, decision-makers should take steps to emphasize the importance of continuous monitoring of fluoride concentrations in drinking water.

Preventive potential of nano silver fluoride versus sodium fluoride varnish on enamel caries like lesions in primary teeth: in vitro study

Background

Professionally applied topical fluoride preparations have been commonly used and have proven to prevent dental decay. Alternative preparations that provide further benefits may be of interest to investigate. This study aimed to investigate the effect of experimental nano silver fluoride (NSF) formulation compared to commercial sodium fluoride varnish (FV) on prevention of in vitro demineralization of initially sound enamel in primary teeth.

Methods

Forty-eight extracted/exfoliated sound molars were sectioned buccolingually into 96 specimens then assigned randomly into two equal groups. Each group was further subdivided into two equal subgroups (Ia: NSF, IIa: FV, Ib and IIb as negative controls). The test materials were applied, then all the specimens were subjected to a demineralization pH cycling model for 7 days. Specimens were examined for surface microhardness using Vickers microhardness device and lesion depth was evaluated by polarized light microscope using image J 1.46r software. Data were analyzed using paired t-test, independent t-test, and Mann Whitney U test.

Results

The test materials were significantly superior to their negative controls, (P < 0.001) and comparable to each other, (P > 0.05) regarding microhardness and lesion depth. In comparison to FV, NSF showed lower yet statistically insignificant percent increase in microhardness and decrease in lesion depth, (P = 0.81, 0.86, respectively). Qualitative evaluation revealed that both agents reduced the lesion depth formation.

Conclusion

NSF showed similar effect to that of FV in limiting in vitro enamel demineralization caused by acidic challenge. Hence, it could be regarded as a promising alternative preventive agent in primary teeth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02271-6.

Mothers' Sources of Child Fluoride Information and Misinformation From Social Connections

Importance

Fluoride delivered either topically (eg, fluoride varnish) or systemically (eg, water fluoridation, prescription fluoride supplements) is widely used as a caries preventive agent in children. The widespread existence of misinformation, including inaccurate information that attaches negative values or suspicion to fluoride treatments, raises concerns that misinformation will lead to underutilization of fluoride and contribute to avoidable increases in caries prevalence.

Objective

To describe the social relationships from which mothers obtain child fluoride information and misinformation.

Design, Setting, and Participants

This qualitative study analyzed 126 mothers with children aged 3 to 5 years to explore how their social networks were associated with their child's oral health. Mothers were recruited from community-based sites in Pittsburgh, Pennsylvania, and throughout the state of West Virginia from 2018 to 2020. In-person, semi-structured qualitative interviews were conducted. Data were transcribed, coded, and analyzed using Nvivo 12. Three investigators analyzed data using template analysis, a qualitative technique that combines inductive and deductive approaches to identify patterns until primary themes are identified.

Main Outcomes and Measures

Sources of information regarding fluoride from the mother's social relationships.

Results

Of the 126 mothers with children aged 3 to 5 years in Pittsburgh and West Virginia, 120 (95%) identified as non-Hispanic White and 5 (4%) identified as Hispanic White; 38 (30%) had a bachelor's degree, 77 (61%) had private dental insurance for their child, and 52 (41%) had an income less than $50 000; 82 (65%) reported that they discussed child fluoride information with members of their social network. Mothers described that they obtained fluoride information from family members, health care clinicians, and community members. The receipt of inconsistent child fluoride information from multiple sources resulted in confusion and difficulty assessing whether fluoride information was accurate.

Conclusions and Relevance

This qualitative study found that mothers received inconsistent child fluoride information from multiple sources, which resulted in confusion and difficulty assessing the accuracy of the fluoride information. These findings suggest that social relationships can be a potential target for interventions to communicate fluoride information related to children.

Fluoride Coatings on Magnesium Alloy Implants

After several years of research and development, it has been reported that magnesium alloys can be used as degradable metals in some medical device applications. Over the years, fluoride coatings have received increasing research attention for improving the corrosion resistance of magnesium. In this paper, different methods for preparing fluoride coatings and the characteristics of these coatings are reported for the first time. The influence of the preparation conditions of fluoride coatings, including the magnesium substrate, voltage, and electrolyte, on the coatings is discussed. Various properties of magnesium fluoride coatings are also summarized, with an emphasis on corrosion resistance, mechanical properties, and biocompatibility. We screened experiments and papers that planned the application of magnesium fluoride coatings in living organisms. We have selected the literature with the aim of enhancing the performance of in vivo implants for reading and further detailed classification. The authors searched PubMed, SCOPUS, Web of Science, and other databases for 688 relevant papers published between 2005 and 2021, citing 105 of them. The selected time range is the last 16 years. Furthermore, this paper systematically discusses future prospects and challenges related to the application of magnesium fluoride coatings to medical products.

In Vitro Biocompatibility of Several Children's Toothpastes on Human Gingival Fibroblasts

The European Academy of Paediatric Dentistry has recommended fluoride toothpastes from the eruption of the first teeth in children. Toothpastes stay in the mouth in contact with human gingival fibroblasts (hGFs) for a long time. Thus, the objective of this study was to compare the cytotoxicity of five different commonly used children’s toothpastes: Oral B Kids +3 (Procter & Gamble, Alicante, Spain), Fluor Kin Calcium (Kin, Madrid, Spain), PHB Junior (PHB, Barcelona, Spain), Colgate +3 (Colgate Palmolive, Madrid, Spain) and Vitis Kids (Dentaid, Valencia, Spain) on hGFs. The children’s toothpastes were exposed to hGFs at different concentrations (1:1, 1:2, 1:4). Afterwards, several tests were performed: MTT assays, cell cycle analyses, cell cytoskeleton staining assays, apoptosis/necrosis assays, and ICP-MS and ion chromatography. Oral B displayed the lowest cytotoxicity and was the toothpaste with the highest fluoride ion release; meanwhile, the other toothpastes were cytotoxic (*** p < 0.0001); Fluor Kin being the one with the lowest fluoride ion release. Among all the toothpastes analyzed, Oral B exhibited the best results in vitro in terms of biocompatibility. Future evaluations, both in vitro and in vivo, are required to confirm the biocompatibility of sodium lauryl sarcosinate and sodium lauryl sulfate containing toothpastes.

Knowledge, Attitudes, and Practices of Parents on Early Childhood Caries in Qatar-A Questionnaire Study

OBJECTIVES

 The aims of the present study were to evaluate the level of knowledge, attitudes, and practices (KAP) toward early childhood caries (ECC) in a group of Qatari parents and to assess the association of sociodemographic factors on their KAP.

MATERIALS AND METHODS

 A cross-sectional study which was based on a piloted self-administered questionnaire was conveniently distributed to parents who attended the Pediatric Dentistry Section, Hamad Dental Center (HDC), Doha, Qatar. The questionnaire comprised four parts which asked about sociodemographic characteristics, knowledge, attitudes, and practices. A score for each domain was given based on the percentage of correct answers.

STATISTICAL ANALYSIS

 Descriptive and analytical statistics were employed. For descriptive statistics, frequency of distribution in relation to sociodemographic characteristics and responses to items of the questionnaire were presented. For analytical statistics, associations between independent variables and KAP were employed using Chi-squared tests.

RESULTS

 The overall mean scores of KAP were 60.8%, 65.6% and 72.7%, respectively. Females had significantly higher percentages of correct answers than males (p = 0.001). Only 20% of females had poor knowledge, while it was 40% in males. Parents with university or higher degrees had significantly higher percentage of good attitudes than parents with preparatory or less education (p = 0.05). Areas that necessitated improvement by parents included the following: the amount of toothpaste needed for brushing, signs of tooth demineralization, bacteria that causes tooth decay can be transmitted from mother to her child, and tooth decay can be transmitted by sharing utensils (i.e., spoons, forks).

CONCLUSIONS

 The overall KAP of parents toward ECC was relatively fair. However, certain socioeconomic factors (SEF) seemed to influence each domain, and areas of improvement are needed. Areas of improvement are needed in each domain. Mothers were significantly more knowledgeable than fathers regarding oral health issues of their children. Highly educated parents demonstrated better attitudes than the less educated. Continuous educational programs coordinated by health regulatory bodies should be introduced to improve parents' KAP regarding ECC risk factors and prevention.

Layered double hydroxides for controlled fluoride release

This study aims to develop a nano-sized fluoridated layered double hydroxide (LDH)-based release system via hydrothermal treatment for the controlled delivery of fluoride (F-) ions in the oral environment. The synthesis of conventional LDH-type (C-LDH) precursor nanomaterials was conducted using a co-precipitation method at constant pH, and the nanoparticulate-LDH (N-LDH) was synthesized by a hydrothermal procedure. Fluoride LDH (F-LDH) products were obtained through indirect synthesis using the precursor ion-exchange technique by varying the agitation time (2 and 24 h) and temperature (25 and 40 °C) to produce 12 material samples. The materials were characterized by energy dispersive x-ray, hexamethyldisilazane, digital radiography x-ray, Fourier-transform infrared, thermogravimetric analysis, and scanning electron microscopy. Additionally, the F-release kinetic profile was evaluated for 21 d in neutral and acid media with mathematical model analysis. Products with varying F-quantities were obtained, revealing specific release profiles. In general, there was a higher F-release in the acid medium, with emphasis on F-LDH-8. Fluoride-LDH and controlled fluoride delivery was successfully obtained, proving the potential of these nanomaterials as alternative anti-caries agents.

Effects of health-promoting school strategy on dental plaque control and preventive behaviors in schoolchildren in high-caries, rural areas of Taiwan: a quasi-experimental design

Background

We evaluated the effects of health-promoting school (HPS) strategy on plaque control and behavior change in high-caries schoolchildren in Taitung, Taiwan.

Methods

A quasi-experimental design was adopted; six intervention schools (intervention group [IG]) and six comparison schools (comparison group [CG]) were selected from elementary schools with higher-than-average caries rates (> 68%). The IG was selected using cluster sampling, and the CG was selected to match the IG. In total, the IG and CG groups included 166 and 174 children each. The selected schools implemented the HPS framework for 3 months in the 2019 academic year. An oral examination of dental plaque was administered, and a self-administered questionnaire regarding knowledge, attitude, self-efficacy, and behaviors was distributed at baseline and at 2-week follow-up. A linear and logistic regression model using generalized estimating equations (GEEs) was used to analyze the differences between baseline and the follow-up data.

Results

Compared with the CG, the IG had a greater reduction in plaque index among second graders (β =  − 0.36) and plaque control record scores among second, fourth, and sixth graders (β =  − 27.48, − 26.04, and − 18.38, respectively). The IG also exhibited a greater increase at follow-up with respect to oral health–related knowledge among second graders and fourth graders (β = 1.46 and β = 0.92, respectively), attitude toward oral hygiene behaviors among sixth graders (β = 1.78), and self-efficacy regarding flossing for sixth graders (β = 1.43). Sixth graders in the IG were significantly more likely to brush before sleeping (adjusted odds ratio [aOR] = 2.99) and use fluoride toothpaste (aOR = 5.88) than those in the CG.

Conclusions

The HPS strategy was effective in reducing dental plaque and promoting preventing behaviors in rural high-caries schoolchildren.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01927-z.

Oral health status and knowledge of only and non-only children in China

Objectives To evaluate the oral health status and knowledge of only children (OC) and non-only children (NOC), and to explore potential reasons for the differences.Materials and methods This cross-sectional sampling survey included 3,731 children between the ages of 12 and 15 years. The oral health of the subjects was examined, according to the Basic Methods of Oral Health Survey (fifth edition) recommended by the World Health Organisation, and their eating habits, oral health knowledge and oral habits were recorded. EpiData software was used to input data, and SPSS version 19.0 software was used for analysis and comparison.Results The incidence of dental caries and the decayed, missing and filled teeth index (DMFT) in OC (53.2% and 1.53, respectively) were significantly lower than those in NOC (56.2% and 1.86, respectively) (P <0.05). These values were highest in female NOC (63.7%). Gingival bleeding in NOC (78.9%) was significantly higher than that in OC (74.1%) and the difference was statistically significant (P <0.05). The pit and fissure sealant rate of the OC (17.9%) was better than that of the NOC (11.0%), and the difference was statistically significant (P <0.05). There were no significant differences in the oral health attitudes between the two groups, while the scores of the OC were higher than that of the NOC on eight questions of oral health knowledge and awareness, with statistically significant differences for five of the questions (P <0.05). In terms of oral behavioural habits and related factors, the OC scored better than the NOC.Conclusions Our results show that the oral health status of NOC, especially female children, is worrying. When formulating health-related policies, it is necessary to consider these inequalities in adolescents and to provide more resources to the relatively vulnerable adolescents.

Manifestation and Mechanisms of Abnormal Mineralization in Teeth

Tooth biomineralization is a dynamic and complicated process influenced by local and systemic factors. Abnormal mineralization in teeth occurs when factors related to physiologic mineralization are altered during tooth formation and after tooth maturation, resulting in microscopic and macroscopic manifestations. The present Review provides timely information on the mechanisms and structural alterations of different forms of pathological tooth mineralization. A comprehensive study of these alterations benefits diagnosis and biomimetic treatment of abnormal mineralization in patients.

Study on antibacterial and fluoride-releasing properties of a novel composite resin with fluorine-doped nano-zirconia fillers

OBJECTIVE

A novel composite resin (CR) with fluorine-doped nano-zirconia (F-ZrO₂) fillers was developed as an antibacterial restorative material. This article described the synthesis and investigated the fluoride release, antibacterial property and cytotoxicity of the novel CR.

METHODS

F-ZrO₂ powders with different fluorine contents (0% F-ZrO₂, 5% F-ZrO₂, 10% F-ZrO₂ or 20% F-ZrO₂) were synthesized by chemical precipitation method and characterized by XRD, SEM and TEM-EDS. The content and release of fluoride were also determined. 20% F-ZrO₂ powers were selected to develop the novel CRs (FZ-25, FZ-50, and FZ-75). The fluoride release from the novel CRs during 28 days was recorded. The antibacterial property of the novel CRs was investigated with direct contact test (DCT) and metabolic activity test (CCK8). The cytotoxicity of the CRs was also evaluated here.

RESULTS

F-ZrO₂ powders with different fluorine contents were obtained. The fluoride release increased with increasing of the fluoride content. Through the antibacterial performance evaluation, 20% F-ZrO₂ powders, which exhibiting the best antibacterial property, were selected as the fillers for preparing the novel CR. The novel CR with F-ZrO₂ fillers exhibited an effective antibacterial effect. Compared with the control group, the antibacterial rates of FZ-25, FZ-50 and FZ-75 were 51.65%, 54.14% and 66.80% (p<0.05), respectively. No obvious cytotoxicity of the novel CR was detected in this study.

CLINICAL SIGNIFICANCE

The novel CR with continuous fluoride release and proper antibacterial property is expected to be used as an antibacterial material to reduce secondary caries.

Assessment of the preventive effects of Nd:YAG laser associated with fluoride on enamel caries using optical coherence tomography and FTIR spectroscopy

Objective

This in vitro study characterized and monitored, by Optical Coherence Tomography (OCT) and Fourier Transformed Infrared Spectroscopy (FTIR), the effects of the association of acidulated phosphate fluoride gel (APF-gel) and Nd:YAG (neodymiun:yttrium-aluminum-garnet) laser, as sequencial treatments, in the prevention of incipient enamel caries lesions.

Methods

120 human enamel samples were randomized into 3 groups (n = 40): APF-gel (1.23% F^-, 4 min.); Laser+APF (Nd:YAG laser irradiation—0.6W, 84.9J/cm², 10Hz, followed by APF-gel); and APF+Laser (APF-gel followed by laser irradiation). The samples were subjected to a 15-day pH-cycling, evaluated by OCT (quantification of optical attenuation coefficient–OAC) and FTIR (analysis of carbonate and phosphate content) before treatments, after treatments, and on the 5^th, 10^th and 15^th days of pH-cycling. The statistical analysis was performed (α = 5%).

Results

The Optical Attenuation Coefficient (OAC) assessed by OCT increases with the progression of demineralization, and the Laser+APF presented the highest values of OAC in 10^th and 15^th days of pH-cycling. Nd:YAG decreased the carbonate content after treatment regardless of the application order of the APF-gel, while APF-gel did not interfere in the composition of enamel. The carbonate content was also changed in the first 5 days of the pH-cycling in all groups.

Conclusion

Nd:YAG laser irradiation before or after the application of APF-gel did not influence the appearance of incipient caries lesions, showing no synergistic effect. Regardless of the application order of the APF-gel, laser irradiation reduces the carbonate content of the enamel, which also changes during the demineralization process. However, irradiation before the application of APF-gel increased the speed of progression of the lesions, which positively impacts public health as it can prevent caries disease, even in high risk individuals. OCT and FTIR are suitable for assessing this effect.

Dietary Fluoride Intake by Children: When to Use a Fluoride Toothpaste?

Fluoride is recommended for its cariostatic effect, but excessive fluoride intake may have health risks. Increased prevalence of dental fluorosis in areas with low fluoride content in drinking water has been attributed to the inappropriate excessive intake of fluoride supplements (tablets and drops) and toothpaste ingestion. The aim of the present study was to estimate the fluoride intake and the risk of fluorosis in children (6 months-6 years) in the Castelli Romani area (province of Rome, Italy), which is volcanic, therefore with a higher concentration of fluorine. Measurements of the fluoride content in drinking water, mineral waters, vegetables and commercial toothpaste for children were performed. The fluoride concentrations of all samples were determined using a Fluoride Ion Selective Electrode (GLP 22, Crison, Esp). Data were analyzed by descriptive statistics. Differences between samples were determined by Student's t-test. The fluoride content in tap water samples collected from public sources averaged from 0.35 to 1.11 ppm. The Pavona area showed the highest content of fluoride with respect to the others (p ≤ 0.05). The fluoride content in mineral water samples averaged from 0.07 to 1.50 ppm. The fluoride content of some vegetables showed increased mean values when compared to control vegetables (p ≤ 0.05). Within the limitations of the present study, considerations should be made when prescribing fluoride toothpaste for infants (6 months-4 years) in the areas with high fluoride content, because involuntary ingestion is consistent.

Effects of 9,300 nm Carbon Dioxide Laser on Dental Hard Tissue: A Concise Review

A carbon dioxide laser at 9,300 nm has a high absorption affinity for water and a shallow depth of penetration. It can be used for soft tissue surgery and hemostasis. Besides, it matches well with the absorption characteristic of hydroxyapatite in enamel and dentine. Therefore, the laser possesses a great ability for energy transfer to dental hard tissues. It has a low risk of thermo-damage to the dentine-pulp complex because it has a shallow depth of heat absorption. Hence, the laser is safe for dental hard tissue preparation. A carbon dioxide laser at 9,300 nm can effectively alter the chemical structure of teeth. It increases the ratio of calcium to phosphorus and converts the carbonated hydroxyapatite to the purer hydroxyapatite of enamel and dentine. It can alter the surface morphology of a tooth through surface melting, fusion, and ablation of dentine and enamel. At higher power, it removes caries lesions. It can enhance the success of restoration by increasing the bond strength of dental adhesives to the dentine and enamel. A carbon dioxide laser at 9,300 nm can also be used with fluoride for caries prevention. The advancement of technology allows the laser to be delivered in very short pulse durations and high repetition rates (frequency). Consequently, the laser can now be used with high peak power. The objective of this review is to discuss the effects and potential use of a 9,300 nm carbon dioxide laser on dental hard tissue.

Chemical Aspects of Human and Environmental Overload with Fluorine

Over the last 100-120 years, due to the ever-increasing importance of fluorine-containing compounds in modern technology and daily life, the explosive development of the fluorochemical industry led to an enormous increase of emission of fluoride ions into the biosphere. This made it more and more important to understand the biological activities, metabolism, degradation, and possible environmental hazards of such substances. This comprehensive and critical review focuses on the effects of fluoride ions and organofluorine compounds (mainly pharmaceuticals and agrochemicals) on human health and the environment. To give a better overview, various connected topics are also discussed: reasons and trends of the advance of fluorine-containing pharmaceuticals and agrochemicals, metabolism of fluorinated drugs, withdrawn fluorinated drugs, natural sources of organic and inorganic fluorine compounds in the environment (including the biosphere), sources of fluoride intake, and finally biomarkers of fluoride exposure.

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.

Resilience of the oral microbiome

The human mouth harbors a complex microbiota, the composition of which is potentially influenced by a wide range of factors, including the intake of food and drink, the availability of endogenous nutrients, the host immune system, drug treatments, and systemic diseases. Despite these possible influences, the oral microbiota is remarkably resilient, particularly in comparison with the microbiota of the large intestine. Diet, with the exception of excessive and/or frequent consumption of fermentable carbohydrate or supplementation with nitrate, has minimal impact on the composition of the oral bacterial community. The common oral diseases dental caries and the periodontal diseases is associated with modification of the oral microbiota primarily as a result of the ecological changes induced by excessive acid production and inflammation, respectively. Systemically-administered antimicrobials have only a small effect on the composition of the oral bacterial community, and while locally delivered antimicrobials can have some clinical benefits, the biofilm lifestyle of oral bacteria lends them substantial resistance to the agents used. Saliva plays an important role in oral microbial ecology, by supplying nutrients and providing protection against colonization by nonoral organisms. Dry mouth is one condition that has a major effect on the microbiota, resulting in increased colonization by opportunistic pathogens. Some systemic diseases do affect the oral microbiome, notably diabetes, in which raised levels of glucose in saliva and tissue impact on bacterial nutrition.

Nanozymes go oral: nanocatalytic medicine facilitates dental health

Nanozymes are multi-functional nanomaterials with enzyme-like activity, which rapidly won a place in biomedicine due to their number of nanocatalytic materials types and applications. Yan and Gao first discovered horseradish peroxidase-like activity in ferromagnetic nanoparticles in 2007. With the joint efforts of many scientists, a new concept-nanocatalytic medicine-is emerging. Nanozymes overcome the inherent disadvantages of natural enzymes, such as poor environmental stability, high production costs, difficult storage and so on. Their progress in dentistry is following the advancement of materials science. The oral research and application of nanozymes is becoming a new branch of nanocatalytic medicine. In order to highlight the great contribution of nanozymes facilitating dental health, we first review the overall research progress of multi-functional nanozymes in oral related diseases, including treating dental caries, dental pulp diseases, oral ulcers and peri-implantitis; the monitoring of oral cancer, oral bacteria and ions; and the regeneration of soft and hard tissue. Additionally, we also propose the challenges remaining for nanozymes in terms of their research and application, and mention future concerns. We believe that the new catalytic nanomaterials will play important roles in dentistry in the future.