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Campos MS, Fontana M. Caries Management in Special Care Dentistry. Dent Clin North Am 2022; 66:169-179. [PMID: 35365271 DOI: 10.1016/j.cden.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Marcia S Campos
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, 1011 North University, Room 3169, Ann Arbor, MI 48109, USA.
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, 1011 North University, Room 2303, Ann Arbor, MI 48109, USA
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Patel R, Khan I, Pennington M, Pitts NB, Robertson C, Gallagher JE. Protocol for A randomised feasibility trial comparing fluoride interventions to prevent dental decay in older people in care homes (FInCH trial). BMC Oral Health 2021; 21:302. [PMID: 34126984 PMCID: PMC8200547 DOI: 10.1186/s12903-021-01650-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number and proportion of older people globally is growing faster than that of any other age group. At the same time the number of people retaining some of their own teeth is rising. There significant differences between those living in care and their community dwelling peers, with evidence showing those in care having fewer teeth and significantly higher levels of dental decay. There are numerous Cochrane reviews linking the use of fluoride to a reduction in dental decay, however, the majority of research on effectiveness has been conducted on children and consequently, children and adolescents tend to be the main recipients of fluoride interventions. There are to date no studies comparing the effectiveness of fluoride interventions in older people in care homes in the UK. However, prior to developing an appropriate protocol for full-scale trial comparing clinical effectiveness of fluoride interventions, there are a number of trial feasibility and statistical parameters that need to be clarified. METHODS This trial is a single centre, multi-site randomised controlled assessor blind parallel group (three groups) trial, with the primary objective of establishing the feasibility, practicability and compliance of fluoride interventions to prevent dental decay in care homes. Secondary and tertiary objectives will aim to explore the acceptability of the interventions from resident, care home and dental services perspectives, and estimate the efficacy of the three different fluoride treatments. DISCUSSION This feasibility trial will produce new knowledge and add value to a landscape that is under researched. Although the efficacy of fluoride interventions is proven, the feasibility of dental research and prevention in this vulnerable group and in the complex care home setting is novel. This work will not only add to our understanding of the interface of dental care and social care but will also contribute to our broader understanding on undertaking research in care home settings. Dental care for older people has been a longstanding issue, and the events of this past year has shone a light on the vulnerabilities of those residing in care homes and so this research is landing at a pivotal time. Trial registration EudraCT Registration 2017-002248-34. Registered 20th February 2018 https://www.clinicaltrialsregister.eu/ctr-search/search?query=2017-002248-34 .
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Affiliation(s)
- Rakhee Patel
- Faculty of Dentistry, Oral and Craniofacial Sciences, Dental Public Health, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, Bessemer Road, London, SE59RS, UK.
| | - Iftekhar Khan
- Clinical Trials Unit, University of Warwick, Gibbets Hill, Coventry, CV1 7AL, UK.,Medicines and Health Regulations Agency (MHRA), Canary Wharf, London, E1, UK
| | - Mark Pennington
- Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Kings College London, De Crespigny Park, London, SE58AF, UK
| | - Nigel B Pitts
- Faculty of Dentistry, Oral and Craniofacial Sciences, Dental Innovation and Translation Centre, King's College London, Guys Hospital Campus, London, SE1 9RT, UK
| | - Claire Robertson
- Faculty of Dentistry, Oral and Craniofacial Sciences, Dental Public Health, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, Bessemer Road, London, SE59RS, UK
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral and Craniofacial Sciences, Dental Public Health, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, Bessemer Road, London, SE59RS, UK
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Schiffner U. [Use of fluorides for caries prevention]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:830-837. [PMID: 34115151 PMCID: PMC8241667 DOI: 10.1007/s00103-021-03347-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/30/2021] [Indexed: 11/18/2022]
Abstract
Seit wenigen Jahrzehnten ist in Deutschland ein Rückgang der Karieslast in allen Altersgruppen feststellbar. Hierfür wird die regelmäßige Anwendung von Fluoridpräparaten als wesentliche Ursache beschrieben. Es gilt als gesichert, dass für den Rückgang der Kariesprävalenz und Karieserfahrung die lokale Fluoridapplikation, insbesondere durch fluoridhaltige Zahnpasten und Fluoridlacke, auf die Zahnoberflächen in der Mundhöhle verantwortlich ist. Für die klinische Gesamtwirkung wurden einzelne Wirkungsmechanismen wie die Bildung einer Fluoridspeicherschicht, die Remineralisation sowie Effekte auf die bakterielle Plaque bestimmt. Diese Einzeleffekte können an Schmelz und Wurzeldentin bei Patienten jeden Alters wirksam werden. Dabei besteht eine Dosis-Wirkungs-Beziehung zwischen der Fluoridkonzentration in den angewendeten Präparaten und der durchschnittlich erzielten Kariesreduktion. Es bestehen keine allgemeintoxikologischen Bedenken gegenüber der lokalen Fluoridanwendung. Fluoridzahnpasten sollen ab Durchbruch des ersten Milchzahns verwendet werden. Die Menge der verwendeten Zahnpasta ist auf die empfohlenen Volumina zu begrenzen, um die Entstehung von Schmelzfluorosen zu vermeiden. Die professionell durchgeführte Applikation von hochkonzentrierten Fluoridlacken weist neben einer hohen karieshemmenden Effektivität auch bei erhöhtem Kariesrisiko und bei bereits vorhandenen Demineralisationen besondere Vorteile auf. Dies trifft auch für die Anwendung am Wurzeldentin zu, wo durch Verwendung hochkonzentrierter Fluoridpräparate signifikante primär- und sekundärpräventive Effekte nachgewiesen wurden.
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Affiliation(s)
- Ulrich Schiffner
- Zentrum für Zahn‑, Mund- und Kieferheilkunde, Poliklinik für Parodontologie, Präventive Zahnmedizin und Zahnerhaltung, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Patel R, Fitzgerald R, Warburton F, Robertson C, Pitts NB, Gallagher JE. Refocusing dental care: A risk-based preventative oral health programme for dentate older people in UK care homes. Gerodontology 2021; 39:131-138. [PMID: 33586205 DOI: 10.1111/ger.12543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/13/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is strong evidence for managing the risk of dental caries, notably dose-dependent use of fluoride based on risk. Specific guidance is lacking on higher fluoride use in older people in care homes and prevention is often omitted from dental care plans. OBJECTIVES To introduce a risk-based preventative approach to existing routine dental care for older people in care homes. METHODS Three mixed residential and nursing care homes for the frail and elder (>65 years) were selected to participate. All residents were risk assessed based on dependency, dentition status and self-care abilities and consequently placed on the appropriate evidence-based intervention (2800 ppm high dose fluoride toothpaste and/or quarterly fluoride varnish placement). Full mouth ICDAS dental examinations were completed at baseline, 6 months and 12 months. RESULTS At baseline, 127 risk assessments were completed in which most dentate residents (58.2%, n = 74) were assessed as Risk Level 2/3 (mod/high) whilst edentulous residents were all Risk Level 1 (low) (41.7%, n = 53). Only 13 (26.5%) of the 49 eligible residents completed the 12-month preventative programme. There was a significant difference in root caries (P < .0001), with 17 (51.5%) root lesions changing from active at baseline to arrested at 12 months. CONCLUSIONS The findings provide early indication of fluoride efficacy, especially on root caries in this vulnerable group, and highlight the challenges of delivering programme's in these complex, changing environments.
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Affiliation(s)
- Rakhee Patel
- Public Health England (London), London, UK.,Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, London, UK
| | - Richard Fitzgerald
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, London, UK
| | - Fiona Warburton
- Faculty of Dentistry, Oral & Craniofacial Sciences, Oral Clinical Research Unit, Guys Hospital Campus, London, UK
| | - Claire Robertson
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, London, UK
| | - Nigel B Pitts
- Faculty of Dentistry, Oral & Craniofacial Sciences, Dental Innovation and Translation Centre, King's College London, London, UK
| | - Jennifer E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, London, UK
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Gluzman R, Katz RV, Frey BJ, McGowan R. Prevention of root caries: a literature review of primary and secondary preventive agents. SPECIAL CARE IN DENTISTRY 2012; 33:133-40. [PMID: 23600985 DOI: 10.1111/j.1754-4505.2012.00318.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This literature review summarizes the effectiveness of the seven leading root caries preventive agents and provides recommendations for use of those agents in clinical practice with older adults and vulnerable elderly. METHOD Studies were eligible if they assessed the effectiveness of either fluoride, chlorhexidine, xylitol, amorphous calcium phosphate, sealants, saliva stimulators, or silver diamine fluoride to prevent/control root caries in an English language articles between 1979 and 2010. RESULTS In the 31 eligible studies, the most effective primary (1°) prevention agents had reductions in RC incidence ranging from 72% to nearly 200% as compared to a placebo while for secondary (2°) prevention, the best agents demonstrated arrest rates between 67 and 80%. CONCLUSION For 1° prevention of root caries the recommended "best choice" is a 38% Silver Diamine Fluoride solution professionally applied annually, while for the 2° prevention of root caries, the recommended "best choice" is a 22,500 ppm Sodium Fluoride varnish professionally applied every 3 months.
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Affiliation(s)
- Rima Gluzman
- Department of Epidemiology and Health Promotion, NYU College of Dentistry, NY, USA
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Abstract
DESIGN Randomised controlled trial. INTERVENTION Volunteers aged 14-16 years with DMFS ≥ 5 were recruited, those with orthodontic appliances were excluded. Participants were assigned dentifrices for unsupervised toothbrushing. The test group received Duraphat 5,000 ppm F (Colgate-Palmolive AB, Danderyd, Sweden) and the control group Pepsodent Superfluor 1,450 ppm F (Lever Fabergé, Stockholm, Sweden), both as NaF. Toothbrushes and dentifrices were delivered to their home addresses by post, every third month. Patricipants and their parents were instructed to keep the 5,000 ppm dentifrice in a safe place away from small children. Evaluations were carried out at two years and a compliance questionnaire was administered. OUTCOME MEASURE The outcome variables were caries incidence and progression of proximal and occlusal caries. RESULTS 28% of participants were considered to have had poor compliance as assessed by questionnaire. Those using 5,000 ppm F toothpaste had significantly lower caries progression compared to those using 1,450 ppm F toothpaste with a prevented fraction of 40%, with those with poorer compliance showing a slightly higher prevented fraction (42%). CONCLUSIONS The 5,000 ppm toothpaste therefore appears to be an important vehicle for the treatment and prevention of caries in patients with a high caries risk. The data may indicate that 5,000 ppm toothpaste has a greater impact on individuals who do not use toothpaste regularly or do not brush twice a day.
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Affiliation(s)
- Brett Duane
- Department of Public Health, NHS Fife, Cameron Hospital, Windygates, UK
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