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Godenzi D, Bommer C, Heinzel-Gutenbrunner M, Horst Keeper J, Peters K. Remineralizing potential of the biomimetic P 11-4 self-assembling peptide on noncavitated caries lesions: A retrospective cohort study evaluating semistandardized before-and-after radiographs. J Am Dent Assoc 2023; 154:885-896.e9. [PMID: 37642611 DOI: 10.1016/j.adaj.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/19/2023] [Accepted: 07/06/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Self-assembling peptide (SAP) P11-4 was introduced to treat initial caries lesions by means of guiding hydroxyapatite regeneration within the lesion. The objective of this study was to assess its effectiveness in a practical clinical setting. METHODS Caries lesions in permanent teeth treated with monomeric and polymeric SAP P11-4 from May 2015 through October 2020 were retrospectively analyzed at lesion and child levels by means of bite-wing radiography for changes in stage and cavitation and restoration. RESULTS Two hundred and nineteen children aged 10 through 19 years with a total of 405 proximal lesions in posterior teeth were followed from 0.4 through 5.5 years (median, 7 months; interquartile range, 6-19 months). Regression occurred in 37% of stage RA1 (radiolucency in the outer one-half of enamel) (95% CI, 31% to 44%), 38% of stage RA2 (radiolucency in the inner one-half of enamel plus or minus the enamel-dentin junction) (95% CI, 30% to 45%), and 40% of stage RA3 (radiolucency limited to the outer one-third of dentin) (95% CI, 16% to 68%) lesions. The proportion of lesions with no cavitation was 0.96 (95% CI, 0.94 to 0.98) after 1 year and 0.91 (95% CI, 0.88 to 0.95) after 2 years. CONCLUSIONS Real-world clinical data indicate that SAP P11-4 can lead to recovery and a healthier tooth stage. PRACTICAL IMPLICATIONS SAP P11-4 is a safe treatment for initial caries lesions in permanent teeth that remineralizes in the deepest zone of the lesion and can be introduced easily into routine dental practice.
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Li Y, Liu M, Xue M, Kang Y, Liu D, Wen Y, Zhao D, Guan B. Engineered Biomaterials Trigger Remineralization and Antimicrobial Effects for Dental Caries Restoration. Molecules 2023; 28:6373. [PMID: 37687202 PMCID: PMC10489995 DOI: 10.3390/molecules28176373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 09/10/2023] Open
Abstract
Dental caries is the most prevalent chronic disease globally, significantly impacting individuals' quality of life. A key reason behind the failure of implanted restorations is their biological inactivity, meaning they are unable to form crosslinks with the surrounding tooth structures, thus making patients susceptible to implant loss and recurrent tooth decay. For the treatment of caries, antibacterial medicine and remineralization are effective means of treating the recurrence of caries. Owing to the rapid progression in the biomaterials field, several biomaterials have been reported to display antimicrobial properties and aid in dentin remineralization. Bioactive materials hold considerable potential in diminishing biofilm accumulation, inhibiting the process of demineralization, enabling dentin remineralization, and combating bacteria related to caries. Bioactive materials, such as fluoride, amorphous calcium phosphate, bioactive glass, collagen, and resin-based materials, have demonstrated their effectiveness in promoting dentin remineralization and exerting antibacterial effects on dental caries. However, the concentration of fluoride needs to be strictly controlled. Although amorphous calcium phosphate can provide the necessary calcium and phosphorus ions for remineralization, it falls short in delivering the mechanical strength required for oral mastication. Resin-based materials also offer different advantages due to the complexity of their design. In this review, we delve into the application of advanced bioactive materials for enhancing dentin remineralization and antibacterial properties. We eagerly anticipate future developments in bioactive materials for the treatment of dental caries.
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Affiliation(s)
- Yuexiao Li
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, Shenyang 110022, China
| | - Minda Liu
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, Shenyang 110022, China
| | - Mingyu Xue
- School and Hospital of Stomatology, China Medical University, Shenyang 110002, China
| | - Yuanyuan Kang
- School and Hospital of Stomatology, China Medical University, Shenyang 110002, China
| | - Dongjuan Liu
- School and Hospital of Stomatology, China Medical University, Shenyang 110002, China
| | - Yan Wen
- School and Hospital of Stomatology, China Medical University, Shenyang 110002, China
| | - Duoyi Zhao
- Department of Orthopedics, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Boyu Guan
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, China Medical University, Shenyang 110022, China
- School and Hospital of Stomatology, China Medical University, Shenyang 110002, China
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McGuffog R, Bryant J, Booth K, Collis F, Brown A, Hughes JT, Chamberlain C, McGhie A, Hobden B, Kennedy M. Exploring the Reported Strengths and Limitations of Aboriginal and Torres Strait Islander Health Research: A Narrative Review of Intervention Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3993. [PMID: 36901001 PMCID: PMC10001772 DOI: 10.3390/ijerph20053993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
High quality intervention research is needed to inform evidence-based practice and policy for Aboriginal and Torres Strait Islander communities. We searched for studies published from 2008-2020 in the PubMed database. A narrative review of intervention literature was conducted, where we identified researcher reported strengths and limitations of their research practice. A total of 240 studies met inclusion criteria which were categorised as evaluations, trials, pilot interventions or implementation studies. Reported strengths included community engagement and partnerships; sample qualities; Aboriginal and Torres Strait Islander involvement in research; culturally appropriate and safe research practice; capacity building efforts; providing resources or reducing costs for services and communities; understanding local culture and context; and appropriate timelines for completion. Reported limitations included difficulties achieving the target sample size; inadequate time; insufficient funding and resources; limited capacity of health workers and services; and inadequate community involvement and communication issues. This review highlights that community consultation and leadership coupled with appropriate time and funding, enables Aboriginal and Torres Strait Islander health intervention research to be conducted. These factors can enable effective intervention research, and consequently can help improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people.
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Affiliation(s)
- Romany McGuffog
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jamie Bryant
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kade Booth
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Felicity Collis
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alex Brown
- Indigenous Genomics, Australia National University, Canberra, ACT 2601, Australia
- Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Jaquelyne T. Hughes
- Rural and Remote Health, College of Medicine and Public Health, Flinders University, Darwin, NT 0810, Australia
| | - Catherine Chamberlain
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Alexandra McGhie
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Breanne Hobden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Michelle Kennedy
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308, Australia
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Effectiveness of Silver Diamine Fluoride compared with Sodium Fluoride Varnish on Oral Saliva pH in the Children with Sever-Early Childhood Caries (S-ECC). JOURNAL OF RESEARCH IN APPLIED AND BASIC MEDICAL SCIENCES 2022. [DOI: 10.52547/rabms.8.4.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Bonchev A, Simeonov M, Shestakova P, Vasileva R, Titorenkova R, Apostolov A, Dyulgerova E, Vassileva E. Bioinspired Remineralization of Artificial Caries Lesions Using PDMAEMA/Carbomer/Calcium Phosphates Hybrid Microgels. Gels 2022; 8:gels8100681. [PMID: 36286182 PMCID: PMC9601719 DOI: 10.3390/gels8100681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 11/04/2022] Open
Abstract
Dental caries remains one of the most prevalent bacterium-caused chronic diseases affecting both adults and children worldwide. The development of new materials for enhancing its remineralization is one of the most promising approaches in the field of advanced dental materials as well as one of the main challenges in non-invasive dentistry. The aim of the present study is to develop novel hybrid materials based on (PDMAEMA)/Carbomer 940 microgels with in situ deposited calcium phosphates (CaP) and to reveal their potential as a remineralization system for artificial caries lesions. To this purpose, novel PDMAEMA/Carbomer 940 microgels were obtained and their core–shell structure was revealed by transmission electron microscopy (TEM). They were successfully used as a matrix for in situ calcium phosphate deposition, thus giving rise to novel hybrid microgels. The calcium phosphate phases formed during the deposition process were studied by X-ray diffraction and infrared spectroscopy, however, due to their highly amorphous nature, the nuclear magnetic resonance (NMR) was the method that was able to provide reliable information about the formed inorganic phases. The novel hybrid microgels were used for remineralization of artificial caries lesions in order to prove their ability to initiate their remineralization. The remineralization process was followed by scanning electron microscopy (SEM), X-ray diffraction, infrared and Raman spectroscopies and all these methods confirmed the successful enamel rod remineralization upon the novel hybrid microgel application. Thus, the study confirmed that novel hybrid microgels, which could ensure a constant supply of calcium and phosphate ions, are a viable solution for early caries treatment.
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Affiliation(s)
- Alexander Bonchev
- Faculty of Dental Medicine, Medical University, 1, G. Sofiiski Str., 1431 Sofia, Bulgaria
| | - Marin Simeonov
- Laboratory on Structure and Properties of Polymers, Faculty of Chemistry and Pharmacy, University of Sofia, 1, James Bourchier Blvd., 1164 Sofia, Bulgaria
| | - Pavletta Shestakova
- Institute of Organic Chemistry with Centre of Phytochemistry, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., Bl. 9, 1113 Sofia, Bulgaria
| | - Radosveta Vasileva
- Faculty of Dental Medicine, Medical University, 1, G. Sofiiski Str., 1431 Sofia, Bulgaria
| | - Rositsa Titorenkova
- Institute of Mineralogy and Crystallography, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., Bl. 107, 1113 Sofia, Bulgaria
| | - Anton Apostolov
- Laboratory on Structure and Properties of Polymers, Faculty of Chemistry and Pharmacy, University of Sofia, 1, James Bourchier Blvd., 1164 Sofia, Bulgaria
| | - Elena Dyulgerova
- Faculty of Dental Medicine, Medical University, 1, G. Sofiiski Str., 1431 Sofia, Bulgaria
| | - Elena Vassileva
- Laboratory on Structure and Properties of Polymers, Faculty of Chemistry and Pharmacy, University of Sofia, 1, James Bourchier Blvd., 1164 Sofia, Bulgaria
- Correspondence:
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Sousa GPD, Lima CCB, Braga MM, Moura LDFADD, Lima MDDMD, Moura MSD. Early childhood caries management using fluoride varnish and neutral fluoride gel: a randomized clinical trial. Braz Oral Res 2022; 36:e099. [PMID: 35830143 DOI: 10.1590/1807-3107bor-2022.vol36.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the clinical efficacy of varnish and neutral fluoride gel in the management of early childhood caries (ECC). A randomized clinical trial was conducted to compare two strategies for ECC management: topical application of neutral fluoride gel (NFG group) and varnish (FV group) every four months for a period of one year. The sample consisted of children between the ages of three and four years, enrolled in public daycare centers. The incidence of ECC between the groups was compared by assessing values (new dmfs) at two levels: d2 when enamel/dentin were affected and d3 when dentin affected. Pearson's Chi-square, Fisher's Exact, Kolmogorov-Smirnov and Mann-Whitney tests were used to compare the incidence and increment of caries between the NFG and FV groups (p<0.05). A total of 240 children were included in this study and 213 children (88.7%) were followed up for 12 months. The incidence of ECC was 24.1% in the GF and 21.0% in the FV groups (p=0.586). The increment of caries in d2mfs was 1.36 (95% CI = 0.83 - 1.89) in the NFG and 1.33 (95% CI = 0.75 - 1.89) in FV (p=0.756) groups. Increment of caries in d3mfs was 1.60 (95% CI = 0.95 - 2.25) in NFG and 1.40 (95% CI = 0.75 - 2.04) in FV (p=0.468). Neutral fluoride gel and fluoride varnish exhibited similar efficacy in the management of ECC after 12 months of follow-up.
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Affiliation(s)
- Geovanna Peres de Sousa
- Universidade Federal do Piauí - UFPI, Department of Pathology and Dental Clinics, Teresina, PI, Brazil
| | | | - Mariana Minatel Braga
- Universidade de São Paulo - USP, School of Dentistry, Department of Pediatric Dentistry, São Paulo, SP, Brazil
| | | | | | - Marcoeli Silva de Moura
- Universidade Federal do Piauí - UFPI, Department of Pathology and Dental Clinics, Teresina, PI, Brazil
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Balian A, Campus G, Bontà G, Esteves-Oliveira M, Salerno C, Cirio S, D'Avola V, Cagetti MG. Long-term caries prevention of dental sealants and fluoride varnish in children with autism spectrum disorders: a retrospective cohort study. Sci Rep 2022; 12:8478. [PMID: 35589819 PMCID: PMC9119978 DOI: 10.1038/s41598-022-12176-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/06/2022] [Indexed: 11/11/2022] Open
Abstract
The aim was to compare two strategies for caries prevention in children with Autism Spectrum Disorders (ASDs). Participants were retrospectively retrieved and divided in two groups. Group one had first permanent molars treated with fluoride varnishes, FA group (n = 92, 9.43 ± 2.44 years) whilst the second, with dental sealant plus fluoride varnishes, FA + S group (n = 140, 7.77 ± 2.57 years). Logistic and multivariate analysis were run to evaluate the caries incidence, the retention rate of sealants, and background factors associated with caries risk over a period of at least 11 years. Survival rates from dental caries were statistically significantly higher in the FA + S group compared to the FA group (LogRank test p < 0.01). Dental sealant plus fluoride varnish played as a protective factor towards the development of caries (HR = 0.25 95%CI = 0.00/0.55 and HR = 0.34 95%CI = 0.00/0.66 in the upper right and left first molars; HR = 0.32 95%CI = 0.00/0.66 and HR = 0.26 95%CI = 0.00/0.58 in the lower right and left first molars). Dental sealants retention rate was high, ranging between 58.02% and 64.29%. No baseline variable was statistically significantly associated to the risk of caries development. Combined dental sealant and fluoride varnish application was more effective in reducing caries risk in first permanent molars of ASDs children than fluoride varnish alone. This preventive strategy should be therefore routinely applied in high caries risk patients as ASDs children.
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Affiliation(s)
- Araxi Balian
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142, Milan, Italy.
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012, Bern, Switzerland
- Department of Pediatric, Preventive Dentistry and Orthodontics, School of Dentistry, Sechenov University, 119991, Moscow, Russia
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Viale San Pietro 3/c, 07100, Sassari, Italy
| | - Giuliana Bontà
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142, Milan, Italy
| | - Marcella Esteves-Oliveira
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012, Bern, Switzerland
| | - Claudia Salerno
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142, Milan, Italy
| | - Silvia Cirio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142, Milan, Italy
| | - Valeria D'Avola
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142, Milan, Italy
| | - Maria Grazia Cagetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142, Milan, Italy
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Manchanda S, Sardana D, Liu P, Lee GH, Li KY, Lo EC, Yiu CK. Topical fluoride to prevent early childhood caries: Systematic review with network meta-analysis. J Dent 2021; 116:103885. [PMID: 34780874 DOI: 10.1016/j.jdent.2021.103885] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To summarize the evidence on prevention of early childhood caries (ECC) by professionally or self-applied topical fluorides using network meta-analysis. DATA Randomized-controlled trials with minimum 1-year follow-up assessing caries-preventive effect among children younger than six years. SOURCES Eight electronic databases and grey literature. STUDY SELECTION After screening and data extraction, risk of bias assessment using Cochrane risk of bias tool 2.0 was done. Twenty-four trials were included, among which 17 were assessed as "high risk" and remaining as "low risk". Fifteen studies evaluated professionally-applied, and the other nine used self-applied topical fluorides. Ten studies on professionally-applied fluorides reporting the net caries increment (dmfs increment) at 2-years follow-up were included in Network meta-analysis (NMA). NMA and ranking the interventions were conducted using a frequentist random-effects approach and surface under the cumulative ranking command, followed by assessing the certainty of evidence using an extension of GRADE approach with CINeMA framework. Among the eight included interventions of professionally-applied fluorides, only two, i.e., 3-monthly 0.9% difluorosilane (DFS) and 6-monthly 5% sodium fluoride varnish were effective in preventing ECC compared to control with 3-monthly DFS application ranking higher than 6-monthly sodium fluoride varnish application. CONCLUSION Among all the professionally-applied topical fluoride interventions reviewed, very low to moderate evidence was found with 0.9% DFS application at 3-monthly intervals, which was ranked highest in prevention of ECC. Among the included studies on self-applied topical fluorides, the evidence was inconclusive due to heterogeneity among studies. CLINICAL SIGNIFICANCE The 0.9% DFS varnish applied every 3 months is most effective for preventing early childhood caries. The review recommends that good quality studies be conducted in future, comparing two or more interventions for both self- as well as professionally-applied topical fluoride agents with adequate follow-up.
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Affiliation(s)
- Sheetal Manchanda
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, Hong Kong
| | - Divesh Sardana
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, Hong Kong
| | - Pei Liu
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, Hong Kong
| | - Gillian Hm Lee
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, Hong Kong
| | - Kar Yan Li
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, Hong Kong
| | - Edward Cm Lo
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, Hong Kong
| | - Cynthia Ky Yiu
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong S.A.R, Hong Kong.
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Turska-Szybka A, Gozdowski D, Twetman S, Olczak-Kowalczyk D. Clinical Effect of Two Fluoride Varnishes in Caries-Active Preschool Children: A Randomized Controlled Trial. Caries Res 2021; 55:137-143. [PMID: 33706305 DOI: 10.1159/000514168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022] Open
Abstract
The prevention of dental caries in preschool children is a priority for dental services. The aim of the study was to investigate the caries-preventive effect of 2 fluoride varnishes in caries-active preschool children, and then compare the outcome with a non-varnish control group. After screening, 180 preschool children aged 36-71 months, with at least 1 noncavitated lesion, were enrolled and randomly allocated into 3 parallel groups, namely A: 1.5% ammonium fluoride varnish (Fluor Protector S), B: 5% NaF varnish (Duraphat), and C: professional tooth-cleaning. All children were recalled every third month for intervention and their parents were instructed to have them brush their teeth with a 1,000-ppm fluoride toothpaste twice daily. Caries were recorded at baseline and after 12 months by a calibrated examiner and the incidence was scored on noncavitated (d2) and cavitated (d3) level. We tested differences between the groups with the χ2 and two-sided t tests. One hundred and seventy-two children (95.6%) completed the trial and 56 (32.6%) and 35 (19.2%) developed new d2 and d3 lesions, respectively. Both varnishes reduced the incidence of caries compared with the control group, but there was no significant difference between group A and group B. Compared with group C, the relative risk for developing cavitated lesions was 0.39 (95% CI 0.22-0.62) in group A and 0.26 (95% CI 0.14-0.50) in group B. The total prevented fraction (Δd2d3mft) for group A and group B was 19.9 and 22.5% (p < 0.05), respectively. No adverse effects were observed or reported during the study period. In conclusion, the 2 fluoride varnishes demonstrated an equal capacity to reduce the incidence of caries in caries-active preschool children over a 12-month period in comparison with a control group.
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Affiliation(s)
- Anna Turska-Szybka
- Department of Paediatric Dentistry, Medical University of Warsaw, Warsaw, Poland
| | - Dariusz Gozdowski
- Department of Experimental Statistics and Bioinformatics, Warsaw University of Life Science, Warsaw, Poland
| | - Svante Twetman
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sun J, Gil M, Khorashadi S, Chen G, Lee C, Ishida Y, Nagai M, Wada S, Ishikawa-Nagai S, Da Silva JD. Efficacy of bisphosphonates in detection of early enamel caries using NIR fluorescence imaging and inhibition of caries progression. Int J Med Sci 2021; 18:2971-2980. [PMID: 34220325 PMCID: PMC8241787 DOI: 10.7150/ijms.60013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/25/2021] [Indexed: 11/05/2022] Open
Abstract
NIR fluorescence imaging using bisphosphonate-Indocyanine green has been indicated for early interproximal caries detection. This study assessed diagnostic accuracy of caries detection by NIR fluorescence imaging with OsteoSense 750® (OS750) in vitro and ex vivo, and to analyze the therapeutic efficacy of a bisphosphonate (Etidronate) in inhibiting enamel caries progression in vitro. Methods: Four experiments were conducted using extracted human teeth; 1) to calculate the infiltration rate of OS750 into interproximal white spot lesions using fluorescence microscope, 2) to assess diagnostic accuracy of interproximal natural white spot lesions using desktop NIR fluorescence imaging device in vitro setting, 3) to assess diagnostic accuracy of artificially created deeper enamel carious lesion (0.5 mm~1.0 mm) using NIR fluorescence image through the head-mount display in ex vivo setting, 4) to compare the progression on the enamel caries lesions treated by Etidronate, NaF and distilled-water. Diagnostic accuracy was analyzed using sensitivity, specificity and receiver operating curves (ROC). The caries progression was calculated with micro-CT and was statistically analyzed using a two-way ANOVA and the Tukey HDS post-hoc test. Results: 1) The infiltration rate of OS750 was 101.83% ± 8.66 (Min: 90.10%, Max: 133.94%). 2) The average of sensitivity and specificity in vitro setting experiments were 86.7% ± 4.4% and 70% ± 11%, respectively. The average of area under the ROC curves (AUC) was 0.883 ± 0.059 indicating excellent performance. 3) The mean sensitivity and specificity in ex vivo setting was 82.97% ± 15% and 76.78% ± 13.27% respectively. 4) The carious lesion volume treated by Etidronate was significantly smaller at post treatment-1 (p<0.05) and treatment-2 (p<0.01) than the control. There was no significant difference in lesion volume in the Etidronate and NaF group at the time point of post treatment-1. Conclusion: This study suggests that bisphosphonates contribute to both early diagnosis of enamel caries and inhibition of caries progression.
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Affiliation(s)
- Jie Sun
- Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, USA
| | - Mindy Gil
- Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, USA
| | - Shahrzad Khorashadi
- Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, USA
| | - George Chen
- Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, USA
| | - Cliff Lee
- Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, USA
| | - Yoshiki Ishida
- Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, USA
| | - Masazumi Nagai
- Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, USA
| | - Shinichiro Wada
- Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, USA
| | | | - John D Da Silva
- Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, USA
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11
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Turton B, Durward C, Crombie F, Sokal-Gutierrez K, Soeurn S, Manton DJ. Evaluation of a community-based early childhood caries (ECC) intervention in Cambodia. Community Dent Oral Epidemiol 2020; 49:275-283. [PMID: 33200439 DOI: 10.1111/cdoe.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/28/2020] [Accepted: 10/30/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To critically evaluate an early childhood caries (ECC) intervention performed by non-dental primary healthcare providers. METHODS This mixed-methods investigation includes data from three sources: (a) a pilot non-randomized controlled trial to examine clinical outcomes at four health centres; (b) stakeholder focus group interviews; and (c) a survey of parents whose children were exposed to the intervention. The pilot study involved four Community Health Centres in rural Cambodia whereby mother-child (6-24 months of age)dyads received oral health education (OHE), toothbrushes, fluoride toothpaste and fluoride varnish on up to six occasions as part of the routine vaccination schedule. Outcomes were as follows: presence of ECC; impacts on oral health-related quality of life (OHRQoL); stakeholder perceptions of intervention delivery; and parental perceptions of fluoride varnish. RESULTS Participants in the intervention group had six times lower odds of developing ECC than those in the comparison group after controlling for socio-economic status (OR 0.13). Those in the intervention group also had a large reduction OHRQoL scale scores. Key knowledge and practice gaps were identified among stakeholders. Surveyed parents had favourable views of the fluoride varnish placement by medical professionals, and four out of five stated that they would recommend fluoride varnish for other children. Primary healthcare providers, commune council representatives and community health promoters supported oral health interventions being provided in CHCs. CONCLUSIONS OHE and fluoride varnish interventions provided by non-dental primary health workers were feasible and acceptable for stakeholders in a Cambodian setting. The intervention group had lower ECC experience and better OHRQoL at 2 years of age.
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Affiliation(s)
- Bathsheba Turton
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - Callum Durward
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - Felicity Crombie
- Melbourne Dental School, University of Melbourne, Melbourne, Vic., Australia
| | | | - Sopharith Soeurn
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - David J Manton
- Centrum voor Tandheelkunde en Mondzorgkunde, UMCG, University of Groningen, Groningen, The Netherlands
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Spinola MDS, Moecke SE, Rossi NR, Nakatsuka T, Borges AB, Torres CRG. Efficacy of S-PRG filler containing varnishes on enamel demineralization prevention. Sci Rep 2020; 10:18992. [PMID: 33149256 PMCID: PMC7642416 DOI: 10.1038/s41598-020-76127-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022] Open
Abstract
This study evaluated the efficacy of S-PRG vanishes on preventing enamel demineralization. Bovine enamel specimens were obtained, polished and the baseline Knoop microhardness was evaluated. Specimens were stratified into six groups (n = 15), according to the varnish applied: S10—experimental varnish containing 10% of S-PRG fillers, S20—20% of S-PRG fillers, S30—30% of S-PRG fillers; S40—40% of S-PRG fillers; PC (positive control)—5% of NaF; NC (negative control)—no treatment was performed. Half of enamel surfaces were protected to work as a control and varnishes were applied over the unprotected area. A demineralizing pH-cycling was performed, and surface and cross-sectional microhardness were measured. The percentage of microhardness of the treated area was calculated comparing with the untreated area. Statistical analysis was performed by one-way ANOVA and Tukey’s test (p = 5%). All experimental S-PRG varnishes protected against demineralization in relation to no treatment, but S40 was the most effective on the surface. For all depths, S30 and S40 were superior in enamel demineralization prevention than other S-PRG filler concentrations and 5% NaF. It was concluded that S-RPG filler containing varnishes were effective to prevent enamel demineralization. The higher concentrated products were more effective than 5% sodium fluoride on surface demineralization prevention.
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Affiliation(s)
- Manuela da Silva Spinola
- Department of Restorative Dentistry, São Paulo State University - UNESP, Institute of Science and Technology, Av. Eng. Francisco Jose Longo, 777, São José dos Campos, SP, 12245-000, Brazil
| | - Sabrina Elise Moecke
- Department of Restorative Dentistry, São Paulo State University - UNESP, Institute of Science and Technology, Av. Eng. Francisco Jose Longo, 777, São José dos Campos, SP, 12245-000, Brazil
| | - Natália Rivoli Rossi
- Department of Dental Materials and Prosthodontics, São Paulo State University - UNESP, Institute of Science and Technology, Av. Eng. Francisco Jose Longo, 777, São José dos Campos, SP, 12245-000, Brazil
| | - Toshiyuki Nakatsuka
- Department of Research and Development, Shofu Inc., 11 Kamitakamatsu-cho, Fukuine, Higashiyama-ku, Kyoto, 605-0983, Japan
| | - Alessandra Bühler Borges
- Department of Restorative Dentistry, São Paulo State University - UNESP, Institute of Science and Technology, Av. Eng. Francisco Jose Longo, 777, São José dos Campos, SP, 12245-000, Brazil
| | - Carlos Rocha Gomes Torres
- Department of Restorative Dentistry, São Paulo State University - UNESP, Institute of Science and Technology, Av. Eng. Francisco Jose Longo, 777, São José dos Campos, SP, 12245-000, Brazil.
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13
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Abstract
Abstract
This study evaluated the efficacy of S-PRG vanishes on preventing enamel demineralization. Bovine enamel specimens were obtained, polished and the baseline Knoop microhardness was evaluated. Specimens were stratified into six groups (n = 15), according to the varnish applied: S10—experimental varnish containing 10% of S-PRG fillers, S20—20% of S-PRG fillers, S30—30% of S-PRG fillers; S40—40% of S-PRG fillers; PC (positive control)—5% of NaF; NC (negative control)—no treatment was performed. Half of enamel surfaces were protected to work as a control and varnishes were applied over the unprotected area. A demineralizing pH-cycling was performed, and surface and cross-sectional microhardness were measured. The percentage of microhardness of the treated area was calculated comparing with the untreated area. Statistical analysis was performed by one-way ANOVA and Tukey’s test (p = 5%). All experimental S-PRG varnishes protected against demineralization in relation to no treatment, but S40 was the most effective on the surface. For all depths, S30 and S40 were superior in enamel demineralization prevention than other S-PRG filler concentrations and 5% NaF. It was concluded that S-RPG filler containing varnishes were effective to prevent enamel demineralization. The higher concentrated products were more effective than 5% sodium fluoride on surface demineralization prevention.
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Schmoeckel J, Gorseta K, Splieth C, Juric H. How to Intervene in the Caries Process: Early Childhood Caries – A Systematic Review. Caries Res 2020; 54:102-112. [DOI: 10.1159/000504335] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/24/2019] [Indexed: 11/19/2022] Open
Abstract
For an Organisation for Caries Research/European Federation of Conservative Dentistry consensus, this systematic review is aimed to assess the question of how to manage the caries process in the case of early childhood caries (ECC). Medline via PubMed was searched systematically regarding management of ECC. First priority was existing systematic reviews or randomized clinical trials otherwise cohort studies dealing with management of ECC, primarily with carious anterior teeth. After data extraction, the potential risk of bias was estimated depending on the study types, and the level of evidence was evaluated. Regarding management of ECC, results are presented for silver diamine fluoride (SDF, n = 5), nonoperative caries management (NOCM, n = 10), and restorative approaches (RA, n = 8) separately, as different kinds of studies with different levels of evidence were found for the different aspects in the management of ECC. The 5 systematic reviews on SDF showed a high potential for arrest of ECC on a high level of evidence. In NOCM, a low level of evidence for a moderate effect of fluoride varnish in arresting or remineralizing, especially non-cavitated lesions, was assessed. For RA in carious anterior upper primary teeth, a low level of evidence was found for higher failure rates of glass ionomer cement and composite fillings than composite strip crowns even if placed under general anaesthesia and especially compared to other crowns (stainless steel and zirconia). In conclusions, ECC may be managed successfully with nonoperative (SDF, regular fluoride application) and moderately well with operative approaches, but the decision is affected by many other variables such as pulpal involvement, the child’s cooperation, or a general anaesthesia setting.
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Nguyen TM, Tonmukayakul U, Warren E, Cartwright S, Liew D. A Markov cost-effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70-year time horizon. Health Promot J Austr 2019; 31:177-183. [PMID: 31373066 PMCID: PMC7187475 DOI: 10.1002/hpja.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/27/2019] [Accepted: 07/28/2019] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Biannual application of fluoride varnish is effective for dental caries prevention, but its cost-effectiveness using quality-adjusted life years (QALY) is unknown. This study performed a cost-effectiveness analysis, from the Australian health care system perspective of biannual application of fluoride varnish versus current practice (non-routine application) for an individual aged 15 years and older over a 70-year time horizon. METHODS Health outcomes measured were the number of prevented decayed, missing, and filled teeth (prevented-DMFT) and QALY gained. The calculated incremental cost-effectiveness ratio (ICER) was compared against the reference cost-effectiveness ICER threshold of AUD$28 033 per QALY gained. A published Markov model capturing dental caries progression of eight permanent molars was used. This 6-monthly cycle model represented ten possible health states for an individual tooth. A 5% discount rate was applied with relevant sensitivity analysis. RESULTS In the base-case scenario, the net cost for the intervention was $3600 compared to $2303 in the current practice arm. The intervention arm yielded 13.99 DMFT and 15.44 QALY gained, whereas the current practice arm yielded 15.52 DMFT and 14.74 QALY gained. The estimated ICER was $849 per prevented-DMFT and $1851 per QALY gained. Sensitivity analysis shows the ICER ranged from $424-$1807 per prevented-DMFT and $1851-$3941 per QALY gained. CONCLUSION Biannual professional application of fluoride varnish appears to be a highly cost-effective strategy and should be considered for universal funding in Australia's health care system.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, Vic., Australia.,Melbourne Dental School, The University of Melbourne, Melbourne, Vic., Australia
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, Vic., Australia
| | | | | | - Danny Liew
- Nursing and Health Sciences, School of Public Health & Preventive Medicine, Faculty of Medicine, Monash University, Clayton, Vic., Australia
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Nguyen TM, Tonmukayakul U, Calache H. A dental workforce strategy to make Australian public dental services more efficient. HUMAN RESOURCES FOR HEALTH 2019; 17:37. [PMID: 31146760 PMCID: PMC6543641 DOI: 10.1186/s12960-019-0370-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/02/2019] [Indexed: 05/22/2023]
Abstract
BACKGROUND Dental services can be provided by the oral health therapy (OHT) workforce and dentists. This study aims to quantify the potential cost-savings of increased utilisation of the OHT workforce in providing dental services for children under the Child Dental Benefits Schedule (CDBS). The CDBS is an Australian federal government initiative to increase dental care access for children aged 2-17 years. METHODS Dental services billed under the CDBS for the 2013-2014 financial year were used. Two OHT-to-dentist workforce mix ratios were tested: Model A National Workforce (1:4) and Model B Victorian Workforce (2:3). The 30% average salary difference between the two professions in the public sector was used to adjust the CDBS fee schedule for each type of service. The current 29% utilisation rate of the CDBS and the government target of 80% were modelled. RESULTS The estimated cost-savings under the current CDBS utilisation rate was AUD 26.5M and AUD 61.7M, for Models A and B, respectively. For the government target CDBS utilisation rate, AUD 73.2M for Model A and AUD 170.2M for Model B could be saved. CONCLUSION An increased utilisation of the OHT workforce to provide dental services under the CDBS would save costs on public dental service funding. The potential cost-savings can be reinvested in other dental initiatives such as outreach school-based dental check programmes or resource allocation to eliminate adult dental waiting lists in the public sector.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin University, 75 Pigdons Road, Waurn Ponds, Victoria 3216 Australia
- University of Melbourne, Parkville, Australia
- Peninsula Health, Frankston, Australia
- Coburg Hill Oral Care, Hill, Coburg, Australia
| | | | - Hanny Calache
- Deakin University, 75 Pigdons Road, Waurn Ponds, Victoria 3216 Australia
- University of Melbourne, Parkville, Australia
- La Trobe University, Bendigo, Australia
- North Richmond Community Health, North Richmond, Australia
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17
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Randomised in situ clinical trial investigating self-assembling peptide matrix P11-4 in the prevention of artificial caries lesions. Sci Rep 2019; 9:269. [PMID: 30670760 PMCID: PMC6343002 DOI: 10.1038/s41598-018-36536-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/21/2018] [Indexed: 11/26/2022] Open
Abstract
The aim was to investigate the ability of self-assembling Peptide P11-4 Matrix (SAPM) to remineralize artificial initial caries lesions compared to the use of fluoride varnish. Volunteers were recruited for this randomised, cross-over in situ trial. Bovine specimens, half including orthodontic brackets, were recessed on the buccal aspects of mandibular appliances. Specimens included internal sound enamel control, a demineralised control and a part exposed during the in situ phase. Each phase lasted four weeks, followed by a one-week washout. Treatment groups were: A: negative control, no treatment,B: positive control, 22,600 ppm fluoride varnish,C: test group, 1,000 ppm SAPM. Laser fluorescence values (LF) were measured before/after demineralisation, and after the in situ period. Micro-CT analysis was used to assess mineral changes within the specimens after the in situ phase. In specimens without brackets, ΔLF values after in situ phase were: A: +5.28, B: +0.85, C: −2.89. Corresponding ΔLF for specimens with brackets were: A: +5.77, B: +1.30, C: −3.15. LF-values between groups significantly differed from each other (p < 0.0001) after the in situ phase. Micro-CT analysis yielded no significant difference among groups for specimens without brackets. For specimens with brackets, the test group showed significantly more remineralisation than the negative (p = 0.01) and positive control (p = 0.003). Within the limitations of the study, SAPM showed prevention of caries and remineralisation of enamel around orthodontic brackets.
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18
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Alkilzy M, Santamaria RM, Schmoeckel J, Splieth CH. Treatment of Carious Lesions Using Self-Assembling Peptides. Adv Dent Res 2018; 29:42-47. [PMID: 29355413 DOI: 10.1177/0022034517737025] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Modern approaches in caries treatment involve lesion management without tissue removal. Regenerative medicine focuses on replacing damaged tissues with biologically similar tissues. This article discusses the scientific evidence and clinical results for self-assembling peptides in modern caries management. The biomimetic remineralization promoted by self-assembling peptide P11-4 has been proven in vitro as an effective therapy for initial caries. P11-4 was rationally designed to promote formation of hydroxyapatite on its surface. The formulation was optimized to ensure the ability of monomeric P11-4 to penetrate past the subsurface lesions and assembly into a biomatrix within. Furthermore, P11-4 has shown that it assembles into fibers within carious lesions, and promotes the remineralization thereof. In a recent clinical study, the safety and efficacy of P11-4 in treatment of initial caries were evaluated. The additional effect of the application of P11-4 (Curodont Repair) was compared to the application of fluoride varnish (Duraphat) alone in active occlusal initial caries lesions on erupting permanent molars. In the 3- and 6-month recalls, the test group showed, both in the laser fluorescence readings and in the clinical assessment of the caries stage and activity, significantly superior lesion regression compared to the control group. No adverse events, medical complications, or allergic reactions related to the treatments were reported. Clinical applicability of treatment was regarded as satisfactory. Patients were happy to receive noninvasive caries treatments. In conclusion, biomimetic mineralization facilitated by P11-4 in combination with fluoride may present a simple, safe, and effective noninvasive treatment for early carious lesions.
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Affiliation(s)
- M Alkilzy
- 1 Department of Preventive and Pediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
| | - R M Santamaria
- 1 Department of Preventive and Pediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
| | - J Schmoeckel
- 1 Department of Preventive and Pediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
| | - C H Splieth
- 1 Department of Preventive and Pediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
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Souza BM, Santos DMS, Braga AS, Santos NMD, Rios D, Buzalaf MAR, Magalhães AC. Effect of a Titanium Tetrafluoride Varnish in the Prevention and Treatment of Carious Lesions in the Permanent Teeth of Children Living in a Fluoridated Region: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e26. [PMID: 29374001 PMCID: PMC5807625 DOI: 10.2196/resprot.9376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/15/2017] [Accepted: 12/16/2017] [Indexed: 11/17/2022] Open
Abstract
Background Titanium tetrafluoride (TiF4) has regained interest due to new formulations that have been shown to be more effective against tooth demineralization than sodium fluoride (NaF) formulations in vitro and in situ. Objective The aim of this study is to evaluate the effect of two types of varnishes (4% TiF4 and a commercial 5% NaF) on the prevention of carious lesions and the treatment of noncavitated enamel carious lesions in the permanent teeth of children living in a fluoridated area. Methods This randomized, controlled, parallel and single-blind clinical trial involves 63 children, 6-7 years old, living in Bauru, São Paulo, Brazil. Children were selected according to their caries activity (ie, presence of at least 1 tooth with a Nyvad score of 1) and randomly divided into the following treatment categories: 4% TiF4 varnish (2.45 % F-, pH 1, FGM); 5% NaF varnish (2.26% F-, pH 5, Duraphat, Colgate) and control (placebo varnish, pH 5, FGM). The varnishes will be applied on all permanent teeth, once a week for 4 weeks and they will be reapplied only once 6 and 12 months after the study begins. Two calibrated examiners will carry out the clinical examination (International Caries Detection and Assessment System [ICDAS] and Nyvad indexes, kappa>.8) at baseline, before the first application, after the 1st, 6th, 12th, and 18th month of the study begins. Furthermore, quantitative fluorescence changes will be measured using Quantitative Light-Induced Fluorescence (QLF). The degree of patient satisfaction with the treatment will also be computed. The data will undergo statistical analysis (P<.05). Results This ongoing study is funded by funding agencies from Brazil (São Paulo Research Foundation, FAPESP-015/14149-1, and National Council for Scientific and Technological Development, CNPq-401313/2016-6). We expect to confirm the efficacy of TiF4 on the prevention and treatment of carious lesions by comparing it to NaF varnish. The subjects are under 1 month evaluation and the dropout was about 8%. No differences between the treatments have been detected at the first month so far (P>.05). Conclusions If our hypothesis is confirmed, TiF4 varnish can be marketed and applied at the individual level and used in community programs to control dental caries. Trial Registration Brazilian Clinical Trials Registry: RBR-5VWJ4Y; http://www.ensaiosclinicos.gov.br/rg/?q=RBR-5VWJ4Y (Archived by WebCite at http://www.webcitation.org/6wUurEnm7)
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Affiliation(s)
- Beatriz Martines Souza
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | - Aline Silva Braga
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Natália Mello Dos Santos
- Department of Pediatric Dentistry, Orthodontic and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Daniela Rios
- Department of Pediatric Dentistry, Orthodontic and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | - Ana Carolina Magalhães
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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de Silva AM, Martin-Kerry J, Geale A, Cole D. Flying blind: trying to find solutions to Indigenous oral health. AUST HEALTH REV 2018; 40:570-583. [PMID: 26691689 DOI: 10.1071/ah15157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/29/2015] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to identify all published evidence about oral health in Indigenous children in Australia and to determine trends in Indigenous oral health over time. Methods PubMed was used to search for published peer-reviewed articles that reported caries (decay) prevalence rates and/or caries experience (based on caries indices) in Indigenous children. Studies included in the analysis needed to report clinical oral health data (not self-reported dental experiences), and articles were excluded if they reported caries in only a select, specific or targeted sample (e.g. only children undergoing hospital admissions for dental conditions). Results The review identified 32 studies that met the inclusion criteria. These studies reported data from the Northern Territory (n=14), Western Australia (n=7), South Australia (n=7), Queensland (n=7), New South Wales (n=1), Australian Capital Territory (n=1) and Tasmania (n=1). Of the studies, 47% were in rural locations, 9% were in urban locations and 44% were in both rural and urban locations. Data are limited and predominantly for Indigenous children living in rural locations, and there are no published studies on caries in Indigenous children living in Victoria. Conclusions The present study documents the published prevalence and severity of caries in Indigenous children living in Australia and highlights that limited oral health data are available for this priority population. Although risk factors for oral disease are well known, most of the studies did not analyse the link between these factors and oral disease present. There is also inconsistency in how caries is reported in terms of age and caries criteria used. We cannot rely on the available data to inform the development of policies and programs to address the oral health differences in Indigenous populations living contemporary lives in metropolitan areas. What is known about the topic? Many studies report that Indigenous people have poorer general health in Australia compared with non-Indigenous people. What does this paper add? This paper documents the available published prevalence and experience of caries for Indigenous children in Australia. It demonstrates significant limitations in the data, including no Victorian data, inconsistency with reporting methods and most data being for Indigenous children who are living in rural locations. What are the implications for practitioners? It is important for practitioners to have access to oral health data for Indigenous children in Australia. However, the present study highlights significant knowledge gaps for this population group and identifies ways to collect data in future studies to enable more meaningful comparisons and policy development.
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Affiliation(s)
- Andrea M de Silva
- Centre of Applied Oral Health Research, Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia.
| | - Jacqueline Martin-Kerry
- Centre of Applied Oral Health Research, Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia.
| | - Alexandra Geale
- Centre of Applied Oral Health Research, Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia.
| | - Deborah Cole
- Centre of Applied Oral Health Research, Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia.
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Comar LP, Souza BM, Al-Ahj LP, Martins J, Grizzo LT, Piasentim IS, Rios D, Buzalaf MAR, Magalhães AC. Mechanism of Action of TiF4 on Dental Enamel Surface: SEM/EDX, KOH-Soluble F, and X-Ray Diffraction Analysis. Caries Res 2017; 51:554-567. [DOI: 10.1159/000479038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 06/20/2017] [Indexed: 11/19/2022] Open
Abstract
This in vitro study aimed to evaluate the action of TiF4 on sound and carious bovine and human enamel. Sound (S) and pre-demineralised (DE) bovine and human (primary and permanent) enamel samples were treated with TiF4 (pH 1.0) or NaF varnishes (pH 5.0), containing 0.95, 1.95, or 2.45% F for 12 h. The enamel surfaces were analysed using SEM-EDX (scanning electron microscopy/energy-dispersive X-ray spectroscopy) (n = 10, 5 S and 5 DE) and KOH-soluble fluoride was quantified (n = 20, 10 S and 10 DE). Hydroxyapatite powder produced by precipitation method was treated with the corresponding fluoride solutions for 1 min (n = 2). The formed compounds were detected using X-ray diffraction (XRD). All TiF4 varnishes produced a coating layer rich in Ti and F on all types of enamel surface, with micro-cracks in its extension. TiF4 (1.95 and 2.45% F) provided higher fluoride deposition than NaF, especially for bovine enamel (p < 0.0001). It also induced a higher fluoride deposition on DE samples compared to S samples (p < 0.0001), except for primary enamel. The Ti content was higher for bovine and human primary enamel than human permanent enamel, with some differences between S and DE. The XRD analysis showed that TiF4 induced the formation of new compounds such as CaF2, TiO2, and Ti(HPO4)2·H2O. In conclusion, TiF4 (>0.95% F) interacts better, when compared to NaF, with bovine and human primary enamel than with human permanent enamel. TiF4 provoked higher F deposition compared to NaF. Carious enamel showed higher F uptake than sound enamel by TiF4 application, while Ti uptake was dependent on the enamel condition and origin.
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Alkilzy M, Tarabaih A, Santamaria RM, Splieth CH. Self-assembling Peptide P 11-4 and Fluoride for Regenerating Enamel. J Dent Res 2017; 97:148-154. [PMID: 28892645 DOI: 10.1177/0022034517730531] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Regenerative medicine-based approaches for caries treatment focus on biomimetic remineralization of initial carious lesions as a minimal invasive therapy. In vitro, self-assembling peptide P11-4 enhances remineralization of early carious lesions. To investigate the safety and clinical efficacy of P11-4 for treatment of initial caries, a randomized controlled single-blind study was conducted on children aged >5 y with visible active early caries on erupting permanent molars. Subjects were randomized to either the test group (P11-4 + fluoride varnish) or control group (fluoride varnish alone). Caries were assessed at baseline and at 3 and 6 mo posttreatment per laser fluorescence, a visual analog scale, the International Caries Detection and Assessment System, and Nyvad caries activity criteria. Intention-to-treat analyses were performed, and safety and clinical feasibility of the treatment approaches were assessed. Compared with the control group, the test group showed clinically and statistically significant improvement in all outcomes at 3 and 6 mo. The laser fluorescence readings (odds ratio = 3.5, P = 0.015) and visual analog scale scores (odds ratio = 7.9, P < .0001) were significantly lower for the test group, and they showed regression in the International Caries Detection and Assessment System caries index (odds ratio = 5.1, P = 0.018) and conversion from active to inactive lesions according to Nyvad criteria (odds ratio = 12.2, P < 0.0001). No adverse events occurred. The biomimetic mineralization facilitated by P11-4 in combination with fluoride application is a simple, safe, and effective noninvasive treatment for early carious lesions that is superior to the presently used gold standard of fluoride alone. By regenerating enamel tissue and preventing lesion progression, this novel approach could change clinical dental practice from a restorative to a therapeutic approach. This could avoid additional loss of healthy hard tissue during invasive restorative treatments, potentially enabling longer tooth life and thereby lowering long-term health costs ( ClinicalTrials.gov NCT02724592).
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Affiliation(s)
- M Alkilzy
- 1 Department of Preventive and Paediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
| | - A Tarabaih
- 1 Department of Preventive and Paediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
| | - R M Santamaria
- 1 Department of Preventive and Paediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
| | - C H Splieth
- 1 Department of Preventive and Paediatric Dentistry, Centre for Oral Health, University of Greifswald, Greifswald, Germany
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23
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Schlee M, Schad T, Koch JH, Cattin PC, Rathe F. Clinical performance of self‐assembling peptide P
11
‐4 in the treatment of initial proximal carious lesions: A practice‐based case series. ACTA ACUST UNITED AC 2017; 9. [DOI: 10.1111/jicd.12286] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 06/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Markus Schlee
- 32 Schöne Zähne Forchheim Germany
- Department of Maxillofacial SurgeryGoethe University Frankfurt Germany
| | - Till Schad
- 32 Schöne Zähne Forchheim Germany
- Department of Maxillofacial SurgeryGoethe University Frankfurt Germany
| | - Jan H. Koch
- Dental Text and Consultancy Services Freising Germany
| | | | - Florian Rathe
- 32 Schöne Zähne Forchheim Germany
- Department of Maxillofacial SurgeryGoethe University Frankfurt Germany
- Department of Prosthodontics and BiomaterialsDanube Private University Krems Austria
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24
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Nozari A, Ajami S, Rafiei A, Niazi E. Impact of Nano Hydroxyapatite, Nano Silver Fluoride and Sodium Fluoride Varnish on Primary Teeth Enamel Remineralization: An In Vitro Study. J Clin Diagn Res 2017; 11:ZC97-ZC100. [PMID: 29207844 DOI: 10.7860/jcdr/2017/30108.10694] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 07/07/2017] [Indexed: 01/12/2023]
Abstract
Introduction Dental caries is still prevailing worldwide, although different anti caries products have been introduced. Each remineralizing agent has its own shortcomings. Therefore, looking for new agents to have benefits of previous ones with lesser side effects is worthwhile. Aim To determine the remineralization ability of NaF varnish, nano-Hydroxyapatite Serum (n-HAP) and Nano Silver Fluoride (NSF) on enamel of primary anterior teeth. Materials and Methods Incipient caries were induced in primary sound anterior teeth by storing each specimen in demineralization solution for 72 hours. Then they were randomly divided into four groups of 15 samples each: (1) NaF varnish; (2) n-HAP repairing serum; (3) NSF and (4) no treatment (control). Surface Microhardness (SMH) was assessed with Vickers micro hardness tester before and after demineralization and after 10 days of pH-cycling. A total of 12 random specimens from groups 1 to 4 (3 random samples of each group) were examined by Atomic Force Microscopy (AFM). The SMH values were analysed with one-way and repeated measures ANOVA. Level of significance was set at p=0.05. Results Post lesion SMH values significantly decreased in all groups (p<0.001). Post treatment SMH values significantly increased in comparison to post lesion ones (p<0.001) except for control group which was not different statistically (p=0.86). The highest SMH values were observed in NSF group (mean 222.90 ± 28.79). Statistically significant differences were shown between all groups (p<0.05). However, NaF varnish and n-HAP groups were not statistically different (p=0.165). AFM images demonstrated protective layers in all treated groups. Conclusion The results of this in vitro study suggest that NSF could have the greatest remineralization efficacy. NaF varnish and n-HAP serum were similar in remineralizing initial caries. Future clinical studies are recommended for selection of the most appropriate remineralizing agent in primary teeth.
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Affiliation(s)
- Ali Nozari
- Assistant Professor, Department of Paediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Shabnam Ajami
- Assistant Professor, Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Azade Rafiei
- Assistant Professor, Oral and Dental Disease Research Center, Department of Paediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elmira Niazi
- Postgraduate Student, Oral and Dental Disease Research Center, Department of Paediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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25
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Comar L, Souza B, Martins J, Santos M, Buzalaf M, Magalhães A. Response of carious enamel to TiF 4 varnish treatment under diverse cariogenic activities in situ. J Dent 2017; 63:81-84. [DOI: 10.1016/j.jdent.2017.05.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 05/25/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022] Open
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26
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Anderson M, Dahllöf G, Soares FC, Grindefjord M. Impact of biannual treatment with fluoride varnish on tooth-surface-level caries progression in children aged 1-3 years. J Dent 2017; 65:83-88. [PMID: 28739318 DOI: 10.1016/j.jdent.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/04/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study describes caries progression at tooth-surface level in children from 1 to 3 years of age and the impact of biannual treatment with fluoride varnish. METHODS Children who participated in a cluster-randomized controlled trial and had shown signs of dental caries were included in this study (n=801). International Caries Detection and Assessment System (ICDAS) was used to classify dental caries. The present study compared children receiving a standard yearly intervention to children receiving the same standard preventive intervention supplemented with an application of fluoride varnish every half year. RESULTS The maxillary incisors were the first teeth to develop cavitation (ICDAS 3-6) and also mostly affected. Further analyses focusing on maxillary incisors buccal surfaces showed that sound surfaces had least progression and that progression to extensive decay was more common in teeth that had exhibited moderate decay. A summarizing progression index (PI) was calculated for the buccal surfaces of the maxillary incisors. Between 1 and 2 years of age PI was 26% and between 2 and 3 years of age PI was 21%. The progression on buccal incisors and on occlusal first primary molars did not differ between intervention groups (p≤0,05). CONCLUSION No impact on caries progression for biannual treatment with fluoride varnish was found. CLINICAL SIGNIFICANCE Using fluoride varnish as a complement to standard intervention in toddlers did not add in the prevention of dental caries or its progression. The education of parents in the use fluoride toothpaste as they start brushing the teeth of their children is essential.
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Affiliation(s)
- Maria Anderson
- Department of Dental Medicine (DENTMED), OF, Division 6, Pedodontics, Box 4064, 141 04, Huddinge, Sweden; Pediatric Dentistry, Public Dental Service, Eastman Institute, Dalagatan 11, SE-11324, Stockholm, Sweden.
| | - Göran Dahllöf
- Department of Dental Medicine (DENTMED), OF, Division 6, Pedodontics, Box 4064, 141 04, Huddinge, Sweden; Center for Pediatric Oral Health Research, Pediatric Dentistry, Public Dental Service, Eastman Institute, Dalagatan 11, SE-11324, Stockholm, Sweden.
| | - Fernanda Cunha Soares
- Department of Dental Medicine (DENTMED), OF, Division 6, Pedodontics, Box 4064, 141 04, Huddinge, Sweden.
| | - Margaret Grindefjord
- Department of Dental Medicine (DENTMED), OF, Division 6, Pedodontics, Box 4064, 141 04, Huddinge, Sweden; Pediatric Dentistry, Public Dental Service, Eastman Institute, Dalagatan 11, SE-11324, Stockholm, Sweden; Center for Pediatric Oral Health Research, Pediatric Dentistry, Public Dental Service, Eastman Institute, Dalagatan 11, SE-11324, Stockholm, Sweden.
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27
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Salomão PMA, de Oliveira FA, Rodrigues PD, Al-Ahj LP, Gasque KCDS, Jeggle P, Buzalaf MAR, de Oliveira RC, Edwardson JM, Magalhães AC. The cytotoxic effect of TiF4 and NaF on fibroblasts is influenced by the experimental model, fluoride concentration and exposure time. PLoS One 2017; 12:e0179471. [PMID: 28614381 PMCID: PMC5470716 DOI: 10.1371/journal.pone.0179471] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/31/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Titanium tetrafluoride (TiF4) has shown promising effect in preventing tooth lesions. Therefore, we compared the cytotoxicity of TiF4 with sodium fluoride (NaF) (already applied in Dentistry) considering different fluoride concentrations, pH values and experimental models. Materials and methods Step 1) NIH/3T3 fibroblasts were exposed to mediums containing NaF or TiF4 (from 0.15 to 2.45% F), both at native and adjusted pH, for 6 h. Step 2) NIH/3T3 were exposed to NaF or TiF4 varnishes with 0.95, 1.95 or 2.45% F (native pH), for 6, 12 or 24 h. We applied MTT (1st and 2nd steps) and Hoescht/PI stain (2nd step) assays. Step 3) NIH/3T3 were exposed to NaF or TiF4 varnish (2.45% F), at native pH, for 6 or 12 h. The cell stiffness was measured by atomic force microscopy (AFM). Results Step 1) All cells exposed to NaF or TiF4 mediums died, regardless of the F concentration and pH. Step 2) Both varnishes, at 1.90 and 2.45% F, reduced cell viability by similar extents (33–86% at 6 h, 35–93% at 12 h, and 87–98% at 24 h) compared with control, regardless of the type of fluoride. Varnishes with 0.95% F did not differ from control. Step 3) TiF4 and NaF reduced cell stiffness to a similar extent, but only TiF4 differed from control at 6 h. Conclusions Based on the results of the 3 experimental steps, we conclude that TiF4 and NaF have similar cytotoxicity. The cytotoxicity was dependent on F concentration and exposure time. This result gives support for testing the effect of TiF4 varnish in vivo.
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Affiliation(s)
| | - Flávia Amadeu de Oliveira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Paula Danielle Rodrigues
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Luana Polioni Al-Ahj
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Pia Jeggle
- Department of Pharmacology, University of Cambridge, Cambridge, United Kingdom
| | | | - Rodrigo Cardoso de Oliveira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - Ana Carolina Magalhães
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
- * E-mail:
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28
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Tsai C, Blinkhorn A, Irving M. Oral Health Programmes in Indigenous Communities Worldwide-Lessons learned from the field: A qualitative systematic review. Community Dent Oral Epidemiol 2017; 45:389-397. [DOI: 10.1111/cdoe.12302] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/11/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Carrie Tsai
- Faculty of Dentistry; University of Sydney; Westmead NSW Australia
| | | | - Michelle Irving
- Faculty of Dentistry; University of Sydney; Westmead NSW Australia
- The Poche Centre for Indigenous Health; University of Sydney; Westmead NSW Australia
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29
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de Silva AM, Hegde S, Akudo Nwagbara B, Calache H, Gussy MG, Nasser M, Morrice HR, Riggs E, Leong PM, Meyenn LK, Yousefi-Nooraie R. WITHDRAWN: Community-based population-level interventions for promoting child oral health. Cochrane Database Syst Rev 2016; 12:CD009837. [PMID: 28004389 PMCID: PMC6463845 DOI: 10.1002/14651858.cd009837.pub3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dental caries and gingival and periodontal disease are commonly occurring, preventable chronic conditions. Even though much is known about how to treat oral disease, currently we do not know which community-based population-level interventions are most effective and equitable in preventing poor oral health. OBJECTIVES Primary • To determine the effectiveness of community-based population-level oral health promotion interventions in preventing dental caries and gingival and periodontal disease among children from birth to 18 years of age. Secondary • To determine the most effective types of interventions (environmental, social, community and multi-component) and guiding theoretical frameworks.• To identify interventions that reduce inequality in oral health outcomes.• To examine the influence of context in the design, delivery and outcomes of interventions. SEARCH METHODS We searched the following databases from January 1996 to April 2014: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), BIOSIS Previews, Web of Science, the Database of Abstracts of Reviews of Effects (DARE), ScienceDirect, Sociological Abstracts, Social Science Citation Index, PsycINFO, SCOPUS, ProQuest Dissertations & Theses and Conference Proceedings Citation Index - Science. SELECTION CRITERIA Included studies were individual- and cluster-randomised controlled trials (RCTs), controlled before-and-after studies and quasi-experimental and interrupted time series. To be included, interventions had to target the primary outcomes: dental caries (measured as decayed, missing and filled deciduous teeth/surfaces, dmft/s; Decayed, Missing and Filled permanent teeth/surfaces, DMFT/S) and gingival or periodontal disease among children from birth to 18 years of age. Studies had to report on one or more of the primary outcomes at baseline and post intervention, or had to provide change scores for both intervention and control groups. Interventions were excluded if they were solely of a chemical nature (e.g. chlorhexidine, fluoride varnish), were delivered primarily in a dental clinical setting or comprised solely fluoridation. DATA COLLECTION AND ANALYSIS Two review authors independently performed screening, data extraction and assessment of risk of bias of included studies (a team of six review authors - four review authors and two research assistants - assessed all studies). We calculated mean differences with 95% confidence intervals for continuous data. When data permitted, we undertook meta-analysis of primary outcome measures using a fixed-effect model to summarise results across studies. We used the I2 statistic as a measure of statistical heterogeneity. MAIN RESULTS This review includes findings from 38 studies (total n = 119,789 children, including one national study of 99,071 children, which contributed 80% of total participants) on community-based oral health promotion interventions delivered in a variety of settings and incorporating a range of health promotion strategies (e.g. policy, educational activities, professional oral health care, supervised toothbrushing programmes, motivational interviewing). We categorised interventions as dietary interventions (n = 3), oral health education (OHE) alone (n = 17), OHE in combination with supervised toothbrushing with fluoridated toothpaste (n = 8) and OHE in combination with a variety of other interventions (including professional preventive oral health care, n = 10). Interventions generally were implemented for less than one year (n = 26), and only 11 studies were RCTs. We graded the evidence as having moderate to very low quality.We conducted meta-analyses examining impact on dental caries of each intervention type, although not all studies provided sufficient data to allow pooling of effects across similar interventions. Meta-analyses of the effects of OHE alone on caries may show little or no effect on DMFT (two studies, mean difference (MD) 0.12, 95% confidence interval (CI) -0.11 to 0.36, low-quality evidence), dmft (three studies, MD -0.3, 95% CI -1.11 to 0.52, low-quality evidence) and DMFS (one study, MD -0.01, 95% CI -0.24 to 0.22, very low-quality evidence). Analysis of studies testing OHE in combination with supervised toothbrushing with fluoridated toothpaste may show a beneficial effect on dmfs (three studies, MD -1.59, 95% CI -2.67 to -0.52, low-quality evidence) and dmft (two studies, MD -0.97, 95% CI -1.06 to -0.89, low-quality evidence) but may show little effect on DMFS (two studies, MD -0.02, 95% CI -0.13 to 0.10, low-quality evidence) and DMFT (three studies, MD -0.02, 95% CI -0.11 to 0.07, moderate-quality evidence). Meta-analyses of two studies of OHE in an educational setting combined with professional preventive oral care in a dental clinic setting probably show a very small effect on DMFT (-0.09 weighted mean difference (WMD), 95% CI -0.1 to -0.08, moderate-quality evidence). Data were inadequate for meta-analyses on gingival health, although positive impact was reported. AUTHORS' CONCLUSIONS This review provides evidence of low certainty suggesting that community-based oral health promotion interventions that combine oral health education with supervised toothbrushing or professional preventive oral care can reduce dental caries in children. Other interventions, such as those that aim to promote access to fluoride, improve children's diets or provide oral health education alone, show only limited impact. We found no clear indication of when is the most effective time to intervene during childhood. Cost-effectiveness, long-term sustainability and equity of impacts and adverse outcomes were not widely reported by study authors, limiting our ability to make inferences on these aspects. More rigorous measurement and reporting of study results would improve the quality of the evidence.
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Affiliation(s)
- Andrea M de Silva
- Centre for Applied Oral Health Research, Dental Health Services Victoria, Carlton, Victoria, Australia, 3053
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
| | - Shalika Hegde
- Centre for Applied Oral Health Research (Corporate Level), Dental Health Services Victoria, The Royal Dental Hospital of Melbourne, Carlton, Melbourne, Victoria, Australia, 3053
- School of Health & Social Development, Faculty of Health, Melbourne Burwood Campus, Deakin University, Burwood, Victoria, Australia
| | - Bridget Akudo Nwagbara
- Independent consultant, Abuja, Nigeria
- Nigerian Branch of the South African Cochrane Centre, Calabar, Nigeria
| | - Hanny Calache
- Melbourne Dental School, University of Melbourne, Carlton, Victoria, Australia
- Clinical Leadership, Dental Health Services Victoria, 720 Swanston Sreet, Carlton, Victoria, Australia
- School of Dentistry and Oral Health, La Trobe University, Bendigo, Victoria, Australia
| | - Mark G Gussy
- Dept of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, Australia, 3552
| | - Mona Nasser
- Peninsula Dental School, Plymouth University Peninsula Schools of Medicine and Dentistry, The John Bull Building, Tamar Science Park,, Plymouth, UK, PL6 8BU
| | - Hannah R Morrice
- Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria, Australia, 3052
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Parkville, Victoria, Australia
| | - Pamela M Leong
- Early Life Epigenetics, Murdoch Childrens Research Institute, Flemington Road, Carlton, Victoria, Australia, 3053
| | - Lisa K Meyenn
- Centre for Applied Oral Health Research, Dental Health Services Victoria, Carlton, Victoria, Australia, 3053
| | - Reza Yousefi-Nooraie
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada, M5T 3M6
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30
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Anderson M, Grindefjord M, Dahllöf G, Dahlén G, Twetman S. Oral microflora in preschool children attending a fluoride varnish program: a cross-sectional study. BMC Oral Health 2016; 16:130. [PMID: 27931257 PMCID: PMC5146842 DOI: 10.1186/s12903-016-0325-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 12/01/2016] [Indexed: 11/30/2022] Open
Abstract
Background To compare the oral microflora in preschool children attending a fluoride varnish program with a reference group receiving a standard oral health program without fluoride varnish applications. A second aim was to relate the microbial composition to the caries prevalence. Methods Five hundred seven 3-year-old children were enrolled from a cohort of 3403 preschool children taking part in a community based oral health project. Two hundred sixty-three of them had attended caries-preventive program with semi-annual applications of a fluoride varnish since the age of 1 year (test group) while 237 had received standard preventive care (reference group). Oral samples were collected with a sterile swab and analysed with checkerboard DNA-DNA hybridization using 12 pre-determined bacterial probes. Caries and background data were collected from clinical examinations and questionnaires. Results Gram-positive streptococci (S. intermedius, S. salivarius, S. oralis) were most frequently detected and displayed the highest counts in both groups. There were no significant differences between the groups concerning prevalence of any of the selected bacterial strains except for S. oralis that occurred less frequently in the reference group. In children with caries, V. parvula were significantly more common (p < 0.05) while strains of Lactobacillus, Bifidobacterium and Neisseria were more prevalent among the caries-free children (p < 0.05). Conclusions A 2-year community program with semi-annual fluoride varnish applications did not seem to significantly influence the oral microflora in preschool children. Trial registration www.controlled-trials.com (ISRCTN35086887) 20131216 ‘retrospectively registered’.
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Affiliation(s)
- Maria Anderson
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden. .,Department of Pediatric Dentistry, Eastman Institute, Public Dental Service, Stockholm, Sweden. .,Pedodonti, Folktandvården Eastmaninstitutet, Dalagatan 11, SE-11324, Stockholm, Sweden.
| | - Margaret Grindefjord
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Pediatric Dentistry, Eastman Institute, Public Dental Service, Stockholm, Sweden
| | - Göran Dahllöf
- Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Gunnar Dahlén
- Department of Oral Microbiology and Immunology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Svante Twetman
- Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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31
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Perin J, Preisser JS. Alternating logistic regressions with improved finite sample properties. Biometrics 2016; 73:696-705. [DOI: 10.1111/biom.12614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 08/01/2016] [Accepted: 09/01/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jamie Perin
- Department of International Health, Johns Hopkins University; Baltimore, Maryland U.S.A
| | - John S. Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill; Chapel Hill, North Carolina U.S.A
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32
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de Silva AM, Hegde S, Akudo Nwagbara B, Calache H, Gussy MG, Nasser M, Morrice HR, Riggs E, Leong PM, Meyenn LK, Yousefi‐Nooraie R. Community-based population-level interventions for promoting child oral health. Cochrane Database Syst Rev 2016; 9:CD009837. [PMID: 27629283 PMCID: PMC6457580 DOI: 10.1002/14651858.cd009837.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dental caries and gingival and periodontal disease are commonly occurring, preventable chronic conditions. Even though much is known about how to treat oral disease, currently we do not know which community-based population-level interventions are most effective and equitable in preventing poor oral health. OBJECTIVES Primary • To determine the effectiveness of community-based population-level oral health promotion interventions in preventing dental caries and gingival and periodontal disease among children from birth to 18 years of age. Secondary • To determine the most effective types of interventions (environmental, social, community and multi-component) and guiding theoretical frameworks.• To identify interventions that reduce inequality in oral health outcomes.• To examine the influence of context in the design, delivery and outcomes of interventions. SEARCH METHODS We searched the following databases from January 1996 to April 2014: MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), BIOSIS Previews, Web of Science, the Database of Abstracts of Reviews of Effects (DARE), ScienceDirect, Sociological Abstracts, Social Science Citation Index, PsycINFO, SCOPUS, ProQuest Dissertations & Theses and Conference Proceedings Citation Index - Science. SELECTION CRITERIA Included studies were individual- and cluster-randomised controlled trials (RCTs), controlled before-and-after studies and quasi-experimental and interrupted time series. To be included, interventions had to target the primary outcomes: dental caries (measured as decayed, missing and filled deciduous teeth/surfaces, dmft/s; Decayed, Missing and Filled permanent teeth/surfaces, DMFT/S) and gingival or periodontal disease among children from birth to 18 years of age. Studies had to report on one or more of the primary outcomes at baseline and post intervention, or had to provide change scores for both intervention and control groups. Interventions were excluded if they were solely of a chemical nature (e.g. chlorhexidine, fluoride varnish), were delivered primarily in a dental clinical setting or comprised solely fluoridation. DATA COLLECTION AND ANALYSIS Two review authors independently performed screening, data extraction and assessment of risk of bias of included studies (a team of six review authors - four review authors and two research assistants - assessed all studies). We calculated mean differences with 95% confidence intervals for continuous data. When data permitted, we undertook meta-analysis of primary outcome measures using a fixed-effect model to summarise results across studies. We used the I2 statistic as a measure of statistical heterogeneity. MAIN RESULTS This review includes findings from 38 studies (total n = 119,789 children, including one national study of 99,071 children, which contributed 80% of total participants) on community-based oral health promotion interventions delivered in a variety of settings and incorporating a range of health promotion strategies (e.g. policy, educational activities, professional oral health care, supervised toothbrushing programmes, motivational interviewing). We categorised interventions as dietary interventions (n = 3), oral health education (OHE) alone (n = 17), OHE in combination with supervised toothbrushing with fluoridated toothpaste (n = 8) and OHE in combination with a variety of other interventions (including professional preventive oral health care, n = 10). Interventions generally were implemented for less than one year (n = 26), and only 11 studies were RCTs. We graded the evidence as having moderate to very low quality.We conducted meta-analyses examining impact on dental caries of each intervention type, although not all studies provided sufficient data to allow pooling of effects across similar interventions. Meta-analyses of the effects of OHE alone on caries may show little or no effect on DMFT (two studies, mean difference (MD) 0.12, 95% confidence interval (CI) -0.11 to 0.36, low-quality evidence), dmft (three studies, MD -0.3, 95% CI -1.11 to 0.52, low-quality evidence) and DMFS (one study, MD -0.01, 95% CI -0.24 to 0.22, very low-quality evidence). Analysis of studies testing OHE in combination with supervised toothbrushing with fluoridated toothpaste may show a beneficial effect on dmfs (three studies, MD -1.59, 95% CI -2.67 to -0.52, low-quality evidence) and dmft (two studies, MD -0.97, 95% CI -1.06 to -0.89, low-quality evidence) but may show little effect on DMFS (two studies, MD -0.02, 95% CI -0.13 to 0.10, low-quality evidence) and DMFT (three studies, MD -0.02, 95% CI -0.11 to 0.07, moderate-quality evidence). Meta-analyses of two studies of OHE in an educational setting combined with professional preventive oral care in a dental clinic setting probably show a very small effect on DMFT (-0.09 weighted mean difference (WMD), 95% CI -0.1 to -0.08, moderate-quality evidence). Data were inadequate for meta-analyses on gingival health, although positive impact was reported. AUTHORS' CONCLUSIONS This review provides evidence of low certainty suggesting that community-based oral health promotion interventions that combine oral health education with supervised toothbrushing or professional preventive oral care can reduce dental caries in children. Other interventions, such as those that aim to promote access to fluoride, improve children's diets or provide oral health education alone, show only limited impact. We found no clear indication of when is the most effective time to intervene during childhood. Cost-effectiveness, long-term sustainability and equity of impacts and adverse outcomes were not widely reported by study authors, limiting our ability to make inferences on these aspects. More rigorous measurement and reporting of study results would improve the quality of the evidence.
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Affiliation(s)
| | | | | | | | - Mark G Gussy
- La Trobe UniversityDept of Dentistry and Oral Health, La Trobe Rural Health SchoolPO Box 199BendigoAustralia3552
| | - Mona Nasser
- Plymouth University Peninsula Schools of Medicine and DentistryPeninsula Dental SchoolThe John Bull Building, Tamar Science Park,PlymouthUKPL6 8BU
| | - Hannah R Morrice
- University of MelbourneJack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global HealthCarltonAustralia
| | | | - Pamela M Leong
- Murdoch Childrens Research InstituteEarly Life EpigeneticsFlemington RoadCarltonAustralia3053
| | - Lisa K Meyenn
- Dental Health Services VictoriaCentre for Applied Oral Health ResearchCarltonAustralia3053
| | - Reza Yousefi‐Nooraie
- University of TorontoInstitute of Health Policy, Management and Evaluation155 College StreetTorontoCanadaM5T 3M6
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Miller MJ, Bernstein S, Colaiacovo SL, Nicolay O, Cisneros GJ. Demineralized white spot lesions: An unmet challenge for orthodontists. Semin Orthod 2016. [DOI: 10.1053/j.sodo.2016.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gao SS, Zhang S, Mei ML, Lo ECM, Chu CH. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment - a systematic review. BMC Oral Health 2016; 16:12. [PMID: 26831727 PMCID: PMC4736084 DOI: 10.1186/s12903-016-0171-6] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a low-cost and easily operated treatment, the use of professionally applied topical fluoride was approved for preventing dental caries and remineralising early enamel caries or white spot lesions. It is also used to arrest dentine caries. The aim of this study is to investigate the clinical efficacy of professional fluoride therapy in remineralising and arresting caries in children. METHOD A systematic search of publications from 1948 to 2014 was conducted using four databases: PubMed, Cochrane Library, ISI Web of Science and Embase. The key words used were (fluoride) AND (remineralisation OR remineralization OR arresting) AND (children caries OR early childhood caries). The title and abstract of initially identified publications were screened. Clinical trials about home-use fluorides, laboratory studies, case reports, reviews, non-English articles and irrelevant studies were excluded. The full texts of the remaining papers were retrieved. Manual screening was conducted on the bibliographies of the remaining papers to identify relevant articles. RESULTS A total of 2177 papers were found, and 17 randomised clinical trials were included in this review. Ten studies investigated the remineralising effect on early enamel caries using silicon tetrafluoride, fluoride gel, silver diamine fluoride or sodium fluoride. Seven studies reported an arresting effect on dentine caries using silver diamine fluoride or nano-silver fluoride. Meta-analysis was performed on four papers using 5 % sodium fluoride varnish to remineralise early enamel caries, and the overall percentage of remineralised enamel caries was 63.6 % (95 % CI: 36.0 % - 91.2 %; p < 0.001). Meta-analysis was also performed on five papers using 38 % silver diamine fluoride to arrest dentine caries and the overall proportion of arrested dentine caries was 65.9 % (95 % CI: 41.2 % - 90.7 %; p < 0.001). CONCLUSION Professionally applied 5 % sodium fluoride varnish can remineralise early enamel caries and 38 % silver diamine fluoride is effective in arresting dentine caries.
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Affiliation(s)
| | - Shinan Zhang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - May Lei Mei
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | | | - Chun-Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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Perrini F, Lombardo L, Arreghini A, Medori S, Siciliani G. Caries prevention during orthodontic treatment: In-vivo assessment of high-fluoride varnish to prevent white spot lesions. Am J Orthod Dentofacial Orthop 2016; 149:238-43. [DOI: 10.1016/j.ajodo.2015.07.039] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 11/27/2022]
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Abstract
In recent years, unprecedented gains in the understanding of the biology and mechanisms underlying human health and disease have been made. In the domain of oral health, although much remains to be learned, the complex interactions between different systems in play have begun to unravel: host genome, oral microbiome with its transcriptome, proteome and metabolome, and more distal influences, including relevant behaviors and environmental exposures. A reasonable expectation is that this emerging body of knowledge can help improve the oral health and optimize care for individuals and populations. These goals are articulated by the National Institutes of Health as "precision medicine" and the elimination of health disparities. Key processes in these efforts are the discovery of causal factors or mechanistic pathways and the identification of individuals or population segments that are most likely to develop (any or severe forms of) oral disease. This article critically reviews the fundamental concepts of risk assessment and outcome prediction, as they relate to early childhood caries (ECC)-a common complex disease with significant negative impacts on children, their families, and the health system. The article highlights recent work and advances in methods available to estimate caries risk and derive person-level caries propensities. It further discusses the reasons for their limited utility in predicting individual ECC outcomes and informing clinical decision making. Critical issues identified include the misconception of defining dental caries as a tooth or surface-level condition versus a person-level disease; the fallacy of applying population-level parameters to individuals, termed privatization of risk; and the inadequacy of using frequentist versus Bayesian modeling approaches to derive individual disease propensity estimates. The article concludes with the notion that accurate caries risk assessment at the population level and "precision dentistry" at the person level are both desirable and achievable but must be based on high-quality longitudinal data and rigorous methodology.
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Affiliation(s)
- K Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina-Chapel Hill, NC, USA Department of Epidemiology, Gillings School of Global Health, University of North Carolina-Chapel Hill, NC, USA
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Donovan TE, Marzola R, Becker W, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP. Annual review of selected scientific literature: report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2014; 112:1038-87. [PMID: 25443419 DOI: 10.1016/j.prosdent.2014.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Terence E Donovan
- Chair, Committee on Scientific Investigation, American Academy of Restorative Dentistry (AARD); Professor and Section Head for Biomaterials, Department of Operative Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - William Becker
- Clinical Professor, Advanced Education in Prosthodontics, Herman Ostrow School of Dentistry, University of Southern California; private practice, Tucson, Ariz
| | - David R Cagna
- Associate Dean, Professor and Director, Advanced Prosthodontics, University of Tennessee, Health Science Center, College of Dentistry, Memphis, Tenn
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Caries-preventive effectiveness of fluoride varnish as adjunct to oral health promotion and supervised tooth brushing in preschool children: A double-blind randomized controlled trial. J Dent 2014; 42:1277-83. [DOI: 10.1016/j.jdent.2014.07.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 07/02/2014] [Accepted: 07/31/2014] [Indexed: 11/19/2022] Open
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Kutsch VK. Dental caries: An updated medical model of risk assessment. J Prosthet Dent 2014; 111:280-5. [DOI: 10.1016/j.prosdent.2013.07.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/23/2013] [Accepted: 07/25/2013] [Indexed: 11/27/2022]
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40
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Oliveira BH, Salazar M, Carvalho DM, Falcão A, Campos K, Nadanovsky P. Biannual fluoride varnish applications and caries incidence in preschoolers: a 24-month follow-up randomized placebo-controlled clinical trial. Caries Res 2014; 48:228-36. [PMID: 24481085 DOI: 10.1159/000356863] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/21/2013] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Sound evidence on the effectiveness of fluoride varnishes (FV) to reduce caries incidence in preschool children is lacking. OBJECTIVE To assess whether the application of FV in preschool children at 6-month intervals decreases the incidence of caries and produces any adverse effects. METHODS A randomized, examiner- and patient-blind, placebo-controlled, parallel-group design, clinical trial, comprising 1- to 4-year-old children, 100 in each group (FV or placebo varnish, PV), was conducted in Rio de Janeiro, Brazil. Two trained pediatric dentists performed the clinical examinations (kappa = 0.85). Dental caries was recorded at the d2 (cavitated enamel) and d3 (dentine) levels using the International Caries Diagnosis and Assessment System. RESULTS At baseline, the mean age of the participants was 2.4 years (SD 0.9) and the mean d3mfs was 0.8 (SD 1.9). Most of the children brushed their teeth with fluoride toothpaste and consumed fluoridated tap water. After 24 months, 89 and 92 children of the test and the control groups were analyzed, respectively. A total of 32 (35.9%) children in the FV group and 43 (46.7%) in the PV group presented new dentine caries lesions (χ(2) test; p = 0.14), showing relative and absolute risk reductions of 23% (95% CI: -9.5 to 45.9) and 11% (95% CI: -3.5 to 25.0). The mean caries increment differences between the test and control groups were -0.8 (95% CI: -2.0 to 0.4) at the d2 level and -0.7 (95% CI: -1.9 to 0.4) at the d3 level. Only 2 minor complaints regarding the intervention were reported. CONCLUSION Although safe and well accepted, twice-yearly professional FV application, during 2 years, did not result in a significant decrease in caries incidence.
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Affiliation(s)
- B H Oliveira
- Department of Preventive and Community Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
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