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Xu GY, Yin IX, Zhao IS, Lung CY, Lo EC, Chu CH. Minimizing tooth discoloration caused by topical silver diamine fluoride application: A systematic review. J Dent 2024; 150:105353. [PMID: 39284509 DOI: 10.1016/j.jdent.2024.105353] [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: 07/28/2024] [Revised: 09/05/2024] [Accepted: 09/09/2024] [Indexed: 10/25/2024] Open
Abstract
OBJECTIVE The objective of this systematic review is to examine the methods used to minimize discoloration of the carious lesions after topical silver diamine fluoride (SDF) application. DATA/SOURCES Two independent researchers conducted a search of English literature published up to 30th April 2024 in three databases (PubMed, Scopus, and Web of Science). They screened titles and abstracts, excluding conference proceedings, books, reviews and publications unrelated to SDF. They included only original research on methods to minimize SDF-induced discoloration. The publications lacking comparative color change data were excluded. Full texts of the included articles were then analyzed. The Cochrane guidelines for clinical trials and the guidelines for in-vitro studies on dental materials were used for the risk of bias assessment. RESULTS The systematic review included 33 publications from 1,283 identified publications (26 laboratory studies and 7 clinical studies). Thirteen laboratory studies and five clinical studies were rated as having 'low risk'. Three main methods to minimize discoloration were identified: masking with restoration, using chemicals, and substituting silver with nano-silver. Nine studies used resin composite or glass ionomer cement to mask the SDF-induced discoloration. Twenty-nine studies used chemicals to reduce SDF-induced discoloration. These chemicals included precipitating agents like potassium iodide, oxidizing agents like hydrogen peroxide, and chelating agents like glutathione. Seven publications used chemicals (potassium iodide or glutathione) before restoration and six of them found improved masking effect. Four studies substituted silver ions with silver nanoparticles which did not discolor carious lesion. CONCLUSIONS Masking with restoration, using chemicals, and substituting silver ions with nano-silver particles have been reported to address the discoloring effects of SDF therapy. However, most are laboratory studies, and more clinical trials are needed to confirm their effectiveness in reducing SDF-induced discoloration. CLINICAL SIGNIFICANCE SDF effectively arrests caries, but it discolors carious lesions. This review summarizes the methods and their outcomes for reducing SDF-induced discoloration. This study is supported by the General Research Fund of Research Grant Council No. 17,100,222.
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Affiliation(s)
- Grace Y Xu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, PR China
| | - Iris X Yin
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, PR China
| | - Irene S Zhao
- School of Dentistry, Shenzhen University Health Science Center, Shenzhen, PR China.
| | - Christie Yk Lung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, PR China
| | - Edward Cm Lo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, PR China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, PR China.
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Manuschai J, Sotozono M, Takenaka S, Kornsombut N, Takahashi R, Saito R, Nagata R, Ida T, Noiri Y. In Vitro Inhibitory Effect of Silver Diamine Fluoride Combined with Potassium Iodide against Mixed-Species Biofilm Formation on Human Root Dentin. Antibiotics (Basel) 2024; 13:743. [PMID: 39200043 PMCID: PMC11350696 DOI: 10.3390/antibiotics13080743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 09/01/2024] Open
Abstract
Applying a saturated potassium iodide (KI) solution immediately after silver diamine fluoride (SDF) application may affect the inhibitory effects of SDF on biofilm formation. This study compared the efficacy of 38% SDF with and without KI on preventing mixed-species biofilm formation on human root dentin surfaces and assessed ion incorporation into root dentin. The biofilms, composed of Streptococcus mutans, Lactobacillus rhamnosus, and Actinomyces naeslundii, were grown on specimen surfaces treated with either SDF or SDF + KI. After 24 h, the biofilms were evaluated using scanning electron microscopy, live/dead staining, adenosine triphosphate (ATP) assays, colony-forming unit (CFU) counts, and quantitative polymerase chain reaction. A Mann-Whitney U test was used to compare the results between the groups. Ion incorporation was assessed using an electron probe microanalyzer. The relative ATP content in the SDF + KI group was significantly higher than that in the SDF group (p < 0.05). However, biofilm morphology and the logarithmic reduction in CFUs and bacterial DNA were comparable across the groups. The SDF + KI treatment resulted in less silver and fluoride ion incorporation than that yielded by SDF alone. The inhibitory effects of SDF and SDF + KI on mixed-species biofilm formation were almost equivalent, although KI application affected the ion incorporation.
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Affiliation(s)
- Jutharat Manuschai
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (J.M.)
- Department of Conservative Dentistry, Faculty of Dentistry, Prince of Songkla University, Hat Yai 90112, Songkhla, Thailand
| | - Maki Sotozono
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (J.M.)
| | - Shoji Takenaka
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (J.M.)
| | - Niraya Kornsombut
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (J.M.)
| | - Ryouhei Takahashi
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (J.M.)
| | - Rui Saito
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (J.M.)
| | - Ryoko Nagata
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (J.M.)
| | - Takako Ida
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (J.M.)
| | - Yuichiro Noiri
- Division of Cariology, Operative Dentistry and Endodontics, Faculty of Dentistry, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8514, Japan; (J.M.)
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Xu GY, Zhao IS, Lung CYK, Yin IX, Lo ECM, Chu CH. Frontiers of Global Research Trend on Root Caries: A Bibliometric Analysis. Int Dent J 2024:S0020-6539(24)00161-8. [PMID: 39003120 DOI: 10.1016/j.identj.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 07/15/2024] Open
Abstract
OBJECTIVE This study aimed to examine the global research trend and frontiers in the field of root caries. METHODS Two independent investigators searched the Web of Science Core Collection to include journal articles published on root caries from 1994 to 2023. They examined citation trends of the selected publications and performed bibliometric analysis using VOSviewer. Cooccurrence and cocitation analysis were used to calculate the burst strength of the most cited keywords and the most cited publications. RESULTS This study included 1144 publications (1004 scientific research articles and 140 review articles) for bibliometric analysis. The number of publications from 2018 to 2023 was 404, accounting for 35% (404/1144) over the last 30 years. The annual citation count showed a gradual upward trend with a surge from 2018. The cooccurrence analysis classified the publications into four clusters which were in vitro studies, prevention, microbiology, and epidemiology. Cocitation analysis revealed silver diamine fluoride, systematic review, and randomized clinical trial were the three main keywords; and their citation burst strength (period) were 17.2 (2017-2023), 9.4 (2015-2023), and 6.9 (2018-2023), respectively. Noninvasive treatment of root caries (narrative review), aetiology of root caries (narrative review), and use of silver diamine fluoride in arresting root caries (clinical trial) were the topics (publication type) of the three most cited publications; and their burst strength (period) were 8.9 (2017-2020), 5.9 (2017-2021), and 4.7 (2015-2018), respectively. CONCLUSION This study highlights the recent growing research interest in root caries, particularly on its microbiology, prevention, and the use of silver diamine fluoride.
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Affiliation(s)
- Grace Yuchan Xu
- School of Dentistry, Shenzhen University Health Science Center, Shenzhen, China; Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Irene Shuping Zhao
- School of Dentistry, Shenzhen University Health Science Center, Shenzhen, China; Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | | | - Iris Xiaoxue Yin
- 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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Sun IG, Duangthip D, Chai HH, Luo BW, Lo ECM, Chu CH. Postoperative instructions for silver diamine fluoride therapy: A scoping review of current evidence and practice. J Dent 2024; 145:105029. [PMID: 38679132 DOI: 10.1016/j.jdent.2024.105029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVES Silver diamine fluoride (SDF) has gained popularity in dentistry as an anti-hypersensitive and anti-caries agent. This study aims to review the postoperative instructions for SDF therapy and examine the evidence supporting these instructions in treating dentine hypersensitivity and caries control. DATA AND SOURCES Two independent reviewers searched three electronic databases (EMBASE, PubMed, and Web of Science) to identify clinical studies that used SDF to treat dentine hypersensitivity and dental caries. Additionally, they searched Google Chrome for information from manufacturers, the department of health, national dental organisations, authoritative dental organisations, and universities regarding SDF therapy for these conditions. Data on postoperative instructions were extracted, and their impact on the treatment of dentine hypersensitivity and caries control was investigated. STUDY SELECTION This review included 74 clinical studies, 11 sets of instructions from SDF manufacturers, and six recommendations from national dental organisations, departments of health and universities. Amongst the included records, 50 clinical studies, two manufacturers, and one department of health mentioned postoperative instructions for SDF therapy. The recommendations varied, from suggesting no specific instructions, immediate rinsing, refraining from eating or drinking for 30 to 60 min, and even avoiding brushing until the next day after SDF therapy. Notably, no clinical studies reported the effects of these postoperative instructions on the SDF treatment of dentine hypersensitivity or dental caries. CONCLUSIONS This scoping review highlights the presence of inconsistent postoperative instructions for SDF therapy in the treatment of dentine hypersensitivity and caries control. Furthermore, there is a lack of evidence supporting the effectiveness of these instructions. CLINICAL SIGNIFICANCE No evidence supports the postoperative instructions for SDF therapy for managing dentine hypersensitivity and dental caries. Studies are necessary to provide guidance for clinicians using SDF in their clinical practice.
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Affiliation(s)
- Ivy Guofang Sun
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Duangporn Duangthip
- Division of Pediatric Dentistry, The Ohio State University, Columbus, United States
| | | | - Bella Weijia Luo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | | | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
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Zhu LW, Wang RX, Zhang Y, Zhan JY, Lu HX, Chen X. A cost-effectiveness analysis of fluoride varnish application in preventing Root caries in elderly persons: a Markov simulation study. BMC Oral Health 2024; 24:483. [PMID: 38649858 PMCID: PMC11034159 DOI: 10.1186/s12903-024-04226-5] [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: 10/03/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Root caries are prevalent issues that affect dental health, particularly among elderly individuals with exposed root surfaces. Fluoride therapy has shown effectiveness in preventing root caries, but limited studies have addressed its cost-effectiveness in elderly persons population. This study aimed to evaluate the cost-effectiveness of a fluoride treatment program for preventing root caries in elderly persons within the context of Chinese public healthcare. METHODS A Markov simulation model was adopted for the cost-effectiveness analysis in a hypothetical scenario from a healthcare system perspective. A 60-year-old subject with 23 teeth was simulated for 20 years. A 5% sodium fluoride varnish treatment was compared with no preventive intervention in terms of effectiveness and cost. Tooth years free of root caries were set as the effect. Transition probabilities were estimated from the data of a community-based cohort and published studies, and costs were based on documents published by the government. The incremental cost-effectiveness ratio (ICER) was calculated to evaluate cost-effectiveness. Univariate and probabilistic sensitivity analyses were performed to evaluate the influence of data uncertainty. RESULTS Fluoride treatment was more effective (with a difference of 10.20 root caries-free tooth years) but also more costly (with a difference of ¥1636.22). The ICER was ¥160.35 per root caries-free tooth year gained. One-way sensitivity analysis showed that the risk ratio of root caries in the fluoride treatment group influenced the result most. In the probabilistic sensitivity analysis, fluoride treatment was cost-effective in 70.5% of the simulated cases. CONCLUSIONS Regular 5% sodium fluoride varnish application was cost-effective for preventing root caries in the elderly persons in most scenarios with the consideration of data uncertainty, but to a limited extent. Improved public dental health awareness may reduce the incremental cost and make the intervention more cost-effective. Overall, the study shed light on the economic viability and impact of such preventive interventions, providing a scientific basis for dental care policies and healthcare resource allocation.
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Affiliation(s)
- Long-Wen Zhu
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai, China
| | - Rui-Xin Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Yu Zhang
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai, China
| | - Jing-Yu Zhan
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai, China
| | - Hai-Xia Lu
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai, China.
| | - Xi Chen
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai, China.
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Noureldin A, Alshehri W, Tapias H, Mallonee L, Mancl LM, Milgrom P, Svboda K. Efficacy of 38% silver diamine fluoride in reducing gingival inflammation and plaque accumulation in older adults living in retirement-homes: A randomized controlled pilot trial. J Dent 2024; 143:104890. [PMID: 38387597 DOI: 10.1016/j.jdent.2024.104890] [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: 01/25/2024] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES Emerging from earlier case reports the potential benefits of 38 % silver diamine fluoride (SDF) in addressing pathogenic biofilms and mitigating gingival inflammation and enlargement have sparked interest. Our study aimed to evaluate the efficacy of 38 % SDF in reducing gingival inflammation and plaque accumulation in older adults living in retirement-homes. METHODS This 7-week randomized, controlled, double-blinded pilot trial employed a parallel assignment design. The study enrolled older adults (aged ≥65) residing in retirement homes in Dallas County, ultimately comprising a cohort of 40 participants who were evenly divided into two arms. The experimental group received SDF treatment, whereas the comparator group received a placebo. Over three consecutive weeks, both groups had solutions applied to the facial surfaces of all their teeth once per week. The primary outcomes measured the change in Löe-Silness Gingival Index (GI) and Silness-Löe Plaque Index (PI) at 7 weeks following baseline treatment. Repeated measures ANOVA was utilized to assess changes over time within each group (n = 15 each). Post-hoc paired t-tests were conducted to compare changes between week 1 and each subsequent follow-up time point (weeks 3, 5, 7), supplemented with 95 % confidence intervals for change from week 1. RESULTS In the SDF group, within-group comparisons demonstrated significant reductions (adjusted p < .05) in GI scores within 3 weeks (-.93±.37), as opposed to week 1 (1.90±.39). Between-group comparisons unveiled reductions in both mean GI (p < .05) and PI (p < .05), indicating less gingival inflammation and plaque accumulation in the SDF group at all time points, commencing at week 3. CONCLUSIONS This study showed that 38 % SDF was effective in reducing gingival inflammation and plaque accumulation in older adults living in retirement-homes. CLINICAL SIGNIFICANCE Oral health in older adults is a public health concern, especially for the medically compromised or those without traditional care. Our findings offer hope for enhancing oral health quality of life by introducing a cost-effective, compliance-free, noninvasive, and accessible therapeutic. TRIAL REGISTRATION NCT03445286.(clinicaltrials.gov).
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Affiliation(s)
- Amal Noureldin
- Department of Department Public Health Sciences, Texas A&M University, School of Dentistry, United States
| | - Wedad Alshehri
- Department of Dental Health, College of Applied Medical Science, King Saud University, United States
| | - Helena Tapias
- Department of Comprehensive Dentistry, Texas A&M University, School of Dentistry, United States
| | - Lisa Mallonee
- School of Dental Hygiene, Texas A&M University, School of Dentistry, United States
| | - Lloyd M Mancl
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475, United States
| | - Peter Milgrom
- Department of Oral Health Sciences, University of Washington, Box 357475, Seattle, WA 98195-7475, United States.
| | - Kathy Svboda
- Department of Biomedical Sciences, School of Dentistry, Texas A&M University, United States
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Xu GY, Zhao IS, Lung CYK, Yin IX, Lo ECM, Chu CH. Silver Compounds for Caries Management. Int Dent J 2024; 74:179-186. [PMID: 38008704 PMCID: PMC10988255 DOI: 10.1016/j.identj.2023.10.013] [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: 06/21/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 11/28/2023] Open
Abstract
Silver metal and compounds have antibacterial properties, although their action's mechanisms are not fully understood. Scientists generally consider that silver disrupts the bacterial cell wall. It causes a structural change in the bacterial cell membrane and cytoplasm. It also stops deoxyribonucleic acid replication, resulting in inactivating enzymatic activity and cell death. The antimicrobial effect of silver-containing compounds relies on the release of bioactive silver ions. Hence, silver metal and compounds have been used in medicine to prevent infection for hundreds of years. Silver metal and compounds are also used as antibacterial agents in dentistry. Studies have shown that silver compounds are effective in the management of dental caries. Fluoride-containing silver compounds have been found in experiments to be beneficial at remineralising dental cavities. Silver diamine fluoride (SDF) can assist in preventing and arresting tooth cavities. The World Health Organization included SDF in its Model List of Essential Medicine for both adults and children in 2021. Clinicians also use SDF to manage dentine hypersensitivity as well as to inhibit growth of periodontal pathogens. However, traditional silver compounds cause tooth discolouration because of the silver-staining effect. These side effects of their applications depend on the amount applied and the frequency of application. Researchers are developing nanosilver fluoride and silver nanoparticles to overcome the staining. This review gives an overview of the antibacterial mechanism of silver compounds, namely silver nitrate, silver fluoride, SDF, silver nanoparticles, and nano silver fluoride for caries management. The outlook for the future development of silver compounds will be discussed.
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Affiliation(s)
- Grace Y Xu
- School of Dentistry, Shenzhen University Health Science Center, Shenzhen, China; Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Irene S Zhao
- School of Dentistry, Shenzhen University Health Science Center, Shenzhen, China; Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Christie Y K Lung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Iris X Yin
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
| | - Edward C M Lo
- 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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Turton B, Alqunaybit G, Tembhe A, Qari A, Rawal K, Mandel E, Calabrese J, Henshaw M. Estimation of Oral Disease Burden among Older Adults in LTC: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:248. [PMID: 38541250 PMCID: PMC10970488 DOI: 10.3390/ijerph21030248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 07/23/2024]
Abstract
Oral health is an essential part of healthy aging and very little data exists around the disease burden for older adults in a long-term care setting. The aim of this scoping review was to estimate the disease burden of dental caries, periodontal disease, and tooth loss among older adults in Long-Term Care (LTC). This scoping review was conducted in accordance with the Joanna Briggs Institute methodology. A detailed strategy was used to conduct a comprehensive search of electronic databases: PubMed, Embase, and Dentistry and Oral Sciences Source (DOSS). The Rayyan AI platform was used to screen abstracts for assessment by one of five co-investigators. Results indicate that only one in three might have a functional dentition upon entry into LTC, and among those who are dentate, most might expect to develop at least one new coronal and one new root caries lesion each year. There is a need to better document the disease experiences of this group to tailor approaches to care that might reduce the avoidable suffering as a result of dental caries and periodontal disease.
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Affiliation(s)
- Bathsheba Turton
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
| | - Gheed Alqunaybit
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
| | - Amrita Tembhe
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
| | - Alaa Qari
- Faculty of Dentistry, Umm Al-Qura University, Makkah 02131, Saudi Arabia;
| | - Kadambari Rawal
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
| | - Ernest Mandel
- Hebrew Seniorlife, Harvard Medical School, Boston, MA 02131, USA;
| | - Joseph Calabrese
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
| | - Michelle Henshaw
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
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López-García S, Sanz JL, Oñate-Sánchez RE, Forner L, García-Bernal D, Murcia L, Rodríguez-Lozano FJ, Llena C. In vitro biocompatibility of ammonia-free silver fluoride products on human dental pulp stem cells. Tissue Cell 2024; 86:102283. [PMID: 38113650 DOI: 10.1016/j.tice.2023.102283] [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: 10/01/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Silver fluoride (SF) is a preventive and therapeutic option for dental pathological processes involving structural alterations of the hard tissues, either during their formation or those caused by caries or other pathological reasons. This study aimed to compare the biological properties of two commercial SF products, one of them with ammonium (Riva Star; SDF) and the other ammonium-free (Riva Star Aqua; AgF), both with or without potassium iodide (KI), by the assessment of the cytotoxicity of the materials' eluates. METHODS Human dental pulp stem cells (hDPSCs) were obtained from healthy 18-23-year-old donors. Three dilutions were prepared for the tested materials (0.005%, 0.0005%, and 0.0001%). The following groups were assessed: (AgF, AgF+KI, SDF, SDF+KI, KI, negative control). A series of cytocompatibility assays were performed: MTT assay, IC50 assay, wound healing (migration) assay, cell cytoskeleton staining, analysis of cell apoptosis and necrosis, and reactive oxygen species production. The normality in the distribution of the data was previously confirmed via a Q-Q plot. Statistical significance was tested using one way ANOVA and Tukey's post hoc test. RESULTS The incorporation of KI improved the cytocompatibility of both SF products in terms of viability, migration, morphology, apoptosis, and reactive oxygen species production. This difference was higher in the AgF group. The lowest dilutions of SF+KI and AgF+KI showed a similar cytocompatibility to that of the control group (MTT assay (p > 0.05 after 24, 48, and 72 h of culture); migration assay (p > 0.05 after 24, 48, and 72 h of culture); reactive oxygen species production (p > 0.05 after 72 h of culture). SIGNIFICANCE Riva Star Aqua shows lower cytotoxicity than Riva Star on hDPSCs. It can be considered as a good alternative in the conservative treatment of dental caries and in the preservation and remineralisation of viable dentine tissue.
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Affiliation(s)
| | - José Luis Sanz
- Department of Stomatology, Universitat de València, 46010 Valencia, Spain
| | - Ricardo E Oñate-Sánchez
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, IMIB-Arrixaca, University of Murcia, 30008 Murcia, Spain.
| | - Leopoldo Forner
- Department of Stomatology, Universitat de València, 46010 Valencia, Spain
| | - David García-Bernal
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, IMIB-Arrixaca, University of Murcia, 30008 Murcia, Spain
| | - Laura Murcia
- Department of Health Sciences, Catholic University San Antonio of Murcia, 30107 Murcia, Spain
| | - Francisco J Rodríguez-Lozano
- Department of Dermatology, Stomatology, Radiology and Physical Medicine, Morales Meseguer Hospital, Faculty of Medicine, IMIB-Arrixaca, University of Murcia, 30008 Murcia, Spain
| | - Carmen Llena
- Department of Stomatology, Universitat de València, 46010 Valencia, Spain
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Poudel P, Paudel G, Acharya R, George A, Borgnakke WS, Rawal LB. Oral health and healthy ageing: a scoping review. BMC Geriatr 2024; 24:33. [PMID: 38191307 PMCID: PMC10773108 DOI: 10.1186/s12877-023-04613-7] [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: 07/10/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Good oral health is an important part of healthy ageing, yet there is limited understanding regarding the status of oral health care for older people globally. This study reviewed evidence (policies, programs, and interventions) regarding oral health care for older people. METHODS A systematic search of six databases for published and grey literature in the English language by the end of April 2022 was undertaken utilising Arksey and O'Malley's scoping review framework. RESULTS The findings from oral health policy documents (n = 17) indicated a lack of priorities in national health policies regarding oral health care for older people. The most common oral health interventions reported in the published studies (n = 62) included educational sessions and practical demonstrations on oral care for older adults, nurses, and care providers. Other interventions included exercises of facial muscles and the tongue, massage of salivary glands, and application of chemical agents, such as topical fluoride. CONCLUSION There is currently a gap in information and research around effective oral health care treatments and programs in geriatric dental care. Efforts must be invested in developing guidelines to assist both dental and medical healthcare professionals in integrating good oral health as part of healthy ageing. Further research is warranted in assessing the effectiveness of interventions in improving the oral health status of the elderly and informing approaches to assist the integration of oral health into geriatric care.
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Affiliation(s)
- Prakash Poudel
- Office of Research and Education, Canberra Health Services, Australian Capital Territory (ACT) Government, Garran, ACT, 2606, Australia
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Grish Paudel
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW, 2000, Australia
- Appleton Institute, Physical Activity Research Group, Central Queensland University, QLD, Rockhampton, 4702, Australia
| | - Reecha Acharya
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia
| | - Ajesh George
- Australian Centre for Integration of Oral Health (ACIOH), School of Nursing & Midwifery, Western Sydney University, Liverpool, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, Australia.
- School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
- School of Nursing, Faculty of Science, Medicine & Health, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Wenche S Borgnakke
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA
| | - Lal B Rawal
- School of Health, Medical and Applied Sciences, Central Queensland University, Sydney, NSW, 2000, Australia
- Appleton Institute, Physical Activity Research Group, Central Queensland University, QLD, Rockhampton, 4702, Australia
- Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, 2751, Australia
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11
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Chou R, Selph SS, Bougatsos C, Nix C, Ahmed A, Griffin J, Schwarz E. Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Adults: A Systematic Review for the US Preventive Services Task Force. JAMA 2023; 330:1780-1790. [PMID: 37934490 DOI: 10.1001/jama.2023.20685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Importance Dental caries and periodontal disease are common adult oral health conditions and potentially amenable to primary care screening and prevention. Objective To systematically review the evidence on primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force. Data Sources MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023. Study Selection Diagnostic accuracy studies of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions; cohort studies on primary care oral health screening and preventive intervention harms. Data Extraction and Synthesis One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Diagnostic accuracy data were pooled using a bivariate mixed-effects binary regression model. Main Outcomes and Measures Dental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy. Results Five randomized clinical trials, 5 nonrandomized trials, and 6 observational studies (total 3300 participants) were included. One poor-quality trial (n = 477) found no difference between oral health screening during pregnancy vs no screening in caries, periodontal disease, or birth outcomes. One study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity (0.42 and 0.56) and high specificity (0.84 and 0.87) for periodontal disease and with variable sensitivity (0.33 and 0.83) and high specificity (0.80 and 0.93) for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 (95% CI, 0.57-0.83) and specificity of 0.74 (95% CI, 0.66-0.82) for periodontal disease. For preventive interventions no study evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, -0.33 to -1.3) and decreased likelihood of new root caries lesion (2 trials; adjusted odds ratio, 0.4 [95% CI, 0.3-0.7]). No trial evaluated primary care-administered preventive interventions. Conclusions and Relevance Screening questionnaires were associated with moderate diagnostic accuracy for periodontal disease. Research is needed to determine benefits and harms of oral health primary care screening and preventive interventions.
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Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
- Division of General Internal Medicine; Oregon Health & Science University, Portland
| | - Shelley S Selph
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Christina Bougatsos
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Chad Nix
- School of Medicine; Oregon Health & Science University, Portland
| | - Azrah Ahmed
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Jessica Griffin
- Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland
| | - Eli Schwarz
- School of Dentistry, Division of Dental Public Health, Oregon Health & Science University, Portland
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12
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Bashirian S, Khoshravesh S, Ayubi E, Karimi-Shahanjarini A, Shirahmadi S, Solaymani PF. The impact of health education interventions on oral health promotion among older people: a systematic review. BMC Geriatr 2023; 23:548. [PMID: 37697260 PMCID: PMC10494401 DOI: 10.1186/s12877-023-04259-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/27/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND One of the most common pathologic changes in older people is oral and dental problems. The oral health of older people is a public health concern. Promotion of good oral health for this cohort will have beneficial impacts on the longer-term quality of life. This study aimed to identify the types of health education interventions for the oral health of older people and to determine their effects on the oral and dental health of older people. METHODS Potential articles were retrieved from four electronic databases (PubMed/Medline, Scopus, Web of Sciences, and Embase) up to 31 September 2022 in English without limit of time. Experimental and quasi-experimental interventional studies investigating the impact of educational interventions on oral and dental health among older people over 60 years old in both sexes were considered. The quality assessment tool was the Effective Public Health Practice Project (EPHPP). RESULTS In the initial search, 1104 articles were retrieved. Finally, according to the inclusion criteria, 23 studies (seventeen randomized controlled trials (RCT) and six quasi-experimental studies) were reviewed. In this review, educational interventions for older people and their caregivers are classified. Theoretical frameworks were used in only three interventions related to older people. Outcome measures were both self-reported and objective measures. Fifteen of the included studies were of moderate quality. CONCLUSION This review provides evidence that the use of oral and dental health educational interventions was effective in improving the oral health of older people. Educational interventions were carried out both among older people and among their caregivers. Although a variety of interventions were used in the reviewed studies, more lectures were used in the interventions related to older people. In the interventions related to caregivers, in addition to lectures, practical education was also used. It is recommended to perform higher quality studies for assessing the effectiveness of interventions in this field.
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Affiliation(s)
- Saeid Bashirian
- Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sahar Khoshravesh
- Department of Community Health Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Erfan Ayubi
- Cancer Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Karimi-Shahanjarini
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Samane Shirahmadi
- Department of Community Oral Health, School of Dentistry, Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Parshang Faghih Solaymani
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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13
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Milgrom P. The paper by Ericson and colleagues "Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults-A randomised clinical trial" demonstrates a fundamental failure of peer review. Gerodontology 2023; 40:406. [PMID: 36691885 DOI: 10.1111/ger.12673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/18/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Peter Milgrom
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
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14
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Ericson D, Carlsson P, Gabre P, Wårdh I, Zimmerman M, Sjögren P. Effect of a single application of silver diamine fluoride on root caries after 12 months in institutionalised older adults-A randomised clinical trial. Gerodontology 2023; 40:390-397. [PMID: 36404644 DOI: 10.1111/ger.12668] [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: 01/17/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Silver diamine fluoride (SDF) has been shown to be highly effective against caries, in particular for arresting root surface caries and for dentine caries in primary teeth. SDF may complement fluoride varnish routines for treatment of root caries in nursing home residents. The aim of this randomised, single-blinded, placebo-controlled trial was to evaluate the additive effect of a single annual application of SDF for prevention and treatment of incipient root caries in older adult nursing home residents. METHOD Four hundred older adult nursing home residents (≥70 years old) with at least one exposed root surface (on teeth 15, 14, 13, 23, 24, or 25) were identified during routine dental examination visits in the domiciliary dental care setting. Eligible patients, who were able to understand the implication of consenting to the study, were invited to participate. Their cleaned root surfaces were randomly allocated to treatment with SDF (Advantage Arrest Silver Diamine Fluoride 38%, Advantage Arrest, LLC, Redmond, OR 97756, USA, Lot 16 152) or with placebo (tap water), each for 1 minute. RESULTS Of the 400 eligible individuals, 42 declined to participate and two forms were destroyed. The remaining 356 participants (89.0%; mean age 87.7 years) were randomly allocated, with 174 going to the SDF group and 182 to the placebo group. At 1 year, 273 participants (76.7%) were available for assessment: 135 in the SDF group and 138 in the placebo group. By that time, 109 individuals (39.9%) demonstrated root caries progression or regression. Among those 118 (16.7%) of the 708 included root surfaces had developed caries There were no statistically significant differences in the primary outcome related to treatment with SDF or placebo, at either patient or root surface level. CONCLUSION Based on the finding of this clinical trial, it is concluded that a single SDF application to complement a risk-based preventive programme including fluoride varnish applications did not have a statistically significant additional preventive effect on root caries development in a group of older adult nursing home residents with limited caries activity and cognitive capacity to cooperate in oral care activities.
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Affiliation(s)
- Dan Ericson
- Faculty of Odontology, Malmö University, Malmo, Sweden
| | | | - Pia Gabre
- Institute of Odontology, The Sahlgrenska Academy of Gothenburg, Gothenburg, Sweden
| | - Inger Wårdh
- Department of dental medicine and Academic centre for geriatric dentistry, Karolinska institutet, Stockholm and Department of health sciences, University of Karlstad, Karlstad, Sweden
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15
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Rinsathon J, Wiriyasuebpong S, Thariya K, Jiradechochai P, Phetsuk P, Bouanil S, Saikaew P, Pawaputanon Na Mahasarakham C. Bonding performance of glass ionomer cement to carious dentin treated with different surface treatment protocols using silver diamine fluoride. Sci Rep 2023; 13:14233. [PMID: 37648840 PMCID: PMC10468524 DOI: 10.1038/s41598-023-41511-9] [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: 04/05/2023] [Accepted: 08/28/2023] [Indexed: 09/01/2023] Open
Abstract
This study investigated the influence of silver diamine fluoride (SDF) on the shear bond strength (SBS) to artificial carious dentin and GIC restorations with various SDF application protocols. Artificial caries were prepared on human dentin discs using bacteria model. These samples were randomly allocated to five groups (n = 10/group) according to the following treatment: (1) control group (CD): no treatment (2) CSR: dentin conditioner, SDF, and rinsing (3) CS: dentin conditioner and SDF (4) SRC: SDF, rinsing and dentin conditioner, and (5) SC: SDF and dentin conditioner. The treated-dentin surface was bonded with GIC and subjected to SBS test. Mean SBS was analyzed using one-way ANOVA. Surface morphology and elemental contents after surface treatment were examined (n = 3/group) by scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM/EDX). There was no significant difference in the mean SBS among CD (2.45 ± 0.99 MPa), CSR (1.76 ± 0.65 MPa), and SRC (2.64 ± 0.95 MPa). Meanwhile, the mean SBS of CS (0.35 ± 0.21 MPa) was significantly lower than the control and SRC group. SEM/EDX demonstrated deeper silver penetration in CSR and CS groups when compared to SRC and SC groups. SDF-modified GIC restorations resulted in significantly lower bond strength in CS and SC groups. The findings suggested treating the carious dentin surface with CSR and SRC protocol. SDF-treated carious dentin should be rinsed off prior to restore with GIC.
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Affiliation(s)
| | - Suthinee Wiriyasuebpong
- Department of Restorative Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Kunwara Thariya
- Department of Restorative Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Panupong Jiradechochai
- Department of Restorative Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Porada Phetsuk
- Research Unit, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Sanit Bouanil
- Research Unit, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Pipop Saikaew
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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16
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Morén E, Skott P, Edman K, Gavriilidou N, Wårdh I, Domeij H. The Effect of Domiciliary Professional Oral Care on Root Caries Progression in Care-Dependent Older Adults: A Systematic Review. J Clin Med 2023; 12:jcm12072748. [PMID: 37048831 PMCID: PMC10094771 DOI: 10.3390/jcm12072748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/17/2023] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
With care dependency, untreated root caries lesions (RCLs) and irregular dental visits are common. RCLs, if left untreated, could lead to pain, tooth loss, difficulties eating, and impact on general health. Therefore, there is a need for prevention and effective treatment for RCLs, and especially in those with care dependency. The aim of this systematic review was to investigate the effect of domiciliary professional oral care on root caries development and progression, in comparison with self-performed or nurse-assisted oral care. A literature search was conducted in four databases in November 2022. Two authors independently screened the literature throughout the review process. Five of the identified studies were found to be relevant. Four of these were assessed as having moderate risk of bias and were included in the review, while one study had high risk of bias and was excluded from further analyses. Due to heterogenicity of the included studies (and of the interventions and outcomes), no meta-analysis or synthesis without meta-analysis (SWiM) was performed. The participation of dental personnel performing mechanical plaque removal and fluoride, or chlorhexidine application seems beneficial for care-dependent older adults with risk of RCLs development and progression. However, future studies are needed.
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Affiliation(s)
- Elisabeth Morén
- Department of Dental Medicine, Karolinska Institute, 141 04 Huddinge, Sweden
- Public Dental Service, Folktandvården Region Dalarna, 791 29 Falun, Sweden
- Centre for Clinical Research Dalarna, Uppsala University, 791 82 Falun, Sweden
| | - Pia Skott
- Department of Dental Medicine, Karolinska Institute, 141 04 Huddinge, Sweden
- Public Dental Services, Folktandvården Stockholm AB, 118 27 Stockholm, Sweden
- Academic Centre for Geriatric Dentistry, 112 19 Stockholm, Sweden
| | - Kristina Edman
- Centre for Clinical Research Dalarna, Uppsala University, 791 82 Falun, Sweden
- Administrative Centre for Public Dental Service, 791 29 Falun, Sweden
- Department of Surgical Sciences, Odontology & Maxillofacial Surgery, Uppsala University, 751 85 Uppsala, Sweden
| | - Nivetha Gavriilidou
- Department of Dental Medicine, Karolinska Institute, 141 04 Huddinge, Sweden
- Public Dental Services, Folktandvården Stockholm AB, 118 27 Stockholm, Sweden
- Academic Centre for Geriatric Dentistry, 112 19 Stockholm, Sweden
| | - Inger Wårdh
- Department of Dental Medicine, Karolinska Institute, 141 04 Huddinge, Sweden
- Academic Centre for Geriatric Dentistry, 112 19 Stockholm, Sweden
- Department of Health Sciences, Karlstad University, 651 88 Karlstad, Sweden
| | - Helena Domeij
- Health Technology Assessment-Odontology, Faculty of Odontology, Malmö University, 205 06 Malmö, Sweden
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17
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Mungur A, Chen H, Shahid S, Baysan A. A systematic review on the effect of silver diamine fluoride for management of dental caries in permanent teeth. Clin Exp Dent Res 2023; 9:375-387. [PMID: 36823765 PMCID: PMC10098297 DOI: 10.1002/cre2.716] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/01/2023] [Accepted: 01/07/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVES The objective of this review is to assess the available literature systematically related to the effect of silver diamine fluoride (SDF) for the management of occlusal and root carious lesions in permanent teeth regardless of age. MATERIALS AND METHODS: This systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Review and Meta-Analyses statement. A literature search was performed using PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, DOAJ, and Open Gray with no language restrictions up to December 2022. Three reviewers critically assessed the studies for eligibility. Any disputes between the reviewers were handled by a fourth independent reviewer. The quality assessment and data extraction of the studies were performed. RESULTS A total of 2176 studies were screened. The titles and abstracts of the studies were then reviewed (n = 346), and 52 studies met the search criteria. Following the full-text review, 11 studies investigated the effect of SDF against other treatments such as chlorhexidine, sodium fluoride, ammonium bifluoride, tricalcium silicate paste, casein phosphopeptide amorphous calcium phosphate, glass ionomer cement (GIC) combined with fluoride varnish, resin-modified GIC, and atraumatic restorative treatment were assessed. CONCLUSIONS Within the limitations of this review, the use of SDF is promising with high preventative fractions in permanent teeth of children and older populations when compared to other topical applications such as dental varnish containing sodium fluoride.
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Affiliation(s)
- Alvin Mungur
- Institute of Dentistry, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Haoran Chen
- Institute of Dentistry, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Saroash Shahid
- Institute of Dentistry, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
| | - Aylin Baysan
- Institute of Dentistry, Barts and The London School of Medicine and DentistryQueen Mary University of LondonLondonUK
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Hartshorn JE, Nair RU. Dental innovations which will influence the oral health care of baby boomers. SPECIAL CARE IN DENTISTRY 2023; 43:359-369. [PMID: 36782274 DOI: 10.1111/scd.12835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/13/2023] [Accepted: 01/27/2023] [Indexed: 02/15/2023]
Abstract
From the widespread use of smartphones and tablets to the multitude of applications available, older adults are showing an interest in utilizing technology to maintain their independence and to improve their quality of life. As technology continues to advance and be incorporated into many day-to-day activities, the baby boom generation will see these changes affecting the way they access and utilize dental services. Innovative toothbrushes and chemotherapeutics are continuing to be developed and utilized by many older adults. Within the dental office, older adults are seeing greater application of technology in every day dental procedures. These include the use of teledentistry, artificial intelligence (AI), innovative restorative materials, digitization of fixed and removable prosthodontics, cone beam computed tomography (CBCT) scans to guide dental implant placement and endodontic procedures. There is also new technology to aid in cancer detection and shielding during cancer treatment. Improved communication between the medical and dental fields has become increasingly necessary to facilitate effective patient care and a few innovative healthcare systems have begun to consolidate these services. Overall, the baby boom generation will continue to see dental innovations that will change the way they experience everyday life and dental services.
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Affiliation(s)
- Jennifer E Hartshorn
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
| | - Rohit U Nair
- Department of Preventive and Community Dentistry, The University of Iowa College of Dentistry and Dental Clinics, Iowa City, Iowa, USA
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19
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Zheng FM, Yan IG, Duangthip D, Gao SS, Lo ECM, Chu CH. Silver diamine fluoride therapy for dental care. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:249-257. [PMID: 36097560 PMCID: PMC9463534 DOI: 10.1016/j.jdsr.2022.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 08/05/2022] [Accepted: 08/21/2022] [Indexed: 11/29/2022] Open
Abstract
Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is used to control early childhood caries, arrest root caries, prevent fissure caries and secondary caries, desensitise hypersensitive teeth, remineralise hypomineralised teeth, prevent dental erosion, detect carious tissue during excavation and manage infected root canals. SDF is commonly available as a 38% solution containing 255,000 ppm silver and 44,800 ppm fluoride ions. Silver is an antimicrobial and inhibits cariogenic biofilm. Fluoride promotes remineralisation and inhibits the demineralisation of teeth. SDF also inactivates proteolytic peptidases and inhibits dentine collagen degradation. It arrests caries without affecting dental pulp or causing dental fluorosis. Indirect pulp capping with SDF causes no or mild inflammatory pulpal response. However, direct application of SDF to dental pulp causes pulp necrosis. Furthermore, SDF stains carious lesions black. Patients must be well informed before SDF treatment. SDF therapy is simple, painless, non-invasive, inexpensive, and requires a simple armamentarium and minimal support. Both clinicians and patients generally accept it well. In 2021, the World Health Organization included SDF as an essential medicine that is effective and safe for patients. Moreover, it can be used for caries control during the COVID-19 pandemic because it is non-aerosol-generating and has a low risk of cross-infection.
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Affiliation(s)
| | - Iliana Gehui Yan
- Faculty of Dentistry, The University of Hong Kong, 999077, Hong Kong, China
| | | | - Sherry Shiqian Gao
- Faculty of Dentistry, The University of Hong Kong, 999077, Hong Kong, China
- Department of Stomatology, School of Medicine, Xiamen University, Xiamen 361000, China
| | - Edward Chin Man Lo
- Faculty of Dentistry, The University of Hong Kong, 999077, Hong Kong, China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, 999077, Hong Kong, China
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20
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Hiraishi N, Sayed M, Takahashi M, Nikaido T, Tagami J. Clinical and primary evidence of silver diamine fluoride on root caries management. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:1-8. [PMID: 34950254 PMCID: PMC8672042 DOI: 10.1016/j.jdsr.2021.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/05/2021] [Accepted: 11/16/2021] [Indexed: 01/24/2023] Open
Abstract
Root caries is a growing problem for the worldwide aging population. Silver diamine fluoride (SDF) contains high concentrations of silver and fluoride ions, which prevents and arrests root caries, as well as dentin caries in the primary teeth of young children. Unlike other fluoride products that mainly reduce the formation of new carious lesions, 38% SDF is an effective agent that can efficiently arrest the carious process, remineralize the decayed dental tissues, and protect the tooth structure against the formation of new caries lesions. The use of SDF can result in more caries-resistant tooth structures. Despite these merits, its clinical disadvantages are the deep penetration of silver ions and sequential formation of silver compounds, which cause esthetic concern due to the discoloration and impaired efficacy of dentin bonding after using SDF. Thus, this narrative review, by addressing the primary experimental results and clinical applications of SDF on root caries, proposes management methods for root caries in conjunction with the application of SDF. We propose a two-visit treatment protocol to take advantage of the SDF application for root surface caries and utilize the discoloration caused by SDF.
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Affiliation(s)
- Noriko Hiraishi
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mahmoud Sayed
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoi Takahashi
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toru Nikaido
- Department of Operative Dentistry, Division of Oral Functional Science and Rehabilitation, School of Dentistry, Asahi University, Gifu, Japan
| | - Junji Tagami
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Chan AKY, Tamrakar M, Jiang CM, Tsang YC, Leung KCM, Chu CH. Clinical evidence for professionally applied fluoride therapy to prevent and arrest dental caries in older adults: A systematic review. J Dent 2022; 125:104273. [PMID: 36058347 DOI: 10.1016/j.jdent.2022.104273] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/06/2022] [Accepted: 08/25/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To assess the clinical evidence for professionally applied fluoride therapy to prevent and arrest caries in older adults. DATA/SOURCES Two independent researchers searched the English literature published up to 31st Dec 2021 in five databases (PubMed, Scopus, the Cochrane Library, EMBASE, and Web of Science) for clinical trials with a comparison group on professionally applied fluoride therapy for caries prevention or arrest at older adults aged ≥60 years with any follow-up period. The outcomes were the mean difference in the number of new caries/caries-prevented fraction and caries arrest rate. The Cochrane guidelines were used for the risk of bias assessment. STUDY SELECTION/RESULTS Five hundred and twenty-seven studies were identified, and seven studies were finally included. Five studies were rated as having 'low risk'. The root caries-prevented fraction of 38% silver diamine fluoride (SDF) solution, 5% sodium fluoride (NaF) varnish, and 1.23% acidulated phosphate fluoride (APF) gel were 25-71%, 64%, and 32%, respectively. Meta-analysis indicated a decrease in the number of new root caries by 0.55 (95% CI: 0.32-0.78; p < 0.001) and an overall proportion of arrested root caries of 42% (95% CI: 33% to 49%; p < 0.001) after receiving 38% SDF application at the 24-month follow-up. CONCLUSIONS According to the findings, 5% NaF varnish and 1.23% APF gel prevented root caries, whereas 38% SDF solution prevented and arrested root caries in older adults. More well-designed clinical trials should be conducted to investigate various methods in caries prevention and arrest in older adults. CLINICAL SIGNIFICANCE Preventive measures effective in other age groups may not suit older adults, as caries type and associated risk factors vary. To date, no systematic review has evaluated professionally applied fluoride therapy in older adults. Evidence from clinical trials in older adults could aid clinical practice and public health measures. The International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42022307025.
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Affiliation(s)
- Alice Kit Ying Chan
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Manisha Tamrakar
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Chloe Meng Jiang
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Yiu Cheung Tsang
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Katherine Chiu Man Leung
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China.
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22
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Gibson G, Wehler CJ, Jurasic MM. Providing Effective Dental Care for an Ageing Population. Int Dent J 2022; 72:S39-S43. [PMID: 36031324 PMCID: PMC9437804 DOI: 10.1016/j.identj.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Effective treatment produces improved outcomes from the patient and clinician perspectives. The focus of this article is effective dental care for ageing patients. This concept must be embraced through research, education and, finally, clinical care. RESEARCH Older adults often carry a higher burden of health and socioeconomic issues that limit their participation in clinical trials. This leaves providers to extrapolate care decisions from research in other age groups. However, electronic health records allow researchers to converge extensive medical, pharmacologic, and dental data, thereby including older patients in research questions. EDUCATION Dental and medical educators are tasked with teaching skills specific to ageing patients. This requires teaching and active use of concepts such as whole health and patient-centred outcomes. PROVISION OF CARE For ageing patients, effective care is precision care (the right care to the right patient at the right time). Clinicians must be trained and then actively participate in the interdisciplinary approach to assure good oral health for all older patients.
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Affiliation(s)
- Gretchen Gibson
- VHA Office of Dentistry, Oral Health Quality Group, Washington, DC, USA.
| | - Carolyn J Wehler
- VHA Office of Dentistry, Oral Health Quality Group, Washington, DC, USA; Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
| | - M Marianne Jurasic
- VHA Office of Dentistry, Oral Health Quality Group, Washington, DC, USA; Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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23
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Jabin Z, Jain G, Jaiswal M, Vishnu Priya V. Top 100 cited articles on Silver diamine fluoride-A bibliometric analysis. J Oral Biol Craniofac Res 2022; 12:413-420. [DOI: 10.1016/j.jobcr.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/24/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
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24
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Campos MS, Fontana M. Caries Management in Special Care Dentistry. Dent Clin North Am 2022; 66:169-179. [PMID: 35365271 DOI: 10.1016/j.cden.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The objective of this article is to provide a summary of the current evidence-based recommendations for caries management in patients with special health care needs (SHCNs). Considerations regarding caries risk assessment and preventive measures are also discussed with the goal of helping clinicians to manage the caries disease process using a person-centered approach and risk-based interventions. Importantly, most of the evidence is still based on the general population, because the evidence for those with SHCNs is still limited.
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Affiliation(s)
- Marcia S Campos
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, 1011 North University, Room 3169, Ann Arbor, MI 48109, USA.
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, 1011 North University, Room 2303, Ann Arbor, MI 48109, USA
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25
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Weber MT, Alkhafaji Y, Pioch A, Trips E, Basche S, Dannemann M, Kilistoff A, Hannig C, Sterzenbach T. Quantification of Bacterial DNA from Infected Human Root Canals Using qPCR and DAPI after Disinfection with Established and Novel Irrigation Protocols. MATERIALS 2022; 15:ma15051911. [PMID: 35269141 PMCID: PMC8912041 DOI: 10.3390/ma15051911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/05/2023]
Abstract
The removal of bacterial infections within the root canal system is still a challenge. Therefore, the cleansing effect of established and new irrigation-protocols (IP) containing silver diamine fluoride (SDF) 3.8% on the whole root canal system was analyzed using quantitative PCR (qPCR) and 4′,6-diamidino-phenylindole-(DAPI)-staining. Extracted human premolars were instrumented up to F2 (ProTaper Gold) under NaCl 0.9% irrigation and incubated with Enterococcus faecalis for 42 days. Subsequently, different ultrasonically agitated IP were applied to the roots: control (no irrigation), 1. NaOCl 3%, EDTA 20%, CHX 2%, 2. NaOCl 3%, EDTA 20%, 3. NaOCl 3%, EDTA 20%, SDF 3.8%, 4. SDF 3.8%, and 5. NaCl 0.9%. One half of the root was investigated fluorescent-microscopically with DAPI. The other half was grinded in a cryogenic mill and the bacterial DNA was quantified with qPCR. The qPCR results showed a statistically significant reduction of bacteria after the application of IP 1, 2, and 3 compared to the control group. While IP 4 lead to a bacterial reduction which was not significant, IP 5 showed no reduction. These data corresponded with DAPI staining. With qPCR a new molecular-biological method for the investigation of the complete root canal system was implemented. The novel IP 3 had an equally good cleansing effect as the already established IP.
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Affiliation(s)
- Marie-Theres Weber
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
- Correspondence: ; Tel.: +49-351-458-7456
| | - Yousef Alkhafaji
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
| | - Anne Pioch
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
| | - Evelyn Trips
- Coordination Center for Clinical Studies Dresden, Medical Faculty Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01309 Dresden, Germany;
| | - Sabine Basche
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
| | - Martin Dannemann
- Faculty of Automotive Engineering, Institute of Energy and Transport Engineering, Westsächsische Hochschule Zwickau, Scheffelstraße 39, 08012 Zwickau, Germany;
| | - Alan Kilistoff
- Faculty of Medicine & Dentistry, University of Alberta, 11405 87th Ave NW, Edmonton, AB T6G 1C9, Canada;
| | - Christian Hannig
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
| | - Torsten Sterzenbach
- Clinic of Operative and Pediatric Dentistry, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany; (Y.A.); (A.P.); (S.B.); (C.H.); (T.S.)
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26
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Ezzeldin T, Al-Awasi KA, Bader RM, Alshaikhi AY, Hakami AH, Siddiqui IA, Almulhim AA, Alsubaie TM. A Study to assess the awareness and use of Silver Diammine Fluoride and Hall Technique among dental professionals and dental students in the Eastern Province. Saudi Dent J 2021; 33:1166-1173. [PMID: 34938063 PMCID: PMC8665155 DOI: 10.1016/j.sdentj.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/06/2020] [Accepted: 01/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background A major shift has occured in the trend of dealing with dental caries from primary to secondary prevention, specially after SDF approval off-label by US FDA in recent years and Hall Technique (HT) in the last decade. Objectives To determine the frequency of awareness and use of Silver Diammine Fluoride (SDF) and Hall technique among dental professionals in the Eastern province of Saudi Arabia. Methods This cross-sectional study was conducted in a public hospital, metropolitan city of Middle Eastern region between March 15, 2019 & January 31, 2020. Dental practitioners were requested, with their consent, to fill up a digitally designed survey. Chi-square test on SPSS-20.0 was applied to compare frequency of awareness and use of SDF and HALL Technique among the survey participants. Results The awareness of SDF was found to be 73.6% among specialists, 54.9% among graduates and 29.6% among students whereas awareness of HALL technique for stainless steel crown in pediatric dentistry was found statistically similar in all participants groups i.e. 42.7% in students, 55.5% in graduates and 54.9% in specialist group (p = 0.125). Conclusion The results show potential with regards to awareness of dental specialists & postgraduate residents but inadequate among general dentists and students though all were keen advocates and found committed to its use to help the community. It points towards a further need of the of education for all groups. Those non- invasive techniques are very useful tools in general but specifically during Covid-19 pandemic where they can play a major role in preventing the spread of infection, arresting decay, alleviating pain and anxiety without resorting to aggressive treatment like pulp treatment/extraction. Low response rate may be improved in future through the respondents’ counselling and regular follow up.
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Affiliation(s)
- Tarek Ezzeldin
- Medical Program Director Saudi Board Pediatric Dentistry, Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia
| | - Khalaf A Al-Awasi
- Medical Program Director Saudi Board Endodontics, Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia
| | - Rawan M Bader
- Pediatric Dentistry Specialist, Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia
| | - Abdulaziz Y Alshaikhi
- Advanced Restorative Dentistry, Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia
| | - Ashwaq H Hakami
- Pediatric Dentistry, Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia
| | | | - Ahmad A Almulhim
- Orthodontics Saudi Board Resident, Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia
| | - Turki M Alsubaie
- Prosthodontics Fellowship Resident, Dammam Specialized Dental Center, Dammam Medical Complex, Ministry of Health, Saudi Arabia
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27
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Tong N, To S, Wyatt CCL. Impact of the COVID-19 pandemic on the University of British Columbia Geriatric Dentistry Program: Clinical education and service. Gerodontology 2021; 39:348-353. [PMID: 34580910 PMCID: PMC8652979 DOI: 10.1111/ger.12591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/24/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
Background and Objective In Canada, the COVID‐19 pandemic was associated with significant morbidity and mortality in older adults, particularly those in long‐term care (LTC). Access to oral health services was limited during the pandemic due to public health restrictions. The aim of this paper was to describe the impact of the pandemic on the clinical education and service of the University of British Columbia (UBC) Geriatric Dentistry Program (GDP), which provides care to LTC residents. Methods Data were collected from UBC GDP AxiUm dental software records, including number of dental appointments in 2019 and 2020. Data on revenue in 2019 and 2020 based on clinical production were collected through financial summary reports. Data on the number of educational rotations were collected from summary reports from scheduling software. Results In 2020, significant reductions in clinical service, revenue, and productivity were observed in the UBC GDP relative to 2019. The number of GDP appointments for June‐December 2020 was lower by 68%. The clinical productivity reduced by 67% for the same period. Expenses were slightly reduced. The overall number of LTC clinical rotations for students were only slightly lower for undergraduate students in 2020 than in 2019, and it increased for graduate students. Conclusion The COVID‐19 pandemic and associated public health restrictions had a negative impact on the clinical service and productivity of the UBC GDP in 2020 relative to 2019. However, clinical educational rotations to LTC were slightly increased in 2020 relative to 2019. Dental care for LTC residents can be provided if rigorous administrative controls, engineering controls and personal protective equipment are employed.
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Affiliation(s)
- Nicholas Tong
- Program Director- General Practice Residency Program, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Shunhau To
- University of British Columbia Geriatric Dentistry Program, Vancouver, BC, Canada
| | - Chris C L Wyatt
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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28
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Haiat A, Ngo HC, Samaranayake LP, Fakhruddin KS. The effect of the combined use of silver diamine fluoride and potassium iodide in disrupting the plaque biofilm microbiome and alleviating tooth discoloration: A systematic review. PLoS One 2021; 16:e0252734. [PMID: 34115788 PMCID: PMC8195348 DOI: 10.1371/journal.pone.0252734] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022] Open
Abstract
Silver diamine fluoride (SDF) is used in minimally invasive dentistry for arresting dental caries. However, discoloration of teeth is a significant side effect that has limited the use of SDF. Hence, the application of potassium iodide (KI) following SDF has been proposed to ameliorate the staining. Although antimicrobial activity is one of the major mechanisms of the caries-arresting effect of SDF, the antimicrobial potency of SDF/KI combination is unclear. Thus, the primary objective of this systematic review was to appraise the studies on the antimicrobial efficacy of SDF/KI combination on cariogenic microbes. The secondary objective was to summarize the evidence on the potential of KI in reducing the discoloration associated with the application of SDF. Electronic databases of Medline via PubMed, Cochrane Library, Web of Science, and EBSCO host were searched for English language manuscripts from January 2005 to 15th November 2020. The reference lists of these manuscripts were manually searched for additional studies. Twelve studies were included in the final analysis, seven of which have investigated the antimicrobial efficacy of SDF/KI, and the rest have examined the anti-staining potential of KI. The exploratory findings from the reviewed articles revealed the promising antimicrobial potential of SDF/KI on cariogenic microbes associated with dentine caries. There is, however, contradictory evidence on the effect of SDF/KI on tooth color. The reviewed in-vitro studies indicated significant effectiveness of KI in preventing staining. A clinical trial on primary dentition showed 25% reduction in the incidence of staining by SDF after applying KI, while a clinical study on root caries in adults showed no significant effect. Within the methodological limitations of this review, we conclude that for arresting dental caries, SDF could be combined with KI, as there may be a lower likelihood of staining. Further, well-designed clinical trials on the antimicrobial and anti-staining effect of SDF/KI are needed to obtain more robust evidence.
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Affiliation(s)
- Anahita Haiat
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - Hien Chi Ngo
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
| | - Lakshman Perera Samaranayake
- UWA Dental School, The University of Western Australia, Perth, WA, Australia
- Faculty of Dentistry, University of Hong Kong, Hong Kong, Hong Kong
| | - Kausar Sadia Fakhruddin
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
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29
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Castelo R, Attik N, Catirse ABCEB, Pradelle-Plasse N, Tirapelli C, Grosgogeat B. Is there a preferable management for root caries in middle-aged and older adults? A systematic review. Br Dent J 2021:10.1038/s41415-021-3003-2. [PMID: 34045674 DOI: 10.1038/s41415-021-3003-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/26/2020] [Indexed: 11/09/2022]
Abstract
Aim This systematic review aimed to critically summarise the results of clinical studies investigating agents able to: stop the progression of carious lesions; stop the development of new root carious lesions; preserve the vitality of the infected dental tissues; and increase the surface hardness or change of surface texture, in middle-age and older adults.Methods PubMed, Scopus, and Web of Science were searched systematically, following PRISMA guidelines. Clinical trials published from 2011 to 2020 (March) were included. This systematic review is registered in the PROSPERO database (CRD42018104399). Languages were restricted to English.Results Thirteen of 312 studies were eligible for this review. Eight agents were identified in the studies and their efficacy was assessed using different methods. The agents that presented valuable results on preventing or arresting root caries were 38% silver diamine fluoride (SDF), arginine-containing toothpaste and high-fluoride toothpastes.Conclusions Based on the selected studies' findings, annual applications of 38% SDF could be the most effective treatment for root caries in older adults. In addition, the daily use of a 1.5% arginine toothpaste or a high-fluoride toothpaste could also be recommended. More research on root caries-specific diagnostic methods, especially at very early stages, is necessary.
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Affiliation(s)
- Raísa Castelo
- Departmento de Materiais Dentários e Prótese, Faculdade de Odontologia de Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil; Université de Lyon - Université Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, F-69622, France
| | - Nina Attik
- Université de Lyon - Université Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, F-69622 Villeurbanne, France; Université de Lyon - Université Claude Bernard Lyon 1, Faculté d'Odontologie, 69008 Lyon, France.
| | | | - Nelly Pradelle-Plasse
- Université de Lyon - Université Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, F-69622 Villeurbanne, France; Département d'Odontologie Conservatrice - Endodontie, Université de Paris, Faculté Dentaire, Hôpital Rothschild, Assistance Publique-Hôpitaux de Paris, France
| | - Camila Tirapelli
- Departmento de Materiais Dentários e Prótese, Faculdade de Odontologia de Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Brigitte Grosgogeat
- Université de Lyon - Université Claude Bernard Lyon 1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, F-69622 Villeurbanne, France; Université de Lyon - Université Claude Bernard Lyon 1, Faculté d'Odontologie, 69008 Lyon, France; Hospices Civils de Lyon, Centre de Consultations et de Traitements Dentaires, 69007 Lyon, France
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30
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Silver diamine fluoride treatment of active root caries lesions in older adults: A case series. J Dent 2020; 105:103561. [PMID: 33347946 DOI: 10.1016/j.jdent.2020.103561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The authors conducted a case series to determine arrest of root surface caries lesions in older adults when teeth were treated topically with 38 % silver diamine fluoride (SDF). METHODS The study was a prospective, single center case series. The patients were 62 older adults (age ≥55 years) who sought treatment at a dental school clinic. To be included, a patient needed to have at least one active root caries lesion. Lesions were rinsed and then dried with air, isolated, and then 38 % SDF was applied for two minutes with a microbrush. Treated lesions were re-evaluated at 2-3 weeks. Treatment was repeated every six months. Survival analysis methods for clustered data were used to estimate the caries lesion arrest probability over time separately for root surfaces and at crown margins. RESULTS Fifty-five participants returned for follow-up (44 % female, mean age (SD) 79.8 (7.4)). The probability of a lesion arresting with treatment ranged from 82.9 to 91.6%. Arrest rates at 18 months were slightly higher in root surfaces than around crown margins, 91.6 % (95 % CI 69.1-97.1) versus 89.8 % (95 % CI 71.6-96.3). All furcal lesions (n = 7) were arrested by 6 months, 100 % (95 % CI 59-100). CONCLUSION AND CLINICAL SIGNIFICANCE Repeated application of 38 % SDF at 6-month intervals was effective in arresting decay of root surface lesions and lesions around crowns in older adults. Study outcomes support SDF treatment for older adult patients who are frail and residing in nursing homes or dependent living facilities.
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31
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AlQranei MS, Balhaddad AA, Melo MAS. The burden of root caries: Updated perspectives and advances on management strategies. Gerodontology 2020; 38:136-153. [PMID: 33236462 DOI: 10.1111/ger.12511] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Root caries has gained much attention in the last few years. As the world's population is ageing and people currently tend to retain more teeth compared with older generations, there is an increased prevalence of periodontal disease and gingival recession, which may accelerate the onset of root caries. OBJECTIVE This review aims to summarise recent findings related to the diagnosis, prevention and treatment of root caries. MATERIALS AND METHODS MEDLINE (OVID) and Scopus (Elsevier) searches were performed to identify and discuss articles that address the pathogenicity and clinical management of root caries. RESULTS Root caries is a multifactorial disease. Cariogenic species involved in root caries are less dependent on carbohydrates since collagen degradation inside the dentinal tubules can provide nutrients and microcavities for the invading microorganisms. Furthermore, the root surface has fewer minerals in comparison with enamel, which may accelerate the onset of demineralisation. Root caries could be prevented by patient education, modification of risk factors, and the use of in-office and home remineralisation tools. The use of non-invasive approaches to control root caries is recommended, as the survival rate of root caries restorations is poor. When plaque control is impossible and a deep/large cavity is present, glass ionomer or resin-based restorations can be placed. CONCLUSION The assessment of root carious lesions is critical to determine the lesion activity and the required intervention. Dental practitioners should also be aware of different prevention and treatment approaches to design optimum oral health care for root caries-affected patients.
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Affiliation(s)
- Mohammed S AlQranei
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulrahman A Balhaddad
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mary A S Melo
- Division of Operative Dentistry, Department of General Dentistry, University of Maryland Dental School, Baltimore, MD, USA
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Abdullah N, Al Marzooq F, Mohamad S, Abd Rahman N, Rani KGA, Chi Ngo H, Samaranayake LP. The antibacterial efficacy of silver diamine fluoride (SDF) is not modulated by potassium iodide (KI) supplements: A study on in-situ plaque biofilms using viability real-time PCR with propidium monoazide. PLoS One 2020; 15:e0241519. [PMID: 33141868 PMCID: PMC7608867 DOI: 10.1371/journal.pone.0241519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022] Open
Abstract
Silver diamine fluoride (SDF) is commonly used to arrest caries lesions, especially in early childhood caries. Recently, it was suggested that SDF can be combined with potassium iodide (KI) to minimize the discoloration of demineralized dentine associated with SDF application. However, the antibacterial efficacy of SDF alone or combined with KI on in-situ biofilm is unknown. Hence, we compared the anti-plaque biofilm efficacy of two different commercially available SDF solutions, with or without KI, using an in-situ biofilm, analysed using viability real-time PCR with propidium monoazide (PMA). Appliance-borne in-situ biofilm samples (n = 90) were grown for a period of 6 h in five healthy subjects who repeated the experiment on three separate occasions, using a validated, novel, intraoral device. The relative anti-biofilm efficacy of two SDF formulations; 38.0% Topamine (SDFT) and 31.3%, Riva Star (SDFR), KI alone, and KI in combination with SDFR (SDFR+KI) was compared. The experiments were performed by applying an optimized volume of the agents onto the biofilm for 1min, mimicking the standard clinical procedure. Afterwards the viability of the residual biofilm bacteria was quantified using viability real-time PCR with PMA, then the percentage of viable from total bacteria was calculated. Both SDF formulations (SDFT and SDFR) exhibited potent antibacterial activities against the in-situ biofilm; however, there was non-significant difference in their efficacy. KI alone did not demonstrate any antibacterial effect, and there was non-significant difference in the antibacterial efficacy of SDF alone compared to SDF with KI, (SDFT v SDFR/KI). Thus, we conclude that the antibacterial efficacy of SDF against plaque biofilms is not modulated by KI supplements. Viability real-time PCR with PMA was successfully used to analyze the viability of naturally grown oral biofilm; thus, the same method can be used to test the antimicrobial effect of other agents on oral biofilms in future research.
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Affiliation(s)
- Nizam Abdullah
- College of Dental Medicine, University of Sharjah, Sharjah, UAE
- School of Dental Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Farah Al Marzooq
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Suharni Mohamad
- School of Dental Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
- * E-mail:
| | - Normastura Abd Rahman
- School of Dental Sciences, Universiti Sains Malaysia Health Campus, Kubang Kerian, Kelantan, Malaysia
| | | | - Hien Chi Ngo
- College of Dental Medicine, University of Sharjah, Sharjah, UAE
- UWA Dental School, The University of Western Australia, Nedlands, Australia
| | - Lakshman Perera Samaranayake
- College of Dental Medicine, University of Sharjah, Sharjah, UAE
- Faculty of Dentistry, University of Hong Kong, Hong Kong, China (SAR)
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Firouzmandi M, Vasei F, Giti R, Sadeghi H. Effect of silver diamine fluoride and proanthocyanidin on resistance of carious dentin to acid challenges. PLoS One 2020; 15:e0238590. [PMID: 32941456 PMCID: PMC7498094 DOI: 10.1371/journal.pone.0238590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023] Open
Abstract
The aim of this study was to evaluate the effect of silver diamine fluoride and grape seed extract on the microstructure and mechanical properties of carious dentin following exposure to acidic challenge. Ninety-eight molars with occlusal caries were used. In the control group the specimens were kept in distilled water. In the GSE group, the specimens were immersed in 6.5% grape seed extract solution for 30 minutes. In the SDF group, the specimens were immersed in 30% SDF solution for 4 minutes. In the GSE+SDF group, the specimens were immersed in 6.5% grape seed extract solution for 30 minutes and then exposed to 30% SDF solution for 4 minutes. All the groups underwent pH cycling model for 8 days. Microhardness measurements were taken at the baseline before surface treatments and after pH cycling. Elastic modulus was measured, after pH cycling. In the control group, the final hardness was significantly lower than the initial hardness (P = 0.001). In the SDF group, the final hardness was significantly higher than the initial hardness (P < 0.001). There was no significant difference between the initial and final hardness values in the GSE and GSE + SDF groups (p = 0.92, p = 0.07). The H1-H0 in the SDF group was significantly higher than the other groups (P<0.05). Moreover, elastic modulus of the experimental groups except GSE+SDF group was significantly higher than control. The highest mean elastic modulus was detected in the SDF group (P<0.001). The use of SDF and GSE prior to the acid challenge improved mechanical properties. Microstructural investigation, using scanning electron microscope showed dentin structure protection against acid challenges with SDF treatment and collagen matrix stabilization with GSE treatment. However combined use of these agents was not beneficious.
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Affiliation(s)
- Maryam Firouzmandi
- Oral and Dental Disease Research Center, Department of Operative Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fateme Vasei
- Department of Operative Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
- * E-mail:
| | - Rashin Giti
- Department of Prosthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadis Sadeghi
- Student Research Committee, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
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Nelson S, Albert JM, Milgrom P. Comparative Effectiveness of Two Nonsurgical Treatments to Reduce Oral Health Disparities From Untreated Tooth Decay in Older Adults: Protocol for a Cluster Randomized Trial. JMIR Res Protoc 2020; 9:e17840. [PMID: 32897236 PMCID: PMC7509639 DOI: 10.2196/17840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/14/2020] [Accepted: 07/19/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The majority of dental caries lesions in older adults are at the gumline, at the edges of failed fillings and crowns, and in the surfaces of roots after gum recession. These lesions are difficult to restore with conventional surgical treatments using a dental drill and restorations often fail. Clinical guidelines are general and apply treatments that were designed for younger individuals in the dental care of older adults. OBJECTIVE This study will compare the effectiveness of 2 evidence-based nonsurgical strategies to manage dental caries lesions in adults aged 62 or older: (1) biannual topical application of silver diamine fluoride versus (2) atraumatic restorative treatment + biannual fluoride varnish. METHODS A cluster randomized clinical trial is being conducted in 22 publicly subsidized and other low-income housing facilities/sites (Arm 1: 11 sites, 275 participants; Arm 2: 11 sites, 275 participants). At baseline, participants will be screened for caries lesions. Those with nonurgent lesions will be treated according to the treatment arm to which the housing site was randomly assigned. The primary outcomes are caries lesion arrest, tooth sensitivity, and tooth pain at 52 weeks after treatment. Analytic methods for the primary aim include a generalized estimating equation approach to determine noninferiority of silver diamine fluoride relative to atraumatic restorative treatment + fluoride varnish treatment. RESULTS The trial was funded in April 2019. Enrollment began in September 2019 and results are expected in June 2023. CONCLUSIONS This study will inform the standard of care for treating caries lesions in older adults. If effective, either of these interventions has broad applicability in clinical and community-based settings. TRIAL REGISTRATION ClinicalTrials.gov NCT03916926; https://clinicaltrials.gov/ct2/show/NCT03916926. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/17840.
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Affiliation(s)
- Suchitra Nelson
- Case Western Reserve University, Cleveland, OH, United States
| | | | - Peter Milgrom
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Interventions to improve oral health of older people: A scoping review. J Dent 2020; 101:103451. [PMID: 32810577 DOI: 10.1016/j.jdent.2020.103451] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES A range of interventions have been tested to improve oral health of older people. We performed a scoping review to map interventions' aims, outcome measures and findings, and to locate them on different levels of care. DATA We systematically screened for (1) controlled studies on (2) people over 65 years of age, (3) comparing at least two interventions to improve oral health. Interventions were summarized according to their aims and the employed intervention type, mapped on their level of action, and classified as primary/secondary/tertiary prevention. SOURCES Studies retrieved via MEDLINE, EMBASE, CINAHL. STUDY SELECTION Eighty-one studies (published 1997-2019, conducted mainly in high-income countries) were included. Sample sizes varied (n = 24-1987). Follow-up was 0.25-60 months. Most studies (64/81) found a statistically significant benefit of the intervention. A total of 13 different aims were identified, and a range of intervention types employed (e.g. educational interventions, professional oral healthcare, restorative treatment, fluoride application and, generally, dentifrices, mouthwashes, chewing gums/food supplements). Most studies were located on the carer/patient level (56/81 studies) or the system/policy-maker level (44/81). The majority of studies aimed for primary prevention (64/81). CONCLUSIONS Oral health improvement interventions are widely studied. However, study aims, methods and outcome measures are highly heterogeneous, which limits the ability for robust conclusions. Current research focusses on primary prevention on the level of patients/carers or system/policy-maker level. Future studies may want to consider interventions on dentists' level focussing on secondary prevention. These studies should rely on a core set of comprehensive, standardized set of outcome measures. CLINICAL SIGNIFICANCE While specific interventions seem efficacious to improve older people's oral health, the current body of evidence is neither comprehensive (significant gaps exists in relevant levels of the care process) nor comparable enough to draw robust conclusions.
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Firouzmandi M, Mohaghegh M, Jafarpisheh M. Effect of silver diamine fluoride on the bond durability of normal and carious dentin. J Clin Exp Dent 2020; 12:e468-e473. [PMID: 32509229 PMCID: PMC7263774 DOI: 10.4317/jced.56303] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 01/27/2020] [Indexed: 11/05/2022] Open
Abstract
Background Silver diamine fluoride (SDF) has attracted attention because of its clinical success in arresting dentin caries. It has been shown that it can inhibit matrix metalloproteinases and cysteine cathepsins. These two properties might be beneficial in bonding to caries-affected dentin (CAD). Therefore, the present study aimed to investigate the effect of SDF on the durability and bond strength to the CAD. Material and Methods Forty-eight third molars with occlusal caries were used. The roots were cut, and the occlusal enamel was removed. The CAD area surrounded by the normal dentin (ND) was exposed. All the specimens were bonded with an etch-and-rinse adhesive, but half of them were treated with SDF after acid etching (NT or SDF). Two cylinders of composite (0.9 mm in diameter and 0.7 mm in height) were built-up on each specimen, one on the CAD and the other on the ND area. The specimens in each group (NT-ND, NT, CAD, SDF-ND, SDF-CAD) (n=24) were equally divided into two subgroups. One subgroup was tested for microshear bond strength 24 hours after bonding (T0), and the other subgroup was tested after six months of water storage (T6). The bond strength data were analyzed using three-way ANOVA. Subgroup analysis was performed using independent samples t-test. Fracture patterns were also evaluated. Results At T0, the bond strength of NT-ND was higher than that of NT-CAD (p<0.00), but the bond strength of SDF-ND and SDF-CAD were not different (p=0.77). Comparison of the bond strength of the groups between the two time intervals yielded the following results: NT-ND-T0> NT-ND-T6 (p=0.04), SDF-ND-T0=SDF-ND-T6 (p=0.39), NT-CAD-T0=NT-CAD-T6 (p=0.51) and SDF-CAD-T0>SDF-CAD-T6 (p<0.00). Conclusions The SDF treatment increased the bond strength to CAD but did not affect the bond strength to the ND. SDF hindered the decrease in the bond strength to the ND caused by aging. However, the effect of SDF on increasing the bond strength to CAD disappeared after aging. Key words:Silver diamine fluoride, caries-affected dentin, bond strength.
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Affiliation(s)
- Maryam Firouzmandi
- Assistant Professor, Oral and Dental Disease Research Center, Department of Operative Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mina Mohaghegh
- Assistant professor, Department of prosthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maedeh Jafarpisheh
- Undergraduate Dental Student, Student Research Committee, School of Dentistry, Shiraz University of Medical Science, Shiraz, Iran
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Zhang J, Sardana D, Li K, Leung K, Lo E. Topical Fluoride to Prevent Root Caries: Systematic Review with Network Meta-analysis. J Dent Res 2020; 99:506-513. [DOI: 10.1177/0022034520906384] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of this systematic review and network meta-analysis was to summarize the direct and indirect clinical evidence on the effectiveness of professionally applied and self-applied topical fluorides in preventing dental root caries. Controlled clinical trials with any follow-up duration were included. MEDLINE, PubMed, Embase, Scopus, and Cochrane Library were searched. Two reviewers independently carried out the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Fixed effects model and frequentist approach were used in the network meta-analyses. Nine clinical trials involving 4,030 participants were included. Five professionally applied and 7 self-applied topical fluoride agents or combinations were included in the meta-analyses. Compared to control group, 38% silver diamine fluoride solution, 5% sodium fluoride varnish, and 1.2% acidulated phosphate fluoride reduced root caries increment after 2 y (ranging from 0.59 to 0.85 mean decayed or filled root [DF-root]). Fluoride mouth rinse and fluoride toothpaste, used alone or in combination, reduced root caries increment after 1 y (ranging from 0.29 to 1.90 mean DF-root). Among the professionally applied topical fluorides reviewed, an annually applied 38% silver diamine fluoride (SDF) solution combined with oral health education is most likely to be the most effective in preventing dental root caries. Among the reviewed self-applied topical fluoride methods, daily use of a 0.2% sodium fluoride (NaF) mouth rinse is most likely to be the most effective, followed by 1100 ppm to 1500 ppm fluoride toothpaste plus 0.05% NaF mouth rinse, and 1100 ppm to 1500 ppm fluoride toothpaste.
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Affiliation(s)
- J. Zhang
- The University of Hong Kong, Hong Kong
| | | | - K.Y. Li
- The University of Hong Kong, Hong Kong
| | | | - E.C.M. Lo
- The University of Hong Kong, Hong Kong
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Lin YS, Rothen ML, Milgrom P. Pharmacokinetics of 38% topical silver diamine fluoride in healthy adult volunteers. J Am Dent Assoc 2019; 150:186-192. [PMID: 30803490 DOI: 10.1016/j.adaj.2018.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/25/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Silver diamine fluoride (SDF) is used topically to prevent or arrest caries. The authors' aim was to characterize the kinetics of silver and fluoride after topical application of SDF. METHODS Sixteen adults participated in a pharmacokinetics study after the application of 38% SDF to 5 teeth (approximately 50 microliters, estimated 4-11 milligrams per participant). Serum and urine samples were collected over 24 hours after application and were analyzed for silver and fluoride. RESULTS Silver serum peak was 0.67 (standard deviation [SD], 0.49) nanograms per milliliter; median time to peak was 3 hours. The estimated elimination half-life of silver was 46 (SD, 26) hours. No silver was recovered in urine. Baseline fluoride serum levels ranged from less than 10 through 50 ng/mL (< 0.01-0.05 parts per million) and fluctuated around baseline after SDF. The 24-hour urinary fluoride was 1.29 (SD, 0.81) mg. CONCLUSIONS SDF was well tolerated in this study, and no adverse events related to SDF were reported. PRACTICAL IMPLICATIONS This clinical study confirmed that topical application of 38% SDF, in growing use in the United States, is safe and well tolerated in healthy adults.
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Risk predictors of dental root caries: A systematic review. J Dent 2019; 89:103166. [DOI: 10.1016/j.jdent.2019.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 11/22/2022] Open
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Meyer-Lueckel H, Machiulskiene V, Giacaman RA. How to Intervene in the Root Caries Process? Systematic Review and Meta-Analyses. Caries Res 2019; 53:599-608. [PMID: 31412343 DOI: 10.1159/000501588] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
The aim of this review as part of the preparation for a workshop organized by the European Federation of Conservative Dentistry (EFCD) in conjunction with the European Organisation for Caries Research (ORCA) was to systematically analyze available evidence of non-, micro- as well as invasive interventions for root caries lesions (RCLs). For each treatment strategy, a separate systematic review was either performed (micro-invasive and choice of restorative material) or updated (non-invasive and excavation technique) each of them following PRISMA guidelines, and if possible meta-analyses were performed. Besides the general advice to improve tooth brushing with fluoride toothpaste main findings for non-invasive interventions in RCLs, the use of dentifrices containing 5,000 ppm F- as well as professionally applied chlorhexidine varnish or silver diamine fluoride seemed to be more efficacious to arrest root caries compared to conventional fluoride toothpaste or placebo respectively. However, this conclusion is based only on a few randomized clinical trials. For micro-invasive treatments, only 2 studies focusing on sealants were available without clear conclusions. A recent review on the comparison of atraumatic restorative treatment compared with conventional treatment concluded that there is insufficient data to clearly rule out if any difference with regard to restoration longevity between both techniques exists. When restoring coventionally, composites performed better than resin-modified and glass ionomer cements. However, all materials showed rather high annual failure rates in the majority of the studies and evidence is based on a low number of prospective studies with a rather high risk of bias.
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Affiliation(s)
- Hendrik Meyer-Lueckel
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland,
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, University of Talca, Talca, Chile
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Mitwalli H, Mourao M, Dennison J, Yaman P, Paster B, Fontana M. Effect of Silver Diamine Fluoride Treatment on Microbial Profiles of Plaque Biofilms from Root/Cervical Caries Lesions. Caries Res 2019; 53:555-566. [DOI: 10.1159/000499578] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/12/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose: To assess the effect of silver diamine fluoride (SDF) on microbial profiles present in plaque from root/cervical carious lesions, and its association with caries lesion arrest. Materials and Methods: Twenty patients with at least one soft cavitated root/cervical carious lesion were included. One lesion/patient was randomly selected and treated with 38% SDF. Supragingival plaque samples were harvested at preintervention and 1 month postintervention. Using an MiSeq platform, 16S rDNA sequencing of the V3-V4 regions was used to determine bacterial profiles. Clinical evaluation of lesion hardness was used to evaluate arrest. t tests, principal component analysis (PCA), multidimensional scaling (MDS), and generalized linear models (GLMs) tests were used for statistical comparisons. Results: From a total of 40 plaque samples, 468 probe targets were observed. Although 60% of lesions became hard postintervention, PCA and MDS tests showed no distinct pre- and postintervention groups. In addition, pre- and postintervention differences in diversity (Shannon index) of microbial profiles between patients with and without lesion arrest were not statistically different. A likelihood ratio test for pre- versus postintervention differences within patients, i.e., adjusting for differences between patients using negative binomial GLMs, showed 17 bacterial taxa with significant differences (FDR <0.05). Conclusion: Although 60% of lesions hardened after SDF treatment, this was not directly due to either overall statistically significant differences in microbial profiles or differences in microbial diversity. Nevertheless, there was a trend with some acid-producing species in that their relative abundance was reduced postintervention. The negative binomial GLMs showed 17 bacterial taxa that were significantly different after SDF treatment.
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Göstemeyer G, da Mata C, McKenna G, Schwendicke F. Atraumatic vs conventional restorative treatment for root caries lesions in older patients: Meta- and trial sequential analysis. Gerodontology 2019; 36:285-293. [PMID: 31125136 DOI: 10.1111/ger.12409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/07/2019] [Accepted: 03/23/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We aimed to appraise the comparative clinical efficacy of atraumatic restorative treatment (ART) versus conventional restorative treatment (CT) using a meta-analysis, and assessed the robustness of evidence by trial sequential analysis (TSA). BACKGROUND Due to its simplified clinical approach, ART may be advantageous over CT for restoration of root caries lesions in institutionalised older patients. METHODS Three electronic databases (PubMed, Embase and Cochrane CENTRAL) were screened, and hand searches and cross-referencing performed to identify randomised controlled trials reporting on survival of ART vs CT for restoration of root caries in older patients. Trial selection, data extraction and risk of bias assessment were performed by two independent reviewers. ART and CT were compared using fixed- or random-effects pairwise meta-analysis for per-protocol (PP), intention-to-treat (ITT) and best-case scenarios. TSA was used to control for risk of random errors. RESULTS A total of 235 studies were identified, and three trials involving 130 patients (463 restorations) were included. Risk of bias was high or moderate in all but one trial. ART was associated with a significantly increased risk of failure (OR [95% CI] 2.06 [1.06/4.00]) in PP- but not in ITT analysis (1.36 [0.92/2.02]). Analyses for best-case scenarios found great uncertainty introduced by attrition. No firm evidence was reached according to TSA. CONCLUSIONS For restoration of root caries, there is insufficient data to clearly rule out whether differences between ART and CT exist. Limited available data indicate there might be an increased risk of failure for ART.
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Affiliation(s)
- Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cristiane da Mata
- Cork University Dental School and Hospital, University College Cork, Cork, Ireland
| | - Gerald McKenna
- Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Magno MB, Silva LPD, Ferreira DM, Barja-Fidalgo F, Fonseca-Gonçalves A. Aesthetic perception, acceptability and satisfaction in the treatment of caries lesions with silver diamine fluoride: A scoping review. Int J Paediatr Dent 2019; 29:257-266. [PMID: 30637833 DOI: 10.1111/ipd.12465] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/04/2018] [Accepted: 01/09/2019] [Indexed: 12/07/2022]
Abstract
BACKGROUND Silver diamine fluoride (SDF) causes dental black staining after its application. AIM Evaluate the aesthetic perception, acceptability, and/or satisfaction of patients, parents, and professionals to the treatment of caries lesions with SDF through a scoping review. DESIGN A search was performed in seven databases and two key journals with no language or date restrictions. Studies that evaluated the aesthetic perception, satisfaction, and/or acceptability of patients, parents, and professionals to the treatment of carious lesions with SDF were considered eligible. RESULTS From a total of 1177 articles, 10 studies were full text assessed for eligibility, with nine included in this scoping review. In general, the studies varied by population, study design, and methodologic evaluation. The type of tooth (anterior or posterior), family income, parental schooling, ethnicity, and need for advanced behaviour control methods were factors that influenced the results. The acceptability level increased as the child required more advanced methods of behaviour guidance. In general, the pigmentation caused by SDF did not interfere with the parents' acceptability of the treatment; however, professionals believe that this could have influence. Regarding satisfaction, pigmentation did not influence parental satisfaction. CONCLUSION Parents were satisfied with and found SDF acceptable, whereas professionals did not.
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Affiliation(s)
- Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciana Pereira da Silva
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniele Masterson Ferreira
- Central Library of the Health Science Center, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernanda Barja-Fidalgo
- Department of Community and Preventive Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Andréa Fonseca-Gonçalves
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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Zander V, Chan D, Sadr A. Microcomputed Tomography Evaluation of Root Dentin Caries Prevention by Topical Fluorides and Potassium Iodide. SENSORS (BASEL, SWITZERLAND) 2019; 19:E874. [PMID: 30791530 PMCID: PMC6412410 DOI: 10.3390/s19040874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/16/2019] [Accepted: 02/16/2019] [Indexed: 11/17/2022]
Abstract
The mineral content of dental hard tissues has traditionally been measured by destructive tests such as transverse microradiography. Microfocus X-ray computed tomography (micro CT) has enabled non-destructive 3D assessment of tooth demineralization. This study compared the preventive effects of silver diammine fluoride (SDF) and potassium iodide (KI) in comparison with fluoride varnish. SDF has been known to arrest caries but darkens the tooth. KI creates a precipitate with SDF that reduces the discoloration, but its effects on SDF efficacy in terms of preventing demineralization of at-risk root dentin surfaces is unknown. Bovine root dentin blocks were randomly distributed into four groups and subjected to a pretreatment in each group (n = 8); Control: deionized water (DIW); F-Varnish: 5% sodium fluoride varnish: 38% Saforide; SDF+KI: SDF followed by saturated solution of KI in DIW. The treated dentin was subjected to 8 cycles of demineralization (pH 5) for 14 h and remineralization in artificial saliva (pH 7) for 10 h. Specimens were then scanned for 12 min using micro CT at 73 KV and 1012 µA with 8.3 μm resolution. The 3D images were analyzed in Amira software to calculate lesion depth (LD), surface layer mineral density (SL) and mineral loss (ΔZ) for each specimen. One-way ANOVA with Bonferroni posthoc showed that there was a statistically significant difference between Control and all three other groups for all parameters (P < 0.001), however, there was no statistical difference among F-Varnish, SDF and SDF+KI (P > 0.05). Single application of F-Varnish, SDF and SDF+KI showed comparable preventive effects against root dentin demineralization. Application of KI did not affect anti-demineralization properties of SDF in this study. Micro CT is a quick and effective method for objective and high-resolution characterization of dentin caries lesions.
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Affiliation(s)
- Vernon Zander
- Department of Restorative Dentistry, University of Washington, Seattle, WA 98195, USA.
| | - Daniel Chan
- Department of Restorative Dentistry, University of Washington, Seattle, WA 98195, USA.
| | - Alireza Sadr
- Department of Restorative Dentistry, University of Washington, Seattle, WA 98195, USA.
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Karched M, Ali D, Ngo H. In vivo antimicrobial activity of silver diammine fluoride on carious lesions in dentin. J Oral Sci 2019; 61:19-24. [PMID: 30726799 DOI: 10.2334/josnusd.17-0366] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Minimally invasive treatment protocols may leave a residual layer of carious dentin, which requires treatment for the inhibition of bacterial growth beneath restorations. We aimed to examine the in vivo effect of silver diammine fluoride (SDF) and SDF + potassium iodide (KI) application on bacteria present in deep carious lesions. We studied the in vivo efficacy in five patients, each of which had five carious lesions. Dentin samples taken before and after treatment were subjected to microbial analyses. Following treatment with SDF, the median colony-forming unit (CFU) counts per mg of dentin reduced from 9 × 105 to 1.6 × 102 (P < 0.05), and following that with SDF + KI, the counts decreased from 2.9 × 105 to 9.2 × 10 (P < 0.05). The use of chlorhexidine gluconate (CHX) reduced CFU counts from 1.1 × 105 to 4.8 × 102 (P < 0.05). In four of the five patients, no CFUs were found on mitis salivarius-bacitracin agar with respect to SDF or SDF + KI application. For CHX, the median CFU count before treatment was 1.6 × 103 and that after treatment was 1.1 × 102. SDF completely inhibited mutans streptococci growth in four of the five patients, while the growth of anaerobes was not completely inhibited.
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Affiliation(s)
- Maribasappa Karched
- Oral Microbiology Research Laboratory, Department of Bioclinical Sciences, Faculty of Dentistry, Kuwait University
| | - Dena Ali
- Department of General Dental Practice, Faculty of Dentistry, Kuwait University
| | - Hien Ngo
- Department of General Dental Practice, Faculty of Dentistry, Kuwait University
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Abstract
This article reviews current evidence on the effectiveness of silver diamine fluoride (SDF) as a caries arresting and preventive agent. It provides clinical recommendations around SDF's appropriate use as part of a comprehensive caries management program. Systematic reviews confirm that SDF is effective for caries arrest on cavitated lesions in primary teeth and root caries in the elderly. It may also prevent new lesions. Application is easy, noninvasive, affordable, and safe. Although it stains the lesions dark as it arrests them, it provides clinicians with an additional tool for caries management when esthetics are not a primary concern.
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Affiliation(s)
- Yasmi O Crystal
- Pediatric Dentistry, New York University College of Dentistry, 345 East 24th Street. 9W, New York, NY 10010, USA.
| | - Richard Niederman
- Department of Epidemiology & Health Promotion, New York University College of Dentistry, 433 1st Avenue, Room 720, New York, NY 10010, USA
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Ngoc CN, Mehta R, Donovan TE, Ferreira Zandona AG. Teaching Silver Diamine Fluoride in U.S. Dental Schools' Predoctoral Curricula. J Dent Educ 2018; 82:1305-1309. [PMID: 30504468 DOI: 10.21815/jde.018.141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/02/2018] [Indexed: 01/28/2023]
Abstract
Silver diamine fluoride (SDF), a low-cost topical agent used in many countries to arrest dental caries, was cleared as a desensitizing agent by the Food & Drug Administration for the U.S. market in 2014. The aim of this study was to survey U.S. dental schools regarding their teaching of SDF. Email invitations were sent to all accredited U.S. predoctoral dental education programs (n=66) in September 2016. Deans, chairs, and selected faculty members were asked to respond or forward the survey-link provided to the appropriate person in their school. Under the assumption that some respondents from the same school were unaware of SDF implementation across departments, multiple responses from the same school were collapsed for analysis. A total of 62 schools (94% response rate) responded to the survey, and 67.7% of them reported that SDF was part of their curricula. There was a wide variation across dental schools' teaching about SDF indications and protocols of application. All but one school consistently agreed on using SDF for arresting caries on primary teeth. Only 18 respondents were able to confirm if there was an existing protocol at their school for the use of SDF. When re-application after initially arresting caries with SDF was taught, 50% of respondents advocated 2×/year re-application. Schools not teaching SDF (n=20) planned on including it in their curricula in the future. These findings suggest that, with the use of SDF increasing rapidly in the U.S. and its adoption in most dental schools, there is a need for the development of standardized evidence-based protocols.
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Affiliation(s)
- Caroline Nguyen Ngoc
- Caroline Nguyen Ngoc, DMD, MS, is Assistant Professor, Department of Restorative Dentistry, Faculté de Médecine Dentaire, Université de Montréal; Ritu Mehta, BDS, is Research Assistant, Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry; Terry E. Donovan, DMD, is Professor, Division of Operative Dentistry and Biomaterials, Department of Restorative Sciences, University of North Carolina at Chapel Hill School of Dentistry; and Andrea G. Ferreira Zandona, DDS, MSD, PhD, is Professor and Chair, Department of Comprehensive Dentistry, Tufts University School of Dental Medicine
| | - Ritu Mehta
- Caroline Nguyen Ngoc, DMD, MS, is Assistant Professor, Department of Restorative Dentistry, Faculté de Médecine Dentaire, Université de Montréal; Ritu Mehta, BDS, is Research Assistant, Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry; Terry E. Donovan, DMD, is Professor, Division of Operative Dentistry and Biomaterials, Department of Restorative Sciences, University of North Carolina at Chapel Hill School of Dentistry; and Andrea G. Ferreira Zandona, DDS, MSD, PhD, is Professor and Chair, Department of Comprehensive Dentistry, Tufts University School of Dental Medicine
| | - Terry E Donovan
- Caroline Nguyen Ngoc, DMD, MS, is Assistant Professor, Department of Restorative Dentistry, Faculté de Médecine Dentaire, Université de Montréal; Ritu Mehta, BDS, is Research Assistant, Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry; Terry E. Donovan, DMD, is Professor, Division of Operative Dentistry and Biomaterials, Department of Restorative Sciences, University of North Carolina at Chapel Hill School of Dentistry; and Andrea G. Ferreira Zandona, DDS, MSD, PhD, is Professor and Chair, Department of Comprehensive Dentistry, Tufts University School of Dental Medicine
| | - Andrea G Ferreira Zandona
- Caroline Nguyen Ngoc, DMD, MS, is Assistant Professor, Department of Restorative Dentistry, Faculté de Médecine Dentaire, Université de Montréal; Ritu Mehta, BDS, is Research Assistant, Department of Operative Dentistry, University of North Carolina at Chapel Hill School of Dentistry; Terry E. Donovan, DMD, is Professor, Division of Operative Dentistry and Biomaterials, Department of Restorative Sciences, University of North Carolina at Chapel Hill School of Dentistry; and Andrea G. Ferreira Zandona, DDS, MSD, PhD, is Professor and Chair, Department of Comprehensive Dentistry, Tufts University School of Dental Medicine.
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48
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Abstract
Medical management of caries is a distinct treatment philosophy that employs topical minimally invasive therapies that treat the disease and is not merely prevention. This strategy is justified as an alternative or supplement to traditional care by significant disease recurrence rates following comprehensive operative treatment under general anesthesia. Silver diamine fluoride (SDF) is one agent to enable effective noninvasive treatment. The announcement of breakthrough therapy designation by the Food and Drug Administration (FDA) suggests that SDF may become the first FDA-approved drug for treating caries. Since our systematic review performed in April 2015, 4 clinical trials have been completed, which inform an update to the application protocol and frequency regimen. Suggestions from these studies are to skip the rinsing step due to demonstration of safety in young children, start patients with high disease severity on an intensive regimen of multiple applications over the first few weeks, and continue with semiannual maintenance doses as previously suggested. Breakthroughs in elucidating the impact of SDF on the dental plaque microbiome inform potential opportunities for understanding caries arrest. SDF can be added to the set of evidence-based noninvasive methods to treat caries lesions in primary teeth, such as the Hall crown technique and sealing lesions with accessible margins.
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Affiliation(s)
- J A Horst
- 1 Department of Biochemistry and Biophysics, University of California, San Francisco, CA, USA
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49
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Burgess JO, Vaghela PM. Silver Diamine Fluoride: A Successful Anticarious Solution with Limits. Adv Dent Res 2018; 29:131-134. [PMID: 29355424 DOI: 10.1177/0022034517740123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Silver diamine fluoride (SDF) is a solution containing ionic silver, fluoride, and ammonia that arrests the progress of carious lesions and prevents the development of future caries. The silver particle extends into the dentin tubules and could create some bonding problems for subsequent composite resin restorations placed over SDF-treated darkened tooth structures. The fluoride penetrates deeper into the tooth with SDF as compared with other fluoride solutions, creating a fluoride reservoir in the tooth structure. The fluoride component of SDF contributes to remineralization and fluorapatite formation, producing harder, more caries-resistant tooth structures. The silver provides the antimicrobial activity for the material and inhibits biofilm formation. It has been evaluated in >20 clinical studies and reviewed in systemic reviews. The material was recently approved by the Food and Drug Administration for desensitizing cold-sensitive teeth and has been used off-label to treat carious lesions. SDF will produce a caries lesion darker (brown to black) than the original, which is the major criticism of the material. A nanoparticle-sized silver material was recently developed that may retain the antimicrobial properties of the larger-sized ion silver material without the discoloring effects. The application of SDF is easily adapted for field use. The lesion is isolated, and the solution is painted onto the clean caries lesion and dried. This simple application process requires little equipment, and its low cost per application makes the material ideal for large populations.
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Affiliation(s)
- J O Burgess
- 1 Division of Biomaterials, Clinical and Community Sciences, School of Dentistry, University of Alabama, Birmingham, AL, USA
| | - P M Vaghela
- 1 Division of Biomaterials, Clinical and Community Sciences, School of Dentistry, University of Alabama, Birmingham, AL, USA
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50
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Urquhart O, Tampi MP, Pilcher L, Slayton RL, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Brignardello-Petersen R, Banfield L, Parikh A, Joshi G, Carrasco-Labra A. Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. J Dent Res 2018; 98:14-26. [PMID: 30290130 PMCID: PMC6304695 DOI: 10.1177/0022034518800014] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The goal of nonrestorative or non- and microinvasive caries treatment (fluoride-
and nonfluoride-based interventions) is to manage the caries disease process at
a lesion level and minimize the loss of sound tooth structure. The purpose of
this systematic review and network meta-analysis was to summarize the available
evidence on nonrestorative treatments for the outcomes of 1) arrest or reversal
of noncavitated and cavitated carious lesions on primary and permanent teeth and
2) adverse events. We included parallel and split-mouth randomized controlled
trials where patients were followed for any length of time. Studies were
identified with MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane
Database of Systematic Reviews. Pairs of reviewers independently conducted the
selection of studies, data extraction, risk-of-bias assessments, and assessment
of the certainty in the evidence with the Grading of Recommendations Assessment,
Development, and Evaluation (GRADE) approach. Data were synthesized with a
random effects model and a frequentist approach. Forty-four trials (48 reports)
were eligible, which included 7,378 participants and assessed the effect of 22
interventions in arresting or reversing noncavitated or cavitated carious
lesions. Four network meta-analyses suggested that sealants + 5% sodium fluoride
(NaF) varnish, resin infiltration + 5% NaF varnish, and 5,000-ppm F (1.1% NaF)
toothpaste or gel were the most effective for arresting or reversing
noncavitated occlusal, approximal, and noncavitated and cavitated root carious
lesions on primary and/or permanent teeth, respectively (low- to
moderate-certainty evidence). Study-level data indicated that 5% NaF varnish was
the most effective for arresting or reversing noncavitated facial/lingual
carious lesions (low certainty) and that 38% silver diamine fluoride solution
applied biannually was the most effective for arresting advanced cavitated
carious lesions on any coronal surface (moderate to high certainty). Preventing
the onset of caries is the ultimate goal of a caries management plan. However,
if the disease is present, there is a variety of effective interventions to
treat carious lesions nonrestoratively.
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Affiliation(s)
- O Urquhart
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - M P Tampi
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - L Pilcher
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA
| | - R L Slayton
- 2 Department of Pediatric Dentistry, School of Dentistry, University of Washington, Seattle, WA, USA
| | - M W B Araujo
- 3 Science Institute, American Dental Association, Chicago, IL, USA
| | - M Fontana
- 4 Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - S Guzmán-Armstrong
- 5 Advance Education Program in Operative Dentistry, University of Iowa, Iowa City, IA, USA
| | - M M Nascimento
- 6 Division of Operative Dentistry, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - B B Nový
- 7 DentaQuest Institute and DentaQuest Oral Health Center, Westborough, MA, USA
| | - N Tinanoff
- 8 Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Maryland, College Park, MD, USA
| | - R J Weyant
- 9 Department of Dental Public Health and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - M S Wolff
- 10 University of Pennsylvania, Philadelphia, PA, USA
| | - D A Young
- 11 Department of Diagnostic Sciences, Arthur A. Dugoni School of Dentistry, University of the Pacific, Stockton, CA, USA
| | - D T Zero
- 12 Department of Cariology, Operative Dentistry and Dental Public Health, Oral Health Research Institute, School of Dentistry Indiana University, Indianapolis, IN, USA
| | - R Brignardello-Petersen
- 13 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - L Banfield
- 14 Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - A Parikh
- 15 College of Dental Medicine, Midwestern University, Downers Grove, IL, USA
| | - G Joshi
- 16 GC America, Alsip, IL, USA
| | - A Carrasco-Labra
- 1 Center for Evidence-Based Dentistry, Science Institute, American Dental Association, Chicago, IL, USA.,17 Evidence-Based Dentistry Unit and Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Santiago, Chile
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