O uso de vernizes fluoretados e a redução da incidência de cárie dentária em pré-escolares: uma revisão sistemática

Clinical interventions with various agents to prevent early childhood caries: A systematic review with network meta-analysis

BACKGROUND

Dental caries is one of the most prevalent chronic diseases among preschool children globally. Different preventive agents and combinations have been studied. However, the rank of the effectiveness of clinical interventions is equivocal.

AIM

To summarize and rank the effectiveness of clinical interventions using different agents for primary prevention of early childhood caries (ECC).

DESIGN

Two reviewers independently searched PubMed, Embase, and Cochrane Library to identify randomized controlled trials with at least 12-month follow-up. The network meta-analysis (NMA) on different agents was based on a random-effects model and frequentist approach. Standardized mean differences (SMD) with 95% CI of the caries increment were calculated in terms of either dmft or dmfs and used in the NMA. Caries incidences at the child level were compared using odds ratios (ORs) with 95% CI. The effectiveness of the agents was ranked using the surface under the cumulative ranking curve (SUCRA).

RESULTS

After screening 3807 publications and selection, the NMA finally included 33 trials. These trials used either a single or combination of agents such as fluorides, chlorhexidine, casein phosphopeptide-amorphous calcium phosphate, probiotics, xylitol, and triclosan. Compared with control, fluoride foam (FF; SMD -0.69, 95% CI: -1.06, -0.32) and fluoride salt (F salt; SMD -0.66, 95% CI: -1.20, -0.13) were effective in preventing caries increment. Probiotic milk plus low fluoride toothpaste (PMLFTP; OR 0.34, 95% CI: 0.15, 0.77), FF (OR 0.48, 95% CI: 0.37, 0.63), fluoride varnish (FV; OR 0.63, 95% CI: 0.48, 0.81), and fluoride varnish plus high fluoride toothpaste (FVHFTP; OR 0.73, 95% CI: 0.57, 0.93) were effectively preventing caries incidence. According to the SUCRA, FF ranked first in preventing caries increment, whereas PMLFTP ranked first in preventing caries incidence.

CONCLUSION

Fluoride foam, F salt, PMLFTP, FV, and FVHFTP all effectively reduce caries increment or caries incidence in preschool children, but the evidence indicates low degree of certainty. Considering the relatively small number of studies, confidence in the findings, and limitations in the study, clinical practitioners and readers should exercise caution when interpreting the NMA results.

Parental Knowledge and Awareness of Fluoride Varnish Application on Their Children - A Cross-Sectional Study

Introduction

Fluoride varnishes are forms of topical fluoride that are applied on the surfaces of teeth to prevent from dental caries. It contains sodium fluoride, which is the active ingredient in the varnish and the concentration is about 22,600 ppm. Fluoride can promote enamel remineralization which protect against dental caries and it can be professionally applied by dentists and physicians for infants and young children.

Methods

In this, cross-sectional study, a close-ended survey containing 14 items was given to 399 randomly assigned parents in Jeddah, Saudi Arabia. The questionnaire included demographic data and items to assess the general knowledge about fluoride and fluoride varnish. The responses were coded and statistical analysis was performed.

Results

About 65.3% of males and 47.4% females were not sure if fluoride application was safe for their children, however, 67.2% of the population revealed that tooth pastes were one among the fluoride sources for their children. Pearson’s correlation test showed high statistical significance between the parents’ educational background and awareness level of fluoride varnish was of with p-value-0.000 and correlation coefficient (r-value-0.427).

Conclusion

The lack of awareness among parents on an important caries-control measure warrants the implementation of special awareness programs on fluorides and its benefits in young children.

Risk factors for and prevention of caries and dental erosion in children and adolescents with asthma

There are many studies and reviews of the relationship between the asthma disease in young individuals on the one hand and caries and dental erosion on the other. The causes of caries and dental erosion might be related to the asthmatic drugs, low pH and the sweeteners that the inhaled drug contains and perhaps even the lifestyle of children and adolescents with asthma. The main focus of this review is therefore to describe various preventive strategies, based on long experience of preventive dental care in Sweden. Two fact boxes are presented, one on fluoride toothpaste as a population-based intervention for different ages and one on diet counselling in children and adolescents with asthma. The most important thing is to introduce fluoride toothpaste early in the child's life and that the parents brush the child's teeth twice a day, in the morning after breakfast and at night before bedtime, up to the age of 10. Moreover, a high-risk approach with an additional fluoride supply at home is presented, together with the application of fluoride varnish at the clinic. Regarding diet counselling, it is important to make sure that the child has regular meals during the day, maximum five to six times a day, to allow the teeth to rest between meals and restrict sweets and soft drinks to once a week. It is important to identify children and adolescents with asthma as early as possible and to refer them to a dental team for preventive treatment.

Long-Term Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention

A guideline called FRAMM, which is an acronym in Swedish for the most important parts of this guideline, namely “fluoride”, “advice”, “arena”, “motivation” and “diet”, was implemented in 2008 in the Västra Götaland Region in Sweden. This guideline included fluoride varnish applications performed at school twice a year at six-monthly intervals for all 12- to 15-year-olds, together with lessons on oral health. The aim of this analysis was to estimate the long-term cost-effectiveness, using prognostic calculations, of the FRAMM Guideline for 12- to 15-year-olds, compared with routine care, until the participants were 23 years old. A cost-effectiveness analysis was performed from a health care perspective, based on four years of verified data and seven years of prognosis. Data from FRAMM were combined with cost data from price lists in Sweden. The cost-effectiveness was analyzed by relating the difference in costs to the difference in the number of approximal surfaces with fillings and/or dentin lesions (DFSa). The analysis shows that FRAMM was considered dominant compared to the controls in all alternative scenarios, hence costs were prognosed to be lowered and outcomes were prognosed to be improved. A dental health program like the FRAMM Guideline with fluoride varnish during the caries risk period from 12 to 15 years is predicted to be cost-effective in the longer perspective. To further study the actual long-term caries increment after a preventive dental health program would be of great interest to verify these results.

Topical fluoride to prevent early childhood caries: Systematic review with network meta-analysis

OBJECTIVES

To summarize the evidence on prevention of early childhood caries (ECC) by professionally or self-applied topical fluorides using network meta-analysis.

DATA

Randomized-controlled trials with minimum 1-year follow-up assessing caries-preventive effect among children younger than six years.

SOURCES

Eight electronic databases and grey literature.

STUDY SELECTION

After screening and data extraction, risk of bias assessment using Cochrane risk of bias tool 2.0 was done. Twenty-four trials were included, among which 17 were assessed as "high risk" and remaining as "low risk". Fifteen studies evaluated professionally-applied, and the other nine used self-applied topical fluorides. Ten studies on professionally-applied fluorides reporting the net caries increment (dmfs increment) at 2-years follow-up were included in Network meta-analysis (NMA). NMA and ranking the interventions were conducted using a frequentist random-effects approach and surface under the cumulative ranking command, followed by assessing the certainty of evidence using an extension of GRADE approach with CINeMA framework. Among the eight included interventions of professionally-applied fluorides, only two, i.e., 3-monthly 0.9% difluorosilane (DFS) and 6-monthly 5% sodium fluoride varnish were effective in preventing ECC compared to control with 3-monthly DFS application ranking higher than 6-monthly sodium fluoride varnish application.

CONCLUSION

Among all the professionally-applied topical fluoride interventions reviewed, very low to moderate evidence was found with 0.9% DFS application at 3-monthly intervals, which was ranked highest in prevention of ECC. Among the included studies on self-applied topical fluorides, the evidence was inconclusive due to heterogeneity among studies.

CLINICAL SIGNIFICANCE

The 0.9% DFS varnish applied every 3 months is most effective for preventing early childhood caries. The review recommends that good quality studies be conducted in future, comparing two or more interventions for both self- as well as professionally-applied topical fluoride agents with adequate follow-up.

Methods for prevention of early childhood caries: Overview of systematic reviews

Early childhood caries (ECC) is a global problem, disproportionately affecting disadvantaged populations. The aim of this study was to evaluate systematically the available scientific evidence on the effectiveness of methods for ECC prevention. Six electronic databases were searched. Two independent reviewers selected the publications and analysed the quality of the included systematic reviews. Thirteen studies were included. Overall, eight reviews were classified with methodological quality critically low using the AMSTAR 2, whereas five reviews achieved a high risk of bias using the ROBIS tool. The methods identified that were positively related to the prevention of ECC were as follows: preventive dental programmes for pregnant women; advice on diet and feeding; prenatal oral health care; integration of maternal and children's oral health promotion into nursing practice; maternal oral health programmes undertaken by non-dental health professionals; dental health education in combination with the use of fluoride for children; early preventive dental visits; and the use of fluoride varnish and toothpastes with more than 1000 ppm of fluoride. The currently available evidence supporting the effectiveness of methods for prevention of ECC, although suggesting some methods of greater potential, is still lacking due to the methodological quality of the systematic reviews and the included primary studies.

Antimicrobial Efficacy of Propolis-Containing Varnish in Children: A Randomized and Double-Blind Clinical Trial

Dental caries is a sugar-dependent condition common in childhood, which causes microbiological imbalance in dental biofilm. The present study evaluated the antimicrobial efficacy of a 2.5% Brazilian Red Propolis (BRP) dental varnish to prevent caries in children. Seventy-five children with high caries risk, aged between 36 and 71 months and with no caries, were assigned to three groups to receive varnish treatment containing 2.5% BRP, 1% chlorhexidine, or 5% fluoride. The varnish was applied to the occlusal surfaces of the deciduous second molars on the first day of treatment (D1), after 90 days (D90), and 180 days of the start of treatment (D180). Saliva was collected to assess S. mutans before each varnish application and 180 days at the end of treatment (D360). Values were expressed in log10 (CFU/mL). Statistics were performed by applying repeated measures of variance analysis, Tukey's multiple comparisons test, and paired t-test. In the first dilution (1 : 10), there was microbial load reduction at the following periods: BRP in D0-D90 (p < 0.05) and D0-D180 (p < 0.01); fluoride in D0-D90 (p < 0.001); and chlorhexidine in D0-D180 (p < 0.05). In the second dilution (1 : 100), there was microbial load reduction in the groups at the following periods: BRP in D0-D90 (p < 0.05) and D0-D180 (p < 0.01); fluoride in D0-D180 (p < 0.05), and chlorhexidine in D0-180 (p < 0.01) and D0-360 (p < 0.05). The 2.5% BRP dental varnish was effective in decreasing S. mutans colonies in saliva when used within 90 days.

Clinical Effect of Two Fluoride Varnishes in Caries-Active Preschool Children: A Randomized Controlled Trial

The prevention of dental caries in preschool children is a priority for dental services. The aim of the study was to investigate the caries-preventive effect of 2 fluoride varnishes in caries-active preschool children, and then compare the outcome with a non-varnish control group. After screening, 180 preschool children aged 36-71 months, with at least 1 noncavitated lesion, were enrolled and randomly allocated into 3 parallel groups, namely A: 1.5% ammonium fluoride varnish (Fluor Protector S), B: 5% NaF varnish (Duraphat), and C: professional tooth-cleaning. All children were recalled every third month for intervention and their parents were instructed to have them brush their teeth with a 1,000-ppm fluoride toothpaste twice daily. Caries were recorded at baseline and after 12 months by a calibrated examiner and the incidence was scored on noncavitated (d2) and cavitated (d3) level. We tested differences between the groups with the χ2 and two-sided t tests. One hundred and seventy-two children (95.6%) completed the trial and 56 (32.6%) and 35 (19.2%) developed new d2 and d3 lesions, respectively. Both varnishes reduced the incidence of caries compared with the control group, but there was no significant difference between group A and group B. Compared with group C, the relative risk for developing cavitated lesions was 0.39 (95% CI 0.22-0.62) in group A and 0.26 (95% CI 0.14-0.50) in group B. The total prevented fraction (Δd2d3mft) for group A and group B was 19.9 and 22.5% (p < 0.05), respectively. No adverse effects were observed or reported during the study period. In conclusion, the 2 fluoride varnishes demonstrated an equal capacity to reduce the incidence of caries in caries-active preschool children over a 12-month period in comparison with a control group.

Fluoride Varnish Application in Preschoolers Have a Modest Effectiveness in Reducing the Incidence of Dentinal Caries

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis. de Sousa FSO, Dos Santos APP, Nadanovsky P, Hujoel P, Cunha-Cruz J, de Oliveira BH. Caries Res. 2019;53(5):502-513.

SOURCE OF FUNDING

Government.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis of data.

Efficacy of S-PRG filler containing varnishes on enamel demineralization prevention

This study evaluated the efficacy of S-PRG vanishes on preventing enamel demineralization. Bovine enamel specimens were obtained, polished and the baseline Knoop microhardness was evaluated. Specimens were stratified into six groups (n = 15), according to the varnish applied: S10—experimental varnish containing 10% of S-PRG fillers, S20—20% of S-PRG fillers, S30—30% of S-PRG fillers; S40—40% of S-PRG fillers; PC (positive control)—5% of NaF; NC (negative control)—no treatment was performed. Half of enamel surfaces were protected to work as a control and varnishes were applied over the unprotected area. A demineralizing pH-cycling was performed, and surface and cross-sectional microhardness were measured. The percentage of microhardness of the treated area was calculated comparing with the untreated area. Statistical analysis was performed by one-way ANOVA and Tukey’s test (p = 5%). All experimental S-PRG varnishes protected against demineralization in relation to no treatment, but S40 was the most effective on the surface. For all depths, S30 and S40 were superior in enamel demineralization prevention than other S-PRG filler concentrations and 5% NaF. It was concluded that S-RPG filler containing varnishes were effective to prevent enamel demineralization. The higher concentrated products were more effective than 5% sodium fluoride on surface demineralization prevention.

Effects of the professional oral care management program on patients with head and neck cancer after radiotherapy: A 12-month follow-up

Background/purpose

Because oral health of patients with head & neck cancer is prone to disease after radiotherapy, effective and long-lasting oral care program is necessary. We aimed to evaluate the effects of the oral care management program, which lasted up to 12 months after radiotherapy for patients with head and neck cancer.

Materials and methods

Sixty-eight patients who visited a dental clinic prior to the initiation of radiotherapy were recruited and categorized into either a “healthy” or a “vulnerable” group. The vulnerable group was made of patients with dental caries or periodontal attachment loss. Professional oral hygiene care, including tooth brushing instructions, professional mechanical tooth cleaning, and fluoride varnish application, was conducted once every week for a month during radiotherapy and once every 3 months after radiotherapy. Oral health, including dental caries, plaques, gingival index, and periodontal attachment loss, was examined at baseline, 6 months, and 12 months after radiotherapy.

Results

; Twenty-nine and 16 patients were followed up at 6 and 12 months after radiotherapy, respectively. Oral health indices, such as the number of decayed teeth, amount of plaque, and gingival index, did not significantly change in either group. However, the periodontal pocket depth significantly decreased in both groups at 6 months after baseline, and this decrease continued in the vulnerable group up to 12 months after baseline.

Conclusion

Periodic dental visits and professional oral hygiene care during and after radiotherapy were effective in maintaining oral health for over 12 months after radiotherapy in patients with head and neck cancer.

Dose-response Evaluation of Propolis Dental Varnish in Children: A Randomized Control Study

BACKGROUND

Early childhood caries is a sugar-dependent disease with multifactorial modulating factors affecting deciduous dentition. It is defined as the presence of at least one decayed tooth, absence of a tooth due to caries or the existence of a temporary restoration in a tooth in a child between zero and 71 months of age. No BRP varnish was found in intellectual property banks, therefore it was registered and deposited with patent number BR1020160190142.

OBJECTIVE

The objective of this study was to evaluate the dose-response concentration of alcoholic extract of Brazilian red propolis (BRP), in the form of dental varnish, against Streptococcus mutans (S. mutans) in children.

METHODS

Twenty-four children, aged between 36 and 71 months, of both genders and without caries, were selected to participate in this pilot study and grouped randomly into four groups to receive different concentrations of BRP varnish (1%, 2.5%, 5% and 10%). The varnish was applied to the surface of all second deciduous molars. The antimicrobial activity was observed in saliva, which was collected in two phases: before applying the BRP varnish and after use.

RESULTS

There was microbiological reduction of S. mutans in the oral cavity of the children in all the tested concentrations. The highest percentage reduction of S. mutans was observed at the concentration of 2.5% (P = 0.0443).

CONCLUSION

The BRP extract in the form of dental varnish has antimicrobial activity against S. mutans and constitutes a possible alternative in the prevention of dental caries.

Effect of Chlorhexidine and Fluoride Varnishes on Streptococcus mutans Count and Dental Plaque Index

AbstractThe control of dental plaque by chemical means can be a valuable auxiliary resource for individuals who have difficulties in performing dental plaque control through regular oral hygiene procedures. The aim of this study was to evaluate the effect of chlorhexidine and fluorine varnishes on the levels of Streptococcus mutans (S. mutans) present in the dental biofilm and on the dental plaque index. The study was carried out in a sample comprised thirty-nine schoolchildren between 13 and 15 years of age, distributed into 2 groups. Group I received a single layer of varnish with chlorhexidine and thymol on the maxillary right first molar. Group II received the application of varnish with fluoride following the same methodology. S. mutans count and dental plaque index recording were performed 7 days before the application and 7, 15 and 30 days after the treatment. It was observed that chlorhexidine and fluoride varnishes significantly reduced the number of S. mutans in dental plaque for 30 days (p<0.05). There was no difference between the varnishes. With regard to the dental plaque index, there was no alteration in any of the experimental time periods for both groups. It was concluded that varnishes, mainly those that contain fluoride, can be an interesting alternative for the prevention of dental caries in collective oral health programs. Keywords: Chlorhexidine. Fluorides. Dental Plaque. ResumoO controle da placa dental por meios químicos pode ser um valioso recurso auxiliar para indivíduos que apresentam dificuldades em realizar o controle da placa dental por meio de procedimentos regulares de higiene bucal. O objetivo neste estudo foi avaliar o efeito dos vernizes de clorexidina e de flúor sobre os níveis de Streptococcus mutans (S. mutans) presentes no biofilme dental e sobre o índice de placa dental. O estudo foi realizado em uma amostra composta por 39 escolares, entre 13 e 15 anos de idade, distribuídos em 2 grupos. O grupo I recebeu uma única aplicação de verniz com clorexidina e timol no primeiro molar superior direito. O grupo II recebeu a aplicação de verniz com flúor seguindo a mesma metodologia. A contagem de S. mutans e o índice de placa dental foram registrados 7 dias antes da aplicação e 7, 15 e 30 dias após o tratamento. Observou-se que os vernizes de clorexidina e flúor reduziram significativamente o número de S. mutans na placa dental por 30 dias (p <0,05). Não houve diferença entre os vernizes. Com relação ao índice de placa dental, não houve alteração em nenhum dos períodos experimentais para ambos os grupos. Concluiu-se que os vernizes, principalmente aqueles que contêm flúor, podem ser uma alternativa interessante para a prevenção da cárie dentária em programas coletivos de saúde bucal. Palavras-chave: Clorexidina. Fluoretos. Placa Dentária.

Fluoride varnish containing chitosan demonstrated sustained fluoride release

Fluoride varnish is a professionally applied product that prevents dental caries. However, fluoride varnishes do not provide sustained fluoride release. The objective of this study was to prepare fluoride varnish formulations containing various amounts of chitosan that would generate sustained fluoride release. We evaluated their chemical structure, viscosity, and in vitro fluoride release. Furthermore, the 3-(4, 5-dimethylthiazolyl-2)-2,5diphenyltetrazolium bromide (MTT) assay and direct contact test were used to determine varnish cytotoxicity. We found that all fluoride varnish formulations had the same chemical structure. Their viscosity demonstrated a chitosan concentration-dependent increase. In vitro fluoride release showed a sustained fluoride release. The chitosan fluoride varnishes were cytotoxic to human gingival fibroblasts. We propose the new fluoride varnish formulation as a potential material to be used as a sustained release fluoride varnish.

Effects of treatment with three types of varnish remineralizing agents on the microhardness of demineralized enamel surface

Background

Remineralization of incipient caries is one of the goals in dental health care ,especially in pediatric dentistry. The present study aimed at comparing the effects of MI varnish (3M (United states)) , Nano paste( FGM(Brezil) ), 5% sodium fluoride varnish) DuraphatColgate (united states) ) on remineralization of enamel lesions.

Material and Methods

In this in-vitrostudy, 60 intact human pre-molars, were randomly allocated to four groups of 15. Baseline surface microhardness in three points in the center of the polished area was measured. After two days of immersion in demineralizing solution, microhardness of all samples was measured. Afterward, groups 1-3 under-went treatment with MI varnish, nano paste, 5% sodium fluoride varnish and then again microhardness was measured. The results were analyzed by one-way analysis of variance (ANOVA), repeated measures ANOVA, and Bonfreni table was used.

Results

Duraphat varnish in comparison with control group, significantly increased surface microhardness and in comparison with Nano and MI paste varnish groups significant differences was shown between groups. (P< 0.05). MI paste varnish and Nano paste similary showed more increases in surface microhardness in comparison with Duraphat varnish and control groups (P≈1).

Conclusions

According to the results of this study, all three varnishes, Duraphat , MI paste and Nano paste increase the enamel surface microhardness and remineralization of incipient caries. MI paste and Nano paste compared to Duraphat Varnish, significantly showed more increases in enamel surface microhardness but Nano paste and MI paste were almost the same. Key words:CPP-ACP, Nano varnish, fluoride varnish, microhardness, demineralization, remineralization.

Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis

The aim of this study was to assess the effectiveness of fluoride varnish (FV) in reducing dentine caries at the patient, tooth, and surface levels as well as caries-related hospitalizations in preschoolers. We performed a systematic review of clinical trials of FV, alone or associated with an oral health program, compared with placebo, usual care, or no intervention. Bibliographical search included electronic searches of seven databases, registers of ongoing trials, and meeting abstracts, as well as hand searching. We performed random-effects meta-analyses and calculated confidence and prediction intervals. The search yielded 2,441 records; 20 trials were included in the review and 17 in at least one meta-analysis. Only one study had low risk of bias in all domains. We found no study reporting on caries-related hospitalizations. At the individual level, the pooled relative risk was 0.88 (95% confidence interval [CI] 0.81, 0.95); this means that in a population of preschool children with 50% caries incidence, we need to apply fluoride varnish in 17 children to avoid new caries in one child. At the tooth level, the pooled weighted mean difference was –0.30 (95% CI –0.69, 0.09) and at the surface level –0.77 (95% CI –1.23, –0.31). Considering the prediction intervals, none of the pooled estimates were statistically significant. We conclude that FV showed a modest and uncertain anticaries effect in preschoolers. Cost-effectiveness analyses are needed to assess whether FV should be adopted or abandoned by dental services.

An In Vitro Investigation of Anticaries Efficacy of Fluoride Varnishes

Most currently marketed fluoride varnishes (FVs) have not been evaluated for their effectiveness in preventing dental caries. The objective of this study was to investigate the anticaries efficacy, measured as fluoride release into artificial saliva (AS); change in surface microhardness of early enamel caries lesions; and enamel fluoride uptake (EFU) of 14 commercially available FVs and two control groups. Bovine enamel specimens (5×5 mm) were prepared and assigned to 18 groups (n=12). Early caries lesions were created in the specimens and characterized using Vickers microhardness (VHN_lesion). FV was applied to each group of specimens. Immediately afterward, specimens were incubated in 4 mL of AS for 18 hours, which were collected and renewed every hour for the first six hours. AS samples were analyzed for fluoride using an ion-specific electrode. Specimens were then brushed for 20 seconds with toothpaste slurry and subjected to pH cycling consisting of a four-hour/day acid challenge and one-minute treatments with 1100 ppm F dentifrice for five days. Microhardness was measured following pH cycling (VHN_post). EFU was determined using microbiopsy. Acid resistance (eight-hour demin challenge) was performed after pH cycling, and microhardness was measured (VHN_art) and compared with baseline values to test the FV impact after pH cycling. One-way analysis of variance was used for data analysis (α=0.05). FVs differed in their release characteristics (mean ± SD ranged from 14.97 ± 2.38 μg/mL to 0.50 ± 0.15 μg/mL), rehardening capability (mean ± SD ranged from 24.3 ± 15.1 to 11.7 ± 12.7), and ability to deliver fluoride to demineralized lesions (mean ± SD ranged from 3303 ± 789 μg/cm³ to 707 ± 238 μg/cm³). Statistically significant but weak linear associations were found between ΔVHN_{(post - lesion)}, EFU, and fluoride release (correlations 0.21-0.36). The results of this study demonstrated that differences in FV composition can affect their efficacy in in vitro conditions.

Parental perception of fluoridated tap water

PURPOSE

The purpose of this study was to investigate parental knowledge and preference of tap water in a country where faucet water is fluoridated according to international standards and where the average percentage of dental caries in young children reaches up to approximately 73%.

MATERIALS AND METHODS

A cross-sectional perspective study was conducted at Hamad Medical Corporation, the only tertiary care and academic hospital in the state of Qatar. Parents of children older than 1 year of age were offered an interview survey.

RESULTS

A total of 200 questionnaires were completed (response rate = 100%). The mean age of participant children was 6 ± 4 years. One of the main finding in our study was that primary care physicians never discussed the topic of the best water choice for children in our community, as expressed by more than 86% of parents. More than two-third of parents used bottled water. The main concerns of why parents did not allow their children to drink tap water were taste (8.94%), smell (9.76%), concerns of toxins content (32.52%), and concerns that tap water might cause unspecified sickness (52.03%). Amid revealing participants that our tap water is safe and that fluorine can prevent dental caries, 33% of parents would you use tap water due to its fluoride content. The study also showed that 65% of parents would allow their children to drink tap water if it is free from any toxic ingredients.

CONCLUSION

Actions to augment fluoridated water acceptability in the developing world, such as focusing on safety and benefits, could be important in the disseminated implementation of the use of faucet water. Ultimately, a slump in the prevalence of dental caries among children will depend on the ability of pediatricians and dental professionals to institute evidence-based and preventive approach that can benefit oral health in childhood. These data will also allow us to propose the use of tap water safely in young children in the state of Qatar while simultaneously advocating awareness of oral health.

Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12- to 15-Year-Olds in Sweden

Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Västra Götaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the “low” subgroup, those with 1–3 into the “moderate” subgroup and those with ≥4 into the “high” subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12.

Managing Early Childhood Caries with Atraumatic Restorative Treatment and Topical Silver and Fluoride Agents

Early childhood caries (ECC) is a significant global health problem affecting millions of preschool children worldwide. In general, preschool children from families with 20% of the lowest family incomes suffered about 80% of the ECC. Most, if not all, surveys indicated that the great majority of ECC was left untreated. Untreated caries progresses into the dental pulp, causing pain and infection. It can spread systemically, affecting a child's growth, development and general health. Fundamental caries management is based on the conventional restorative approach. Because preschool children are too young to cope with lengthy dental treatment, they often receive dental treatment under general anaesthesia from a specialist dentist. However, treatment under general anaesthesia poses a life-threatening risk to young children. Moreover, there are few dentists in rural areas, where ECC is prevalent. Hence, conventional dental care is unaffordable, inaccessible or unavailable in many communities. However, studies showed that the atraumatic restorative treatment had a very good success rate in treating dentine caries in young children. Silver diamine fluoride is considered safe and effective in arresting dentine caries in primary teeth. The aim of this paper is to review and discuss updated evidence of these alternative approaches in order to manage cavitated ECC.

Effectiveness of fluoride varnish in preventing early childhood caries in rural areas without access to fluoridated drinking water: A randomized control trial

OBJECTIVES

Early childhood caries (ECC) constitutes a serious public health issue, especially in communities without water fluoridation. We assessed the effectiveness of biannual fluoride varnish applications to prevent ECC in children from nonfluoridated rural areas.

METHODS

A triple-blind randomized control trial with two parallel arms was conducted with 275 two- to three-year-old children without cavitated carious lesions from 28 rural public preschools in Chile. The preschools were located in areas of low socioeconomic status without access to fluoridated water. An oral health education component was administered to children, parents and educators. A new toothbrush and toothpaste for each child was delivered to the parents at baseline and at four follow-up visits. The participants were randomly allocated to receive fluoride varnish or placebo applications every six months. Trained, calibrated dentists blind to the treatment arm performed visual dental assessments at 6, 12, 18 and 24 months. The primary endpoint was the development of cavitated carious lesions in children during the 24-month follow-up period using WHO criteria, and the secondary outcomes were an increase in caries measured as a change in the index of decayed, missing or filled teeth (dmft) since the beginning of the study and the development of adverse effects. An intention-to-treat (ITT) approach was used for the primary analysis.

RESULTS

We included 131 participants in the intervention group and 144 participants in the placebo group; of these children, 89 (67.9%) in the intervention group and 100 (69.4%) in the control group completed the protocol. The comparative ITT analysis of caries incidence after 24 months of follow-up showed a between-group prevention fraction of 18.9% (-2.9%-36.2%). Caries incidence was 45.0% for the experiment group and 55.6% for the control group (P = .081), with a mean dmft of 1.6 (SD = 2.4) and 2.1 (SD = 2.5), respectively. No adverse effects were reported.

CONCLUSIONS

In conclusion, biannual fluoride varnish application is not effective in preschool children from rural nonfluoridated communities at a high risk of caries.

Role of fluoride varnish in preventing early childhood caries: A systematic review

Background:

Early childhood caries is a public health problem that continues to affect babies and preschool children worldwide. This untreated caries process results in progressive destruction of the crowns of the teeth, often accompanied by severe pain and suffering, affecting the quality of life. Fluoride varnish which is one of the most important materials to prevent ECC is easy to apply and well tolerated by children. This study aimed to evaluate the scientific evidence regardingthe role of fluoride varnish in preventing early childhood caries.

Materials and Methods:

Records were searched from various databases such as PubMed/Medline, Cochrane, and EMBASE. Articles published over the past 36 years (1979-2015) were identified using the key search terms. A total of 190 records were identified by title/abstracts/full text articles and were retrieved. Potentially relevant reports identified from the reference lists of relevant studies, review articles and chapters were hand-searched, which yielded an additional 10 articles. The main outcome of our investigation was prevention of early childhood caries following application of fluoride varnish and unavoidable fluoride exposure. Out of 190 articles originally identified, 30 records were considered potentially eligible and sought for further assessment. 17 articles met the inclusion criteria and these studies were assessed independently for methodology and performance.

Results:

Analysis of literature revealed that basically two concentrations of fluoride varnishes have been used: 1% and 5%, with a caries preventive fraction ranges of 6.4-30% and 5-63%, respectively.

Conclusion:

The results showed that fluoride varnishes have been used at concentrations of 1% and 5% in the prevention of ECC. The preventive fraction was influenced by the frequency of application, the duration of study and sample size. The evidence level of the studies was of moderate to limited value.

A randomized, double-blind, placebo-controlled clinical trial of fluoride varnish in preventing dental caries of Sjögren's syndrome patients

BACKGROUND

Sjögren's syndrome (SS) patients are prone to caries development due to reduction of salivary flow. Topical fluoride is commonly prescribed for caries prevention.

METHODS

In this 24-month randomized, double-blind, placebo-controlled clinical trial, SS patients were randomly assigned to receive either fluoride varnish or placebo gel quarterly. Development and arrest of caries at the coronal and root surfaces were recorded at 12-month and 24-month and compared to that of the baseline. Effect of fluoride varnish on oral Candida and lactobacilli colonization was explored by comparing baseline oral microbiological assessments to data obtained at 12-month and 24-month.

RESULTS

Seventy-eight SS patients (mean age = 50 years, 2 men) completed this trial. At 24-month, the mean new coronal enamel caries were 1.6 surfaces in both groups, and new dentin caries were 1.4 and 2.7 surfaces in the fluoride and placebo group respectively (p > 0.05). Mean arrested caries were 0.6 and 0.7 surfaces for fluoride and placebo groups respectively and that of root caries were 0.3 and 0.1 surfaces (p > 0.05). The mean oral Candida count was reduced by 30 % in the fluoride group but increased 61 % in the placebo group while no change in oral lactobacilli counts in both groups at 24 months (p > 0.05). SS patients receiving fluoride varnish were significantly less likely to develop dentin caries (p < 0.05). In contrast, those with high baseline DMFS scores (p = 0.05), harbored mixed Candida species (p < 0.05), or unstimulated whole saliva at low pH (p < 0.01) were significantly more likely to develop dentin caries.

CONCLUSIONS

Results of this randomized clinical trial did not provide clear evidence to support or refute that quarterly applications of fluoride varnish can prevent development of dental caries in people with Sjögren's syndrome.

TRIAL REGISTRATION

This study was retrospectively registered at the ISRCTN registry ( ISRCTN85164658 ) on 9 Sept 2016 and was funded by the Research Grant Council of Hong Kong.

Comparison of Oral Health Education and Fluoride Varnish to Prevent Early Childhood Caries: A Randomized Clinical Trial

Early childhood caries, a serious health problem among young children, can be prevented with effective intervention. The aim of this study was to evaluate the efficacy of oral health education and a fluoride varnish in the prevention of caries in children under the age of 3 years. For this single-blind randomized parallel group 1-year clinical trial in Shiraz, 300 children aged 12-24 months with sound primary teeth were selected and randomly divided into three groups (n = 100): (1) control: no preventive intervention; (2) oral health counseling, and (3) oral health counseling and fluoride varnish at baseline and 6 months later. At baseline and 4, 8 and 12 months after the intervention, caries risk reduction was recorded as the primary outcome. The mothers' knowledge and performance regarding oral health in children was used as a secondary outcome. A total of 260 children (mean age: 20.49 ± 7.33 months) completed the study. Compared to group 1, caries risk reduction in group 2 was 28% (95% CI: -39.05 to -17.45) and 31% in group 3 (95% CI: -41.88 to -21.73). However, there was no significant difference between groups 2 and 3 (95% CI: -8.58 to 1.47). In all groups, mothers' knowledge and performance at baseline were low; however, they increased significantly in follow-up appointments in groups 2 and 3 (p < 0.001). Oral health education increased mothers' knowledge and performance regarding oral health in children. Oral health counseling alone or associated with the use of fluoride varnish reduced the caries incidence in young children.

Parental preference for fluoride varnish: a new concept in a rapidly developing nation

OBJECTIVE

The objective of this study was to investigate parental preference for fluoride varnish in a country where the average percentage of dental caries in young children is up to ~73%. Consequently, the aim of this study, despite being a pilot, was to create a nationwide project in the State of Qatar to promote oral health in children.

METHODS

A cross-sectional perspective study was conducted at Hamad Medical Corporation in Qatar. Parents of children aged ≤5 years were offered an interview survey. A total of 200 questionnaires were completed (response rate =100%). The study was conducted between December 1, 2014 and March 30, 2015, and included all children aged >1 year and <5 years who came to the outpatient clinics for well-child and sick visits. We also included children who were admitted to the inpatient wards.

RESULTS

The mean age of participant children was 2.8±1.1 years. When inquiring regarding parents' knowledge and awareness of dental health, we found that >90% of families were aware that dental health affects the health of the whole body. The study showed that ~70% of parents were not aware of the existence of fluoride varnish, but would allow a health provider to apply fluoride varnish. Furthermore, ~80% of parents would not stop brushing their child's teeth and would not skip dentist appointments if varnish was to be applied. Approximately 40% of parents conveyed some concerns regarding the safety of fluoride varnish, despite being considered as a new concept. The main concern was that the child might swallow some of the fluoride. Another important concern expressed by parents was the availability of the fluoride varnish in all clinics.

CONCLUSION

The robust positive attitude of parents in this sample suggests that introducing fluoride varnish is feasible and acceptable in our community. Actions to augment fluoride varnish acceptability in the developing world, such as focusing on safety, could be important in the disseminated implementation of fluoride varnish.

Effects of Physician-Based Preventive Oral Health Services on Dental Caries

BACKGROUND

Most Medicaid programs reimburse nondental providers for preventive dental services. We estimate the impact of comprehensive preventive oral health services (POHS) on dental caries among kindergarten students, hypothesizing improved oral health among students with medical visits with POHS.

METHODS

We conducted a retrospective study in 29,173 kindergarten students by linking Medicaid claims (1999-2006) with public health surveillance data (2005-2006). Zero-inflated regression models estimated the association between number of visits with POHS and (1) decayed, missing, and filled primary teeth (dmft) and (2) untreated decayed teeth while adjusting for confounding.

RESULTS

Kindergarten students with ≥4 POHS visits averaged an adjusted 1.82 dmft (95% confidence interval: 1.55 to 2.09), which was significantly less than students with 0 visits (2.21 dmft; 95% confidence interval: 2.16 to 2.25). The mean number of untreated decayed teeth was not reduced for students with ≥4 POHS visits compared with those with 0 visits.

CONCLUSIONS

POHS provided by nondental providers in medical settings were associated with a reduction in caries experience in young children but were not associated with improvement in subsequent use of treatment services in dental settings. Efforts to promote oral health in medical settings should continue. Strategies to promote physician-dentist collaborations are needed to improve continuity of care for children receiving dental services in medical settings.

A systematic map of systematic reviews in pediatric dentistry--what do we really know?

OBJECTIVES

To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry.

METHODS

A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps.

RESULTS

Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low.

CONCLUSION

There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.

Efficacy of fluoride varnish and casein phosphopeptide-amorphous calcium phosphate for remineralization of primary teeth: a randomized clinical trial

OBJECTIVE

We aimed to evaluate the efficacy of oral hygiene instruction, fluoride varnish and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) for remineralizing white spot lesions (WSL), and the effect of these on the dmft index in primary teeth.

SUBJECTS AND METHODS

In this 1-year, randomized clinical trial, 140 children aged 12-36 months with WSL in the anterior maxillary teeth were selected and randomly divided into 4 groups of 35 children each. Group 1 (control) received no preventive intervention. In group 2, there was oral hygiene and dietary counseling. In group 3, there was oral hygiene and the application of fluoride varnish at 4, 8 and 12 months after baseline. In group 4, there was oral hygiene and tooth mousse was applied by the parents twice a day over a 12-month period. At baseline and 4, 8 and 12 months after the intervention, the size of WSL in millimeters and the dmft index were recorded. One hundred and twenty-two children completed the study. Data were analyzed using the repeated-measures ANOVA test.

RESULTS

In group 1, the mean percent WSL area and dmft index values had increased significantly at 12 months after baseline (p < 0.001). The interventions led to significant decreases in the size of the WSL; the greatest reduction was in group 4 (63%) followed by group 3 (51%) and group 2 (10%) after 12 months. The smallest increase in the dmft index was in group 4 (0.17), followed by groups 3 (0.3) and 2 (0.42). However, there were no significant differences between the groups (p < 0.001).

CONCLUSIONS

Oral hygiene along with four fluoride varnish applications or constant CPP-ACP during the 12- month period reduced the size of WSL in the anterior primary teeth and caused a small increase in dmft index values.

Evaluation of fluoride release from experimental TiF4 and NaF varnishes in vitro

Fluoride varnishes play an important role in the prevention of dental caries, promoting the inhibition of demineralization and the increase of remineralization.

An oral health program for children

Caries, the most infectious chronic disease of childhood in America, leads to health, learning, and quality-of-life issues. Using the Missouri Preventive Service Program model, a pilot oral health program for children from ages birth to 5 years in a rural health clinic was the first to implement the application of fluoride varnish.

Biannual fluoride varnish applications and caries incidence in preschoolers: a 24-month follow-up randomized placebo-controlled clinical trial

Sound evidence on the effectiveness of fluoride varnishes (FV) to reduce caries incidence in preschool children is lacking.

OBJECTIVE

To assess whether the application of FV in preschool children at 6-month intervals decreases the incidence of caries and produces any adverse effects.

METHODS

A randomized, examiner- and patient-blind, placebo-controlled, parallel-group design, clinical trial, comprising 1- to 4-year-old children, 100 in each group (FV or placebo varnish, PV), was conducted in Rio de Janeiro, Brazil. Two trained pediatric dentists performed the clinical examinations (kappa = 0.85). Dental caries was recorded at the d2 (cavitated enamel) and d3 (dentine) levels using the International Caries Diagnosis and Assessment System.

RESULTS

At baseline, the mean age of the participants was 2.4 years (SD 0.9) and the mean d3mfs was 0.8 (SD 1.9). Most of the children brushed their teeth with fluoride toothpaste and consumed fluoridated tap water. After 24 months, 89 and 92 children of the test and the control groups were analyzed, respectively. A total of 32 (35.9%) children in the FV group and 43 (46.7%) in the PV group presented new dentine caries lesions (χ(2) test; p = 0.14), showing relative and absolute risk reductions of 23% (95% CI: -9.5 to 45.9) and 11% (95% CI: -3.5 to 25.0). The mean caries increment differences between the test and control groups were -0.8 (95% CI: -2.0 to 0.4) at the d2 level and -0.7 (95% CI: -1.9 to 0.4) at the d3 level. Only 2 minor complaints regarding the intervention were reported.

CONCLUSION

Although safe and well accepted, twice-yearly professional FV application, during 2 years, did not result in a significant decrease in caries incidence.

Prevalence of caries among preschool-aged children in a central Anatolian population

Objective:

Early childhood caries (ECC) is a particularly destructive form of tooth decay that afflicts young children. The etiology and associated factors of ECC should be studied adequately to overcome this health hazard. The aim of this study was to determine caries prevalence and its consequences in toddlers in an Anatolian city, Kırıkkale.

Materials and Methods:

Examinations were performed in family medicine centers by three calibrated dentists during a period of 6 months. The status of dental caries was recorded according to the World Health Organization (WHO) criteria. We recorded the clinical indexes of decayed, missed, and filled teeth (DMFT and dmft; upper-case letters refer to permanent and lower-case letters to primary teeth), and decayed, missed, and filled surfaces (DMFS).

Results:

Totally 3171 toddlers were included (52% males and 48% females). The mean age was 25.8 ± 10.1 months. The prevalence of ECC in preschool children was 17.3%, while the mean df(t) was 0.63 ± 1.79. ECC increased significantly with age. Dental caries were mostly observed in primary maxillary central teeth. Occlusal and buccal surfaces were the most affected sites. The difference in distribution of caries between maxilla and mandibula was found to be statistically significant (P < 0.05).

Conclusions:

When compared to other data obtained from various epidemiologic studies, the toddlers living in Kırıkkale city center had a significant caries level. This observation had clearly suggested that early preventive measures should urgently be put into effect all over the city.

Substantial reduction in caries from regular fluoride varnish application

DATA SOURCES

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, LILACS and BBO, ProQuest Dissertations and Theses, Web of Science Conference Proceedings and ClinicalTrials.gov databases were searched. Reference lists of identified articles were also scanned for relevant papers. Study authors were contacted for additional information.

STUDY SELECTION

Randomised or quasi-randomised controlled trials using or indicating blind outcome assessment that compared fluoride varnish to placebo or no treatment for at least one year were included. Risk of bias assessment was undertaken.

DATA EXTRACTION AND SYNTHESIS

Study assessment and data extraction was carried out independently by at least two reviewers. The primary measure of effect was the prevented fraction, that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. The caries increments nearest to three years were used from each included study. Random-effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random-effects meta-regression analyses. Adverse effects information was collected from the included trials.

RESULTS

Twenty-two trials (12,455 participants) were included. Thirteen trials were included in the permanent tooth surfaces meta-analysis, the pooled D(M)FS prevented fraction estimate comparing fluoride varnish with placebo or no treatment was 43% (95% confidence interval (CI) 30% to 57%; P < 0.0001). There was substantial heterogeneity, confirmed statistically (P < 0.0001; I(2) = 75%), however this body of evidence was assessed as of moderate quality. Ten trials contributed to the meta-analysis of primary teeth, the pooled d(e/m)fs prevented fraction estimate was 37% (95% CI 24% to 51%; P < 0.0001), there was some heterogeneity (P = 0.009; I(2) = 59%) this evidence was assessed as of moderate quality. No significant associations in either dentitions were found with baseline caries severity, background exposure to fluorides, application features such as prior prophylaxis, concentration of fluoride or frequency of application. There was little information concerning possible adverse effects or acceptability of treatment.

CONCLUSIONS

The conclusions of this updated review remain the same as when it was first published. The review suggests a substantial caries inhibiting effect of fluoride varnish in both permanent and primary teeth; however the quality of the evidence was assessed as moderate, as it included mainly high risk of bias studies, with considerable heterogeneity.

Differences in loosely bound fluoride formation and anticaries effect of resin-based fluoride varnishes

OBJECTIVE.  Our in vitro study evaluated calcium fluoride formation in enamel and the anticaries effect of seven resin-based varnishes under cariogenic challenge. METHODS.  Enamel blocks were subjected to pH cycling. The experimental groups received fluoride varnish application, the positive control received topical fluoride gel treatment, and the negative control did not receive any treatment. The pH cycling surface hardness (SH1 ) and integrated loss of subsurface hardness (ΔKHN) were then determined. We measured the amount of fluoride released into the demineralizing and remineralizing (DE-RE) solutions used in pH cycling. The fluoride concentration in the enamel was determined 24 h after application of the products as loosely bound fluoride and firmly bound fluoride. RESULTS.  Higher deposits of loosely bound fluoride were observed for Duofluorid, followed by Biophat. For Duraphat, Bifluorid, Duraflur, and Duofluorid, no difference was observed in the SH1 and ΔKHN values, with the lowest mineral loss compared to the other groups. The Bifluorid and Duofluorid groups released high fluoride amounts into the DE-RE, and statistically significant difference was noted between them. CONCLUSIONS.  The anticaries effect showed no correlation with higher deposited fluoride amounts, resin type, or fluoride source.