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

Evaluation of the Caries-Arresting Potential of Silver Diamine Fluoride Gel With Potassium Iodide Versus Sodium Fluoride Varnish: An Observational Study

Introduction Silver diamine fluoride (SDF) with potassium iodide (KI) has emerged as a promising, aesthetic, non-invasive management by limiting the staining caused by SDF. However, no studies are comparing the caries-arresting potential of SDF gel with KI. The study aims to observe and evaluate the caries-arresting potential of SDF gel with KI compared to sodium fluoride (NaF) varnish. Materials and methods The present observational study was conducted with a split-mouth design. A total of 33 participants, in the age group of two to six years, with occlusal caries of the International Caries Detection and Assessment System (ICDAS) I and II involving both right and left upper or lower primary molar teeth, were included. SDF gel with KI and fluoride varnish (FV) was applied to the contralateral teeth on the same arch. Participants were recalled at 3, 6, 9, and 12-month intervals to monitor the progression or arrest of carious lesions. Result At the end of 12 months, 66.7% and 70.5% of the teeth showed arrest of caries with SDF gel with KI and FV, respectively. Intra-group analysis using the Friedman test shows significant differences in both groups across the timeline (p=0.001). Intergroup analysis using the Whitney U test reveals no significant difference in caries-arresting potential between the groups at various timelines (p=0.231). Conclusion There was no significant difference in arresting enamel caries of primary teeth between the use of 5% NaF and 38% SDF with KI. However, there was a significant difference within the group between the 3rd and 12th-month follow-up. Hence, the biannual application is recommended in both FV and SDF with KI.

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

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

Health professionals' recommendations on the use of fluoride varnish for caries prevention in preschool children

BACKGROUND

Fluoride varnish (FV) is widely recommended for caries prevention in preschool children, despite its anticaries benefits being uncertain and modest. Dentists often report using clinical practice guidelines (CPGs) as a source of scientific information.

AIM

To identify and analyze recommendations for clinical practice on the use of FV for caries prevention in preschool children and to assess the methodological quality of the CPG on this topic.

DESIGN

Two researchers independently used 12 search strategies and searched the first five pages of Google Search™ and three guideline databases for recommendations freely available to health professionals on the use of FV for caries prevention in preschoolers. Then, they retrieved and recorded recommendations that met the eligibility criteria and extracted the data. A third researcher resolved disagreements. Each included CPG was appraised using the AGREE II instrument.

RESULTS

Twenty-nine documents were included. Recommendations varied according to age, patients' caries risk, and application frequency. Of the six CPGs, only one scored above 70% in the AGREE II overall assessment.

CONCLUSION

Recommendations on the use of FV lacked scientific evidence, and CPGs were of poor quality. Application of FV is widely recommended despite recent evidence showing an uncertain, modest, and possibly not clinically relevant anticaries benefit. Dentists should be aware that it is necessary to critically appraise CPGs since they may be of poor quality.

Fluoride hesitancy: A mixed methods study on decision-making about forms of fluoride

OBJECTIVES

To investigate whether professionally applied topical fluoride-hesitant caregivers are also hesitant about other forms of fluoride for their child.

METHODS

This was a mixed methods study of 56 caregivers hesitant about professionally applied topical fluoride for their child recruited from the University of Washington Center for Paediatric Dentistry and Seattle Children's Hospital's Odessa Brown Children's Dental Clinic. A 32-item semi-structured interview script was piloted and finalized. One-time interviews with caregivers were conducted by phone in 2019. Associations between hesitancy of topical fluoride, fluoridated water and toothpaste were assessed quantitatively via two-tailed chi-squared tests. Qualitative data were coded using an inductive approach and content analytic methods to investigate reasons for hesitancy.

RESULTS

There were significant associations between hesitancy in all three pairwise comparisons of fluoride form (p < .01). Similar proportions of caregivers strongly or somewhat opposed fluoridated water compared with toothpaste (75% and 65%, respectively), but four times as many caregivers strongly or somewhat favoured fluoridated toothpaste compared to water for their child (25% and 7%, respectively). Concerns about harm were the most common reason caregivers opposed both fluoridated water and toothpaste. However, fluoride-hesitant caregivers reported being more comfortable with fluoridated toothpaste because amount and frequency can be controlled, and ingestion can be prevented.

CONCLUSIONS

Professionally applied topical fluoride hesitancy is significantly associated with fluoridated water and toothpaste hesitancy, but caregivers who were hesitant about topical fluoride was more comfortable with fluoridated toothpaste than fluoridated water for their child.

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.

Economic evaluation of fluoride varnish application in preschoolers: A systematic review

BACKGROUND

Fluoride varnish (FV) is a convenient way of professionally applying fluoride in preschoolers. However, its modest anticaries effect highlights the need for economic evaluations.

AIM

To assess economic evaluations reporting applications of FV to reduce caries incidence in preschoolers.

DESIGN

We included full economic evaluations with preschool participants, in which the intervention was FV and the outcome was related to dentin caries. We searched in CENTRAL; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; and BVS Economia em saúde, OpenGrey, and EconoLit. Clinical trial registers, thesis and dissertations, and meeting abstracts were hand searched, as well as 11 dental journals. Risk of bias in the included studies was assessed using the Philips' and Drummond's (full and simplified) tools.

RESULTS

Titles and abstracts of 2871 articles were evaluated, and 200 were read in full. Eight cost-effectiveness studies were included: five modeling and three within-trial evaluations. None of the studies gave sufficient information to allow a thorough assessment using the bias tools. We did not combine the results of the studies due to the great heterogeneity among them. Four studies reported that FV in preschool children was a cost-effective measure, but in one of these studies, sealants and fluoride toothpaste were more cost-effective measures than the varnish, and three studies used limited data that compromised the generalizability of their results. The other four studies showed a large increase in costs due to the application of varnish and/or low cost-effectiveness.

CONCLUSION

We did not find convincing overall evidence that applying FV in preschoolers is an anticaries cost-effective measure. The protocol of this systematic review is available at Open Science Framework (https://osf.io/xw5va/).

Is It Mum or the Dad? Parental Factors That Influence the Use and Acceptance of Fluoride Varnish among Parents in Eastern Saudi Arabia

Objective

To investigate parental factors that influence knowledge, use, and acceptance of fluoride varnish (FLV) application.

Methods

This cross-sectional study was conducted during December 2021. A multistage sampling technique was used to recruit parents with children aged 3 to 6 years and residing in Eastern Saudi Arabia, excluding those working in the dental field. The questionnaire consisted of four parts: demographics, knowledge, previous experience, and acceptance of FLV and was pilot-tested and distributed online using social media.

Results

A total of 623 parents responded to the survey. Only 36.9% of parents had good FLV knowledge with dentists being the main source of information. Gender, educational level, family income, being in the medical field, and source of knowledge were factors that significantly (P < 0.05) influenced parental knowledge. Only 24.6% of the parents applied fluoride varnish to their children before, of whom only 29% were satisfied with the experience. Parent's FLV knowledge, view of dental visits, satisfaction with previous experience, perception of children's oral health, and willingness to reapply FLV were factors that significantly (P < 0.05) influenced FLV use. Working in the medical field, perception of dental visits, and the source of knowledge were factors that significantly (P < 0.05) influenced the parent's acceptance to apply FLV. While lack of knowledge about fluoride benefits (15%) was the main reason for parental refusal to apply FLV.

Conclusions

The current study highlights the lack of knowledge and application of FLV among parents. There were more factors influencing mothers' acceptance of FLV application compared to fathers. Age, educational level, working in the medical field, perception, and patterns of dental visits were some of the identified factors. Dentists played a major role in parental knowledge and FLV acceptance. In a country with high caries prevalence, preventive programs such as FLV education and application are crucial.

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

Background

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

Methods

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

Results

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

Conclusion

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

Supplementary Information

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

Caries Experience and Increment in Children Attending Kindergartens with an Early Childhood Caries Preventive Program Compared to Basic Prophylaxis Measures-A Retrospective Cohort Study

Dental caries constitutes a public health challenge. As preventive strategies are desirable, this retrospective cohort study aimed to assess the caries experience and increment in children attending kindergartens with an early childhood caries (ECC) preventive program (intervention group, IG) compared to basic prophylaxis measures (control group, CG) located in areas of different socioeconomic status (SES) within Marburg (Germany). The long-term caries experience (2009−2019) of these 3−5-year-old kindergarten children was evaluated. For the caries increment, dental records of 2019 were screened for the availability of a minimum of two dental examinations at least 8 months apart. Caries was scored according to the WHO criteria (dmf−t). The data were split by observation period (300−550 and >550 days). Overall, 135 children (Ø 3.7 years) attended IG, and 132 children (Ø 3.6 years) attended CG. After 300−550 days, no significant differences were found between both groups regarding mean caries increment and experience (p > 0.05). After >550 days, IG with low SES exhibited a high caries experience. Fluoride varnish applications could not reduce the caries increment compared to CG in the short-term but slightly decreased the long-term caries experience. Comprehensive ECC prevention measures actively involving parents are needed to overcome the caries burden.

Effect of Fluoride-based Varnishes with Added Calcium and Phosphate on Microhardness of Esthetic Restorative Materials: An In Vitro Study

Background and objectives

Fluoride varnishes are being used to prevent caries in children. The high concentration of fluoride in varnishes apart from caries prevention may cause changes in surface properties of esthetic restorations. The study aims to evaluate and compare the effect of four commercially available fluoride varnishes with added calcium and phosphate on microhardness of three esthetic materials namely conventional GIC (Fuji II), high viscosity GIC (Fuji IX), and nanocomposite (Filtek Z350).

Materials and methods

A total of 28 pellets were made of each material and stored in distilled water at 37 °C for 48 hours. The microhardness of the pellets was tested which served as a baseline. These were then randomly divided into four subgroups. In one subgroup Profluorid varnish was applied, second subgroup MI varnish was applied, third subgroup Embrace varnish was applied, and in the fourth subgroup Enamel Pro varnish was applied as per protocol. Thereafter, all the pellets were subjected to microhardness testing (load = 100 g for 15 seconds).

Results

The fluoride varnishes increased the microhardness of conventional GIC (Fuji II) whereas in case of high viscosity GIC (Fuji IX) the application of varnishes reduced the microhardness. In case of nanocomposite restorative material (Filtek Z350) only Profluorid varnish increased its microhardness.

Conclusion

Fluoride varnish and calcium-phosphate containing fluoride varnish effect on the microhardness of restorative material is material dependent. So, the choice of fluoride varnish with or without proprietary additives depends on the nature and composition of the restorative material.

How to cite this article

Shetty RS, Bhat SS, HK Sundeep, et al. Effect of Fluoride-based Varnishes with Added Calcium and Phosphate on Microhardness of Esthetic Restorative Materials: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(2):187-193.

Review of Professionally Applied Fluorides for Preventing Dental Caries in Children and Adolescents

This review aims to evaluate the effectiveness of professional topical fluoride application on the prevention of dental caries in primary and permanent dentition. A web search was conducted for English papers published from 2000 to 2020, using various digital resources (Pubmed, Google Scholar, Cochrane Library, and ResearchGate). The keywords were “professionally applied fluoride”, “fluoride gel”, “fluoride varnish”, “fluoride foam”, “fluoride mouthrinses”, and “non-cavitated caries lesions”. Inclusion criteria: (a) participants: children and adolescents, treated in a dental care setting; (b) intervention: professionally applied fluorides (gel, varnish, foam, mouthrinse); (c) comparator: no professional treatment or other preventive treatments; (d) outcomes: clinical effectiveness (e.g., caries reduction, tooth remineralization); (e) study design: randomized controlled trials, systematic reviews, meta-analyses; (f) publication period: 1 January 2000–31 December 2021. Clinical studies about home-use fluoride products, discussion papers, in-vitro studies, case reports, non-English articles, and studies with unclear methodology were excluded. Topical fluoride applications are indicated for patients with active smooth surface caries and for patients in high caries risk groups. Both APF gel and fluoride varnish are effective and can be recommended for caries prevention in primary and permanent teeth. For children under the age of 6, only 2.26% fluoride varnish is recommended.

The Effectiveness of Early Childhood Caries Treatment with MI Varnish Fluor in Obese Subjects: A Study from Vietnam

Objective: We conducted this work to evaluate the effectiveness of treatment for early childhood caries (ECC) using MI Varnish Fluor in obese children aged from 36 to 71 months. Methods: This study was conducted on 300 carious teeth of obese children and normal-weight children in Hanoi, Vietnam, over the period 2019–2020. Diagnodent KaVo 2190 laser equipment was used to diagnose ECC. The children in each group were selected on the basis of similarities in age, gender, and study location, and the teeth in the two groups were selected on the basis of similarities in damage level and jaw position. ECC treatment was performed once a week for four consecutive weeks with MI Varnish Fluor. The child, the child’s family, and the child’s teacher were consulted on diet and oral hygiene during the treatment. Children were examined and monitored throughout the treatment period. Children were re-examined after 3 and 6 months from the start time of treatment. The Mann–Whitney U test and Kruskal–Wallis tests were used, with statistical significance indicated at p < 0.05. Results: After six months of treatment with MI Varnish Fluor, the number of cases of code 0 damage recovery (D0) increased in both groups. The result showed that MI Varnish fluor was effective in ECC treatment. D0 damage recovery rates of 79.3% in obese children and 62.7% in normal-weight children were observed after six months of treatment, but there was no statistically significant difference between the two groups. Furthermore, there was no statistically significant difference between the two groups according to age, tooth position, or tooth surface position in D0 damage recovery. Conclusions: MI Varnish Fluor was effective in ECC treatment, with D0 damage recovery rates of 79.3% in obese children and 62.7% in normal-weight children after six months of treatment.

Cost-effectiveness and efficacy of fluoride varnish for caries prevention in South African children: A cluster-randomized controlled community trial

OBJECTIVES

This cluster-randomized controlled community trial aimed to assess the efficacy and costs of fluoride varnish (FV) application for caries prevention in a high-risk population in South Africa.

METHODS

513 children aged 4-8 years from two schools in a township in South Africa were randomly allocated by class to the FV or Control (CO) groups. In addition to supervised toothbrushing with fluoridated toothpaste in both groups, FV was applied in 3-month intervals by trained local non-professional assistants. Intraoral examinations were conducted at baseline, 12, 21 and 24 months. Primary outcome was the increment of teeth with cavitated lesions (i.e. newly developed or progressed, formerly non-cavitated lesions), requiring restoration or extraction over the study period. Additionally, treatment and re-treatment costs were analyzed.

RESULTS

513 children (d_1-4 mft 5.9 ± 4.3 (mean ± SD)) were randomly allocated to FV (n = 287) or CO (n = 226). 10.2% FV and CO teeth received or required a restoration; 3.9% FV and 4.1% CO teeth were extracted, without significant differences between groups. While FV generated high initial costs, follow-up costs were comparable in both groups, resulting in FV being significantly more expensive than CO (1667 ± 1055 ZAR vs. 950 ± 943 ZAR, p < .001).

CONCLUSIONS

Regular FV application, in addition to daily supervised toothbrushing, had no significant caries-preventive effect and was not cost-effective in a primary school setting within a peri-urban, high-risk community in South Africa. Alternative interventions on community or public health level should be considered to reduce the caries burden in high-risk communities.

Impact of Sociodemographic Factors on Dental Caries in Children and Availing Fluoride Treatment: A Study Based on National Survey of Children's Health (NSCH) Data 2016-2019

Introduction Dental caries is a global health issue. It is a largely preventable, multifactorial non-communicable disease. Given the gravity of the situation, in 2014 United States Preventive Services Task Force recommended that the primary care physician apply fluoride varnish from the eruption of the first tooth till the child attains five years of age. Using 2016-2019 National Survey of Children's Health (NSCH) cross-sectional representative data, the aim of this study was to determine if the child's age, gender, and race are predictors of the child having decayed teeth or cavities in the past 12 months and if they had availed preventative dental services from the dentist in the past 12 months in the US and if so, did they receive fluoride treatment. Methods The prevalence of dental caries and dental treatment among children under each category of sociodemographic risk factors were estimated using 2016-2019 NSCH's cross-sectional representative data on two survey questions. Then, the statistical significance of the association of the categorical risk factors with the prevalence of dental caries and the association of the categorical risk factors with the prevalence of fluoride dental treatment were tested using two-sample proportion tests and chi-square tests. Further, chi-square residual analysis was employed to better understand the nature of the association and to reveal the degree of contribution to the test statistic from each categorical combination of risk factors. Results Prevalence and associative risk of tooth decay in children was the highest in the 6-11 years age group across all three years under study. The 6-11 years age group had the highest prevalence and association of receiving fluoride treatment across all three years. In our study, the prevalence of dental caries in children by race varied according to the year. In 2016-2017 and 2018-2019, it was the Hispanic population with the highest prevalence of tooth decay. In 2017-2018 the highest prevalence was seen in the Non-Hispanic Black (NHB) population. Across all three years, the Hispanic population had the highest associative risk of tooth decay. The Non-Hispanic White (NHW) population had the highest prevalence and association with receiving fluoride treatment across all three years. Male children were found to have the higher prevalence and associative risk of decayed teeth across all three survey years. Conclusion Dental caries is a worldwide health burden. However, it can be prevented by different precautionary measures. The results of our study revealed that certain sociodemographic factors such as age, gender, and race of the child make certain groups of the child population more at risk for the development of dental caries; most notable findings were that the male children were significantly associated to have decayed teeth and not availing dental fluoride treatment for which limited information is available in the literature. Additionally, the age groups 1-5 and 6-11 were significantly associated with the prevalence of not receiving dental treatment and the prevalence of dental caries, respectively. More active participation of pediatricians in getting trained for the application of fluoride varnish and helping getting their patients established with dental services per recommendations will help streamline preventative dental care.

Risk Indicators for Early Childhood Caries in South Africa: Protocol for a Systematic Review

Background

Early childhood caries (ECC) is a common disorder characterized by the presence of one or more decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces of primary teeth in children 71 months old or younger. South Africa has a diverse population in terms of culture, education, income, and occupation. This diversity is due to the consequences of historical racial discrimination, poverty, unemployment, lack of accessibility to health services, and quality of education. These factors make South Africa unique, and the disease and risk profiles for this country differ from those of other countries at similar stages of development. For these reasons, it is important to identify the unique maternal and infant risk factors for ECC in the South African context.

Objective

The purpose of this study is to determine the risk factors associated with the incidence and prevalence of ECC in South Africa in children under the age of 6 years.

Methods

All cross-sectional and cohort studies documenting risk factors associated with the prevalence and incidence of dental disease and severity (decayed, missing, and filled scores) will be included. We will search 7 databases for eligible studies, and those included will be based on prespecified inclusion criteria. Only studies conducted with South African children who are aged 6 years and younger in which dental caries risk factors are documented will be included. There is no restriction on the time or language of publication. Included articles will be scrutinized for quality by using a risk of bias tool developed by the Joanna Briggs Institute. The results will be presented narratively, and if possible, a meta-analysis will be performed.

Results

The literature search was conducted in November 2020.

Conclusions

The results of this study will provide a framework to inform medical and dental personnel to highlight mothers and infants at risk of developing ECC.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42020216455; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216455

International Registered Report Identifier (IRRID)

DERR1-10.2196/26701

Fluoride Varnishes for Preventing Occlusal Dental Caries: A Review

Dental caries are most likely to occur on occlusal surfaces from the early eruptive stages of the tooth. In children, about 80% to 90% of dental caries are occlusal caries. Different preventive modalities are used to prevent occlusal caries. One of the methods used for occlusal caries prevention is fluoride varnish. A vast number of clinical trials have evaluated several types of sealant material and fluoride varnish to assess their ability to prevent occlusal caries in both primary and permanent dentition. The purpose of the current study was to provide an updated overview of the development, composition, mechanism of action, application, and safety of fluoride varnish, as well as its effect on occlusal caries prevention. This review of recently published studies on fluoride varnish and its effect on occlusal caries prevention shows that in children at moderate to high risk of caries, fluoride varnishes prevent occlusal caries. Both resin-based fissure sealants and fluoride varnish are effective for occlusal caries prevention for first-permanent molars. However, it was not possible to identify which one has the best effect. It is recommend that fluoride varnish is applied for children at high risk of caries two to four times per year.

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.

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.

Carious lesions in permanent dentitions are reduced in remote Indigenous Australian children taking part in a non-randomised preventive trial

We tested the effect of an annual caries preventive intervention, delivered by a fly-in/fly-out oral health professional team, with Indigenous children residing in a remote Australian community. Around 600 Indigenous children aged 5 to 17 years were invited to participate at baseline, of who 408 had caregiver consent. One hundred and ninety-six consented to the epidemiological examination and intervention (Intervention group) and 212 consented to the epidemiological examination only (Comparison group). The intervention, which occurred annually, comprised placement of fissure sealants on suitable teeth, and application of povidone-iodine and fluoride varnish to the whole dentition, following completion of any necessary restorative dental treatment. Standard diet and oral hygiene advice were provided. Caries increment (number of tooth surfaces with new dental caries) in both deciduous and permanent dentitions was measured at the 2-year follow-up. Comparison group children had significantly higher number of new surfaces with advanced caries in the permanent dentition than the Intervention group (IRR = 1.61; 95% CI: 1.02–2.54; p = 0.04); with a preventive fraction of 43%. The effect of intervention remained significant with children in the Comparison group developing significantly more advanced caries lesions in the permanent dentition than the Intervention group children in the adjusted multivariable analysis (IRR = 2.21; 95% CI: 1.03–4.71). Indigenous children exposed to the intervention had less increment in advanced dental caries in the permanent dentition than those not exposed to the intervention.

Costing the Scale-Up of a National Primary School-Based Fluoride Varnish Program for Aboriginal Children Using Dental Assistants in Australia

There is good evidence that fluoride varnish programs are effective in preventing dental caries in children. This study aims to provide a costing for the scale-up of a child fluoride varnish program in New South Wales (NSW), Australia. Most child fluoride varnish programs are school-based, and a number of studies have examined the acceptability and cost effectiveness of using non-dental providers to apply the fluoride varnish. This paper describes the number of primary schools in Australia that could be targeted using a standard population-based risk criteria based on published data. A costing method was developed for various scenarios of school enrolment and provider types, along with potential revenue from the Child Dental Benefits Schedule (CDBS). Most of the costs of a school-based fluoride varnish program can be covered by the CDBS with assumptions of 80% child consent and 75% CDBS eligibility. While the scale-up of child fluoride varnish programs to prevent dental caries has been recommended by numerous strategic plans and reports, particularly for Aboriginal and Torres Strait Islander children, limited progress has been made. This paper concludes that using a standardized criteria for targeting schools using a combination of ICSEA and Aboriginal enrolments, and aiming at four applications a year, is feasible, and that the main costs of the program could be covered by using the CDBS.

Evaluation of a community-based early childhood caries (ECC) intervention in Cambodia

OBJECTIVE

To critically evaluate an early childhood caries (ECC) intervention performed by non-dental primary healthcare providers.

METHODS

This mixed-methods investigation includes data from three sources: (a) a pilot non-randomized controlled trial to examine clinical outcomes at four health centres; (b) stakeholder focus group interviews; and (c) a survey of parents whose children were exposed to the intervention. The pilot study involved four Community Health Centres in rural Cambodia whereby mother-child (6-24 months of age)dyads received oral health education (OHE), toothbrushes, fluoride toothpaste and fluoride varnish on up to six occasions as part of the routine vaccination schedule. Outcomes were as follows: presence of ECC; impacts on oral health-related quality of life (OHRQoL); stakeholder perceptions of intervention delivery; and parental perceptions of fluoride varnish.

RESULTS

Participants in the intervention group had six times lower odds of developing ECC than those in the comparison group after controlling for socio-economic status (OR 0.13). Those in the intervention group also had a large reduction OHRQoL scale scores. Key knowledge and practice gaps were identified among stakeholders. Surveyed parents had favourable views of the fluoride varnish placement by medical professionals, and four out of five stated that they would recommend fluoride varnish for other children. Primary healthcare providers, commune council representatives and community health promoters supported oral health interventions being provided in CHCs.

CONCLUSIONS

OHE and fluoride varnish interventions provided by non-dental primary health workers were feasible and acceptable for stakeholders in a Cambodian setting. The intervention group had lower ECC experience and better OHRQoL at 2 years of age.

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 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.

Factors facilitating dental practitioners' provision of infant-toddler dental homes in Alberta

BACKGROUND

The Canadian Dental Association and Canadian Dental Hygienists Association recommend that a child's first dental visit should occur no later than 1 year of age. However, this recommendation has not been strongly supported by the dental community. The purpose of this study was to explore factors influencing the provision of infant-toddler dental homes from providers' perspectives. Understanding facilitating factors is integral to developing strategies to improve infant-toddler oral health care.

METHODS

This study employed a qualitative interpretive descriptive methodology, using semi-structured interviews with a purposive sample of 13 dentists and dental hygienists who routinely provide dental homes for the infant-toddler cohort. The constant comparative method was used to support thematic analysis.

RESULTS

Thematic analysis revealed factors that were both endogenous and exogenous to the practitioner. They were categorized into 4 interrelated themes: 1) practitioner; 2) practice; 3) profession; and 4) population. Together these 4 themes form a model of the 4 Ps that influence provision of infant-toddler dental homes. Common endogenous factors include the practitioner's comfort with young children and having clinical exposure to pediatric clients during dental education. Common exogenous factors include parental awareness and adequate insurance coverage for preventive procedures. Strategies to improve acceptance of infant-toddler dental homes include enhanced practitioner education and public awareness, consistent messaging from the dental community, as well as increased remuneration for preventive pediatric oral health care.

CONCLUSION

Provision of infant-toddler dental homes is affected by multifaceted variables. Consequently, strategies to improve uptake must employ a multipronged approach.

Sodium fluoride induces apoptosis and autophagy via the endoplasmic reticulum stress pathway in MC3T3-E1 osteoblastic cells

Fluorosis and bone pathologies can be caused by chronic and/or excessive fluoride intake. Despite this, few studies have been conducted on the cellular mechanisms underlying osteoblast toxicity in the presence of NaF. Here, we investigated the effects of fluoride on MC3T3-E1 cells. We showed that the proliferation of MC3T3-E1 cells was inhibited by exposure to NaF. In addition, apoptosis was induced by NaF, as caspase-associated proteins showed a higher level of expression and apoptotic bodies were formed. Furthermore, endoplasmic reticulum (ER) stress induced by NaF activated the unfolded protein response (UPR) and upregulated the expression of the glucose-regulated proteins 94 (GRP94) and 78 (BiP). Therefore, ER stress plays a vital role in NaF-induced autophagy and apoptosis. Furthermore, apoptosis is promoted following the inhibition of NaF-induced autophagy. In conclusion, under NaF treatment, the ER stress-signaling pathway is activated, leading to apoptosis and autophagy and affecting the proliferation and survival of MC3T3-E1 cells.