Caries prevention with chlorhexidine-thymol varnish in high risk schoolchildren

In a prospective, randomised and blinded cohort study, the acceptance and effectiveness of a 3-monthly chlorhexidine-thymol varnish application was assessed in 8- to 10-yr-old children (n=29) with high caries incidence after brushing with a 1.23% fluoride gel. The children of the control group (n=25) brushed with a fluoride gel only. The standardised interview showed good acceptance of the varnish applications in spite of the bitter taste. Caries incidence in one year was 1.2 DMFS (SD 1.5, median 1; 95% confidence interval 0-1) for the test group and 2.1 DMFS (SD 2.3, median 2; 95% confidence interval 0-3) for the control group. Due to a slightly lower reduction in caries incidence (42.3%) than in other studies and a higher standard deviation than in unselected study groups, the power of the present study was not high enough to prove this difference in caries incidence to be statistically significant in the Mann-Whitney test (P=0.11). This was also found for the difference of 0.4 initial lesions. The distribution patterns of caries incidence for tooth groups (70% in the first permanent molar) and surfaces (58% on occlusal surfaces) did not differ between the test and the control group. The reductions of caries incidence which have been found in highly caries active children of the present study should be evaluated further with a larger study sample.     

绿茶多酚涂膜临床防龋效果观察

本研究将含绿茶多酚涂膜（0.078g/L）用于乳牙，观察其对乳牙的防龋作用，并分析其作用特点。实验组107名儿童的第一乳磨牙和乳中切牙涂布绿茶多酚涂膜，隔6个月后重复涂布一次，一年后复查患龋情况，记录dmft和dmfs。另110名儿童作为对照。结果涂布牙新患龋率与对照组相比下降66％；实验组非涂布牙新患间牙、新患龋牙面和新患龋率均显著低于对照组；绿茶多酚涂膜对后牙防龋作用大于前牙；从不同牙面看，涂膜对面作用最强，颊舌面次之，近远中面较小。表明绿茶多酚涂膜对涂布牙和口腔中其它非涂布牙具有显著防龋作用。     

Results of the Sherbrooke-Lac Megantic fluoride varnish study after 20 months

The purpose of this study was to demonstrate the effectiveness of two fluoride varnishes (Duraphat and Fluor Protector) in the prevention of dental caries in children residing in a non-fluoridated community. At baseline, 787 grade one children (6-7-yr old) were examined and randomly allocated into a control and two treatment groups. At 20 months, 703 children remained in the study. The mean baseline caries experience and the mean number of permanent teeth present at 20 months were not significantly different among the treatment and control groups. The mean DMFS increments after 20 months were 1.70, 1.73 and 2.02 for Fluor-Protector, Duraphat and control groups respectively (% reductions of 15.8 and 14.4 for Fluor-Protector and Duraphat groups). The mean dfs increments for primary molars after 20 months were 1.56, 1.62 and 1.74 for Fluor-Protector, Duraphat and control groups respectively (% reductions of 10 for Fluor-Protector and 7 for Duraphat).     

Effect of a sodium fluoride varnish on the progress of initial caries lesions

Abstract – Effect of applications of a sodium fluoride varnish, Duraphat®, on progress of initial caries lesions was studied in 11–13-year-old children. All 60 children included in the study had high caries activity and life-long exposure to fluoridated drinking water. The varnish was applied semiannually using the half mouth technique, and annual clinical and radiographic examinations were made for 3 years. The treatment had little effect on the progress of initial caries lesions present before the first application of varnish. The progress of caries lesions formed during the study was inhibited more distinctly, and the difference between test and control side in the rate of progress of caries lesions was highly statistically significant. Use of fluoride varnish seems to help to prevent further development of early caries lesions.     

Evaluation of a fluoride-containing varnish in children with low caries incidence

Abstract – The purspose of the present study was to investigate the caries-preventive effect of four applications during 2 year of the fluoride-containing varnish, Fluor Protector®. The final series examined during the 2-year follow-up period comprised 76 girls and 87 boys, whose average age at the onset of the experiment was 12.8±0.6 yars. The test was carried out as a blind study, using a half-month technique. The fluoride content of the surface enamel was measured in 40 children. The results obtained by the conventional fluoride electrode technique were compared with those obtained by the sensitive physical technique based on proton beam bombarding using bovine primary teeth. The teeth were cut longitudinally into two halves; one half was treated with Fluor Protector® and the other half served as a control Clinical examintions of the children showed that the the number of carious lesions requiring active treatment was low on both the control and experimental sides of the mouth. Varnish treatment did not reduce caries in these children. The fluoride content of the surface enamel was relatively high on the untreated control side, but on increasing trend was observed during the 2-year follow-up period. The fluoride content of the treated teeth was markedly elevated throughout the follow-up period. The in vitro experiments with the bovine teech showed that etching did not release all the fluoride present in the tooth enamel.     

Effect of a fluoride varnish (Duraphat®) in preschool children

The caries-preventive effect of semiannual applications of a fluoride varnish (Duraphat) was tested for 2 years in 225 3-year-old children; 113 children served as a control group. At the baseline examination, 69% of the children in the test group and 75% in the control group were caries-free. The results after 2 years showed an average caries increment of 2.1 surfaces in the test group and 3.7 in the control group. The difference is statistically significant. Thirty-eight percent of the children in the test group and 27% in the control group were still caries-free. The caries reduction was 44%.     

Using chlorhexidine varnish to prevent early childhood caries in American Indian children

Objectives: To test the efficacy of 10% chlorhexidine (CHX) dental varnish applied to the mothers' dentition in preventing caries in American Indian children. Methods: This was a placebo‐controlled, double‐blind, randomized clinical trial. Mother–child pairs were enrolled when the child was 4.5‐6.0 months. Mothers received 4 weekly applications of the study treatment (CHX or placebo) followed by single applications when her child was age 12 and 18 months. Children received caries examinations at enrollment, 12, 18 and 24 months. Analyses were limited to the intent‐to‐treat (ITT) group: children whose mothers received the first study treatment and who received at least one post‐baseline exam. The outcome variable was the number of new carious surfaces (NNCS) at the child's last visit. Wilcoxon nonparametric and Fisher's exact tests were used to test differences between the active and placebo groups. Results: We randomized 414 mother–child pairs, with 367 (88.6%) included in the ITT group (active = 188, placebo = 179). The proportion of children caries‐free at their final exam was 51.1% and 50.8% for the active and placebo groups (P > 0.99). The mean NNCS for the active and placebo groups was 3.82 (standard deviation [SD] = 8.18) and 3.80 (SD = 6.08), respectively (P = 0.54). The proportion with NNCS > 6 was 18.1% for active children versus 27.9% for placebo (relative risk [RR] = 0.65, P = 0.03). The number needed to treat to shift one child from NNCS > 6 to a lower severity was 10.2. Conclusions: In this population CHX varnish did not reduce the mean NNCS or proportion of children with caries, but did reduce the proportion with severe caries.     

Fluoride retention in sound and demineralized enamel in vivo after treatment with a fluoride varnish (Duraphat)

Abstract – The retention of alkali soluble (CaF₂) and alkali insoluble (fluorapatite) fluoride in sound enamel and demineralized enamel 2 wk after application of Duraphat was investigated in a group of orthodontic patients from whom pairs of homolog premolars were to be extracted. Demineralization of the enamel was induced during a 4-wk period prior to application of fluoride by applying orthodontic bands to the premolars. The bands also remained attached to the teeth during and after application of fluoride (2 wk) to maintain a cariogenic environment. Three consecutive enamel layers (～5 μm) were subsequently etched off. A significant uptake of fluoride in the first and second layer of sound enamel and in all the three enamel layers of demineralized enamel was found. More fluoride was found in demineralized enamel and a higher proportion of this fluoride was found to be in an alkali insoluble form compared with the fluoride in sound enamel. The SEM study showed a rough enamel surface after three consecutive acid etchings. The etching pattern differed within the etched area. It was suggested that the variation in etching pattern might be due to differences in orientation of the crystallites and the original surface morphology.     

Fluoride varnish for caries prevention: comparisons with other preventive agents and recommendations for a community-based protocol

This paper reviews fluoride varnish (FV) literature to develop a community-based protocol for people with special needs or those who are caries susceptible. Safety, personnel and cost issues are discussed and existing NIH, CDC and WHO recommendations are presented. FV studies are assessed with respect to type of FV to use and frequency of application. FV is compared with studies using other caries preventive agents: 0.2% NaF mouthrinse, acidulated phosphate fluoride (APF) gel, dental sealants, water fluoridation and chlorhexidine. Because there are few FV studies among special need populations, conclusions are based on available literature and public health principles. If personnel are available, FV use is preferred to APF gel and may be preferable to 0.2% NaF mouthrinse. FV is more effective in optimally fluoridated communities. If many occlusal surfaces are at risk, sealants should be applied. Additional combinations and frequencies of preventive agents should be tested, especially for people with special needs and high caries risk adults.     

Caries preventive effect of fluoride varnish applications performed two or four times a year

Abstract – The efficacy of Duraphat varnish applications performed two or four times a year was compared in a 2-yr clinical trial. 254 children aged 9-13 yr and having higher than average DMFS values participated in the study. The children were randomly divided into two treatment groups. Clinical and radiographical examinations were performed at baseline and after 2 yr by one dentist. For the group receiving applications every 3 months, the 2-yr DMFS increment was 2.90 (SD 4.45) and for the group receiving applications every 6 months, 2.92 (4.47). There were no significant differences in DMFS increments between the groups for any type of tooth surfaces. Neither was there any difference between the groups when the children were divided into two subgroups on the basis of baseline DMFS values. The increments for the children with high (10) baseline DMFS values were 4.25 (4.81) and 4.30 (5.53) in the groups receiving applications four times and twice a year, respectively. The results suggest that fluoride varnish applications performed more frequently than twice a year may not provide additional caries protection in a population with relatively low caries activity.     

氟保护漆预防儿童乳牙龋齿的临床效果评价

目的对氟保护漆预防儿童乳牙龋齿的临床效果进行评价。方法将重庆市一所幼儿园的150名3岁儿童随机分为4组,0.5%氟保护漆组、0.1%氟保护漆组、0.5%氟化钠组和空白对照组,分别采用质量分数为0.5%氟保护漆、0.1%氟保护漆、0.5%氟化钠和去离子水作为涂擦药物,每6个月涂擦1次,为期2年,记录试验前后患龋情况,对4组药物的防龋效果进行比较分析。结果0.5%氟保护漆组的龋均和龋面均显著低于0.1%氟保护漆组、0.5%氟化钠组和空白对照组（P<0.05）。结论质量分数为0.5%的氟保护漆具有明显的预防乳牙龋齿的作用。     

氟化物涂膜的临床应用

氟化物的防龋作用较为明显，目前临床上应用的各种氟化物剂型多有其缺点，严重影响了氟化物的临床应用。氟化物涂膜作为一种局部应用氟化物缓释剂型，由于其独特的剂型特点，在防龋、治疗牙本质过敏症和预防正畸过程中牙釉质白斑的发生等多个方面都有着不可替代的优点，因此在许多国家氟化物涂膜已取代了氟化物凝胶的应用。本文就氟化物涂膜的临床应用情况及功能特点作一简要综述。     

Caries preventive effect of a fluoride-containing varnish (Duraphat®) after 1 year's study

ABSTRACT The caries prophylactic effect of semi-annual applications of a fluoride-containing varnish (Duraphat®) was tested in 121 15-year-old children. The children were divided into a test (60 subjects) and a control group (61 subjects). The teeth of the children in the test group were coated with the fluoride varnish at the beginning of the experimental period and again 6 months later. A clinical and radiographic examination of all children was performed immediately prior to the first application of varnish and 1 year later. The mean caries increment was 0.9 new DMFS in the test group and 4.0 in the control group. The difference was statistically significant at the 0.1 % level. The caries prophylactic effect on different tooth surfaces was statistically significant both on proximal and on occlusal surfaces at the 0.1 % level. Analyzing the material with respect to the caries prophylactic effect against the background of caries prevalence at the start of the investigation showed a better effect in the group of children with low and medium initial DMFS values.     

Caries increment in primary teeth after application of Duraphat® fluoride varnish

Abstract In order to evaluate the possible cariostatic effect of a fluoride varnish in the primary dentition, Duraphat® varnish was applied twice yearly for 2 years to the teeth of 195 3¹/₂-year-old children of both sexes attending nine preparatory schools in the Warsaw area. A control group of 127 children attending nine other preparatory schools was also examined. For each child a dmfs₁ index (including “caries without macroscopic defect”) and a dmfs₂ index (“caries without macroscopic defect” excluded) were determined as well as a dmft₁ and a dmft₂ index. After 2 years the difference between the test and the control groups regarding the mean dmfs₁ and dmft₂ index increments was 9.39% (P > 0.1) and 24.09% (P < 0.05) respectively. No significant differences were found, however, concerning the dmft₂ and dmfs₂ indices, the percentage children with new gingival caries, the number of teeth extracted on account of caries and the number of remaining teeth. A test group of 46 children treated with fluoride varnish in which a complete radiological examination could be carried out before and after the experimental period and which was treated with fluoride varnish was compared with a similar group of 27 children, which was not treated with fluoride varnish. The differences in caries increments were small, less than 15%, and were not significant. Taking into consideration the great variation between the schools it was concluded that the cariostatic effect of Duraphat application twice yearly in the primary dentition of these children was slight.     

Caries prevention with fluoride varnish in a socially deprived community

It has been suggested that specific preventive programs be developed for children with high caries risk. One possibility is to consider whole classes in socially deprived schools as caries-risk groups and perform an intensified preventive program for the entire class. OBJECTIVE: The purpose of this study was to evaluate the effectiveness of such a program which includes the application of a fluoride varnish (Duraphat). METHODS: The application of the varnish was offered three to four times a year in a community with low socio-economic status and a generally high caries level. Two hundred and sixty-nine children in six primary schools of Linden/Limmer, a district in Hannover, Germany, were allocated to a test or a control group. The test group received the fluoride varnish for 4 years whereas the control group received no professional fluoride application. DMFT was recorded at the beginning of the study and after 4 years. RESULTS: At the end of the study, children who had received a minimum of two fluoride applications per year showed a significantly lower caries increment in comparison with the control group (0.88 DMFT vs 1.39 DMFT, P < 0.05). CONCLUSIONS: It can be concluded that a minimum of two applications of the fluoride varnish Duraphat per year may be an effective measure in preventing caries in socially deprived children with high caries activity.     

Change in caries prevalence after implementation of a fluoride varnish program

Objective : In 1996 the caries prevalence of schoolchildren living in Neukölln, a district of Berlin, Germany, was higher than the mean of total Berlin. Hence, a special preventive program including the application of fluoride varnish was initiated. All 49 primary schools of the district joined the project. The aim of the present study was to evaluate in a cross‐sectional study whether the preventive program resulted in a reduced caries prevalence. Methods : The complete program included oral health education as well as the application of a highly concentrated fluoride varnish (Duraphat®). All children whose parents' consent was given could receive fluoride varnish twice a year. All children were examined once a year by four calibrated dentists. The baseline examination was conducted in 1995–96, the final examination in 1999–2000 (1995–96: n= 7,748; 1996–97: n= 15,673; 1997–98: n= 19,362; 1998–99: n= 19,822; 1999–2000: n= 17,984). Results : A total of 80,589 dental records were used for data analysis. A decline of DMFT‐values was observed in all age groups and school years. The major improvement was found in school year 1999–2000, when the program had been established for four years. Conclusion : The described program may be an effective public health measure for 6‐ to 12‐year‐old children with high caries prevalence.     

Three-year caries increments after fluoride rinses or topical applications with a fluoride varnish

251 9-12-yr-old children completed a 3-yr, double-blind, clinical trial of two caries preventive fluoride programs. Caries increments and progression patterns were compared in two groups of children who rinsed every fortnight with a 0.2% NaF solution or received biannual topical applications with a fluoride varnish (Fluor-Protector). Clinically recorded mean DFS increments were 3.3 +/- 0.2 (SE) in the rinse group and 3.5 +/- 0.2 in the varnish group. In both groups nearly half of these increments were recorded in the occlusal surfaces of second molars. The mean incremental DFS recorded radiographically on approximal surfaces of posterior teeth were 1.1 +/- 0.2 and 1.5 +/- 0.2 in the rinse and varnish group, respectively. None of the inter-group differences were statistically significant (P greater than 0.05). Detailed analyses of the radiographic scores revealed a similar and extremely slow caries progression in the two study groups and they strengthened the conclusion of equal clinical efficacy of the two treatments. None of the fluoride programs had been able to change preestablished patterns of caries development among the children.     

Caries incidence in permanent first molars after discontinuation of a school-based chlorhexidine-thymol varnish program

OBJECTIVES: To determine whether the cessation for 3 years of a 24-month program of chlorhexidine-thymol varnish applications would affect caries incidence in the first permanent molars of a population of schoolchildren of middle and lower-middle socioeconomic level. METHODS: Two groups of 6-7-year-old schoolchildren, randomized by school-class, were followed up in a clinical trial. One group received applications of chlorhexidine-thymol varnish every 3 months and the other group acted as controls. The program ended after 24 months and its effects were evaluated. Three years later, 55.5% of the schoolchildren were re-examined and the caries increments were documented. RESULTS: At the end of the 24-month program, the treated children had significantly fewer decayed and filled surfaces in permanent molars (lower DFS index) versus the controls. At 3 years after the discontinuation of the program, this difference had disappeared; there were no differences in the incidence of decayed, missing and filled surfaces (DMFS) index in permanent molars between the treated children and the controls. CONCLUSION: The cessation for 3 years of a 3-month program of chlorhexidine-thymol varnish applications resulted in a nonsignificant increase in the prevalence of dental caries in the permanent first molar.     

Three-year study of the effect of fluoride varnish (Duraphat) on proximal caries progression in teenagers

Abstract – The effect of sodium fluoride varnish (Duraphat) applications on proximal caries progression was studied during a 3-yr period in 87 teenagers and compared to a control group (n= 107). In the fluoride varnish group the children were treated with fluoride varnish every third month during the experimental period. Caries lesions on the mesial surfaces of first premolars to the mesial surfaces of second molars were recorded annually on radiographs and an individual progression value was calculated. The study showed that topical application of fluoride varnish every third month significantly (p<0.05) reduced the progression of proximal caries lesions in premolars and molars. The most obvious reduction of caries progression was observed among children who developed between two and eight new proximal lesions during the test period. In the children with the highest caries activity (> nine new proximal lesions) Duraphat treatments did not significantly reduce proximal caries progression in premolars and molars.