Effects of silver diamine fluoride on dentine carious lesions induced by Streptococcus mutans and Actinomyces naeslundii biofilms

BACKGROUND. Silver diamine fluoride (SDF) has been shown to be a successful treatment for arresting caries. However, the mechanism of SDF is to be elucidated. AIM. To characterize the effects of SDF on dentine carious induced by Streptococcus mutans and Actinomyces naeslundii. DESIGN. Thirty-two artificially demineralized human dentine blocks were inoculated: 16 with S. mutans and 16 with A. naeslundii. Either SDF or water was applied to eight blocks in each group. Biofilm morphology, microbial kinetics and viability were evaluated by scanning electron microscopy, colony forming units, and confocal microscopy. The crosssection of the dentine carious lesions were assessed by microhardness testing, scanning electron microscopy with energy-dispersive x-ray spectroscopy and Fourier transform infrared spectroscopy. RESULTS. Biofilm counts were reduced in SDF group than control (P < 0.01). Surfaces of carious lesions were harder after SDF application than after water application (P < 0.05), in S. mutans group, Ca and P weight percentage after SDF application than after water application (P < 0.05). Lesions showed a significantly reduced level of matrix to phosphate after SDF treatment (P < 0.05). CONCLUSION. Present study showed that SDF posses an anti-microbial activity against cariogenic biofilm of S. mutans or A. naeslundii formed on dentine surfaces. SDF slowed down demineralization of dentine. This dual activity could be the reason behind clinical success of SDF.     

Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool children

ObjectiveTo compare the effectiveness of annual topical application of silver diamine fluoride (SDF) solution, semi-annual topical application of SDF solution, and annual application of a flowable high fluoride-releasing glass ionomer in arresting active dentine caries in primary teeth.MethodsA total of 212 children, aged 3–4 years, were randomly allocated to one of three groups for treatment of carious dentine cavities in their primary teeth: Gp1-annual application of SDF, Gp2-semi-annual application of SDF, and Gp3-annual application of glass ionomer. Follow-up examinations were carried out every six months to assess whether the treated caries lesions had become arrested.ResultsAfter 24 months, 181 (85%) children remained in the study. The caries arrest rates were 79%, 91% and 82% for Gp1, Gp2 and Gp3, respectively (p = 0.007). In the logistic regression model using GEE to adjust for clustering effect, higher caries arrest rates were found in lesions treated in Gp2 (OR = 2.98, p = 0.007), those in anterior teeth (OR = 5.55, p < 0.001), and those in buccal/lingual smooth surfaces (OR = 15.6, p = 0.004).ConclusionAnnual application of either SDF solution or high fluoride-releasing glass ionomer can arrest active dentine caries. Increasing the frequency of application to every 6 months can increase the caries arrest rate of SDF application.Clinical significanceArrest of active dentine caries in primary teeth by topical application of SDF solution can be enhanced by increasing the frequency of application from annually to every 6 months, whereas annual paint-on of a flowable glass ionomer can also arrest active dentine caries and may provide a more aesthetic outcome.     

Silver Diamine Fluoride Protocol for Reducing Preventable Dental Hospitalisations in Victorian Children

IntroductionThis study was designed to assess whether a dental caries management protocol combining a single application of 38% silver diamine fluoride (SDF) with comprehensive oral health education will successfully divert high-risk children from dental treatment under dental general anaesthesia (DGA), arrest active caries in primary teeth, and improve parent-reported child oral health–related quality of life (OHRQoL).MethodsChildren aged 2 to 10 years, who attended two public dental agencies in Victoria, Australia, and were unable to tolerate restorative treatments in the clinic setting, elected to participate in either a 38% SDF intervention protocol or, alternatively, referral for DGA. Follow-up examinations were completed at 6 months to assess caries progression, decayed missing filled tooth index, PUFA index (pulpal involvement, ulceration, fistula, abscess), DGA referral rates, and OHRQoL (Early Childhood Oral Health Impact Scale [ECOHIS]).ResultsOf the total sample, 89.5% of children (n = 102) [mean (SD) age, 4.1 (1.0) years] with 401 active carious lesions elected to participate in the 38% SDF protocol; 10.5% (n = 12) of parents opted for referral for treatment under DGA. The proportion of active caries subsequently arrested at follow-up (number of arrested lesions/number of lesions treated) was 0.78 (95% CI, 0.69 to 0.87). There was an 88% reduction in referrals for DGA in eligible children over the 6-month period. The 38% SDF intervention group showed a significant improvement in ECOHIS scores at follow-up (P < .001).DiscussionAdoption of the 38% SDF intervention protocol resulted in a significant reduction in the rate of preventable dental hospitalisations. Most parents opted against referral for DGA. Parent-reported OHRQoL for children improved significantly.     

Efficacy of diode laser application versus silver diamine fluoride (SDF) as a modification of Hall technique in primary teeth

BackgroundThe Hall technique is a new technique aimed at depriving bacteria of any substrate, thereby limiting the progression of caries. Silver diamine fluoride (SDF) and diode laser are documented to have an antibacterial effect on carious enamel and dentin by eradicating bacteria such as Streptococcus mutans.AimThe current study aimed to increase the success rate of the Hall technique in carious primary molars by eradicating bacteria present in carious lesions using SDF or diode laser in combination with the Hall technique.Materials and methodsA total of 159 children aged 4–8 years were randomly divided into three equal groups: Group I, application of the Hall technique; Group II, SDF with Hall technique; Group III, diode laser with Hall technique. Children were recalled at regular intervals over a year. Results: At the end of the follow-up period, Group III showed the highest clinical success rate (94.3 %), followed by Group II (96.2 %), while Group I showed the lowest clinical and radiographic success rates (88.7 % and 86.8 %, respectively); however, these differences were statistically non-significant.ConclusionTreatment of carious lesions using SDF or Diode Laser increased the success rate of the Hall technique in primary teeth.     

Orthodontic bonding to porcelain: A systematic review

Objective:To use a systematic review to determine which materials and technique/protocol present the highest success rate in bonding brackets to porcelain surfaces.Materials and Methods:Different databases were searched without limitations up to July 2013. Additionally, the bibliographies of the finally selected articles were hand searched to identify any relevant publications that were not identified earlier. In vitro and in vivo articles were included.Results:No in vivo articles were found that fulfilled the inclusion criteria. A total of 45 in vitro articles met all inclusion criteria. They were published between 2000 to July 2013.Conclusions:The best protocol described in this review is the etching of 9.6% hydrofluoric acid for 1 minute, rinsed for 30 seconds, and then air-dried. The etching of hydrofluoric acid should be followed by an application of silane. Considering the harmful effects of etching with hydrofluoric acid, another appropriate suggestion is mechanical roughening with sandblasting followed by an application of silane.     

Controlling caries in exposed root surfaces with silver diamine fluoride: A systematic review with meta-analysis

Background

In this systematic review, the authors aim to assess the effect of silver diamine fluoride (SDF) in preventing and arresting caries in exposed root surfaces of adults.

Evaluating YouTube as a Patient Information Source for the Risks of Root Canal Treatment

IntroductionYouTube is one of the most used social media platforms for health care information. Misinformation and poor educational content on this platform can exacerbate public anxiety and fear of root canal treatment. This study aimed to investigate the quality of videos examining risks of root canal treatment on YouTube.MethodsYouTube was searched using a combination of keywords relating to endodontic complications to replicate goal-orientated browsing. Video quality was assessed using a modified DISCERN score and global quality score by 2 authors independently. Manifest quantitative content analysis was used to capture information about the video and extent of interactions. The 10 most viewed videos were further analyzed in terms of the messaging and format of the videos.ResultsThe mean overall quality of the videos was relatively low (2.20). Videos produced by regulatory bodies had the highest mean score (3.00) and the shortest mean length (2 minutes 23 seconds) but had the fewest views and interactions. The poorest quality videos (mean 1.5) were produced by nonclinicians and news/media, which tended to be longer (mean 8 minutes 49 seconds) and received more engagement. Across all videos, information related to patient decision making tended to be poorly presented.ConclusionsThe dental community, particularly institutions and organizations, need to strategically create engaging videos to redress patients’ concerns about root canal treatment. This can counterbalance the existing misleading information and improve access to evidence-based content, which will ultimately affect patient decision making.     

Twelve-month randomized controlled trial of 38% silver diamine fluoride with or without potassium iodide in indirect pulp capping of young permanent molars

BackgroundThe clinical and radiographic effectiveness of 38% silver diamine fluoride (SDF) with and without potassium iodide (KI) was tested and compared with resin-modified glass ionomer cement (RMGIC) in indirect pulp capping of deep carious lesions in young permanent molars.MethodsOne hundred eight permanent first molars with deep occlusal cavitated carious lesions in 49 children aged 6 through 9 years were randomly allocated into 3 groups (n = 36 molars per group) and treated with SDF plus KI, SDF, and RMGIC. RMGIC was used as a base and a resin-based composite restoration followed. Clinical assessments for secondary caries (primary outcome), postoperative pain, tooth vitality, and restoration success and quality rates according to Modified US Public Health Service and Ryge Criteria for Direct Clinical Evaluation of Restorations were performed after 3, 6, and 12 months. Periapical radiographs were obtained at baseline, 6 months, and 12 months. Outcomes were assessed using mixed effects multilevel logistic and linear regression analyses.ResultsThere were no significant differences (P = .26) among the groups at all times for secondary caries, postoperative pain, tooth vitality, clinical abscess, radiographic signs of pulpal pathology, restorations’ marginal adaption, anatomic form, and surface roughness. There was a significant difference (P = .03) in restoration color, marginal staining, and luster. The RMGIC group outperformed the 2 SDF groups in color and luster.ConclusionsThe authors did not find differences among the groups in preventing secondary caries or pain or in maintaining pulpal health. The RMGIC group had better restoration color and luster than both SDF groups and better marginal staining than the SDF group.Practical ImplicationsThe results of this study can help guide treatment decision making regarding use of SDF and SDF plus KI as indirect pulp capping materials in deep cavitated lesions.This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04236830.     

Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school children

Untreated dental caries in Chinese pre-school children is common. This prospective controlled clinical trial investigated the effectiveness of topical fluoride applications in arresting dentin caries. Three hundred seventy-five children, aged 3-5 years, with carious upper anterior teeth were divided into five groups. Children in the first and second groups received annual applications of silver diamine fluoride solution (44,800 ppm F). Sodium fluoride varnish (22,600 ppm F) was applied every three months to the lesions of children in the third and fourth groups. For children in the first and third groups, soft carious tissues were removed prior to fluoride application. The fifth group was the control. Three hundred eight children were followed for 30 months. The respective mean numbers of arrested carious tooth surfaces in the five groups were 2.5, 2.8, 1.5, 1.5, and 1.3 (p < 0.001). Silver diamine fluoride was found to be effective in arresting dentin caries in primary anterior teeth in pre-school children.     

Prevalence of demarcated hypomineralisation defects in second primary molars in Iraqi children

International Journal of Paediatric Dentistry 2013; 23: 48–55 Background. Demarcated hypomineralization lesions are not uncommon in second primary molars. Data on the prevalence of hypomineralized second primary molars (HSPM) are scarce. Aim. To investigate the prevalence of HSPM, assess the relationship between HSPM and first permanent molars previously diagnosed with demarcated lesions and to determine the severity of HSPM in relation to dental caries severity. Design. A cluster sample of 809, 7‐ to 9‐year‐old children was examined. The scoring criteria proposed by the European Academy of Paediatric Dentistry for hypomineralization in permanent dentition were adapted to score HSPMs. The International Caries Detection and Assessment System was used to assess caries status in the second primary molar of the children diagnosed with demarcated defects. The examination was carried out in schools by a calibrated dentist. Results. Of the children examined, 53 (6.6%) had hypomineralization defects in at least one second primary molar. Combinations of affected first permanent and second primary molars were reported in 21 (39.6%) of cases. Severe carious lesions were found mostly in teeth with enamel breakdown. Conclusions. The prevalence of HSPM was 6.6%. Over one‐third of affected second primary molars were associated with demarcated lesions in the first permanent molars. The chance of severe caries increased with the increase in the demarcated lesion severity.     

An ex vivo study of arrested primary teeth caries with silver diamine fluoride therapy

Objectives

This ex vivo study compared the physico-chemical structural differences between primary carious teeth biannually treated with silver diamine fluoride (SDF) and carious teeth without such treatment.

Method

Twelve carious primary upper-central incisors were collected from 6-year-old children. Six teeth had arrested caries after 24-month biannual SDF applications and 6 had active caries when there was no topical fluoride treatment. The mineral density, elemental contents, surface morphology, and crystal characteristics were assessed by micro-computed tomography (micro-CT), energy-dispersive X-ray spectrometry (EDX), scanning electron microscopy (SEM), and transmission electron microscopy (TEM).

Results

Micro-CT examination revealed a superficial opaque band approximately 150 μm on the arrested cavitated dentinal lesion. This band was limited in the active carious lesion. EDX examination detected a higher intensity of calcium and phosphate of 150 μm in the surface zone than in the inner zone, but this zone was restricted in the active cavitated dentinal lesion. SEM examination indicated that the collagens were protected from being exposed in the arrested cavitated dentinal lesion, but were exposed in the active cavitated dentinal lesion. TEM examination suggested that remineralised hydroxyapatites were well aligned in the arrested cavitated dentinal lesion, while those in the active cavitated dentinal lesion indicated a random apatite arrangement.

Conclusions

A highly remineralised zone rich in calcium and phosphate was found on the arrested cavitated dentinal lesion of primary teeth with an SDF application. The collagens were protected from being exposed in the arrested cavitated dentinal lesion.

Clinical significance

Clinical SDF application positively influences dentine remineralisation.     

YouTube as a source of information about orthodontic clear aligners

ObjectivesTo evaluate the content, reliability, and quality of videos about orthodontic clear aligners on YouTube.Materials and MethodsResearchers used the Google Trends website to determine that the most frequently used search term for orthodontic clear aligners on the Internet was: “Invisalign.” A search was then conducted on YouTube using the key word “Invisalign.” From the first 140 results, 100 videos were selected for analysis. A 13-point content score was used to classify poor-content and rich-content videos, and the global quality scale (GQS) was used to examine quality of the videos. To evaluate reliability of the information, a five-question scale was used. The Mann-Whitney U-test, χ² test, and Pearson correlation coefficients were used for statistical evaluations.ResultsOf the YouTube videos, 33 were classified as rich content and 67 as poor content. Most videos (73%) were uploaded by laypeople, and most uploaders (71%) were women. The most commonly discussed content was instructions (65%), followed by procedure (57%) and pain (52%). Regarding the GQS, most of the videos were evaluated as moderate quality (51%). Compared with the poor-content video group, the rich-content video group had a significantly higher GQS score (P = .004). There was no significant difference between the poor-content and rich-content groups regarding information reliability (P > .05).ConclusionsVideo content on YouTube relating to aligner orthodontics was generally insufficient. The quality of videos was moderate, but the reliability of information was generally poor. Specialists should refer patients to reliable sources of information.     

非创伤性修复与乳牙龋病治疗的研究现状

非创伤性修复治疗（Atraumatic Restorative Treatment, ART）是指使用手用器械清除软化的、完全脱矿的龋坏牙体组织,然后用有粘接性的口腔修复材料充填龋洞,并同时封闭容易患龋的点隙窝沟的一种治疗方法,其常用的具有代表性的材料之一为富士IX玻璃离子水门汀（GIC富士IX）。氟化氨银（Silver Diamine Fluoride, SDF）是一种银基龋病预防材料,在龋病预防技术（Arrest of Caries Technique, ACT）起着至关重要的作用。ART是当前龋病治疗的微创技术之一、GIC富士IX为ART的代表性材料、SDF能增加ART的成功率,这三者与龋病治疗之间有密切的联系。本综述的目的是建立一个由ART、GIC富士IX、SDF组成的牙本质龋双层修复系统。     

Combined CPP-ACP and photoactivated disinfection (PAD) therapy in arresting root surface caries: a case report

A 19-year-old male was referred to the School of Dentistry, University of Queensland for management and treatment of uncontrolled root caries. A total of 12 teeth had non-cavitated root carious lesions requiring treatment. The lesions were treated with a daily application of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP; GC Tooth Mousse) and in-surgery photo-activated disinfection (PAD). Laser fluorescence (KaVo Diagnodent) was used to monitor the changes in the carious lesions. The combination of CPP-ACP and PAD proved to be very effective and holds great potential as a recommended treatment for stabilising root surface caries in the clinical practice.     

Nonrestorative Caries Treatment: A Systematic Review Update

Caries is the most prevalent chronic noncommunicable disease. Strategies to prevent its onset and early interventions to arrest the progression of early lesions have been emphasised throughout recent decades to avoid or delay the restorative spiral of the tooth. More individuals are retaining their natural teeth into old age, thereby necessitating ongoing restorative dentistry intervention for their maintenance. The aim of this systematic review was to update the state of the art regarding clinical studies reporting the effectiveness of different nonrestorative caries treatment options in the 5-year period from 2017 to 2022. Relevant articles were retrieved from 2 electronic databases, including randomised clinical trials (RCTs) published from January 2017 until April 2022, assessing effectiveness and secondary effects of at least one nonrestorative caries treatment option, carried out with adults and/or children with noncavitated or cavitated carious lesions on either primary or permanent teeth and diagnosed by radiographs or visual/tactile assessment. All 35 included articles presented the results of RCTs with a follow-up period ranging from 6 to 84 months. Most of these studies were considered high-quality articles with a low risk of bias. Sealants and fluoride gels and varnishes were mentioned in 12 studies as effective strategies to prevent the onset of caries lesions and to arrest them in the early stages. Resin infiltration reported high caries arresting rates in noncavitated proximal lesions in 10 publications. Silver diammine fluoride presented high caries-arresting rates in open dentin lesions, both in primary and permanent dentitions as well as in root caries lesions that were accessible for cleansing. New evidence has been published between 2017 and 2022 as the result of numerous clinical studies providing further evidence of the effectiveness of nonrestorative caries treatment options.     

Evaluation of YouTube videos about smile design using the DISCERN tool and Journal of the American Medical Association benchmarks

Statement of problemYouTube contains many videos on health-related topics. “Smile Design” is one that is frequently searched on YouTube. Whether YouTube can be considered useful for patients seeking information on smile design is unclear.PurposeThe purpose of this study was to assess and validate the features of the most popular YouTube videos on smile design.Material and methodsIn September 2019, the keyword “smile design” was searched on YouTube in North America using a virtual private network (VPN). The top 100 videos in a constantly updated list were recorded. The DISCERN instrument (Quality Criteria for Consumer Health Information) and the benchmarks established by the Journal of the American Medical Association (JAMA) were used to evaluate these 100 videos. A spreadsheet (Excel v2016; Microsoft Corp) was used to process statistical data, calculated as mean and frequency.ResultsOf the 100 videos identified, some were excluded as duplicates (11), irrelevant (4), and not presented in English (7). No video met all the JAMA criteria. Adherence to authorship and currency principles was observed in each video, and those adhering to attribution and disclosure principles were categorized as “good.” The average DISCERN score for the 78 included videos was fair (39.6 points); all videos scored poor or fair—very poor, good, or excellent scores were not found.ConclusionsThe quality of information on YouTube videos relating to smile design was only fair. Patients should use smile design information found on YouTube with caution. When professionals upload a video to YouTube, they should use evaluation tools as a quality guide.     

氟化氨银和氟化钠涂料对乳牙龋治疗作用

目的 :观察 3 8mL/L氟化氨银液和 50mg/L氟化钠涂料对乳前牙龋的治疗作用。 方法 :来自 8所幼儿园的 3 75名 3～ 5岁患有上颌前牙龋的儿童参加了该项研究 ,他们被随机分配到 5个组。各组处理分别为去腐和每年涂布 1次氟化氨银 ;每年涂布 1次氟化氨银 ;去腐和每 3个月涂布 1次氟化钠 ;每 3个月涂布 1次氟化钠 ;涂布水。结果 :2 4个月后各组儿童上颌前牙平均静止龋牙面数分别为 3 .52、3 .54、1.93、1.95和1.67(P <0 .0 0 1)。结论 :1年 1次涂布 3 8mL/L氟化氨银对乳前牙龋有治疗作用 ,涂氟前是否去腐对治疗效果无影响