Paradigm shift in the effective treatment of caries in schoolchildren at risk

Background: Silver diamine fluoride (SDF) is an effective agent for the arrest of caries in children, is easy to apply and can be used outside the clinical environment. Interim restorative treatment (IRT) using glass ionomer cement has also been claimed to be a simple and effective method to arrest caries in deciduous teeth. Objective: To examine whether, for underprivileged schoolchildren with cavities, treatment with 30% SDF gives better results than IRT for carries arrest. Method: This randomised controlled study compares the effect of IRT (FUJI IX) with 30% SDF in 91 children aged 5–6 years. Results: After 1 year, treatment with SDF was more effective [relative risk (RR) = 66.9%] than IRT (RR = 38.6%) for the arrest of caries; this was statistically significant (P < 0.05). Conclusion: The SDF technique showed better results than IRT for the arrest of cavities in deciduous teeth, indicating that its use for underprivileged communities may justify a paradigm shift in paediatric dentistry.     

Parental perceptions and acceptance of silver diamine fluoride staining

Background

The caries arrest that can be achieved by using silver diamine fluoride (SDF) offers a minimally invasive and inexpensive alternative to traditional restorative caries treatment. The authors evaluated how the dentinal staining that is associated with SDF influences the acceptance of this treatment among parents of young children in the New York City metropolitan area.

Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial

We hypothesized that the six-monthly application of silver diamine fluoride (SDF) can arrest the development of caries in the deciduous dentition of six-year-old schoolchildren and prevent caries in their first permanent molars. A prospective controlled clinical trial was conducted on the efficacy of a 38% SDF solution for caries reduction. Four hundred and twenty-five six-year-old children were divided into two groups: One group received SDF solution in primary canines and molars and first permanent molars every 6 mos for 36 mos. The second group served as controls. The 36-month follow-up was completed by 373 children. The mean number of new decayed surfaces appearing in primary teeth during the study was 0.29 in the SDF group vs. 1.43 in controls. The mean of new decayed surfaces in first permanent molars was 0.37 in the SDF group vs. 1.06 in controls. The SDF solution was found to be effective for caries reduction in primary teeth and first permanent molars in schoolchildren.     

An alternate technique of care using silver fluoride followed by stannous fluoride in the management of root caries in aged care

An alternate technique of care to prevent, arrest and manage root caries using aqueous silver fluoride followed by stannous fluoride (AgF+SnF₂) in aged care is demonstrated by three case studies. With increasing age, the inability to maintain ones own oral care from dementia, illness or frailty and polypharmacy induced salivary gland hypofunction will result in dental caries becoming a progessively greater burden for the elderly. Future generations of elders will live longer and need to maintain many more teeth longer than earlier generations. Both silver diamine fluoride (SDF)and AgF+SnF₂ arrest and prevent caries and are easy to use in residential aged care facilities. Clinical differences between SDF and AgF+SnF₂ are discussed. However, in aged care, AgF+SnF₂ may offer advantages over SDF. AgF+SnF₂ used to arrest and prevent caries in children can be modified to provide effective but minimally invasive care for an ageing and frail population. These techniques are rapid, inexpensive and nonthreatening suited to treat frail elders, dementia patients exhibiting challenging behaviours and patients with multiple rapidly progressing decay. Silver fluoride, applied before placing glass‐ionomer cement (GIC) restorations is an important adjunct to the atraumatic restorative technique and may retard caries reactivation more than GIC used alone.     

Silver Diamine Fluoride: Extending the spectrum of Preventive Dentistry,a literature review

Dental caries continues to be a severe oral health problem despite a decrease in its prevalence over the past few decades. The contemporary philosophy of caries management has shifted from the traditional approach to a newer medical one, that frequently includes utilization of fluoridated and antimicrobial agents. Among these different agents, Silver Diamine Fluoride (SDF)¹ has gained significant recognition. Dr Nishino and Dr Yamaga in Japan, pioneered its application to arrest caries. It is an alkaline, colourless solution composed of diamine-silver and fluoride ions having silver's antibacterial and fluoride's remineralising property. It has been used successfully to arrest and prevent caries in deciduous and permanent teeth, prevent recurrence of secondary caries and treat dentinal hypersensitivity. No adverse systemic effects due to SDF have been noted although black discolouration following its application has raised concerns. When used wisely it is an effective, sustainable and inexpensive option for children with high caries risk, for individuals who cannot endure conventional modalities of restorative treatment and those with special health-care needs. The current review is an insight into the clinical significance and application of SDF based on published literature.     

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.     

二硅酸锂铸瓷牙合贴面在牙列重度磨耗修复中的临床应用

［摘要］ 目的 评价二硅酸锂铸瓷后牙牙合贴面的临床效果。方法 对12例160颗重度磨耗前磨牙和磨牙用二硅酸锂铸瓷进行牙合贴面修复,观察3年,按照美国公共卫生服务修正标准对修复体的颜色匹配、边缘着色、修复体折裂、继发龋及边缘适合度等进行评价。结果 后牙牙合贴面中95.62%的颜色为A级,93.75%的修复体无边缘着色,98.13%的修复体完好无损,所有修复体中没有发现继发龋,95%的修复体边缘适合度为A级。结论 二硅酸锂铸瓷后牙牙合贴面近期临床修复效果优良。     

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.     

Factors modulating parental acceptance of SDF treatment

ObjectivesTo assess the degree of parental acceptance of SDF treatment on their children's carious teeth and to explore different factors affecting their decisions.MethodsParents of healthy children younger than 12-year-old of both gender were asked to fulfill a questionnaire describing their perspective of Silver Diamine Fluoride SDF treatment and different factors that could modify their opinion as sociodemographic characteristics, tooth location, type of dentition, advanced management techniques as well as dental caries management during- and post-COVID pandemic. Participants’ responses were categorized according to the three-Point Likert scale as acceptable, neutral, and not acceptable. Fisher test was used to test for significant factors affecting parental acceptance of SDF treatment. The level of significance was tested at 0.05 using SPSS program.ResultsA total of 158 parents participated in this study. The parental acceptance of SDF treatment was found to be limited to 31.6%. The SDF acceptance rate increased significantly if SDF was used on posterior teeth, on deciduous dentition, prior to shifting to conventional restoration under general anesthesia, and to minimize chances for cross-infection particularly during- and after the recovery from the COVID pandemic.ConclusionsSDF treatment on posterior teeth and deciduous dentition was found to be more accepted by the parents than anterior and permanent teeth. Although a majority of parents reported restricted SDF treatment acceptance, most parents were willing to compromise the esthetic dilemma as they understand the risks of alternative interventions.Clinical significanceDentists are encouraged to adopt SDF treatment and offer it for their patients and caregivers prior to shifting to advanced dental management techniques particularly during and following the COVID era. The dentist must provide an informed consent form, which includes clear photographs showing expected staining, especially when treating anterior teeth.     

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.

Silver diamine fluoride and glass ionomer differentially remineralize early caries lesions,in situ

Objectives

The aim of the present study was to evaluate the percent mean mineral density (MD) change of early caries lesions after the application of silver diamine fluoride (SDF) or glass ionomer cement (GIC).

Materials and methods

This double-blind, crossover study involved two experimental phases of 28 days each. Thirty-two pairs of enamel slabs were created from the proximal surfaces of 16 premolars. Each pair of artificial carious slabs was randomly divided into the control or test group (38 % SDF or GIC). The slabs were attached to orthodontic brackets and bonded to the maxillary first permanent molars of 16 subjects for 28 days. After a 7-day washout period between phases, the subjects received the other material for the second phase. The mean MD of the lesions was measured by microcomputed tomography.

Results

SDF yielded a percent mean MD increase at a depth of 0–84 μm, although increase in the GIC group was observed at a depth of 24–108 μm. The percent mean MD changes of the SDF and GIC groups were similar (p?=?0.100) and significantly higher than in control (p?<?0.001, p?=?0.003, respectively).

Conclusions

The two materials increased the percent mean MD change of early proximal caries lesions to a similar extent, but with different spatial patterns.

Clinical relevance

Due to deeper level of GIC remineralization, the refractive index of the GIC applied enamel might be closer to sound enamel. Hence, GIC is recommended for remineralization of anterior teeth. SDF staining makes it unsuitable for use in anterior teeth; thus, it is reserved for use in posterior teeth.

     

Association of dental caries and weight status in 6- to 7-year-old Filipino children

Objectives

The aims of the study were (1) to assess in 6- to 7-year-old Filipino children caries prevalence and experience and the weight status and (2) to investigate the association between dental caries and weight status.

Materials and methods

Dental and anthropometric examinations were conducted on 1,962 6- to 7-year-old children during the National Oral Health Survey in 2005–2006. Dental caries assessments were carried out using World Health Organisation (WHO) criteria (1997). Weight status was assessed with body mass index according to WHO growth reference. A multivariable logistic regression model was applied to investigate the effect of dental caries and sociodemographic variables on the children’s weight status.

Results

Caries prevalence was 96.8 % in primary and 39.7 % in permanent teeth, and caries experience was 8.4 dmft and 0.6 DMFT. Of the children, 17.8 % were underweight, 73.0 % had normalweight, 6.0 % were overweight and 3.2 % were obese. Girls had a lower risk of being underweight than boys odds ratios (OR) 0.70, confidence interval (CI) 0.55–0.88. Children living in rural areas and with no television at home were more likely to be underweight (OR 1.36, CI 1.07–1.72; OR 1.37, CI 1.07–1.76, respectively). Fewer primary and permanent teeth were risk factors for being underweight (OR 0.93, CI 0.92–0.95; OR 0.90, CI 0.89–0.94, respectively).

Conclusions

Underweight was associated stronger with demographic and socioeconomic conditions than with dental variables. However, underweight and dental caries are public health issues of high priority affecting children at an important phase of their development.

Clinical relevance

Definite conclusions upon an association between dental caries and weight status in high caries risk schoolchildren cannot be drawn.     

Longevity of composite restorations in patients with early childhood caries (ECC)

Objectives

The aim of this retrospective study was to describe the type and extent of composite fillings in a high risk pediatric caries population and analyze restoration survival probability in relation to severity of decay, Black classification, and composite type.

Materials and methods

A total of 1,017 fillings in 855 primary teeth performed under general anesthesia from 2004–2007 were included into this study. All 157 patients had early childhood caries after the classification of Wyne and were recalled for at least 6 months. A total etch adhesive system, in combination with flowable and/or packable composites, was used. Failures were evaluated according to clinical criteria. Survival probability was calculated using Kaplan–Meier survival analysis.

Results

The mean observation period for restorations was 30.9 months, with a success rate of 81.5 %. In 125 cases, restorations failed after an average retention time of 23.6 months, resulting in an annual failure rate of 4.2 %. The reasons for failure were fracture or partial failure (9.6 %), secondary caries (44 %), or complete restoration loss (46.4 %). Fillings in patients with severe decay had significantly lower survival probabilities. No significant differences were found between flowable and packable composites.

Conclusions

Composite fillings are a long lasting, high-quality treatment option in pediatric patients with a high risk of caries who are treated under general anesthesia. A strict caries prevention regimen should be followed to minimize the loss of restorations caused by secondary caries.

Clinical relevance

Composite fillings are a long lasting, high-quality treatment option in children with early childhood caries treated under general anesthesia.     

Silver Diamine Fluoride: Transforming Community Dental Caries Program

IntroductionUntreated dental caries is the most frequent childhood chronic disease worldwide. Silver diamine fluoride (SDF) offers a safe and effective alternative treatment, especially for children.ObjectiveTo inform the dental community about the efficacy of SDF in community dental caries programs and to advocate for its use as an affordable and equitable approach to promote health and well-being within the dental setting.MethodsA summary of the literature shared during a webinar about the use and efficacy of SDF in community dental programs hosted by the Oral Health Working Group of the World Federation of Public Health AssociationsResultsBased on the traditional “drill-and-fill” approach, the current treatment for severe caries is associated with pain, fear, and poor oral health outcomes in later life. Innovative approaches to prevent and control caries are needed. SDF offers an alternative treatment option for caries. It is a practical, affordable, and acceptable option for caries treatment, eliminating the need for general anaesthetic in young children, and improving long-term oral health outcomes.ConclusionSDF can improve oral health outcomes for community members, especially for individuals from low-socioeconomic settings.     

Caries diagnosis using light fluorescence devices in comparison with traditional visual and tactile evaluation: a prospective study in 152 patients

The objective of the study was to evaluate the in vivo effectiveness of two fluorescence techniques (DIAGNOdent and VistaProof) and of visual and tactile evaluation in the diagnosis of occlusal caries in permanent teeth. A total of 302 teeth (molars and premolars) from 152 patients were studied. The occlusal surfaces were cleaned using pumice mixed with water, followed by application of the diagnostic methods according to the instructions of the manufacturer, and of the visual and tactile methods according to the recommendations. The true extent of the lesions was determined by fissurotomy. The sensitivity and specificity of visual diagnosis were 79 and 72 %, respectively, versus 53 and 98 % in the case of tactile diagnosis. Teeth with caries lesions exhibited significantly higher DIAGNOdent and VistaProof scores than those without caries. Using the optimum cutoff point of 23.5 obtained in our study for DIAGNOdent, sensitivity and specificity were found to be 92.4 and 92.7 %, respectively, while values of 88.1 and 95.1 % were obtained with a cutoff point of 28.5. Sensitivity in the case of the VistaProof system varied between 92.9 % (cutoff point 1.05) and 85.3 % (cutoff point 1.3), with respective specificity values of 95.8 and 88.6 %. The areas under the curve were 0.756, 0.759, 0.954 and 0.965 for the visual and tactile methods and for DIAGNOdent and VistaProof, respectively. The fluorescence-based techniques showed greater internal and external validity than the visual and tactile methods in diagnosing occlusal caries in permanent teeth. VistaProof is the best method for diagnosing caries in its early stages.     

A cohort study on prevalence of dental caries concerning primary schoolchildren in one village of Niigata Prefecture

To review the previous preventive measures against the incidence of dental caries in children, we started to examine the state of dental health in children at the age of 18 months. The annual dental examination continued up to 12 years of age (sixgraders). Enrolled in this study were a total of 225 children living in a Town T and born between 1980 and 1982. Meanwhile, we made surveys in order to gauge the degree to which the subjects and their parents have concern for oral health. The findings and their relationships to the caries incidence were analyzed using an epidemiological technique. The annual dental examinations revealed that in primary dentition the incidence of caries tends to increase in 3-year-olds while in permanent dentition the carious process extends in 4–6 graders. By kind of teeth, primary molars accounted for 52% of the affected deciduous teeth. First molars made up 72% of all the decayed permanent teeth. Using the two caries cumulative indexes developed by our department for recording the prevalence and severity of tooth decay in the deciduous dentition and in the permanent dentition, respectively, we found that there is a correlation between the incidence of caries in the deciduous dentition and that in the permanent teeth. The two formulae are based on the cumulative number of decayed teeth that appeared in the deciduous dentition and permanent dentition for a given period of time. In order to find whether there is any correlation between caries attack and attention paid to the risk factors, we divided the subjects into two groups by the number of decayed teeth per person. In the group made up of those with many carious teeth, it was noted that between-meal snacks are most likely to produce caries in deciduous teeth, while lifestyle affects permanentteth.

     

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。     

Oral health literacy and associated oral conditions: A systematic review

Background

The authors systematically reviewed the scientific evidence regarding an association between oral health literacy (OHL) and oral conditions.

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.     

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.