A community-based caries control program for pre-school children using topical fluorides: 18-month results.

Dental caries in Chinese pre-school children is common, and restorative treatment is not readily available. This prospective controlled clinical trial investigated the effectiveness of topical fluoride applications in arresting dentin caries. We divided 375 children (aged 3-5 yrs) with carious upper anterior teeth into five groups. Children in the first and second groups received annual applications of silver diamine fluoride solution (44,800 ppm F). NaF varnish (22,600 ppm F) was applied every three months onto 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. We followed 341 children for 18 months. The mean numbers of new caries surfaces in the five groups were 0.4, 0.4, 0.8, 0.6, and 1.2, respectively (p = 0.001). The respective mean numbers of arrested carious tooth surfaces were 2.8, 3.0, 1.7, 1.5, and 1.0 (p < 0.001).     

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     

Microhardness of dentine in primary teeth after topical fluoride applications

OBJECTIVES: This study measured the microhardness of arrested dentinal caries on primary teeth receiving regular fluoride applications after 30 months. METHODS: Caries on primary upper anterior teeth of preschool children were randomly assigned to receive 38% silver diamine fluoride every 12 months or 5% sodium fluoride varnish every 3 months. Lesions that were hard on probing were considered arrested. At 30 months, very mobile teeth were extracted, sectioned, and polished and they underwent Knoop hardness number (KHN) measurements at sites below the surface at the center of the carious lesion every 25 microm toward the pulp. Three sets of measurements were made on parallel tracks approximately 150-200 microm apart, and the median KHN at each depth were analyzed. RESULTS: Five arrested and five soft carious lesions were examined. Within the outer 25-200 microm, the median KHN of arrested carious lesions (range, 20-46 or 196-451 MPa) were greater than those of soft carious lesions (range, 5-20, or 49-196 MPa). The difference between them, however, was not statistically significant. At a distance of 225 microm or more from the surface of the lesion, the median KHN of both groups were between 20 and 30 (196-294 MPa). CONCLUSIONS: The outermost dentinal surface of carious lesions that had been arrested by topical fluoride application was harder than that of active carious lesions. At a distance of 225 microm or more from the lesion surface, the microhardness of both arrested and soft dentinal caries was similar.     

Bayesian analysis of clustered interval-censored data

The recording of multiple interval-censored failure times is common in dental research. Modeling multilevel data has been a difficult task. This paper aims to use the Bayesian approach to analyze a set of multilevel clustered interval-censored data from a clinical study to investigate the effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting active dentin caries in Chinese pre-school children. The time to arrest dentin caries on a surface was measured. A three-level random-effects Weibull regression model was used. Analysis was performed with WinBUGS. Results revealed a strong positive correlation (0.596) among the caries lesions' arrest times on different surfaces from the same child. The software WinBUGS made the above complicated estimation simple. In conclusion, the annual application of silver diamine fluoride on caries lesions, and caries removal before the application, were found to shorten the arrest time.     

学龄前儿童乳牙局部加氟抑龋研究

目的 :利用局部加氟方法抑制乳上前牙龋病进展。方法 :选用同一生活区内有上前牙乳牙龋的 779名 3～6岁学龄前儿童 ,经基线检查、记录结束后 ,分成实验组和对照组。第一、二组每日氟水含漱 (0 .0 5 %) ,第三、四组每3个月一次含氟涂料涂布 ,其中第二、四组处理前去除软龋 ,1年后复查抑龋效果。结果 :各组抑龋牙面龋为 0 .91±1.88、1.0 2± 2 .11、2 .47± 1.90、2 .75± 1.90、0 .75± 2 .34。结论 :局部加氟抑龋效果确定 ,实施前是否去除龋坏组织对抑龋效果无明显影响。     

Slow-release devices for fluoride delivery to high-risk individuals

The latest fluoride research is investigating the use of slow-release devices for the long-term intra-oral provision of fluoride. 174 children aged 8 years with fluoride slow-releasing glass devices were shown to develop 67% fewer new carious teeth and 76% fewer new carious surfaces in a 2-year double-blind caries study. There were 55% fewer new occlusal fissure carious cavities showing that occlusal surfaces were also protected by the fluoride released from the devices. The fluoride devices release low levels of fluoride for at least 2 years and have great potential for use in preventing dental caries in high-caries-risk groups and irregular dental attenders in addition to a number of other applications.     

Pulp response in primary teeth with deep residual caries treated with silver fluoride and glass ionomer cement ('atraumatic' technique)

A bstract — Histological assessment of the dental pulps of 55 carious primary teeth was carried out 3 to 56 months after treatment by the 'atraumatic' technique involving application of 40 per cent silver fluoride to residual caries followed by restoration with glass ionomer cement. Fifty of the 55 teeth examined showed a favourable pulpal response, including presence of abundant reparative dentine and a wide odontoblast layer. Histological comparisons were made between these teeth and others not treated with silver fluoride but restored with glass ionomer cement, amalgam or zinc oxide and eugenol.
Possible mechanisms of the action of silver fluoride in arresting residual caries are discussed. The question of whether or not treatment of carious dentine with silver fluoride represents a biologically acceptable clinical procedure cannot be answered on the basis of pulpal histology alone. The very high concentration of fluoride in commercial preparations of silver fluoride raises several questions concerning its clinical safety.     

Clinical trial of a low-fluoride toothpaste for young children

In this double-blind trial, the anticaries effectiveness of a test toothpaste formulated for young children with 550 ppm F was compared with that of a positive control toothpaste containing 1055 ppm fluoride. More than 3000 2-year-old children were enrolled in the study and after 3 years of toothpaste use, 2177 (72 per cent) were examined. From a clinical and radiographic assessment, more than half the children were found to be caries free and only 32 (1.5 per cent) had evidence of rampant caries. There appeared to be little or no difference between children who had used test or control pastes, either in caries or in plaque levels. On the basis of this clinical trial the experimental toothpaste with 550 ppm fluoride would appear to have a similar anticaries efficacy to that of the control toothpaste. Differences were seen in relation to sex of the child and to social class. Girls had lower levels of plaque than boys but more carious teeth. Children from families in higher social classes had fewer carious teeth and lower levels of plaque.     

A dental caries severity index for primary teeth

Criteria for scoring the caries attack on each surface of an affected primary tooth are described. The score for each carious surface ranges from 1 to 3. The score per tooth is a sum of the surface scores. The caries severity index (csi) is the mean of the scores of all carious teeth in the population examined. Three groups of children aged 5-6.5 yr were examined. In Jerusalem, with a water fluoride concentration of 0.4 ppm, 54 children had a csi of 2.99 and a defs of 10.19. In a semirural African town, Soshanguva, with a 0.2 ppm fluoride concentration, 103 children had a csi of 3.10 and a defs of 5.75. In a nearby rural African area with a water fluoride concentration well above the optimum, 86 children had a csi of 1.93 and a defs of 1.99. Interexaminer and intraexaminer reproducibility of the csi were good. The csi expresses the severity of the caries attack on affected teeth and gives additional information to that of the def indices.     

Effect of fluoride on caries progression and dentin apposition in rats fed on a cariogenic or non-cariogenic diet

The effect of fluoride in drinking water on the progression of dentinal caries and dentin apposition was studied in Wistar rats. The initiation of enamel caries lesions was first induced for 2 wk with S. sobrinus and a 43% sucrose diet after weaning. Thereafter the animals were fed on either a cariogenic or a non-cariogenic diet and distilled water supplemented with 0, 1, 7 or 19 ppm fluoride. The areas of dentinal caries and dentin apposition were quantified after tetracycline staining. Fluoride reduced dentinal caries progression after the initiation of lesions in the presence of a cariogenic diet at a concentration of 19 ppm F, and without sucrose at 1 ppm F. The effect of fluoride in reducing dentin apposition with a cariogenic diet was dose-dependent, whereas fluoride in non-cariogenic groups had practically no effect on dentin formation. These results suggest that fluoride together with a high concentration of sucrose in the diet might have an odontoblast-mediated effect on the regulation of the progression of dentinal caries.     

氟,镧和铈联合应用对人牙根面龋的近期临床疗效观察

目的 观察镧，铈，氟联合应用对根龋的防龋效果。方法 分别联合应用含２０００ｐｐｍ氟镧和氟铈的凝胶液对１６４颗根龋患牙进行治疗，半年随访。结果 联合用药的防龋效果优于单独用药，结论联合应用镧，铈对氟对根龋具有潜在的防龋应用价值。     

Fluoride concentrations in enamel and dentin of primary teeth after pre- and postnatal fluoride exposure

The aim of this study was to determine any existing difference in the amount of fluoride incorporated in the surface, body enamel and dentin of two groups of deciduous teeth, either exposed to pre- and postnatal fluoride supplements or to postnatal fluoride only. One hundred and eighty five subjects with intact deciduous incisors were selected from a randomized, double blind study of the caries preventive efficacy of prenatal fluoride (F) supplementation. Surface and body enamel samples were obtained by the acid etch biopsy technique. Dentin microsamples were obtained by drilling to a depth of 100 microm using the microdrill biopsy technique. It was concluded that fluoride exposure during the prenatal period offered no additional measurable fluoride uptake by dental tissues other than that attributable to postnatal fluoride alone.     

A comparison of the anticaries effect on the primary dentition of two dentifrices containing 250 ppm and 1450 ppm fluoride

The purpose of the study was to compare the anticaries effects of two dentifrices containing sodium fluoride with fluoride concentrations of 250 ppm and 1450 ppm on the primary dentition of kindergarten children. A total of 319 children participated in the study (155 in the low-fluoride and 164 in the high-fluoride group) and brushed their teeth daily under supervision in their kindergartens. The children were examined by one dentist trained according to the procedures of O'Mullane et al., and carious lesions were recorded at the cavitation level according to the WHO criteria. At the final examination after 22 months, the groups comprised 83 (low-fluoride group) and 89 (high-fluoride group) children. The differences in mean dmfs and dmft increments between the two groups were not statistically significant. In both groups about 57% of the children remained caries free. Excluding these children from the analyses, the mean dmfs increment was significantly lower in the high-fluoride group, but not the mean dmft increment. The mean dmfs increment excluding occlusal surfaces was significantly lower in the high-fluoride group.     

Effect of fluoride on the rate of dentin apposition and caries progression in young and old Wistar rats

The effect of fluoride in drinking water on the progression of dentinal caries and dentin apposition was studied separately in young and old Wistar rats. The animals were inoculated with Streptococcus sobrinus and fed ad libitum on a 43% sucrose diet and distilled water supplemented with 0, 1, or 19 ppm fluoride. After a 7-wk (young) or 13-wk (adult) cariogenic challenge, the areas of dentinal caries and dentin apposition were quantified after tetracycline staining. Fluoride in the drinking water reduced the progression of dentinal caries and the speed of dentin formation in the young animals but only the progression of dental caries in the adult ones. Both the progression of carious lesions in the dentin and the rate of dentin apposition were 10 times faster during primary dentinogenesis.     

Comparison of the caries-preventive effect of a glass ionomer sealant and fluoride varnish on newly erupted first permanent molars of children with and without dental caries experience

Abstract

Purpose: This longitudinal clinic study evaluated the effect of a glass ionomer sealant (GIS) and a fluoride varnish (FV) in the prevention of dental decay on newly erupted permanent molars of children with and without caries experience. Materials and methods: Eighty children, aged 6–8 years, with all four newly erupted first permanent molars, were divided into two groups. Group 1 consisted of 53 children without caries experience and group 2 consisted of 27 children with dental caries experience. Permanent molars of the right side were sealed with GIS and the fluoride varnish was applied on the other two permanent first molars. Evaluation of GIS retention and the effectiveness of both materials in the prevention of dental caries were performed after 6, 12 and 18 months. Results: After 18 months, of the 299 teeth, 271 (91%) showed no caries lesions and 28 presented caries lesions (9%). Teeth sealed with GIS had more carious lesions (15) than teeth with fluoride varnish (13). Most of the teeth (70%) that presented carious lesions were in group 2. Of the 138 sealed teeth, only one showed GIS to be totally present, 95 were partially present and 42 teeth were absent. Conclusion: The caries-preventive effect was very similar between both treatments. The presence of dental caries prevailed in the children with caries experience.     

Evaluation of the anticaries benefit of fluoride toothpastes using an enamel insert model

The remineralization potential of fluoride toothpastes was studied using an in situ enamel insert model. Matched blocks of artificially demineralized human enamel were attached to partial dentures of 16 adult volunteers who brushed their teeth with either a toothpaste containing 1,500 ppm F or one containing 2,500 ppm F for a period of 6 weeks in a balanced, randomized crossover experiment. Computerized image analysis of microradiographs was used to measure the mineral density distribution in the enamel before and after in situ treatment. Both toothpastes demonstrated remineralization of artificial carious lesions. Significantly more remineralization was observed in enamel samples treated with the toothpaste containing 2,500 ppm F compared to that containing 1500 ppm F. This result is consistent with the outcome of a recent caries clinical trial testing the same toothpastes and finding enhanced anticaries efficacy from the higher fluoride level.     

The Efficiency of Semiannual Silane Fluoride Varnish Applications: a Two-year Clinical Study in Preschool Children

Objective : The aim of this two-year community demonstration trial was to study the caries inhibitory effects of semiannual applications of a fluoride varnish in preschool children. Methods : Twenty-four public dental health clinics in the county of Halland, Sweden, with 5,137 preschool children, 4 and 5 years of age, were matched and equally allocated to a fluoride varnish group ( n =2,535) and a reference group ( n =2,602). The children in the fluoride varnish group were treated every six months with topical applications of a silane fluoride varnish, Fluor Protector (0.1% F), while no fluoride varnish was used in the reference group. Both groups received a basic preventive program at annual checkups consisting of dietary counseling and instructions to parents to brush their children's teeth at least once daily with fluoridated dentifrice. Caries data were collected by clinical examinations at baseline and after one and two years. Results : Caries prevalence at baseline did not differ significantly between the groups. After two years, the mean caries incidence was low and no statistical difference was found in the total number of carious and filled surfaces (dfs) between the two groups. However, the incidence of approximal lesions (dfsa) was significantly lower ( P <.05) in the fluoride varnish group than the reference group. Children in the fluoride varnish group with dfs scores of 1–4 and ≥5 at the start of the study exhibited a statistically significant ( P <.05) reduction in approximal caries incidence of 19 percent and 25 percent, respectively, when compared with the reference group. Conclusion : Preschool children 4 and 5 years of age with clinical caries who receive semiannual applications of a silane fluoride varnish containing 0.1 percent F experience a reduced incidence of approximal caries over two years.     

The effects of 1% pyrophosphate and 0.02% sodium fluoride on artificial caries lesions in vivo

We evaluated the potential of a pyrophosphate-fluoride solution to affect the remineralizing-demineralizing equilibrium, i.e., caries-inhibiting/-promoting effects on enamel in vivo. Fifteen subjects carried dentin blocks and enamel thin sections with artificial caries lesions in removable partial dentures for periods of two weeks, during which time they rinsed twice daily in a double-blind, randomized cross-over design with solutions containing (a) 90 ppm F, (b) 90 ppm F and 1% pyrophosphate, or (c) no active agents (placebo). A severe cariogenic challenge provided to the lesions by plaque under a stainless steel mesh cover resulted in the placebo-treated lesions losing 70.2% +/- 72.1% mineral. The pyrophosphate rinse with fluoride held the mineral loss to only 28.1 +/- 52.8%, while the fluoride rinse without pyrophosphate held the loss to 24.2 +/- 50.1%. The differences between the fluoride and placebo results were significant (p less than 0.01), but the difference between the two fluoride groups was not. A large amount of fluoride was deposited in the dentin lesions. In the surface layer, the concentration was increased from 1000 ppm F to more than 2300 ppm F by both fluoride treatments. The concentration of fluoride in both groups of fluoride-treated lesions further increased to more than 3500 ppm F in the approximate center of the lesion before declining in deeper layers toward the level found in the placebo-treated group. The findings from both mineral change and fluoride uptake phases of this study show that in the presence of 90 ppm F, 1% pyrophosphate did not promote demineralization of artificial caries lesions.     

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.

Effects of daily rinsing and ingestion of fluoride solutions upon dental caries and enamel fluoride

Three groups of children (age 8–11 yr), rinsed daily in school for 3 yr with 5 ml of either (1) acidulated phosphate fluoride (APF, 0.02 per cent F, 0.1 M phosphate, pH 4.0); (2) neutral NaF (0.02 per cent F) or (3) a neutral placebo. The solutions were kept in the mouth for 1 min and then swallowed. At the end of the study, reductions in DFS of 30 and 27 per cent were observed in the APF and the neutral NaF groups, respectively. The caries reduction in the teeth initially erupted was 25 per cent in both groups. Analyses of enamel biopsies from teeth initially erupted indicated small posteruptive F uptakes in both treatment groups. The APF solution was superior to the neutral NaF in depositing fluoride in intact enamel. The fluoride acquisition of teeth erupting during the study was substantially greater than that of teeth initially erupted.