Caries preventive effect of sugar-substituted chewing gum

OBJECTIVES: The aim of this 3-year community intervention trial was to determine the caries preventive effect of sugar-substituted chewing gum among Lithuanian school children, and to assess compliance with the instructions for gum use. METHODS: A total of 602 children, aged 9-14 years, from 28 school classes in five secondary schools in Kaunas, Lithuania, were given a baseline clinical and radiographic caries examination. The schools were randomly allocated to receive one of the following interventions: sorbitol/carbamide gum; sorbitol gum; xylitol gum; control gum; and no gum. Children in the four active intervention groups were asked to chew at least five pieces of gum per day, preferably after meals. The children were reexamined clinically after 1, 2 and 3 years, and radiographically after 3 years. Self-reported compliance was monitored anonymously four times during the study. RESULTS: A total of 432 children were available at the 3-year clinical follow-up examination. The crude mean 3-year caries increments (DMFS--all stages of lesion formation) were 11.8 for the sorbitol/carbamide gum group; 9.0 for the sorbitol gum group; 8.1 for the xylitol gum group; 8.3 for the control gum group; and 12.4 for the no gum group. The adjusted 3-year caries increments were statistically significantly lower in the sorbitol gum group, the xylitol gum group and the control gum group than in the no gum group, whereas no statistically significant difference was seen between the no gum group and the sorbitol/carbamide gum group. Adjusted 3-year caries increments in the xylitol gum group and the sorbitol gum group did not differ statistically significantly from the caries increments in the control gum group. Compliance with the study protocol was better in School C (xylitol gum) than in the other schools. In all schools, compliance decreased over time. CONCLUSION: The results indicate that the caries preventive effect of chewing sugar-free gum is related to the chewing process itself rather than being an effect of gum sweeteners or additives, such as polyols and carbamide.     

Caries preventive effects of toothpastes containing monofluorophosphate and trimetaphosphate: a 3-year clinical trial

The caries-preventive effects of two toothpastes were tested in a 3-year clinical trial involving 1319 children aged 11-13 years. The test toothpastes were: 1) a low abrasion paste containing 0.8% sodium monofluorophosphate (MFP), and 2) a paste containing 3% sodium trimetaphosphate (TMP). The control toothpaste was a conventional, moderately abrasive paste containing 0.8% sodium monofluorophosphate. The children were examined clinically and radiologically each year. Toothpaste was supplied to the children's homes, and its use was unsupervised. Caries increments after 3 years, in terms of DMF teeth and DMF surfaces, showed no significant differences between the MFP test group (444 children) and the MFP control group (450 children). However, the TMP test group (425 children) had significantly higher caries increments than the MFP control group. All three groups of children showed some improvement in oral hygiene and in gingival health, but there were no significant differences between the groups.     

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.     

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.     

A systematic review of the performance of methods for identifying carious lesions

This systematic review evaluates evidence describing histologically validated performance of methods for identifying carious lesions. A search identified 1,407 articles, of which 39 were included that described 126 assessment of visual, visual/tactile, radiographic (film and digital), fiber optic transillumination, electrical conductance, and laser fluorescence methods. A subsequent update added four studies contributing 10 assessments. The strength of the evidence was judged to be poor for all applications, signifying that the available information is insufficient to support generalizable estimates of the sensitivity and specificity of any given application of a diagnostic method. The literature is problematic with respect to complete reporting of methods, variations in histological validation methods, the small number of in vivo studies, selection of teeth, small numbers of examiners, and other factors threatening both internal and external validity. Future research must address these problems as well as expand the range of assessments to include primary teeth and root surfaces.     

Caries,periodontitis and tooth loss after haematopoietic stem cell transplantation: A systematic review

Objective

A systematic review was conducted to assess scientific knowledge concerning the effect of haematopoietic stem cell transplantation (HSCT) on the occurrence of caries, periodontal conditions and tooth loss, and to evaluate the prevalence of these diseases in adult HSCT survivors (PROSPERO 152906).

Methods

PubMed and Embase were searched for papers, published from January 2000 until November 2020 without language restriction, assessing prevalence, incidence or parameters of caries, periodontal conditions and tooth loss in HSCT recipients (≥80% transplanted in adulthood). Bias risk was assessed with checklists from Joanna Briggs Institute, and data synthesis was performed by narrative summary.

Results

Eighteen papers were included (1618 subjects). Half were considered at high risk of bias. Longitudinal studies did not show caries progression, decline in periodontal health or tooth loss after HSCT. The prevalence in HSCT survivors ranged from 19% to 43% for caries, 11% to 67% for periodontitis, and 2% to 5% for edentulism. Certainty in the body of evidence was very low.

Conclusions

Haematopoietic stem cell transplantation, on the short term, may have little to no effect on caries, periodontal conditions and tooth loss. Caries and periodontitis may be more common in HSCT survivors compared with the general population, whereas edentulism may be comparable. However, the evidence for all conclusions is very uncertain.     

Xylitol candies in caries prevention: results of a field study in Estonian children

All field studies have unequivocally reported significant reductions in dental caries occurrence associated with the use of chewing gum containing xylitol. No other xylitol products besides chewing gum have so far been tested in field trials. A 5-year follow-up study with 2- or 3-year xylitol consumption periods began in Estonia in 1994 with 740 10-year-old children in 12 schools at baseline examinations. For the study, 3 clusters each including 3-5 schools were formed on the basis of baseline caries experience. The products were used under the supervision of the teachers 3 times per day during school days but not during weekends or during the 3-month summer holiday. The daily dose of xylitol was 5 g in all groups. The children were examined every year in September by two experienced clinicians. Dental caries was recorded according to WHO criteria. After 3 years, all xylitol groups showed a highly significant 35%-60% reduction in caries incident, compared with the corresponding control groups. The differences between candies, between candies and chewing gum, and between 2- and 3-year users in the xylitol groups were non-systematic, indicating no trends between the groups. The results suggest that not only xylitol chewing gum but also xylitol candies are effective in caries prevention, and that a school-based delivery system seems to offer a practical way to distribute and control the use of the xylitol products.     

Selective versus non-selective removal for dental caries: a systematic review and meta-analysis

Objective: Selective and non-selective methods for caries removal were controversial so far, thus we aimed to compare the efficacy of selective and non-selective caries removal by conducting meta-analysis of randomized controlled trials (RCTs).

Materials and methods: Eligible RCTs studies comparing selective caries removal with non-selective caries removal were retrieved by searching PubMed, EMBASE and Cochrane Library till 15 July 2017. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for outcome indictors, including pulpal exposure, pulpal symptoms and failure using Inverse variance-random effects or Mantel-Haenszel-fixed effects models.

Results: Totally, seven studies were eligible for the meta-analysis. Compared with the non-selective caries removal group, the risk of pulpal exposure was significantly reduced in the selective caries removal group (OR?=?0.11, 95% CI: 0.04–0.30). No significant difference was observed in pulpal symptoms (OR?=?0.79, 95% CI: 0.30–2.12) and failure (OR?=?1.40, 95% CI: 0.69–2.84) between the groups.

Conclusions: The efficacy of selective caries removal appears comparable to that of non-selective caries removal in children, with similar pulpal symptoms and failure, but selective caries removal may result in a low incidence of pulpal exposure. However, larger-scale RCTs with long-term follow-up are required to confirm this conclusion.     

Incidence of early childhood caries: A systematic review and meta‐analysis

The aim was to systemically review the incidence of early childhood caries (ECC). The addressed focused question was “What is the reported incidence of ECC?” Indexed databases were searched using various key words. Five studies were included and processed for data extraction. All studies were prospective and two studies were randomized clinical trials. The number of participants ranged between 96 and 1275 children. Two studies reported the mean age of children, that ranged between 1.8 and 2.5 years (range 0.5 to 5 years). In three studies, the follow‐up duration was 2 years, and in two studies the participants were followed‐up till 3 and 5 years, respectively. Results from all studies reported that the incidence of ECC was significantly higher among children with caries at baseline compared with caries‐free children. In conclusion, the incidence of ECC is significantly higher in children with a previous history of dental caries.     

Professional fluoride varnish treatment for caries control: a systematic review of clinical trials

The aim of this paper was systematically to evaluate the caries‐preventive effect of professional fluoride varnish treatments. A search of the literature for articles published between 1966 and August 2003 was carried out in electronic databases, reference lists of articles, and selected textbooks in accordance with the strategy of the Swedish Council on Technology Assessment in Health Care. Out of 302 identified papers, 24 randomized and controlled clinical trials comparing fluoride varnish with placebo, no active treatment or other fluoride preventive regimens of at least 2 years' study duration were included. The trials that met the inclusion criteria were assessed independently and systematically by at least two reviewers and scored from A to C according to predetermined criteria for methodology and performance. The main outcome measure was the preventive fraction expressed as a percentage. The results displayed limited evidence (evidence level 3) for the caries preventive effect of topical applications of fluoride varnishes in permanent teeth. The average prevented fraction was 30% (0–69%) when compared with untreated controls. Inconclusive evidence (evidence level 4) was found for fluoride varnish treatment in the primary dentition and in adults. This systematic review reinforces the need for future clinical research of high quality, incorporating modern concepts of clinical performance and evaluation to assess dental caries control using professional fluoride varnish.     

Chlorhexidine varnish for preventing dental caries in children, adolescents and young adults: a systematic review

This systematic review aimed to determine the caries-inhibiting effect of chlorhexidine (CHX) varnishes on the permanent dentition of children, adolescents and young adults, and to explore two possibly related factors, namely application frequency and the time between evaluation and the last application. The literature search identified 14 publications of randomized controlled trials or controlled clinical trials where the effect of CHX varnish was compared with placebo controls or controls that received no preventive treatment. To obtain uniform outcome effects, the prevented fraction and 95% confidence intervals of caries increment were calculated. Owing to insufficient data presentation, only eight publications were included. Another two publications were included after receiving additional data from the authors. This systematic review did not result in a meta-analysis as an overall prevented fraction could not be computed because of the large variation of outcome results. The variation could not be explained by the time between evaluation and last application but might be explained by application frequency. It is tentatively concluded that CHX varnish has a moderate caries-inhibiting effect when applied every 3-4 months. However, this effect seems to have diminished by around 2 yr after the last application. There is no evidence for a caries-inhibiting effect of CHX varnish with longer intervals between applications.     

Caries experience in a Norwegian urban population

DMF teeth were recorded in a random sample of 117 35-year-old citizens of Oslo. The mean number of DMF teeth was 25.7, reflecting a high caries experience in the population surveyed. The mean number of decayed teeth was 5.1, the majority being due to recurrent carious lesions. Only 61.2% of the total number of posterior carious teeth were observed clinically. The remaining lesions (38.8%) were diagnosed on bitewing radiographs. The mean number of missing teeth in the sample was 6.3, while the mean number of filled teeth was 18.9. This indicates that the subjects have had acces to regular dental treatment. Females in the lower educational group had significantly more missing teeth and fewer filled teeth than females in the higher educational group. Similar differences could not be detected in males.     

Indigenous Australian dental health: a brief review of caries experience

The indigenous community in Australia is an at risk population for oral diseases such as dental caries. The majority of communities are isolated and dental services in these areas are limited. Oral hygiene standards are poor and this combined with a diet rich in refined carbohydrates has led to high incidences of dental caries. In addition, diabetes, which is related to obesity (and a diet high in sugar and fat) has been linked to increases in oral disease. Caries prevalence was found to be low in areas where fluoridation levels in the water were high. The fact that the fluoride supplementation appears to improve oral health to a significant degree suggests that implementation of fluoride treatment programmes for school children and, where viable, fluoridation of water sources would be appropriate. In addition, dental education programmes should receive high priority. As with the rest of the community, these preventive measures will result in less need for emergency dental treatment in the future, better oral health for the community and reduced financial burden on the State. It is under these circumstances that oral health planners and providers must, in consultation with the relevant community representatives, develop appropriate mechanisms to address the needs of this group. The development of strategies that integrate with the plethora of general health strategies currently being implemented is just one means of achieving improved oral health outcomes for indigenous Australians.     

儿童乳牙氟滴剂防龋效果3年观察

本研究的目的是观察氟滴预防儿童乳牙龋的作用。由幼儿园老师使用,剂量根据美国儿童牙科学会推荐标准,并参照成都市饮水氟含量制定,３岁以前每日给０．２５ｍｇ,３岁以后每日给０．５ｍｇ（４滴／日）,观察３年,结果表明;参加本项目的儿童较对照组儿童龋病患病明显减少,随着项目实施时间的延续,效果持续增加。用氟组与对照组的ｄｍｆｔ为２．２１与４．３２。     

Retention and caries preventive effects of a GIG and a resin-based fissure sealant

Abstract Fissure sealing using partially filled resins is an established caries preventive practice. Glass ionomer cement (GIC) sealants may offer additional advantages due to their ability to bond chemically to enamel and release fluoride. The aim of this study was to compare the caries preventive effect and retention of a GIC and a resin-based sealant. Ketac-fil® was tested against a chemically cured resin-based material (Delton®) using a split mouth design. Perth (Western Australia) schoolchildren (n= 465), mean age 7 yr±0.72 (S.D.), received sealants on the occlusal surfaces of sound homologous permanent first molar pairs. Test (GIC) and control (resin) sealants were systematically allocated to left and right sides based on the child's month of birth, and were placed by dental therapists. After 3.64±0.11 yr, 415 children were examined by different clinicians, and the clinical status of the teeth and the extent of sealant retention recorded. Sealants were deemed retained when at least 2/3 of the fissure pattern was still sealed. In 252 tooth pairs, neither sealant was retained to this extent. In 71 pairs, the GIC was not retained and the resin sealant retained. In 40 pairs the reverse occurred (McNemar's test, χ²= 8.66, P < 0.005). Net gain (additional lesions prevented by the test agent per 100 treatments) was 6.1%(95% CI 3.3%, 8.9%). Effectiveness of the GIC was 80.6% (95% CI 59.6%, 90.7%). The relative risk of caries in test teeth was 0.19 (95% CI 0.09, 0.40). The study suggests that complete retention of GIC sealant is not necessary for caries prevention in newly erupted permanent first molars.