Fissure sealants or fluoride varnish? Factors associated with choice of management method for occlusal caries in Public Dental Service in Norway

PURPOSE

The aim of this practice-based study was to identify factors associated with choice of caries management method in first permanent molars in high-risk children treated in Public Dental Service in Norway.

METHODS

The present study was based on practice-based observational data from 366 high-risk children (6-9 years). Caries management of occlusal surface of first permanent molars was used as outcome variable and categorized into "no treatment", "fluoride varnish" or "fissure sealant". Patient-related variables (age, gender, oral hygiene, caries experience at age 5, sugar snacking and dental anxiety), tooth-related variables (upper or lower jaw and diagnosis of occlusal surface) and county were used as independent variables. Data were analysed by descriptive analyses followed by generalized structural equation models (GSEM) and presented as relative risk ratios (RRR) with 95% confidence intervals (CIs).

RESULTS

In 319 of the 366 children, both first permanent molars in the same jaw were available for analyses, 276 (87%) had the same diagnosis for both teeth and received the same treatment. Multivariable analysis at patient level showed that age (RRR = 2.42, CI 1.38, 4.23) and caries experience (RRR = 1.39, CI 1.09, 1.77) were associated with higher probability of fissure sealant, while the county variable was significantly associated with lower probability for fluoride varnish use (RRR = 0.03 (0.004, 0.31).

CONCLUSION

The majority of high-risk children in PDS received fluoride varnish or fissure sealants on newly erupted occlusal surfaces of first permanent molars. In addition to age and caries experience of the child, county appeared to substantially influence occlusal caries management method.

Effectiveness of Fluoride Varnish in Prevention of Early Childhood Caries in 3-4 Years Old Children - A 36 Month Prospective Community Based Randomized Controlled Trial

BACKGROUND

Evidence for the benefit of applying Fluoride Varnish FV to permanent teeth is generally very positive. However, the caries-inhibiting effect of FVs on primary teeth is still debatable.

AIM

To assess the effectiveness of fluoride varnish in prevention of early childhood caries in children over the period of 3 years in high fluoride areas.

STUDY DESIGN

A double-blind cluster-randomized controlled trial was undertaken amongst 3-4 years old children. The varnish application was done at three points in the intervention group.

RESULTS

Experimental group showed significantly lesser increment in mean ICDAS score than control group at both 12 month and 36 months. Preventive fraction was 72.4% at 12 months and 18.2% at 36 months. Multiple linear regression showed that at 12 months, intervention was the significant predictor with varnish group having 0.140 (95% CI 0.175-0.230) lower net caries increment. At 36 months, baseline ICDAS score and intervention were the significant predictors.

CONCLUSION

This study suggests that fluoride varnish is an effective and a safe mode of prevention of early childhood caries in children residing in high fluoride zone. However, the overall effect is influenced by the baseline caries status.

Association between population-based fluoride varnish application services and dental caries experience among schoolchildren in Taiwan

BACKGROUND/PURPOSE

Taiwan government has provided population-based fluoride varnish application services for all preschool children since July 2004. This study investigated the association providing such services on dental caries experiences among schoolchildren.

METHODS

A cross-sectional study was conducted on schoolchildren aged 8-9 years. A questionnaire collected information on sociodemographic background, parents' oral health status, children's oral health-related behavior, and dietary habits. Dental caries was recorded through standardized oral examinations. The number of services was retrieved from the Taiwan National Health Insurance Research Database. Univariate, multivariable linear, and logistic regression analyses were performed.

RESULTS

The study involved 1246 children. The mean dental caries indices were 3.97 for decayed, extracted, and filled teeth (deft) and 0.94 for decayed, missing and filled teeth (DMFT). After adjustments for confounding factors, it was revealed that children receiving services were not associated with significantly lower deft and DMFT indices (P > 0.05). The adjusted odds ratio (OR) for untreated primary teeth of children receiving 3 or more services was 0.64 (95% CI = 0.44-0.95) compared with those who received no services (P = 0.025). However, subgroup analyses demonstrated that children in the low-risk group were mainly affected (adjusted OR = 0.36-0.89, P = 0.013).

CONCLUSION

This study revealed that children receiving 3 or more services were associated with a 36% decreased risk of having untreated caries in primary dentition, but these children were mainly in the low-risk group. These results illustrate real data that provides dentists and policymakers with valuable information.

Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a systematic review and meta-analysis

OBJECTIVE

The present review systematically analyzed clinical studies investigating the efficacy of resin infiltration on post-orthodontic or non-post-orthodontic, white spot lesions (WSL), or fluorosis.

MATERIALS

Five electronic databases (Central, PubMed, Ovid MEDLINE, Ovid EMBASE, LILACS) were screened. Article selection and data abstraction were done in duplicate. No language or time restrictions were applied. Outcomes were visual-tactile or DIAGNOdent measurements.

RESULTS

Eleven studies with 1834 teeth being affected in 413 patients were included. Nine studies were randomized control trials, one a prospective cohort study, and one had an unclear study design. Meta-analysis could be performed for "resin infiltration vs. untreated control," "resin infiltration vs. fluoride varnish," and "resin infiltration without bleaching vs. resin infiltration with bleaching." WSL being treated with resin infiltration showed a significantly higher optical improvement than WSL without any treatment (standard mean difference (SMD) [95% CI] = 1.24 [0.59, 1.88], moderate level of evidence [visual-tactile assessment]) and with fluoride varnish application (mean difference (MD) [95% CI] = 4.76 [0.74, 8.78], moderate level of evidence [DIAGNOdent reading]). In patients with fluorosis, bleaching prior to resin infiltration showed no difference in the masking effect compared to infiltration alone (MD [95% CI] = - 0.30 [- 0.98, 0.39], moderate level of evidence).

CONCLUSION

Resin infiltration has a significantly higher masking effect than natural remineralization or regular application of fluoride varnishes. However, although the evidence was graded as moderate, this conclusion is based on only very few well-conducted RCTs.

CLINICAL RELEVANCE

Resin infiltration seems to be a viable option to esthetically mask enamel white spot lesions and fluorosis.

Glass Ionomer Sealant versus Fluoride Varnish Application to Prevent Occlusal Caries in Primary Second Molars among Preschool Children: A Randomized Controlled Trial

Fissure sealant is a recommended preventive measure on permanent molars, but its efficacy on primary molars in preschool children is still in doubt. Sodium fluoride varnish (NaFV) enhances remineralization and is effective in preventing caries in smooth surfaces, but limited information is available regarding its use on occlusal surfaces of primary molars. The present study aimed to compare the efficacy of glass ionomer sealant (GIS) versus topical application of 5% NaFV in preventing and arresting occlusal caries in primary second molars among preschool children. One calibrated examiner examined children aged 3-4 years for visible plaque index (VPI), decayed-missing-filled primary surface (dmfs) index, and extent of carious lesions by the International Caries Detection and Assessment System (ICDAS). Subjects with 1 or more primary second molars that were sound or with incipient lesions (ICDAS 0-1), with distinct visual enamel changes (ICDAS 2), or with localized enamel breakdown (ICDAS 3) were recruited. The children were randomly assigned to either NaFV group - application of 5% NaFV at 3-monthly intervals or GIS group - 1 single placement of GIS. A parental questionnaire was used to collect information on the children's sociodemographic background and oral health-related habits. Two blinded examiners conducted clinical examinations after 6 and 12 months to evaluate the development of occlusal caries and the retention of GIS. Negative binomial regression using generalized estimating equations was employed to adjust for the clustering effect and evaluate the influence of selected variables on the development of occlusal caries into dentin at 12 months. A total of 323 children with 1,159 primary second molars received the respective preventive measures at baseline. At 12 months, 280 children with 989 molars were evaluated. Caries had developed or progressed into dentin in 7.8% and 8.0% of the molars in the NaFV and GIS groups, respectively, with no significant difference between the groups (p = 0.913). The overall retention rates of GIS were 24.6% and 13.5% at 6 and 12 months, respectively. Regression analyses showed only baseline caries experience, and an ICDAS code had a significant association with occlusal caries progression. Quarterly NaFV application and single GIS placement showed similar effectiveness in the prevention of occlusal caries development among preschool children.

How different time intervals between repeated applications of CPP-ACP fluoride varnish effect smooth surface enamel demineralization?

OBJECTIVES

To evaluate the preventive effects of different time intervals between repeated applications of the CPP-ACP fluoride varnish on enamel demineralization.

METHODS

Human teeth were sectioned and randomly allocated to three groups: 4-week, 6-week, and 12-week (N = 22/group). Baseline images of the enamel surfaces were obtained using the FluoreCam recording the area, intensity, and impact of baseline enamel demineralization. All groups received fluoride varnish applications at the beginning of the experiment. The varnish was reapplied every 4 or 6 weeks in the 4-week and 6-week groups, respectively. Following each application, the groups underwent thermo-cycling, tooth brushing and pH cycling to simulate the time effect. After 12 weeks, the enamel surfaces were reimaged using the FluoreCam. Within and between-group differences in the area, intensity and impact of demineralization were evaluated.

RESULTS

At baseline, there were no significant between-group differences for area, intensity, or impact. Statistically significant (p<0.001) enamel demineralization occurred over time within each group. There were significant between-group differences in the changes that occurred in area (P = 0.004), impact (P = 0.022), but not intensity. The 12-week had significantly larger areas of demineralization than the 6-week (P = 0.041) and 4-week (P = 0.001) groups. Changes in impact was significantly (P = 0.007) greater in the 12-week group than 4-week group, but not greater than the 6-week group. There were no statistically significant differences between 4- and 6-week groups in the changes of area, intensity, or impact.

CONCLUSION

Reapplication of the CPP-ACP fluoride varnish every 4-6 weeks, is more effective in reducing enamel demineralization compared to every 12 weeks.

Low level laser therapy, Er,Cr:YSGG laser and fluoride varnish for treatment of dentin hypersensitivity after periodontal surgery: A randomized clinical trial

This clinical trial aimed to compare the effects of low-level laser therapy (LLLT), Er,Cr;YSGG laser, and fluoride varnish, as compared to the placebo laser on decreasing dentin hypersensitivity (DH). This randomized, double-blinded clinical trial included 60 jaw quadrants in 24 patients who underwent periodontal surgery. The quadrants were randomly assigned to 4 groups and received treatments as follows. Group 1: LLLT with a combination of red and infrared wavelengths, group 2: Er,Cr:YSGG laser (0.25 W and 0.5 W), group 3: fluoride varnish, and group 4: placebo laser. The sensitivity response to the cold spray was recorded using visual analogue scale (VAS) at baseline, immediately, and 1 week post-treatment. The data were analyzed by repeated measures analysis at the significance level of P<0.05. There was a significant reduction in DH after treatment by low-level lasers, Er,Cr:YSGG laser, or fluoride varnish compared to the baseline data (P<0.05), but the placebo group displayed no significant alteration in DH (P=0.069). At 1 week, the VAS score in the Er,Cr:YSGG laser group was significantly lower than that of the LLLT (P= 0.043) and placebo (P<0.001) groups. Furthermore, the subjects who received fluoride varnish exhibited significantly lower DH compared with the placebo group (P = 0.023). Er,Cr:YSGG laser was the most effective strategy in dealing with DH, as it caused the greatest pain reduction over the study period and showed a significant superiority over LLLT and placebo groups. Alternatively, the application of fluoride varnish could be recommended for attenuating DH following periodontal surgery.

Prevention of non-cavitated lesions with fluoride and xylitol varnishes during orthodontic treatment: a randomized clinical trial

OBJECTIVE

Fixed orthodontic appliances impair oral hygiene increasing the risk of non-cavitated lesions (NCLs) and tooth decay. The aim of this study was to compare the outcomes of fluoride and xylitol varnishes in preventing NCLs during comprehensive orthodontic treatment.

MATERIALS AND METHODS

The sample comprised 55 volunteers from 15 to 20 years of age under orthodontic treatment that were randomly divided into three groups: Fluoride Group (FG; n=17), Xylitol Group (XG; n=19), and Placebo Group (PG; n=19). The patients in each group received two applications of the following varnishes: Duraphat^TM (5% NaF), 20% xylitol, and placebo (no F/Xylitol) in the three groups, respectively. The varnishes were applied in the first appointment (T0) and 3 months later (T1). Clinical examinations were carried out at T0 and 6 months after (T2) using the ICDAS index and the QLF system (fluorescence difference). The intergroup comparisons were performed by ANOVA/Tukey's or Kruskal-Wallis/Dunn's tests (P<0.05).

RESULTS

There was no significant intergroup difference regarding ICDAS index changes from T0 to T2. Fluoride varnish produced significantly greater increase in fluorescence of NCLs (mean change of -0.65 +0.78 and -0.56 +0.83, for maxilla and mandible, respectively) in comparison to the other groups. The majority of non-cavitated lesions improved in the fluoride and xylitol varnish groups.

CONCLUSIONS

Fluoride varnish produced significantly greater increase in enamel fluorescence compared to xylitol and placebo varnishes. In short term, both fluoride and xylitol varnishes produced remineralization of NCLs in orthodontic patients.

CLINICAL RELEVANCE

Non-cavitated lesions can be effectively controlled in high-risk orthodontic patients by means of fluoride varnishes.

CLINICAL TRIAL REGISTRATION

ReBEC Identifier: RBR-6mdxfq; Date of Register: March 19th, 2020. Retrospectively Registered.

The additional benefit of professional fluoride application for children as an adjunct to regular fluoride toothpaste: a systematic review and meta-analysis

OBJECTIVE

To assess whether professional fluoride application (PFA) used in addition to regular fluoride toothpaste (RFT, ≥ 1,000 ppm) is more effective than RFT alone in children.

MATERIALS AND METHODS

A systematic search was conducted using the PubMed, Embase, Google Scholar and CENTRAL databases. Randomized controlled trials (RCTs) comparing the effectiveness of RFT + PFA and RFT alone were included. Meta-analyses with random-effects models were performed. The certainty of evidence was assessed using the GRADE approach.

RESULTS

A total of 2,729 records were identified from electronic and manual searches, which were screened by two reviewers independently and in duplicate. Six RCTs (5,034 participants) were included, of which four had high risk of bias and two had unclear risk of bias. The PFA used in all these trials was fluoride varnish (FV). In meta-analyses, no significant difference was observed between participants receiving FV + RFT and RFT alone of d(m/e)fs increment (mean difference (MD) - 0.17, 95% confidence interval (CI) - 0.60 to 0.26, P = 0.43, I² = 38%; 6 trials, 5,034 participants, moderate certainty evidence), incidence of caries (risk ratio (RR) 0.91, 95% CI 0.80 to 1.05, P = 0.21, I² = 41%; 4 trials, 4,487 participants, moderate certainty evidence) or changes in prevalence of caries (RR 0.89, 95% CI 0.78 to 1.01, P = 0.07, I² = 0%, 4 trials, 4,189 participants, low certainty evidence).

CONCLUSIONS

Low to moderate certainty evidence suggests that FV does not have significant additional caries-preventive benefit for children (under 8 years old) when provided as an adjunct to daily tooth brushing with RFT (≥ 1,000 ppm). There is insufficient evidence regarding the additional benefit of other PFA interventions.

CLINICAL RELEVANCE

The decision to apply FV to children needs to be made in light of their actual usage of RFT.

TRIAL REGISTRATION

PROSPERO (CRD42020165270).

Is fluoride varnish safe?: Validating the safety of fluoride varnish

BACKGROUND

Fluoride varnish is widely used in dentistry as a caries preventive measure with recommendations for its use even in infants. In addition, nondental providers are also applying varnish on children's teeth in various settings. However, there are questions from these nondental providers as to the safety of fluoride varnish.

METHODS

To evaluate and describe the adverse events (AEs) related to fluoride varnish, the US Food and Drug Administration's Manufacturer and User Facility Device Experience database was used. AEs reported for the dental product code for "varnish, cavity," "varnish," and "fluoride" were evaluated. The identified AEs were then reviewed and categorized using appropriate key words for the various signs and symptoms, outcomes, and treatment.

RESULTS

Over the 10-year period, only 65 AEs were reported for fluoride varnish products. Swelling (33.8%); burning, itching, or soreness (23.1%); and rash (16.9%) were the most common signs and symptoms reported. The most common site reported was the lips (27.7%). The most common outcome was that the patient was taken to the hospital (18.5%) or emergency department (15.4%). No deaths were reported. The patients were treated primarily using diphenhydramine (Benadryl, Johnson & Johnson Consumer) (26.1%), followed by an epinephrine autoinjector (EpiPen, Mylan) and other forms of epinephrine (15.4%), and prednisolone (9.2%). In 16.9% of the cases with AEs there was a history of allergies. The rate of AEs is estimated to be between 0.099 and 0.105 per million for fluoride varnish. A concern is the likelihood of underreporting AEs in the Manufacturer and User Facility Device Experience database.

CONCLUSIONS

Given the widespread use of fluoride varnish in the United States, the number of AEs reported to the US Food and Drug Administration were few. Thus fluoride varnish can be considered a safe dental product.

PRACTICAL IMPLICATIONS

Provides data on the safety of fluoride varnish that can be used by the dental profession to allay concerns by nondental providers and patients on this important caries preventive measure.

A service evaluation of an intervention to increase application of topical fluoride varnish in general dental practice in South Yorkshire

PURPOSE

Dental caries is still common in children in the UK despite many available preventative interventions. Application of topical fluoride varnish can reduce caries experience. National and international guidance recommends at least twice-yearly application of topical fluoride varnish, however guidance is not always followed. This project aimed to first identify the proportion of patients receiving fluoride varnish by their primary care dental practitioner prior to their referral to a secondary care service and subsequently increase this rate by introducing an intervention.

METHODS

The intervention required the referring practitioner to document the date of which topical fluoride was applied prior to referral. Referrals without this information were rejected. Data were collected pre and post this change in policy to ascertain fluoride application rates. Parents and children were questioned about the frequency of application, and referral forms were reviewed for practitioner-reported application.

RESULTS

Topical fluoride application rates improved by 19% points for patient-reported application, and 31% points for practitioner-reported application. The biggest increase in application rate was in the cohort of patients receiving 6-monthly fluoride application.

CONCLUSION

This study demonstrated that a simple intervention, mandating that primary care dental practitioners record the most recent application of topical fluoride before referring a patient to secondary care, can improve the rates of topical fluoride varnish application in the UK.

Comparative evaluation of fluoride varnishes, self-assembling peptide-based remineralization agent, and enamel matrix protein derivative on artificial enamel remineralization in vitro

Background

One of the most unfavorable side effects of fixed orthodontic treatment is white spot lesions (WSLs). Although the most important approach is prevention of WSLs, it is also essential to evaluate the efficacy of the remineralization agents. However, there is no concurrence in the literature with respect to the remineralization process of these agents. The objective of the present study was to evaluate the effects of different fluoride varnishes, enamel matrix protein, and self-assembling peptide derivatives with varying chemical compositions on remineralization of artificially created WSLs in vitro using quantitative light-induced fluorescence (QLF).

Methods

Artificial WSLs were created on bovine enamel samples using acidic buffer solution (pH 5, 10 days). Specimens were randomly allocated to six groups (n = 10/group): (1) Emdogain (Straumann, Basel, Switzerland), (2) Curodont Repair (Credentis AG, Switzerland), (3) Duraphat (Colgate-Palmolive, New York, NY), (4) Clinpro XT (3 M ESPE, Pymble, New South Wales, Australia), (5) Enamel Pro Varnish (Premier Dental Products, PA, USA), and (6) control (untreated). The agents were applied to the WSLs according to the manufacturers’ instructions. Fluorescence loss (ΔF), lesion area (area), and impact (ΔQ) values of enamel surfaces were quantified by QLF-D Biluminator^TM (Inspektor-Pro, Amsterdam, The Netherlands) at baseline and after 7, 14, and 21 days of application of the respective materials.

Results

ΔF value presented a significantly decreasing trend throughout the 21 days for all groups except the Duraphat and Enamel Pro varnishes. The changes between 14th and 21st days of the Clinpro XT varnish application were significantly higher than Emdogain, Curodont, and Enamel Pro. The Curodont group showed higher lesion area changes between the first and second week in comparison to the Emdogain, Clinpro XT, and Enamel Pro groups, whereas Clinpro XT assured the highest reduction from the second to the third week of the observation period.

Conclusions

The fluorescence loss was significantly reduced with enamel matrix protein, self-assembling peptide, and light-curable fluoride varnishes in the analysis for 21 days. Curodont and Clinpro XT were effective in diminishing the fluorescence loss and lesion area compared to the Duraphat, Enamel Pro fluoride varnishes, and Emdogain in different time points.

Effect of TiF4 varnish after pre-treatment with proanthocyanidin or chlorhexidine on the progression of erosive dentin loss in the presence or absence of the demineralized organic matrix

This study evaluated the protective effect of TiF₄ varnish, after pre-treatment with proantocyanidin or chlorhexidine, on the progression of erosive dentin loss (EDL), under the presence or absence of the demineralized organic matrix (DOM). Bovine root dentin samples were eroded for 30 min (0.1% citric acid, pH 2.5) and the loss was measured by profilometry. Half of them were subjected to the DOM removal using collagenase for 4 days, while the other half remained immersed in water. The removal of DOM was checked by profilometry. Samples were divided into 24 groups (n = 15) according to the factors: 1- With or without DOM; 2- Pre-treatment with 0.012% chlorhexidine gel, 10% proanthocyanidin gel or untreated for 1 min; 3-Final Treatment with TiF₄ varnish, NaF varnish, placebo varnish or untreated for 6 h. The samples were submitted to a pH cycling for 5 days: 0.1% citric acid (4 × 90s/day) and artificial saliva between the challenges. The final profile was obtained for the calculation of EDL (μm, three-way ANOVA/Tukey test). When DOM was preserved, the EDL was lower compared to the condition without DOM (7.08 ± 4.03 μm and 9.80 ± 3.79 μm, p < 0.001, respectively), regardless of the treatments. The pre-treatment had no influence on the progression of EDL (p = 0.637), while the final treatment (TiF₄ varnish only, 6.77 ± 4.08 μm) was effective in reducing the progression of EDL (NaF varnish: 9.52 ± 4.02 μm; Placebo varnish: 8.64 ± 4.06 μm and no treatment: 8.80 ± 3.95 μm). It can be concluded that DOM has important protective effect on the progression of EDL. TiF₄ was the unique treatment capable of reducing EDL progression, regardless of the pre-treatment of DOM.

Fluoride Varnish Application in Preschoolers Have a Modest Effectiveness in Reducing the Incidence of Dentinal Caries

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis. de Sousa FSO, Dos Santos APP, Nadanovsky P, Hujoel P, Cunha-Cruz J, de Oliveira BH. Caries Res. 2019;53(5):502-513.

SOURCE OF FUNDING

Government.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis of data.

Effect of different remineralizing agents on the initial carious lesions - A comparative study

Objectives

This study aimed to assess and compare the effectiveness of three different remineralizing agents (Tricalcium phosphate paste, Fluoride varnish, and Nano-hydroxyapatite gel) using the DIAGNOdent device.

Material and Methods

The present clinical study was carried out on 90 initial carious lesions detected by ICDAS caries diagnostic criteria and then take the baseline record by DIAGNOdent device. The selected initial carious lesions were randomly classified into three groups according to treatment modalities (30 lesions in each group) according to remineralizing agents: group A (TCP), group B (fluoride varnish) and group C (nano-hydroxyapatite gel). The remineralizing agents were applied for four minutes once weekly for four weeks. At the fifth week, the DIAGNOdent scores of initial carious lesions were recorded to evaluate the effect of remineralizing agents. A paired t-test was used to compare between baseline date and follow up of DIAGNOdent scores. A one-way ANOVA test was used to compare DIAGNOdent scores among the three groups. Post- Hoc Tukey test was used to determine the significant difference between every two groups.

Results

There were statistically significant differences among the three groups at follow up (p = 0.001). Within each group, there was a significant difference between baseline and follow up scores (p = 0.000 for the three groups). Multiple comparisons between every two groups showed a highly statistically significant difference at follow up records between nano-hydroxyapatite versus TCP and fluoride varnish on pit and fissure caries (p = 0.039 and p = 0.007 respectively) and the nano-hydroxyapatite was the best of them.

Conclusion

The present study concluded that the three remineralizing agents were effective in the treatment of initial carious lesion and the most effective remineralizing agent was nano-hydroxyapatite.

Costing the Scale-Up of a National Primary School-Based Fluoride Varnish Program for Aboriginal Children Using Dental Assistants in Australia

There is good evidence that fluoride varnish programs are effective in preventing dental caries in children. This study aims to provide a costing for the scale-up of a child fluoride varnish program in New South Wales (NSW), Australia. Most child fluoride varnish programs are school-based, and a number of studies have examined the acceptability and cost effectiveness of using non-dental providers to apply the fluoride varnish. This paper describes the number of primary schools in Australia that could be targeted using a standard population-based risk criteria based on published data. A costing method was developed for various scenarios of school enrolment and provider types, along with potential revenue from the Child Dental Benefits Schedule (CDBS). Most of the costs of a school-based fluoride varnish program can be covered by the CDBS with assumptions of 80% child consent and 75% CDBS eligibility. While the scale-up of child fluoride varnish programs to prevent dental caries has been recommended by numerous strategic plans and reports, particularly for Aboriginal and Torres Strait Islander children, limited progress has been made. This paper concludes that using a standardized criteria for targeting schools using a combination of ICSEA and Aboriginal enrolments, and aiming at four applications a year, is feasible, and that the main costs of the program could be covered by using the CDBS.

Protective factors for caries of a school-based oral health program in Bangkok, Thailand: a retrospective cohort study

OBJECTIVES

The aim of the study was to assess protective factors of a school-based oral health preventive program on caries in permanent teeth in students and to identify other risk and protective factors associated with caries in this group.

STUDY DESIGN

This is a retrospective cohort study.

METHODS

A total of 433 students were examined in the 1st grade and followed up until the 6th grade. Each student was annually assessed for caries as per the World Health Organization index. Binary simple and multiple logistic regressions were performed to assess risk or protective factors with a P-value ≤0.05.

RESULTS

In 1st graders, the caries prevalence in deciduous teeth was 87.2%, and the mean decayed, missing and filled teeth (dmft) index was 6.44 (±4.4); in 6th graders, the caries prevalence in permanent teeth was 51.7%, and the mean DMFT was 1.37 (±1.84). Protective factors for caries in permanent teeth were complete participation in the program, receiving fluoride varnish >4 times, and sealant applications on all first molars. Risk factors were female sex and caries prevalence in deciduous teeth. After multiple logistic regression, sealant application only remained significant, with an odds ratio (OR) of 0.19 (95% confidence interval [CI] = 0.06-0.63, P = 0.007), and for risk factor, caries prevalence in deciduous teeth only remained significant, with an OR of 5.44 (95% CI = 2.23-13.27, P < 0.001).

CONCLUSIONS

There is an association between deciduous dentition caries and permanent dentition caries. Early prevention in school settings by applying fluoride varnish and dental sealants onto molars is protective and feasible. The study suggests that regular fluoride varnish and sealant applications should be extended to similar low-income area schools.

Synergistic Effect of Arginine on Remineralization Potential of Fluoride Varnish and Nanohydroxyapatite on Artificial Caries Lesions: An In Vitro Study

AIM AND OBJECTIVE

To evaluate the synergistic effect of arginine on the remineralizing potential of fluoride varnish and nanohydroxyapatite.

MATERIALS AND METHODS

A total of 100 teeth were taken; of them, 50 teeth were allotted for microhardness test and 50 teeth for scanning-electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDX) analysis. Fifty teeth used for hardness testing were sectioned to obtain 100 samples, and the baseline hardness values were measured. Samples were allotted into five groups (n = 20): group I: arginine; group II: fluoride varnish; group III: nanohydroxyapatite; group IV: arginine + fluoride varnish; group V: arginine + nanohydroxyapatite. Microhardness values were measured after 96 hours of demineralization and then again after application of remineralizing agents (pH cycling) for 10 days to check for gain in microhardness. The other 50 samples were subjected to SEM-EDX analysis for evaluating gain in the mineral content after demineralization and after application of the remineralizing agents. The collected data were subjected to statistical analysis using SPSS software version 22.0.

RESULTS

The maximum mean microhardness values were observed in group IV and group V. There was no statistical significance between them. Similarly, maximum mineral gain was seen in groups IV and V. A significant increase in fluoride gain was seen in group IV.

CONCLUSION

Arginine has a synergistic effect on remineralization potential of fluoride varnish and nanohydroxyapatite.

CLINICAL SIGNIFICANCE

The incorporation of arginine into fluoride varnishes and nanohydroxyapatite significantly increased their remineralization potential.

Fissure caries inhibition with a CO2 9.3-μm short-pulsed laser-a randomized, single-blind, split-mouth controlled, 1-year clinical trial

OBJECTIVES

The objective of this randomized, single-blind, split-mouth controlled, clinical trial was to evaluate whether the use of a short-pulsed 9.3-μm CO₂ laser increases the caries resistance of occlusal pit and fissures in addition to fluoride therapy over 12 months.

MATERIALS AND METHODS

A total of 60 participants, average age 13.1 years, were enrolled. At baseline, second molars were randomized into test and control, and assessed by ICDAS, SOPROLIFE, and DIAGNOdent. An independent investigator irradiated test molars with a CO₂ laser (wavelength 9.3 μm, pulse duration 4 μs, pulse repetition rate 43 Hz, beam diameter 250 μm, average fluence 3.9 J/cm², 20 laser pulses per spot). Test molars received laser and fluoride treatment, control teeth fluoride alone. Fluoride varnish was applied at baseline and at 6 months. After 6 and 12 months, teeth were again assessed.

RESULTS

A total of 57 participants completed the 6-month and 51 the 12-month recall. Laser-treated surfaces showed very slight ICDAS improvements over time with ICDAS change - 1 in 11% and 8%, no changes (ICDAS change 0) in 68% and 67%, and slightly worsened (ICDAS change 1) in 19% and 24% at 6- and 12-month recalls, respectively, and worsened by two scores in 2% at both recall time points. Control teeth showed significantly higher ICDAS increases, with 47% and 25% showing ICDAS change 0, ICDAS change 1 in 49% and 55%, and ICDAS change 2 in 4% and 20% at 6- and 12-month recalls, respectively. Differences in ICDAS changes between the groups were statistically significant (P = 0.0002 and P < 0.0001; Wilcoxon's signed-rank test, exact). A total of 22% of the participants developed ICDAS 3 scores on the control teeth.

CONCLUSIONS

Microsecond short-pulsed 9.3-μm CO₂ laser irradiation markedly inhibits caries progression in pits and fissures in comparison with fluoride varnish alone.

CLINICAL RELEVANCE

The 9.3-μm CO₂ laser irradiation of pits and fissures enhances caries resistance.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02357979.

Inhibitory effects on Streptococcus mutans of antibacterial agents mixed with experimental fluoride varnish

We investigated the inhibitory effect of antibacterial agents mixed with experimental fluoride varnish (EFV) on Streptococcus mutans. The antibacterial agents used were (1 and 10) mM of xanthorrhizol, bakuchiol, bavachalcone, isobavachromene, and bavachromene. Agar diffusion tests were performed on S. mutans (1.1×10¹⁰ CFU/mL), using antibacterial agents without and with EFV. Bavachalcone showed the highest inhibition zone without and with EFV at both (1 and 10) mM (p<0.05). All EFV with antibacterial agents showed greater inhibition and semi-inhibition zones than EFV alone (p<0.05). The cell viability of each antibacterial agent was not significantly different from the vehicle controls (p>0.05), except xanthorrhizol and bakuchiol at 1 mM. All antibacterial agents were effective, while antibacterial agents with EFV co-formulations were more effective than EFV alone. Bavachalcone was the most effective agent against S. mutans, indicating its potential usefulness with fluoride varnish in preventing dental caries.

A randomized clinical trial to arrest dentin caries in young children using silver diamine fluoride

OBJECTIVES

The study aimed to compare the effectiveness of 38% silver diamine fluoride (SDF) solution, and 5% sodium fluoride (NaF) varnish applied semiannually in arresting dentin caries in young children with high caries risk.

METHODS

Children aged 1-3 years who had at least one active dentin carious lesion were randomly allocated into 2 groups as follows: Group 1 = 38% SDF (Topamine), and Group 2 = 5% NaF varnish (Duraphat). Both agents were applied every 6 months onto the carious surface. Lesion activity was assessed by the visual-tactile examination. Baseline and follow-up examinations were conducted by the same examiner. The children's demographic background, oral health-related habits, and oral hygiene practices, as well as parental satisfaction with children's dental appearance were collected at baseline and the 12-month follow-up.

RESULTS

At baseline, 153 and 149 children were recruited in Group 1 and Group 2, respectively. The mean dmfs scores in Groups 1 and 2 were 8.89 and 9.79, respectively. After 12 months, 87.1% remained in the study. The caries arrest rate of Group 1 (35.7%) was significantly higher than that of Group 2 (20.9%) (p < 0.001). The results of the multilevel logistic regression analysis confirmed that the treatment in Group 1 was more effective in arresting dentin carious lesions than that of Group 2 (OR = 2.04; 95% CI, 1.41-2.96). The presence of plaque on caries lesions, tooth type, tooth surface type, frequency of milk feeding, snack taking, and family income influenced on caries activity. Regardless of the intervention groups, there were no differences in parental satisfaction with on the child's dental appearance before and after receiving the intervention.

CONCLUSION

Based on the 12-month results, 38% SDF is more effective than 5% NaF varnish in arresting dentin carious lesions in young children. SDF has no negative impact on parental satisfaction with the child's dental appearance.

CLINICAL SIGNIFICANCE

To control dentin carious lesions in young children with high caries risk, 38% SDF is more effective than 5% NaF varnish.

Effectiveness of fluoride varnish on caries in the first molars of primary schoolchildren: a 3-year longitudinal study in Guangxi Province, China

AIMS

To evaluate the effectiveness of 5% sodium fluoride varnish on caries in first permanent molars and to assess the suitability of using this method to control caries among children in rural areas of Guangxi province, China.

METHODS

A total of nine schools with 32 classes were selected by simple random sampling. There were 999 students in the experimental group and 1,004 in the control group. The experimental group received oral health education and topical application of 5% sodium fluoride varnish, while the control group received oral health education only. Dental examinations were performed in November 2014 and November 2017, and the modified International Caries Detection and Assessment System (ICDAS-II) was used to record the caries status of the first permanent molars. The data were entered into SPSS 22 for statistical analysis.

RESULTS

A total of 1,748 students (853 in the experimental group and 895 in the control group) completed the study. After 3 years of intervention, the experimental group had a lower prevalence of caries, a lower caries increment, a lower decayed, missing and filled teeth (DMFT) index and a lower decayed, missing and filled surfaces (DMFS) index compared with the control group (respectively: 58.9% vs 65.5%, 34.8% vs 42.1%, 1.38 vs 1.59 and 2.06 vs 2.38). All the differences were statistically significant (P < 0.05).

CONCLUSION

In this study population, twice-yearly application of 5% sodium fluoride varnish and oral health education were more effective for preventing caries in first permanent molars than oral health education alone. The implementation of fluoride varnish application as a public health measure in schools in rural areas is recommended.

Implementing Pediatric Fluoride Varnish Application in a Rural Primary Care Medical Office: A Feasibility Study

INTRODUCTION

The objective of this study was to determine if the application of fluoride varnish (FV) to children 5 years and under was acceptable and practical for health care providers in a rural primary care office.

METHODS

We employed a quasi-experimental study design comprised of providers who received education and training in FV application. Pre- and post-study surveys regarding barriers and facilitators were administered. Data was collected on the number of FV applications, time spent on procedure, perceived barriers, and overall cost.

RESULTS

The total direct variable cost of providing FV was $4.35 per procedure, resulting in an $11.85 profit. FV application increased 9.57%. Potential barriers were lack of proper supplies, lack of adequate support staff, and lack of additional financial compensation for providers.

DISCUSSION

FV application is a service that can be delivered in a rural practice with existing resources, but the initiative needs support from practice management.

Fluoride varnish containing chitosan demonstrated sustained fluoride release

Fluoride varnish is a professionally applied product that prevents dental caries. However, fluoride varnishes do not provide sustained fluoride release. The objective of this study was to prepare fluoride varnish formulations containing various amounts of chitosan that would generate sustained fluoride release. We evaluated their chemical structure, viscosity, and in vitro fluoride release. Furthermore, the 3-(4, 5-dimethylthiazolyl-2)-2,5diphenyltetrazolium bromide (MTT) assay and direct contact test were used to determine varnish cytotoxicity. We found that all fluoride varnish formulations had the same chemical structure. Their viscosity demonstrated a chitosan concentration-dependent increase. In vitro fluoride release showed a sustained fluoride release. The chitosan fluoride varnishes were cytotoxic to human gingival fibroblasts. We propose the new fluoride varnish formulation as a potential material to be used as a sustained release fluoride varnish.

Enamel protection after stripping procedures: An in vivo study

INTRODUCTION

Interproximal enamel reduction (IPR) is a clinical procedure that has been in use since the advent of non-extraction orthodontic techniques. However, such a procedure affects the surface condition of the enamel and may predispose patients to cavities and hypersensitivity. The use of a remineralizing agent is recommended to prevent these side effects. The objective of our study was to evaluate the evolution of stripped proximal dental surfaces after exposure to the oral environment for 4 months with and without fluoride protection.

MATERIALS AND METHODS

Our sample consisted of 14 premolars (PM) from 6 patients of the Dentofacial Orthopaedics Department of the Consultation and Dental Treatment Centre of Rabat (CDTC) who required orthodontic treatment with PM extraction and had given their informed consent. The teeth were divided into 5 groups: group 1: intact enamel; group 2: intact enamel+fluoride varnish+4-month oral exposure; group 3: IPR (manual and mechanized)+extraction; group 4: IPR (manual and mechanized) without varnish+4-month oral exposure; group 5: IPR (manual and mechanized)+fluoride varnish+4-month oral exposure. Proximal surfaces were subjected to qualitative analysis by scanning electron microscopy and quantitative analysis by Dispersive Energy Spectroscopy (DES) to quantify the percentage of mineral elements.

RESULTS

Exposure of stripped dental surfaces to the oral environment for 4 months with or without fluoride protection showed the persistence of surface irregularities caused by stripping. We noted an improvement in the percentage of mineral elements for both groups with and without fluoride protection. However, the percentages of calcium (Ca) and phosphorus (P) were close to that of intact enamel in the fluoride varnish group.

CONCLUSION

Protecting stripped surfaces with fluoride varnish could help preserve the integrity of the enamel surface by restoring some of the mineral elements lost during stripping.