Topical Fluoride Effectiveness in High Caries Risk Adults

Effectiveness of fluorides in root caries prevention, Department of Veterans Affairs (2009-2018)

AIMS

The aim of this study was to examine the effectiveness of topical fluorides in prevention of root caries-related treatment in high caries risk Veterans.

METHODS

This retrospective analysis of longitudinal data examined the effectiveness of professionally applied or prescription (Rx) fluoride treatment, in VHA clinics from FY 2009-2018. Professional fluoride treatments included 5% Sodium Fluoride (NaF) varnish (22 600 ppm fluoride), 2% NaF gel/rinse (9050 ppm fluoride), and 1.23% APF gel (12 300 ppm fluoride). The Rx for daily home use was 1.1% NaF paste/gel (5000 ppm fluoride). Outcomes studied were new root caries restorations or extractions and percent of patients with treatment over 1 year. Logistic regressions were adjusted for age, gender, race, ethnicity, chronic medical or psychiatric conditions, number of medication classes, anticholinergic drugs, smoking, baseline root caries treatment, preventive care, and time between first-last restoration in the index year.

RESULTS

Root caries at baseline was associated with a high risk for new root caries. Veterans without root caries during the index year who received a fluoride gel/rinse intervention were 32-40% less likely to receive caries-related treatment for root caries during the follow-up period. Once Veterans had root caries, fluorides did not exhibit a positive effect.

CONCLUSION

In older adults with high caries risk, early fluoride prevention is key, before root caries requires treatment.

Fluoride Release and Rechargeability of Poly(lactic acid) Composites with Glass Ionomer Cement

This study investigates the fluoride release, rechargeability and degradation behaviors of newly developed anticariogenic poly(lactic acid) (PLA) composites. The PLA composite with various concentrations (0%, 5%, 10%, 15% and 20% by weight) of glass ionomer cement (GIC) and sodium fluoride (NaF) were prepared using solvent casting method. The fluoride release, fluoride rechargeability and degradation behavior were evaluated. All experimental groups demonstrated fluoride-releasing ability. The highest level of fluoride ions released was found in PLA composite with sodium fluoride (PLA/NaF). Following the 28-day period, both groups showed a gradual reduction in fluoride ion released, ranging between 0.03 ± 0.01 and 0.53 ± 0.06 ppm, although remaining within the effective range for tooth remineralization. However, the rechargeability was only observed in PLA composite with GIC (PLA/GIC). Following an eight-week in vitro degradation test, all PLA/NaF groups displayed a significantly higher percentage of weight change and water absorption compared to the PLA/GIC and the control group. In SEM analysis, the formation of surface porosities was clearly noticed in all PLA/NaF. All specimens retained their structural integrity throughout the study. In conclusion, the newly developed PLA/GIC displays promising possibilities as an anticariogenic material. Furthermore, the rechargeability of these ions are repeatable, ensuring their long-term utility.

Enamel Fluoride Uptake Determined Using the Microbiopsy Technique and Time-of-Flight Secondary Ion Mass Spectrometry: A Pilot Study

This study evaluated the suitability of time-of-flight secondary ion mass spectrometry (ToF-SIMS) to assess enamel fluoride uptake (EFU) in comparison with the microbiopsy technique. Enamel specimens were exposed to equimolar solutions of fluoride prepared from sodium fluoride (NaF), stannous fluoride (SnF2), or amine fluoride (AmF). EFU was quantified by both techniques on the same specimens. EFU was found to be highest for samples treated with AmF, followed by SnF2 and NaF. Both methods yielded clearly interpretable, highly correlating (r = 0.95) data. ToF-SIMS can be considered a promising alternative to the microbiopsy technique for near-surface EFU assessment.

Providing Effective Dental Care for an Ageing Population

Background

Effective treatment produces improved outcomes from the patient and clinician perspectives. The focus of this article is effective dental care for ageing patients. This concept must be embraced through research, education and, finally, clinical care.

Research

Older adults often carry a higher burden of health and socioeconomic issues that limit their participation in clinical trials. This leaves providers to extrapolate care decisions from research in other age groups. However, electronic health records allow researchers to converge extensive medical, pharmacologic, and dental data, thereby including older patients in research questions.

Education

Dental and medical educators are tasked with teaching skills specific to ageing patients. This requires teaching and active use of concepts such as whole health and patient-centred outcomes.

Provision of care

For ageing patients, effective care is precision care (the right care to the right patient at the right time). Clinicians must be trained and then actively participate in the interdisciplinary approach to assure good oral health for all older patients.