Prevention of Dental Caries by Silver Diamine Fluoride

The use of silver diamine fluoride (SDF) for management of dental caries has gained considerable attention due to recent regulatory clearance in the United States. The primary focus of policies, presentations, and publications has been the arrest of caries lesions (cavities) because of the material's unique ability to non-invasively achieve this elusive and clinically important goal. However, SDF also has proven efficacy in prevention, ie, decreasing the incidence of new caries lesions. Analysis of nine clinical trials in children shows that SDF prevented 61% of new lesions compared to controls. To prevent one new caries lesion, clinicians need to treat four primary teeth (one patient) or 12.1 permanent molars (three patients) with SDF. The preventive effect appears to be immediate and maintains at the same fraction over time. Direct comparisons of SDF applied once per year with alternative treatments show that SDF is more effective than other topical fluorides placed two to four times per year and more cost-effective than dental sealants. Enamel lesions may be even more responsive than cavitated dentin lesions. Annual application of SDF to high-risk surfaces (eg, mesial surfaces of permanent first molars where the distal surface of the second primary molar is carious) in patients with any risk of new caries lesions appears to be the most cost-effective approach available to prevent dental caries. SDF is an underutilized evidence-based preventive agent for dental caries.

Long-term changes of acidifying deposition in Finland (1973-2000)

The long-term changes of acidifying deposition in Finland during the period 1973-2000 were studied using bulk deposition data from 19 stations belonging to the national monitoring network. The regional-scale approach (southern, central and northern Finland) was used for trend assessment with respect to implementation of European sulphur (S) emission reduction amendments involving deposition changes prior to (1973-1985) and after (1986-2000) the agreements (S protocols in 1985 and 1994). There were no marked changes in sulphate deposition between the 1970s and 1980s and consistent trends in 1973-1985 were not observed. Deposition of nitrogen (N) compounds, particularly NO3-N, were increasing between the 1970s and 1980s. Deposition of base cations exhibited a slight decline throughout the 1970s and 1980s. Decrease of calcium and magnesium deposition without corresponding decrease in sulphate resulted in increased acidifying potential (AP) of deposition. Due to successful implementation of S (and N) emission reduction measures, sulphate deposition has decreased substantially (30% in northern and up to 60% in southern Finland) since the late 1980s. N deposition also decreased, but less than S deposition. Base cation deposition has also declined substantially, but this decline appeared to be leveling off during the 1990s, accounting for the decrease of AP in deposition. The observed deposition pattern is in agreement with the on-going biochemical recovery of acidified small Finnish lakes taking place since the early 1990s.