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Zhu LW, Wang RX, Zhang Y, Zhan JY, Lu HX, Chen X. A cost-effectiveness analysis of fluoride varnish application in preventing Root caries in elderly persons: a Markov simulation study. BMC Oral Health 2024; 24:483. [PMID: 38649858 PMCID: PMC11034159 DOI: 10.1186/s12903-024-04226-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Root caries are prevalent issues that affect dental health, particularly among elderly individuals with exposed root surfaces. Fluoride therapy has shown effectiveness in preventing root caries, but limited studies have addressed its cost-effectiveness in elderly persons population. This study aimed to evaluate the cost-effectiveness of a fluoride treatment program for preventing root caries in elderly persons within the context of Chinese public healthcare. METHODS A Markov simulation model was adopted for the cost-effectiveness analysis in a hypothetical scenario from a healthcare system perspective. A 60-year-old subject with 23 teeth was simulated for 20 years. A 5% sodium fluoride varnish treatment was compared with no preventive intervention in terms of effectiveness and cost. Tooth years free of root caries were set as the effect. Transition probabilities were estimated from the data of a community-based cohort and published studies, and costs were based on documents published by the government. The incremental cost-effectiveness ratio (ICER) was calculated to evaluate cost-effectiveness. Univariate and probabilistic sensitivity analyses were performed to evaluate the influence of data uncertainty. RESULTS Fluoride treatment was more effective (with a difference of 10.20 root caries-free tooth years) but also more costly (with a difference of ¥1636.22). The ICER was ¥160.35 per root caries-free tooth year gained. One-way sensitivity analysis showed that the risk ratio of root caries in the fluoride treatment group influenced the result most. In the probabilistic sensitivity analysis, fluoride treatment was cost-effective in 70.5% of the simulated cases. CONCLUSIONS Regular 5% sodium fluoride varnish application was cost-effective for preventing root caries in the elderly persons in most scenarios with the consideration of data uncertainty, but to a limited extent. Improved public dental health awareness may reduce the incremental cost and make the intervention more cost-effective. Overall, the study shed light on the economic viability and impact of such preventive interventions, providing a scientific basis for dental care policies and healthcare resource allocation.
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Affiliation(s)
- Long-Wen Zhu
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai, China
| | - Rui-Xin Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Yu Zhang
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai, China
| | - Jing-Yu Zhan
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai, China
| | - Hai-Xia Lu
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai, China.
| | - Xi Chen
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, College of Stomatology, National Center for Stomatology, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, National Clinical Research Center for Oral Diseases, Shanghai Research Institute of Stomatology, 639 Zhizaoju Road, Shanghai, China.
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Fernando JR, Shen P, Yuan Y, Adams GG, Reynolds C, Reynolds EC. Remineralisation of enamel and dentine with stabilised stannous fluoride dentifrices in a randomised cross-over in situ trial. J Dent 2024; 143:104895. [PMID: 38387598 DOI: 10.1016/j.jdent.2024.104895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES To compare the remineralisation efficacy and ion bioavailability of two novel SnF2-containing dentifrices in a blinded, cross-over, randomised in situ clinical study. METHODS Six participants wore removal palatal appliances holding human enamel and dentine blocks with subsurface lesions. Appliances were worn for two treatment periods of 14 consecutive days each, with a one-week washout period in-between. Participants were randomly allocated to rinse with a 1:5 diluted coded slurry of one of two dentifrices containing either 5 % casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) +1100 ppm F as SnF2 [MIPOP], or 1100 ppm F as SnF2 [CT], for 1 min, four times a day. Saliva was collected post-treatment and analysed for tin, calcium, inorganic phosphate and fluoride ions using atomic absorption spectrophotometry and ion chromatography. Enamel and dentine lesions were analysed for percent remineralisation (%R) using transverse microradiography and percent surface microhardness recovery (%SMHR). RESULTS MIPOP released significantly higher F (3.00 ± 0.27 mM), Ca (15.23 ± 3.23 mM) and Sn (1.18 ± 0.13 mM) into saliva whereas CT released 2.89 ± 0.32 mM F and only 0.84 ± 0.11 mM Ca and 0.28 ± 0.10 mM Sn. MIPOP produced significantly higher %R than CT: 25.6 ± 1.5 % compared to 15.2 ± 0.7 % in enamel, and 33.6 ± 3.1 % compared to 20.6 ± 1.1 % in dentine. Additionally, MIPOP produced significantly higher %SMHR (18.2 ± 7.9 %) compared to CT (4.1 ± 0.6 %). CONCLUSIONS Both dentifrices promoted remineralisation, but the MIPOP dentifrice with added CPP-ACP and the ion-stabilising effects of CPP released higher amounts of bioavailable tin and produced significantly higher remineralisation and surface microhardness recovery. CLINICAL SIGNIFICANCE Modern dentifrices contain SnF2 for a range of oral health benefits. Challenges associated with stability of these formulations can affect ion bioavailability, reducing efficacy. Two dentifrices with SnF2 promoted remineralisation in situ, however the dentifrice with the added saliva biomimetic CPP-ACP was superior and therefore may produce greater health benefits.
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Affiliation(s)
- James R Fernando
- Oral Health CRC, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Peiyan Shen
- Oral Health CRC, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Yi Yuan
- Oral Health CRC, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Geoffrey G Adams
- Oral Health CRC, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Coralie Reynolds
- Oral Health CRC, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Eric C Reynolds
- Oral Health CRC, Melbourne Dental School, Bio21 Institute, The University of Melbourne, Melbourne, Victoria 3010, Australia.
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Bartlett DW, Jadeja SP, Austin RS, Charalambous P, Stewart B, Ruan Q, Won B, Dogu N, Vandeven M, Lavender S. Pilot clinical study to evaluate the efficacy of a professionally delivered high fluoride varnish on erosive tooth wear in an in-situ model. J Dent 2024; 143:104884. [PMID: 38373521 DOI: 10.1016/j.jdent.2024.104884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVES The aim for this pilot study was to investigate the effect of a sodium fluoride varnish on step height measured by a profilometer from human enamel worn by healthy volunteers with a novel in situ/ex vivo erosion design. METHOD Healthy volunteers aged 18-70 years wore a palatal splint containing 8 human enamel samples and underwent two 3-day treatment periods for 6 h a day with a varnish containing sodium fluoride at 22,600 ppm and the control with the same ingredients but without fluoride. Each splint contained 4 polished and 4 unpolished samples. The interventions were applied to the surface of the enamel samples in randomised order, removed after 6 h, then immersed ex-vivo in 1 %, pH 2.7 citric acid for 2 min, repeated 4 times a day, over 2 days. Measurements of enamel were assessed blindly by microhardness on day 2 and by non-contact laser profilometry on day 3 for the two treatments. RESULTS 24 volunteers, 2 males and 22 females aged 27-54 years, were screened and recruited. The delta microhardness, from polished samples removed at the end of day 2, for the control and fluoride treatment was 95.7 (22.9) kgf/mm2 and 123.7 (28.9) kgf/mm2, respectively (p < .005). The mean (SD) step height for the control polished enamel surfaces was 3.67 (2.07) µm and for the fluoride varnish was 1.79 (1.01) µm (p < .0005). The control unpolished enamel surfaces had a mean 2.09 (1.53) µm and the fluoride varnish was 2.11 (1.53) µm but no statistical difference was detected. CONCLUSIONS The results from this pilot study, utilizing an in-situ model where enamel was exposed to acid over the course of 2 days, demonstrated that a high fluoride varnish containing sodium fluoride at 22,600 ppm prevented erosive wear compared to a control on the polished enamel surfaces. CLINICAL SIGNIFICANCE Intra-oral study demonstrated that a high fluoride varnish containing sodium fluoride at 22,600 ppm reduced erosive tooth wear.
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Affiliation(s)
- David W Bartlett
- Centre for Clinical, Oral and Translational Sciences, Faculty of Dentistry, Oral and Clinical Sciences, King's College London, London, SE1 9RT, United Kingdom.
| | - Sagar P Jadeja
- Centre for Clinical, Oral and Translational Sciences, Faculty of Dentistry, Oral and Clinical Sciences, King's College London, London, SE1 9RT, United Kingdom
| | - Rupert S Austin
- Centre for Clinical, Oral and Translational Sciences, Faculty of Dentistry, Oral and Clinical Sciences, King's College London, London, SE1 9RT, United Kingdom
| | - Polyvios Charalambous
- Centre for Clinical, Oral and Translational Sciences, Faculty of Dentistry, Oral and Clinical Sciences, King's College London, London, SE1 9RT, United Kingdom; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester, M15 6FH, United Kingdom
| | - Bernal Stewart
- Colgate Palmolive Company, Global Technology Center, Piscataway, NJ, USA
| | - Qichao Ruan
- Colgate Palmolive Company, Global Technology Center, Piscataway, NJ, USA
| | - Betty Won
- Colgate Palmolive Company, Global Technology Center, Piscataway, NJ, USA
| | - Nihal Dogu
- Colgate Palmolive Company, Global Technology Center, Piscataway, NJ, USA
| | - Mark Vandeven
- Colgate Palmolive Company, Global Technology Center, Piscataway, NJ, USA
| | - Stacey Lavender
- Colgate Palmolive Company, Global Technology Center, Piscataway, NJ, USA
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Nath SJC, Fu Y, Li KC, Loho T, Loch C, Ekambaram M. A Comparison of the Enamel Remineralisation Potential of Self-Assembling Peptides. Int Dent J 2024; 74:187-194. [PMID: 37743135 PMCID: PMC10988264 DOI: 10.1016/j.identj.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/19/2023] [Accepted: 07/04/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND The aim of this research was to compare the efficacy of the remineralising potential of self-assembling peptides (SAPs): Curodont Repair (P11-4), P26, and leucine-rich amelogenin peptides (LRAP) with the standard 5% NaF varnish (Duraphat) on early enamel caries lesions (EECLs). METHODS A demineralising solution (DS) was used to create artificial EECLs in human dental enamel specimens, which were randomly allocated to treatment groups: P11-4; P26 solution; LRAP solution; 5% NaF varnish; and deionised water (DIW). Each specimen was subjected to 8 days of pH cycling. Specimens from each test group were subjected to microcomputed tomography (micro-CT) and nanomechanical testing to assess mineral density (MD), hardness (H), and elastic modulus (EM) properties of sound, demineralised, and treated enamel. RESULTS The mean MD percentage gain was highest in the P26 and P11-4 groups, followed by the LRAP, 5% NaF varnish, and DIW groups. There were statistically significant differences amongst groups. In the outer layer of EECLs, the EM and H were highest in P26 and P11-4 groups, followed by the LRAP and 5% NaF varnish. In the inner layer of EECLs, the EM and H were highest in P11-4 and P26 groups, indicative of enhanced penetration and remineralisation of the deeper parts of the artificial EECLs. CONCLUSIONS P26 and P11-4 SAPs are more effective than 5% NaF varnish in remineralising the depth of EECLs.
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Affiliation(s)
- Suneil Jason Chand Nath
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Yipeng Fu
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand; The Fifth Outpatient Department, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, People's Republic of China
| | - Kai Chun Li
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Thomas Loho
- Faculty of Engineering, Chemical and Materials Engineering, University of Auckland, New Zealand
| | - Carolina Loch
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Manikandan Ekambaram
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
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Yazicioglu O, Ucuncu MK, Guven K. Ingredients in Commercially Available Mouthwashes. Int Dent J 2024; 74:223-241. [PMID: 37709645 PMCID: PMC10988267 DOI: 10.1016/j.identj.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Mouthwashes, a cornerstone of oral and dental hygiene, play a pivotal role in combating the formation of dental plaque, a leading cause of periodontal disease and dental caries. This study aimed to review the composition of mouthwashes found on retail shelves in Turkey and evaluate their prevalence and side effects, if any. METHODS The mouthwashes examined were sourced from the 5 largest chain stores in each district of Istanbul. A comprehensive list of the constituents was meticulously recorded. The research was supported by an extensive compilation of references from scholarly databases such as Google Scholar, PubMed, and ScienceDirect. Through rigorous analysis, the relative proportions of mouthwash ingredients and components were determined. RESULTS A total of 45 distinctive variations of mouthwashes, representing 17 prominent brands, were identified. Amongst the 116 ingredients discovered, 70 were evaluated for potential adverse effects and undesirable side effects. The aroma of the mouthwash (n = 45; 100%), as welll as their sodium fluoride (n = 28; 62.22%), sodium saccharin (n = 29; 64.44%), sorbitol (n = 21; 46.6%), and propylene glycol (n = 28; 62.22%) content were the main undesireable features. CONCLUSIONS The limited array of mouthwashes found on store shelves poses a concern for both oral and public health. Furthermore, the intricate composition of these products, consisting of numerous ingredients with the potential for adverse effects, warrants serious attention. Both clinicians and patients should acknowledge the importance and unwarranted side effects of the compnents of the mouthwashes.
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Affiliation(s)
- Oktay Yazicioglu
- Istanbul University, Faculty of Dentistry, Department of Restorative Dentistry, Istanbul, Turkey
| | - Musa Kazim Ucuncu
- Altinbas University, Faculty of Dentistry, Department of Restorative Dentistry, Istanbul, Turkey.
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Li R, Yang W, Grimaldi R, Zeng P, Smith G, Chen X. Efficacy of a stannous fluoride dentifrice for relieving dentinal hypersensitivity in Chinese population: an 8-week randomized clinical trial. Clin Oral Investig 2024; 28:230. [PMID: 38530474 PMCID: PMC10965716 DOI: 10.1007/s00784-024-05610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/09/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES To compare the effectiveness of using a 0.454% stannous fluoride-containing dentifrice twice daily in relieving dentinal hypersensitivity (DH) in a Chinese population. MATERIALS AND METHODS This was a single-centre, randomized, controlled, examiner-blind, three-treatment-arm, parallel-group study in participants with clinically diagnosed DH. Subjects who met inclusion criteria (n = 197) were randomly allocated into 3 groups: test group (n = 66)-using a 0.454% stannous fluoride-containing dentifrice twice daily; positive control group (n = 64)-using a 5.0% calcium sodium phosphosilicate-containing dentifrice twice daily; negative control group (n = 67)-using a 1150 ppm of NaF dentifrice twice daily. Status of DH was assessed at week 4 and week 8 by the same independent examiner. Changes from baseline in Schiff sensitivity score, tactile threshold and Dentine Hypersensitivity Experience Questionnaire (DHEQ) score were analysed using analysis of covariance models. The DHEQ evaluated subject-perceived oral health-related quality of life (OHRQoL). RESULTS Statistically significant improvements in mean Schiff scores (p < 0.0001 for all products at Weeks 4 and 8), tactile threshold (p < 0.0001 for test and negative control at Weeks 4 and 8: Week 4 p = 0.0040 and Week 8 p < 0.0001 for positive control) and all DHEQ scores (p < 0.01 for all groups) were observed. No statistically significant differences were observed in the adjusted mean between all dentifrices at both timepoints, potentially driven by a placebo effect. Forty-two treatment-emergent adverse events (TEAEs) were reported (n = 32 subjects), with 2 serious AEs (n = 1) in the test group. TEAEs were not considered treatment-related. CONCLUSIONS All groups demonstrated statistically significant improvements in Schiff score, tactile threshold and OHRQoL. However, due to a possible placebo effect in the negative control, there were no statistically significant differences between the dentifrices. CLINICAL RELEVANCE This study adds to the growing research exploring why the placebo effect is a common phenomenon in DH studies. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04950465.
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Affiliation(s)
- Rui Li
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, No. 639 Zhizaoju Road, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Wenjie Yang
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, No. 639 Zhizaoju Road, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Roberta Grimaldi
- Haleon (Formerly Known As GSK Consumer Healthcare), Weybridge, UK
| | - Peter Zeng
- Haleon (Formerly Known As GSK Consumer Healthcare), Shanghai, China
| | - Gary Smith
- Haleon (Formerly Known As GSK Consumer Healthcare), Weybridge, UK
| | - Xi Chen
- Department of Preventive Dentistry, Shanghai Ninth People's Hospital, No. 639 Zhizaoju Road, Shanghai, China.
- Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.
- National Center for Stomatology, Shanghai, China.
- National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Shanghai Research Institute of Stomatology, Shanghai, China.
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Kongyodsueb P, Poolthong S, Chumprasert S, Sae-Ear P, Tantilertanant Y. The effect of silver nanoparticles in addition to sodium fluoride on remineralization of artificial root dentin caries. Aust Dent J 2024; 69:56-66. [PMID: 37813824 DOI: 10.1111/adj.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Silver nanoparticle was developed to overcome the drawback of silver diamine fluoride. However, evidence is limited, especially in root caries. The aim of this study was to evaluate the remineralization effect of silver nanoparticles on root caries. MATERIALS AND METHODS Fifty-five root human dentin slices size 5 × 5 mm2 from patients aged over 60 years old were immersed in demineralized solution to create artificial caries. Specimens were allocated into five groups according to the remineralizing agents: silver diamine fluoride (SDF), silver nanoparticles solution (AgNPs), silver nanoparticle solution followed by sodium fluoride varnish (AgNPs+NaF), sodium fluoride varnish (NaF), and tap water. After 8 days of pH-cycling challenge, the microhardness test, lesion depth evaluation, dentin surface morphology, and elemental analysis were performed. Data was analysed using F-test One-way ANOVA followed by Tukey's post hoc test and paired T-test. RESULTS All test groups demonstrated a significantly higher microhardness value and lower lesion depth compared with the control group. AgNPs+NaF and NaF-treated groups showed lower efficacy than SDF. Crystal precipitation was presented in all groups composed of silver. CONCLUSION Addition of fluoride varnish did not benefit for silver nanoparticles in preventing further demineralization. SDF provides the highest effectiveness in elderly root carious dentin.
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Affiliation(s)
- P Kongyodsueb
- Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - S Poolthong
- Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - S Chumprasert
- Oral Biology Research Center, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - P Sae-Ear
- Oral Biology Research Center, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Y Tantilertanant
- Department of Operative Dentistry, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Axe A, Patel N, Qaqish J, Ling MR, Araga M, Parkinson C, Goyal CR. Efficacy of an experimental toothpaste containing sodium bicarbonate, sodium hyaluronate and sodium fluoride on gingivitis. BMC Oral Health 2024; 24:209. [PMID: 38336635 PMCID: PMC10858478 DOI: 10.1186/s12903-024-03981-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Gingivitis is driven by plaque accumulation and, if left untreated, can progress to irreversible periodontitis. For many, the mechanical action of toothbrushing does not achieve adequate plaque control. The aim of this study was to investigate whether twice-daily use of a toothpaste containing 0.2% high molecular weight (HMW) sodium hyaluronate with 67% sodium bicarbonate and 0.221% sodium fluoride (experimental toothpaste) could improve gingival health compared with a regular fluoride toothpaste (negative control). The study also assessed whether the experimental toothpaste could provide additive gingival health benefit over a toothpaste containing only 67% sodium bicarbonate and 0.221% sodium fluoride (positive control). METHODS This was a single-center, examiner-blinded, randomized, clinical study in healthy adults with mild-to-moderate gingivitis. At baseline, after abstaining from toothbrushing for 12 h, prospective participants underwent oral soft tissue (OST) and oral hard tissue examination followed by assessments for gingival inflammation (Modified Gingival Index [MGI]), gingival bleeding (Bleeding Index [BI]), and supra-gingival plaque (Turesky Plaque Index [TPI]). Eligible participants were stratified by gender and baseline number of bleeding sites (low: <45; high: ≥45 bleeding sites). Following randomization, participants underwent prophylactic dental treatment. Participants received a full OST examination, MGI, BI and TPI assessments after 3 days, 1, 2 and 6 weeks of product use. RESULTS In total, 110 participants were screened for study entry and all were randomized to receive one of three toothpastes (experimental: sodium hyaluronate, sodium bicarbonate, sodium fluoride; positive control: sodium bicarbonate, sodium fluoride; negative control: regular fluoride toothpaste). For all measures, significant improvements were observed in participants receiving either sodium bicarbonate-containing toothpaste (experimental or positive control) compared with the regular fluoride toothpaste (negative control) at week 6. No significant difference was observed in any assessment or visit comparing the experimental toothpaste with the positive control. CONCLUSIONS Both the experimental and the positive control toothpastes demonstrated clinically relevant improvements in gingival health compared with a regular fluoride toothpaste (negative control). However, no additional gingival health improvement was observed for the experimental toothpaste compared with the positive control, therefore, no additional gingival health benefit can be attributed to the inclusion of sodium hyaluronate in this formulation. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04737538 (04/02/2021).
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Affiliation(s)
- Alyson Axe
- Haleon, St George's Avenue Weybridge, Surrey, ODE, KT13, UK.
| | - Nisha Patel
- Haleon, St George's Avenue Weybridge, Surrey, ODE, KT13, UK
| | | | - Martin R Ling
- Haleon, St George's Avenue Weybridge, Surrey, ODE, KT13, UK
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Rupel K, Ottaviani G, Bogdan Preda MT, Poropat A, Gobbo M, DI Lenarda R, Biasotto M. Ozone treatment combined with sodium fluoride for the treatment of dentin hypersensitivity: an exploratory study. Minerva Dent Oral Sci 2024; 73:20-26. [PMID: 37943289 DOI: 10.23736/s2724-6329.23.04830-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Dentin hypersensitivity is one of the most common complains faced by dental professionals, and there is still lack of consensus for the most effective treatment approaches. The aim of the present study was to evaluate the efficacy of ozone therapy combined with sodium fluoride in reducing pain associated with dental hypersensitivity, compared to a paint-on adhesive desensitizing agent. METHODS The study included 20 patients (131 teeth), selected according to specific inclusion criteria and divided into two groups according to the type of desensitizing therapy (ozone with sodium fluoride or paint-on adhesive). The efficacy of both treatments were evaluated recording pain for each treated tooth immediately after treatment, after 1 month and after 6 months using a Numeric Rating Scale (NRS). Subjective parameters were also recorded: patients were asked to report whether they experienced pain caused by air, teeth brushing, cold and hot topical stimuli (present/absent). RESULTS In both groups, pain values significantly decreased over time. Six months after treatment we registered significantly lower pain values in the ozone-treated group compared with the adhesive group and the mean percentage of NRS reduction from was significantly higher in the ozone-treated group. We did not register significant differences in subjective pain-related parameters between groups. CONCLUSIONS The results of this exploratory study were aimed at exploring the combined effect of ozone with natrium fluoride, which was before described only in vitro. With the limitation of the sample size, our results suggest that this approach provides a pain reduction that was comparable to the paint-on adhesive.
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Affiliation(s)
- Katia Rupel
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy -
| | - Giulia Ottaviani
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Augusto Poropat
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Margherita Gobbo
- Unit of Oral and Maxillofacial Surgery, Ca' Foncello Hospital, Treviso, Italy
| | - Roberto DI Lenarda
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Matteo Biasotto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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Donners R, Tunariu N, Tovey H, Hall E, Chua S, Cook G, Du Y, Blackledge MD, Parker CC, Koh DM. The value of baseline 18F-sodium fluoride and 18F-choline PET activity for identifying responders to radium-223 treatment in castration-resistant prostate cancer bone metastases. Eur Radiol 2024; 34:1146-1154. [PMID: 37615760 PMCID: PMC10853307 DOI: 10.1007/s00330-023-10172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/27/2023] [Accepted: 07/15/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES To investigate whether baseline 18F-sodium fluoride (NaF) and 18F-choline PET activity is associated with metastatic castration-resistant prostate cancer (mCRPC) global and individual bone metastases' DWI MR imaging response to radium-223 treatment. METHODS Thirty-six bone-only mCRPC patients were prospectively recruited from three centers. Whole-body (WB)-MRI with DWI and 18F-NaF and 18F-choline PET/CT were performed at therapy baseline and 8-week intervals. In each patient, bone disease median global (g)ADC change between baseline and follow-up was calculated. Additionally, up to five bone target lesions per patient were delineated and individual median ADC change recorded. An ADC increase > 30% defined response per-patient and per-lesion. For the same targets, baseline 18F-NaF and 18F-choline PET SUVmax were recorded. Mean SUVmax across patient targets was correlated with gADC change and lesion SUVmax with per-lesion ADC change. RESULTS A total of 133 lesions in 36 patients (14 responders) were analyzed. 18F-NaF PET per-patient mean SUVmax was significantly higher in responders (median = 56.0 versus 38.7 in non-responders; p = 0.008), with positive correlation between SUVmax and gADC increase (rho = 0.42; p = 0.015). A 48.7 SUVmax threshold identified responders with 77% sensitivity and 75% specificity. Baseline 18F-NaF PET per-lesion SUVmax was higher in responding metastases (median = 51.6 versus 31.8 in non-responding metastases; p = 0.001), with positive correlation between baseline lesion SUVmax and ADC increase (rho = 0.39; p < 0.001). A 36.8 SUVmax threshold yielded 72% sensitivity and 63% specificity. No significant association was found between baseline 18F-choline PET SUVmax and ADC response on a per-patient (p = 0.164) or per-lesion basis (p = 0.921). CONCLUSION 18F-NaF PET baseline SUVmax of target mCRPC bone disease showed significant association with response to radium-223 defined by ADC change. CLINICAL RELEVANCE STATEMENT 18F-sodium fluoride PET/CT baseline maximum SUV of castration-resistant prostate cancer bone metastases could be used as a predictive biomarker for response to radium-223 therapy. KEY POINTS • 18F-sodium fluoride PET baseline SUVmax of castration-resistant prostate cancer bone metastases showed significant association with response to radium-223. • Baseline 18F-sodium fluoride PET can improve patient selection for radium-223 therapy. • Change in whole-body DWI parameters can be used for response correlation with baseline 18F-sodium fluoride PET SUVmax in castration-resistant prostate cancer bone metastases.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Nina Tunariu
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Holly Tovey
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Emma Hall
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Sue Chua
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Gary Cook
- King's College London and Guy's and St. Thomas' PET Centre, St. Thomas' Hospital, King's College London, Westminster Bridge Rd, London, UK
| | - Yong Du
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | | | - Christopher C Parker
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Dow-Mu Koh
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
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11
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Orilisi G, Vitiello F, Notarstefano V, Furlani M, Riberti N, Monterubbianesi R, Bellezze T, Campus G, Carrouel F, Orsini G, Putignano A. Multidisciplinary evaluation of the remineralization potential of three fluoride-based toothpastes on natural white spot lesions. Clin Oral Investig 2023; 27:7451-7462. [PMID: 37857734 PMCID: PMC10713761 DOI: 10.1007/s00784-023-05334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES This in vitro study aimed assessing the remineralization potential of three commercial fluoride-based toothpastes in permanent teeth with natural white spot lesions (WSLs). A multidisciplinary approach based on Raman microspectroscopy (RMS), Scanning electron microscopy (SEM), Energy-dispersive x-ray spectroscopy (EDS), and Vickers microhardness (VMH) was exploited. METHODS N = 12 human molars with natural WSLs in the proximal-vestibular zone were selected and divided into 4 groups (n = 3) according to the different treatments: HAF (hydroxyapatite with fluoride ions); SMF (sodium monofluorophosphate with arginine); SF (sodium fluoride with enzymes), and CTRL (untreated group). All toothpastes tested contained 1450 ppm of fluoride. Teeth samples were submitted to the following protocol: a 7-day pH cycling treatment, with two daily exposures (2 min each time) to the commercial toothpastes described above. The surface micromorphology (SEM), the chemical/elemental composition (RMS and EDS), and the Vickers microhardness (VMH) were evaluated. Statistical analysis was performed. RESULTS A remarkable remineralization of WSLs in SEM images was observed in all treated groups compared to CTRL. In particular, HAF and SF displayed higher values of VMH, phosphates amount (I960), crystallinity (FWHM960), and lower ones of C/P (I1070/I960) with respect to CTRL. Intermediate values were found in SMF, higher than CTRL but lower with respect to HAF and SF. As regards the Ca/P ratio, statistically significant differences (p < 0.05) were found between SF and the other groups. CONCLUSIONS All the tested dentifrices have shown to remineralize the WSLs. SF and HAF have comparable capability in hardness recovery and crystallinity; however, SF shows the best remineralizing potential according to both micromorphological and chemical analyses. Clinical relevance The daily use of toothpastes containing hydroxyapatite partially replaced with fluoride, sodium monofluorophosphate with arginine and sodium fluoride toothpaste associated with enzymes represents a preventive, therapeutic, effective, and non-invasive tool for remineralize WSLs.
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Affiliation(s)
- Giulia Orilisi
- Department of Clinical Sciences and Stomatology (DISCO), Università Politecnica Delle Marche, 60126, Ancona, Italy
| | - Flavia Vitiello
- Department of Clinical Sciences and Stomatology (DISCO), Università Politecnica Delle Marche, 60126, Ancona, Italy
- Health, Systemic, Process (P2S), Research Unit UR 4129, University Claude Bernard Lyon 1, University of Lyon, 69008, Lyon, France
| | - Valentina Notarstefano
- Department of Life and Environmental Sciences, Università Politecnica Delle Marche (DISVA), 60131, Ancona, Italy
| | - Michele Furlani
- Department of Clinical Sciences and Stomatology (DISCO), Università Politecnica Delle Marche, 60126, Ancona, Italy
| | - Nicole Riberti
- Department of Neurosciences Imaging and Clinical Sciences (DNISC), University of Chieti-Pescara, 66100, Chieti, Italy
| | - Riccardo Monterubbianesi
- Department of Clinical Sciences and Stomatology (DISCO), Università Politecnica Delle Marche, 60126, Ancona, Italy
| | - Tiziano Bellezze
- Department of Materials, Environmental Sciences and Urban Planning (SIMAU), Università Politecnica Delle Marche, 60131, Ancona, Italy
| | - Guglielmo Campus
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, 07100, Sassari, Italy
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, CH-3010, Bern, Switzerland
| | - Florence Carrouel
- Health, Systemic, Process (P2S), Research Unit UR 4129, University Claude Bernard Lyon 1, University of Lyon, 69008, Lyon, France
| | - Giovanna Orsini
- Department of Clinical Sciences and Stomatology (DISCO), Università Politecnica Delle Marche, 60126, Ancona, Italy.
| | - Angelo Putignano
- Department of Clinical Sciences and Stomatology (DISCO), Università Politecnica Delle Marche, 60126, Ancona, Italy
- National Institute of Health and Science of Aging (INRCA), 60124, Ancona, Italy
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Yip K, Abdalla MM, Bijle MN, Yiu C. Effect of arginine-fluoride varnish on preventing enamel erosion by paediatric liquid medicaments. BMC Oral Health 2023; 23:892. [PMID: 37985984 PMCID: PMC10662501 DOI: 10.1186/s12903-023-03621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The study objective was to examine the effect of arginine-sodium fluoride (Arg-NaF) varnish on preventing enamel erosion by acidic paediatric liquid medicaments (PLM). METHODS The treatment groups were: 1) 2% Arg-NaF; 2) 4% Arg-NaF; 3) 8% Arg-NaF; 4) NaF; 5) MI (CPP-ACFP) varnishes; and 6) no varnish. The pH of PLM (paracetamol and chlorpheniramine) was measured at baseline and after immersing the Perspex® blocks coated with varnishes at 0 min, 30 min, 1 h, and 4 h. Seventy-two enamel specimens (n = 72) were randomly divided into 2 groups by PLM and further by treatment groups. Then, the specimens were pre-treated with varnishes and subjected to erosive cycles (5 min, 2×/day for 4 days) by PLM. After each erosive challenge, the specimens were stored in artificial saliva. At baseline and after 4 days, the specimens were assessed for surface roughness (Ra) using 2D-surface profilometric analysis (SPA) and atomic force microscopy (AFM). Additionally, the Ca/P ratio was determined using scanning electron microscopy with energy-dispersive X-ray spectroscopy. Paired samples dependent t-test, 1-way ANOVA and 2-way ANOVA with Bonferroni post-hoc tests were used to analyse data with the level of significance set at p < 0.05. RESULTS The pH of PLM with 8% Arg-NaF was significantly higher than the other groups at 30 min and 4 h (p < 0.05). With paracetamol, no significant difference was observed between the baseline and post-erosive cycle measured enamel Ra (by SPA/AFM) and Ca/P ratio for all treatment groups (p > 0.05). The Ra determined by AFM, at the post-erosive cycle with chlorpheniramine, when treated with 4 and 8% Arg-NaF was significantly lower than the other groups (p < 0.05); except CPP-ACFP (p > 0.05). With the chlorpheniramine post-erosive cycle, the Ca/P ratio for 4, 8% Arg-NaF and CPP-ACFP treated specimens was significantly higher than the baseline Ca/P (p < 0.05). CONCLUSION The 4%/8% Arg-NaF and MI varnish® application exhibit an enhanced preventive effect against low pH (pH < 3.0) PLM-mediated enamel erosive challenges compared to 5% NaF varnish.
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Affiliation(s)
- Kimberley Yip
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong Island, Hong Kong
| | - Mohamed Mahmoud Abdalla
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong Island, Hong Kong
- Dental Biomaterials, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Nadeem Bijle
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong Island, Hong Kong
| | - Cynthia Yiu
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong Island, Hong Kong.
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Abdellatif EB, El Kashlan MK, El Tantawi M. Silver diamine fluoride with sodium fluoride varnish versus silver diamine fluoride in arresting early childhood caries: a 6-months follow up of a randomized field trial. BMC Oral Health 2023; 23:875. [PMID: 37978488 PMCID: PMC10656986 DOI: 10.1186/s12903-023-03597-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Early childhood caries (ECC) is the most prevalent chronic health problem in young children, and it can be arrested using professionally applied fluoride such as Sodium fluoride (NaF) varnish and Silver Diamine Fluoride (SDF). This trial compared two interventions to arrest ECC lesions: 38% SDF combined with 5% NaF varnish versus 38% SDF and assessed whether the arrest rate was affected by baseline lesion severity measured by ICDAS. METHODS Children aged ≤ 4 years from 4 nurseries in a rural area in Alexandria, Egypt joined the study in March 2022. They were included if they had at least one active carious lesion with ICDAS codes ≥ 3. They were randomized to receive either 38% SDF with 5% NaF varnish or 38% SDF alone. In both groups, the agents were applied at baseline and after 6 months on the caries lesions. NaF was additionally applied on all teeth in the oral cavity, and it was also applied after three months. The primary outcome was lesion arrest status after six months. Parents' satisfaction with their children's appearance was the secondary outcome. Pearson Chi-Square test was used for bivariate comparison and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest controlling for confounders. The interaction between the intervention and baseline lesion severity (categorized into moderate and severe lesions) was assessed and the p value was calculated. RESULTS The study included 1606 lesions in 220 children, median (IQR) age = 48(9) months. The percentages of arrested lesions after the application of SDF + NaF and SDF only were 77.7% and 73.2% (p = 0.035). In multivariable analysis, SDF + NaF had significantly greater caries arrest effect than SDF alone (AOR = 2.12, p = 0.03) with significant difference (p = 0.03) between moderate (AOR = 4.10, p = 0.005) and advanced (AOR = 1.92, p = 0.08) lesions. Most parents were satisfied with their children's appearance with no significant difference between groups (SDF + NaF = 84.5%, SDF = 78.18%, p = 0.23). CONCLUSION SDF + NaF had a higher arrest rate than SDF alone and this difference was significant in moderate but not advanced lesions. The findings have implications for the non-invasive management of ECC. TRIAL REGISTRATION This trial was registered in the clinicaltrials.gov registry (#NCT05642494).
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Affiliation(s)
- Enas B Abdellatif
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champolion St, Azarita, 21527, Alexandria, Egypt.
| | - Mona K El Kashlan
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champolion St, Azarita, 21527, Alexandria, Egypt
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champolion St, Azarita, 21527, Alexandria, Egypt
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Inchingolo AM, Inchingolo AD, Latini G, Garofoli G, Sardano R, De Leonardis N, Dongiovanni L, Minetti E, Palermo A, Dipalma G, Inchingolo F. Caries prevention and treatment in early childhood: comparing strategies. A systematic review. Eur Rev Med Pharmacol Sci 2023; 27:11082-11092. [PMID: 38039039 DOI: 10.26355/eurrev_202311_34477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Early childhood caries is a common condition that poses a serious risk to children's health because it can progress quickly, resulting in pain, abscesses, and a general decline in health. As a result, invasive therapies are needed, which call for highly skilled personnel. This systematic review of the literature aims to identify the most recent and widely applied early childhood caries (ECC) prevention and treatment approaches. Only substances that act topically and minimally invasive interventions were considered. MATERIALS AND METHODS The database search was restricted to randomized clinical trials completed within the last five years, specifically those that examined the following procedures: sodium fluoride (NaF) varnish, alternative restorative technique (ART), nano-silver fluoride, silver diamine fluoride, and silver modified atraumatic restorative treatment sealants (SMART). RESULTS A total of 815 articles were found. After removing duplicates, 584 articles were included, and 567 of them were excluded due to not meeting the predefined inclusion criteria. CONCLUSIONS Every method considered has been proven to be successful in halting the progression of ECC and is well-liked by patients, even those who are unwilling to cooperate, as well as by parents. The most common unfavorable effect of SDF is irreversible black discoloration in treated tooth surfaces, but this is typically not a problem. They are all low-cost, minimally invasive techniques that might also be widely used in large communities and low socioeconomic settings.
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Affiliation(s)
- A M Inchingolo
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy.
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Paiva MF, Delbem ACB, Veri IV, Sampaio C, Wiegand A, Pessan JP. Fluoride varnishes supplemented with nano-sized sodium trimetaphosphate reduce enamel erosive wear in vitro. J Dent 2023; 138:104726. [PMID: 37757908 DOI: 10.1016/j.jdent.2023.104726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE To evaluate the effect of fluoride (F) varnishes with sodium trimetaphosphate (TMP) on erosive tooth wear (ETW) in vitro. METHODS Enamel blocks (n = 100) were divided into 5 experimental groups (n = 20/group): Placebo (Pla - without F/TMP); 5 % NaF (NaF); 5 % NaF + 5 % micrometric TMP (NaF+5 %MICRO); 5 % NaF + 2.5 % nano-sized TMP (NaF+2.5 %NANO), and 5 % NaF + 5 % nano-sized TMP (NaF+5 %NANO). Blocks received a single varnish application (6 h contact), and were submitted to 4 daily erosive challenges (ERO, 0.05 M citric acid, pH 3.2, 90 s, under agitation), for 5 days. After ERO, half of the blocks (n = 10/group) were subjected to brushing abrasion (ERO+ABR). Profilometry, surface hardness (SH), and cross-sectional hardness (ΔKHN) were determined. The data were submitted to 2-way ANOVA and Fisher's LSD test (p < 0.05). RESULTS Enamel wear was significantly lower for ERO compared with ERO+ABR for all varnishes tested (p < 0.001), following the pattern NaF+5 %NANO < NaF+5 %MICRO < NaF < NaF+2.5 %NANO < Pla (both for ERO and ERO+ABR). The highest SH loss was observed for Pla and the lowest for NaF (ERO) and NaF+2.5 %NANO (ERO+ABR), without significant differences among NaF+2.5 %NANO, NaF, and NaF+5 %MICRO. The highest ΔKHN values were observed for NaF+5 %MICRO and NaF+5 %NANO at 5-30 µm, with less marked differences among the groups at 30-70 µm (ERO and ERO+ABR). CONCLUSIONS The addition of TMP to F varnishes significantly improves protection against ETW in vitro. The use of 5 % nano-sized TMP further enhances such effects. CLINICAL SIGNIFICANCE F varnishes containing TMP can reduce enamel loss caused by ERO or ERO+ABR.
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Affiliation(s)
- Mayra Frasson Paiva
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), José Bonifácio 1193, Araçatuba, SP 16015-050, Brazil
| | - Alberto Carlos Botazzo Delbem
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), José Bonifácio 1193, Araçatuba, SP 16015-050, Brazil
| | - Isabela Vecchiatti Veri
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), José Bonifácio 1193, Araçatuba, SP 16015-050, Brazil
| | - Caio Sampaio
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), José Bonifácio 1193, Araçatuba, SP 16015-050, Brazil
| | - Annette Wiegand
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Göttingen, Germany
| | - Juliano Pelim Pessan
- Department of Preventive and Restorative Dentistry, School of Dentistry, São Paulo State University (UNESP), José Bonifácio 1193, Araçatuba, SP 16015-050, Brazil.
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Abdalla MM, Bijle MN, Abdallah NMA, Yiu CKY. Enamel remineralization potential and antimicrobial effect of a fluoride varnish containing calcium strontium silicate. J Dent 2023; 138:104731. [PMID: 37777085 DOI: 10.1016/j.jdent.2023.104731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/13/2023] [Accepted: 09/28/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVES To investigate enamel remineralization and antimicrobial effect of sodium fluoride (NaF) varnish containing calcium strontium silicate (CSR). METHODS CSR was synthesized by sol-gel process and incorporated in 5 % NaF varnish at three different concentrations (1 %, 2 %, and 4 % w/v). The treatment/control groups were: 1 % CSR+NaF, 2 % CSR+NaF, 4 % CSR+NaF, NaF, and no treatment. Strontium and fluoride release from the varnishes was evaluated. Sound enamel specimens (n = 6) were demineralized, varnish-treated, and subjected to remineralization cycle. Mineral density of enamel specimens was evaluated using micro-CT. Antimicrobial effect of the varnishes on Streptococcus mutans and Lactobacillus acidophilus biofilms was assessed using confocal laser scanning microscopy. The HGF-1 cytotoxicity of the varnishes was examined using CCK-8 assay. RESULTS Both 2 % and 4 % CSR+NaF varnishes showed significantly higher F release and remineralization potential than NaF varnish (p < 0.05). Dead bacterial proportion of 4 % CSR+NaF varnish was significantly higher than NaF varnish (p < 0.05). The CFUs values of both S. mutans and L. acidophilus were significantly lower in 4 % CSR+NaF group than NaF group (p < 0.05). No significant difference in cell viability was observed among the groups (p > 0.05). CONCLUSIONS Incorporation of 4 % CSR in a NaF varnish significantly enhanced its enamel remineralization and antimicrobial potential with no cytotoxic effect. CLINICAL SIGNIFICANCE Dental caries is a major public health problem globally. The study highlights the great potential of CSR-doped NaF varnish as a novel anti-caries agent with synergistic remineralizing and antimicrobial properties to combat early enamel caries lesions in the general population.
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Affiliation(s)
- Mohamed Mahmoud Abdalla
- Paediatric Dentistry, Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong, China; Dental Biomaterials, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Nadeem Bijle
- Paediatric Dentistry, Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Nermeen M A Abdallah
- Medical Microbiology and Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Cynthia Kar Yung Yiu
- Paediatric Dentistry, Faculty of Dentistry, Prince Philip Dental Hospital, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong, China.
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Yassin R, Amer H, Tantawi ME. Effectiveness of silver diamine fluoride versus sodium fluoride varnish combined with mother's motivational interviewing for arresting early childhood caries: a randomized clinical trial. BMC Oral Health 2023; 23:710. [PMID: 37789300 PMCID: PMC10548636 DOI: 10.1186/s12903-023-03456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Silver Diamine Fluoride (SDF) has gained attention as one of the minimally invasive modalities to manage ECC although it causes black staining of treated carious lesions. A possible affordable alternative may be Sodium Fluoride (NaF) varnish combined with good oral hygiene promoted by parental Motivational Interviewing (MI). The study compared the effectiveness of 38% SDF solution and 5% NaF varnish supported by parental MI in arresting ECC. MATERIALS AND METHODS Children aged ≤ 4 years old with at least one active carious lesion (ICDAS score ≥ 3) were randomly assigned to treatment by a single application of 38% SDF solution or a single application of 5% NaF varnish supported by two MI sessions for mothers at baseline and after three months. Chi-Squared test was used to compare groups and multilevel logistic regression analysis was used to assess the effect of the interventions on ECC arrest adjusting for confounders. The interaction between the type of intervention and baseline lesion severity, moderate (ICDAS 3/4) or advanced (ICDAS 5/6), was also assessed. RESULTS The study included 165 children with 949 active lesions. After 6 months, there were no significant differences between SDF and NaF/MI groups in overall caries arrest (63.7% and 58.1%, p = 0.08), and in moderate lesions (72.9% and 69.6%, p = 0.52). However, in advanced lesions, the arrest rate was significantly higher in the SDF than the NaF/ MI group (60.3% and 50.0%, P = 0.01). Multilevel multiple logistic regression showed no significant differences between the interventions (AOR = 1.56, P = 0.27) with significant interaction between the intervention and baseline lesion severity (p < 0.001). Moderate lesions treated with SDF (AOR = 3.69, P = 0.008) or NaF/MI (AOR = 3.32, P < 0.001) had significantly higher odds of arrest than advanced lesions treated with NaF/ MI with no difference between advanced lesions treated with SDF or NaF/ MI (AOR = 1.85, P = 0.155) in arrest rate. CONCLUSION NaF/ MI can be an alternative to SDF in arresting advanced and moderate ECC lesions without staining with stronger effect on moderate lesions (ICDAS 3/4). TRIAL REGISTRATION The trial was retrospectively registered at clinicaltrial.gov registry (#NCT05761041) on 9/3/2023.
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Affiliation(s)
- Randa Yassin
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Hala Amer
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Singh DK, Goyal S, Bhola L, Shivkumar AT, Manningal A, Reddy U, Moothedath M, Mishra D. Influence of Different Mouthwashes on the Efficacy of Fluoridated Dentifrices in Prevention of Enamel Erosion: An In Vitro Study. J Contemp Dent Pract 2023; 24:739-742. [PMID: 38152905 DOI: 10.5005/jp-journals-10024-3539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
AIM The purpose of the current study was to evaluate the impact of three various mouthwashes on the effectiveness of fluoride dentifrices in preventing enamel erosion. MATERIALS AND METHODS A total of 120 sound intact human premolar teeth which were extracted for orthodontic treatment were selected for the study. A 3 × 3 mm window section was positioned in the middle of the coronal surface of the tooth in order to define the study area. Each sample was placed in a solution of 1% citric acid (pH 3.5) for 10 minutes in order to produce an eroded surface. All samples were divided into two main groups (60 samples each) as follows: Group A for sodium fluoride dentifrices and group B for stannous fluoride dentifrices, again it is subdivided into: CHX: Chlohex ADS®, EO: Listerine®, CPC: Colgate® Plax (20 samples in each subgroup). After that, samples underwent the pH cycling model for 5 days. Samples were examined for surface loss using a scanning electron microscope. RESULTS In sodium fluoride dentifrices group, before intervention, the surface loss was 3.12 ± 1.03 in CHX group, 3.08 ± 1.20 in EO group, and 3.09 ± 0.96 in CPC group. After intervention, the less surface loss found with CHX group (2.18 ± 0.84), followed by CPC (2.34 ± 0.74) and EO group (2.46 ± 0.97). In stannous fluoride dentifrices group, before intervention, the surface loss in CHX group was 3.26 ± 1.19, in EO group, it was 3.18 ± 1.31, and in CPC group, it was 3.22 ± 1.06. After intervention, the less surface loss found with CHX: group (1.90 ± 0.54), followed by CPC (2.24 ± 0.28) and EO group (2.38 ± 0.20). CONCLUSION The present study concluded that the fluoride dentifrices' preventive effects against tooth surface loss were unaffected by a different mouthwashes with varying compositions and major constituents. In terms of erosion, fluoridated toothpaste containing stannous fluoride was found to provide better surface loss protection than sodium fluoride. CLINICAL SIGNIFICANCE Primary prevention and the eradication of contributing causes are the greatest strategies for preventing erosion. Simultaneously, antibacterial agent in the mouthwashes may help in enhancing the effect of fluoride in the enamel, owing to their high affinity for teeth structures. Therefore, in addition to cause-related treatment, further efforts to reduce tooth tissue loss are also necessary.
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Affiliation(s)
- Dhirendra Kumar Singh
- Department of Periodontics, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Srishty Goyal
- Department of Periodontics, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India, Phone: +07060128287, e-mail:
| | - Lucy Bhola
- Department of Periodontics, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
| | - Ashwini Tumukur Shivkumar
- Department of Conservative Dentistry and Endodontics, JSS Dental College and Hospital, JSS Academy of Higher Education and Research (JSSAHER), Mysuru, Karnataka, India
| | - Aparna Manningal
- Department of Public Health Dentistry, KMCT Dental College, Kozhikode, Kerala, India
| | - Upasana Reddy
- Department of Conservative Dentistry and Endodontics, AB Shetty Memorial Institute of Dental Sciences (ABSMIDS), NITTE (Deemed to be University), Mangaluru, Karnataka, India
| | - Muhamood Moothedath
- Department of Oral and Dental Health, College of Applied Health Sciences in Arrass, Qassim University, Al Qassim, Kingdom of Saudi Arabia
| | - Debasish Mishra
- Department of Periodontics, Kalinga Institute of Dental Sciences, KIIT Deemed to be University, Bhubaneswar, Odisha, India
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Enerbäck H, Lövgren ML, Strömberg N, Westerlund A. Effect of high-fluoride toothpaste and mouth rinse on the prevention of demineralized lesions during orthodontic treatment: a randomized controlled trial. Eur J Orthod 2023; 45:477-484. [PMID: 37524332 PMCID: PMC10566543 DOI: 10.1093/ejo/cjad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVE To evaluate the effect of high-fluoride mouth rinse and high-fluoride toothpaste on the development of demineralized lesions (DLs) during orthodontic treatment. TRIAL DESIGN Three-armed parallel-group randomized controlled trial. METHODS The trial was performed with 270 adolescent orthodontic patients. Randomization was performed in blocks of 30, enrolling the patients into one of the following groups: the fluoride mouth rinse (FMR) group receiving 0.2% sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; high-fluoride toothpaste (HFT) group receiving 5000 ppm F toothpaste; and the Control (CTR) group receiving 1450 ppm F toothpaste. Inclusion criteria were patients scheduled for treatment in both arches with fixed appliances and age between 12 and 20 years. The primary outcome variable was the proportion of participants with at least one new demineralized lesion as assessed on digital photos taken before and after treatment, analysed by a blinded clinician. The analysis included all teeth or teeth in the aesthetic zone, i.e. all central incisors, lateral incisors, and canines. A random sample of 30 participants was assessed to check intra- and inter-reliability. For pairwise comparison between groups, Fisher's non-parametric permutation test was used for continuous variables. Blinding was employed during the caries registration and data analysis. RECRUITMENT October 2010 to December 2012. RESULTS In total, 270 patients were randomized, of which 22 were excluded during treatment. Therefore, 248 participants were included in the study. The number of patients with an increase of ≥1 DL, including only central- and lateral incisors and canines, during orthodontic treatment, was significantly lower in the HFT group, 51/85 60%, compared to the CTR group, 64/82 78%, RR 0.77 (CI 0.62; 0.95), P = .01 and in the FMR group, 47/81 58%, compared to the CTR group, RR 0.74 (CI 0.60; 0.92), P < .01. CONCLUSIONS To prevent demineralized lesions in the aesthetic zone, high-fluoride mouth rinse and high-fluoride toothpaste may be recommended. LIMITATIONS The protocol was not registered, and the present study did not use a double-blinded design.
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Affiliation(s)
- Hanna Enerbäck
- Department of Orthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mai Lin Lövgren
- Department of Orthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicklas Strömberg
- Department of Cariology, Institute of Odontology, University of Umeå, Umeå, Sweden
| | - Anna Westerlund
- Department of Orthodontics, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Specialist Clinic for Orthodontics, Public Dental Service, Mölndal, Sweden
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20
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Jiemkim A, Tharapiwattananon T, Songsiripradubboon S. Combined use of stannous fluoride-containing mouth rinse and toothpaste prevents enamel erosion in vitro. Clin Oral Investig 2023; 27:5189-5201. [PMID: 37432505 PMCID: PMC10492772 DOI: 10.1007/s00784-023-05138-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To compare the protective effect of commercial stannous-containing mouth rinses on enamel erosion in a simulated 5-day in vitro cycling model. MATERIALS AND METHODS 81 human enamel specimens were embedded in resin blocks and divided into nine groups as follows; group 1: stannous fluoride (1000SnF2) toothpaste; groups 2,3, and 4 were the same as group 1 plus Elmex®, PerioMed™, and Meridol®, respectively, group 5: stannous fluoride (1450SnF2) toothpaste, groups 6, 7, and 8 were the same as group 5 plus Elmex®, PerioMed™, and Meridol®, respectively, group 9: negative control. An erosive challenge was induced with a 1 min hydrochloric acid (0.01 M, pH 2.2) treatment 3 times per day. Each cycle included immersing in the toothpaste slurry twice for two minutes and a one-minute rinse. The enamel slabs were immersed in artificial saliva between each erosive cycle and incubated overnight at 37 °C. Surface hardness loss and enamel loss were determined by Knoop surface hardness and non-contact profilometry, respectively. Finally, enamel surfaces were analyzed by scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDS). RESULTS All three mouth rinses had similar protective effects against erosion when using adjunct with 1000 SnF2 toothpaste (p > 0.05). With 1450 SnF2 toothpaste, Elmex® presented significantly lower surface hardness loss than Meridol® (p < 0.05). The combined use of Elmex® or PerioMed™ with toothpaste provided significantly better erosion protection than toothpaste alone, either 1000 or 1450 SnF2. In addition, 1000SnF2 toothpaste adjunct with mouth rinse is comparable to 1450 SnF2 toothpaste alone in preventing enamel erosion. CONCLUSION All three mouth rinses reduced enamel erosion. The additional use of a high concentration stannous containing mouth rinse with 1450 SnF2 toothpaste increases the protective effect against enamel erosion in vitro. CLINICAL SIGNIFICANCE To date, no standard protocol for preventing dental erosion is available. There are three stannous-containing mouth rinses on the market; however, no study compared their efficacy or indicated whether using adjuncts with anti-erosion toothpaste provides additional benefits. This study found that adding stannous mouth rinse to twice-daily toothpaste increases erosion protection.
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Affiliation(s)
- Apichaya Jiemkim
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant, Road, Pathumwan, Bangkok, 10330, Thailand
| | - Thipawan Tharapiwattananon
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant, Road, Pathumwan, Bangkok, 10330, Thailand
| | - Siriporn Songsiripradubboon
- Department of Pediatric Dentistry, Faculty of Dentistry, Chulalongkorn University, 34 Henri Dunant, Road, Pathumwan, Bangkok, 10330, Thailand.
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21
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Chan AKY, Tsang YC, Jiang CM, Leung KCM, Lo ECM, Chu CH. Treating hypersensitivity in older adults with silver diamine fluoride: A randomised clinical trial. J Dent 2023; 136:104616. [PMID: 37454789 DOI: 10.1016/j.jdent.2023.104616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the desensitizing effect of topically applied 38% silver diamine fluoride (SDF) solution on the exposed root surface of hypersensitive teeth in older adults. METHOD This double-blind randomised clinical trial recruited healthy older adults with dentine hypersensitivity. A trained examiner tested the most hypersensitive tooth root surface with a blast of compressed cold air from a three-in-one syringe. The participants gave a sensitivity score (SS) in visual analogue scale from 0 (no pain) to 10 (agonizing) at the baseline visit. Then, they received 38% SDF or 5% potassium nitrate solution (control) as intervention on the root surface. After the intervention, they received a compressed cold air test and reported the SS again. The compressed cold air test followed by intervention was repeated at 4- and 8-week follow ups. The primary outcome was the reduction in SS at 8-week follow-up with reference to the SS at baseline before intervention. Shapiro-Wilk and Mann-Whitney U tests were performed for data analysis following a normality test of SS. RESULTS This trial recruited 148 participants, and 139 (94%) participants completed the trial. The median percentage reductions in SS in the SDF and potassium nitrate groups were 60% and 50%, respectively (p < 0.001). CONCLUSION According to the results, 38% SDF solution reduced hypersensitivity on the exposed root surface of older adults. In addition, 38% SDF was more effective than 5% potassium nitrate solution to reduce hypersensitivity on the exposed root surface of older adults. CLINICAL SIGNIFICANCE Dentin hypersensitivity is common amongst older adults and negatively affects their quality of life. To date, there is no gold standard professionally applied desensitizing therapy in treating hypersensitivity. Evidence from this clinical trial could aid clinical practice and improve oral health in older adults. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov (NCT05392868).
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Affiliation(s)
- Alice Kit Ying Chan
- Faculty of Dentistry, The University of Hong Kong, Postal address: 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Yiu Cheung Tsang
- Faculty of Dentistry, The University of Hong Kong, Postal address: 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Chloe Meng Jiang
- Faculty of Dentistry, The University of Hong Kong, Postal address: 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Katherine Chiu Man Leung
- Faculty of Dentistry, The University of Hong Kong, Postal address: 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Edward Chin Man Lo
- Faculty of Dentistry, The University of Hong Kong, Postal address: 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Postal address: 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China.
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22
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Geisinger ML, Geurs NC, Novy B, Otomo-Corgel J, Cobb CM, Jacobsen PL, Takesh T, Wilder-Smith P. A randomized double-blind clinical trial evaluating comparative plaque and gingival health associated with commercially available stannous fluoride-containing dentifrices as compared to a sodium fluoride control dentifrice. J Periodontol 2023; 94:1112-1121. [PMID: 37016272 PMCID: PMC10524004 DOI: 10.1002/jper.22-0675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/15/2023] [Accepted: 03/18/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Gingivitis is a non-specific inflammatory lesion in response to the accumulation of oral biofilm and is a necessary precursor to periodontitis. Enhanced oral hygiene practices, including utilization of a dentifrice that could significantly improve plaque accumulation and gingival inflammation, is desirable to prevent and treat gingivitis and potentially prevent progression to periodontitis. This clinical study aimed to investigate the effect of a new stannous fluoride-containing dentifrice with 2.6% ethylenediamine tetra acetic acid (EDTA) as an anti-tartar agent to reduce plaque index and gingival index over a 3-month study period compared to other commercially-available fluoride-containing dentifrices. METHODS This double-blind, randomized controlled clinical study evaluated plaque, gingival inflammation, and sulcular bleeding in patients using one of five commercially available fluoride-containing dentifrices The dentifrices tested contained: 0.454% stannous fluoride and 2.6% EDTA (D1), 0.24% sodium fluoride (C), and 0.454% stannous fluoride (D2-D4). One hundred fifty subjects participated over a 3-month period. Co-primary endpoints were improvements in plaque index (PI) and modified gingival index (mGI) from baseline values. No professional cleaning was performed during the study period. RESULTS All subjects in the study demonstrated statistically significant improvements in all measures of oral hygiene over the 3-month study period. Subjects using dentifrice 1 (D1) showed statistically significantly greater reductions in PI, mGI, and modified sulcular bleeding index (mSBI) compared with all other commercially-available dentifrices tested (p < 0.00001). CONCLUSIONS A new dentifrice with 0.454% stannous fluoride and 2.6% EDTA demonstrated significant improvements in clinical parameters associated with gingivitis compared to other sodium and stannous fluoride containing dentifrices.
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Affiliation(s)
- Maria L. Geisinger
- University of Alabama at Birmingham School of Dentistry, Department of Periodontology
| | - Nicolaas C. Geurs
- University of Alabama at Birmingham School of Dentistry, Department of Periodontology
| | - Brian Novy
- Harvard University, School of Dental Medicine
| | - Joan Otomo-Corgel
- University of California at Los Angeles, School of Dentistry, Department of Periodontology
| | - Charles M. Cobb
- University of Missouri-Kansas City, Department of Periodontology
| | | | - Thair Takesh
- University of California at Irvine, Beckman Laser Institute and Medical Center, Department of Dentistry
| | - Petra Wilder-Smith
- Department of Ecology and Evolutionary Biology, University of California Irvine, Irvine, California, USA
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23
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Martinez A, Im J, Bezman E, Lee E, DeAnda D, Ree R, Oyoyo U, Kwon SR. A comparison of toothpaste tablets and a sodium fluoride dentifrice for the control of supragingival plaque and gingivitis: A 2-week randomized controlled trial. Am J Dent 2023; 36:172-176. [PMID: 37587026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
PURPOSE To compare toothpaste tablets containing 0.243% sodium fluoride and a conventional sodium fluoride dentifrice for gingivitis and plaque control over a 2-week period. METHODS Forty adult participants were randomized into two groups: Toothpaste tablets (Colgate Anywhere Travel Toothpaste Tablets) and conventional dentifrice (Colgate Cavity Protection). A blinded examiner measured the gingival and plaque index at baseline and after 2 weeks. A questionnaire was distributed at the end to determine overall satisfaction of the product used. Statistical analyses were performed separately for the gingival index and plaque index scores. Comparisons of the two treatment groups with respect to baseline and 2-week gingival index and plaque index scores were performed using Mann-Whitney U-test. Within-treatment comparisons of the gingival index and plaque index scores obtained at the 2-week examinations versus baseline were performed using Wilcoxon test. RESULTS Both groups had statistically significant improvements in plaque control at the 2-week visit (P< 0.05). There was no statistically significant difference between groups for gingival and plaque index at the 2-week visit (P> 0.05). Overall satisfaction for both products were positive while perception on "texture/foaminess" was more negative for toothpaste tablets (P= 0.001). The results showed that toothpaste tablets' short-term performance on gingivitis and plaque control was equivalent to conventional dentifrice while the " texture/foaminess" of toothpaste tablets was found to be less appealing. CLINICAL SIGNIFICANCE Toothpaste tablets are a relatively new form of toothpaste that can be a viable alternative to conventional dentifrice with the added benefit of an eco-friendly way of maintaining oral hygiene.
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Affiliation(s)
- Amber Martinez
- School of Dentistry, Loma Linda University, Loma Linda, California, USA
| | - Jaclyn Im
- School of Dentistry, Loma Linda University, Loma Linda, California, USA
| | - Emili Bezman
- School of Dentistry, Loma Linda University, Loma Linda, California, USA
| | - Esther Lee
- School of Dentistry, Loma Linda University, Loma Linda, California, USA
| | - Dominic DeAnda
- School of Dentistry, Loma Linda University, Loma Linda, California, USA
| | - Rachel Ree
- School of Dentistry, Loma Linda University, Loma Linda, California, USA
| | - Udochukwu Oyoyo
- Dental Education Services, School of Dentistry, Loma Linda University, Loma Linda, California, USA
| | - So Ran Kwon
- Student Research Program, Division of General Dentistry, School of Dentistry, Loma Linda University, Loma Linda, California, USA,
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Al-Nuaimi N, Gasgoos S. EFFECT OF CHICKEN EGGSHELL PASTE ON ENAMEL SURFACE MICROHARDNESS AND COLOUR CHANGE OF ARTIFICIAL CARIOUS LESIONS CREATED ON PERMANENTLY EXTRACTED TEETH. Georgian Med News 2023:107-112. [PMID: 37805883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Remineralizing agents such as fluoride and hydroxyapatite (HA) (Ca5 (po4)3OH) are well-known treatment choices for incipient enamel lesions. Hydroxyapatite has been newly presented to return the color of such enamel lesions. The purpose of this prospective in vitro study was to compare commercial sodium fluoride paste to hydroxyapatite paste (HA) made from chicken eggshells powder (CESP) in terms of how it affected the microhardness and color of the enamel surface of artificially demineralized permanent teeth. Fifty healthy maxillary premolars were gathered, decoronated, and the crowns were placed in acrylic moulds with the buccal enamel surfaces exposed. Baseline microhardness evaluation was done for the baseline group, while the colour assessment was done at baseline to three treatment groups. Then specimens were randomly divided into the following five groups (n = 10) based on the treatment of enamel surface: Group 1: Baseline group; Group 2: Acid group demineralized only; Group 3: demineralized followed by the application of hydroxyapatite paste (HA); Group 4: demineralized followed by the application of sodium fluoride toothpaste (Naf); and Group 5: demineralized followed by application of combination treatments (HA paste at morning and Naf paste at evening. The specimens were stored in deionized water at room temperature during treatments, after one week they were subjected to a Vickers microhardness test, and colour assessment to three treatment groups after treatment. One‑way ANOVA and Tukey's post hoc multiple comparison tests were used for statistical analysis (P < 0.05). After artificial demineralization, the enamel's surface microhardness was greatly reduced, and after management, it dramatically increased. The combination group had the greatest mean microhardness value when compared to the HA paste group and the Naf paste group. Statistically, there was no significant variance in microhardness values among the Naf paste and HA paste groups. Hydroxyapatite sourced from chicken eggshell was as effective as Naf paste in remineralizing and restoring the lost microhardness of artificially demineralized enamel, hydroxyapatite paste changed tooth color, while sodium fluoride paste, a combination group neither changed nor masked color of early caries lesion.
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Affiliation(s)
| | - S Gasgoos
- 2College of Dentistry, University of Mosul, Mosul, Iraq
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25
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Piesiak-Pańczyszyn D, Zakrzewski W, Piszko A, Piszko PJ, Dobrzyński M. Review on fluoride varnishes currently recommended in dental prophylaxis. Polim Med 2023; 53:141-151. [PMID: 38014987 DOI: 10.17219/pim/174016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 11/29/2023] Open
Abstract
In dentistry, fluoride compounds play a very important role in the development of teeth hard tissue. They have been modifying the development of the carious process for many years in accordance with the principles of minimally invasive therapy. Studies have confirmed their effectiveness in the prevention and treatment of carious lesions and erosion of deciduous and permanent teeth, as well as in the dentin hypersensitivity treatment. Typically, each varnish consists of 3 basic components, i.e., a resin usually in the form of mastic, shellac and/or rosin, an alcohol-based organic solvent (usually ethanol) and active agents. In the first-generation varnishes, the active agent is fluorine compounds, most often in the form of 5% NaF, while in second-generation varnishes, the composition is further enriched with calcium and phosphorus compounds in the form of CPP-ACP/CPP-ACPF, ACP, TCP, fTCP, CSPS, TMP, CXP, or CaGP. This influences the bioavailability of fluoride in the oral environment by increasing both its release from the product and its subsequent accumulation in enamel and plaque, promotes more efficient closure of dentinal tubules, and facilitates pH buffering in the oral cavity.
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Affiliation(s)
| | | | - Aleksandra Piszko
- Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Poland
| | - Paweł J Piszko
- Faculty of Chemistry, Department of Polymer Engineering and Technology, Wroclaw University of Science and Technology, Poland
| | - Maciej Dobrzyński
- Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Poland
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Takesh T, Goshtasbi A, Lin K, Yang SM, Wink C, Geisinger ML, Wilder-Smith P. Better living through chemistry? A randomized, double-blind controlled study evaluating the efficacy of plaque control and gingival health impacts of a novel stannous fluoride-containing gel. J Periodontol 2023; 94:509-518. [PMID: 35980316 PMCID: PMC10569749 DOI: 10.1002/jper.22-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/19/2022] [Accepted: 08/06/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Gingivitis is a nonspecific inflammatory lesion in response to the accumulation of oral biofilm and is a necessary precursor to periodontitis. Enhanced oral hygiene practices are necessary to reverse gingivitis and a dentifrice that could provide significant clinical reductions in plaque accumulation and gingival inflammation would be desirable to treat gingivitis and potentially prevent progression to periodontitis. This clinical study aimed to investigate the effect of a novel stannous fluoride-containing dentifrice with 2.6% ethylenediamine tetra-acetic acid (EDTA) as an antitartar agent to reduce Plaque Index (PI) and Gingival Index over a 3-month study period. METHODS This double-blind, randomized controlled clinical study evaluated plaque, gingival inflammation, and sulcular bleeding in patients using either a novel dental gel containing 0.454% stannous fluoride and 2.6% EDTA or a dentifrice with 0.24% sodium fluoride. Sixty subjects participated over a 3-month period. Co-primary endpoints were improvements in PI and Modified Gingival Index (mGI) from baseline values. No professional cleaning was performed during the study period. RESULTS All subjects in the study demonstrated statistically significant improvements in all measures of oral hygiene over the 3-month study period. Subjects using the novel dental gel showed statistically significantly greater reductions in PI (ΔPI) [(-1.43 ± 0.34; -0.49 ± 0.13) (p < 0.00001)], mGI (ΔmGI) [(-1.11 ± 0.22; -0.16 ± 0.12) (p < 0.00001)], and modified sulcular bleeding index (ΔmSBI) [(-1.15 ± 0.18; -0.20 ± 0.07) (p < 0.00001)]. CONCLUSIONS The novel dental gel demonstrated significant improvements in clinical parameters associated with gingivitis compared to a commercially available sodium fluoride dentifrice.
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Affiliation(s)
- Thair Takesh
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Arezou Goshtasbi
- Concorde College of Dental Hygiene, Garden Grove, California, USA
| | - Kairong Lin
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Susan Meishan Yang
- Beckman Laser Institute, University of California, Irvine, California, USA
| | - Cherie Wink
- Beckman Laser Institute, University of California, Irvine, California, USA
- Concorde College of Dental Hygiene, Garden Grove, California, USA
| | | | - Petra Wilder-Smith
- Beckman Laser Institute, University of California, Irvine, California, USA
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Tunar OL, Kuru BE. Microstructural Changes of Human Dentin Tubules after Citric Acid Immersion of Specimens Treated with Different Desensitising Approaches: An SEM Analysis. Oral Health Prev Dent 2022; 20:369-378. [PMID: 36259440 DOI: 10.3290/j.ohpd.b3464895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE This in-vitro study aimed to evaluate the effectiveness and acid resistance on dentin surfaces following the application of a linear-oscillating device (LOD) with a hydroxyapatite-based polishing fluid, Er:YAG laser or sodium fluoride (NaF) used alone or in combinations for desensitising purposes. MATERIALS AND METHODS Freshly extracted impacted third molars were used to obtain 120 specimens, all completely immersed in 1% citric acid for 5 min and divided randomly into 6 groups. Group I, with no treatment, served as the control; group II: Er:YAG laser (30 Hz, 60 mJ/pulse, 10 s); group III: NaF gel; group IV: LOD; groups V and VI: the combinations of NaF+Er:YAG and LOD+Er:YAG, respectively, were applied. Following these treatments, the effectiveness of each was evaluated in half of the specimens in each group (n = 10). The other half of the specimens (n = 10) served for acid-resistance testing. All evaluations were made on SEM photomicrographs. RESULTS The post-treatment tubule diameters and numbers were the lowest with LOD+Er:YAG, followed by NaF+Er:YAG, LOD, Er:YAG and NaF. Paired comparisons revealed LOD+Er:YAG to be the best treatment method (p < 0.05). After 3 h of acid immersion, all treatments revealed significant increases (p < 0.05) in both tubule number and diameter study between post-treatment and post-acid immersion values. The exception was LOD+Er:YAG. LOD+Er:YAG showed the highest resistance to acid challenge, presenting the lowest increase in tubular diameters and numbers followed by NaF+Er:YAG, LOD, Er:YAG and NaF. CONCLUSION Combined LOD+Er:YAG treatment revealed the highest effectiveness and acid resistance. Further clinical studies are warranted to confirm these in-vitro results.
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Chan AKY, Tamrakar M, Jiang CM, Tsang YC, Leung KCM, Chu CH. Clinical evidence for professionally applied fluoride therapy to prevent and arrest dental caries in older adults: A systematic review. J Dent 2022; 125:104273. [PMID: 36058347 DOI: 10.1016/j.jdent.2022.104273] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/06/2022] [Accepted: 08/25/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To assess the clinical evidence for professionally applied fluoride therapy to prevent and arrest caries in older adults. DATA/SOURCES Two independent researchers searched the English literature published up to 31st Dec 2021 in five databases (PubMed, Scopus, the Cochrane Library, EMBASE, and Web of Science) for clinical trials with a comparison group on professionally applied fluoride therapy for caries prevention or arrest at older adults aged ≥60 years with any follow-up period. The outcomes were the mean difference in the number of new caries/caries-prevented fraction and caries arrest rate. The Cochrane guidelines were used for the risk of bias assessment. STUDY SELECTION/RESULTS Five hundred and twenty-seven studies were identified, and seven studies were finally included. Five studies were rated as having 'low risk'. The root caries-prevented fraction of 38% silver diamine fluoride (SDF) solution, 5% sodium fluoride (NaF) varnish, and 1.23% acidulated phosphate fluoride (APF) gel were 25-71%, 64%, and 32%, respectively. Meta-analysis indicated a decrease in the number of new root caries by 0.55 (95% CI: 0.32-0.78; p < 0.001) and an overall proportion of arrested root caries of 42% (95% CI: 33% to 49%; p < 0.001) after receiving 38% SDF application at the 24-month follow-up. CONCLUSIONS According to the findings, 5% NaF varnish and 1.23% APF gel prevented root caries, whereas 38% SDF solution prevented and arrested root caries in older adults. More well-designed clinical trials should be conducted to investigate various methods in caries prevention and arrest in older adults. CLINICAL SIGNIFICANCE Preventive measures effective in other age groups may not suit older adults, as caries type and associated risk factors vary. To date, no systematic review has evaluated professionally applied fluoride therapy in older adults. Evidence from clinical trials in older adults could aid clinical practice and public health measures. The International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42022307025.
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Affiliation(s)
- Alice Kit Ying Chan
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Manisha Tamrakar
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Chloe Meng Jiang
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Yiu Cheung Tsang
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Katherine Chiu Man Leung
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, 3/F, The Prince Philip Dental Hospital, 34, Hospital Road, Sai Ying Pun, Hong Kong, China.
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Phonghanyudh A, Duangthip D, Mabangkhru S, Jirarattanasopha V. Is Silver Diamine Fluoride Effective in Arresting Enamel Caries? A Randomized Clinical Trial. Int J Environ Res Public Health 2022; 19:ijerph19158992. [PMID: 35897363 PMCID: PMC9331268 DOI: 10.3390/ijerph19158992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
Background: There is limited information on the effectiveness of 38% silver diamine fluoride (SDF) in managing enamel caries. Objective: This study aimed to compare effectiveness of 38% SDF and 5% Sodium fluoride (NaF) varnish in arresting enamel caries in young children when applied semiannually over 18 months. Methods: A randomized controlled trial was conducted on children aged 1−3 years who had at least one active carious surface. They were allocated into two groups: Group 1 (38% SDF) and Group 2 (5% NaF varnish). Visual-tactile examination was used to assess extent of carious lesions. Enamel caries that did not progress to dentin were classified as having caries arrest. Intention-to-treat analysis was performed. Results: At baseline, 290 children with 1974 tooth surfaces with enamel caries were recruited. Caries arrest rates at the tooth surface level in Group 1 and Group 2 were 59.1% and 58.8%, respectively (p = 0.873), at 18 months. The multilevel logistic regression analysis revealed that tooth position, tooth surface, extent of enamel caries at baseline, caries experience, and brushing with fluoride toothpaste influenced caries arrest (p < 0.05). Conclusion: The semiannual application of 38% SDF and 5% NaF varnish had comparable effectiveness in arresting enamel caries in primary teeth.
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Affiliation(s)
- Araya Phonghanyudh
- School of Dentistry, King Mongkut’s Institute of Technology Ladkrabang, Bangkok 10520, Thailand;
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Mylonas P, Moazzez R, Joiner A, Bartlett D. Superimposition of sequential scans to measure erosion on unpolished and curved human enamel. J Dent 2021; 117:103879. [PMID: 34762989 DOI: 10.1016/j.jdent.2021.103879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/18/2021] [Accepted: 10/29/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To determine if superimposition of sequential scans can discriminate between different fluorides at step heights less than 5 μm on natural human enamel surfaces. MATERIALS AND METHODS Natural, unpolished, human enamel specimens (n = 60) were randomly assigned to one of three pre-treatment toothpaste slurries with a calcium silicate/fluoride, fluoride-only and a control. Baseline and post treatment scans, from a non-contacting profilometer with a 0.01 μm z-axis and <1 μm lateral scanning resolution were imported into superimposition software to define change in mean 3D step height and surface roughness following erosion in 0.3 % citric acid for 15 min. Statistical analysis conducted with two-way repeated measures ANOVA and post-hoc Tukey's multiple comparisons. RESULTS Confidence and resolution of superimposition and subtraction of repeated profiles from unpolished enamel revealed accuracy within 1-2 μm. The technique was able to discriminate between the fluorides demonstrating statistical differences in mean (SD) 3D step height (μm) of 1.96 (0.40) and 2.75 (0.49) (p=0.0024). There was a statistically significant increase in surface roughness for all groups after 15 min erosion compared to baseline. But no statistically significant difference between the interventions after 15 min erosion but there was compared to no fluoride (p=0.006). CONCLUSION Superimposition and subtraction of profiles could discriminate between fluoride interventions, which showed statistical differences in enamel loss differences less than 3 μm. CLINICAL SIGNIFICANCE This erosion model and data analysis workflow was able to distinguish differences between scans of 3 μm on unpolished enamel following the interaction with fluoride.
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Affiliation(s)
- P Mylonas
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff CF14 4XY, United Kingdom; Centre for Oral, Clinical &Translational Sciences, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, United Kingdom.
| | - R Moazzez
- Centre for Oral, Clinical &Translational Sciences, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, United Kingdom
| | - A Joiner
- Unilever Oral Care, Bebington, Wirral, United Kingdom
| | - D Bartlett
- Centre for Oral, Clinical &Translational Sciences, King's College London Faculty of Dentistry, Oral & Craniofacial Sciences, London, United Kingdom
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Tavares JDP, da Silva CV, Engel Y, de Freitas PM, Rechmann P. In situ effect of CO2 laser (9.3 μm) irradiation, combined with AmF/NaF/SnCl2 solution in prevention and control of erosive tooth wear in human enamel. Caries Res 2021; 55:617-628. [PMID: 34689142 DOI: 10.1159/000520215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This single-blind, controlled cross-over in situ study aimed to evaluate the effect of CO2 laser (9.3µm) irradiation, combined with AmF/NaF/SnCl2 solution on prevention and control of Erosive Tooth Wear (ETW) in human enamel. MATERIALS AND METHODS Two trial conditions were analyzed, Condition-1 as ETW-prevention (sound tooth surface) and Condition-2 as ETW-control (in vitro initial erosive lesion). The experiment was conducted in two phases, one with one without exposure to AmF/NaF/SnCl2 solution. A hundred and ninety-two samples of human enamel (3x3x1mm) were randomly divided into 4 experimental groups for each condition: (C) without treatment (negative control); (F) AmF/NaF/SnCl2 solution (positive control); (L) CO2 laser irradiation; (L+F) CO2 laser+AmF/NaF/SnCl2 solution. Twelve volunteers used a removable device each containing 8 samples per phase. Ex-vivo erosive challenges (4×5min/day) and rinsing protocol (1×30s/day) were performed. The surface loss was determined using optical profilometer (n=12 per group), and the surface morphology was observed with Scanning Electron Microscopy (n=3). RESULTS Condition-1 data were analyzed by one-way ANOVA and Condition-2 by two-way repeated measures ANOVA, both with Tukey post-hoc tests (α=5%). Condition-1: groups L (4.59 ±2.95µm) and L+F (1.58 ±1.24µm) showed significantly less surface loss in preventing ETW than groups C and F. Condition-2: in controlling the progression of ETW, L+F was the only group with no significant surface loss between initial erosive lesion (3.65 ±0.16µm) and after erosive challenge (4.99 ±1.17µm). CONCLUSIONS CO2 9.3µm laser application prevented and controlled ETW progression in human enamel, with greater efficiency when combined with AmF/NaF/SnCl2 solution application.
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Affiliation(s)
- Juliane de Paula Tavares
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil,
| | - Camila Vieira da Silva
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Yael Engel
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | - Peter Rechmann
- Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California at San Francisco, San Francisco, California, USA
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Vertuan M, Machado PF, de Souza BM, Braga AS, Magalhães AC. Effect of TiF 4/NaF and chitosan solutions on the development of enamel caries under a microcosm biofilm model. J Dent 2021; 111:103732. [PMID: 34174348 DOI: 10.1016/j.jdent.2021.103732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To evaluate the effect of experimental solutions containing TiF4/NaF and chitosan on bacterial species and on enamel caries prevention. METHODS Microcosm biofilm was produced from human saliva mixed with McBain saliva (0.2% sucrose) on bovine enamel for five days, under 5% CO2 and 37 °C. From the second day until the end, the treatments were applied (1 × 60 s/day): (1) NaF (500 ppm F-, positive control); (2) TiF4 and NaF (TiF4: 190 ppm Ti4+ and 300 ppm F-; NaF: 190 ppm F-); (3) similar to 2 plus 0.5% chitosan (Ch 500 mPas, 75% deacetylation); (4) phosphate buffer solution (negative control); and (5) 0.5% chitosan (Ch 500 mPas, 75% deacetylation). CFU counting was performed for total microorganism, total streptococcus, total lactobacillus and Streptococcus mutans. Enamel demineralization was measured by transverse microradiography-TMR. The data were compared using ANOVA/Tukey or Kruskal-Wallis/Dunn tests (p < .050). RESULTS No differences were found between the treatments with respect to CFU counting (ANOVA, p > .050). Enamel treated with TiF4/NaF plus chitosan solution presented the lowest demineralization compared to the negative control and pure chitosan solution. On the other hand, this experimental solution did not significantly differ from TiF4/NaF and NaF solutions, being all of them able to significantly reduce mineral loss (50-74%), but only TiF4/NaF plus chitosan reduced lesion depth (55%) compared to the negative control (p = .001). CONCLUSION TiF4/NaF plus chitosan solution had no antimicrobial effect, but it was able to reduce enamel caries development in 79% compared to control under this model. CLINICAL SIGNIFICANCE This study showed that TiF4/NaF plus chitosan solution had no antimicrobial effect, but it was able to reduce enamel caries development under a microcosm biofilm model.
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Affiliation(s)
- Mariele Vertuan
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, Bauru-SP, Zip code: 17012-901, Brazil.
| | - Paula Fontana Machado
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, Bauru-SP, Zip code: 17012-901, Brazil.
| | - Beatriz Martines de Souza
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, Bauru-SP, Zip code: 17012-901, Brazil
| | - Aline Silva Braga
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, Bauru-SP, Zip code: 17012-901, Brazil
| | - Ana Carolina Magalhães
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, Bauru-SP, Zip code: 17012-901, Brazil.
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Creeth JE, Burnett GR. Efficacy of an Experimental Occlusion Technology Toothpaste in the Relief of Dentinal Hypersensitivity: An 8-week Randomised Controlled Trial. Oral Health Prev Dent 2021; 19:195-202. [PMID: 33723979 DOI: 10.3290/j.ohpd.b1075109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE A novel anhydrous toothpaste formulation has been developed containing the anti-dentinal hypersensitivity (DH) ingredient stannous fluoride (SnF2). MATERIALS AND METHODS This randomised, controlled, examiner-blind, parallel-group, stratified (by baseline Schiff sensitivity score) study compared efficacy of an experimental 'Test' toothpaste (n = 67) containing 0.454% SnF2, 0.072% sodium fluoride and 5% sodium tripolyphosphate (all percentages w/w) with a negative 'Control' 0.76% sodium monofluorophosphate toothpaste (n = 68) in relieving DH in healthy Chinese adults. After 4-6 weeks acclimatisation, DH was assessed at baseline and following 4 and 8 weeks' twice-daily brushing by response to evaporative (air) (Schiff sensitivity score) and tactile (Yeaple probe) stimuli. An analysis of covariance model was used (factor: treatment group; covariate: baseline Schiff sensitivity score). RESULTS Both Test and Control toothpastes statistically significantly reduced Schiff sensitivity score from baseline after 8 weeks' use; the Test toothpaste also statistically significantly reduced the score after 4 weeks' use (all p < 0.001). The Test toothpaste reduction was statistically significantly superior to the Control toothpaste reduction at both timepoints (p < 0.001). Percentage differences in treatment effects between Test and Control groups were 24.1% at 4 weeks and 31.7% at 8 weeks. Tactile threshold scores for both treatments statistically significantly increased from baseline at both timepoints (all p < 0.001); however, there were no statistically significant differences between Test and Control groups. Both toothpastes were well-tolerated with no adverse events reported. CONCLUSION The Test toothpaste containing 0.454% SnF2 reduced DH statistically significantly more than the Control as evaluated by the Schiff sensitivity score, but not by tactile threshold.
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Gao SS, Chen KJ, Duangthip D, Wong MCM, Lo ECM, Chu CH. Preventing early childhood caries with silver diamine fluoride: study protocol for a randomised clinical trial. Trials 2020; 21:140. [PMID: 32019596 PMCID: PMC7001262 DOI: 10.1186/s13063-020-4088-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Silver diamine fluoride (SDF) solution is effective in arresting early childhood caries (ECC). Previous studies have suggested that it might exert a preventive effect in managing ECC. However, no well-designed clinical trials have yet been performed to study the effect of SDF on caries prevention. The objective of this randomised clinical trial is to determine whether 38% SDF solution is superior to 5% sodium fluoride (NaF) varnish in preventing new carious lesions in primary anterior teeth. METHODS/DESIGN This is a phase II, single-centre, randomised, double-blind, active-controlled, parallel-group pragmatic trial. The hypothesis tested is that 38% SDF would be more effective than 5% NaF in preventing new caries development in primary anterior teeth. Approximately 730 3-year-old children who are generally healthy and with parental consent will be recruited from Hong Kong kindergartens. This sample size will be sufficient for appropriate statistical analysis of a superiority trial with 90% power, allowing for a 20% drop-out rate. Stratified randomisation will be adopted for allocating the intervention. The intervention will either be 38% SDF or 5% NaF (as a positive control) therapy on primary upper anterior teeth. A single trained examiner will conduct a dental examination every 6 months until 30 months in kindergarten. Another operator will provide fluoride therapy immediately after each dental examination. The examiner, children and children's parents will be blinded to the treatment allocation. A questionnaire survey will be conducted to study the children's oral health-related behaviours and socioeconomic backgrounds. Chi-square tests, t tests, regression analyses and survival analyses will be adopted for data analysis. DISCUSSION The effectiveness of 38% SDF in preventing ECC remains uncertain. If the results are as anticipated, care standards using 5% NaF for ECC prevention will be changed. In addition, the results will be widely available and increase the adoption of SDF in other countries to reduce the global burden of ECC. TRIAL REGISTRATION ClinicalTrials.gov, NCT04075474. Registered on 30 Aug 2019.
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Affiliation(s)
- Sherry Shiqian Gao
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR China
| | - Kitty Jieyi Chen
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR China
| | - Duangporn Duangthip
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR China
| | - May Chun Mei Wong
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR China
| | - Edward Chin Man Lo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Hong Kong SAR China
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Gözetici B, Öztürk-Bozkurt F, Toz-Akalın T. Comparative Evaluation of Resin Infiltration and Remineralisation of Noncavitated Smooth Surface Caries Lesions: 6-month Results. Oral Health Prev Dent 2019; 17:99-106. [PMID: 30874252 DOI: 10.3290/j.ohpd.a42203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To compare the therapeutic effects of the resin infiltration technique, self-assembling peptide (P11-4), and fluoride varnish application on white spot lesions (WSLs) on buccal surfaces based on LF pen measurements and LAA-ICDAS scores. MATERIALS AND METHODS The lesions of 113 patients from a total of 319 patients with at least four visible WSL on buccal surfaces were assessed by LAA-ICDAS and laser fluoresence (LF pen). To be included in the study, participants were required to have at least 4 buccal WLSs, each in different quadrants, with an LF pen score ≥ 8. Twenty-one patients were included in the study based on the laser fluoresence values. The lesions were randomly assigned into 4 groups (n = 21): IG (Icon), CRG (Curodont Repair), DG (Duraphat), and CG (control) groups. The treatment protocols were applied, but the control group received no treatment except regular brushing. Lesions were scored by LAA-ICDAS after 3 and 6 months and LF pen after 1 week, 3 and 6 months. RESULTS There was a statistically significant decrease in LF pen measurements of the control and the intervention groups after 6 months when compared to baseline. The greatest lesion regression was observed with IG (-23.25 ± 18.21), which differed statistically significantly from CRG (-8.15 ± 13.89), DG (-10.1 ± 10.31) and CG (-4.15 ± 9.72), followed by DG which differed statistically significantly from CG. Statistically significant differences were observed in the activity status of the lesions between baseline and 6 months, except for the control group. CONCLUSION In this study, the lesion regression rates shown by mean LF pen values in all groups after six months encourages the management of non-cavitated smooth surface caries lesions with non-operative treatment approaches. Regular brushing and professional tooth cleaning seem to be effective for the management of WSLs on buccal surfaces, and resin infiltration or fluoride varnish might enhance the improvement of these lesions in moderate- to high-caries-risk individuals.
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Trieu A, Mohamed A, Lynch E. Silver diamine fluoride versus sodium fluoride for arresting dentine caries in children: a systematic review and meta-analysis. Sci Rep 2019; 9:2115. [PMID: 30765785 PMCID: PMC6376061 DOI: 10.1038/s41598-019-38569-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/07/2018] [Indexed: 11/08/2022] Open
Abstract
Dental caries can compromise quality of life and is associated with demineralization of tooth structure by organic acids produced by microorganisms. This study systematically reviewed the dentine caries arrest capabilities of silver diamine fluoride (SDF) and sodium fluoride (NaF). A comprehensive search strategy was developed to identify the relevant publications in electronic databases and hand searched journals and reviews (to March 2018). By applying strict inclusion and exclusion criteria, only six papers (two randomized controlled trials, two follow-up articles and two secondary statistical analysis studies) were considered for full text qualitative and quantitative assessment. The included studies were critically appraised and statistically evaluated. Only four articles were considered for meta-analysis, as the other two were secondary analyses of included studies. When comparing the caries arrest lesions of SDF and NaF, SDF was found to be statistically more effective in dentine caries arrest of primary teeth during the 18 and 30 month clinical examinations. The weighted total effect size of the differences between SDF and NaF regarding arrested caries surfaces was calculated and showed nearly double the effectiveness of SDF to NaF at 30 months. Therefore, SDF is a more effective caries management reagent than NaF. Further clinical research is needed to consolidate the findings of this systematic review.
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Affiliation(s)
- Alice Trieu
- Pediatric Dental Resident, Pediatric Dentistry Department, University of Nevada, Las Vegas (UNLV), 89106, USA
| | - Ahmed Mohamed
- Visiting Faculty, Biomedical and Clinical Research, University of Nevada, Las Vegas (UNLV), 89106, USA
| | - Edward Lynch
- Professor and Principal Director of Biomedical and Clinical Research, University of Nevada, Las Vegas (UNLV), 89106, USA.
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Su HR, Yang RR, Qian WH, Yu JM. [The effect of fluoride varnish Duraphat in preventing deciduous dental caries in preschool children]. Shanghai Kou Qiang Yi Xue 2019; 28:48-52. [PMID: 31080999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To evaluate the effect of fluoride varnish Duraphat on preventing caries of primary teeth caries, and provide scientific basis for the establishment of oral health care. METHODS 1140 preschool children aged 3~4 years old were chosen from 25 public kindergartens in Xuhui district of Shanghai by cluster sampling method, they were divided into 2 groups on a voluntary basis with the informed consent of the child's parents. 762 preschool children in Fluoride Varnish group were taken oral examination and used fluoride varnishes every 6 months, 378 preschool children in the control group were without treatment. Oral health instruction was given to all the children. The data of caries prevalence, mean dmft, caries incidence and mean increments of dmft (decayed, missing and filled teeth) of 2 groups were compared. The results were analyzed using SAS 9.4 software package. RESULTS After 2 years, caries prevalence, mean dmft, caries incidence and mean increments of dmft of fluoride varnish groups were lower than those of control group and the difference was statistically significant (P<0.05). CONCLUSIONS Fluoride varnish Duraphat is effective in decreasing caries incidence and mean dmft increments of primary teeth in preschool children and is worthy to be used widely in Xuhui district.
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Affiliation(s)
- Hong-Ru Su
- Dental Disease Control Institute, Xuhui District. Shanghai 200032,China. E-mail:
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Yu OY, Zhao IS, Mei ML, Lo ECM, Chu CH. Caries-arresting effects of silver diamine fluoride and sodium fluoride on dentine caries lesions. J Dent 2018; 78:65-71. [PMID: 30114443 DOI: 10.1016/j.jdent.2018.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/06/2018] [Accepted: 08/10/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the remineralising effect and bacterial growth inhibition of 38% silver diamine fluoride (SDF) solution and 5% sodium fluoride (NaF) varnish on artificial dentine caries lesions. METHODS Demineralised dentine blocks were treated with SDF + NaF (Group 1), SDF (Group 2), NaF (Group 3) and water (Group 4) and subjected to a Streptococcus mutans biofilm challenge. Lesion depth, precipitates' characteristics and matrix (collagen)-to-mineral ratio were evaluated by micro-computer tomography (micro-CT), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR), respectively. The biofilm kinetics, viability and topography were assessed by counts of colony forming units (CFUs), confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM), respectively. Data were analysed by two-way ANOVA test. RESULTS The lesion depths of Groups 1-4 were 170 ± 28 μm, 160 ± 32 μm, 353 ± 38 μm and 449 ± 24 μm, respectively. The addition of NaF to SDF did not show better remineralisation than SDF (p = 0.491). Metallic silver and silver chloride were found in Groups 1 and 2. The amide I-to-hydrogen phosphate ratios of the four groups were 0.14 ± 0.02, 0.14 ± 0.01, 0.29 ± 0.05 and 0.49 ± 0.16, respectively, and the addition of NaF to SDF did not offer better protection against collagen exposure than SDF (p = 0.986). The Log10 CFUs of Groups 1-4 were 5.75 ± 0.56, 4.49 ± 0.57, 6.55 ± 0.39 and 6.40 ± 0.38, respectively. The presence of NaF reduced the antibacterial effect of SDF (p < 0.001). The SEM and CLSM images supported the findings. CONCLUSION Application of SDF with or without NaF reduced the demineralisation of dentine caries, but SDF exerted stronger inhibition of biofilm growth than SDF with NaF. CLINICAL SIGNIFICANCE NaF varnish affects the antibacterialeffects of SDF, the adjunctive application of SDF solution and NaF varnish is not recommended to arrest dentine caries in clinic.
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Affiliation(s)
- Ollie Y Yu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Irene S Zhao
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - May L Mei
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Edward C M Lo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - C H Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong.
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Oliveira BH, Rajendra A, Veitz-Keenan A, Niederman R. The Effect of Silver Diamine Fluoride in Preventing Caries in the Primary Dentition: A Systematic Review and Meta-Analysis. Caries Res 2018; 53:24-32. [PMID: 29874642 PMCID: PMC6292783 DOI: 10.1159/000488686] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/08/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To investigate whether silver diamine fluoride (SDF) is effective in preventing new caries lesions in primary teeth when compared to placebo or active treatments. METHODS Systematic review (CRD42016036963) of controlled clinical trials. Searches were performed in 9 electronic databases, 5 registers of ongoing trials, and reference lists of identified review articles. Two researchers carried out data extraction and quality appraisal independently. The primary outcome was the difference in caries increment (decayed, missing, and filled surfaces or teeth - dmfs or dmft) between SDF and control groups. These differences were pooled as weighted mean differences (WMD) and prevented fractions (PF). RESULTS Searches yielded 2,366 unique records; 6 reports of 4 trials that randomized 1,118 and analyzed 915 participants were included. Two trials compared SDF to no treatment, 1 compared SDF to placebo and sodium fluoride varnish (FV), and 1 compared SDF to high-viscosity glass ionomer cement (GIC). All studies had at least 1 domain with unclear or high risk of bias. After 24 months of follow-up, in comparison to placebo, no treatment, and FV, SDF applications significantly reduced the development of new dentin caries lesions (placebo or no treatment: WMD = -1.15, PF = 77.5%; FV: WMD = -0.43, PF = 54.0%). GIC was more effective than SDF after 12 months of follow-up but the difference between them was not statistically significant (WMD, dmft: 0.34, PF: -6.09%). CONCLUSION When applied to caries lesions in primary teeth, SDF compared to no treatment, placebo or FV appears to effectively prevent dental caries in the entire dentition. However, trials specifically designed to assess this outcome are needed.
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Affiliation(s)
- Branca Heloisa Oliveira
- Department of Community and Preventive Dentistry, Faculty of Dentistry, University of the State of Rio de Janeiro, Brazil.
| | - Anjana Rajendra
- Department of Epidemiology & Health Promotion College of Dentistry, New York University,
| | - Analia Veitz-Keenan
- Department of Oral & Maxillofacial Pathology, Radiology and Medicine, College of Dentistry, New York University,
| | - Richard Niederman
- Department of Epidemiology & Health Promotion College of Dentistry, New York University,
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Zhao X, He T, He Y, Cheng C, Chen H. A Randomized Clinical Trial to Measure the Erosion Protection Benefits of a Novel Stabilized Stannous Fluoride Dentifrice versus a Control Dentifrice. J Clin Dent 2017; 28:B17-B20. [PMID: 29334437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The aim of this investigation was to assess the erosion protection ability of a novel stabilized stannous fluoride (SnF2) dentifrice and a control sodium fluoride dentifrice (NaF) using a well-credentialed human in situ model. METHODS A novel smooth texture 0.454% stabilized SnF2 dentifrice (Crest® Pro-Health™ smooth formula) and a 0.23% NaF marketed control dentifrice with 5% potassium nitrate (Sensodyne® Pronamel®) were compared in a 10-day, single center, randomized, controlled, double-blind, two-treatment, three-period crossover in situ clinical trial. Subjects wore a mandibular buccal appliance fitted with eight enamel specimens for approximately six hours over the course of each study day. Twice daily, subjects brushed the lingual surfaces of their teeth for 30 seconds while wearing the appliance, then swished with their assigned treatment toothpaste slurry for 90 seconds under the supervision of clinic staff. Erosive acid challenges with a citric acid-containing beverage (commercial orange juice) were done four times each day. RESULTS The SnF2 dentifrice provided 26.9% greater erosion protection relative to the NaF dentifrice at Day 10 (p < 0.03). Adjusted means of enamel surface loss at Day 10 were 9.117 µm for the SnF2 dentifrice and 12.471 µm for the NaF marketed control. CONCLUSIONS These results demonstrate the stabilized SnF2 dentifrice offered greater protection over the NaF dentifrice against the initiation and progression of dental erosion.
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Affiliation(s)
- Xinyi Zhao
- School of Stomatology, the Fourth Military Medical University, Xi'an, China
| | - Tao He
- Procter & Gamble, Mason, OH, USA
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Young S, Mason S, Milleman JL, Milleman KR. A randomized clinical study to evaluate the effect of an ultra-low abrasivity dentifrice on extrinsic dental stain. Am J Dent 2017; 30:255-261. [PMID: 29178728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To investigate the stain-removal efficacy of an experimental ultra-low abrasivity anti-sensitivity dentifrice containing sodium tripolyphosphate (STP) and a cocamidopropyl betaine/sodium methyl cocoyl taurate detergent system. METHODS This was a single-center, examiner-blind, randomized, parallel-group study. Extrinsic dental stain was assessed on the facial surfaces of the six maxillary and six mandibular anterior teeth and the lingual surfaces of the six mandibular anterior teeth using the Macpherson modification of the Lobene Stain Index (MLSI). Treatments were: ultra-low abrasivity dentifrice [5% w/w KNO3, 5% w/w STP, 1,100 ppm fluoride as sodium fluoride; relative dentin abrasivity (RDA) ~10; n=54]; moderate abrasivity fluoride dentifrice (1,100 ppm fluoride as sodium monofluorophosphate; RDA ~68; n= 57); higher abrasivity daily-use whitening dentifrice (1,100 ppm fluoride as sodium fluoride; RDA~137; n= 57). Subjects brushed for 1 minute, twice daily, for 8 weeks. RESULTS Mean total MLSI [ Area × Intensity (A×I) ] change from baseline score at Weeks 4 and 8 was significant (P< 0.0001) for all groups. At Week 8, for the ultra-low abrasivity dentifrice versus the moderate and higher abrasivity dentifrices, mean total MLSI (A×I) scores (P< 0.0001), along with MLSI endpoints in facial, lingual, and interproximal regions (P= 0.0035 to P< 0.0001), favored the ultra-low abrasivity dentifrice. Dentifrices were generally well-tolerated. The ultra-low abrasivity dentifrice containing 5% STP reduced extrinsic dental stain more effectively than moderate or higher abrasivity dentifrices. CLINICAL SIGNIFICANCE The ultra-low abrasivity, anti-sensitivity dentifrice containing 5% STP reduced extrinsic dental stain more effectively than moderate or higher abrasivity dentifrices, and is thus suitable for patients with sensitive teeth who wish to control extrinsic dental stain.
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Affiliation(s)
- Sarah Young
- GSK Consumer Healthcare, Weybridge, Surrey, UK
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Fluoride Therapy. Pediatr Dent 2017; 39:242-5. [PMID: 29179364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Bataineh M, Malinowski M, Duggal MS, Tahmassebi JF. Comparison of the newer preventive therapies on remineralisation of enamel in vitro. J Dent 2017; 66:37-44. [PMID: 28859965 DOI: 10.1016/j.jdent.2017.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To investigate in vitro the effect of MI Paste, MI Paste Plus and 2800ppm fluoride (F) toothpaste (TP) on the remineralisation of enamel subsurface lesions and to compare these to the effect of 1450ppm and 0ppm F toothpastes. METHODS Enamel subsurface lesions were created in bovine enamel slabs (n=120) which were assigned randomly to five groups; (1) 0ppm F TP, (2) 1450ppm F TP, (3) 2800ppm F TP, (4) 1450ppm F TP+MI Paste (Tooth Mousse-TM,10% w/v CPP-ACP) and (5) 1450ppm F TP+MI Paste Plus (Tooth Mousse Plus,10% w/v CPP-ACP, 900ppm F as 0.2% w/w sodium fluoride). The enamel slabs were subjected to a pH cycling regimen for 21days. Quantitative Light-induced Fluorescence (QLF) images were taken and analysed. Data analysis was carried out using one way ANOVA. RESULTS In all groups, both ΔF (percentage fluorescence loss) and ΔQ (ΔF times the area) values improved significantly within the same group after the treatment. In addition, the mean difference in ΔF of the non-fluoride control group was significantly lower than all other groups but not for the 2800ppm F- group. Whereas the mean difference in ΔQ of the non-fluoride control of group was significantly lower when compared with all other groups (p<0.05). CONCLUSIONS Both MI Paste and MI Paste Plus when used in conjunction with 1450ppm F did not show a significant increase in efficacy for the remineralisation of bovine enamel subsurface lesions in the model used in this study. CLINICAL SIGNIFICANCE Newer preventive agents such as MI paste and MI paste plus are advocated as promoting remineralisation when used in addition to routine oral care. This in vitro study shows that they may have a limited value in promoting remineralisation over and above that of 1450ppm F toothpaste used twice a day.
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Affiliation(s)
- M Bataineh
- Department of Paediatric Dentistry, Leeds School of Dentistry, University of Leeds, UK
| | - M Malinowski
- Department of Paediatric Dentistry, Leeds School of Dentistry, University of Leeds, UK
| | - M S Duggal
- Department of Paediatric Dentistry, Leeds School of Dentistry, University of Leeds, UK; Faculty of Dentistry, National University of Singapore, Singapore
| | - J F Tahmassebi
- Department of Paediatric Dentistry, Leeds School of Dentistry, University of Leeds, UK.
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Abstract
INTRODUCTION Dental caries (tooth decay) is a common disease in which the products of sugar metabolism by certain bacteria that populate the tooth surface induce the development and progression of lesions (cavities). This is a phase II single-centre randomised, double-blind, active-controlled, parallel-group trial to assess the efficacy of a combination povidone iodine and sodium fluoride dental varnish to determine if it is superior to a varnish containing only sodium fluoride in the prevention of new caries lesions. The objective of this report is to describe the rationale and protocol for the trial. METHODS AND ANALYSIS The study site is Pohnpei State, Federated States of Micronesia. The study population is 284 children 48-84 months old. The primary outcome will be the surface-level primary molar caries increment (d2-3mfs/DMFS) at 2 years post baseline. The incremental dental caries at 1 year will also be compared between the two interventions. The secondary outcome is the Facial Image Scale after the initial treatment and after the fifth treatment at 1 year that gauges the child's response to the treatment. ETHICS AND DISSEMINATION The Western Institutional Review Board (designated IRB) and the Institutional Review Board of the College of Micronesia-FSM approved all study procedures. The US Food and Drug Administration (FDA) has issued IND 128835 covering this study. The study results will be published and submitted to the FDA in support of a new drug application. TRIALREGISTRATION NUMBER NCT03082196.
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Affiliation(s)
- Peter Milgrom
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
- Advantage Silver Dental Arrest, LLC, Redmond, Oregon, USA
| | - Ohnmar Tut
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Marilynn Rothen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
- Regional Clinical Dental Research Center, Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Lloyd Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, Washington, USA
| | - Marcelle Gallen
- Department of Dental Services, Pohnpei State Health Department, Kolonia, Federated States of Micronesia
| | - Jason M Tanzer
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Connecticut Health Center, Farmington, Connecticut, USA
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Gallob J, Sufi F, Amini P, Siddiqi M, Mason S. A randomised exploratory clinical evaluation of dentifrices used as controls in dentinal hypersensitivity studies. J Dent 2017; 64:80-87. [PMID: 28652142 DOI: 10.1016/j.jdent.2017.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To explore relative efficacy of six negative-control dentifrices utilised as controls in clinical studies compared with two dentine hypersensitivity (DH)-relief dentifrices used 2×/day for 8 weeks. METHODS Six control dentifrices differing in terms of fluoride source (sodium fluoride/sodium monofluorophosphate), abrasive base (silica/dicalcium phosphate), relative dentine abrasivity (RDA) (∼17 to ∼180) and colour (white/blue/multicoloured stripes) were compared with a depolarising dentifrice (5% KNO3; RDA ∼70-97; 'Test 1') and an occlusion-technology dentifrice (0.454% SnF2; RDA ∼160-180; 'Test 2'). DH was assessed using tactile and evaporative (air) (measured by Schiff Sensitivity Scale and a visual rating scale [VRS]) stimuli. RESULTS In total 249 subjects were randomized. All dentifrices yielded statistically significant improvements from baseline on all endpoints. The two DH-relief dentifrices ranked highest in terms of improvement in scores over the control dentifrices. While there was a clear differentiation between Test 1 and control dentifrices on both measures at 4/8 weeks, for Test 2, statistically significant improvements in Schiff scores were observed over all controls at Week 4 but only over three at Week 8. At Week 4 none of the controls separated from Test 2 on tactile threshold; all separated by Week 8. VRS scores did not separate test and control dentifrices. Dentifrices were generally well-tolerated. CONCLUSIONS The six negative-control dentifrices can be used to assess dentifrices considered to be effective in reducing DH. Although response ranges for commercially available negative controls varied, these results may begin to set acceptable performance ranges for control dentifrices in DH trials.
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Affiliation(s)
- John Gallob
- Silverstone Research Group, Las Vegas, NV, USA; UNLV School of Dental Medicine, Las Vegas, NV, USA.
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Zhao X, Zhou C, Chen H, Ma J, Zhu Y, Wang P, Zhang Y, Ma H, Zhang H. Efficacy and safety of medical therapy for low bone mineral density in patients with Crohn disease: A systematic review with network meta-analysis. Medicine (Baltimore) 2017; 96:e6378. [PMID: 28296781 PMCID: PMC5369936 DOI: 10.1097/md.0000000000006378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Low bone mineral density (BMD) is a frequent complication of inflammatory bowel disease (IBD), particularly in patients with Crohn disease (CD). The aim of our study is to determine the efficacy and safety of different drugs used to treat low BMD in patients with CD. METHODS PUBMED/MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched for eligible studies. A random-effects model within a Bayesian framework was applied to compare treatment effects as standardized mean difference (SMD) with their corresponding 95% credible interval (CrI), while odds ratio (OR) was applied to compare adverse events with 95% CrI. The surface under the cumulative ranking area (SUCRA) was calculated to make the ranking of the treatments for outcomes. RESULTS Twelve randomized controlled trials (RCTs) were eligible. Compared with placebo, zoledronate (SMDs 2.74, 95% CrI 1.36-4.11) and sodium-fluoride (SMDs 1.23, 95% CrI 0.19-2.26) revealed statistical significance in increasing lumbar spine BMD (LSBMD). According to SUCRA ranking, zoledronate (SUCRA = 2.5%) might have the highest probability to be the best treatment for increasing LSBMD in CD patients among all agents, followed by sodium-fluoride (27%). For safety assessment, the incidence of adverse events (AEs) demonstrated no statistical difference between agents and placebo. The corresponding SUCRA values indicated that risedronate (SUCRA = 77%) might be the most safe medicine for low BMD in CD patients and alendronate ranked the worst (SUCRA = 16%). CONCLUSIONS Zoledronate might have the highest probability to be the best therapeutic strategy for increasing LSBMD. For the safety assessment, risedronate showed the greatest trend to decrease the risk of AEs. In the future, more RCTs with higher qualities are needed to make head-to-head comparison between 2 or more treatments.
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Affiliation(s)
- Xiaojing Zhao
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University
| | - Changcheng Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Han Chen
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University
| | - Jingjing Ma
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University
| | - Yunjuan Zhu
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University
| | - Peixue Wang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University
| | - Yi Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University
| | - Haiqin Ma
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University
| | - Hongjie Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University
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Abstract
The question has been raised whether low-caries children regularly using fluoride toothpaste will benefit from the professional application of additional fluoride gel. To investigate the caries-reducing effect of semi-annually-applied neutral 1% sodium fluoride gel, we carried out a double-blind randomized controlled clinical trial (n = 594) in a child population, initially aged 9.5–11.5 years, with baseline caries experience of D3MFS = 0 (decayed, missing, and filled tooth surfaces of permanent teeth). The mean number of tooth surfaces saved from caries development by fluoride gel application after 4 years was 0.2 D3MFS (SE = 0.17). The preventive fraction (PF) showed a mean relative effect of professionally applied fluoride gel of 18%. The cariostatic effect of the fluoride gel on pits and fissures would have been influenced by the sealant strategy in the study. Professionally applied fluoride gel showed no statistically significant effect on mean D3MFS score in low-caries 9.5- to 11.5-year-olds.
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Affiliation(s)
- G J Truin
- Department of Preventive and Restorative Dentistry/117, Radboud University, Nijmegen Medical Center, PO Box 9101, NL-6500 HB Nijmegen, The Netherlands.
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Young S, Sufi F, Siddiqi M, Maclure R, Holt J. A Randomized Non-Inferiority Clinical Study to Evaluate the Efficacy of Two Dentifrices for Dentin Hypersensitivity. J Clin Dent 2016; 27:97-104. [PMID: 28391662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Calcium sodium phosphosilicate (CSPS) is a particulate bioactive material incorporated into oral healthcare products for the treatment of dentin hypersensitivity (DH). This study aimed to determine whether a dentifrice containing 5% CSPS and fluoride as sodium fluoride (NaF; "Test dentifrice") was non-inferior to a dentifrice containing 5% CSPS and fluoride as sodium monofluorophosphate (SMFP; "Comparator dentifrice") in reducing DH after eight weeks' twice-daily brushing. METHODS This was a randomized, examiner-blind, parallel-group, non-inferiority study in healthy adults with self-reported and clinically diagnosed DH. After an initial lead-in period, subjects were randomized to either the Test (n = 150) or Comparator dentifrice (n = 154) and instructed to brush twice daily for the next eight weeks. DH was assessed at baseline and following four and eight weeks of dentifrice use by response to a tactile stimulus (tactile threshold) and evaporative (air) stimulus (Schiff sensitivity score and 100 mm visual analog scale [VAS]). The non-inferiority margin was defined as 6 mm on the VAS. RESULTS Both dentifrices were associated with statistically significant reductions in DH from baseline after four and eight weeks' use for all efficacy parameters (all p < 0.0001). There were no statistically significant differences between the groups. After eight weeks' use, the between-treatment difference in VAS scores was 2.67 mm (per-protocol analysis) in favor of the Comparator dentifrice; the upper limit of the 95% confidence interval (CI) of the between-treatment difference in VAS scores exceeded the pre-specified non-inferiority margin of 6 mm (upper 95% CI = 7.4). The non-inferiority margin was also exceeded after four weeks. Both dentifrices were generally well tolerated. CONCLUSIONS The pre-defined non-inferiority margin of 6 mm was not met, thus it is not possible to conclude from the present analysis that the Test dentifrice is non-inferior to the Comparator. However, for all efficacy measures, a statistically significant reduction in DH was observed for both dentifrice groups. There were no statistically significant differences between dentifrice groups, suggesting that changing the source of fluoride from SMFP to NaF does not affect the overall efficacy of the dentifrice in alleviating DH.
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Affiliation(s)
- Sarah Young
- GSK Consumer Healthcare, Weybridge, Surrey, UK
| | | | | | - Robert Maclure
- Intertek Clinical Research Service Ltd., Hooton, Cheshire, UK
| | - Jonathan Holt
- Intertek Clinical Research Service Ltd., Hooton, Cheshire, UK
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Abstract
Laser and fluoride treatments have been shown to inhibit enamel demineralization in the laboratory. However, the intra-oral effects of this association have not been tested. This study assessed in situ the effect of a Transversely Excited Atmospheric CO2 laser (λ = 9.6 μm) and the use of pressure fluoridated dentifrice on enamel demineralization. During two 14-day phases, 17 volunteers wore palatal appliances containing human enamel slabs assigned to treatment groups, as follows: (1) non-fluoride dentifrice, (2) CO2 laser irradiation plus non-fluoride dentifrice, (3) fluoride dentifrice, and (4) CO2 laser irradiation plus fluoride dentifrice. A 20% sucrose solution was dripped onto the slabs 8 times per day. The specimens treated with laser and/or fluoridated dentifrice presented a significantly lower mineral loss when compared with those from the non-fluoride dentifrice group. The results suggested that CO2 laser treatment of enamel inhibits demineralization in the human mouth, being more effective when associated with fluoride.
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Affiliation(s)
- L K A Rodrigues
- Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, CE, Brazil
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50
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Abstract
Calcium (Ca), inorganic phosphorus (Pi), and fluoride (F) concentrations are low in the whole plaque biofilm formed under exposure to sucrose. It was hypothesized that this would be reflected in the biofilm fluid, where these low values should greatly influence the de/remineralization process. Dental biofilms were formed in situ over enamel blocks mounted in palatal appliances and exposed 8 times/day to distilled water, glucose+fructose, or sucrose solutions for 14 days. While Ca, Pi, and F concentrations in the whole biofilms were significantly lower in the glucose+fructose and sucrose groups, no effect on biofilm fluid was observed, even after a cariogenic challenge. An increase in whole biofilm mineral ions was observed 24 hrs after the carbohydrate treatments were suspended, but this effect was also not observed in the fluid. These results suggest that there is a homeostatic mechanism that maintains biofilm fluid mineral ion concentration, regardless of its total concentration in the whole biofilm.
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Affiliation(s)
- L M A Tenuta
- Faculty of Dentistry of Piracicaba, UNICAMP, Av. Limeira 901, 13414-903, Piracicaba, SP, Brazil
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