Caries preventive efficacy of silver diammine fluoride (SDF) and ART sealants in a school-based daily fluoride toothbrushing program in the Philippines.

BACKGROUND: Occlusal surfaces of erupting and newly erupted permanent molars are particularly susceptible to caries.The objective of the study was to assess and compare the effect of a single application of 38% SDF with ART sealants and no treatment in preventing dentinal (D3) caries lesions on occlusal surfaces of permanent first molars of school children who participated in a daily school-based toothbrushing program with fluoride toothpaste. METHODS: The prospective community clinical trial in the Philippines was conducted over a period of 18 months and included 704 six- to eight-year-old school children in eight public elementary schools with a daily school-based fluoride toothpaste brushing program. Children were randomly assigned for SDF application or ART sealant treatment. Children from two of the eight schools did not receive SDF or ART sealant treatment and served as controls. SDF or ART sealant treatment was applied on sound occlusal surfaces of permanent first molars. Surfaces that were originally defined as sound at baseline but which changed to dentinal (D3) caries lesions were defined as surfaces with new caries (caries increment). Non-compliance to the daily toothbrushing program in three schools offered the opportunity to analyze the caries preventive effect of SDF and sealants separately in fluoride toothpaste brushing and in non-toothbrushing children. RESULTS: In the brushing group, caries increment in the SDF treatment group was comparable with the non-treatment group but caries increment in the sealant group was lower than in the non-treatment group with a statistically significant lower hazard ratio of 0.12 (0.02-0.61). In the non-brushing group, caries increment in the SDF treatment group and the sealant group was lower than the non-treatment group but the hazard ratio was only statistically significant for the sealant group (HR 0.33; 0.20-0.54). Caries increment was lower in toothbrushing children than in non-toothbrushing children. Hazard ratios reached statistical significance for the non-treated children (HR 0.43; 0.21-0.87) and the sealant-treated children (HR 0.15; 0.03-0.072). CONCLUSIONS: A one-time application of 38% SDF on the occlusal surfaces of permanent first molars of six- to eight-year-old children is not an effective method to prevent dentinal (D3) caries lesions. ART sealants significantly reduced the onset of caries over a period of 18 months. TRIAL REGISTRATION NUMBER: German Clinical Trial Register DRKS00003427.

Comparison of the use of different modes of mechanical oral hygiene in prevention of plaque and gingivitis.

BACKGROUND: The objective of this study was to evaluate the effect of an oscillating/rotating/pulsating powered toothbrush on plaque and gingivitis prevention over a 9-month period. METHODS: The study had an examiner-masked, randomized, three-group parallel design. A total of 122 subjects >or= 18 years of age in good general health and with at least five teeth per quadrant and no pockets >or= 5 mm were included. A 3-week preexperimental period of extensive oral home care, including rinses, was started to improve gingival health. Professional oral hygiene instruction with a manual brush was provided. At baseline, subjects were assigned to one of three regimens: twice daily brushing with a manual toothbrush, a manual toothbrush and the use of floss, or a powered toothbrush. Subjects were professionally instructed in their regimen and given a prophylaxis. Two weeks later, oral hygiene reinforcement was provided. Gingival bleeding, plaque, staining, and gingival abrasion were assessed during the preexperimental period and at baseline, 10 weeks, and 6 and 9 months. RESULTS: There was a significant reduction in plaque and gingivitis from the preexperimental period to baseline. At 10 weeks and 6 and 9 months, the level of plaque was statistically significantly lower with the powered toothbrush versus the other two regimens (P

The atraumatic restorative treatment (ART) approach for managing dental caries: a meta-analysis.

The number of publications reporting on the survival of ART sealants and ART restorations has increased considerably in recent years. A systematic investigation of their longevity is therefore warranted. Based on three exclusion criteria, a literature search in the electronic libraries Pubmed and Medline revealed 28 eligible publications for inclusion in a meta-analysis. High mean survival rates for single-surface ART restorations using high-viscosity glass-ionomer in primary dentitions over 3 years were found (95% after 1 year to 86% after 3 years). These rates were statistically significantly higher than for those of multiple-surface ART restorations in primary dentitions (p<0.0001). High mean survival rates for single-surface ART restorations using high-viscosity glass-ionomer in permanent dentitions over 6 years were found (97% after 1 year to 72% after 6 years). The mean annual failure rates for single-surface ART restorations using high-viscosity glass-ionomer in primary and permanent dentitions and for multiple-surface ART restorations in primary dentitions are 4.7%, 4.7% and 17%, respectively. The number of studies reporting on the retention and caries preventive effect of ART sealants was low. It is concluded that single-surface ART restorations using high-viscosity glass-ionomer in both primary and permanent dentitions show high survival rates. Medium-viscosity glass-ionomer should not be used for ART restorations.

Effectiveness of primary school-based oral health education in West Java, Indonesia.

UNLABELLED: A study in West Java has indicated that involvement of primary health care personnel and schoolteachers in oral health education (OHE) at primary schools is a feasible approach that is sustainable. AIM: The present study aims to assess the effects of that school-based OHE programme on pupils who had completed the programme one and a half years ago. METHODS: Eight experimental and six control primary schools in the same area participated in the study. Out of each school 10 children, aged 8-12-years old, were randomly selected. RESULTS: ANOVA with age and gender as co-variables showed statistically significantly lower (21%) habitual plaque scores among children from experimental schools as compared to those from control schools. Tooth brushing effectiveness had significantly improved among experimental children and they took longer for tooth brushing when supervised. The dmft/dmfs values were comparable but the DMFT/DMFS values of children from experimental schools tended to be lower (not statistically significant) than of those from control schools. Differences in oral health knowledge were apparent but self-reported habits pertaining to oral health were comparable between children from experimental and control schools. CONCLUSION: This school-based OHE programme had a moderate positive effect on oral health knowledge and on habitual plaque levels and on the effectiveness of tooth brushing. The effects on caries levels and on self-reported behaviour were inconclusive.

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

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