Silver Diamine Fluoride: A Successful Anticarious Solution with Limits.

Silver diamine fluoride (SDF) is a solution containing ionic silver, fluoride, and ammonia that arrests the progress of carious lesions and prevents the development of future caries. The silver particle extends into the dentin tubules and could create some bonding problems for subsequent composite resin restorations placed over SDF-treated darkened tooth structures. The fluoride penetrates deeper into the tooth with SDF as compared with other fluoride solutions, creating a fluoride reservoir in the tooth structure. The fluoride component of SDF contributes to remineralization and fluorapatite formation, producing harder, more caries-resistant tooth structures. The silver provides the antimicrobial activity for the material and inhibits biofilm formation. It has been evaluated in >20 clinical studies and reviewed in systemic reviews. The material was recently approved by the Food and Drug Administration for desensitizing cold-sensitive teeth and has been used off-label to treat carious lesions. SDF will produce a caries lesion darker (brown to black) than the original, which is the major criticism of the material. A nanoparticle-sized silver material was recently developed that may retain the antimicrobial properties of the larger-sized ion silver material without the discoloring effects. The application of SDF is easily adapted for field use. The lesion is isolated, and the solution is painted onto the clean caries lesion and dried. This simple application process requires little equipment, and its low cost per application makes the material ideal for large populations.

Silver Fluoride as a Treatment for Dental Caries.

Medical management of caries is a distinct treatment philosophy that employs topical minimally invasive therapies that treat the disease and is not merely prevention. This strategy is justified as an alternative or supplement to traditional care by significant disease recurrence rates following comprehensive operative treatment under general anesthesia. Silver diamine fluoride (SDF) is one agent to enable effective noninvasive treatment. The announcement of breakthrough therapy designation by the Food and Drug Administration (FDA) suggests that SDF may become the first FDA-approved drug for treating caries. Since our systematic review performed in April 2015, 4 clinical trials have been completed, which inform an update to the application protocol and frequency regimen. Suggestions from these studies are to skip the rinsing step due to demonstration of safety in young children, start patients with high disease severity on an intensive regimen of multiple applications over the first few weeks, and continue with semiannual maintenance doses as previously suggested. Breakthroughs in elucidating the impact of SDF on the dental plaque microbiome inform potential opportunities for understanding caries arrest. SDF can be added to the set of evidence-based noninvasive methods to treat caries lesions in primary teeth, such as the Hall crown technique and sealing lesions with accessible margins.

Fluoride supplementation (with tablets, drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children.

BACKGROUND: Dental caries (tooth decay) is one of the most common chronic childhood diseases. Caries prevalence in most industrialised countries has declined among children over the past few decades. The probable reasons for the decline are the widespread use of fluoride toothpaste, followed by artificial water fluoridation, oral health education and a slight decrease in sugar consumption overall. However, in regions without water fluoridation, fluoride supplementation for pregnant women may be an effective way to increase fluoride intake during pregnancy. If fluoride supplements taken by pregnant women improve neonatal outcomes, pregnant women with no access to a fluoridated drinking water supply can obtain the benefits of systemic fluoridation. OBJECTIVES: To evaluate the effects of women taking fluoride supplements (tablets, drops, lozenges or chewing gum) compared with no fluoride supplementation during pregnancy to prevent caries in the primary teeth of their children. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 25 January 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11) in the Cochrane Library (searched 25 January 2017); MEDLINE Ovid (1946 to 25 January 2017); Embase Ovid (1980 to 25 January 2017); LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 25 January 2017); and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 25 January 2017). We searched the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 25 January 2017. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials (RCTs) of fluoride supplements (tablets, drops, lozenges or chewing gum) administered to women during pregnancy with the aim of preventing caries in the primary teeth of their children. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the titles and abstracts (when available) of all reports identified through electronic searches. Two review authors independently extracted data and assessed risk of bias, as well as evaluating overall quality of the evidence utilising the GRADE approach. We could not conduct data synthesis as only one study was included in the analysis. MAIN RESULTS: Only one RCT met the inclusion criteria for this review. This RCT showed no statistical difference on decayed or filled primary tooth surfaces (dfs) and the percentage of children with caries at 3 years (risk ratio (RR) 1.46, 95% confidence interval (CI) 0.75 to 2.85; participants = 938, very low quality of evidence) and 5 years old (RR 0.84, 95% CI 0.53 to 1.33; participants = 798, very low quality of evidence). The incidence of fluorosis at 5 years was similar between the group taking fluoride supplements (tablets) during the last 6 months of pregnancy and the placebo group. AUTHORS' CONCLUSIONS: There is no evidence that fluoride supplements taken by women during pregnancy are effective in preventing dental caries in their offspring.

Absence of Fluoride Varnish-Related Adverse Events in Caries Prevention Trials in Young Children, United States.

INTRODUCTION: Fluoride varnish is an effective prevention intervention for caries in young children. Its routine use in clinical care is supported by meta-analyses and recommended by clinical guidelines, including the US Preventive Services Task Force (B rating). This report is the first prospective systematic assessment of adverse events related to fluoride varnish treatment in young children. METHODS: We determined the incidence of adverse events related to fluoride varnish treatment in 3 clinical trials on the prevention of early childhood caries, conducted under the auspices of the Early Childhood Caries Collaborating Centers, an initiative sponsored by the National Institute of Dental and Craniofacial Research. Each trial incorporated use of fluoride varnish in its protocol and systematically queried all children's parents or legal guardians about the occurrence of acute adverse events after each fluoride varnish treatment. RESULTS: A total of 2,424 community-dwelling, dentate children aged 0 to 5 years were enrolled and followed for up to 3 years. These children received a cumulative total of 10,249 fluoride varnish treatments. On average, each child received 4.2 fluoride varnish treatments. We found zero fluoride varnish-related adverse events. CONCLUSION: Fluoride varnish was not associated with treatment-related adverse events in young children. Our findings support its safety as an effective prevention intervention for caries in young children.

Caries Preventive Effect of Sodium Fluoride Varnish on Deciduous Dentition: A Clinical Trial.

AIM: The aim of the study is to evaluate the efficacy of intensive application of sodium fluoride varnish in reducing caries incidence among children aged 6 to 7 years. MATERIALS AND METHODS: The study was a randomized controlled trial conducted among 6- to 7-year-old children of Sangamner, Maharashtra, India. Nearly 200 randomly selected children were randomized into two groups: Control group and intervention (varnish) group. Dental examination to record the caries experiences was conducted at baseline and at 1-year follow-up. The fluoride varnish was applied for three times in a week for a period of 1 year. Mean decayed, missed, and filled teeth (DMFT) were compared between and within groups using t-test. RESULTS: Out of 200 participants, there were 3 dropouts for control group and 4 for intervention group. Nearly 55% study participants were males and remaining were females. There was a statistically significant difference between the baseline and follow-up caries levels in varnish group for deciduous dentition. Mean caries reduction in this study was 26%. CONCLUSION: After 1 year of study, we found significant caries reversal in deciduous dentition among the 6- to 7-year-olds after intensive fluoride application. Such a regimen can be advocated to encourage the practitioners and the caregivers alike for early caries prevention. CLINICAL SIGNIFICANCE: Intensive fluoride application (three times a week) once a year was found to be effective in reducing the incidence of detectable carious lesions and can be advocated to the dental professionals to be incorporated in their routine preventive clinical practice.

Silver Diamine Fluoride: Changing the Caries Management Paradigm and Potential Societal Impact.

Silver diamine fluoride is a topically-applied agent for managing dental caries. It stops caries lesion progression, turning them black and hard in a high percentage of cases. Populations including pediatric, geriatric, special health care needs, and those with limited access to oral health care can all benefit from silver diamine fluoride. This commentary addresses some of the many questions that have arisen with the availability of SDF and marked gaps in our knowledge.

[Preventive dentistry 5. Secondary caries]. / Preventieve tandheelkunde 5. Secundaire cariës.

Secondary caries is reported as one of the most important reasons for replacing restorations. The patient's general caries risk plays an important role in the development of secondary caries. The connection, at the patient level, between various factors, the risk of caries and restoration factors, such as the presence of a gap and the kind of restoration material, deserves additional investigation. The minimum gap width in which secondary caries can develop is most likely less than 100 µm and could depend on the patient's caries risk. Composite restorations seem more susceptible to secondary caries than amalgam restorations in patients with high caries risk. So far, there is no unambiguous explanation for this difference. The prevention of secondary caries is comparable to that of primary caries and stresses the importance of fluoride, diet and oral hygiene.

Using High Fluoride Concentration Products in Public Policy: A Rapid Review of Current Guidelines for High Fluoride Concentration Products.

Despite improvements in dental caries levels since the widespread introduction of fluoride toothpastes, it is still a disease which is considered to be a priority in many countries around the world. Individuals at higher risk of caries can be targeted with products with a high fluoride concentration to help reduce the amount and severity of the disease. This paper compares guidance from around the world on the use of products with a high fluoride concentration and gives examples of how guidance has been translated into activity in primary care dental practice. A rapid review of electronic databases was conducted to identify the volume and variation of guidance from national or professional bodies on the use of products with a high fluoride concentration. Fifteen guidelines published within the past 10 years and in English were identified and compared. The majority of these guidelines included recommendations for fluoride varnish use as well as for fluoride gels, while a smaller number offered guidance on high fluoride strength toothpaste and other vehicles. Whilst there was good consistency in recommendations for fluoride varnish in particular, there was sometimes a lack of detail in other areas of recommendation for other vehicles with a high fluoride concentration. There are good examples within the UK, such as the Childsmile project and Delivering Better Oral Health, which highlight that the provision of evidence-based guidance can be influential in directing scarce resources towards oral health improvements. Policy can be influenced by evidence-based national recommendations and used to help encourage dental professionals and commissioners and third-party payers to adopt higher levels of practices aimed at oral health improvement.

Fluoride and Oral Health.

The discovery during the first half of the 20th century of the link between natural fluoride, adjusted fluoride levels in drinking water and reduced dental caries prevalence proved to be a stimulus for worldwide on-going research into the role of fluoride in improving oral health. Epidemiological studies of fluoridation programmes have confirmed their safety and their effectiveness in controlling dental caries. Major advances in our knowledge of how fluoride impacts the caries process have led to the development, assessment of effectiveness and promotion of other fluoride vehicles including salt, milk, tablets, toothpaste, gels and varnishes. In 1993, the World Health Organization convened an Expert Committee to provide authoritative information on the role of fluorides in the promotion of oral health throughout the world (WHO TRS 846, 1994). This present publication is a revision of the original 1994 document, again using the expertise of researchers from the extensive fields of knowledge required to successfully implement complex interventions such as the use of fluorides to improve dental and oral health. Financial support for research into the development of these new fluoride strategies has come from many sources including government health departments as well as international and national grant agencies. In addition, the unique role which industry has played in the development, formulation, assessment of effectiveness and promotion of the various fluoride vehicles and strategies is noteworthy. This updated version of 'Fluoride and Oral Health' has adopted an evidence-based approach to its commentary on the different fluoride vehicles and strategies and also to its recommendations. In this regard, full account is taken of the many recent systematic reviews published in peer reviewed literature.

UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent.

The Food and Drug Administration recently cleared silver diamine fluoride for reducing tooth sensitivity. Clinical trials document arrest and prevention of dental caries by silver diamine fluoride. This off-label use is now permissible and appropriate under U.S. law. A CDT code was approved for caries arresting medicaments for 2016 to facilitate documentation and billing. We present a systematic review, clinical indications, clinical protocol and consent procedure to guide application for caries arrest treatment.

[Preventive dentistry 1. Fluoride toothpaste, the cornerstone of caries prevention]. / Preventieve tandheelkunde 1. Fluoridetandpasta's, de hoeksteen van de cariëspreventie.

After the introduction of effective fluoride toothpastes in the 1970s oral health has improved significantly. Since that time, a lot of energy has gone into improving the toothpastes. An important improvement is the increased substantivity of fluoride and the increase in the duration of its effectiveness. In addition, attempts are currently being made to combine fluoride with effective re-mineralising systems, which is technically challenging. Due to a diversity of compositions, the effectiveness of toothpastes varies. It is, however, impossible to compare all available toothpastes on a 1 to 1 basis. The precise effectiveness cannot be deduced from the ingredients, nor is the dosage-response relationship between the concentration of fluoride and its effectiveness clear. The careful use of toothpaste will compensate for small differences in effectiveness. Times for tooth brushing should be chosen when there is enough time to brush carefully. After brushing, rinsing for one minute with the toothpaste slurry and a sip of water possibly increases the effectiveness of the toothpaste.

[Hygienic aspects of dental caries and its prevention]. / Gigienicheskie aspekty kariesa zubov i ego profilaktika.

This review summarizes fluoride content in surface water sources of various Russian regions and its relationship with the prevalence of caries in the population. Low Fluoride content in almost all water sources of Russia highlights the importance of individual prevention of dental caries above all by the use of fluorinated toothpaste. From the standpoint of evidence-based medicine the tooth brushing with fluorinated paste twice daily has the highest level of efficiency of caries reduction.

Whole-Saliva Fluoride Levels and Saturation Indices in 65+ Elderly during Use of Four Different Toothpaste Regimens.

BACKGROUND: Elderly individuals suffering from subnormal saliva secretion combined with inadequate oral hygiene may develop rampant caries and caries in parts of the dentition not normally affected by caries if preventive measures are not undertaken. Such measures include elevating fluoride levels at the saliva/biofilm/tooth interface. AIM: To analyse whole-saliva fluoride levels and mineral saturation indices during different fluoride toothpaste regimens in home-living elderly. MATERIALS AND METHODS: Whole saliva was collected from 27 subjects (7 males and 20 females, mean age 73.5±6.1 years) at ten time points covering the whole day during five 2-week periods. During the first period, participants used their normal toothpaste without instructions (baseline). This was followed by TP1: 1,450-ppm NaF toothpaste; TP2: 1,450-ppm monofluorophosphate (MFP) toothpaste with addition of calcium; TP3: 5,000-ppm NaF toothpaste, and TP4: the same toothpaste with additional 'smearing' of toothpaste on the teeth, twice daily. During TP1-TP4, the participants were instructed to brush 3 times per day using 1.5 g of toothpaste without rinsing. RESULTS: Salivary fluoride levels increased with toothpaste fluoride content (p<0.001), although major interindividual and intraindividual variations were observed. The highest fluoride values appeared in the morning and at night (p<0.001). Saturation indices for calcium fluoride were affected by the fluoride content in pastes (p<0.05). Concerning hydroxyapatite and fluorapatite, indices were highest with the MFP toothpaste and extra calcium (NS to p<0.05). CONCLUSIONS: Use of a high-fluoride toothpaste resulted in significantly increased fluoride levels in whole saliva and mineral saturation indices were indeed influenced by choice of toothpaste.

Insufficient evidence that slow-release fluoride devices reduce caries.

DATA SOURCES: Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, US National Institutes of Health Trials Register and World Health Organisation (WHO) International Clinical Trials Registry Platform. STUDY SELECTION: Parallel randomised controlled trials (RCTs) of any type of slow-release fluoride device irrespective of publication status, language or blinding were considered. Split mouth studies were excluded. DATA EXTRACTION AND SYNTHESIS: Standard Cochrane methods were followed with at least two reviewers independently undertaking all the key steps. RESULTS: Only one trial which was considered to be at high risk of bias was included. The trial included 174 children with 132 available for two year examination. However statistical analysis was performed on only the 63 children (31 in intervention group, 32 in control group) who had retained the beads (retention rate was 47.7% at two years). Among these 63 children, caries increment was reported to be statistically significantly lower in the intervention group than in the control group (DMFT: mean difference -0.72, 95% confidence interval (CI) -1.23 to -0.21; DMFS: mean difference -1.52, 95% CI -2.68 to -0.36 (very low quality evidence)). Although this difference was clinically significant, it only holds true for those children who retained the fluoride beads; over 50% of the children did not retain the beads. Adverse effects were not reported. CONCLUSIONS: There is insufficient evidence to determine the caries-inhibiting effect of slow-release fluoride glass beads. The body of evidence available is of very low quality and there is a potential overestimation of benefit to the average child. The applicability of the findings to the wider population is unclear; the study had included children from a deprived area that had low levels of fluoride in drinking water, and were considered at high risk of carries. In addition, the evidence was only obtained from children who still had the bead attached at two years (48% of all available children); children who had lost their slow-release fluoride devices earlier might not have benefited as much from the devices.

Low quality evidence for effectiveness of fluoridated milk.

DATA SOURCES: The Cochrane Oral Health Groups Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the U.S. National Institutes of Health Trials Register and WHO International Clinical Trials Registry. STUDY SELECTION: Randomised controlled trials with an intervention and follow-up period of at least two years, comparing fluoridated milk with non-fluoridated milk. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed risk of bias with the Cochrane risk of bias tool. RESULTS: Only one unpublished trial was included. It involved 180 children aged three years at study commencement and was considered to be at high risk of bias. After three years permanent teeth had a caries reduction (mean difference (MD) -0.13, 95% CI -0.24 to -0.02) and primary teeth a caries reduction (MD -1.14, 95% CI -1.86 to -0.42). For primary teeth this is a substantial reduction, equivalent to a prevented fraction of 31%. For permanent teeth,the disease level was very low in the study, resulting in a small absolute effect size. CONCLUSIONS: There is low quality evidence to suggest fluoridated milk may be beneficial to schoolchildren, contributing to a substantial reduction in dental caries in primary teeth. Due to the low quality of the evidence, further research is likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. There was only one relatively small study, which had important methodological limitations on the data for the effectiveness in reducing caries. Furthermore, there was no information about the potential harms of the intervention. Additional RCTs of high quality are needed before we can draw definitive conclusions about the benefits of milk fluoridation.

Xylitol and caries prevention.

DATA SOURCES: Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, CINAHL, Web of Science Conference Proceedings, Proquest Dissertations and Theses, US National Institutes of Health Trials Register (http://clinicaltrials.gov) and the WHO Clinical Trials Registry Platform for ongoing trials. No language or year restrictions were used. STUDY SELECTION: Randomised controlled trials assessing the effects of xylitol products on dental caries in children and adults. DATA EXTRACTION AND SYNTHESIS: Two review authors independently screened the results of the electronic searches, extracted data and assessed the risk of bias of the included studies. Authors were contacted where possible for missing data or clarification where feasible. For continuous outcomes, means and standard deviations were used to obtain the mean difference and 95% confidence interval (CI). Continuous data was used to calculate prevented fractions (PF) and 95% CIs to summarise the percentage reduction in caries. For dichotomous outcomes, reported risk ratios (RR) and 95% CIs were used. As there were fewer than four studies included in the meta-analysis, a fixed effect model was used. RESULTS: Ten studies were included with a total of 5903 participants. One study was assessed as being at low risk of bias, two were assessed as unclear risk of bias with seven at high risk of bias. Over 2.5­3 years, low quality evidence demonstrated that with 4216 children analysed, a fluoride toothpaste with 10% xylitol (exact dosage unsure) reduced caries by 13% when compared to a fluoride only toothpaste. (PF −0.13, 95% CI −0.18 to −0.08. Remaining evidence of the use of xylitol in children has risk of bias and uncertainty of effect and was therefore insufficient to determine a benefit from xylitol. Four studies reported that there were no adverse effects from any of the interventions. Two studies reported similar rates of adverse effects between study arms. The remaining studies either mentioned adverse effects but did not report any usable data, or did not mention them at all. Adverse effects include sores in the mouth, cramps, bloating, constipation, flatulence and loose stool or diarrhoea. CONCLUSIONS: Low quality evidence suggested that fluoride toothpaste containing xylitol may be more effective than fluoride-only toothpaste for preventing caries in the permanent teeth of children. The effect estimate should be interpreted with caution due to high risk of bias and the fact that it was derived from two studies that were carried out by the same authors in the same population. The remaining evidence was low to very low quality and is insufficient to determine whether any other xylitol-containing products can prevent caries in infants, older children or adults.

Some beneficial effect on root caries from use of higher concentration fluoride toothpaste (5000 ppm F).

DESIGN: Single-blind, multi-centre, parallel, randomised controlled trial. Intervention Adult patients (18-75 years) with 10 or more natural teeth, and one or more root caries lesion in a tooth not crowned or compromised were included. Patients were randomised to receive a high fluoride toothpaste, 1.1% sodium fluoride (5000 ppm F) or a regular toothpaste (1350 ppm F). Packaging was identical and standard brushes were also provided. Patients were strictly instructed to refrain from using toothpastes or toothbrushes other than the ones provided and restricted from using mouth rinses. OUTCOME MEASURE: The primary outcome measure was changes in the surface structure of the root caries lesions after the intervention. This was graded using a surface hardness score (HS) scale: Level 1: hard; Level 2: hard to leathery; Level 3: leathery; Level 4: leathery with local softening; Level 5: soft. Scores were recorded at baseline, three and six months. Examiners were masked to the group assignment. RESULTS: One hundred and thirty-five patients (test group: n = 67; control group: n = 68) with 318 identified root caries lesions were randomised. Five patients were lost to follow up, three in the test group and two in the control. The groups were similar at baseline. Overall there was no difference between the two groups for the overall HS (test group: HS = 3.4 ± 0.61; control group: HS = 3.4 ± 0.66; P = 0.8757, unpaired t-test). However the ANOVA revealed significantly better HS for the test group than for the control groups (T1: test group: HS = 2.9 ± 0.67; control group: HS = 3.1 ± 0.75; T2: test group: HS = 2.4 ± 0.81; control group: HS = 2.8 ± 0.79; P < 0.0001). CONCLUSIONS: The application of a high-fluoride containing dentifrice (5000 ppm F) in adults, twice daily, significantly improves the surface hardness of otherwise untreated root caries lesions when compared with the use of regular fluoride containing (1350 ppm F) toothpastes. ACKNOWLEDGEMENTS: The authors' institutions received per capita remunerations and the products used in this clinical trial, from Colgate-Palmolive Company. Roger P. Ellwood and Michael Warncke are employees of the Colgate-Palmolive Company.

Fluoridation update 2014.

This year more than 4 million people living in 140 communities in Massachusetts will have the health and economic benefits of community water fluoridation. However Massachusetts is ranked only 37th in the country for fluoridation, with just 62 percent of the population on a public water supply living in fluoridated communities. Nationally, more than 210 million Americans, about 74.6 percent of the U.S. population on a community water supply live in fluoridated communities.

Focus on fluorides: update on the use of fluoride for the prevention of dental caries.

UNLABELLED: Improving the efficacy of fluoride therapies reduces dental caries and lowers fluoride exposure. BACKGROUND: Fluoride is delivered to the teeth systemically or topically to aid in the prevention of dental caries. Systemic fluoride from ingested sources is in blood serum and can be deposited only in teeth that are forming in children. Topical fluoride is from sources such as community water, processed foods, beverages, toothpastes, mouthrinses, gels, foams, and varnishes. The United States Centers for Disease Control and Prevention (CDC) and the American Dental Association (ADA) have proposed changes in their long standing recommendations for the amount of fluoride in community drinking water in response to concerns about an increasing incidence of dental fluorosis in children. Current research is focused on the development of strategies to improve fluoride efficacy. The purpose of this update is to inform the reader about new research and policies related to the use of fluoride for the prevention of dental caries. METHODS: Reviews of the current research and recent evidence based systematic reviews on the topics of fluoride are presented. Topics discussed include: updates on community water fluoridation research and policies; available fluoride in dentifrices; fluoride varnish compositions, use, and recommendations; and other fluoride containing dental products. This update provides insights into current research and discusses proposed policy changes for the use of fluoride for the prevention of dental caries. CONCLUSIONS: The dental profession is adjusting their recommendations for fluoride use based on current observations of the halo effect and subsequent outcomes. The research community is focused on improving the efficacy of fluoride therapies thus reducing dental caries and lowering the amount of fluoride required for efficacy.

[Efficacy of the caries preventive agents in children during mixed dentition period].

UNLABELLED: In this blind randomized study the results of the use of agents for dental caries prevention are presented. The study included 136 children of 7-12 years old, divided into four groups according to the used agent: 3M ESPE Clinpro XT Varnish (n=35), Multifluorid (n=37), Gluftored (n=23) and a control group (n=41) who was given the recommendations on individual oral hygiene with the use of fluoride toothpaste. The groups correlate to gender, age and the risk of dental caries development. Prevention efficacy was determined using the test of enamel resistance (painting of enamel area pretreated with acid). RESULTS: the use of long-acting fluorine varnish 3M ESPE Clinpro XT Varnish statistically significantly increases enamel resistance in comparison with other fluorine agents. The effect of the agent is due to the possibility of long-term exposure to the tooth enamel.