Minimizing tooth discoloration caused by topical silver diamine fluoride application: A systematic review.

OBJECTIVE: The objective of this systematic review is to examine the methods used to minimize discoloration of the carious lesions after topical silver diamine fluoride (SDF) application. DATA/SOURCES: Two independent researchers conducted a search of English literature published up to 30th April 2024 in three databases (PubMed, Scopus, and Web of Science). They screened titles and abstracts, excluding conference proceedings, books, reviews and publications unrelated to SDF. They included only original research on methods to minimize SDF-induced discoloration. The publications lacking comparative color change data were excluded. Full texts of the included articles were then analyzed. The Cochrane guidelines for clinical trials and the guidelines for in-vitro studies on dental materials were used for the risk of bias assessment. RESULTS: The systematic review included 33 publications from 1,283 identified publications (26 laboratory studies and 7 clinical studies). Thirteen laboratory studies and five clinical studies were rated as having 'low risk'. Three main methods to minimize discoloration were identified: masking with restoration, using chemicals, and substituting silver with nano-silver. Nine studies used resin composite or glass ionomer cement to mask the SDF-induced discoloration. Twenty-nine studies used chemicals to reduce SDF-induced discoloration. These chemicals included precipitating agents like potassium iodide, oxidizing agents like hydrogen peroxide, and chelating agents like glutathione. Seven publications used chemicals (potassium iodide or glutathione) before restoration and six of them found improved masking effect. Four studies substituted silver ions with silver nanoparticles which did not discolor carious lesion. CONCLUSIONS: Masking with restoration, using chemicals, and substituting silver ions with nano-silver particles have been reported to address the discoloring effects of SDF therapy. However, most are laboratory studies, and more clinical trials are needed to confirm their effectiveness in reducing SDF-induced discoloration. CLINICAL SIGNIFICANCE: SDF effectively arrests caries, but it discolors carious lesions. This review summarizes the methods and their outcomes for reducing SDF-induced discoloration. This study is supported by the General Research Fund of Research Grant Council No. 17,100,222.

Randomized clinical trial to compare three fluoride varnishes in preventing early childhood caries.

OBJECTIVES: To compare the effectiveness of two 5% sodium fluoride (NaF) varnishes containing casein phosphopeptide amorphous calcium phosphate (CPP-ACP) (MI VarnishTM) or tricalcium phosphate (TCP) (ClinproTM White) to the conventional 5% NaF varnish (Duraphat®) in preventing early childhood caries (ECC) in high-risk preschool children. METHODS: A double-blinded, randomized controlled trial recruited healthy 3-4-year-old children (N = 582) having at least one carious lesion (pre-cavitated or cavitated) after obtaining written informed consent from parents. Using a computer-generated random-number table, children were assigned to one of the 3 groups: Control group (n = 196): 5% NaF varnish (Duraphat®) or two test groups: 5% NaF with TCP (Clinpro™ White) (n = 193) and 5% NaF varnish with CPP-ACP (MI Varnish™) (n = 193) to receive quarterly (every 3 months) application over 24 months. RESULTS: Incidence of new caries over 2 years was 59.2% in MI Varnish™ group (n = 125), 65.1% in the Clinpro™ White group (n = 129) and 66.1% in the Duraphat® group (n = 127) (p = 0.466). The mean cavitated lesions increment was not significant among the 3 groups (p = 0.714), as was the mean increment in non-cavitated carious lesions (p = 0.223). There was no significant difference (p = 0.630) in the distribution of total fluoride varnish applications among the three groups. Also, no significant difference was found in comparison of outcomes among the different number of fluoride varnish applications received by children in each group. CONCLUSIONS: Both calcium- and phosphate-containing NaF varnishes showed similar efficacy against cavitated and non-cavitated carious lesions as compared to conventional NaF varnish in high-risk preschool children. CLINICAL SIGNIFICANCE: Randomized trial provided a crucial opportunity to advance the understanding of the clinical effectiveness of different fluoride varnishes in preventing early childhood caries. Varnishes containing tricalcium phosphate or casein phosphopeptide amorphous calcium phosphate when compared to sodium fluoride varnish, demonstrated a similar efficacy against early childhood caries in high caries-risk preschool children.

Topical fluoride to prevent early childhood caries: Systematic review with network meta-analysis.

OBJECTIVES: To summarize the evidence on prevention of early childhood caries (ECC) by professionally or self-applied topical fluorides using network meta-analysis. DATA: Randomized-controlled trials with minimum 1-year follow-up assessing caries-preventive effect among children younger than six years. SOURCES: Eight electronic databases and grey literature. STUDY SELECTION: After screening and data extraction, risk of bias assessment using Cochrane risk of bias tool 2.0 was done. Twenty-four trials were included, among which 17 were assessed as "high risk" and remaining as "low risk". Fifteen studies evaluated professionally-applied, and the other nine used self-applied topical fluorides. Ten studies on professionally-applied fluorides reporting the net caries increment (dmfs increment) at 2-years follow-up were included in Network meta-analysis (NMA). NMA and ranking the interventions were conducted using a frequentist random-effects approach and surface under the cumulative ranking command, followed by assessing the certainty of evidence using an extension of GRADE approach with CINeMA framework. Among the eight included interventions of professionally-applied fluorides, only two, i.e., 3-monthly 0.9% difluorosilane (DFS) and 6-monthly 5% sodium fluoride varnish were effective in preventing ECC compared to control with 3-monthly DFS application ranking higher than 6-monthly sodium fluoride varnish application. CONCLUSION: Among all the professionally-applied topical fluoride interventions reviewed, very low to moderate evidence was found with 0.9% DFS application at 3-monthly intervals, which was ranked highest in prevention of ECC. Among the included studies on self-applied topical fluorides, the evidence was inconclusive due to heterogeneity among studies. CLINICAL SIGNIFICANCE: The 0.9% DFS varnish applied every 3 months is most effective for preventing early childhood caries. The review recommends that good quality studies be conducted in future, comparing two or more interventions for both self- as well as professionally-applied topical fluoride agents with adequate follow-up.

FISSURE SEALANT IN A NUTSHELL. EVIDENCE-BASED META-EVALUATION OF SEALANTS' EFFECTIVENESS IN CARIES PREVENTION AND ARREST.

OBJECTIVE: This meta-evaluation aimed to summarize all available evidence regarding different fissure sealants on occlusal caries prevention, arrest, retention rate, adverse effect, and cost-effectiveness; when compared with no intervention, other preventive or minimally-invasive procedures. MATERIALS AND METHODS: The systematic reviews and meta-analyses were identified via four electronic databases and manual searching. Two independent reviewers performed study selection, data extraction, quality assessment with AMSTAR-2. RESULTS: Among the 366 records yielded, 38 systematic reviews were identified as eligible 24 of them included meta-analyses. Moderate evidence has supported the efficacies of resin-based sealants (RBS) in occlusal caries prevention, arrest and cost-effectiveness compared to no interventions. Low to very low certainty of evidence suggested similar effectiveness of glass-ionomer cements in caries prevention with RBS and more superior performance of resin infiltration in arresting non-cavitated occlusal lesions. CONCLUSION: This meta-evaluation supports the use of RBS on permanent molars to reduce occlusal caries occurrence, arrest lesion progression and alleviate oral health inequalities between individuals of different socioeconomic status. This meta-evaluation also advocates further research on glass-ionomer cements and resin infiltration with respect to their efficacies in caries prevention and arrest.

The enamel remineralization potential of fluoride varnishes containing arginine.

OBJECTIVES: To examine the effect of incorporating arginine in a 5% sodium fluoride (NaF) varnish on its remineralization potential and HGF-1 cytotoxicity. METHODS: Experimental varnishes were prepared using two arginine variants: l-arginine (Arg) and l-arginine monohydrochloride (Arg.HCl) at 2%, 4%, & 8% w/v. with control 5% NaF varnish. Sound enamel specimens with varnish treatments were subjected to a 4-day demineralization assay and surface roughness analysis using AFM (n = 3). Enamel specimens with artificial incipient caries-like lesions were subjected to a remineralization assay (n = 6) and an 8-day pH-cycling (n = 3). For remineralization assay, enamel F/Arg-uptake and Ca/PO43-i-content were estimated. During pH-cycling, EDX mapping for Ca/F-content and mineral density using micro-CT were assessed. The HGF-1 cytotoxicity of the varnishes was examined using MTT/CCK-8 assay. RESULTS: The Ca-content/F-uptake of the 2% Arg-NaF varnish treated specimens were significantly higher than other varnishes (p < 0.05). The 2% Arg-NaF had significantly higher remineralization potential than NaF (p < 0.001), suggesting Arg-Ca-F complex formation post-varnish application. The 8% Arg-NaF exhibited significantly more pronounced cytotoxicity to HGF-1 cells than 2% Arg-NaF (p < 0.001) and NaF varnish. CONCLUSIONS: Incorporation of 2% Arg in NaF varnish enhanced the enamel remineralization potential of NaF varnish; while 8% Arg in NaF varnish was cytotoxic to HGF-1. CLINICAL SIGNIFICANCE: A professionally deliverable l-arginine-enriched NaF varnish for caries prevention addresses a global public health priority. The synergism between l-arginine and NaF varnish counters the limited antimicrobial effects of fluorides and supports acquisition of a balanced oral microbiome. The combined arginine-fluoride varnish will provide the much-needed ecological-based approach for caries prevention.

Motivational interviewing to prevent early childhood caries: A randomized controlled trial.

OBJECTIVES: Prevailing health education (PE) often fails to achieve sustained behavioral changes. This randomized controlled trial integrated motivational interviewing (MI) and a patient communication tool featuring interactive caries risk assessment (RA) into PE and investigated the effectiveness of PE, PE + MI, and PE + MI + RA in preventing early childhood caries. METHODS: This study targeted children aged 3-4 years with unfavorable oral health behaviors. 692 parent-child dyads were recruited, randomly assigned into three groups (PE, PE + MI, and PE + MI + RA), and received respective interventions. A questionnaire was completed at baseline and after 6 and 12 months to collect information on socio-demographic background, parental efficacy and children's oral health behaviors. Children's oral hygiene status and dental caries were recorded at baseline and after 12 months. RESULTS: 655 (94.7%) parent-child dyads remained in the study after 12 months. Caries increment was significantly lower in PE + MI group (ß=-0.717, 95% CI: -1.035, -0.398) and PE + MI + RA group [ß=-0.600, 95% CI: -0.793, -0.407] than in PE group. There was significantly greater reduction in plaque score in PE + MI group (ß=-0.077, 95% CI: -0.106, -0.048) and PE + MI + RA group (ß=-0.075, 95% CI: -0.113, -0.036), as compared with PE group. Significantly greater improvements were found in parental efficacy and children's oral health behaviors in PE + MI and PE + MI + RA groups than in PE group (all p < 0.05). There was no significant difference between PE + MI group and PE + MI + RA group across all outcome measures (all p > 0.05). CONCLUSIONS: Intergration of motivational interviewing improves the effectiveness of prevailing health education in preventing early childhood caries, enhancing parental efficacy, and improving children's oral health behaviors. Incorporation of the communication tool for caries risk assessment does not further improve the effectiveness of motivational interviewing in protecting children's oral health. CLINICAL SIGNIFICANCE: The findings of this study provide much needed evidence for dentists, dental auxiliary staff and public health workers to select effective intervention to empower parents for improving children's oral health behaviors and preventing early childhood caries.

Enhancing the Remineralization Potential of Child Formula Dentifrices: An In Vitro Study.

Objective(s): The incorporation of Arginine (Arg) in NaF-containing child dentifrice might enhance its remineralizing potential, reducing fluorosis risk with significant anti-caries benefit. The study objective was to examine the remineralizing potential of arginine in child formula dentifrice (600-ppm NaF).Study Design: Primary teeth enamel specimens (n = 10) with artificial caries-like lesion were randomly divided to 4 treatment groups: A: 2% Arg-(600-ppm) NaF; B: 600-ppm NaF; C: 1100-ppm NaF; and D: deionized water subjected to 7-day pH-cycling. The mineral density (MD) of the treated specimens was assessed using micro-CT. The pre-/post-treated artificial caries-like lesion were acid-etched for enamel fluoride uptake (EFU) evaluation, Ca and P element analysis using ICP-OES, and the inorganic phosphate (PO43-) determination using colorimetric assay. Results: The percentage remineralization of the 2% Arg-NaF and 1100-ppm NaF groups was significantly higher than the 600-ppm NaF group (p<0.001). However, no significant difference in remineralization was observed between the two groups (p>0.05). The EFU, Ca/P ratio, PO43- content of the 2% Arg-NaF group were significantly higher than the 600-ppm NaF group (p<0.01); while no significant difference was found between the 2% Arg-NaF and 1100-ppm NaF groups. Conclusion: Within the limitations of the present study, incorporation of 2% arginine in 600-ppm NaF child formula dentifrice enhanced the remineralization potential of artificial enamel caries, to a level comparable to 1100-ppm NaF adult formula dentifrice.

The combined enamel remineralization potential of arginine and fluoride toothpaste.

OBJECTIVE(S): This study examined the remineralization potential of arginine (Arg) in NaF toothpaste. METHODS: Fifty enamel specimens allocated to five groups (n = 10) were subjected to artificial caries formation. A 10-day pH-cycling was performed to treat specimens as per group - [1]: 2% Arg - NaF, [2]: 4% Arg - NaF, [3]: 8% Arg - NaF, [4]: NaF and [5]: deionized water. The test solutions were subjected to pH measurement, fluoride estimation, Na-Cl element analysis using ICP-EOS and FTIR analyses. Mineral density of the specimens were assessed using micro-CT; while Ca/P ratio and surface fluorine concentration were determined using energy dispersive x-ray spectroscopy (EDS) and enamel fluoride uptake (EFU) by acid-etch method. RESULTS: pH, fluoride concentration and Na-Cl ratio exhibited significant difference amongst groups (p < 0.001). FTIR analysis showed presence of free amino acids in 2% and 4% Arg-NaF group. The mean mineral gain (0.40 ±â€¯0.07 g/cm3) and percent remineralization (27.91 ±â€¯4.66%) of 2% Arg-NaF group were significantly higher than the other 4 groups (p < 0.001). Conversely, the median Ca/P ratio for 2% Arg-NaF (1.60) was significantly higher than deionized water (1.53) (p = 0.029). The mean surface fluorine concentration of specimens treated with 2% Arg-NaF (1.51 ±â€¯0.14%) was significantly higher than treatment with NaF (1.02 ±â€¯0.28%) (p < 0.001). The EFU of 2% Arg-NaF group (6.84 ±â€¯1.59 µg/cm2) was significantly higher than NaF group (5.22 ±â€¯1.88 µg/cm2) (p < 0.001). CONCLUSION: Incorporation of 2% arginine in NaF toothpaste significantly increased the remineralization of enamel caries-like lesion when compared to NaF toothpaste; while 4% and 8% arginine in NaF toothpastes were ineffective in improving enamel remineralization. CLINICAL SIGNIFICANCE: In high-risk patients, daily use of 2% arginine in NaF toothpaste might provide a synergistic anti-caries effect given the proven prebiotic benefits of arginine in caries prevention and the demonstrated remineralization effect in the present study.

Dental and periodontal status of 12-year-old Dai school children in Yunnan Province, China: a cross-sectional study.

BACKGROUND: The Dai people are one of the ethnic minorities in China and have a population of 1,260,000. They have the same origin as one of the main ethnic groups in Laos and Thailand. The study aims to describe the dental caries and gingival status of 12-year-old Dai children in China and to study the factors affecting their oral-health status. METHODS: This cross-sectional oral-health survey was conducted from 2011-2012 with ethics approval. A sample of 12-year-old Dai children living in Yunnan, China, was selected using a multistage and cluster sampling method. One trained examiner performed the clinical examination. Caries experience was measured using DMFT index, and gingival status was assessed with CPI index. A self-completed questionnaire was sent to the children, and they were asked about their backgrounds and oral-health-related behaviors and oral-health knowledge. Binary logistic regression analysis was performed to investigate the factors that affected the caries status. RESULTS: A total of 875 children were invited, and 823 (94 %) joined the survey. The prevalence of caries experience among the participants was 40 %. The mean DMFT and DT scores were 0.9 and 0.8, respectively. Most children (93 %) had gingivitis, and many (46 %) had calculus. Girls and those who had visited a dentist during the previous year had a higher prevalence of caries. CONCLUSION: Dental caries were prevalent among 12-year-old Dai children in China. The periodontal condition of most of the children was poor. Caries were associated with gender and dental attendance.

The effectiveness of the biannual application of silver nitrate solution followed by sodium fluoride varnish in arresting early childhood caries in preschool children: study protocol for a randomised controlled trial.

BACKGROUND: The application of 38 % silver diamine fluoride (SDF) has been shown to be effective in arresting early childhood caries (ECC). Since SDF is not available in certain countries, some dentists use adjunctive application of 25 % silver nitrate (AgNO3) and 5 % sodium fluoride (NaF) to arrest ECC. This randomised controlled trial will systematically compare the efficacy of a 25 % AgNO3 solution followed by 5 % NaF varnish with that of a 38 % SDF solution in arresting ECC when applied at half-yearly intervals over a 30-month period. METHODS/DESIGN: This study is a randomised, double-blinded, non-inferiority clinical trial. The hypothesis tested is that adjunctive application of 25 % AgNO3 followed by 5 % NaF is at least not appreciably worse than a 38 % SDF in arresting ECC. Approximately 3100 kindergarten children aged 3-4 years will be screened and at least 1070 children with caries will be recruited. This sample size is sufficient for an appropriate statistical analysis (power at 90 % (ß = 0.10) with a 2-sided type-I error of α = 0.05), allowing for an overall 20 % drop-out rate. The children will be randomly allocated into 2 groups to treat their caries over a 30-month period: Group A - biannual adjunctive application of a 25 % AgNO3 solution and a 5 % NaF varnish, and Group B - biannual adjunctive application of a 38 % SDF solution followed by a placebo varnish. Clinical examinations will be conducted at 6-month intervals. Primary outcome measured is the number of active caries surfaces which are arrested. Information on confounding factors such as oral hygiene habits will be collected through a parental questionnaire. DISCUSSION: We expect that adjunctive application of 25 % AgNO3 solution and 5 % NaF varnish and of 38 % SDF solution can both effectively arrest ECC. Lower concentrations of silver and fluoride are contained in 25 % AgNO3 and 5 % NaF, respectively, than in 38 % SDF; therefore, AgNO3/NaF are more favourable for use in young children. Because its use for caries management is painless, simple, low-cost, and approved in many countries, AgNO3/NaF could be widely recommended and promoted as an alternative treatment to conventional invasive management of ECC. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02019160 . Date of registration: 11 December 2013.

Dental caries and erosion status of 12-year-old Hong Kong children.

BACKGROUND: This study aimed to assess the dental caries and erosion status of 12-year-old Hong Kong children and study the determinants of dental caries and dental erosion of these children. METHODS: The survey was performed from 2011 to 2012 with ethics approval. Stratified random sampling was adopted to select 12-year-old children in 7 primary schools in Hong Kong. The participating parents were asked to complete a self-administered questionnaire concerning their children's diet and oral health habits. The children were examined for caries status with WHO criteria by 3 calibrated examiners. Detection of dental erosion followed Basic Erosive Wear Examination (BEWE) criteria. RESULTS: A total of 704 children were recruited and 600 (316 boys, 53%) participated in the survey. There were 124 children (21%) with caries experience (DMFT > 0) and their DMFT was 0.34 ± 0.76. About half of their decay was unfilled (DT = 0.16 ± 0.52) The DMFT of girls and boys were 0.45 ± 0.89 and 0.23 ± 0.61, respectively (p = 0.001). Girls also had a higher DT (0.21 ± 0.62 compared with 0.11 ± 0.41, p = 0.013) and FT than boys (0.23 ± 0.63 compared with 0.12 ± 0.44, p = 0.016). Most children (75%) had at least some sign of erosion (BEWE > 0), but no severe erosion (BEWE = 3). Logistic regression showed girls who consumed soft drinks and took vitamin C supplements had higher caries risk. Dental erosion was more severe among the children who had caries experience and consumed fruit juice. CONCLUSIONS: The 12-year-old Hong Kong children had low caries experience, and almost half of the decay was left untreated. Although severe erosion was not found, many children had early signs of erosion.

Topical fluoride as a cause of dental fluorosis in children.

BACKGROUND: For many years, topical use of fluorides has gained greater popularity than systemic use of fluorides. A possible adverse effect associated with the use of topical fluoride is the development of dental fluorosis due to the ingestion of excessive fluoride by young children with developing teeth. OBJECTIVES: To describe the relationship between the use of topical fluorides in young children and the risk of developing dental fluorosis. SEARCH STRATEGY: Electronic search of the Cochrane Oral Health Group Trials Register, CENTRAL, MEDLINE, EMBASE, BIOSIS, Dissertation Abstracts and LILACS/BBO. Reference lists from relevant articles were searched. Date of the most recent searches: 9th March 09. SELECTION CRITERIA: Randomised controlled trials (RCTs), quasi-RCTs, cohort studies, case-control studies and cross-sectional surveys, in which fluoride toothpastes, mouthrinses, gels, foams, paint-on solutions, and varnishes were compared to an alternative fluoride treatment, placebo or no intervention group. Children under the age of 6 years at the time topical fluorides were used. DATA COLLECTION AND ANALYSIS: Data from all included studies were extracted by two review authors. Risk ratios for controlled, prospective studies and odds ratios for case-control studies or cross-sectional surveys were extracted or calculated. Where both adjusted and unadjusted risk ratios or odds ratios were presented, the adjusted value was included in the meta-analysis. MAIN RESULTS: 25 studies were included: 2 RCTs, 1 cohort study, 6 case-control studies and 16 cross-sectional surveys. Only one RCT was judged to be at low risk of bias. The other RCT and all observational studies were judged to be at moderate to high risk of bias. Studies were included in four intervention/exposure comparisons. A statistically significant reduction in fluorosis was found if brushing of a child's teeth with fluoride toothpaste commenced after the age of 12 months odds ratio 0.70 (random-effects: 95% confidence interval 0.57 to 0.88) (data from observational studies). Inconsistent statistically significant associations were found between starting using fluoride toothpaste/toothbrushing before or after the age of 24 months and fluorosis (data from observational studies). From the RCTs, use of higher level of fluoride was associated with an increased risk of fluorosis. No significant association between the frequency of toothbrushing or the amount of fluoride toothpaste used and fluorosis was found. AUTHORS' CONCLUSIONS: There should be a balanced consideration between the benefits of topical fluorides in caries prevention and the risk of the development of fluorosis. Most of the available evidence focuses on mild fluorosis. There is weak unreliable evidence that starting the use of fluoride toothpaste in children under 12 months of age may be associated with an increased risk of fluorosis. The evidence for its use between the age of 12 and 24 months is equivocal. If the risk of fluorosis is of concern, the fluoride level of toothpaste for young children (under 6 years of age) is recommended to be lower than 1000 parts per million (ppm).More evidence with low risk of bias is needed. Future trials assessing the effectiveness of different types of topical fluorides (including toothpastes, gels, varnishes and mouthrinses) or different concentrations or both should ensure that they include an adequate follow-up period in order to collect data on potential fluorosis. As it is unethical to propose RCTs to assess fluorosis itself, it is acknowledged that further observational studies will be undertaken in this area. However, attention needs to be given to the choice of study design, bearing in mind that prospective, controlled studies will be less susceptible to bias than retrospective and/or uncontrolled studies.