The Effect of Various Fluoride Products on Dentine Lesions during pH-Cycling.

This study compared the effect of topically applied fluoride products on dentine lesions in an in vitro experiment. Demineralized bovine dentine specimens were treated once with either SDF solution (35,400 ppm F), NaF varnish (22,600 ppm F), TiF4 solution (9,200 ppm F), SnF2 gel (1,000 ppm F), no treatment (control), or preserved as baseline lesions. After the application and subsequent removal of the fluoride products, the specimens were subjected to pH-cycling. Calcium loss and uptake in the de- and remineralization buffers were assessed daily. Fluoride release into the buffers was analyzed on days 1, 2, 3, 5, 8, and 13. After the pH-cycling period, mineral distribution throughout the lesion depth was analyzed using transversal microradiography (TMR). X-ray energy-dispersive spectroscopy (EDS) examined the deposition of silver, titanium, and tin after application of SDF, TiF4, and SnF2, respectively. Overall, calcium loss and uptake analysis in the de- and remineralization buffers revealed that the SDF product was the most effective in inhibiting lesion progression, followed by the TiF4, NaF, and SnF2 products. Fluoride analysis disclosed a steep reduction of the amount of fluoride released into de- and remineralization buffers with time. The fluoride effects on de- and remineralization continued beyond the days that fluoride was released into the buffers. TMR analysis showed significant remineralization in the outer zone of the dentine lesions for all fluoride products, with SDF giving hypermineralization in this zone. In the inner zone, lesions developed in all fluoride groups, with the smallest in the SDF group. EDS showed silver and titanium deposition in depth up to 85 µm and 8 µm, respectively, while no tin deposition was observed. The silver in the dentine lesions did not contribute significantly to the density of the TMR profiles in the SDF group. In conclusion, all topical fluoride products protected the dentine lesions against lesion progression, but at different degrees. SDF showed a superior effect in protection against further demineralization and enhancement of remineralization. This was probably attributed to its fluoride concentration that was the highest among the fluoride products.

[Preventive dentistry 9. Non-Restorative Cavity Treatment: advanced insight or controversial?] / Preventieve tandheelkunde 9. Niet-Restauratieve Caviteitsbehandeling: voortschrijdend inzicht of controversieel?

Non-Restorative Cavity Treatment (NRCT) is not as popular in paediatric dentistry as it should be. Substantial quantitative and qualitative evidence concerning the treatment has now been published that testifies to the success of the treatment. Some healthcare providers apply the method successfully, while others have no trust in this non-invasive cavity treatment and continue to favour the restoration of carious lesions. Reasons given for this are, among others, that NRCT is too bothersome, the patient's (or the patient's parents') compliance is low and the reimbursement is inadequate. Children, however, benefit from oral healthcare providers who take the position that a child has a right to an etiological treatment that addresses the source of the caries process and that NRCT offers a uniquely viable treatment option for this purpose. This approach fits within the parameters established by professional ethics and the law. Apart from oral healthcare providers, all agencies involved in the profession and beyond have the moral and social obligation to do justice to the implied question of the child regarding this shift in oral healthcare.

Evaluation of Possible Associated Factors for Early Childhood Caries and Severe Early Childhood Caries: A Multicenter Cross-Sectional Survey.

OBJECTIVES: The present study evaluated associated factors for developing early childhood caries (ECC) and Severe-ECC (S-ECC) in a group of children aged 24-71 months. Potential positive effects of early dental visit on formation of ECC is investigated as well. STUDY DESIGN: This was a multicenter, cross-sectional study conducted at three governmental and university pediatric dentistry clinics in 408 preschool children who were randomly selected from a total of 4116 children. The questionnaires administered to the mothers by interview and intraoral examination performed by calibrated pediatric dentists. The children were evaluated in three groups according to their caries experience as who had caries free, ECC and S-ECC. RESULTS: The following factors were significantly associated with caries formation: 1. Prolonged (i.e., >18 months) breastfeeding in preterm babies (OR=2.4) 2. Prolonged breastfeeding in children who started tooth brushing after 1.5 years of age (OR=3.7), 3. Sugar (p<0.001) and fruit-juice consumption (p<0.0001), and 4. Lack of periodic dental examination (p<0.05). Parental smoking habit does not significantly affect ECC development. Nocturnal bottle feeding and nocturnal feeding also affected S-ECC formation significantly (p=0.043 and p=0.005, respectively). CONCLUSIONS: There is a significant difference between the children with caries and caries-free associated with the brushing initiation age started before or after 18 months. If a child is under the risk of multiple caries factors, it is very difficult to evaluate which habits affect the caries formation or increase the severity of the caries lesions.

[A paradigmatic change in the management of caries in children: 'Gewoon Gaaf']. / Een omslag in cariësbehandeling bij kinderen: 'Gewoon Gaaf'.

This is a position paper about 'Gewoon Gaaf' ['Just Smooth'], a paradigmatic change in the management of caries in children with a special focus onprevention. Caries is now considered a disease related to behaviour. Behavioural changes are essential in the prevention of caries because only patient's self care can keep caries under control. It is the task of the oral care provider to alert parents and child to their own influence on the development of caries and particularly on how to keep this process under control. Evaluations have revealed that the traditional form of preventive care has hardly improvedoral health. In contrast, various studies have shown the good results of the 'Gewoon Gaaf' approach. Moreover it fits in well with the public debate, which puts more and more attention on efficiency and transparency in the care.

[Non-restorative treatment of cavities in temporary dentition: effective and child-friendly]. / Niet-restauratieve behandeling van cariës in het melkgebit: doelmatig en kindvriendelijk.

Caries is a multifactorial disease manifesting itself as a dynamic process. Fewer than half of all 5-year-olds have all teeth intact. The treatment of cavities in the temporary dentition requires a switch from predominant restoration to responsible non-restoration. The progression of a process within an existing cavity can in fact be inhibited by cleansing the lesion with fluoride toothpaste if it is, or made, approachable. Such non-restorative treatment changes an acute cavity progression into a chronic one. Chronic caries provides more time to mobilize the immune system through the pulp. Non-restorative treatment of cavities is especially indicated in children with active caries or children who are afraid of treatment by a dentist. Non-restorative treatment of cavities is less burdensome for children than restorative treatment.

[Caries: diagnostics, monitoring and guidance in good oral health behaviour. A reorientation]. / Cariës: diagnostiek, monitoren en begeleiden naar goed mondzorggedrag. Een heroriëntatie.

Caries is a dynamic process which can develop either progressively or regressively under the all-determining influence of oral health behaviour. Management of caries therefore involves first of all: diagnostics, monitoring and preventive care and treatment which result in good oral health behaviour. The oral care provider should recognize all phases ofprogression of the caries process, and should be able to differentiate the symptoms which indicate an active or inactive process. A well maintained patient dossier is necessary to monitor this process over time. Following this procedure, the oral care provider is in a position to guide the patient with relevant information in order to achieve the final objective, good oral health.

Long-term survival of indirect pulp treatment performed in primary and permanent teeth with clinically diagnosed deep carious lesions.

INTRODUCTION: This retrospective study examined clinically and radiographically the 3-year survival of teeth treated with indirect pulp treatment (IPT) performed between 2000 and 2004. METHODS: Sixty-six uncooperative children (4-18 years old) with at least one tooth with clinically diagnosed deep caries were included. Radiographically, the lesion depth was greater than two thirds of the dentin thickness. Incomplete excavation was performed leaving infected carious dentin at the center of the cavity. After placement of a layer of resin-modified glass ionomer as liner, the teeth were restored. A 3-year survival analysis (Kaplan-Meier) was performed. Failure was defined as the presence of either a clinical symptom (pain, swelling, or fistula) or radiologic abnormality at recall. In total, 86 of 125 (69%) treated primary molars and 34 of 45 (76%) treated permanent teeth were available for both clinical and radiographic evaluation. RESULTS: The survival rate was 96% for primary molars (mean survival time, 146 weeks) and 93% for permanent teeth (mean survival time, 178 weeks). CONCLUSION: This study shows that IPT performed in primary and permanent teeth of young patients may result in a high 3-year survival rate.

In situ remineralisation of enamel and dentin after the use of an amine fluoride mouthrinse in addition to twice daily brushings with amine fluoride toothpaste.

It is often claimed that 3 fluoride moments a day significantly reduce the caries risk compared to 2 daily fluoride moments. However, previous research is not conclusive. Therefore, the aim of this study was to compare the effect on lesion progression of 2 versus 3 fluoride moments a day. A double-blind, randomized, cross-over in situ experiment was designed. The experiment comprised 2 in situ periods of 3 weeks with a washout period of 3 weeks in between. Sixteen participants wore an enamel and a dentine specimen with a preformed lesion placed buccally in their partial prosthesis. The participants brushed twice a day with a 1,400 ppm F (amine fluoride) toothpaste and rinsed once a day with either 250 ppm F (amine F/NaF) or a placebo rinse. At the end of the experiment the specimens were retrieved for fluoride analysis and the assessment of integrated mineral loss with transversal microradiography. The fluoride analysis showed a statistically significant increase in structurally bound fluoride in dentine, but not in enamel, when comparing the fluoride mouthrinse group with the placebo rinse group. The amounts of loosely bound, KOH-soluble fluoride were not different between both groups neither for enamel nor for dentine. In dentine IML gain was significantly (p < 0.05) higher for the fluoride mouthrinse group than for the placebo mouthrinse group. In enamel no statistically significant differences in IML gain were found. For dentine a third fluoride moment may be beneficial in enhancing remineralisation, even under the remineralising conditions as in this study.

[Early caries diagnosis]. / Vroegdiagnostiek van cariës.

Early detection of carious lesions enables the dental professional to interfere in caries development. Visual inspection in combination with bitewing radiographs performed better than new quantitative methods in detecting early non-cavitated carious lesions. Once a lesion has been detected assessment of activity (diagnosis) is important in order to distinguish between an active process and a scar developed in the past. The clinical gaze, an intellectual interpretation of the dental condition, whereby the caries experience of the recent past is used as an important caries predictor, is better able to produce a correct estimate of the caries risk than prediction models based on risk factors. A correct diagnosis of lesion activity in combination with the caries risk of the patient gives us a tool to predict caries development in the future. Subsequently caries activity can be influenced by addressing the factors which cause caries (causal therapy).

Chlorhexidine efficacy in preventing lesion formation in enamel and dentine: an in situ study.

BACKGROUND: Clinical studies on the caries-preventive properties of chlorhexidine mouthrinses are limited and the results are inconclusive. AIM: The aim of this study was to elucidate the contribution of a 0.2% chlorhexidine mouthrinse to the protection of enamel and dentine against demineralization. METHODS: In this randomized two-treatment, two-leg study 14 individuals wearing partial prostheses were enrolled. Sound enamel and dentine specimens were placed in situ for 4 weeks. Twice daily, a mouthrinse was performed with either chlorhexidine or saline (control) depending on the experimental group the participant was allocated to. After the experimental period, plaque samples were collected from the surface of the specimens and from natural tooth surfaces to assess the organic acid production upon a sucrose challenge. The specimens were analyzed for mineral loss by transversal microradiography. RESULTS: This study could not demonstrate a significantly better protection of enamel and dentine against demineralization by the chlorhexidine treatment compared to saline. No differences in acid production of plaque samples from the chlorhexidine-treated and control groups were observed. This result was also found for plaque samples originating from the natural tooth surfaces. CONCLUSION: Mouth rinsing with 0.2% chlorhexidine did not prevent demineralization of dentine and enamel in situ.

Host-derived proteinases and degradation of dentine collagen in situ.

Dentine root caries is a process of demineralization and degradation of the organic matrix by proteinases. In this in situ study, the presence and activity of the matrix metalloproteinases 1, 2 and 9 (MMP-1, MMP-2, MMP-9) in saliva and in completely demineralized dentine specimens were investigated. Furthermore, the activity of cathepsin B was determined in saliva. A correlation between these enzymes and the level of degraded collagen was investigated. Demineralized dentine specimens were mounted in the partial prosthesis of 17 volunteers. Saliva samples were taken at 0, 2 and 4 weeks. After 4 weeks, the enzymes were extracted from the dentine specimens and the collagen loss was assessed. The collagen loss varied between 0 and 40.3%. Zymography of the saliva and the dentine extract samples showed that (pro-)MMP-2 and (pro-)MMP-9 were present. The levels of active MMPs were assessed, using fluorogenic MMP-specific substrates. All but 3 of the 51 saliva samples showed MMP-1 activity ranging from 1.5 to 101.1 relative fluorescence units (RFU)/s. Forty-eight saliva samples showed gelatinolytic MMP-2/MMP-9 activity (1.7-141.1 RFU/s). MMP-1 activity was shown in all dentine extracts varying between 3.5 and 295.0 RFU/s. From the dentine extracts, 15 showed MMP-2/MMP-9 activity (0.2-13.7 RFU/s). The MMP activity from both saliva and dentine extracts did not correlate with the collagen loss. The activity of salivary cathepsin B varied from 4.8 to 42.2 arbitrary units/min. A positive correlation was found between salivary MMP activity and cathepsin B activity. This study revealed that gelatinolytic enzyme activity was present both in saliva and dentine collagen. No correlation could be observed, however, between the level of enzyme activity and the collagen loss of the dentine specimens.