Laser fluorescence assessment of dental caries arrest with two silver fluoride agents in patients with special needs- a preliminary report.

PURPOSE: While silver diamine fluoride has been used extensively for caries arrest and desensitising, silver fluoride (AgF) at neutral pH may also have value as a minimally invasive dental caries treatment. This study explored the effectiveness of two AgF products (AgF/KI and AgF/SnF2) when used in adult patients with special needs (SN) who had high caries risk and salivary gland hypofunction. METHODS: This split-mouth clinical study, over two appointments 3-months apart, compared the impact of a single application of AgF/KI (Riva Star Aqua, SDI) and AgF/SnF2 (Creighton Dental CSDS, Whiteley) on matched carious lesions in the same arch, by clinical visual-tactile (cVT) assessment of caries status and laser fluorescence (LF, DIAGNOdent) evaluation of bacterial load in the lesions, using repeated measures analysis. RESULTS: Twelve participants were recruited in the study. A total of 56 teeth (28 pairs) were included. Both AgF products gave a significant decrease in caries activity as measured by cVT (P < 0.0001) and LF (P = 0.0027). There were no statistically significant differences between the two AgF treatments, with response rates for improvements in active lesions of 92% in the AgF/KI arm, and 96% in the AgF/SnF2 arm. There was no effect of tooth type, lesion type, arch type, plaque metabolism and plaque area at the site level on outcomes, nor was there a clustering effect of sites in a patient level analysis. Overall, LF was superior to cVT for detecting lesions that still progressed despite treatment (P = 0.0027). CONCLUSION: A single application of AgF/KI or AgF/SnF2 has high predictability (over 90%) for achieving arrest in active caries lesions in adult patients with SN and high caries risk. Clinical assessment should use visual-tactile examination combined with LF readings to detect lesions that are still progressing and that require additional treatments. Future studies should compare these AgF modalities with SDF and explore factors such as time between applications and the need for repeated applications. TRIAL REGISTRATION: The study was registered with the Australian Clinical Trials Registry (ACTRN12621001139864p) on 23/08/2021.

Effectiveness of preventive intervention programmes aiming to improve oral health in children who have undergone caries-related dental extractions: a rapid review.

OBJECTIVE: To determine the effectiveness of preventive interventions in children who have undergone caries-related dental extractions. METHODS: Rapid review across five databases (CENTRAL, Ovid Medline, Embase, Web of Science and Scopus). Quality was assessed using the Risk of Bias 2 tool. RESULTS: Five studies were included, all randomised controlled trials involving pre-and/or post-extractions activity. Three studies involved oral health education (computer game, motivational interviewing, visual aids), one delivered clinical prevention (fissure sealants), and one an enhanced prevention programme combining additional health education and a clinical intervention (fluoride varnish). Retention was mixed (55%-80% in the intervention groups). Of the three studies measuring caries, all reported less caries development in the test group. However, only a study involving a dental nurse-delivered structured conversation, informed by motivational interviewing, showed an improvement in oral health. Two studies reporting on plaque and gingival bleeding had conflicting results. A study reporting on subsequent dental attendance did not demonstrate a clear improvement. CONCLUSION: Few published studies have explored prevention-based interventions in high caries-risk children requiring dental extractions. Whilst evidence of clinical benefit of preventive interventions in this population is limited, the potential use of contemporary behaviour change techniques appears promising. There is an urgent need for more high-quality longer-term trials using contemporary methodologies.

Evaluation of the remineralization potential of self-assembling peptide P11-4 with fluoride compared to fluoride varnish in the management of incipient carious lesions: a randomized controlled clinical trial.

OBJECTIVES: The present trial's aim was to compare the remineralization potential of self-assembling peptide P11-4 combined with fluoride to that of fluoride varnish. MATERIALS AND METHODS: Twenty-eight participants with 58 incipient carious lesions were enrolled in the present trial. Participants were randomly divided into two groups with 14 participants and 29 incipient lesions in each group. Patients were assigned either to self-assembling peptide combined with fluoride (Curodont Repair Fluoride Plus™) or sodium fluoride varnish (NaF, Bifluorid 10) groups. Both agents were applied according to the manufacturer's instructions on non-cavitated incipient carious lesions. Lesions were assessed by two calibrated and blinded assessors at baseline, and after one-, three- and six-months using a laser fluorescence device (DIAGNOdent). RESULTS: Although laser fluorescence scores significantly improved in both groups over time (p < 0.05), no notable differences were evident between both groups at one-month (p > 0.05). Yet, at three- and six-months statistically lower laser fluorescence readings were evident in the self-assembling peptide combined with fluoride group in comparison to the fluoride alone group (p < 0.05). There was 60% less risk for caries progression for Curodont Repair Fluoride Plus™ when compared to NaF varnish after six months. Self-assembling peptide combined with fluoride was able to change 65.5% of non-cavitated carious lesions from DIAGNOdent score 3 (11-20) to score 1 (0-4). Fluoride varnish was able to change 13.8% of the lesions from score 3 to score 1 after six months. CONCLUSIONS: The self-assembling peptide combined with fluoride varnish showed higher remineralization potential than fluoride varnish alone for incipient carious lesions over a six-months follow up. CLINICAL RELEVANCE: The combination of self-assembling peptide P11-4 and fluoride could offer a new tool in managing incipient carious lesions.

Resin infiltration versus fluoride varnish for visual improvement of white spot lesions during multibracket treatment. A randomized-controlled clinical trial.

AIMS: This study aimed to evaluate the visual improvement of resin infiltration of white spot lesions (WSL) during orthodontic treatment with the multibracket appliance (MBA) compared to fluoride varnish. METHODS: Patients aged 12-17 years with at least one WSL with an International Caries Detection and Assessment System (ICDAS) score of 1-2 during an active MBA treatment were included and randomized to receive either resin infiltration (Icon) or fluoride application (Flairesse). Standardized digital images were obtained before, one-day, one-week, one-month, three-months and six-months after treatment using a DSLR camera and a matching polarization filter. A grey reference card was used for color standardization. A Matlab routine was used to measure the color difference between adjacent healthy enamel and treated WSL. The independent-samples t-test was used for intergroup and paired-samples t-test for intragroup comparison. RESULTS: Images of 116 teeth from 36 patients were analyzed. The ΔE for the "Icon" treated WSL was smaller (T1ICON = 5.0 ± 1.4) than in the fluoride group (T1Fluoride = 8.4 ± 3.2). Caries infiltration significantly improved the aesthetic appearance of WSL (p < 0.001), which remained satisfactory at six months (T5ICON = 5.2 ± 1.6). CONCLUSION: WSL infiltration management during orthodontic treatment was superior to topical fluoridation in not only arresting the enamel lesions but also significantly improving the aesthetic appearance of demineralized regions around the brackets. CLINICAL RELEVANCE: WSL treatment in orthodontic patients is usually initiated after debonding. Research has shown that the earlier WSL is treated, the better the aesthetic outcome. There is limited data on the efficacy of resin infiltration of WSL during orthodontic treatment.

Health professionals' recommendations on the use of fluoride varnish for caries prevention in preschool children.

BACKGROUND: Fluoride varnish (FV) is widely recommended for caries prevention in preschool children, despite its anticaries benefits being uncertain and modest. Dentists often report using clinical practice guidelines (CPGs) as a source of scientific information. AIM: To identify and analyze recommendations for clinical practice on the use of FV for caries prevention in preschool children and to assess the methodological quality of the CPG on this topic. DESIGN: Two researchers independently used 12 search strategies and searched the first five pages of Google Search™ and three guideline databases for recommendations freely available to health professionals on the use of FV for caries prevention in preschoolers. Then, they retrieved and recorded recommendations that met the eligibility criteria and extracted the data. A third researcher resolved disagreements. Each included CPG was appraised using the AGREE II instrument. RESULTS: Twenty-nine documents were included. Recommendations varied according to age, patients' caries risk, and application frequency. Of the six CPGs, only one scored above 70% in the AGREE II overall assessment. CONCLUSION: Recommendations on the use of FV lacked scientific evidence, and CPGs were of poor quality. Application of FV is widely recommended despite recent evidence showing an uncertain, modest, and possibly not clinically relevant anticaries benefit. Dentists should be aware that it is necessary to critically appraise CPGs since they may be of poor quality.

Perception of nurses applying silver diamine fluoride to children's teeth: A mixed methods study.

BACKGROUND: No studies have evaluated the unique potential of nurse-led silver diamine fluoride (SDF) application for children to bridge the gap in interprofessional collaboration. AIM: To investigate the attitudes, beliefs and perceptions of nurses regarding nurse-led SDF application at the well-child visit and identify possible barriers and make recommendations. DESIGN: Mixed methods design involving a questionnaire and semi-structured individual interviews were conducted. RESULTS: All eligible nurses (n = 110) completed the questionnaire, and 16 were interviewed. Questionnaire responses highlighted that nurses were not confident in providing oral health services (score: <3 of 5) beyond oral hygiene advice (score: ≥3.9 of 5) but believed that they should be providing these services for individuals with difficulty accessing care. Interviews reflected that most nurses viewed oral health care as an important part of paediatric health but were limited by knowledge, time and manpower. Most were willing to expand their job scope to include SDF application with formal education and training, competency assessments and approaches to counter time limitations. CONCLUSION: Where nurses are already providing basic oral healthcare, nurse-led SDF application could be the next step. Findings suggest that systemic changes should include strategies to empower and motivate nurses to apply SDF at the well-child visit.

Qualitative and quantitative evaluation of enamel surface roughness and remineralization after interproximal reduction: An in vivo study.

INTRODUCTION: Interproximal reduction (IPR) damages the caries protective superficial layer of the enamel, making the enamel surface prone to caries because of the increase in surface roughness. Remineralizing solutions can help in preventing these undesirable side effects. Therefore, this study aimed to compare the effect of nanohydroxyapatite (nHAp) and sodium fluoride (NaF) application on enamel remineralization after IPR and to evaluate changes in surface roughness, composition, and microhardness of the treated enamel. METHODS: A total of 25 patients with Angle's Class I malocclusion, requiring 4 premolar extractions, were selected and randomly divided into 5 groups (n = 5). Group 1 served as the control. In group 2, the extraction of premolars was done immediately after IPR, and in group 3, the extraction of premolars was done 3 months after IPR. In group 4, the extraction of premolars was performed 3 months after IPR with weekly application of nHAp serum. In group 5, the extraction of premolars was performed 3 months after IPR, along with once-a-month application of NaF varnish. The proximal reduction of premolars in all the groups was done using Strauss IPR burs (Strauss Diamond Instruments, Palm Coast, Fla). The extracted teeth were sectioned, and the enamel surfaces were subjected to energy-dispersive x-ray spectroscopy to evaluate elemental composition. Vicker's microhardness test was used to evaluate enamel hardness and atomic force microscopy for enamel surface roughness. Descriptive statistics were calculated for the 5 groups using a 1-way analysis of variance, and Tukey's multiple post-hoc test was used for intergroup comparison. RESULTS: Calcium-to-phosphorous ratio, enamel microhardness, and surface roughness were found to be closest to untouched enamel in patients treated with nHAp, followed by patients who were treated with NaF. A lower calcium-to-phosphorous ratio and weakened and roughest enamel surface was seen in teeth, which were extracted immediately after IPR. CONCLUSIONS: Among the remineralizing agents tested, nHAp serum can be recommended for better remineralization of enamel surfaces after IPR.

"Evaluation of Silver Diamine Fluoride Modified Atraumatic Restorative Treatment (SMART) on hypomineralized first permanent molar"- a randomized controlled clinical study.

BACKGROUND: Restoring first permanent molars affected with molar incisor hypomineralization (MIH) is challenging. Focusing on improving the quality of life for children affected by MIH, at least until the complete eruption of first permanent molars to receive full coverage, to decrease the hypersensitivity and to be able to perform proper oral hygiene measures, the purpose of this study was to compare silver modified atraumatic restorative technique (SMART) versus the conventional restoration and fluoride varnish application on moderate to severe hypomineralized molars. The comparison considered the restoration survival, hypersensitivity, and digital surface area changes after one year follow up. METHODS: Twenty-eight children were selected (20 girls and 8 boys) with at least 2 MIH molars with the same defect severity. The study comprised 2 groups; MOD group (moderate hypomineralized molar severity) and SEV group (Severe hypomineralized molar severity) (n = 28 tooth). Each group was further subdivided into 2 subgroups according to the technique of restoration: SMART subgroup and CONV subgroup (high viscosity glass ionomer restoration and fluoride varnish application) (each = 14 tooth). Evaluation was done in terms of the restoration survival (6 months and 12 months), hypersensitivity at 1 weak, 6 months and 12 months and occlusal surface area changes at 12 months). Professional Fluoride varnish application and home prophylaxis using MI paste were the protocol for each child patient. RESULTS: There was no significant difference between the 4 subgroups, regarding tooth restoration integrity at 6-months vs. 12-months. However, a statistically significant difference in tooth restoration integrity between the 4 subgroups at 12-months (P = .049). Also, the hypersensitivity score, there was a statistically significant difference between the 4-time intervals (P < .001) and a statistically significant difference in surface area changes between the 4 subgroups. CONCLUSIONS: Selective removal of carious tissue and SMART restoration, combined with dental home and professional preventive measures every 3 months maintained the integrity of restorations in severely and moderately affected permanent molars up to 1 year. TRIAL REGISTRATION: The study protocol was retrospectively registered on Clinical Trials (NCT05931822-05/ 07/2023).

Investigating the efficacy of a varnish containing gallic acid on remineralization of enamel lesions: an in vitro study.

This study evaluated the efficacy of a formulated remineralizing gallic acid (GA) varnish in treating artificial enamel caries lesions. Fifty-five intact bovine incisors were collected. Enamel blocks (5 × 9 mm) were prepared. A third of each block's surface remained intact. Primary carious lesions were induced on the middle and bottom thirds of the blocks by immersing the samples in a demineralization solution for 6 h. The bottom third of the blocks were further remineralized by randomly applying 0.5%, 2%, or 8% GA varnishes and 2.26% fluoride varnish (V varnish, Vericom, Seoul, Korea), or the varnish base without active ingredients (n = 11 each). The specimens were immersed in a remineralizing solution for 4 h and then subjected to a 2-hour immersion in the demineralizing solution. After six days of pH cycling, the surface microhardness was measured at depths of 30, 75, and 120 µm. The percentage of surface microhardness recovery (SMHR%) was compared among the groups using the Shapiro-Wilk, ANOVA, and Tukey HSD post-hoc tests (α = 0.05). The SMHR% of all experimental groups was higher than the control group at 30 µm (p < 0.05). The 0.5% GA varnish showed the highest SMHR% at all depths; however, the difference with the other experimental groups was significant at a depth of 30 µm (p < 0.05). The SMHR% of the fluoride and the 2% and 8% GA varnishes was comparable at all depths. All treatments potentially remineralize enamel lesions, with 0.5% GA varnish having the greatest effect, particularly on the top surface layer. As such, this newly developed varnish may emerge as a promising alternative to fluoride varnish.

An open-label, parallel-group, randomized clinical trial of different silver diamine fluoride application intervals to arrest dental caries.

BACKGROUND: Silver diamine fluoride (SDF) is an antimicrobial agent and alternative treatment option that can be used to arrest dental decay. While there is optimism with SDF with regard to caries management, there is no true consensus on the number and frequency of applications for children. The purpose of this study was to examine the effectiveness of 38% SDF to arrest early childhood caries (ECC) at three different application regimen intervals. METHODS: Children with teeth that met International Caries Detection and Assessment System codes 5 or 6 criteria were recruited from community dental clinics into an open-label, parallel-group, randomized clinical trial from October 2019 to June 2021. Participants were randomized to one of three groups using sealed envelopes that were prepared with one of three regimens inside: visits one month, four months, or six months apart. Participants received applications of 38% SDF, along with 5% sodium fluoride varnish (NaFV), at the first two visits to treat cavitated carious lesions. Lesions were followed and arrest rates were calculated. Lesions were considered arrested if they were hard on probing and black in colour. Statistics included descriptive and bivariate analyses (Kruskal one-way analysis of variance and Pearson's Chi-squared test). A p-value of ≤ 0.05 was considered significant. RESULTS: Eighty-four children participated in the study (49 males and 35 females, mean age: 44.4 ± 14.2 months). Treatment groups were well matched with 28 participants per group. A total of 374 teeth and 505 lesions were followed. Posterior lesions represented only 40.6% of affected surfaces. Almost all SDF treated lesions were arrested for the one-month (192/196, 98%) and four-month (159/166, 95.8%) interval groups at the final visit. The six-month group experienced the lowest arrest rates; only 72% (103/143) of lesions were arrested (p < 0.001). The duration of application intervals was inversely associated with improvements in arrest rates for all lesions. CONCLUSIONS: Two applications of 38% SDF and 5% NaFV in one-month and four-month intervals were comparable and very effective in arresting ECC. Applications six months apart were less effective and could be considered inferior treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT04054635 (first registered 13/08/2019).

Effectiveness of nanosilver fluoride and silver diamine fluoride in arresting early childhood caries: a randomized controlled clinical trial.

BACKGROUND: One of the most prevalent health problems affecting children worldwide is untreated caries in primary teeth. Agents to arrest caries are used to manage untreated decay in children in disadvantaged communities. Nano Silver Fluoride (NSF) overcomes the staining problems of Silver Diamine Fluoride (SDF). This study compared the clinical cariostatic effect of NSF to 38% SDF for arresting caries lesions. METHODS: The study included 360 children younger than 4 years, with at least one active lesion, ICDAS score ≥ 3, recruited from nurseries in a rural area in Alexandria, Egypt, in 2022. They were randomly assigned to receive a single application of NSF at baseline, or two applications of SDF at baseline and after 6 months. The arrest of active carious lesions was assessed after 6 and 12 months using ICDAS criteria, and parents' satisfaction with child appearance was also assessed. Chi-Square test was used to compare the groups and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest at lesion level and binary logistic regression was used to assess the effect at patient level. RESULTS: 1853 active lesions were included in children whose mean (SD) age was 42.3 (8.2) months. The arrest rate was significantly higher in the NSF than the SDF group at lesion level (78.4% and 65.0% at 6 months and 71.3% and 56.3% at 12 months, p < 0.001). In regression analysis, NSF had significantly higher odds of caries arrest than SDF at lesion level (at 6 months, AOR = 2.57, 95% CI: 1.55, 4.26 and at 12 month, AOR = 3.27, 95% CI: 1.89, 5.67). Parents of children receiving NSF had significantly greater satisfaction with their children's dental appearance than those receiving SDF: (97.2% and 76.1%, respectively, p < 0.001). CONCLUSION: NSF demonstrated greater effectiveness in arresting caries in preschool children without inducing black staining of teeth and with greater parental satisfaction than SDF. NSF can be an alternative to SDF in arresting caries especially in underprivileged communities. TRIAL REGISTRATION: The trial was registered in the clinicaltrials.gov registry (#NCT05255913)-16/02/2022.

Knowledge of the health personnel involved in the fluoride varnish therapy programs of primary schools in Tehran, Iran.

INTRODUCTION: The World Health Organization (WHO) places great importance on oral health promotion programs in schools, given that approximately one billion people worldwide are students. This demographic not only includes the students themselves, but also extends to school staff, their families, and the broader community, all of whom are interconnected. The objectives of this study were firstly to assess the knowledge of health personnel conducting fluoride varnish treatment (FVT) in schools, and secondly to solicit their views on the effectiveness of their training methods. METHODS: Data was collected from health personnel involved in FVT in schools, supervised by medical universities in Tehran province, using a questionnaire. The questionnaire was divided into four sections: demographic information, methods of receiving FVT training, respondents' knowledge regarding FVT, and opinions about the effectiveness of FVT training methods. The questionnaire was distributed via social media, phone conversations, and email. The collected data was analyzed using Mann-Whitney in SPSS Version 26. A regression model was also fitted to the data. RESULTS: The present study included 403 participants. Among various educational methods, it was found that participation in previous workshops (P = 0.001) and FVT workshops (P = 0.013) was significantly correlated with a higher FVT knowledge score. Additionally, participation in previous oral health promotion programs was significantly associated with a higher knowledge score (P < 0.05). Therefore, a history of participating in previous health promotion programs significantly contributed to the participants' knowledge. CONCLUSION: Participation in previous oral health programs was found to be significantly correlated with a higher knowledge score. The effectiveness of training programs can be attributed to participation in previous workshops and FVT workshops. This study provided insights into potential strategies for enhancing personnel training in national oral health programs.

Parental acceptance of Silver Diamine Fluoride in two lower-middle-income countries: Iran and Tajikistan.

BACKGROUND: Using Silver Diamine Fluoride (SDF) may be an effective public health approach for managing dental caries in children. Parental acceptance of SDF has rarely been investigated in low-income and middle-income countries (LMICs). The aim of this study was to evaluate parental acceptance of SDF to manage dental caries in children aged 2-12 in Iran and Tajikistan. METHODS: This cross-sectional study was conducted in the Kurdistan province of Iran and Khatlon region of Tajikistan, 2022-2023. Parents watched a video about SDF and its weaknesses and strengths as compared to conventional approaches before completing the questionnaire. We also reported Prevalence Ratios with 95% confidence intervals for the relationship between parental acceptance and associated demographic factors as well as dental attitude and experience. RESULTS: Participants were 245 and 160 parents in Iran and Tajikistan, respectively. In both countries, a majority (Iran: 61.6%, Tajikistan: 77.9%) accepted SDF over conventional treatments for all primary teeth. The majority also accepted SDF only for posterior permanent teeth (Iran: 73.5%, Tajikistan: 78.7%). Black discoloration was the main reason for rejecting SDF. Overall, demographic factors and dental experience and attitude were not significantly associated with SDF acceptance. CONCLUSIONS: SDF was widely accepted by Iranian and Tajik parents. Establishing parental acceptance of SDF is an important step toward its application in LMICs where inexpensive solutions are needed.

Evaluation of staining potential of Silver Diamine Fluoride, Potassium Iodide, Nanosilver Fluoride: an in vitro study.

BACKGROUND: The black staining effect of silver-containing solutions for use to arrest caries can have a negative aesthetic impact on children and parents. This study aims to assess the staining effects of Silver Diamine Fluoride/Potassium Iodide (SDF/KI), SDF and Nanosilver Fluoride (NSF). MATERIALS AND METHODS: Forty-four extracted carious primary molars were collected and randomly divided into four groups (n = 11). The carious tissue in all teeth was removed using a chemo-mechanical caries removal agent with an excavator. After caries removal in all groups, SDF, SDF/KI, and NSF were applied to the different groups, while no solution was applied to the control group. Subsequently, the teeth in all groups were restored with compomer. Color values L*, a* and b* were measured using a spectrophotometer at three time points: immediately after compomer restoration (T0), one week later (T1), and four week later (T2). Changes in brightness (ΔL) and color (ΔE) over time were calculated and comparisons among groups were made. RESULTS: The SDF solution induced statistically significant black staining (p = 0.013) and a decrease in L* value (p < 0.001) on the compomer material compared to the other groups over time. CONCLUSIONS: It was observed that SDF/KI has the potential to reduce the black staining effect of SDF, though not entirely. Novel experimental solutions like NSF may offer an alternative to counteract the staining effect of SDF.

A cost-effectiveness analysis of fluoride varnish application in preventing Root caries in elderly persons: a Markov simulation study.

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.

Efficacy of seventh generation bonding agents as desensitizers in patients with dentin hypersensitivity: a randomized clinical trial.

BACKGROUND: Dentin hypersensitivity (DH) is one of the most challenging and persistent dental complaints characterized by transient, intense pain triggered by various stimuli. It affects a significant portion of the global population, predominantly those aged 20-40. This study aims to evaluate the desensitizing efficacy of seventh-generation dentin bonding agents (Single Bond Universal by 3 M ESPE and Xeno-V + by Dentsply) against a control group using Bifluorid 12 by Voco in mitigating DH within a month of the follow-up period. METHODS: This was a single-center, parallel-group, double-blind, controlled randomized clinical trial conducted at Dow University of Health Sciences, Karachi, Pakistan. A total of 105 patients with DH were allocated into three groups for this study. The patients were divided into three groups (Single Bond Universal by 3 M ESPE and Xeno-V + by Dentsply) and the control group containing fluoride varnish (Bifluorid 12 by Voco). Discomfort Interval Scale scores and Schiff Cold Air Sensitivity Scale scores were recorded at baseline, immediately after the intervention, after 01 weeks, and after 01 month. RESULTS: All the materials demonstrated a statistically significant reduction in discomfort and sensitivity (DIS scores p-value 0.01) immediately after 01 week and over a period of 01 month after treatment compared with the baseline scores before application, with no single material proving superior over the one-month observation period. The study also provided insights into dental hygiene practices, with a significant majority using a toothbrush and sensitivity patterns, with cold stimuli being the most common cause of sensitivity. CONCLUSION: The study demonstrates that Single Bond Universal, Xeno V+, and Bifluorid 12 are equally effective in reducing dentin hypersensitivity, with no distinct superiority observed over a one-month period. The findings highlight the potential of fluoride varnishes as a less technique-sensitive and cost-effective option for treating DH, offering valuable insights for future research and clinical practice. TRIAL REGISTRATION: NCT04225247 ( https://clinicaltrials.gov/study/NCT04225247 ), Date of Registration: 13/01/2020. (Retrospectively registered).

Color change of tooth-colored restorative materials bonded to silver diamine fluoride-treated dentine: a systematic review.

BACKGROUND: The desirable properties of silver diamine fluoride (SDF) make it an effective agent for managing dental caries and tooth hypersensitivity. There are several clinical instances that SDF application might precede the placement of direct tooth-colored restorations. On the other hand, SDF stains demineralized/carious dental tissues black, which might affect the esthetic outcomes of such restorations. Color is a key parameter of esthetics in dentistry. Therefore, this study aims to systematically review dental literature on color/color change of tooth-colored restorations placed following the application of SDF on dentine. METHODS: Comprehensive search of PubMed, Embase, Scopus and ISI Web of Science databases (until August 2023) as well as reference lists of retrieved studies was performed. In vitro studies reported color or color change of tooth-colored restorative materials applied on SDF-treated dentine were included. Methodological quality assessment was performed using RoBDEMAT tool. Pooled weighted mean difference (WMD) and 95% confidence interval (95% CI) was calculated. RESULTS: Eleven studies/reports with a total of 394 tooth-colored restorations placed following a) no SDF (control) or b) SDF with/without potassium iodide (KI)/glutathione dentine pre-treatments were included. Color change was quantified using ∆E formulas in most reports. The pooled findings for the comparison of resin-based composite (RBC) restorations with and without prior 38% SDF + KI application revealed no statistically significant differences in ∆E values at short- and long-term evaluations (~ 14 days: WMD: -0.56, 95% CI: -2.09 to 0.96; I2: 89.6%, and ~ 60 days: WMD: 0.11; 95% CI: -1.51 to 1.72; I2: 76.9%). No studies provided sufficient information for all the items in the risk of bias tool (moderate to low quality). CONCLUSIONS: The limited evidence suggested comparable color changes of RBC restorations with and without 38% SDF + KI pre-treatment up to 60 days. The included studies lacked uniformity in methodology and reported outcomes. Further studies are imperative to draw more definite conclusions. PROTOCOL REGISTRATION: The protocol of this systematic review was registered in PROSPERO database under number CRD42023485083.

Cost-effectiveness and cost-benefit analyses of fluoride varnish for caries prevention in Guangxi, China.

OBJECTIVES: The objectives of this study were to evaluate the cost-effectiveness and cost-benefit of fluoride varnish (FV) interventions for preventing caries in the first permanent molars (FPMs) among children in rural areas in Guangxi, China. METHODS: This study constituted a secondary analysis of data from a randomised controlled trial, analysed from a social perspective. A total of 1,335 children aged 6-8 years in remote rural areas of Guangxi were enrolled in this three-year follow-up controlled study. Children in the experimental group (EG) and the control group (CG) received oral health education and were provided with a toothbrush and toothpaste once every six months. Additionally, FV was applied in the EG. A decision tree model was developed, and single-factor and probabilistic sensitivity analyses were conducted. RESULTS: After three years of intervention, the prevalence of caries in the EG was 50.85%, with an average decayed, missing, and filled teeth (DMFT) index score of 1.12, and that in the CG was 59.04%, with a DMFT index score of 1.36. The total cost of caries intervention and postcaries treatment was 42,719.55 USD for the EG and 46,622.13 USD for the CG. The incremental cost-effectiveness ratio (ICER) of the EG was 25.36 USD per caries prevented, and the cost-benefit ratio (CBR) was 1.74 USD benefits per 1 USD cost. The results of the sensitivity analyses showed that the increase in the average DMFT index score was the largest variable affecting the ICER and CBR. CONCLUSIONS: Compared to oral health education alone, a comprehensive intervention combining FV application with oral health education is more cost-effective and beneficial for preventing caries in the FPMs of children living in economically disadvantaged rural areas. These findings could provide a basis for policy-making and clinical choices to improve children's oral health.

Remineralizing effect of NSF on artificial enamel caries.

INTRODUCTION: Nanotechnology offers new approaches and endless opportunities for remineralizing tooth decay without being toxic or causing allergies. This study aimed to determine the effect of nanosilver fluoride (NSF) on the remineralization potential of enamel caries-like lesions compared to 5% sodium fluoride varnish in permanent teeth. METHODS: Fifteen teeth (molars and premolars) were gathered, cleaned, and polished using a scaler. After sectioning the teeth mesiodistally and removing the roots, the thirty specimens were subjected to a demineralized solution to induce early enamel lesions and then assigned randomly into two equal groups. The test materials were applied, and then all the specimens were subjected to a pH cycling model for 30 days. DIAGNOdent and surface roughness were investigated, and an evaluation of the enamel Ca and P weight% for Ca/P ratio calculation was done using SEM-EDX to analyze the specimens at the end of the study. The data were analyzed using an independent t-test. RESULTS: The mean values for the DIAGNOdent measurements for NSF and NaF at baseline and after demineralization were not significantly different (p > 0.05). After treatment, NaF varnish showed a significantly higher mean DIAGNOdent measurement (11.8 ± 5.80) than NSF (4.7 ± 1.6). The mean surface roughness of the NaF group (1.64 ± 0.39) was much higher than NSF's mean surface roughness (1.07 ± 0.21). Specimens treated with NSF had statistically significant smoother surfaces (p < 0.001). The NSF group had a higher mean Ca/P ratio (2.9 ± 0.35) than NaF (2.2 ± 0.11). This difference was statistically significant (p = 0.012). CONCLUSION: The study reveals that nano silver fluoride is a more effective treatment than sodium fluoride varnish in enhancing teeth's clinical characteristics, particularly in terms of mineral content and surface roughness, suggesting it could be an improved strategy to prevent dental caries and maintain enamel integrity.

Management of white spot enamel lesions with resin infiltration: potentials and future research directions.

DESIGN: The current study1 is a randomized controlled trial with two arm, multicenter and parallel group design. CASE SELECTION: Study subjects were 38 orthodontic patients younger than 17 years who were being treated with metal braces. Patients with at least one white spot lesion (WSL) graded 1 to 2 according to the International Caries Detection and Assessment System (ICDAS) on the labial surface of permanent maxillary and mandibular canines and incisors were included for the trial. Teeth with carious lesions and restorations, anomalies of the enamel, and primary teeth were excluded. METHOD: Patients were allocated by computer generated random sequence into resin infiltration and fluoride varnish intervention groups. Study subjects were blinded until the allocation, outcome assessors and statisticians remained blinded through the study, however the operators could not be blinded. Resin infiltration treatment involved removal of orthodontic wires and auxiliaries followed by cleaning the teeth with fluoride free prophylactic paste and completing the resin infiltration according to manufacturer's instructions. In the fluoride varnish group, a thin layer of the material was applied after isolating the teeth, and patients were asked not to eat or drink for 1 hour. This was continued twice a month for 6 months. Digital images of the teeth were obtained before, and 1 day (T1), 1 week (T2), 1 month (T3), 3 months (T4) and 6 months (T5) after treatment, using a DSLR camera and a matching polarization filter. The images were processed for calibration and color stability. Regions of interest representing WSL (white spot lesion) and SAE (sound adjacent enamel) were isolated in the images for comparison at different stages the images were captured. DATA ANALYSIS: Statistical analysis was performed using SPSS version 28. Independent-samples t-test was utilized for comparison between the two groups, and paired-samples t-test for comparison within the groups. A statistical significance level of α = 0.05 was set. RESULTS: At T1, significant color difference was observed between white spot lesion and adjacent sound enamel in the resin infiltration group and it remained stable after 6 months. Whereas in the fluoride varnish group, there were no statistical differences from baseline to 6 months. A statistical difference of 3.27 CIELAB units (p < 0.001) was reported between the infiltration group and the fluoride group at T5. No significant changes were noted in SAE with respect to changes in lightness. CONCLUSIONS: Resin infiltration was found to be better at masking the demineralization produced by WSL and also enhanced the esthetic appearance of demineralized areas around the brackets. Resin infiltration did not produce any clinically visible effects in non-affected enamel. These changes remained stable for a period of 6 months.