Silver Diamine Fluoride Prevents Caries in Primary Teeth Superior to No Treatment, Placebo, or Fluoride Varnish.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: The effect of silver diamine fluoride in preventing caries in the primary dentition: a systematic review and meta-analysis. Oliveira BH, Rajendra A, Vietz-eenan A, Niederman R. Caries Res 2018;53(1):24-32. SOURCE OF FUNDING: Government: National Institute on Minority Health and Health Disparities of the National Institutes of Health under award no. R01MD011526 and U24MD006964, and Patient-Centered Outcomes Research Institute (PCORI) Award (PCS-1609-36824). The Teacher Training Program of the University of the State of Rio de Janeiro (Programa de Capacitação Docente da Universidade do Estado do Rio de Janeiro-PROCAD UERJ) also supported this work. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis.

Silver Diamine Fluoride May Prevent and Arrest Root Caries in Older Adults.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Controlling caries in exposed root surfaces with silver diamine fluoride: A systematic review with meta-analysis. Oliveira BH, Cunha-Cruz J, Rajendra A, Niederman R. J Am Dent Assoc 2018;149(8):671-9.e1. SOURCE OF FUNDING: Government funding, partially supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health, and partially funded through a Patient-Centered Outcomes Research Institute (PCORI) award. The Teacher Training Program of the University of the State of Rio de Janeiro also supported the work. TYPE OF STUDY/DESIGN: Systematic review with meta-analysis on randomized clinical trials.

Interdisciplinary Community-Based Oral Health Program for Women and Children at WIC.

Objectives To evaluate the women, infants, and children (WIC) Oral Health Program in a county in Florida. Methods The non-traditional interdisciplinary program of the current study was designed to reach at-risk populations with untreated dental diseases and limited access to care; it provides oral health education, dental screenings, preventive dental services, and referrals for women, children, and families at WIC offices. We evaluated the health status of patients enrolled in the program and the services provided. Results From 2013 to 2016, the program provided dental screenings for 576 children and 180 women. Caries prevalence for 3-5 year olds was 46.0%. Only 6.6% (12/114) of pregnant women were eligible for comprehensive dental care under Medicaid (< 21 years). Further, 71.2% (47/66) of all pregnant women had unmet dental care needs. Conclusions for Practice Our results suggested that many children and women had untreated dental diseases and need preventive services and dental care. Also, many pregnant women were not covered by Medicaid. This program demonstrates that collaboration with the WIC program can improve access to oral health services for underserved populations.

Silver Diamine Fluoride Arrests Caries in Primary Teeth.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Silver Diamine Fluoride Has Efficacy in Controlling Caries Progression in Primary Teeth: A Systematic Review and Meta-Analysis. Chibinski AC, Wambier LM, Feltrin J, Loguercio AD, Wambier DS, Reis A. Caries Res 2017;51(5):527-41. SOURCE OF FUNDING: This study was partially supported by the Brazilian Government Organization-National Council for Scientific and Technological Development (CNPq)-under grants 304105/2013-9 and 305588/2014-1 TYPE OF STUDY/DESIGN: Systematic review and meta-analysis.

Limited Evidence Links Silver Diamine Fluoride and Caries Arrest in Children.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review. Gao SS, Zhao IS, Hiraishi N, Duangthi D, Mei ML, Lo ECM, Chu CH. JDR-CTR 2016;1:201-10. SOURCE OF FUNDING: Academic research funding from the General Research Fund of the Research Grants Council of Hong Kong TYPE OF STUDY/DESIGN: Systematic review and meta-analysis.

Oral Health Knowledge and Practices of WIC Staff at Florida WIC Program.

This study was conducted to assess the oral health knowledge, practices and confidence of staff in the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) by administering an anonymous self-completed survey to 39 WIC Clinic staff in Northern Florida. The survey instrument was a 28-item questionnaire adapted from previous validated surveys and covered questions on oral health knowledge, confidence and general practices related to oral health. Survey data were analyzed by descriptive statistics. The majority of WIC staff is knowledgeable about the role of the caregiver in cleaning the child's teeth and the role of bottle use in dental caries. Only 7 (25 %) of total 28 WIC staff indicated that fluoridated toothpaste could be used for children younger than 2 years of age. Only 18 (64 %) agreed that the cariogenic bacteria could be transmitted from mother to child. Nutritionists reported greater confidence compared to others in oral health tasks. Only 6 (67 %) of the nutritionists reported to counsel caregivers on the importance of regular tooth brushing. Only 4 (44 %) nutritionists reported to refer WIC clients to dental care. These results indicate that WIC staff has a limited knowledge on the age recommendations for the fluoride toothpaste use and on the transmission of the cariogenic bacteria. Many do not provide oral health counseling to caregivers. WIC staff with more education is more likely to discuss oral health issues. WIC staff is in need for oral health training and education to provide oral health counseling for at risk WIC population.

Consumption of Xylitol Gummy Bears May not Provide Additional Caries Prevention for School Children.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: The effectiveness of xylitol in a school-based cluster-randomized clinical trial. Lee W, Spiekerman C, Heima M, Eggertsson H, Ferretti G, Milgrom P, Nelson S. Caries Res 2015;49(1):41-9. SOURCE OF FUNDING: Government: Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services, grant no. R40MC07838 TYPE OF STUDY/DESIGN: Double-blind, cluster-randomized controlled trial.

The role of chlorhexidine in caries prevention.

The use of chlorhexidine for caries prevention has been a controversial topic among dental educators and clinicians. In several reviews, it has been concluded that the most persistent reduction of mutans streptococci have been achieved by chlorhexidine varnishes, followed by gels and, lastly, mouth rinses. Also, the evidence for using different chlorhexidine modes or a combination of chlorhexidine-fluoride therapy for caries prevention has been "suggestive but incomplete". Variable study designs and lack of data in high-risk children and adults support the need to continue conducting randomized, well-controlled clinical trials and to search for a practical, effective mode of antimicrobial treatment that augments the known effect of fluoride treatments. Currently, the only chlorhexidine-containing products marketed in the United States (US) are mouthrinses containing 0.12 percent chlorhexidine. Based on the available reviews, chlorhexidine rinses have not been highly effective in preventing caries, or at least the clinical data are not convincing. Due to the current lack of long-term clinical evidence for caries prevention and reported side effects, chlorhexidine rinses should not be recommended for caries prevention. Due to the inconclusive literature and sparse clinical data on gels and varnishes, their use for caries prevention should also be studied further to develop evidence-based recommendations for their clinical role in caries prevention. Since dental caries is a disease with a multifactoral etiology, it is currently more appropriate to use other established, evidence-based prevention methods, such as fluoride applications, diet modifications and good oral hygiene practices. Recent findings also indicate that the effect of an antimicrobial agent for reducing the levels of mutans streptococci or plaque reduction may not always correlate with eventual caries reduction. The clinically important outcome is proven reductions in caries. Many advances in the treatment and prevention of dental caries have been introduced over the past century. The use of chlorhexidine in caries prevention has been referred to as a nonsurgical management of dental caries and has represented the modern medical model of caries treatment. However, there is a lack of consensus on evidence-based treatment protocols and controversy regarding the role of chlorhexidine in caries prevention among dental educators and clinicians. There is a need to standardize guidelines to optimize evidence-based non-surgical disease management to provide appropriate care. This paper reviewed the literature on the effectiveness of different modes of chlorhexidine delivery for caries prevention and provides guidelines for chlorhexidine use in caries management. A literature search was conducted using the PubMed and Evidence-Based Medicine Reviews databases and the keywords "chlorhexidine" and "caries", limiting the search to "humans", "reviews" and "English". Based on the published reviews, it was concluded that chlorhexidine rinses, gels and varnishes or combinations of these items with fluoride have variable effects. Additionally, the sparse clinical data that was reported weakens the conclusions. Due to the current lack of evidence on long-term clinical outcomes and reported side effects, chlorhexidine rinse, which is currently the only treatment mode available in the US, should not be recommended for caries prevention. Clinical evidence on gels and varnishes is also inconclusive. For the treatment of dental caries, there are alternative evidence-based prevention methods available, such as fluoride applications, diet modifications and good oral hygiene practices.

Dental students' opinions and knowledge about caries management and prevention.

Students' attitudes toward caries prevention can impact their receptivity to training and subsequent involvement in preventive services in their future practices. The aim of this study was to evaluate dental students' opinions and knowledge regarding caries management and prevention at the University of Florida College of Dentistry. A twenty-six-item written survey instrument was administered to third- and fourth-year dental students. The response rate was 92.3 percent (72/78) for third-year and 45.5 percent (35/77) for fourth-year students. In their responses, 83 percent reported they would use chlorhexidine rinses for caries control, and 51 percent would use salivary tests for detecting cariogenic bacteria. Ninety-two percent reported they would use fluoride varnishes for caries control, and 40 percent were not sure if varnishes have associated dental or medical side effects. The majority of respondents felt that training and practice on caries prevention should be increased. Favorable responses to increasing education in preventive dentistry indicate that students may be receptive to modern caries management and prevention principles. This study suggests there is a need to update and integrate a more comprehensive caries prevention program into the predoctoral dental curriculum. Such programs should stress, in addition to actual training, the importance of prevention in students' future practice.

Recommendations for fluoride varnish use in caries management.

Available data suggest that fluoride varnish can be a safe and effective method for caries management. The application of varnish can be beneficial for those at risk for caries and for patients with special needs, and for those with no access to daily fluoride or other preventive methods. Even a small amount of varnish can be applied to active noncavitated lesions, assuring that a high concentration of the agent is available at the site where needed and that the total amount of active agent administered to the patient may be markedly reduced. Considering that varnish treatment is painless and can be easily performed by auxiliary dental personnel, it is a caries preventive method that can be easily applied and recommended for any age group, even young children. For high-risk caries patients with a significant cariogenic challenge, topical applications of fluoride might be insufficient and thus could be supplemented with other anticariogenic methods, such as xylitol chewing gum.

Effect and acceptance of silver diamine fluoride treatment on dental caries in primary teeth.

OBJECTIVES: Silver diamine fluoride (SDF) treatment has been identified as a potential solution to address the dental public health issues of untreated dental caries and insufficient access to care. The current study assessed the effectiveness of 38 percent SDF in arresting active dental caries lesions and in reducing or preventing associated dental pain and infections in young, at-risk children. METHODS: We enrolled 32 children aged 2-5 years with 118 active caries lesions in primary teeth from a community dental clinic in Oregon. After baseline examinations, carious lesions were treated with 1-2 applications of 38 percent SDF. Children were re-evaluated at 3-week and 3-month recalls to assess color and consistency changes in lesions (soft/hard). Parents were interviewed regarding symptoms of pain or infection and were surveyed regarding subjective feelings about SDF. RESULTS: Of 102 lesions (16 excluded from analyses), 100 were found to be arrested at first recall and all at second recall. The duration of SDF application was not associated with arrest of decay (P = 0.68). No incidence of pain or infection of an SDF-treated tooth was recorded. Parental impression of ease of application, taste, and esthetics was favorable. CONCLUSIONS: Our results suggested SDF was effective in arresting active caries lesions in primary teeth in young children and was well accepted by parents. SDF offers an easy and highly efficient nonsurgical alternative treatment to traditional restorative dental treatment in young children, and it has great potential to aid the dental public health community to address dental caries in at-risk populations.

Secondary Sjögren syndrome: A case report using silver diamine fluoride and glass ionomer cement.

BACKGROUND AND OVERVIEW: The authors describe dental treatment for a patient with a complex medical history of secondary Sjögren syndrome with systemic lupus erythematosus and rheumatoid arthritis. CASE DESCRIPTION: An 18-year-old woman's rheumatology group referred her for oral evaluation; she had secondary Sjögren syndrome, systemic lupus erythematosus, and rheumatoid arthritis. The patient had multiple advanced carious lesions, extreme sensitivity, and hyposalivation. The patient selected a minimally invasive treatment plan that focused on silver diamine fluoride (SDF), partial caries removal, and glass ionomer cement (GIC) restorations. The SDF treatment and GIC restorations were successful in arresting carious lesions and restoring form and function but may not completely prevent new carious lesions from forming in the future. CONCLUSIONS AND PRACTICAL IMPLICATIONS: The case shows that using less invasive treatments, such as SDF and GIC restorations can be used to manage complex cases involving extreme caries risk and be preferable to endodontic treatment and extractions.

Caries management by risk assessment: implementation guidelines.

ACT This consensus statement supports implementation of caries management by risk assessment in clinical practice by using the following principles: modification of the oral flora, patient education, remineralization, and minimal operative intervention. The statement includes a list of supporters.

Prevalence of noncavitated and cavitated carious lesions in 5-year-old head start schoolchildren in Alachua County, Florida.

PURPOSE: The diagnosis of early carious lesions is essential for nonsurgical management of dental caries. This report describes the prevalence of early noncavitated and cavitated carious lesions in the primary dentition of 5-year-old Head Start schoolchildren in Alachua, Fla. METHODS: As part of the Fluoride Varnish Study conducted at the University of Florida, modified caries diagnostic criteria-which differentiated caries lesion activity and severity-were developed for the primary teeth. Dental examinations were conducted on 221 children ages 5 years by 2 calibrated examiners. RESULTS: Overall, 86% of the children had experienced noncavitated or cavitated caries lesions in the primary dentition. Prevalence of cavitated dentinal lesions was 48%, and prevalence of active noncavitated enamel lesions was 71%. The mean number of active noncavitated enamel lesions (mean +/- SEM: 2.91 +/- 0.21) was slightly higher than the mean number of cavitated dentinal lesions (2.52 +/- 0.31). The mean number of restored surfaces was 1.24 (+/- 0.42), and only 8% of the children had 1 or more restored surfaces. Noncavitated lesions were most common on occlusal surfaces, especially in mandibular second molars. African-American children had a higher prevalence of noncavitated lesions (81%) than whites (69%) or others (33%; P<.0001). Prevalence of cavitated lesions was 49% for African Americans, 46% for whites, and 48% for others. CONCLUSIONS: This study shows that noncavitated enamel and cavitated dentinal lesions are common in this study population's primary dentition. There is a need for preventive measures and treatment of decay in these children living in low-income families.

Knowledge and behaviors regarding early childhood caries among low-income women in Florida: a pilot study.

PURPOSE: This study evaluated the oral health knowledge and behaviors in pregnant women and mothers of young children in relation to early childhood caries to assess the need for an educational oral health program. METHODS: Interviews were conducted from a sample of 103 Medicaid-eligible participants; 56 pregnant women and 47 mothers with children under the age 6 in Florida. The data were collected using a 4-page questionnaire with closed-ended questions and analyzed using SAS/STAT 9.22. RESULTS: Overall, 79 of 101 study participants (78%) did not receive any dental care during pregnancy. There was a significant relationship between the frequencies of mother's tooth brushing and how frequently toddlers' teeth were brushed (C=0.29; p=0.04), and the mothers' self-reported oral health ratings and how frequently they brushed their toddlers' teeth (r2=0.29; p=0.03). CONCLUSION: Mothers' oral hygiene habits are significantly related to the oral hygiene habits of their children. Oral health education, during and after pregnancy, would be beneficial to promote healthier mouths for the mothers and their children.

Assessing fluoride concentration uniformity and fluoride release from three varnishes.

BACKGROUND: The authors investigated the fluoride content uniformity of three commercial fluoride varnishes, as well as their fluoride-release behaviors. METHODS: The authors examined 20 doses from each of two tubes of Duraphat (Colgate-Palmolive Co., New York) and Duraflor (Pharmascience Inc., Montreal), and 20 doses of individually packaged 0.25-milliliter and 0.40-mL units of CavityShield (OMNII Oral Pharmaceuticals, West Palm Beach, Fla.). Part of the dose was dissolved in chloroform, followed by fluoride extraction with distilled water. The authors painted the remaining varnish from five predetermined doses from each group onto plastic substrates for examination of fluoride release. Fluoride concentrations in the solutions were measured with a fluoride-selective ion electrode. RESULTS: One-way analysis of variance showed statistically significant differences between varnish groups. The fluoride content was more uniform in Duraphat and CavityShield than it was in Duraflor. The fluoride release profiles in terms of percentage of total fluoride released over time were different among different groups of varnishes and were similar among samples from the same test group. The authors found that Duraflor released consistently more fluoride in artificial saliva than did the other two varnishes. CONCLUSIONS: Fluoride content can vary between doses dispensed from the same tube. Uniformity also varies between different varnishes and affects the retention of fluoride in the varnish. CLINICAL IMPLICATIONS: Clinicians should be aware that the nonuniform appearance of fluoride varnish as squeezed out of the tube could indicate separation of ingredients, resulting in variation of fluoride content.

Effect of fluoride varnishes on color stability of esthetic restorative materials.

Fluoride varnish applications were applied to two hybrid resin composite materials, Z-100 (3M Dental Products, St Paul, MN, USA) and Esthet-X (Dentsply Caulk, Milford, DE, USA), shades A1 and A2 and a glass ionomer, GC Fuji IX GP Fast (GC Corporation, Tokyo, Japan), shade A2, to evaluate color stability. Specimens (12.6-mm dia x 2.3 mm) were prepared using a polyethylene frame, light-cured and polished through a 1-microm alumina finish. After the initial baseline color measurements, the discs were suspended in Fusayama artificial saliva (FAS) solution at 37 degrees C for 48 hours. Post immersion, the specimens were divided into five groups (n=15 each). The following fluoride varnishes were applied to four groups of test specimens: Duraphat (Colgate Oral Pharmaceutical, Inc, Canton MA, USA), Cavity Shield (OMNII Oral Pharmaceuticals, West Palm Beach, FL, USA), Duraflor (Pharmascience Inc, Montreal, Canada) and Fluor Protector (Vivadent, Ivoclar North America, Amherst, NY, USA). The varnish was allowed to dry for five minutes before immersion. The control group was not coated with varnish, although the specimens were immersed in FAS. All specimens were incubated in newly prepared FAS at 37 degrees C for 24 hours, cleaned with an electric toothbrush and the process repeated using newly prepared FAS. CIE L*a*b* color measurements were recorded five times: at baseline, after 48 hours FAS immersion, after cleaning the first and second fluoride varnish applications and after the final brushing using a commercial toothpaste (Crest). A Minolta CR-300 tristimulus colorimeter with an 8-mm aperture (Ramsey, NJ, USA) was used to record color measurements with the daylight (D65) setting. Calculations were performed for using CIE parameters deltaE*, deltaL*, delta a*, delta b*. Analysis of variance (ANOVA) and post-hoc test (Fisher's PLSD) were used for statistical analysis. After immersion in saliva, the tested glass ionomer (Fuji IX) produced the most significant color changes (deltaE*=1.19 and deltaL*=-1.03), indicating the effect of the color change was due to absorption. After fluoride varnish applications, Duraphat varnish produced significant changes in all tested materials and shades, resulting in color changes with deltaE greater than (>) 1 but less than (<) 3. These color changes are considered visually perceptible, yet have been reported in dental literature as clinically acceptable. Fluoride varnishes can be used without adversely affecting the color of restorative materials.