Combined Effect of a Bioinspired Self-Assembling Peptide and Fluoride Varnish on Remineralisation of Artificial Early Enamel Caries Lesion: An in vitro Study.

INTRODUCTION: This study aimed to investigate the remineralisation effect of combined use of a bioinspired self-assembling peptide (P26) and fluoride varnish on artificial early enamel caries lesions. METHODS: Bovine enamel blocks with artificial early enamel caries lesions were prepared. The blocks were randomly allocated to four experimental groups to receive the following treatments: A = P26 + fluoride varnish, B = P26, C = fluoride varnish, and D. distilled water (negative control). The treated blocks were subjected to pH cycling. Enamel blocks were collected at time points of 7 days (d7) and 21 days (d21). The mineral gain, elemental analysis and crystal characteristics of the caries lesion were assessed by micro-computed tomography, scanning electron microscopy with energy dispersive X-ray and X-ray diffraction (XRD), respectively. RESULTS: The mean ± standard deviation of mineral gain of group A to D were 17.4 ± 4.2%, 10.7 ± 2.2%, 10.1 ± 1.2%, and 6.8 ± 0.5% at d7, respectively, and 15.2 ± 2.6%, 8.7 ± 3.1%, 9.7 ± 1.2%, and 7.8 ± 2.3% at d21, respectively. A significant higher mineral gain was observed in group A when compared to other groups at both d7 and d21 (p < 0.05). The calcium-to-phosphate ratio remained consistent across all groups, ranging between 1.2 and 1.4. XRD analysis indicated that crystal composition on the surfaces was apatite for all groups. CONCLUSION: In conclusion, the present study provided a first indication of better remineralisation effects of the combined use of the bioinspired self-assembling peptide P26 and fluoride varnish compared to the effects of the respective individual uses of P26 or fluoride varnish.

Caries-preventive effectiveness of two different fluoride varnishes: A randomised clinical trial in patients with multi-bracketed fixed orthodontic appliances.

BACKGROUND: Patients with multi-bracketed fixed orthodontic appliances are at a higher risk of developing enamel demineralisation. AIM: To compare the efficacy of the quarterly application of two varnishes in preventing white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment. DESIGN: Ninety-nine patients were randomly allocated into three intervention groups: Group A-standard oral hygiene instructions (OHI); Group B-5% sodium fluoride (NaF) varnish with standard OHI; and Group C-NaF plus tricalcium phosphate varnish with standard OHI. The outcome was assessed at 6-monthly intervals using a quantitative laser fluorescence device, clinical evaluation and photographic evaluation on six maxillary anterior teeth. A logistic regression model using generalised estimating equations with the intervention group, time and their interaction was used to compare the occurrence of WSLs, whereas the independent-samples Kruskal-Wallis test was used to compare the means of fluorescent values among different groups at p = .05. RESULTS: Generalised estimating equations (with intervention and time as predictors) showed that only the effect of time was found to be significant (p < .001), whereas there was no significant difference among the three intervention groups (p = .305) using clinical assessment or photographic assessment (p = .599). At the 18-month follow-up, sodium fluoride (NaF) varnish with standard OHI was shown to reduce the odds of WSLs by 55% (p = .200), and NaF plus tricalcium phosphate varnish with standard OHI by 42% (p = .327). CONCLUSION: The study failed to demonstrate that the quarterly application of both the study varnishes with OHI provided additional benefits compared with standard OHI alone in preventing WSLs, taking the effect of time of follow-up into consideration. There were higher odds of developing WSLs with an increased duration of orthodontic treatment.

Prevention of demineralization during multi-bracketed fixed orthodontic treatment: An overview of systematic reviews.

BACKGROUND: Demineralization during multi-bracketed fixed orthodontic treatment is a well-known problem. AIM: To systematically evaluate the evidence for the prevention of enamel demineralization during multi-bracketed fixed orthodontic treatment. DESIGN: Systematic reviews (with or without meta-analysis) that have appraised the primary studies on the prevention of demineralization during multi-bracketed fixed orthodontic treatment were searched systematically and included as per pre-defined eligibility criteria. The risk of bias of the included reviews was assessed by two authors using the ROBIS tool and AMSTAR-2 tool. RESULTS: Twenty-nine reviews conducted on 128 exclusive primary studies were included for the present overview; 23 of these reviews were assessed to be of a high risk of overall bias, 5 were of low risk, and 1 review was of unclear risk of bias. CONCLUSIONS: Predominantly, the published reviews have focused on fluorides, whereas some reviews have also studied the role of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), reminder therapy, lasers, and sealants. Professional fluorides, sealants, reminder therapy, and lasers might be valuable interventions to prevent demineralization during orthodontic treatment based on the conclusions of reviews with high quality; however, further studies are required to elucidate the role of CPP-ACP, chlorhexidine varnish, and powered toothbrushes.

RISK PREDICTORS OF EARLY CHILDHOOD CARIES INCREMENT-A SYSTEMATIC REVIEW AND META-ANALYSIS.

This systematic review aimed to investigate the risk predictors of caries in primary teeth and evaluate their association with the increment of Early Childhood Caries (ECC) among preschool children. This systematic review included only cohort or case-control studies of at least 2 years duration, over 300 participants and with English full-text. Potentially eligible studies were retrieved from 4 electronic databases (Ovid Embase, Ovid MEDLINE; PubMed, Web of Science) from inception to March 1, 2021. Independent screening and data extraction by 2 reviewers to identify factors associated with ECC increment, including family and socioeconomic factors, dietary and oral health-related habits, and clinical parameters. A total of 18 studies from 163 potential reports were included, involving 1,159,226 preschool children. Lower parental education attainment was found associated with ECC increment (WMD:0.87; 95% CI 0.52, 1.21); whereas immigration status (WMD:-0.38; 95% CI -1.09, 0.34), gender (WMD:-0.02; 95% CI -0.28, 0.24), and dental service utilization (WMD:0.35; 95% CI -0.10, 0.79) were not significant factors for ECC increment. All included studies consistently suggested positive correlations between ECC increment and baseline caries experience, plaque level, cariogenic microorganisms, and prenatal and passive smoking, while mixed findings were detected between ECC increment with dietary and oral hygiene practices. Preschool children whose parents have low education level are more likely to have greater increment of ECC over 2 years. Existing caries lesions, increased dental plaque level, cariogenic microorganisms, prenatal or passive smoking were also consistently identified as risk factors for ECC in all reviewed studies. This systematic review highlights specific risk factors to target for the prevention of ECC and supports implementing more oral health promotion for preschool children with parents of lower educational attainment.

Glass Ionomer Sealant versus Fluoride Varnish Application to Prevent Occlusal Caries in Primary Second Molars among Preschool Children: A Randomized Controlled Trial.

Fissure sealant is a recommended preventive measure on permanent molars, but its efficacy on primary molars in preschool children is still in doubt. Sodium fluoride varnish (NaFV) enhances remineralization and is effective in preventing caries in smooth surfaces, but limited information is available regarding its use on occlusal surfaces of primary molars. The present study aimed to compare the efficacy of glass ionomer sealant (GIS) versus topical application of 5% NaFV in preventing and arresting occlusal caries in primary second molars among preschool children. One calibrated examiner examined children aged 3-4 years for visible plaque index (VPI), decayed-missing-filled primary surface (dmfs) index, and extent of carious lesions by the International Caries Detection and Assessment System (ICDAS). Subjects with 1 or more primary second molars that were sound or with incipient lesions (ICDAS 0-1), with distinct visual enamel changes (ICDAS 2), or with localized enamel breakdown (ICDAS 3) were recruited. The children were randomly assigned to either NaFV group - application of 5% NaFV at 3-monthly intervals or GIS group - 1 single placement of GIS. A parental questionnaire was used to collect information on the children's sociodemographic background and oral health-related habits. Two blinded examiners conducted clinical examinations after 6 and 12 months to evaluate the development of occlusal caries and the retention of GIS. Negative binomial regression using generalized estimating equations was employed to adjust for the clustering effect and evaluate the influence of selected variables on the development of occlusal caries into dentin at 12 months. A total of 323 children with 1,159 primary second molars received the respective preventive measures at baseline. At 12 months, 280 children with 989 molars were evaluated. Caries had developed or progressed into dentin in 7.8% and 8.0% of the molars in the NaFV and GIS groups, respectively, with no significant difference between the groups (p = 0.913). The overall retention rates of GIS were 24.6% and 13.5% at 6 and 12 months, respectively. Regression analyses showed only baseline caries experience, and an ICDAS code had a significant association with occlusal caries progression. Quarterly NaFV application and single GIS placement showed similar effectiveness in the prevention of occlusal caries development among preschool children.

Effectiveness of oral health education methods on oral hygiene in children and adolescents with visual impairment: A systematic review.

BACKGROUND: Conventional methods of oral health education (OHE) are not suitable for children with visual impairment, as these methods usually involve visual demonstration with models or plaque-disclosing dyes. AIM: To systematically review the literature to support the best approach for providing OHE to children and adolescents with visual impairment. DESIGN: A systematic search of five electronic databases and grey literature was conducted. Randomized controlled trials that compared different OHE methods in children and adolescents with visual impairment were included. The Cochrane risk-of-bias tool (RoB 2) was used for the risk-of-bias assessment. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used to determine the certainty of evidence. RESULTS: Nine randomized controlled trials with a total of 804 participants were included in this review. Seven OHE methods were compared. Seven studies were assessed to be at high risk of bias, one study was assessed to have some concerns, and one study was assessed to be at low risk of bias. The overall certainty of evidence was very low according to GRADE. CONCLUSION: There was insufficient evidence to recommend a particular method of OHE as more effective in improving the oral hygiene of children with visual impairment, but combination methods may show similar or better results.

Knowledge of dental enamel defects amongst undergraduate dental students-a cross-sectional survey.

INTRODUCTION/OBJECTIVES: Enamel defects are disturbances in the quantity or quality of enamel, due to disruption or damage to the enamel organ during amelogenesis. The correct diagnosis of enamel defects is critical as diverse management options could be required for different conditions. Difficulties in diagnosis can happen, because these defects may have similar clinical presentations. This study evaluated the diagnostic skills in enamel defects of dental students of a prominent Australasian school. METHODS: A questionnaire consisting of clinical photographs of the affected teeth/dentition in multiple views and four standardised questions for each case of enamel defect were given to Year 4 and Year 5 students. RESULTS: Localised/Chronological Hypoplasia had the lowest percentage of correct diagnosis (20.5%), whilst Enamel White Spot Lesions (EWSLs) had the highest (85%). Localised/Chronological Hypoplasia had the lowest aetiology score (20.5%), and the highest was obtained for EWSLs (85%). In regard to which question to ask to gain insight into the conditions, Enamel Hypomineralisation/MIH had the lowest score for both Year 4 and Year 5 respondents (35.4% and 21.3%). Most respondents agreed more teaching in this topic was needed, with further clinical sessions to observe the enamel defects, workshops/seminars, lectures and student-driven presentations suggested. CONCLUSION: Final-year dental students showed variable knowledge in diagnosis, aetiology and clinical management of enamel defects. Further didactic and clinical teaching should be incorporated in the undergraduate curriculum on this topic .

Identification of Key Functional Motifs of Native Amelogenin Protein for Dental Enamel Remineralisation.

Dental caries or tooth decay is a preventable and multifactorial disease that affects billions of people globally and is a particular concern in younger populations. This decay arises from acid demineralisation of tooth enamel resulting in mineral loss from the subsurface. The remineralisation of early enamel carious lesions could prevent the cavitation of teeth. The enamel protein amelogenin constitutes 90% of the total enamel matrix protein in teeth and plays a key role in the biomineralisation of tooth enamel. The physiological importance of amelogenin has led to the investigation of the possible development of amelogenin-derived biomimetics against dental caries. We herein review the literature on amelogenin, its primary and secondary structure, comparison to related species, and its' in vivo processing to bioactive peptide fragments. The key structural motifs of amelogenin that enable enamel remineralisation are discussed. The presence of several motifs in the amelogenin structure (such as polyproline, N- and C-terminal domains and C-terminal orientation) were shown to play a critical role in the formation of particle shape during remineralization. Understanding the function/structure relationships of amelogenin can aid in the rational design of synthetic polypeptides for biomineralisation, halting enamel loss and leading to improved therapies for tooth decay.

Enhanced Fluoride Bioavailability with Incorporation of Arginine in Child Dentifrices.

OBJECTIVE(S): To: 1) examine the fluoride concentrations in commercial child formula dentifrices (CFD)s; and 2) investigate the effect of arginine incorporation in CFDs on fluoride bioavailability. STUDY DESIGN: Five commercial CFDs were examined for fluoride concentrations. Total, total soluble, and insoluble fluorides in CFDs were determined by the modified Taves acid-diffusion method (TAD). Ionic F and MFP were estimated by modified direct method with standard addition technique. L-arginine (L-Arg)/L-arginine monohydrochloride (L-Arg.HCl) were incorporated at 2% w/w in the commercial CFDs. The pH of the toothpaste slurries, buffer capacity of the added Arg, potentially available fluorides (PAF) and 1-min PAF by TAD were determined. RESULTS: The CFDs had 4 to 32% of insoluble fluorides. Addition of L-Arg/L-Arg.HCl significantly improved the fluoride bioavailability in CFDs (p<0.05). Incorporation of L-Arg significantly increased the pH of toothpaste slurries (p<0.05); while L-Arg.HCl decreased the pH. Principal component analysis showed that L-Arg.HCl decreased the pH of toothpaste slurries due to the presence of Cl in the form of HCl; whereas the inherent elements/molecules (Na/P/Pi/F) remain distinct with unidentified influence on the variables. CONCLUSION(S): The CFDs containing NaF only have higher concentrations of bioavailable fluoride. Incorporating arginine (L-arginine or L-arginine monohydrochloride) at 2% w/w improves fluoride bioavailability of the child formula dentifrices.

A Scoping Review on Arginine in Caries Prevention.

OBJECTIVES: Emerging science on arginine or arginine formulations has driven the need to examine the research in the field. The scoping study objectives were (1) to identify the extent, range, and type of evidence on the role of arginine or arginine formulations in caries prevention and (2) to explore the future scope of research on arginine-containing caries-preventive agents. METHODS: A systematic search was performed in PubMed, Scopus, and Web of Science. In vitro studies, clinical trials, narrative reviews, systematic reviews and or meta-analysis, and umbrella reviews or meta-evaluation examining arginine or arginine formulations for caries prevention were included. The data-charting process involved extracting variables followed by evidence synthesis. Arginine variants investigated up to date were discussed to explore future scope of research. RESULTS: Thirty-nine articles were included for review from 105 identified citations comprising of in vitro studies, clinical trials, and reviews. Most articles studied 1.5% arginine-fluoride toothpaste. Most studies were from Asia, followed by North America, with fewest studies from Europe and South America. Arginine or arginine formulations demonstrated a superior caries-preventive effect compared with their matched controls (including fluorides); however, the evidence is with high risk of bias. Until now, three arginine variants have been investigated with l-arginine monohydrochloride as the least explored variant. CONCLUSIONS: The evidence on the caries-preventive effect of arginine or arginine formulations has a high risk of bias. High-quality clinical trials are needed to assess the caries-preventive potential of arginine in commercial formulations. The role of l-arginine monohydrochloride in caries prevention can further be explored by incorporating in self-applied and professionally applied caries-preventive agents.

Effectiveness of Pit and Fissure Sealants for Preventing and Arresting Occlusal Caries in Primary Molars: A Systematic Review and Meta-Analysis.

OBJECTIVE: The use of pit and fissure sealants have been well supported in permanent teeth, but no concrete evidence is available to support this procedure in primary molars. This review aims to systematically assess randomized controlled trials and summarize the evidence on the effectiveness of different sealants in prevention and arrest of the pit and fissure occlusal caries in primary molars of children. MATERIALS AND METHODS: Four electronic databases were searched from inception to March 2018. Seven studies were included in the qualitative and quantitative syntheses. Two reviewers independently selected studies, extracted data, assessed risk of bias using the revised Cochrane risk of bias tool, and evaluated the certainty in the evidence adopting the Grading of Recommendations Assessment Development and Evaluation approach. Odds ratio and retention rate of different sealants were recalculated and analyzed. RESULTS: This review identified no significant difference in the overall caries incidence and progression when evaluated over 24 months between (1) resin-based sealant (RBS) and glass ionomer sealants (GIS) or resin-modified GIS; (2) conventional and newly developed RBS; (3) autopolymerized and light-polymerized RBS; (4) RBS with topical fluoride application and topical fluoride alone; and (5) RBS with topical fluoride application and resin infiltration with topical fluoride application. The pooled estimates of the mean retention rates of RBS and GIS on primary molars over an 18-months period were 85.94% and 23.18%, respectively. The certainty in the evidence of each outcome was determined as low or very low mainly because of high risk of overall bias and imprecision. CONCLUSION: There are currently insufficient well-controlled randomized controlled clinical trials to determine whether sealants are beneficial in preventing or arresting noncavitated occlusal caries in the primary molars.

Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review.

BACKGROUND: The regular use of fluoride dentifrices is quite practical, widespread and linked to global decline of dental caries. However, the role of self-applied topical fluorides in prevention and reversal of Enamel White Spot Lesions (EWSLs) during multi-bracketed fixed orthodontic treatment is not yet explored. OBJECTIVE: To systematically appraise the current literature on the effectiveness of self-applied topical fluorides in the prevention and reversal of EWSLs occurring during multi-bracketed fixed orthodontic treatment. SEARCH METHODS: Four electronic databases (Cochrane Library, Embase via Ovid, Medline via Ovid, and Scopus) and gray literature were searched using the broad MeSH terms and keywords. SELECTION CRITERIA: Only randomized/quasi-randomized controlled clinical trials evaluating the effectiveness of self-applied fluorides in the prevention of EWSLs during multi-bracketed fixed orthodontic treatment or reversal of post-orthodontic EWSLs were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened for studies, extracted data and assessed the risk of bias using the Cochrane risk of bias tool 2.0. Due to substantial variations in the interventions, control groups, and the measurement of outcome among studies, quantitative synthesis could not be performed as planned. RESULTS: Only three studies could be included in the present review; two of them assessing prevention of EWSLs and one addressing reversal of post-orthodontic EWSLs. One of the studies was judged to be of low risk of overall bias, whereas 2 studies were adjudged to be of high risk of overall bias because of deviations from intended interventions. The certainty of evidence about the role of self-applied fluorides in prevention and reversal of EWSLs was found to be of low quality; hence, our confidence in the effect estimate is limited, and future well-conducted trials might alter the effect estimates. LIMITATIONS: The inclusion of only English literature and inability to perform quantitative synthesis due to a limited number of studies. CONCLUSIONS AND IMPLICATIONS: Although the review did not confirm the effectiveness of self-applied fluorides in the reversal of EWSLs, it did partially substantiate the positive role of self-applied fluorides in the prevention of EWSLs occurring during multi-bracketed fixed orthodontic treatment. The review recommends the need for well-designed randomized controlled trials evaluating the effectiveness of self-applied fluorides on the prevention and reversal of EWSLs during multi-bracketed fixed orthodontic treatment. REGISTRATION: PROSPERO database (Registration number: CRD42018108590) and is freely available at: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108590. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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.

A META-EPIDEMIOLOGICAL REVIEW OF META-ANALYSIS ON ANTI-CARIES EFFECT OF ARGININE-CONTAINING FORMULATIONS.

BACKGROUND: Several significant issues on clinical trials reporting the effect of arginine-containing dental products have been addressed in systematic reviews and meta-analyses identifying the need for high-quality randomized clinical trials. A further methodological analysis of the given systematic reviews with meta-analysis on arginine products might provide information for future high-quality randomized clinical trials and current clinical practice. OBJECTIVE(S): The objective was to perform a meta-epidemiological assessment of meta-analyses reporting the anticaries effect of arginine-containing formulations. METHODS: The data on risk-of-bias assessment, effect size measure, dispersion of estimated precision, and follow-up period were summarized for the meta-epidemiological review analysis. RESULTS: Studies with larger magnitude of effect sizes might present with unclear random sequence generation and unclear allocation concealment representing the selection bias. There was a significant strong negative correlation between the follow-up time and dispersion of precision estimates (rs = -0.79, P = .034). CONCLUSION: Results show that clinical trials on arginine dental products have methodological shortcomings. Both the selection bias and follow-up period influence the effect size magnitude and subsequent precision dispersion during evidence synthesis in clinical trials on arginine-containing dental products.

Can oral ADS activity or arginine levels be a caries risk indicator? A systematic review and meta-analysis.

OBJECTIVES: The objective of this study was to evaluate the association between salivary and plaque arginine levels/ADS activities with dental caries. MATERIALS AND METHODS: A systematic search was performed as per PRISMA statement using PubMed, Scopus, Cochrane Library, and Web of Science. Published studies that investigated adults and children (P) with caries-active status (E) and caries-free status (C), whereby arginine levels/ADS activity (O) was measured in saliva/plaque to analyze exposure-outcome association compared to the control group were deemed eligible for inclusion. Quality assessment was performed using combined Newcastle-Ottawa Scale and Modified RTI Item Bank scale. Meta-analysis was performed for effect size, precision estimation, and subgroup effects analysis. RESULTS: Of 233 records identified, seven (κ = 1.00) were included for qualitative synthesis (systematic review) and four for quantitative synthesis (meta-analysis). No specific bias could be identified in five studies assessed as per the Modified RTI Item Bank scale. Two studies received lower scores on the Newcastle Ottawa scale. Plaque ADS activity in adults (effect size = 0.93, p = 0.008), salivary ADS activity in adults and children (effect size = 0.85, p < 0.001), and salivary ADS activity in adults (effect size = 0.87, p < 0.001) identified a statistically significant effect size. Subgroup analysis demonstrated non-significant variance (Q value = 0.042, p = 0.838) between saliva and plaque ADS activities of adults. CONCLUSIONS: The results of this review suggest the salivary and plaque ADS activities appear to be promising caries risk indicators for adults, while results remain inconclusive in children. CLINICAL RELEVANCE: Measuring ADS activities (saliva or plaque) can be a potential caries risk indicator in adults. The protocol was registered on PROSPERO database: CRD42017060701.

Knowledge, perceptions, and clinical experiences on molar incisor hypomineralization among dental care providers in Hong Kong.

BACKGROUND: Molar incisor hypomineralization (MIH) is an alarming problem with considerable challenges in management. This study aimed to evaluate and compare the knowledge, perceptions, and clinical experiences of molar incisor hypomineralization (MIH) between general dental practitioners (GDPs) and paediatric dentists (PDs) in Hong Kong. METHODS: A cross-sectional survey of 557 randomly selected GDPs (approximately 25% of all registered dentists) and all registered PDs (n = 31) were invited. They were asked to complete a 4-section questionnaire adapted and modified from a study by Gambetta-Tessini and co-workers on sociodemographic profiles, knowledge, experience, and perceptions regarding MIH. Data were analyzed with chi-square, Fisher's exact, and multiple factor ANCOVA tests. RESULTS: The overall response rate was 43.37% (255/588). Majority (74.1%) of the respondents encountered MIH in their practices. A significantly higher mean knowledge score (46.33 ± 7.1) was observed among PDs than GDPs (43.09 ± 7.0) (P < 0.01) and among PDs who are 40 years old or younger (P < 0.001). Differences in treatment of MIH were also observed between PDs and GDPs (P < 0.05). Paediatric dentists were more confident in diagnosing and treating MIH (P < 0.001). Most respondents (87.8%) expressed a need for continuing education on MIH. CONCLUSION: Continuing education on MIH is needed to assure that the highest quality of evidence-based care is given to patients with MIH. Dissemination of latest best evidence on MIH, especially to GDPs, will assure that the condition is accurately diagnosed and well managed.

Calcium-Based Caries Preventive Agents: A Meta-evaluation of Systematic Reviews and Meta-analysis.

OBJECTIVE: This article aims to assess systematic reviews and/or meta-analyses on calcium-based caries preventive agents, evaluating reported evidence, thereby summarizing a critical appraisal on the subject. MATERIALS AND METHODS: A systematic search was done using PubMed, Cochrane Library, and Web of Science. Systematic reviews and/or meta-analyses addressing PICO: P: any age or gender; I: calcium-based caries preventive agents; C: with/without control; and O: any early caries lesion measures were included. Inter-reviewer reliability was assessed using Cohen's kappa coefficient. RESULTS: One hundred sixty-four records were identified, of which 10 (κ = 1.00) were included for quality evaluation. Seven reviews were systematic reviews (only), whereas 3 were meta-analyses. None of the articles provided with an "a priori" review design. Majority of the reviews (7 of 10) were of high quality as assessed by Assessing the Methodological Quality of Systematic Reviews, whereas 3 articles were scored as moderate quality of evidence. All the included meta-analyses were of high-quality evidence as assessed by meta-evaluation of meta-analysis: 10 appraisal questions for biologists. Eight reviews addressed the intervention: casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)/casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP). Two reviews were performed on arginine-containing formulations. Majority of the high-quality systematic reviews were inconclusive over the effects of CPP-ACP/CPP-ACFP. CONCLUSION: This meta-evaluation suggests that CPP-ACP/CPP-ACFP can be considered as an adjunct to fluorides but not as an alternative until long-term well-designed clinical trials assessed by systematic reviews and meta-analysis are available. Arginine-containing dentifrice with an insoluble calcium base and fluoride seem to be a promising agent, but more well-designed non-industry-supported clinical trials can provide better insights in future.

Effect of different fluoride varnishes on remineralization of artificial enamel carious lesions.

OBJECTIVES: To compare remineralization potential of topical fluoride varnishes with added calcium phosphate-based delivery systems on artificial enamel caries. METHODS: Human enamel specimens (n = 60) were randomly divided into six groups: Group 0: Control (no varnish), Group 1: Duraphat® , Group 2: MI Varnish™ , Group 3: Embrace™ Varnish, Group 4: Enamel Pro® Varnish, and Group 5: Clinpro™ White Varnish. Specimens were immersed in demineralizing solution for 96 h to create artificial caries lesion. Each specimen was then immersed in artificial saliva for 6 h after fluoride varnish application and pH cycling was performed for 8 days. Specimens were evaluated using Knoop surface microhardness (KHN) and transverse microradiography (TMR). One-way anova test was performed to examine the effect of fluoride varnishes on change in percentage of surface hardness recovery (%SHR), change in lesion depth (ΔLD), and change in mineral loss (ΔΔZ) with the significance limit set at 5%. RESULTS: %SHR of enamel following treatment with Group 1 was significantly higher than Group 3 and Group 4. Conversely, ΔLD and ΔΔZ of Group 1 were significantly higher than Group 2, Group 3, and Group 4. No significant differences in %SHR, ΔLD, and ΔΔZ were found between Group 1 and Group 5. CONCLUSIONS: Duraphat® alone achieves significant remineralization of enamel carious lesions. Clinpro™ White Varnish had similar enamel remineralization effect as Duraphat® .

Quality of life changes in children following emergency dental extractions under general anaesthesia.

OBJECTIVES: To assess the changes in the oral health-related quality of life (OHRQoL) of 221 preschool children who presented to the emergency department with the consequences of untreated dental caries requiring dental extractions under general anaesthesia (DEGA). METHODS: Two hundred and twenty-one healthy preschool children, who required emergency DEGA, were recruited over a period of 12 months. The same parent or caregiver completed the Early Childhood Oral Health Impact Scale (ECOHIS) questionnaire; both, prior to the DEGA and at the 2-week post-treatment visit. Data were analysed using repeated anova with adjustments for multiple comparisons using the Bonferroni tests with the significance level set at 5%. RESULTS: One hundred and twenty-six participants, with a mean age of 4.02 and a mean dmft score of 8.27 (SD = 4.13), completed the 2-week post-treatment questionnaires. The overall ECOHIS, CIS, and FIS scores decreased significantly (P < 0.001) after emergency DEGA, demonstrating large effect sizes. The biggest decrease in prevalence after emergency DEGA was observed for the items of pain in teeth, trouble sleeping, being irritated or frustrated, difficulty drinking food, and parents being upset. CONCLUSIONS: The OHRQoL of preschool children, who presented to the emergency department with the consequences of untreated dental caries, was significantly improved following emergency DEGA.

A Review of Enamel Remineralisation Potential of Calcium- and Phosphate-based Remineralisation Systems.

PURPOSE: Along with calcium and phosphate ions, fluoride ions promote remineralisation of noncavitated carious lesions to form fluorapatite. However, the supply of calcium and phosphate ions from saliva may not be adequate for effective remineralisation in patients with high caries risk. Therefore, an additional supply of calcium and phosphate ions is mandatory to enhance effective remineralisation with fluoride ions. Several calcium- and phosphate-based remineralisation agents are available for clinical use. However, the nature of the incorporated calcium and phosphate ions and the method of their stabilisation are not similar. Therefore, this review summarises research findings on the enamel remineralisation potential of calcium- and phosphate-based remineralisation agents. MATERIALS AND METHODS: Appropriate key words were used and the Pubmed electronic database was searched to retrieve articles. Screening through titles and abstracts identified relevant articles. Full text review of the identified relevant articles was performed and the significant findings were summarised and presented in this review. RESULTS: Several studies including laboratory-based studies, in situ and randomised controlled clinical trials showed casein phosphopeptide amorphous calcium phosphate (CPP-ACP)-containing remineralisation agents to have superior remineralisation potential compared to other forms of calcium- and phosphate-based remineralisation agents, such as functionalised tri-calcium phosphate (fTCP) and amorphous calcium phosphate (ACP). CONCLUSIONS: More long-term clinical studies are necessary to compare the enamel remineralisation potential of calcium- and phosphate-based agents that contain fTCP and ACP with those containing CPP-ACP. Additional well-designed randomised controlled clinical trials are also necessary to justify long-term clinical supplemental use of products containing CPP-ACP.