The effect of equal fluoride concentrations in silver diamine fluoride and potassium fluoride on demineralized dentin during pH-cycling: chemical data.

The actual contribution of silver in silver diamine fluoride (SDF) towards the anti-demineralizing effect is unclear. This study compared the effects of single applications of three concentrations of fluoride (4.1%, 1.025%, 0.26% F- ) in the form of SDF and potassium fluoride (KF) on demineralized dentin in a 15-day non-microbial pH-cycling model. Calcium loss and uptake in de- and remineralization buffers were analyzed daily. Fluoride release in both buffers was analyzed on days 1, 2, 3, and 8. The net calcium results of de- and remineralization cycles revealed dose-response protection without significant differences between equal fluoride concentrations of SDF and KF. In the demineralization cycles, all fluoride treatments, except KF 0.26% F- , significantly inhibited demineralization, with KF 4.1% F- being the most effective. In the remineralization cycles, remineralization was enhanced in all fluoride concentration groups in a dose-response manner with no difference between similar fluoride concentrations of SDF and KF. Daily fluoride effects were constant throughout the experiment. Fluoride analysis revealed statistically significant differences in fluoride release between the treatments on day 1 that diminished on days 2 and 3. The non-microbial model showed no differences between SDF and KF in inhibiting demineralization and enhancing remineralization of dentin lesions.

No Removal and Inactivation of Carious Tissue: Non-Restorative Cavity Control.

Non-restorative cavity control (NRCC) is a 3-part treatment option for dentine cavities in the primary dentition, for root carious lesions and cavitated coronal smooth surface lesions. The first part is that the patient's oral hygiene procedure/habits improve and involve the exposed dentine. For this, it may be necessary to expose the cavity (second part) so that it is accessible for the toothbrush (the lesion exposure method). As long as the dentine carious lesion is diagnosed as active or there is increased risk that carious lesion activity will recur, it is advisable to support the treatment with a 38% silver diamine fluoride (SDF) or a 5% sodium fluoride (NaF) varnish therapy (third part). NRCC has advantages over traditional restorative therapy as it avoids the stress and fear initiation that often results from invasive restorative therapy. It avoids a futile or detrimental repeat restorative cycle when cavity outlines have to be designed in caries active areas and it increases awareness of people's own responsibility for oral health and the quality of the oral hygiene procedure. NRCC has been advocated, particularly in primary dentitions, for patients or parents/carers who are able to accept responsibility for the disease and commit to remedial action including diet modification and regular, frequent toothbrushing with a fluoride toothpaste. It should not be used when immediate invasive action is required such as in the case of pain, infection, or sepsis, or where there is no readiness to change behaviours that have led to the development of the disease in the first place. Professionals who choose NRCC commit themselves to being critical regarding their educational qualities and to commence a cycle of quality improvement.

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

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