A Time Study Analysis of Fluoride Varnish Application in Pediatric Well Visits to Address Health Disparities among Children.

Dental decay is the most common chronic disease in children. Fluoride varnish (FV) is a preventive oral health service with proven effectiveness at reducing dental caries in dental and primary care settings. The objective of this study was to determine how long it takes to apply FV treatments during primary care well visits to address one of the most common barriers as reported by pediatricians - lack of time. FV treatment videos were collected at six clinics in Georgia with rigorous time studies conducted on each video to determine the Standard Time for the FV treatment process as well as the FV Application Component of the process and reasons for delays. Median Standard Times varied by clinic, ranging from 67.7 seconds to 166.9 seconds with an overall median of 109.7 seconds. This results in per FV application labor costs of approximately $2.38 for pediatricians, $1.16 for registered nurses, and $0.53 for medical assistants. Findings from this study support the inclusion of FV applications as a common practice during primary care well visits.

Effect of wood varnish coating on the water absorption and mechanical properties of jute fiber reinforced epoxy composites.

Natural fiber-reinforced composites are becoming popular day by day because of their low cost and renewable nature. However, a major concern of these composites is water absorption. To minimize the water absorption in natural fiber-reinforced composites, wood varnish coating was used in this paper to investigate the effect of this coating on water absorption and mechanical properties of jute fiber-reinforced composites. Four types of composites were fabricated using the hand lay-up technique, among them on Type 1 no coating was used, Type 2 was surface coated, Type 3 was fiber coated and Type 4 was both fiber and composite surface coated. Water absorption, tensile, bending, short beam shear, and impact tests were performed on the composite specimens according to their respective ASTM standards to see the effect of coating. Both fiber and fracture surface morphology were observed using Scanning Electron Microscope. It was found that the water absorption was significantly reduced for Type 2 (50.31 %) and Type 4 (56.01 %) specimens. However, the tensile strength and bending strength were reduced by 74.17 %, and 72.71 % for Type 3 and 77.07 % and 84.24 % for Type 4 composites while for Type 2, they were slightly increased (7.26 % and 1.13 %). The ILSS of Type 3 and Type 4 were reduced by 69.34 % and 58.07 % respectively while it was reduced by only 4.49 % for Type 2 composite. On the other hand, the impact energy absorption was increased by 85.32 % for Type 4 composite. The findings of this study suggest that Type 2 composite (only composite surface coating) has the overall best performance and wood varnish coating has the potential to reduce the water absorption on natural fiber-reinforced composites.

"Effectiveness of topical 25% Silver Nitrate Solution followed by 5% Fluoride Varnish compared to 38% Silver Diamine Fluoride in Arresting and Preventing Dental Caries among Beta-Thalassemia Major Patients: A Randomized Clinical Trial".

INTRODUCTION: This is the first randomized non-inferiority clinical trial in the evidence literature to examine the effectiveness of topical 25% silver nitrate (SN) followed by 5% sodium fluoride (NaF) varnish is not much worse or acceptable to 38% silver diamine fluoride (SDF) in preventing and arresting dental caries among Beta-Thalassemia Major (BTM) patients. METHOD: 170 BTM participants aged 18 years and older with at least 1 or more active carious lesions were randomly allocated into 2 groups (1:1). 25% silver nitrate solution application followed by 5% NaF varnish was administered to Group I, and Group II received 38% SDF. The Nyvad criteria and DMFT index were used to assess caries arrest and prevention among both groups at 3- and 6-months interval. RESULTS: Caries arrest rate at 3 months was significantly higher in Group I (83.10%) when compared to Group II (76.16%) (p<0.05). While at 6 months, both the groups were comparable with arrest rate (76.16%) (p>0.05). The caries increment was comparable among both groups at 3 months, while at 6 months, caries increment was almost half in SN with NaF group compared to SDF group (p>0.05). Kaplan-Meir survival estimated the median survival time for caries increment was 17 and 39 weeks for Group I and 15 and 36 weeks for Group II at 3 and 6 months, respectively. CONCLUSION: One time application of 25% SN followed by 5% NaF is no worse than a 38% SDF in arresting and preventing dental caries among Thalassemia Major participants at 3 and 6 months. CLINICAL SIGNIFICANCE: The study provides clinicians with a cost-effective, safer, readily available, non-invasive treatment option (25% SN followed by 5% NaF) for caries management.

Antimicrobial Coatings Based on a Photoreactive (Meth)acrylate Syrup and Ferulic Acid-The Effectiveness against Staphylococcus epidermidis.

A novel photopolymerizable (meth)acrylate oligomer syrup modified with ferulic acid (FA) was verified as an antimicrobial coating binder against a biofilm of Staphylococcus epidermidis. A solution-free UV-LED-initiated photopolymerization process of aliphatic (meth)acrylates and styrene was performed to prepare the oligomer syrup. The influence of ferulic acid on the UV crosslinking process of the varnish coatings (kinetic studies using photo-DSC) as well as their chemical structure (FTIR) and mechanical (adhesion, hardness), optical (gloss, DOI parameter), and antibacterial properties against S. epidermidis were investigated. The photo-DSC results revealed that FA has a positive effect on reducing the early occurrence of slowing processes and has a favorable effect on the monomer conversion increment. It turned out, unexpectedly, that the more FA in the coating, the greater its adhesion to a glass substrate and hardness. The coating containing 0.9 wt. part of FA exhibited excellent antimicrobial properties against S. epidermidis, i.e., the bacterial number after 24 h was only 1.98 log CFU/mL. All the coatings showed relatively high hardness, gloss (>80 G.U.), and DOI parameter values (30-50 a.u.).

A Comparative Evaluation of Nanosilver Fluoride, Chlorhexidine, and Sodium Fluoride When Used as a Varnish on Streptococcus mutans Levels in Children with Caries.

Aim: The purpose of the present study is to evaluate the effect of nanosilver fluoride (NSF), chlorhexidine (CHX), and sodium fluoride (NaF) when used as a varnish on Streptococcus mutans levels in children with dental caries. Study design: A total of 120 children (age range 8-12 years) with incipient caries were randomly assigned to four groups (n = 30): group I-NSF varnish, group II-CHX varnish, group III-NaF varnish, and group IV-control. Varnish application at baseline was performed once. To assess the levels of S. mutans using the culture method [colony-forming units (CFUs)] and optical density (OD), plaque and samples were taken at baseline (T0), 1 month (T1), and 3 months (T3). Additionally, the oral hygiene index-simplified (OHI-S) was noted for clinical assessment. Results: By the end of 3 months, a statistically significant reduction in plaque CFU and salivary CFU was found in group II. At the conclusion of the 3 months, group I had the greatest decrease in OHI-S. After 3 months, the plaque CFU score did not differ significantly across groups I, II, and III. However, a statistically significant difference in OD values (p-value of 0.00) was discovered between group I and all other groups. Conclusion: Children with early caries can effectively lower their S. mutans count by using NSF varnish. How to cite this article: Raja T, Agarwal N, Jabin Z, et al. A Comparative Evaluation of Nanosilver Fluoride, Chlorhexidine, and Sodium Fluoride When Used as a Varnish on Streptococcus mutans Levels in Children with Caries. Int J Clin Pediatr Dent 2024;17(4):410-416.

Evaluation of Remineralization Efficacy of Nanoparticle-based Materials on White Spot Lesions in Children: A Comparative Clinical Study.

Background: Despite the introduction of several anticaries products, dental caries continues to be a global problem. In recent years, there has been a rise in interest in noninvasive treatment for noncavitated caries lesions by employing remineralization concepts. Each remineralizing agent has its own drawbacks. Therefore, it is desirable to seek new agents that offer the advantages of earlier counterparts with lower detrimental reactions. Aim: The purpose of this research is to evaluate the remineralization efficacy of nanoparticle-based materials on white spot lesion (WSL) in children. Materials and methods: A total of 45 children between the age-group of 4 and 8 years with WSLs were selected and randomly divided into three groups. At baseline, the teeth with WSLs were confirmed and identified using International Caries Detection and Assessment System II (ICDAS II) criteria, and the dimensions of the lesions were measured using photographic methods. Then, they were randomly placed into three groups of 15 samples each-group I nanosilver fluoride (NSF), group II nanohydroxyapatite (nano-HAP) serum, and group III MI varnish. Following that, the varnish was applied, and follow-up was done in the 2nd, 4th, 12th, and 24th week. Results: By the 4th week, all three groups had a statistically significant difference (p < 0.05). Baseline measurements for groups I, II, and III showed that their respective mean WSL dimensions were 4.9 ± 0.66, 4.27 ± 0.69, and 5.44 ± 2.95. The dimensions of each group were reduced by the 24th week to 1.22 ± 0.46, 0.93 ± 0.41, and 2.19 ± 1.40, respectively. Overall, group II (nano-HAP serum) showed a statistically significant decrease in the dimension of the lesion at the end of the 24th week, followed by groups I and III. Conclusion: The remineralization of enamel was induced by all three agents. Nano-HAP serum is more successful than MI Varnish and NSF. How to cite this article: Annadurai T, Vundela RR, Chowdhary N, et al. Evaluation of Remineralization Efficacy of Nanoparticle-based Materials on White Spot Lesions in Children: A Comparative Clinical Study. Int J Clin Pediatr Dent 2024;17(4):425-432.

Comparative Evaluation of Longevity of Fluoride Release from Three Different Fluoride Varnishes: An Observational Study.

Introduction: The cycles of demineralization and remineralization result in a dynamic process of caries development. Caries are prevented by the shift in the balance from demineralization to remineralization at the tooth-oral fluid interface with the help of salivary fluoride levels (in parts per million). The advantages of fluoride varnish application over other substitutes like dentifrices, mouthrinses, gels, or foams are that varnishes are well tolerated by infants, young children, or children with special healthcare needs and have prolonged therapeutic effects. This study was formulated to evaluate and compare the longevity of fluoride release from different fluoride varnishes, namely Fluor Protector, Enamelast, and Enamel Pro varnish. Aim: To evaluate and compare the longevity of fluoride release from three different fluoride varnishes. Materials and methods: The study samples comprised 72 healthy permanent maxillary anterior teeth. The teeth were divided into four groups, with eighteen teeth in each group. The surfaces of all teeth were then covered by different colored nail varnish according to the respective group, except for a 3 × 3 mm window on the facial (labial) surface of the crown, where the test materials were applied according to their respective group. In group I, Fluor Protector varnish; in group II, Enamelast varnish; and in group III, Enamel Pro varnish was applied. Group IV was the control group; hence, no test material was applied. All specimens were then stored in plastic containers with a pH of 7.2 in artificial saliva at room temperature. The specimens were transferred into new plastic containers after 1 day, containing fresh artificial saliva, and solutions from previous plastic containers were taken for fluoride analysis. This process was repeated sequentially to analyze the amount of fluoride released in ppm from the specimens at the end of 1, 3, and 6 months. Statistical analysis: Analysis was performed on Statistical Package for the Social Sciences (SPSS) software (Windows version 22.0). Results: Conventionally used 1.5% ammonium fluoride varnish, that is, Fluor Protector varnish, showed the least release of fluoride (0.03 ± 0.0 ppm), while resin carrier-based 5% sodium fluoride varnish, that is, Enamelast varnish showed a good amount of fluoride release for 6 months continuously, that is, (0.16 ± 0.06 ppm) at last follow-up. Enamel Pro varnish, which has 5% sodium fluoride with amorphous calcium phosphate (ACP) formula, was found to be the best varnish as it released the maximum amount of fluoride in ppm in artificial saliva for up to 3 months (0.32 ± 0.08) but less than Enamelast varnish only at 6 months follow-up that is 0.09 ± 0.03 ppm. Conclusion: The present study concludes that based on the amount of fluoride released for 6 months duration, Enamel Pro varnish, followed by Enamelast varnish and Fluor Protector varnish, are advisable to apply for caries prevention. How to cite this article: Singh V, Naik S, Vashisth P, et al. Comparative Evaluation of Longevity of Fluoride Release from Three Different Fluoride Varnishes: An Observational Study. Int J Clin Pediatr Dent 2024;17(3):341-345.

Evaluation of the Caries-Arresting Potential of Silver Diamine Fluoride Gel With Potassium Iodide Versus Sodium Fluoride Varnish: An Observational Study.

Introduction Silver diamine fluoride (SDF) with potassium iodide (KI) has emerged as a promising, aesthetic, non-invasive management by limiting the staining caused by SDF. However, no studies are comparing the caries-arresting potential of SDF gel with KI. The study aims to observe and evaluate the caries-arresting potential of SDF gel with KI compared to sodium fluoride (NaF) varnish. Materials and methods The present observational study was conducted with a split-mouth design. A total of 33 participants, in the age group of two to six years, with occlusal caries of the International Caries Detection and Assessment System (ICDAS) I and II involving both right and left upper or lower primary molar teeth, were included. SDF gel with KI and fluoride varnish (FV) was applied to the contralateral teeth on the same arch. Participants were recalled at 3, 6, 9, and 12-month intervals to monitor the progression or arrest of carious lesions. Result At the end of 12 months, 66.7% and 70.5% of the teeth showed arrest of caries with SDF gel with KI and FV, respectively. Intra-group analysis using the Friedman test shows significant differences in both groups across the timeline (p=0.001). Intergroup analysis using the Whitney U test reveals no significant difference in caries-arresting potential between the groups at various timelines (p=0.231). Conclusion There was no significant difference in arresting enamel caries of primary teeth between the use of 5% NaF and 38% SDF with KI. However, there was a significant difference within the group between the 3rd and 12th-month follow-up. Hence, the biannual application is recommended in both FV and SDF with KI.

Evaluation of the cumulative effect of photodynamic therapy and local fluoride on the microhardness and topography of demineralized enamel and cementum surfaces.

Background: The present study aimed to determine the cumulative effect of two photodynamic therapy methods with methylene blue and indocyanine green and two topical fluoride therapy methods with fluoride varnish and silver diamine fluoride alone and in combination on the microhardness and topography of demineralized enamel and cementum surfaces. Materials and methods: Seventy-two sound human teeth were selected, and their buccal and lingual surfaces were assigned to two main groups of enamel and cementum using simple randomization. The initial surface hardness (SH) of the enamel and cementum in each sample was determined using a micro-Vickers hardness tester using a 200-g force in 10 s. Then artificial caries was induced by immersion in a demineralizing/remineralizing solution (i.e., each tooth provided two samples, one on the buccal aspect and the other on the lingual aspect). Each enamel/cementum main group was divided into two subgroups using simple randomization based on the local fluoride type (fluoride varnish and silver diamine fluoride) and the type of the photosensitizer agent (methylene blue and indocyanine green). Finally, 16 groups were achieved (n = 9). The final surface hardness of the enamel and cementum samples was determined as described above. Finally, the sample surfaces were prepared for the surface topography evaluation under a scanning electron microscope. The baseline microhardness was compared between the 16 study groups in the first step using one-way ANOVA. Then, three-way ANOVA was used to evaluate the effect of fluoride, laser, and surface (enamel and cementum) on microhardness. Results: All the groups exhibited decreased microhardness due to the induction of artificial caries. In both main groups of enamel and cementum, the lowest decrease in microhardness was recorded with combined photodynamic therapy and methylene blue photosensitizer material and fluoride varnish (15.1 % for cementum and 16.7 % for enamel), and the highest decrease in microhardness was recorded in the methylene blue group (35.7 % for cementum and 34.9 % for enamel). Conclusion: The combination of photodynamic therapy with the photosensitizer substance methylene blue or indocyanine green together with fluoride varnish or silver diamine fluoride is effective on the remineralization of demineralized enamel and cementum. Although there is no difference between the combination of photodynamic therapy with fluoride varnish compared to fluoride varnish alone, both of these treatments are more effective than using photodynamic therapy alone.

Assessment of the Additive Effect of Remineralizing Agents in Combination With Fluoride Releasing Adhesives in the Prevention of Enamel Decalcification in Orthodontic Patients: An In Vitro Study.

Introduction Incorporation of remineralizing agents with fluoride-releasing bracket adhesives may prevent the development of white spot lesions (WSL) or reverse the established WSL in patients undergoing fixed orthodontic treatment. We aimed to find out how effectively casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride varnish (FV) can remineralize teeth when mixed with fluoride-releasing orthodontic adhesive. Materials and methods We randomly assigned a total of 60 premolar teeth, therapeutically extracted for orthodontic purposes, into two equal groups. Group I (n = 30) utilized fluoride-releasing adhesive (FR), and Group II (n = 30) bonded with non-fluoride adhesive (NFR). Based on the applied remineralizing agent, we further divided each of the two groups into three equal subgroups of 10: Group IA (FR+FV), Group IB (FR+CPP-ACP), Group IC (control-only FR), Group IIA (NFR+FV), Group IIB (NFR+CPP-ACP), and Group IIC (control-only NFR). Following bonding procedures, all the samples underwent pH cycling for 28 days, where the enamel samples were immersed in 20 ml of demineralizing solution for three hours, followed by immersion in 30 ml of remineralizing solution for 17 hours. The samples were analyzed for shear bond strength (SBS) on a universal testing machine and hardness values (HV) by the Vickers microhardness test (VMT) using the indentation method. We also evaluated the adhesive remnant index (ARI) scores to determine the site of bracket failure. Statistical analysis The shear bond strength (SBS) and hardness value (HV) were expressed as the mean, standard deviation (SD), and median for each subgroup. We used the non-parametric Kruskal-Wallis test to analyze the SBS and HV, followed by the Dunn-Bonferroni test for intra-pair differences. The ARI score was expressed as the frequency of the percentage distribution, and the difference in the distribution of ARI scores between the groups was assessed by the Cochran chi-square test. The probability (p) value equal to or less than 0.05 was considered statistically significant. Results The results show that Group IB, bonded with a fluoride-releasing adhesive and a CPP-ACP remineralizing agent surface treatment, has the highest HV of 300.23 units. Group IIC (only NFR) has the lowest hardness of 153.3 units, which is statistically significant (p < 0.001). However, the ARI scores are not statistically significant between the groups tested. Conclusion The bond strength of the adhesive and the surface hardness of the enamel increased with the addition of fluoride varnish and CPP-ACP to both the fluoride-releasing and non-fluoride-releasing adhesives.

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.

Destruction of cariogenic biofilms by antimicrobial photodynamic therapy mediated by phycocyanin and toluidine blue along with sodium fluoride varnish or titanium tetrafluoride.

OBJECTIVE: Evaluation of the effect of phycocyanin (PC) and toluidine blue (TBO) along with sodium fluoride varnish (FV) or titanium tetrafluoride (TiF4) under the conditions of antimicrobial photodynamic therapy (PDT) on a dual-species cariogenic biofilm and on remineralization process. DESIGN: After the development of Streptococcus mutansStreptococcus mutans and Lactobacillus acidophilus dual-species biofilms on the human enamel disks, they were divided into 11 groups (n = 9): Control (0.9 % saline), PC, TBO, FV, and TiF4 alone, PC and TBO in combination with a 635 nm diode laser (PDT treatment), PC-PDT+ (PC + FV or TiF4 + 635 nm diode laser), and TBO-PDT+ (TBO + FV or TiF4 + 635 nm diode laser). After the treatment, crystal violet assay was performed to determine the reduction of cariogenic biofilms. Enamel remineralization changes were analyzed using energy dispersive X-ray spectroscopy (EDX) and field emission scanning electron microscopy (FESEM) for the calcium and phosphorus (Ca/P) ratio. RESULTS: Only TBO-PDT+ showed superior antibiofilm activity when TiF4 was applied. Furthermore, the highest Ca/P ratio was found after treatment of enamel surfaces with TiF4-TBO-PDT+. The FESEM images showed that the enamel disks treated with TiF4 plus TBO-mediated PDT exhibited surface coating. However, TiF4 plus PC-mediated PDT cannot repair demineralized enamel. CONCLUSIONS: These data suggest that TBO-PDT along with TiF4 can effectively reduce cariogenic biofilms and significantly remineralize enamel disks, opening new avenues in caries prevention.

Assessment of Remineralization Ability of Different Fluoride Varnishes on Artificial Enamel Lesion of Primary Teeth - A Comparative Study.

Aim: The current study's aim was to evaluate the potential of various fluoride varnishes to remineralize artificial enamel lesions on primary teeth. Materials and Methods: For the study, 90 deciduous molar teeth that were implicated for extraction were taken. A window region with a size of 3 × 3 mm was located in the middle of the tooth's coronal surface. The remaining portion was given a coat of nail polish and given time to dry. A demineralizing solution was used to create the artificial enamel lesion. The samples were randomized into three experimental groups at random, with 30 samples in each group. Group 1: Application of Clinpro White Varnish, Group 2: Application of Duraphat Varnish, and Group 3: Application of MI Varnish. After 14 days, samples from each group were examined under scanning electron microscopy at a magnification of 1000× to determine whether remineralization had occurred. Microhardness was also determined using a microhardness tester. Result: Before the intervention, the mean demineralized enamel lesion in the Clinpro White Varnish group was 134.44 ± 0.04, in the Duraphat Varnish group was 133.76 ± 0.12, and in the MI Varnish group was 133.89 ± 0.08. After intervention, the maximum remineralized area was found in the MI Varnish group (82.74 ± 0.18) followed by the Clinpro White Varnish group (101.43 ± 0.16) and the Duraphat Varnish group (104.11 ± 0.10). After the intervention, there was a statistically significant difference found between the groups. After the intervention, the maximum microhardness mean value improved in the MI Varnish group (257.03 ± 1.09 to 261.18 ± 1.20) followed by Clinpro White Varnish (258.78 ± 1.64 to 260.10 ± 1.22) and Duraphat Varnish group (255.24 ± 1.51 to 258.02 ± 0.89). Conclusion: According to the findings of the current investigation, all of the varnishes utilized in this in vitro experiment are capable of correcting early enamel defects on primary teeth. However, MI Varnish group was very effective compared to the Clinpro White Varnish group and the Duraphat Varnish group.

Antibacterial activities of phytochemicals against Porphyromonas gingivalis with and without experimental fluoride varnish for periodontal disease prevention.

We aimed to evaluate the antibacterial activity of phytochemicals with or without an experimental fluoride varnish against Porphyromonas gingivalis. Five phytochemicals, chrysophanol (CHR), emodin (EMO), anthrarufin (ANT), bavachalcone (BCC), and isobavachromene (IBC), were tested using agar diffusion, minimal inhibition concentration (MIC), and minimum bacterial concentration (MBC) assays. We also assessed the cell viability and cytotoxicity of phytochemicals. All phytochemicals showed clear inhibition zones in the agar diffusion test. The inhibition zones of all phytochemical-containing fluoride varnishes were similar to or larger than that of the positive control, excluding that of 1 mM EMO. With or without the fluoride varnish, BCC exhibited the lowest MIC and MBC levels. Cell viability was high in the presence of all phytochemicals except 200 µM EMO. In conclusion, BCC was most effective as a phytochemical alone, while all phytochemical-containing fluoride varnishes inhibited P. gingivalis growth without cytotoxicity.

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.

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.

The effect of fluoride varnish application on colour change due to paediatric drug usage in polyacid-modified composite resin: an in vitro study.

OBJECTIVE: Colour stability is important in the long-term aesthetic success of restorative materials and is affected by both internal and external factors. Internal discolourations are due to the properties of the restorative materials. External discolourations can be associated with frequent consumption of food and beverages and the use of suspensions or syrups containing colourants/additives. Fluoride varnish application has an important place in preventive dentistry. The purpose of the research was to examine the protective effect of fluoride varnish application on the colour change on polyacid-modified composite resin restorative materials caused by the use of various paediatric drugs. METHODS: Two hundred ten discs were prepared from polyacid-modified composite resin material and divided into two groups: flouride varnish was applied to one group and flouride varnish was not applied to the other group. The groups were further divided into seven subgroups and the samples were kept in artificial saliva, amoxicillin + clavulanic acid, cefuroxime axetil, clarithromycin, paracetamol, ibuprofen, and iron supplement drug solutions. The colour change values of the discs were measured using a spectrophotometer device before immersion in the drug solutions and on the 7th, 14th, 21st, and 28th days after the immersion. The obtained data were calculated and statistically evaluated using IBM SPSS V23 software. RESULTS: It was found that the application of fluoride varnish in the iron supplement drug group prevented the colour change of the polyacid-modified composite resins for 28 days. In the amoxicillin + clavulanic acid, cefuroxime axetil, and paracetamol groups, the fluoride varnish did not prevent colour change in the polyacid-modified composite resin restorative materials at the end of the 14th day. CONCLUSION: It is thought that fluoride varnish application may be beneficial as a preservative in the colour change of polyacid-modified composite resins due to the use of various paediatric drugs, and this protective feature may be effective for a specific period of time.

Using sequential applications of a novel silver diamine fluoride gel and sodium fluoride varnish to arrest severe early childhood caries lesions: A clinical trial with single group assignment.

BACKGROUND: Silver diamine fluoride (SDF) gel was developed to overcome the clinical limitations of liquids with children. The authors conducted a clinical trial to determine caries lesion arrest in primary teeth at 1-year follow-up when 38% SDF gel and 2.5% sodium fluoride varnish were applied sequentially at the same appointment. Parent satisfaction was assessed. METHODS: The study design was an open-label prospective, clinical trial with single group assignment. Participants were 237 children aged 3 through 4 years at enrollment and from 5 centros educativos iniciales (preschools). Eligible children had 1 or more d3 (cavitation into dentin) active caries lesions. Teeth with active caries lesions (cavitation confined to enamel [d2] or d3) were treated by applying 1 or 2 drops of viscous 38% SDF gel (Advantage Silver Dental Arrest Gel, Elevate Oral Care, LLC) dabbing the excess with cotton. Treated teeth were covered with 2.5% sodium fluoride varnish (Fluorimax, Elevate Oral Care, LLC) to mask the taste. Treatment was repeated at 5 months postexamination. The primary outcome was caries lesion (d2-d3) arrest at 1 year. RESULTS: Two hundred nineteen children were available at the 1-year follow-up. There was a median of 21 (interquartile range [IQR], 13-34) active carious surfaces (d2-d3) at baseline. Median arrested carious surfaces was 92.6% (IQR, 81.1%-100.0%; 95% CI, 86.8% to 95.2%). When parents were asked whether they were bothered by the color change of teeth, the median response on a 10-point scale in which 1 equaled not bothered at all and 10 equaled very bothered was 1.0 (IQR, 1.0-2.0). CONCLUSIONS: Two applications of 38% SDF gel and 2.5% sodium fluoride varnish arrested greater than 90% of carious surfaces at 1 year and with high levels of parental satisfaction. PRACTICAL IMPLICATIONS: Combined treatment was highly efficacious in a population with many caries lesions. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT05395065.

Comparison of the effects of fluoride varnish containing silver nanoparticles and conventional fluoride varnish on the surface microhardness of tooth enamel.

BACKGROUND: Nano-silver fluoride (NSF) has been introduced to improve enamel lesions. The effective use of varnishes is important in the prevention of dental caries. OBJECTIVES: The study aimed to compare the effect of conventional sodium fluoride varnish with the same varnish containing 1% and 2% silver nanoparticles (AgNP) on the surface microhardness of enamel. MATERIAL AND METHODS: The baseline surface microhardness of 40 premolar teeth was measured using a Vickers microhardness tester. After immersing the samples in a demineralizing agent for 24 h, the microhardness was measured again. In group B, a layer of conventional fluoride varnish was applied to the tooth surfaces using a microbrush with soft bristles, following the manufacturer's instructions. Groups C and D were treated with 1% and 2% NSF varnishes, respectively, while group A received no varnish. Surface microhardness tests were conducted on all specimens, including those previously tested. RESULTS: The microhardness of the enamel surface increased significantly in all 3 test groups compared to the microhardness after demineralization (p < 0.05). CONCLUSIONS: Conventional fluoride varnish and fluoride varnishes containing 1% and 2% AgNP are equally effective in remineralizing initial caries.

Fluoride-amorphous calcium phosphate and biomimetic nano-hydroxyapatite for enamel remineralization: An in-vitro study of surface microhardness and composition.

AIM: Fluoride-Amorphous Calcium Phosphate and Biomimetic Nano-Hydroxyapatite for Enamel Remineralization; An In-Vitro Study of Surface Microhardness and Composition. MATERIAL AND METHODS: Ninety-six extracted human premolars with sound buccal surface were divided using a randomization computer-generating software into four groups; Group I (control) sound untreated enamel, Group II (demineralized) demineralized to create white spot lesions, Group III (biom-n-HA) demineralized and then treated with biomimetic nanohydroxyapatite cream, and Group IV (F-ACP) demineralized and then treated using Fluoride-Amorphous Calcium Phosphate varnish. Each group was divided into two subgroups; subgroup "A" evaluated for mineral content using energy dispersive x-ray spectroscopy (EDX) and for surface microhardness using the Vickers microhardness test and Subgroup "B" evaluated for white spot lesion depth using a polarized light microscope (PLM). RESULTS: The highest microhardness (VHN) was found in the (F-ACP) group (mean=428.61±54.43) and then in the (Biom-n-HA) group (mean=408.11±70.16) followed by the (Control) group (mean=402.13±53.40) with no significant difference between them and finally in the significantly different (Demineralized) group (mean=256.99±45.83). The weight percentage of Ca (30.29±1.04 and 33.44±1.07) and Ca/P ratio (1.87±0.06 and 2.03±0.05) were significantly different between Group III and Group IV respectively. PLM measurements in Group II (198.83µm), Group III (60.17µm), and Group IV (26.33µm) were significantly different. CONCLUSIONS: Both the (Biom-n-HA) cream and the (F-ACP) varnish showed promising results for enamel remineralization. The increased enamel surface microhardness was consistent with the mineral content and the changes in the birefringence.