A scoping review of the influence of clinical contaminants on bond strength in direct adhesive restorative procedures.

OBJECTIVE: Clinical contamination during direct adhesive restorative procedures can affect various adhesive interfaces differently and contribute to bulk failure of the restorations. This review aims to summarise the current knowledge on the influence of a variety of clinical contaminants on the bond strength at various adhesive interfaces during adhesive restorative procedures and identify gaps in the literature for future research. DATA AND SOURCES: An electronic database search was performed in PubMed and EMBASE to identify articles that investigated the influence of contaminants on direct restorative bonding procedures. A data-charting form was developed by two researchers to capture the key characteristics of each eligible study. STUDY SELECTION: The initial search yielded 1,428 articles. Fifty-seven articles published between 1 Jan 2007 and 25 Oct 2023 were included in the final review. Thirty-three of the articles examined the influence of saliva contamination, twelve articles examined the influence of blood contamination, and twenty-five articles examined the influence of other contaminants. CONCLUSION: Saliva contamination exerted less influence on the decrease in bond strength when self-etch systems were used, compared to when etch-and-rinse systems were used. Blood contamination adversely affected the bond strength at the interface between resin composite and dentine, and resin composite and resin-modified glass ionomer cement. Treating contaminated surfaces with water spray for 10-30 s followed by air drying could be effective in recovering bond strength following saliva and blood contamination. CLINICAL SIGNIFICANCE: This scoping review provides a valuable overview of the range of potential clinical contaminants that can influence the bond strength between different interfaces in direct adhesive restorative procedures. Additionally, it identifies potential decontamination protocols that can be followed to restore and enhance bond strength.

Remineralization potential of dentifrices with calcium sodium phosphosilicate and functionalized tri-calcium phosphate in the deeper incipient carious lesions: An in vitro study.

OBJECTIVES: This study evaluated the remineralization potential of calcium sodium phosphosilicate and functionalized tri-calcium phosphate (f-TCP) dentifrices in deeper incipient carious lesions (ICLs). MATERIALS AND METHODS: Artificial ICLs were created by placing premolars into demineralizing solutions. Teeth were randomly assigned into four groups: calcium sodium phosphosilicate (Group 1), f-TCP (Group 2), 1450 ppm fluoride (Group 3), and distilled water (Group 4), which were subjected to 10-day pH cycling. Mineral density (MD) was assessed using microcomputed tomography (Micro-CT), while hardness (H) and elastic modulus (EM) were assessed using nanomechanical testing. RESULTS: MD % gain was higher in Groups 1-3 than in Group 4. In addition, Groups 1 and 2 exhibited significantly higher MD % gain than Group 3. Also, Groups 1-3 showed significantly higher EM and H values than Group 4 in the outer enamel area; yet, Groups 1 and 2 displayed significantly higher EM and H values than Groups 3 and 4 in the inner enamel. CONCLUSIONS: The MD, EM, and H of ICLs significantly increased with the addition of calcium sodium phosphosilicate or f-TCP to fluoridated dentifrices compared to standard fluoride dentifrices. The added active ingredients remineralized the deeper parts of the ICLs, while remineralization at the lesion surface was similar between tested dentifrices.

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 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 1.2-1.4. 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.

A Comparison of the Enamel Remineralisation Potential of Self-Assembling Peptides.

BACKGROUND: The aim of this research was to compare the efficacy of the remineralising potential of self-assembling peptides (SAPs): Curodont Repair (P11-4), P26, and leucine-rich amelogenin peptides (LRAP) with the standard 5% NaF varnish (Duraphat) on early enamel caries lesions (EECLs). METHODS: A demineralising solution (DS) was used to create artificial EECLs in human dental enamel specimens, which were randomly allocated to treatment groups: P11-4; P26 solution; LRAP solution; 5% NaF varnish; and deionised water (DIW). Each specimen was subjected to 8 days of pH cycling. Specimens from each test group were subjected to microcomputed tomography (micro-CT) and nanomechanical testing to assess mineral density (MD), hardness (H), and elastic modulus (EM) properties of sound, demineralised, and treated enamel. RESULTS: The mean MD percentage gain was highest in the P26 and P11-4 groups, followed by the LRAP, 5% NaF varnish, and DIW groups. There were statistically significant differences amongst groups. In the outer layer of EECLs, the EM and H were highest in P26 and P11-4 groups, followed by the LRAP and 5% NaF varnish. In the inner layer of EECLs, the EM and H were highest in P11-4 and P26 groups, indicative of enhanced penetration and remineralisation of the deeper parts of the artificial EECLs. CONCLUSIONS: P26 and P11-4 SAPs are more effective than 5% NaF varnish in remineralising the depth of EECLs.

Potential Beneficial Effects of Hydroxyapatite Nanoparticles on Caries Lesions In Vitro-A Review of the Literature.

Dental caries is one of the most common human diseases which can occur in both primary and permanent dentitions throughout the life of an individual. Hydroxyapatite is the major inorganic component of human teeth, consequently, nanosized hydroxyapatite (nHAP) has recently attracted researchers' attention due to its unique properties and potential for caries management. This article provides a contemporary review of the potential beneficial effects of nHAP on caries lesions demonstrated in in vitro studies. Data showed that nHAP has potential to promote mineralization in initial caries, by being incorporated into the porous tooth structure, which resulted from the caries process, and subsequently increased mineral content and hardness. Notably, it is the particle size of nHAP which plays an important role in the mineralization process. Antimicrobial effects of nHAP can also be achieved by metal substitution in nHAP. Dual action property (mineralizing and antimicrobial) and enhanced chemical stability and bioactivity of nHAP can potentially be obtained using metal-substituted fluorhydroxyapatite nanoparticles. This provides a promising synergistic strategy which should be explored in further clinical research to enable the development of dental therapeutics for use in the treatment and management of caries.

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.

A comparative study of two chemical models for creating subsurface caries lesions on aprismatic and prismatic enamel.

PURPOSE: To investigate the mineral density and lesion depth of artificial caries lesions on aprismatic enamel and prismatic enamel created by lactic acid and acetic acid buffers. METHODS: Forty bovine enamel blocks were allocated to: aprismatic enamel (Group A) and prismatic enamel (Group C) in acetic acid buffer for 192 h and aprismatic enamel (Group B) and prismatic enamel (Group D) in lactic acid buffer for 96 h. The mineral loss and lesion depth were measured using micro-computed tomography. RESULTS: A significant difference (P = 0.01) was observed in the mineral loss (%) in the lesions on aprismatic enamel and prismatic enamel treated with lactic acid buffer while no significant difference (P = 0.51) was observed in the mineral loss (%) in the lesions on aprismatic enamel and prismatic enamel treated with acetic acid buffer. No significant difference was noted in the mean lesion depth of lesions on aprismatic enamel and prismatic enamel treated with acetic acid and lactic acid buffers (P > 0.05). CONCLUSION: Aprismatic enamel and prismatic enamel have similar mineral loss in acetic acid while prismatic enamel showed more mineral loss compared to aprismatic enamel in lactic acid.

Does Early Childhood Caries Increase Caries Development among School Children and Adolescents? A Systematic Review and Meta-Analysis.

The aim of this paper is to systematically review the literature to determine whether early childhood caries (ECC) is significantly associated with caries development in permanent teeth among school children and adolescents, and to identify the association of other risk factors over 24 months. A systematic literature search was performed in four electronic databases and via a manual search from inception to 28 July 2022. Independent study selection and screening, data extraction, evaluation of risk of bias using ROBINS-I tool and certainty of evidence with GRADE were performed. Ten cohort studies were included, all of which identified that ECC significantly increased the risk of caries in permanent teeth. Meta-analysis suggested children with ECC were three times more likely to develop caries in their permanent teeth (OR, 3.22; 95% CI 2.80, 3.71; p < 0.001), especially when the lesions were in primary molars and progressed to dentine. However, the certainty of evidence was substantially compromised by serious risk of bias and inconsistency between studies. There were inconsistent findings between socioeconomic or behavioural factors on caries development, which could not be pooled for meta-analyses. ECC significantly increases the likelihood of caries development in permanent teeth. Evidence on the association of socioeconomic and oral health behavioural factors is weak.

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.

Validation of clinical photography and a laser fluorescence device for assessment of enamel demineralization during multi-bracketed fixed orthodontic treatment.

AIM: To compare the validity of DIAGNOdent pen™ 2190 and clinical photographs in the diagnosis (presence or absence) and assessment of white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment. METHODS: A total of 1607 readings from 99 patients were obtained using DIAGNOdent pen™ 2190, clinical photographs, and visual assessment criteria to assess WSLs at 6 -, 12- and 18 months after bonding of brackets. Receiver operating characteristic curves were constructed, and areas under the curve (AUC) were calculated to assess the presence or absence of WSLs and distinguish the severity of WSLs as slight or severe. Sensitivities, specificities, and AUC were calculated for outcomes at an alpha of 0.05 and 95% confidence intervals (CIs). RESULTS: The values of sensitivity and specificity of DIAGNOdent pen™ 2190 were found to be 0.78 and 0.83, respectively, to distinguish presence/absence of WSLs with good accuracy (AUC= 0.855; 95% CI: 0.820-0.889) and for digital photographs, accuracy was excellent (AUC= 0.973, 95% CI: 0.956-0.991) with sensitivity and specificity of 0.96 and 0.99, respectively. However, the accuracy of DIAGNOdent pen™ 2190 was poor (AUC= 0.543, 95% CI: 0.418-0.668) in delineating slight and severe WSLs with a sensitivity of 0.31 and specificity of 0.83; while the values of sensitivity and specificity for distinguishing slight or severe lesions for clinical photographs were 0.96 and 0.99, respectively with excellent accuracy (AUC=0.978, 95% CI: 0.936-1.000). CONCLUSIONS: Clinical photographs had better validity than DIAGNOdent pen™ 2190 in diagnosis and assessment of severity of demineralized lesions during multi-bracketed fixed 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.

Bonding Universal Dental Adhesive to Developmentally Hypomineralised Enamel.

PURPOSE: To investigate the effect of pretreatment protocols involving Papacarie Duo gel and Scotchbond Universal (SU) on the microshear bond strength (µSBS) of resin composite (RC) to hypomineralised enamel (HE). MATERIALS AND METHODS: Specimens of normal enamel (NE) and HE were derived from extracted hypomineralised first permanent molars (FPMs). Based on the colour of demarcated opacities, HE specimens were classified as creamy/white (CW) or yellow/brown (YB). The specimens were randomly allocated into eight groups (n = 20). Each group involved pretreatment with Papacarie Duo gel or no pretreatment, and SU applied in etch-and-rinse (E&R) or self-etch (SE) mode. All specimens were bonded with RC and subjected to µSBS testing. Failure modes were analysed using an optical microscope and SEM. RESULTS: Comparing NE with HE, the following factors were found to be significant (p < 0.001): type of enamel substrate, deproteinising pretreatment, and etching mode. Comparing CW HE with YB HE, a significant interaction between "deproteinising pretreatment" and "etching mode" was demonstrated (p = 0.028). When subjected to the concurrent use of Papacarie Duo gel and phosphoric acid etching, HE specimens showed a significant increase in µSBS (p < 0.001). CONCLUSION: Deproteinising pretreatment using Papacarie Duo gel followed by the application of SU in E&R mode led to increased µSBS of resin composite to HE.

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.

Combined effect of arginine and fluoride on the growth of Lactobacillus rhamnosus GG.

The objectives of the in vitro study were: (1) to investigate the effect of combining L-arginine (Arg) and NaF on the growth of Lactobacillus rhamnosus GG (LRG); and (2) to identify an optimum synergistic concentration for the synbiotic (Arg + LRG)-fluoride (SF) therapy. 1% Arg + 2000-ppm NaF (A-SF) and 2% Arg + 2000-ppm NaF (B-SF) demonstrated antagonism against LRG (FIC > 4.0). Both XTT (2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide) and WST-8 (2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H-tetrazolium, monosodium salt) assays showed that A-SF and B-SF enhanced the growth of LRG when compared to 2000-ppm NaF and LRG control. Colony forming units, bacterial weight, and biofilm thickness of A-SF and B-SF were significantly higher than 2000-ppm NaF and LRG control. Biofilm imaging depicted that 2000-ppm NaF inhibited biofilm formation; while 1%/2% Arg, A-SF, and B-SF increased biofilm growth of LRG. Lactic acid formation was the lowest for 2000-ppm NaF, followed by A-SF and then B-SF. The SF buffer potential after 24 h was the highest for B-SF, and then A-SF. Biofilm pH for B-SF was closest to neutral. Fluoride, Arg and LRG bioavailability remained unaffected in B-SF. The relative gene expression for arcA, argG, and argH was significantly higher for B-SF than the respective controls. In conclusion, combining 2% Arg, 2000-ppm NaF, and LRG provides an optimum synbiotic-fluoride synergism.

Enamel remineralization potential of arginine-fluoride varnish in a multi-species bacterial pH-cycling model.

OBJECTIVES: To examine the enamel fluoride uptake and remineralization potential of arginine-fluoride (Arg-NaF) varnishes in a simulated clinical condition using a multi-species bacterial pH-cycling model. METHODS: L-Arginine (at 1 %, 2 %, and 4 % by wt.) was incorporated in a 5 % NaF varnish. Experimental and control groups were: 1 % Arg-NaF; 2 % Arg-NaF; 4 % Arg-NaF; NaF and no treatment. Artificial incipient caries-like lesions were formed on 30 enamel specimen blocks (n = 6). The specimens underwent multi-species bacterial pH-cycling in an artificial mouth system using oral biofilm reactor for 72 h after treatment. The specimens were evaluated for mineral density using micro-CT, Ca/P ratio with SEM-EDX, enamel fluoride uptake (EFU) and plaque fluoride uptake (PFU). RESULTS: Increasing concentrations of Arg in NaF varnish significantly increased the EFU of incipient caries-like lesions (p < 0.001). The PFU for 1 % Arg-NaF was significantly higher than 4 % Arg-NaF and the control NaF (p < 0.05). Post pH-cycling, Ca/P ratio with 1 %/2 % Arg-NaF was closest to hydroxyapatite (1.67). Mineral gain and % remineralization of 1 %/2 % Arg-NaF was significantly higher than the control NaF varnish (p < 0.05). CONCLUSION: The prebiotic L-arginine (at 1 %/2 % by wt.) in a 5 % NaF varnish enhanced the enamel fluoride uptake and remineralization potential of the conventional 5 % NaF varnish. CLINICAL SIGNIFICANCE: The Arg-NaF varnish addresses the limitations of fluorides on cariogenic biofilms. The Arg-NaF varnish appears a promising caries-preventive regimen that counters the pathogenic biofilms by Arg and promotes remineralization with fluorides. In high caries-risk patients, professional application of Arg-NaF varnish might aid to alleviate the global burden of dental caries.

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 .

Physicochemical Characteristics of Arginine Enriched NaF Varnish: An In Vitro Study.

The in vitro study objectives were to investigate the effect of arginine (Arg) incorporation in a 5% sodium fluoride (NaF) varnish on its physical and chemical properties including F/Arg release. Six experimental formulations were prepared with L-arginine (L-Arg) and L-arginine monohydrochloride at 2%, 4%, and 8% w/v in a 5% NaF varnish, which served as a control. The varnishes were subjected to assessments for adhesion, viscosity, and NaF extraction. Molecular dynamics were simulated to identify post-dynamics total energy for NaF=Arg/Arg>NaF/ArgArg concentration denotes the stabilized environment compared to NaF

Inter-method reliability for determining total and soluble fluorides in child low-fluoride formula dentifrices.

The study aimed to compare three methods for determining total (TF) and total soluble fluorides (TSF) in 5 child formula dentifrices (CFD) using Inter-method reliability (IMR) statistical approach. The methods were direct acid-hydrolysis (DM), the least-time-consuming method; Modified direct acid-hydrolysis with standard-addition method (MDM), ISO 19448:2018 method; and modified Taves acid-HMDS diffusion analysis (TAD), the claimed gold standard method. A significant difference in the mean difference was observed for all methods at all levels (p < 0.001), except DM and TAD for TF (p = 0.622). A proportional bias was discerned in the agreement distribution between DM and TAD for TF (p < 0.001). The ICC analysis identified significant reliability between all measurements, irrespective of the model, measure, and fluoride type (p < 0.001). For TF and TSF, the IMR between DM and TAD was lower than MDM and TAD for consistency/absolute agreement reliability at single/average measures. The reliability measure for DM and MDM was higher than MDM and TAD for TSF, but was lower than MDM and TAD for TF. The ICC measure for DM-TAD was significantly lower than DM-MDM and MDM-TAD (p < 0.05). The ISO 19448:2018 MDM is a reliable test that can be used as an alternative to TAD/DM for determining TF/TSF in CFD.

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.