Efficacy of 30% and 38% Silver Diamine Fluoride in Arresting Caries Lesions After Different Application Times: An in Vitro Study

Abstract Objective: To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dentin caries lesions when applied under different concentrations and times. Material and Methods: Forty-two bovine blocks were selected and fixed in 24-well plates. Each well received a mixed bacterial inoculum added to the culture medium with 5% sucrose. The plates were incubated in microaerophilia (7 days) for caries formation, confirmed by micro-CT (M1). SDF was applied over the carious lesions for different times and concentrations (n=6): SDF 30% - immediate removal, 1 minute and 3 minutes; SDF 38%, - immediate removal, 1 minute and 3 minutes. The group without treatment was the control. Then, the samples were again scanned by micro-CT (M2) and submitted to a second cariogenic challenge for 21 days. Then, a final scan was performed (M3). Results: Mean pH at the culture medium and lesion depth were compared using Kruskal-Wallis and Wilcoxon tests. 38% SDF showed the lowest metabolic activity of the biofilm. All 38% groups and 30% 1 and 3 minutes did not show an increase in mean lesion depth comparing M3 with M1. However, only 30% 3 minutes and 38% 1 and 3 minutes showed a significant reduction of lesion depth. Conclusion: The minimum application time of 30% SDF to arrest dentin caries lesion was 1 minute, while 38% SDF arrested with application and immediate removal.

Oral Health-Related Quality of Life in Preschool Children After Silver Diamine Fluoride Versus Atraumatic Restorative Treatments.

Purpose: The purpose of this study was to evaluate the oral health-related quality of life (OHRQoL) of preschoolers before (T1), 15 days (T2), and three months (T3) after carious lesion treatments using 30 percent silver diamine fluoride (SDF, N equals 59) and atraumatic restorative treatment (ART, n equals 59). Methods: Data about sociodemographic aspects and OHRQoL through the Early Childhood Oral Health Impact Scale questionnaire (B-ECOHIS) were collected between 2016 and 2019. Total B-ECOHIS, impact on children (CIS), and family (FIS) values were used. The Mann-Whitney test compared these values, and the effect size (ES) of treatments was also calculated. Results: Toothache and upset/ guilty parents were the most reported impacts on T1. Total B-ECOHIS did not statistically vary between girls and boys or children older or younger than four years old, and socioeconomic status was not a factor either. Total B-ECOHIS, their impacts, and subscales were higher in children with high decayed, missing, and filled primary teeth (dmft) scores (P<0.05). SDF and ART did not vary among B-ECOHIS, CIS, and FIS at any time (P>0.05). Total B-ECOHIS decreased for both treatments (P<0.05). The ES was moderate for children in T2 and T3, considering all treatments, while for families the ES was moderate at T2 and small/moderate at T3 after treatment with SDF and ART, respectively. Conclusion: Treatments with 30 percent silver diamine fluoride or atraumatic restorative treatment improved the oral health-related quality of life of preschoolers, with no variation among those treated.

Eficácia do diamino fluoreto de prata em paralisar lesões de cárie em dentina: ensaios laboratorial e clínico controlado e randomizado / Efficacy of silver diamine fluoride in arresting dentin caries lesions: controlled randomized clinical tria

Este estudo objetivou: (1) investigar a eficácia in vitro do diamino fluoreto de prata (DFP) em paralisar lesões de cárie em dentina após diferentes concentrações e tempos de aplicação; (2) comparar o impacto do DFP e do tratamento restaurador atraumático (TRA) na qualidade de vida relacionada à saúde bucal (QVRSB) de préescolares; e (3) avaliar a eficácia do DFP comparado ao TRA, em paralisar lesões de cárie, por meio de um ensaio clínico controlado e randomizado após 2 anos de acompanhamento. Para o objetivo 1, blocos de dentina (n=42) foram fixados em placas de poliestireno. Um inóculo bacteriano misto (1,5x108 UFC/mL) foi adicionado ao meio de cultura com sacarose 5%, contido nas placas, que foram incubadas para a formação de biofilme. As amostras foram escaneadas em micro CT (M1) e tratadas com DFP de acordo com os grupos (n=6): DFP 30%, aplicação imediata; DFP 30%, 1'; DFP 30%, 3'; DFP 38%, aplicação imediata; DFP 38%, 1'; DFP 38%, 3'. Um grupo controle, sem tratamento, também foi preparado. Após o escaneamento (M2), os blocos foram submetidos a um desafio cariogênico (21 dias) e novamente escaneados (M3). O pH do meio de cultura e a profundidade das lesões inter e intra grupos foram comparados pelos testes de Kruskal-Wallis e Wilcoxon. Para os objetivos 2 e 3, préescolares com ao menos uma lesão de cárie ativa na oclusal de seus molares decíduos foram randomicamente alocados em dois grupos: DFP e TRA. Os índicesceo-d/CPO-DICDAS foram usados para detecção da presença e atividade de cárie. O B-ECOHIS foi usado para avaliar a QVRSB antes (M1), 15 dias (M2) e 3 meses (M3) após os tratamentos. O sucesso clínico foi avaliado após 6, 12, 18 e 24 meses. Foram ainda avaliados: tempo do procedimento, efeitos adversos/percepção estética e ansiedade. No estudo in vitro, em M1 e M2, não houve diferença na profundidade das lesões entre os grupos (p>0,05). Em M3, o DFP 38% apresentou menor pH do biofilme e os grupos que receberam aplicação por 1' e 3', em ambas as concentrações, não apresentaram aumento na profundidade da lesão em relação ao M1. DFP e TRA não diferiram quanto ao B-ECOHIS total, CIS e FIS em M2 e M3 e o B-ECOHIS total diminuiu de M1 para M2 e M3 em ambos os grupos (p<0,05). Após 2 anos, não houve diferença entre os tratamentos quanto à paralisação da cárie (p=0,072) e o tempo de tratamento para o DFP foi menor (p<0,001). Não houve diferença entre os grupos quanto aos efeitos adversos/percepção estética observados pelo operador (p=0,816) e pelos pais (p=1,000). A ansiedade não mudou após os tratamentos (p=0,583). Assim, o tempo mínimo de aplicação do DFP 30% para paralisar lesões de cárie foi de 1', enquanto o 38% paralisou com aplicação imediata, in vitro. Tanto o DFP quanto TRA melhoraram a QVRSB dos pré-escolares, sem diferença entre eles. Ainda, o DFP mostrou-se semelhante ao TRA na paralisação de cárie, ansiedade e efeitos adversos, requerendo menor tempo de cadeira. (AU)

This study aimed to: (1) investigate the in vitro efficacy of silver diamine fluoride (SDF) in arresting dentin caries lesions after different concentrations and application times; (2) compare the impact of SDF and atraumatic restorative treatment (ART) on the oral health-related quality of life (QHRQoL) in preschoolers; and (3) to evaluate the effectiveness of SDF compared to ART, in arresting caries lesions, through a controlled randomized clinical trial after 2 years of follow-up. For objective 1, dentin blocks (n=42) were fixed in polystyrene plates. A mixed bacterial inoculum (1.5x108 CFU/mL) was added to the culture medium with 5% sucrose, in the plates; that were incubated for biofilm formation. The samples were scanned on micro CT (M1) and treated with SDF according to the groups (n=6): SDF 30%, immediate application; SDF 30%, 1'; SDF 30%, 3'; SDF 38%, immediate application; SDF 38%, 1'; SDF 38%, 3'. A control group, without treatment, was also prepared. After scanning (M2), the blocks were submitted to a cariogenic challenge (21 days) and scanned again (M3). The pH of the culture medium and the depth of lesions between and within the groups were compared using the Kruskal-Wallis and Wilcoxon tests. For objectives 2 and 3, preschoolers with at least one active caries lesion on the occlusal surface of their primary molars were randomly allocated into two groups: SDF and ART. The indexes dmft/DMFT and ICDAS were used to detect the presence and activity of caries. B-ECOHIS was used to assess the QHRQoL of children before (M1), 15 days (M2) and 3 months (M3) after treatments. Clinical success was assessed after 6, 12, 18 and 24 months. Were also evaluated: time of the procedure, adverse effects/aesthetic perception and the child's anxiety. In the in vitro study, in M1 and M2, there was no difference in the depth of the lesions between the groups (p>0.05). In M3, SDF 38% had a lower pH of the biofilm and the groups that received application for 1' and 3', in both concentrations, did not present an increase in the depth of the lesion in relation to M1. SDF and ART did not differ in total B-ECOHIS, CIS and FIS in M2 and M3; and the total B-ECOHIS decreased from M1 to M2 and M3 for both groups (p<0.05). After 2 years, there was no difference between treatments regarding caries arrest (p=0.072) and the treatment time for SDF was shorter (p<0.001). There was no difference regarding the adverse effects/aesthetic perception observed by the operator (p=0.816) and reported by the parents (p=1.000), according to the groups. Anxiety did not change either before or after treatments (p=0.583). Thus, the minimum time of application of SDF 30% to arrest dentin caries was 1', while SDF 38% arrested with immediate application, in vitro. Both SDF and ART improved the QHRQoL of preschoolers, with no difference between them. Still, SDF was similar to ART in arresting caries, anxiety and adverse effects, requiring less chair time. (AU)

Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of preschool children: A 12-months parallel randomized controlled clinical trial.

OBJECTIVES: This clinical trial investigated the efficacy of silver diamine fluoride (SDF) in arresting dentine caries in primary molars of preschoolers. Time required for treatment, adverse effects, parental aesthetic perception, anxiety and oral health related to quality of life (OHRQoL) was evaluated. MATERIALS AND METHODS: Children, 2-5 years old, with active dentine caries lesions on the occlusal surface of primary molars were randomly allocated to test group (SDF) or control group (atraumatic restorative treatment/ART). The dmf-t/DMF-T and ICDAS indexes determined the presence of caries and activity. The main outcome after 3, 6 and 12-month follow-up was assessed by a blind examiner. The time required to perform the treatments was recorded and a facial image scale was applied to assess anxiety before and after treatment. Adverse events and aesthetic perception were assessed through questions addressed to caregivers; and the OHRQoL through the B-ECOHIS questionnaire. RESULTS: In 68 patients that were randomized, the mean number of treated teeth per child was 2.42(1.04) and 2.09(1.18) in the SDF and ART groups (p = 0.074), respectively. The mean difference of arrested lesions between the groups after 12 months was -0,07(0.05; - 0.17-0.30). The time required to treat with SDF was lower than the ART (p < 0.001). There was no difference in the percentage of adverse events + aesthetic perception (p = 0.709), and the change in anxiety (p = 0.155). There was a less impact in OHRQoL after ART treatment, but only when the parents' distress subscale was considered (p = 0.012). CONCLUSION: SDF requires much less chair-time and have similar results as ART in arresting caries lesion, anxiety, adverse effects, aesthetic perception and quality of life.

Direct bonded space maintainer: an alternative in clinical practice after unilateral premature loss of posterior primary tooth

Introduction: The primary dentition is extremely important, because besides the importance during chewing, acts as a guide to eruption for permanent teeth, stimulates the bone growth and helps in digestion and phonation. In cases of premature loss, it is necessary that the professional make adequate planning to space maintenance, so that it is not lost until the eruption of the permanent successor, thus avoiding the establishment of malocclusions. Objective: To describe the clinical steps for preparation and placement of a direct bonded space maintainer, as well as the follow-up until the eruption of the successor tooth. Case report: Girl, eight years old, presented an adjacent fistula to theprimary mandibular right second molar. After clinical and radiographic evaluation, tooth extraction was indicated, due to the impossibility of performing the endodontic treatment. A direct bonded space maintainer was made and installed as an alternative to the band and loop, commonly used in these cases of unilateral loss. Conclusion: The direct bonded space maintainer was a good option for the case presented, as it was able to fulfill its function until the eruption of the successor tooth. It is a good alternative in clinical practice due to the time optimization and material savings it provides.

Introdução: A dentição decídua é de extrema importância, pois exerce função mastigatória, atua como guia de erupção para os dentes permanentes, estimula o crescimento ósseo e auxilia na digestão e fonação. Em casos de perda prematura de algum dente, é necessário que o profissional faça um planejamento adequado para manutenção do espaço, de forma que este não seja perdido até a erupção do sucessor permanente, evitando assim o estabelecimento de más-oclusões. Objetivo: Descrever as etapas clínicas para confecção e instalação do aparelho mantenedor de espaço adesivo, bem como o acompanhamento até a erupção do sucessor. Relato do caso: Menina, 8 anos, apresentou fístula adjacente ao segundo molar inferior direito decíduo. Após avaliação clínica e radiográfica, foi indicada a exodontia do dente, devido à impossibilidade de realizar o tratamento endodôntico. Confeccionou-se e instalou-se o aparelho mantenedor de espaço adesivo, como uma alternativa ao banda-alça, comumente utilizado nesses casos de perda unilateral. Conclusão: O mantenedor de espaço colado foi uma boa opção para o caso apresentado, pois foi capaz de cumprir sua função até a erupção do dente sucessor, constituindo-se uma boa alternativa na prática clínica, devido à otimização do tempo e economia de material que proporciona.

Knowledge of paediatric patients and their guardians about mouth guards

Introduction: Mouth guards are devices used to prevent injuries during sports activities. Objective: The aim of this study is to evaluate the knowledge of paediatric patients and their guardians about mouth guards. Methods: Paediatric patients from 9 to 15 years old and their guardians who sought care in the Paediatric Clinic of the Dentistry School were invited to participate. Their knowledge about mouth guards was collected through a two-part questionnaire with open and closed ended questions. The first part of the questionnaire contained sociodemographic questions and a main question about what a mouth guard is. The second part was solely about mouth guards and was applied immediately after an explanation about mouth guards at the end of the first part. All data collected were tabulated and analysed descriptively. Results: A total of 122 guardians were interviewed; 39.3% had children who practised some type of sports activity and 32% reported a trauma episode. Most (54.9%) did not know what a mouth guard was but, after explanation, 57.4% had seen someone using one. A total of 33 paediatric patients were interviewed, 60.6% of whom practised some sport; 27.3% of these had already suffered some type of dental trauma during the activity. None of the interviewees used a mouth guard during their sports activity, although 97% believed that using a mouth guard was important and 78.8% believed that the protector did not interfere with the activity. Conclusion: Guardians and paediatric patients have little knowledge about mouth guards.

Introdução: Os protetores bucais são usados para prevenir lesões durante atividades esportivas. Objetivo: O objetivo deste estudo é avaliar o conhecimento sobre os protetores bucais dos pacientes pediátricos e seus responsáveis. Métodos: Pacientes pediátricos de 9 a 15 anos, que procuraram atendimento na Clínica Pediátrica da Faculdade de Odontologia e seus responsáveis foram convidados a participar. Seu conhecimento sobre protetores bucais foi coletado através de um questionário em duas partes com perguntas abertas e fechadas. A primeira parte do questionário continha algumas questões sociodemográficas e uma questão principal sobre o que é um protetores bucais. A segunda parte era apenas sobre protetores bucais e foi aplicada imediatamente após uma explicação sobre os protetores bucais no final da primeira parte. Todos os dados coletados foram tabulados e analisados de forma descritiva. Resultado: Um total de 122 guardiões foram entrevistados, 39.3% tiveram crianças que praticavam algum tipo de atividade esportiva e 32% relataram um episódio de trauma. A maioria (54.9%) não sabia o que é um protetor bucal, mas após a explicação, 57.4% tinham visto alguém usando um. Um total de 33 pacientes pediátricos foram entrevistados, 60.6% praticaram algum esporte e 27.3% deles já sofreram algum tipo de trauma dental durante a atividade. Nenhum dos entrevistados usa um protetor bucal durante a atividade esportiva, embora 97% acreditem que usar um protetor bucal é importante e 78.8% acreditam que o protetor não interfere com a atividade. Conclusão: Em conclusão, os guardiões e pacientes pediátricos têm pouco conhecimento sobre os protetores bucais.