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1.
Pediatr Dent ; 43(1): 17-23, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33662244

RESUMO

Purpose: Casein phosphopeptide amorphous calcium phosphate fluoride varnish (commercially available as MI Varnish®) is a promising minimally invasive remineralizing agent. The purpose of this study was to compare the effectiveness of intensive application of MI and sodium fluoride (commercially available as Duraphat Varnish®) varnishes on white spot lesion remineralization. Methods: This randomized controlled clinical trial included a sample of 44 healthy three- to five-year-old children with at least four active white spot lesions on their anterior primary teeth. They were allocated into two groups: either a test group (MI Varnish®) or a control group (Duraphat Varnish®). Each group received three consecutive varnish applications two weeks apart. Selected teeth were evaluated for lesion activity and change in DIAGNOdent™ readings at follow-up periods of six, 18, and 30 weeks. Results: Both groups showed a significant decrease in the mean oral hygiene debris index score at different follow-up periods compared to baseline (P<0.001). MI Varnish® intervention had a significantly decreased number of active lesions when compared to Duraphat Varnish®, at the 18 week time period. DIAGNOdent ™ scores were significantly reduced in the test group versus the control group at the 30 week assessment (P<0.001). Conclusion: MI Varnish® was more effective than Duraphat Varnish® in white spot lesions mineralization.


Assuntos
Caseínas , Cárie Dentária , Fosfatos de Cálcio , Cariostáticos/uso terapêutico , Criança , Pré-Escolar , Cárie Dentária/tratamento farmacológico , Cárie Dentária/prevenção & controle , Fluoretos , Fluoretos Tópicos , Humanos , Fosfopeptídeos , Fluoreto de Sódio , Remineralização Dentária , Dente Decíduo
2.
Pediatr Dent ; 43(1): 44-49, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33662250

RESUMO

Purpose: To determine the effect of a dental curing light on the penetration depth of silver diamine fluoride (SDF), dentin hardness, and silver and fluoride ion precipitation into cavitated carious lesions. Methods: SDF was applied on 16 primary incisors extracted due to caries extending into dentin. Teeth were divided into two groups: (1) control group, was not light-cured; and (2) test group, was light-cured. A scanning electron microscope, and OmniMet software were used to measure penetration depth, dentin hardness, and ion precipitation. Wilcoxon's ranksum test was used for statistical analysis. Results: All samples in both groups showed SDF penetration beyond the carious lesion and into sound dentin. The penetration depth into sound dentin was 70 µm further without the dental curing light it (P<0.001). Silver precipitation in infected dentin with the dental curing light was approximately 2.6 times greater than without it (P=0.02). Dentin hardness of infected dentin was 26 percent more with the dental curing light (P=0.04). Conclusions: Applying a dental curing light during silver diamine fluoride treatment of carious lesions induces more silver ion precipitation in infected dentin, increases its hardness, and, perhaps because more silver stays in the infected dentin, less SDF penetrates into sound dentin.


Assuntos
Luzes de Cura Dentária , Cárie Dentária , Cárie Dentária/terapia , Dentina , Fluoretos Tópicos , Humanos , Incisivo , Cura Luminosa de Adesivos Dentários , Compostos de Amônio Quaternário , Compostos de Prata
3.
Pediatr Dent ; 43(1): 57-61, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33662252

RESUMO

Purpose: The purpose of this study was to assess the effect of potassium iodide (KI) after applying silver diamine fluoride (SDF) on the staining of demineralized dentin covered or not by a composite resin layer. Methods: Dentin blocks from 30 bovine incisors were demineralized and randomly allocated in three groups (N equals 10): (1) control (no treatment); (2) treated with SDF; and (3) treated with SDF and KI. Half of the specimens of each group received a composite resin restoration immediately after treatment. A colorimetric evaluation, according to the CIE L*a*b* system, was performed at baseline and after seven, 14, 30, and 60 days. The ΔE data were analyzed using the generalized linear model (Δ equals 0.05). Results: The use of KI immediately after applying SDF decreased the dentin staining at all assessment times. SDF treatment only stained the dentin under composite resin after 60 days. The application of KI reduced the dentin under composite resin staining as ΔE values were similar to the control group even after 60 days. Conclusions: The use of potassium iodide minimizes the darkening of dentin and prevents the staining of the dentin under composite resin restorations in the long-term.


Assuntos
Dentina , Iodeto de Potássio , Animais , Bovinos , Resinas Compostas , Fluoretos Tópicos , Humanos , Compostos de Amônio Quaternário , Compostos de Prata
4.
Artigo em Inglês | MEDLINE | ID: mdl-33535581

RESUMO

(1) Background: The objective is to systematically review the evidence on intervention programs aiming at reducing inequality in dental caries among children. (2) Methods: Two independent investigators searched MEDLINE, Cochrane library, and Ovid up to December 2020 to identify intervention studies assessing the impact on socioeconomic inequalities in dental caries among children. The interventions included any health promotion/preventive intervention aiming at reducing caries among children across different socioeconomic groups. Comparison groups included children with alternative or no intervention. Cochrane criteria were used to assess interventional studies for risk of bias. (3) Results: After removal of duplicate studies, 1235 articles were retained. Out of 43 relevant papers, 13 articles were identified and used in qualitative synthesis, and reported quantifiable outcomes. The included studies varied in measurements of interventions, sample size, age groups, and follow-up time. Five studies assessed oral health promotion or health-education, four assessed topical fluorides, and four assessed water fluoridation. Interventions targeting the whole population showed a consistent reduction of socioeconomic inequalities in dental caries among children. (4) Conclusion: The quality of included papers was moderate. High heterogeneity did not allow aggregation of the findings. The overall findings suggest that whole population interventions such as water fluoridation are more likely to reduce inequalities in children's caries than target population and individual interventions.


Assuntos
Cárie Dentária , Criança , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Fluoretação , Fluoretos Tópicos , Promoção da Saúde , Humanos , Saúde Bucal
5.
Am J Dent ; 34(1): 44-48, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33544988

RESUMO

PURPOSE: To evaluate the effect of light cure, as well as various dentin surface treatment approaches, on the penetration depth of silver precipitating from 38% silver diamine fluoride into primary dentin tubules. METHODS: The occlusal dentin surfaces of 42 non-carious primary molars were exposed and then sectioned into halves bucco-lingually. The halves from each tooth pair were randomly split in two mega-groups, and each mega-group was divided randomly as follows into six experimental groups: prepared by either carbide bur (G1, G2), ceramic bur (G3, G4), or erbium laser (G5, G6). SDF was then applied to all prepared surfaces, and finally even-numbered groups (G2, G4, G6) were light cured. One mega-group was assigned to quantitative evaluation of silver penetration depth along the axial wall, and the other mega-group was reserved for qualitative observation of relative silver distribution on the occlusal surface, both via scanning electron microscope. RESULTS: No significant difference was observed in silver penetration depth between light cure and non-light cure groups (P= 0.8908). There was a statistically significant association between tooth preparation method and depth of silver penetration (P< 0.000001); laser-treated groups had significantly deeper silver penetration (1,148.9 µm G5, 1160.4 µm G6) than carbide bur (P< 0.05; 184.7 µm G1, 301.8 µm G2) or ceramic bur (P< 0.05; 184.1 µm G3, 131.0 µm G4) groups. A significant difference (P< 0.05) was noted in percentage occlusal surface coverage of particles between laser (51.4% G5, 35.8% G6) and carbide groups (21.1% G1, 19.3% G2). Light cure had no significant effect on the depth of silver penetration from 38% SDF in the dentin of primary teeth. Laser preparation resulted in deeper silver penetration than carbide or ceramic bur. CLINICAL SIGNIFICANCE: Exposure of 38% silver diamine fluoride-treated dentin to light cure did not affect the depth of penetration of silver particles into the dentin tubules of primary teeth. Rather, tooth preparation approaches that reduce the smear layer, like laser ablation, resulted in the deepest penetration of silver into the tubules. Clinical application of these findings will depend on scenario and treatment aim.


Assuntos
Luzes de Cura Dentária , Dentina , Fluoretos Tópicos , Cura Luminosa de Adesivos Dentários , Microscopia Eletrônica de Varredura , Compostos de Amônio Quaternário , Compostos de Prata , Dente Decíduo
6.
Am J Dent ; 34(1): 49-53, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33544989

RESUMO

PURPOSE: To compare the antimicrobial effect of treating dentin caries lesions with silver diamine fluoride (SDF) in different concentrations and chlorhexidine (CHX). METHODS: Children aged 7-10 years presenting one occlusal dentin carious lesion in primary molars were selected, totaling 40 teeth. The sample was randomly divided into four groups: (G1) 38%-SDF + potassium iodide (KI); (G2) 30%-SDF; (G3) 2%-CHX; and (G4) control group. After cleaning the cavity up to firm dentin, a sample of dentin from the pulp wall was collected; the cavity was then treated with the antimicrobial agent tested and, immediately after, another dentin sample was collected. Cavities were restored with high viscosity glass ionomer cement. Microorganisms were counted, and species from the Streptococcus genus were analyzed for susceptibility to antimicrobial agents. Shapiro-Wilk and Levene's tests were used to assess normality and homogeneity, respectively. Student's t-test, two-way ANOVA, and Bonferroni post-test were applied for multiple comparisons. RESULTS: For the overall microorganisms count, it was observed that G1 and G2 presented a statistically lower number of microorganisms following treatment in comparison to G3 and G4 (P< 0.05). When analyzing the Streptococcus spp. and Enterococcus sp. separately, a statistical reduction in the microorganism count before and after the treatment was observed for all groups (P< 0.05), excluding the control group. Among the species tested, S. mutans were the least susceptible to SDF treatments compared to the other species. The treatments with SDF were more effective in reducing microorganisms when compared to CHX. Similarly, the susceptibility of Streptococcus to CHX was lower than that observed for SDF. CLINICAL SIGNIFICANCE: In cases where the dental professional decides to apply an antimicrobial agent prior to the placement of a restoration, silver diamine fluoride proved to be more effective than chlorhexidine, slowing the progression of carious lesions, and possibly preventing future restorative interventions thus improving children's quality of life. It is important to note that clinicians should consider the type of restorative material that will be used due to the possibility that the use of SDF may influence adhesion of the subsequent restoration.


Assuntos
Cárie Dentária , Qualidade de Vida , Criança , Cárie Dentária/tratamento farmacológico , Dentina , Fluoretos Tópicos , Cimentos de Ionômeros de Vidro , Humanos , Compostos de Amônio Quaternário , Dente Decíduo
7.
Prog Orthod ; 22(1): 4, 2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33491110

RESUMO

BACKGROUND: One of the most unfavorable side effects of fixed orthodontic treatment is white spot lesions (WSLs). Although the most important approach is prevention of WSLs, it is also essential to evaluate the efficacy of the remineralization agents. However, there is no concurrence in the literature with respect to the remineralization process of these agents. The objective of the present study was to evaluate the effects of different fluoride varnishes, enamel matrix protein, and self-assembling peptide derivatives with varying chemical compositions on remineralization of artificially created WSLs in vitro using quantitative light-induced fluorescence (QLF). METHODS: Artificial WSLs were created on bovine enamel samples using acidic buffer solution (pH 5, 10 days). Specimens were randomly allocated to six groups (n = 10/group): (1) Emdogain (Straumann, Basel, Switzerland), (2) Curodont Repair (Credentis AG, Switzerland), (3) Duraphat (Colgate-Palmolive, New York, NY), (4) Clinpro XT (3 M ESPE, Pymble, New South Wales, Australia), (5) Enamel Pro Varnish (Premier Dental Products, PA, USA), and (6) control (untreated). The agents were applied to the WSLs according to the manufacturers' instructions. Fluorescence loss (ΔF), lesion area (area), and impact (ΔQ) values of enamel surfaces were quantified by QLF-D BiluminatorTM (Inspektor-Pro, Amsterdam, The Netherlands) at baseline and after 7, 14, and 21 days of application of the respective materials. RESULTS: ΔF value presented a significantly decreasing trend throughout the 21 days for all groups except the Duraphat and Enamel Pro varnishes. The changes between 14th and 21st days of the Clinpro XT varnish application were significantly higher than Emdogain, Curodont, and Enamel Pro. The Curodont group showed higher lesion area changes between the first and second week in comparison to the Emdogain, Clinpro XT, and Enamel Pro groups, whereas Clinpro XT assured the highest reduction from the second to the third week of the observation period. CONCLUSIONS: The fluorescence loss was significantly reduced with enamel matrix protein, self-assembling peptide, and light-curable fluoride varnishes in the analysis for 21 days. Curodont and Clinpro XT were effective in diminishing the fluorescence loss and lesion area compared to the Duraphat, Enamel Pro fluoride varnishes, and Emdogain in different time points.


Assuntos
Cárie Dentária , Fluoretos Tópicos , Animais , Cariostáticos , Bovinos , Cárie Dentária/tratamento farmacológico , Cárie Dentária/prevenção & controle , Humanos , Peptídeos , Fluoreto de Sódio , Suíça , Remineralização Dentária
8.
Oral Health Prev Dent ; 19(1): 93-99, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33511823

RESUMO

PURPOSE: Preschool children with early childhood caries (ECC) frequently exhibit extreme dental anxiety and fear, posing a considerable challenge to paediatric dentists for their treatment. The aim of this study was to evaluate the influence of silver diamine fluoride (SDF) treatment on the oral health-related quality of life (OHRQoL) of uncooperative preschool children using an Arabic version of the Early Childhood Oral Health Impact Scale (A-ECOHIS). MATERIALS AND METHODS: A pre-validated A-ECOHIS was used to assess the sensitivity and responsiveness. Fiftyone children, uncooperative with conventional dental care, underwent SDF treatment; their mothers answered the A-ECOHIS before and 4 weeks after treatment. Based on the global transition rating (GTR), the mothers rated their child's oral health condition following SDF treatment. RESULTS: SDF effectively arrested caries after 4 weeks in all children. There was a statistically significant reduction in mean scores of the total A-ECOHIS, child impact scale and family impact scores at follow-up (Wilcoxon signedrank test; p ˂ 0.001). There were statistically significant changes in the mean GTR of children's oral health. CONCLUSIONS: A-ECOHIS was sensitive and responsive to SDF treatment. SDF statistically significantly improved the OHRQoL of uncooperative preschool children.


Assuntos
Cárie Dentária , Qualidade de Vida , Criança , Pré-Escolar , Ansiedade ao Tratamento Odontológico , Cárie Dentária/tratamento farmacológico , Cárie Dentária/prevenção & controle , Medo , Fluoretos Tópicos , Humanos , Saúde Bucal , Estudos Prospectivos , Compostos de Amônio Quaternário , Compostos de Prata , Inquéritos e Questionários
9.
BMC Oral Health ; 21(1): 35, 2021 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472613

RESUMO

BACKGROUND: Silver diamine fluoride (SDF) is a minimally-invasive preventive service used in the U.S. to avert and arrest caries since 2014. No studies document survival outcomes based in real world delivery. We analyzed 12-month survival outcomes of SDF applied independently or concurrently with other restorative procedures among a population receiving community dental care. METHODS: We analyzed data on SDF applications from de-identified dental claims on Oregon Health Plan patients served by Advantage Dental in 2016, who had been seen in 2015 (patient n = 2269; teeth n = 7787). We compared survival rates of SDF alone, SDF applied with a sedative filling, and SDF with a same-day restoration. Failure was defined as a restoration or extraction of the tooth 7 to 365 days after initial application. Survival was defined as a patient returning 180 or more days after application whose tooth did not have a restoration or extraction. Differences were assessed through Wilcoxon equality of survivor function tests and log-rank equality of survivor tests to compare failure rates, Cox Proportional Hazards models to assess factors associated with survival of SDF, and Kaplan-Meier survival estimate to calculate the probability of survival over time. RESULTS: SDF alone had an overall survival rate of 76%. SDF placed with sedative filling and with a same-day restoration had survival rates of 50% and 84% respectively, likely reflecting treatment intent. SDF alone survived exceptionally well on primary cuspids, permanent molars, and permanent bicuspids and among patients aged 10 to 20 years, with modest variation across caries risk assessment categories. A single annual application of SDF was successful in 75% of cases. Among SDF failures on permanent dentition, more than two-thirds of teeth received a minor restoration. CONCLUSION: SDF is a minimally invasive non-aerosolizing option that prevented non-cavitated lesions and arrested early decay among community dentistry patients when applied independently or concurrently with restorative procedures. Professional organizations, policy makers, providers, and payors should broaden optional SDF use by informing clinical guidelines, reimbursement policies, and treatment decisions. Future research should address clinical, social, service delivery, workforce, and economic outcomes using diverse population-based samples, and the mechanisms underlying single application success and caries prevention potential.


Assuntos
Cárie Dentária , Clínicas Odontológicas , Adolescente , Adulto , Cariostáticos/uso terapêutico , Criança , Cárie Dentária/tratamento farmacológico , Cárie Dentária/prevenção & controle , Fluoretos Tópicos/uso terapêutico , Humanos , Oregon , Compostos de Amônio Quaternário , Compostos de Prata/uso terapêutico , Adulto Jovem
10.
J Adhes Dent ; 23(1): 47-56, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33512115

RESUMO

Purpose: To study the effect of the varnish type, application time and surface polishing on the shear bond strength (SBS) of a universal adhesive in healthy and demineralized bovine enamel. Materials and Methods: 432 bovine primary central incisors were assigned to 18 groups according to enamel mineralization [healthy and demineralized], topical varnish [Clinpro White Varnish (CWV; 3M Oral Care) and Profluorid (PFV, Voco)], remineralization time [24 h or 21 days] and polishing or not of the enamel surface. Adhesion was tested using Futurabond M (Voco)+ and GrandioSO (Voco). Sheer bond strength (SBS) was measured and the fracture mode studied. The statistical analysis was performed using two-way ANOVA, Tukey's test, and Pearson's chi-squared test. Results: In healthy bovine enamel, CWV reduced SBS at 24 h and 21 days; polishing significantly improved SBS. PFV increased SBS in healthy enamel at 21 days and demineralized enamel at 24 h and 21 days; polishing had no effect on SBS. The application time and polishing of the enamel surface affected the behavior of varnishes with respect to SBS. There was a correlation between the type of fracture and the degree of mineralization as well as the timepoint of varnish application. Conclusions: Remineralization of demineralized enamel with fluoride varnishes permits the recovery of the bond strength obtained in healthy enamel. Of the two varnishes studied, PFV had the highest SBS and more uniform behavior, regardless of the application timepoint, degree of mineralization, and surface treatment of the enamel..


Assuntos
Fluoretos Tópicos , Fluoretos , Animais , Bovinos , Cimentos Dentários , Esmalte Dentário , Resistência ao Cisalhamento , Remineralização Dentária
11.
Oral Health Prev Dent ; 19(1): 59-65, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33491379

RESUMO

PURPOSE: The topical fluoride treatment of teeth can lead to a formation of CaF2-like material, which is considered to play a significant role in caries prevention. Different types of fluoride sources are applied. The aim of this study was to analyse the in vitro fluoridation effect of the lesser known organic fluoride compound nicomethanol hydrofluoride (NH) regarding fluoride accumulation and morphological changes on dental enamel surfaces. Materials and Methods: The fluoridation effect was investigated by scanning electron microscopy (SEM) and energy dispersive x-ray analysis (EDX) after treatment with fluoride solutions at a concentration of 1350 ppm F - and a pH value of 5.5. NH was tested against inorganic sodium fluoride (NaF) as reference. Fluoridation was done on pellicle-free and pellicle-covered enamel. Results: Formation of globular CaF2-like material was observed for both fluoride types. However, NH led to considerably higher calcium fluoride accumulation on the enamel surface as shown by both EDX and SEM. The globule diameters varied between 0.2 and 0.8 µm. Cross-sectional analysis revealed that the globular precipitates lay directly on the enamel surface; only the very surface-near volume was affected. No statistically significant difference of the fluoridation effect was measured with vs without saliva pre-treatment. Conclusion: The experiments showed a 6 times greater F - surface uptake on dental enamel with NH compared to sodium fluoride, thus suggesting an important role of NH during remineralization phases, fostering equilibrium between de- and remineralization.


Assuntos
Fluoreto de Cálcio , Fluoretos , Esmalte Dentário , Fluoretos Tópicos , Humanos , Álcool Nicotinílico , Fluoreto de Sódio
12.
Rev. ADM ; 77(6): 301-305, nov.-dic. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1151065

RESUMO

A finales de 2019 se identificó el virus SARS-CoV-2 (por su significado en inglés Severe Acute Respiratory Syndrome Coronavirus 2) como agente etiológico de la COVID-19 (por su significado en inglés coronavirus disease 2019) en la ciudad de Wuhan, China. Debido a su rápida propagación al resto del mundo durante el primer trimestre del año 2020, la Organización Mundial de la Salud (OMS) la declaró pandemia mundial en marzo del mismo año. Por el potencial de contagio de COVID-19 se ha considerado que el entorno clínico en el que se desenvuelve la odontología puede ser de alto riesgo para el paciente, el odontólogo y sus asistentes si no se tienen las medidas de bioseguridad adecuadas. En un principio se vieron suspendidas las consultas regulares; sin embargo, al volver a la actividad laboral se han adaptado protocolos para el control de infecciones como reforzar el uso de barreras de protección y minimizar tratamientos que involucren aerosoles. La caries es uno de los principales motivos de consulta en la odontología pediátrica, por lo que en este escrito se sugieren algunos protocolos basados en la mínima invasión que prescinden de instrumental rotatorio para salvaguardar al paciente en riesgo de contagio, reduciendo el número de visitas y tiempo en consulta e incluso controlando algunos aspectos de salud bucal fuera de consulta clínica por medio de estrategias preventivas que pueden llevarse a cabo desde casa. Esto significa también mantener la tranquilidad por parte de los tutores del paciente ante la pandemia que se vive actualmente (AU)


At the end of 2019, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was identified as the etiological agent of COVID-19 in the city of Wuhan China. Due to its rapid spread to the rest of the world during the first trimester of 2020, the WHO declared a global pandemic in March of the same year. Due to the contagion potential of COVID-19, it has been considered that the clinical environment in which dentistry operates may be in high risk for the patient if the appropriate biosafety measures are not taken, initially clinical practices were suspended. However, when returning to work, protocols have been adapted to the infection control procedures, reinforced the use of protective barriers, and minimize treatments that involve aerosols. Caries is one of the main reasons for consultation in Pediatric Dentistry, this article suggests some protocols based on minimal invasion that dispense with rotating instruments to safeguard the patient from the risk of contagion, reducing the number of visits and time in consultation and even controlling some aspects of the oral health outside the dental visit through preventive strategies that can be carried out from home. Modifications to Dental Home. This should include maintaining tranquility and calm on the part of the patient's tutors in the face of the pandemic that we are currently experiencing (AU)


Assuntos
Humanos , Pré-Escolar , Criança , Infecções por Coronavirus , Assistência Odontológica para Crianças/métodos , Aerossóis , Selantes de Fossas e Fissuras , Remineralização Dentária , Protocolos Clínicos , Fluoretos Tópicos/uso terapêutico , Fatores de Risco , Resinas Compostas , Controle de Infecções Dentárias/métodos , Cárie Dentária/terapia , Placa Dentária/prevenção & controle , Tratamento Dentário Restaurador sem Trauma
13.
J Clin Pediatr Dent ; 44(6): 400-406, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378463

RESUMO

OBJECTIVES: The objective was to compare dental visits, procedures, and expenditures in children with newly diagnosed caries. STUDY DESIGN: A retrospective chart review was conducted in a two dentist private practice in North Carolina. Demographic data, health status, and dental treatment data was collected. Analysis relied upon nearest neighbor matching to estimate the average treatment effects of silver diamine fluoride (SDF) by comparing children who received SDF to children who did not receive SDF (n=104 matches). RESULTS: After matching on age, gender, race, insurance status, dental cooperation, and dmft, the SDF group had significantly more dental visits (average treatment effect on treated (ATET)=1.08), fewer restorations (ATET=2.37), and fewer restorative and overall treatment expenditures (ATET=$402 and $292, respectively) than the non-SDF group. The SDF group more frequently received treatment under general anesthesia (26% vs 7%), so this group was excluded in secondary analysis. Among children who did not receive general anesthesia, the SDF group had significantly more dental visits (ATET=.66), fewer restorations (ATET=2.74), and fewer restorative and overall treatment expenditures (ATET=$566 and $515, respectively) than the non-SDF group. CONCLUSION: SDF can offer cost savings when used as an adjunct to, rather than a complete replacement for, restorative treatment in young children.


Assuntos
Cariostáticos , Cárie Dentária , Cariostáticos/uso terapêutico , Criança , Pré-Escolar , Fluoretos Tópicos , Humanos , Compostos de Amônio Quaternário , Estudos Retrospectivos , Compostos de Prata
14.
J Can Dent Assoc ; 86: k6, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33326366

RESUMO

OBJECTIVES: Fluoride varnish (FV) has been shown to prevent dental caries. Physicians and nurses may be ideally situated to apply FV during well-child visits. Currently, public health units across Ontario have been successfully piloting this intervention. Yet, challenges remain at both the political and practice levels. The objectives of this research were to understand the perspectives of key stakeholders on making FV application a routine primary care practice in Ontario and to consider the potential enabling factors and barriers to implementation. METHODS: In this qualitative study, 16 key stakeholders representing medicine, nursing, dentistry, dental hygiene, public health and government were interviewed. Interview data were transcribed and coded, and a conceptual framework for implementing change to daily health care practice was used as a guide for thematic analysis. RESULTS: Our findings suggest that there is an opportunity for interdisciplinary care when considering children's oral health. There is also motivation and acceptance of this specific intervention across all fields. However, we found that concerns related to funding, knowledge and interprofessional relationships could impede implementation and limit any potential short- or mid-term window for meaningful policy and practice change. CONCLUSION: With respect to introducing FV into medical practice for children under 5 years of age, the many factors required to implement immediate change are arguably not in alignment. However, policymakers and practitioners are motivated and have identified opportunities for change that may form the foundation for this program in the future.


Assuntos
Cárie Dentária , Fluoretos Tópicos , Criança , Pré-Escolar , Cárie Dentária/prevenção & controle , Fluoretos , Humanos , Ontário , Atenção Primária à Saúde
15.
Pediatr Dent ; 42(6): 457-463, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33369557

RESUMO

Purpose: A Current Dental Terminology (CDT) code, D1354, for silver diamine fluoride was made effective on January 1, 2016. The purpose of this study was to investigate the utilization of silver diamine fluoride (SDF) by pediatric dentists (PDs) and general dentists (GDs) in the United States. Methods: Data were obtained from a commercial dental insurance claims warehouse in the United States. Deidentified data for CDT code D1354 were collected from January 2016 to July 2019. Descriptive statistics and chi-square tests were used. Results: A total of 321,726 D1354 claims were found. Data showed that SDF use measured by average monthly claims, unique number of dentists, and percent of paid claims increased each year. Patients zero to nine years old were the most likely to receive SDF treatment. SDF was significantly more likely to be placed on posterior teeth and in children zero to eight years old (P<0.001). PDs were more likely than GDs to submit claims for SDF in children (P<0.001). Conclusions: Silver diamine fluoride use is increasing, especially in patients age zero to nine years. Pediatric dentists are more likely to use SDF in children than general dentists. Posterior teeth receive the majority of SDF treatment.


Assuntos
Cárie Dentária , Revisão da Utilização de Seguros , Cariostáticos , Criança , Pré-Escolar , Cárie Dentária/prevenção & controle , Odontólogos , Fluoretos Tópicos , Humanos , Lactente , Recém-Nascido , Compostos de Amônio Quaternário , Compostos de Prata , Estados Unidos
16.
Braz Dent J ; 31(6): 664-672, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237239

RESUMO

Evaluated the effect of CPP-ACP/NaF and xylitol/NaF varnishes in reduce erosion and progression of erosion. Forty enamel blocks were divided into four groups (n=10): G1=CPP-ACP/NaF varnish (MI varnishTM); G2=xylitol/NaF varnish (Profluorid®); G3=NaF varnish (Duraphat®, positive control) and G4=deionized water (MilliQ®, negative control). Samples were immersed in Sprite ZeroTM (pH 2.58, 4x/day, 3 days), in between immersions, the specimens stayed in artificial saliva. After 3 days of erosion, the eroded area was divided in two (half of one received an additional varnish layer while the other half repeated the same 3-day erosion cycle). The 3D, non-contact profilometry technique was used to determinate tooth structure loss (TSL) and surface roughness (SR). Scanning electron microscopy (SEM) and 3D images were utilized to evaluate the topography of the samples. Mann-Whitney, one-way ANOVA and Tukey tests were used (significance level of 0.05%). SEM and 3D images were descriptively evaluated. After 3 or 6 days of erosion, all tested varnishes were better than G4 (p<0.05) for TSL and SR. In addition, G1 had lower values for TSL than G3 (p<0.05) after 3 days of erosion. Under SEM and 3D images observation, all groups presented porosity, irregularities and depressions on the surface enamel after 3 and 6 days of erosion, more pronounced in G4. An application of topical NaF varnishes was effective in reducing TSL and enamel roughness after erosion challenges, being the CCP-ACP/NaF varnish more effective than NaF varnish and water after 3 days of erosion.


Assuntos
Erosão Dentária , Caseínas , Esmalte Dentário , Fluoretos Tópicos , Humanos , Fluoreto de Sódio , Erosão Dentária/prevenção & controle , Xilitol
17.
J Clin Pediatr Dent ; 44(4): 249-255, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-33167019

RESUMO

OBJECTIVE: To determine changes in knowledge, attitudes, and practices of primary care physicians (PCPs) regarding fluoride varnish (FV). STUDY DESIGN: Fifty-four PCPs at an urban medical center in New York completed a pre-intervention survey. A pediatric dental resident provided an hour-long educational lecture and a hands-on demonstration regarding FV application. Six months later, PCPs were sent a post-intervention survey via electronic mail. RESULTS: Fifty-four PCPs participated in the pre-survey and FV training and 48% completed the post-survey. Prior to the FV training, 57% of PCPs knew that FV application by medical practitioners was reimbursable for children under 6-years-old and 2% of PCPs were applying FV. Post FV training, 62% of PCPs reported applying FV. Pre and post survey, barriers to FV application was not enough hands-on training (43% to 15% respectively) and not enough time (50% to 85% respectively). CONCLUSIONS: Post FV training, PCPs' knowledge, attitudes and practices in regard to FV changed. Interprofessional education may be one approach to increasing FV application participation.


Assuntos
Fluoretos Tópicos , Médicos de Atenção Primária , Atitude do Pessoal de Saúde , Criança , Fluoretos , Humanos , New York , Inquéritos e Questionários
18.
Eur Arch Paediatr Dent ; 21(6): 629-646, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33006116

RESUMO

PURPOSE: To compare the effectiveness of topical fluoride-antibacterial agent combined therapy versus topical fluoride monotherapy in preventing dental caries among 1- to 16-year-old children. METHODS: PubMed, EbscoHost, Scopus, Web of Science and the Cochrane Central Register of Controlled Trials were searched for randomised controlled trials. The trials should have assessed the caries-preventive effectiveness of topical fluoride-antibacterial agent (Povidone Iodine/Chlorhexidine/Xylitol/Triclosan/Cetylpyridinium Chloride) combined therapy versus topical fluoride monotherapy among children. Out of 3475 records that were screened, full text of 41 articles was assessed for potential inclusion. Sixteen trials that fulfilled the eligibility criteria were subjected to qualitative synthesis. The risk of bias was assessed using the Cochrane Collaboration's tool. Continuous data from nine trials were pooled using Inverse Variance test in meta-analysis function of Review Manager (version 5.4). GRADE approach was used to analyse the certainty of evidence. Statistical heterogeneity was quantified using the I2 statistic. A p-value of < 0.05 was considered as statistically significant. RESULTS: With respect to the caries increment, combined therapy showed superior caries-preventive effectiveness than topical fluoride monotherapy [SMD - 0.12, 95% CI (- 0.2 to - 0.04), p = 0.004; (I2 = 20%, p = 0.29)]. No significant difference was noted between the two groups for the post-intervention salivary S mutans count [SMD - 0.11, 95% CI (- 0.33 to 0.1), p = 0.3; (I2 = 0%, p = 0.77)]. CONCLUSION: The pooled analysis indicates towards an added benefit of topical fluoride-antibacterial agent combined therapy over topical fluoride monotherapy in preventing dental caries incidence among children. However, the results may be interpreted with caution since the evidence generated is of low certainty and is driven by two studies on Xylitol, thus it demands further good quality trials.


Assuntos
Cárie Dentária , Fluoretos Tópicos , Adolescente , Antibacterianos , Cariostáticos/uso terapêutico , Criança , Pré-Escolar , Cárie Dentária/tratamento farmacológico , Cárie Dentária/prevenção & controle , Humanos , Lactente , Xilitol
19.
Pediatr Dent ; 42(5): 373-379, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-33087222

RESUMO

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.


Assuntos
Tratamento Dentário Restaurador sem Trauma , Saúde Bucal , Criança , Pré-Escolar , Feminino , Fluoretos Tópicos , Humanos , Masculino , Qualidade de Vida , Compostos de Amônio Quaternário , Compostos de Prata
20.
Indian J Dent Res ; 31(4): 502-506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107447

RESUMO

Background: Children with HIV are a special group with limited access to care and high prevalence of dental caries. Silver Diamine Fluoride (SDF) is approved universally for the management of asymptomatic carious lesions but research on the psychological impact of black staining is scarce. Aims: Effect of silver diamine fluoride (SDF) application as an interim caries management on the child's oral health-related quality of life of children with HIV over a period of 4 months until definitive care was provided. Settings and Design: A pilot study conducted among children with HIV in a care home. It was a pilot trial to check the acceptability of SDF among these children. Methods and Material: Forty-two children (12.3 ± 3.5 years) participated in this pilot study. Prevalence of caries (DMFT), candidiasis, gingival inflammation, and cervical lymphadenitis was evaluated. OHRQoL inventory (COHIP-SF) was completed by the students at baseline, immediately, 4 months after SDF application. Statistical Analysis Used: One-way ANOVA with post hoc Tukey HSD test. Results and Conclusion: Poor oral hygiene was universal and mean DMFT was 3.2 ± 2.5. OHRQoL was not significantly affected at baseline (26.2 ± 6.4), but immediately following SDF application, OHRQoL was significantly poor (48.7 ± 8.2), remained poor even after 4 months (42.6 ± 6.1). Emotional wellbeing was significantly impacted negatively following SDF application (p < 0.001); whereas oral health, functional wellbeing dimensions were not impacted. SDF should be used with caution among special children as the black discoloration of the teeth can cause emotional trauma and negatively impacting their OHRQoL while trying to improve the same.


Assuntos
Cárie Dentária , Infecções por HIV , Criança , Cárie Dentária/epidemiologia , Cárie Dentária/prevenção & controle , Fluoretos Tópicos , Humanos , Projetos Piloto , Qualidade de Vida , Compostos de Amônio Quaternário , Compostos de Prata
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