Dentistry is joining this exciting revolution as well. Minimally invasive dentistry adopts a philosophy that integrates prevention, remineralisation and minimal intervention for the placement and replacement of restorations. Minimally invasive dentistry reaches the treatment objective using the least invasive surgical approach, with the removal of the minimal amount of healthy tissues. This paper reviews in brief the concept of minimal intervention in dentistry. The criterion used by the MDG indicator to determine whether a water source is safe can lead to substantial overestimates of the population with access to safe drinking-water and, consequently, also overestimates the progress made towards the MDG target.
Monitoring drinking-water supplies by recording both access to water sources and their safety would be a substantial improvement. Four new studies were identified on fluoride-containing gels, one on fluoride mouth rinses and four on fluoride-containing varnishes. Prevented fractions obtained in the permanent dentition were consistent with the estimates found in previous reviews, while the effect obtained on caries in the primary dentition remains uncertain.
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The only study that compared the effect of different fluoride compounds, could not find any difference. The effect of the three methods on caries in the permanent dentition is well described, while the effect on caries in the primary dentition remains to be determined. The effect of choice of fluoride compound is also not known. We identified the most common complications associated with the treatment of oral cancers. Based on the information gathered, there is evidence that survival of OPC extends beyond eradication of the diseased tissue. Understanding the potential treatment complications and utilizing available resources to prevent and minimize them are important.
Caring for OPC survivors should be a multidisciplinary team approach involving the dentist, oncologist, internist, and social worker to improve the currently stagnant 5-year survival rate of OPC. More emphasis on improved quality of life after elimination of the cancer will ultimately improve OPC survivorship.
This article presents evidence-based clinical recommendations regarding the intake of fluoride from reconstituted infant formula and its potential association with enamel fluorosis. The panel addressed the following question: Is consumption of infant formula reconstituted with water that contains various concentrations of fluoride by infants from birth to age 12 months associated with an increased risk of developing enamel fluorosis in the permanent dentition?
Twenty-two trials with 12, participants randomised used in analyses were included. Once again this body of evidence was assessed as of moderate quality. A funnel plot of the trials in the main meta-analyses indicated no clear relationship between prevented fraction and study precision. In both methods, power is limited when few trials are included. There was little information concerning possible adverse effects or acceptability of treatment.
The conclusions of this updated review remain the same as those when it was first published. The review suggests a substantial caries-inhibiting effect of fluoride varnish in both permanent and primary teeth, however the quality of the evidence was assessed as moderate, as it included mainly high risk of bias studies, with considerable heterogeneity.
The results were assessed of 7 reviews published from to concerning the relative effectiveness of 4 topical fluoride treatments toothpastes, gels, varnishes and mouthrinses in preventing caries in children and adolescents. Comparisons in these reviews were made against non-fluoride controls, against each other, and against different combinations.
The 7 reviews confirm a clear and similar effectiveness of topical fluoride toothpastes, mouthrinses, gels and varnishes for preventing caries, and show that additional caries reduction can be expected when another topical fluoride is combined with fluoride toothpaste. Evidence is insufficient to confirm the effectiveness of slow release fluoride devices and fluoridated milk. The comparative effectiveness of other modes of delivering fluoride, such as to orthodontic patients is also as yet unclear. Fissure sealants appear more effective than fluoride varnish for preventing occlusal caries but the size of the difference is unclear.
The benefits of topical fluorides are firmly established based on a sizeable body of evidence from randomized controlled trials. The size of the reductions in caries increment in both the permanent and the primary dentitions emphasizes the importance of including topical fluoride delivered through toothpastes, rinses, gels or varnishes in any caries preventive program.
However, trials to discern potential adverse effects are required, and data on acceptability. Better quality research is needed to reach clearer conclusions on the effects of slow release fluoride devices, milk fluoridation, sealants in comparison with fluoride varnishes, and of different modes of delivering fluoride to orthodontic patients. The aim of this paper is to make known the potential of fluoridated salt in community oral health programs, particularly in South Eastern Europe.
Since , the addition of iodine to salt has been successful in Switzerland. Goiter is virtually extinct. By , the caries-protective effect of fluorides was well established. Based on the success of water fluoridation, a gynecologist started adding of fluoride to salt. The sale of fluoridated salt began in in the Swiss Canton of Zurich, and several other cantons followed suit. Studies initiated in the early seventies showed that fluoride, when added to salt, inhibits dental caries.
The addition of fluoride to salt for human consumption was officially authorized in Salt fluoridation schemes are reaching more than one hundred million in Mexico, Colombia, Peru and Cuba. The cost of salt fluoridation is very low, within 0. Children and adults of the low socio-economic strata tend to have substantially more untreated caries than higher strata. Salt fluoridation is by far the cheapest method for improving oral health. Salt fluoridation is by far the cheapest method of caries prevention, and billions of people throughout the world could benefit from this method.
It is the position of the Academy of Nutrition and Dietetics to support optimal systemic and topical fluoride as an important public health measure to promote oral health and overall health throughout life. Fluoride is an important element in the mineralization of bone and teeth. The proper use of topical and systemic fluoride has resulted in major reductions in dental caries and its associated disability. Dental caries remains the most prevalent chronic disease in children and affects all age groups of the population.
The Centers for Disease Control and Prevention has named fluoridation of water as one of the 10 most important public health measures of the 21st century. Fluoride also plays a role in bone health. However, at this time, use of high doses of fluoride for osteoporosis prevention is considered experimental only.
Dietetics practitioners should routinely monitor and promote the use of fluorides for all age groups. Of the 59 publications identified, 3 systematic reviews and 3 guidelines were included in this review. While the reviews themselves were of good methodological quality, the studies included in the reviews were generally of moderate to low quality. The results of the three reviews showed that water fluoridation is effective at reducing caries in children and adults. With the exception of dental fluorosis, no association between adverse effects and water fluoridation has been established.
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Water fluoridation reduces caries for all social classes, and there is some evidence that it may reduce the oral health gap between social classes. Water fluoridation, where technically feasible and culturally acceptable, remains a relevant and valid choice as a population measure for the prevention of dental caries.
Fluoride can reduce tooth mineral solubility by exchanging for hydroxyl groups and reducing carbonate content. Thus its presence in solution facilitates mineral precipitation or reprecipitation by lowering solubility products of precipitating calcium phosphates. While sound enamel tends to lose fluoride with age, it accumulates at stagnation sites where caries lesions develop indicating this as a site of action. Fluoride in the lesion will encourage remineralisation [Robinson et al. Access from plaque, however, is limited due to restricted penetration. Maintaining a very thin plaque layer is thus important in delivering fluoride to the lesion.
This article discusses the possible cariostatic mechanisms of the action of fluoride. In the past, fluoride inhibition of caries was ascribed to reduced solubility of enamel due to incorporation of fluoride F- into the enamel minerals. The present evidence from clinical and laboratory studies suggests that the caries-preventive mode of action of fluoride is mainly topical. There is convincing evidence that fluoride has a major effect on demineralisation and remineralisation of dental hard tissue.
The source of this fluoride could either be fluorapatite formed due to the incorporation of fluoride into enamel or calcium fluoride CaF2 -like precipitates, which are formed on the enamel and in the plaque after application of topical fluoride. Calcium fluoride deposits are protected from rapid dissolution by a phosphate -protein coating of salivary origin.
At lower pH, the coating is lost and an increased dissolution rate of calcium fluoride occurs. The CaF2, therefore, act as an efficient source of free fluoride ions during the cariogenic challenge. The current evidence indicates that fluoride has a direct and indirect effect on bacterial cells, although the in vivo implications of this are still not clear. A better understanding of the mechanisms of the action of fluoride is very important for caries prevention and control.
The effectiveness of fluoride as a cariostatic agent depends on the availability of free fluoride in plaque during cariogenic challenge, i. The panel concluded that dietary fluoride supplements should be prescribed only for children who are at high risk of developing caries and whose primary source of drinking water is deficient in fluoride. These recommendations are a resource for practitioners to consider in the clinical decision-making process. To provide a brief commentary review of strategies to control dental caries. In many counties, severity increased in parallel with importation of sugar, reaching its zenith about s and s.
Since then, severity has declined in many countries, due to the wide use of fluoride especially in toothpaste, but dental caries remains a disease of medical, social and economic importance. The pathogenesis is well understood: bacteria in dental plaque biofilm metabolise dietary sugars to acids which then dissolve dental enamel and dentine. At the present time, only three approaches are of practical importance: sugar control, fluoride, and fissure sealing.
The evidence that dietary sugars are the main cause of dental caries is extensive, and comes from six types of study. Without sugar, caries would be negligible. Fluoride acts in several ways to aid caries prevention. Dental caries is preventable — individuals, communities and countries need strategies to achieve this.
Slow-releasing fluoride devices have been shown to be effective in elevating salivary fluoride levels in both animals and human studies and to enhance the remineralisation of dental enamel. They have been demonstrated to be safe to use and without the risk of fluoride toxicity. These devices have a number of potential uses in dentistry and in particular have great potential for caries prevention of non-compliant high caries-risk groups. We included 11 studies in the review involving children. The effect of fluoride supplements was unclear on deciduous or primary teeth.
In one study, no caries-inhibiting effect was observed on deciduous teeth while in another study, the use of fluoride supplements was associated with a substantial reduction in caries increment. When fluoride supplements were compared with topical fluorides or with other preventive measures, there was no differential effect on permanent or deciduous teeth. The review found limited information on the adverse effects associated with the use of fluoride supplements. This review suggests that the use of fluoride supplements is associated with a reduction in caries increment when compared with no fluoride supplement in permanent teeth.
The effect of fluoride supplements was unclear on deciduous teeth. When compared with the administration of topical fluorides, no differential effect was observed. We rated 10 trials as being at unclear risk of bias and one at high risk of bias, and therefore the trials provide weak evidence about the efficacy of fluoride supplements.
The initial search revealed papers of which 15 met the inclusion criteria. The effect was boosted by supervised tooth brushing, increased brushing frequency to twice daily, and use of a toothpaste concentration of 1, ppm fluoride. There were few studies of high quality reporting findings from the primary dentition. There were no studies available, and therefore insufficient evidence, on when to commence brushing with fluoride toothpaste as well as on the post-brushing behaviour. The results reinforced the outstanding role of fluoride toothpaste as an effective caries preventive measure in children.
There is some evidence of a dose response relationship in that the PF increased as the fluoride concentration increased from the baseline although this was not always statistically significant. The effect of fluoride toothpaste also increased with baseline level of D M FS and supervised brushing, though this did not reach statistical significance.
Six studies assessed the effects of fluoride concentrations on the deciduous dentition with equivocal results dependent upon the fluoride concentrations compared and the outcome measure. Compliance with treatment regimen and unwanted effects was assessed in only a minority of studies. When reported, no differential compliance was observed and unwanted effects such as soft tissue damage and tooth staining were minimal. This review confirms the benefits of using fluoride toothpaste in preventing caries in children and adolescents when compared to placebo, but only significantly for fluoride concentrations of ppm and above.
The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration. The decision of what fluoride levels to use for children under 6 years should be balanced with the risk of fluorosis. A panel of experts convened by the American Dental Association ADA Council on Scientific Affairs presents evidence-based clinical recommendations regarding professionally applied and prescription-strength, home-use topical fluoride agents for caries prevention.
These recommendations are an update of the ADA recommendations regarding professionally applied topical fluoride and were developed by using a new process that includes conducting a systematic review of primary studies. The panel included 71 trials from 82 articles in its review and assessed the efficacy of various topical fluoride caries-preventive agents. The panel makes recommendations for further research. The panel recommends the following for people at risk of developing dental caries: 2. Only 2. This concise review presents two Cochrane Reviews undertaken to determine: 1 the relative effectiveness of fluoride toothpastes of different concentrations in preventing dental caries in children and adolescents; and 2 the relationship between the use of topical fluorides in young children and their risk of developing dental fluorosis.
To determine the relative effectiveness of fluoride toothpastes of different concentrations, we undertook a network meta-analysis utilizing both direct and indirect comparisons from randomized controlled trials RCTs. The review examining fluorosis included evidence from experimental and observational studies. The findings of the reviews confirm the benefits of using fluoride toothpaste, when compared with placebo, in preventing caries in children and adolescents, but only significantly for fluoride concentrations of ppm and above. The relative caries-preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration.
However, there is weak, unreliable evidence that starting the use of fluoride toothpaste in children under 12 months of age may be associated with an increased risk of fluorosis.
The decision of what fluoride levels to use for children under 6 years should be balanced between the risk of developing dental caries and that of mild fluorosis. Only one RCT was judged to be at low risk of bias. The other RCT and all observational studies were judged to be at moderate to high risk of bias.
From the RCTs, use of higher level of fluoride was associated with an increased risk of fluorosis. No significant association between the frequency of toothbrushing or the amount of fluoride toothpaste used and fluorosis was found. There should be a balanced consideration between the benefits of topical fluorides in caries prevention and the risk of the development of fluorosis. Most of the available evidence focuses on mild fluorosis. There is weak unreliable evidence that starting the use of fluoride toothpaste in children under 12 months of age may be associated with an increased risk of fluorosis.
The evidence for its use between the age of 12 and 24 months is equivocal. If the risk of fluorosis is of concern, the fluoride level of toothpaste for young children under 6 years of age is recommended to be lower than parts per million ppm. More evidence with low risk of bias is needed. Future trials assessing the effectiveness of different types of topical fluorides including toothpastes, gels, varnishes and mouthrinses or different concentrations or both should ensure that they include an adequate follow-up period in order to collect data on potential fluorosis.
As it is unethical to propose RCTs to assess fluorosis itself, it is acknowledged that further observational studies will be undertaken in this area. A total of studies met the inclusion criteria; studies provided sufficient data for quantitative synthesis. The results from the caries severity data indicate that the initiation of water fluoridation results in reductions in dmft of 1. There is insufficient information to determine whether initiation of a water fluoridation programme results in a change in disparities in caries across socioeconomic status SES levels.
There is insufficient information to determine the effect of stopping water fluoridation programmes on caries levels. With regard to dental fluorosis, we estimated that for a fluoride level of 0. The available data come predominantly from studies conducted prior to , and indicate that water fluoridation is effective at reducing caries levels in both deciduous and permanent dentition in children.
Our confidence in the size of the effect estimates is limited by the observational nature of the study designs, the high risk of bias within the studies and, importantly, the applicability of the evidence to current lifestyles. There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across SES. There is insufficient information to determine the effect on caries levels of stopping water fluoridation programmes. There is a significant association between dental fluorosis of aesthetic concern or all levels of dental fluorosis and fluoride level.
The evidence is limited due to high risk of bias within the studies and substantial between-study variation. The effects of using different fluoride concentration toothpastes on caries varied. Limited scientific evidence demonstrates that for children younger than 6 years, fluoride toothpaste use is effective in caries control. Ingesting pea-sized amounts or more can lead to mild fluorosis. Practical Implications.
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To minimize the risk of fluorosis in children while maximizing the caries-prevention benefit for all age groups, the appropriate amount of fluoride toothpaste should be used by all children regardless of age. Dentists should counsel caregivers by using oral description, visual aids and actual demonstration to help ensure that the appropriate amount of toothpaste is used.
Various authors have shown that the caries decline in the industrialized countries during recent decades is based on the use of fluorides, of which local fluoride application in the form of fluoridated toothpastes is of primary importance. The caries-protective potential of fluorapatite is quite low; in contrast, dissolved fluorides in the vicinity of enamel are effective both in promoting remineralization and inhibiting demineralization.
Modern commercial toothpastes contain therapeutic ingredients to combat various oral conditions, for example, caries, gingivitis, calculus and tooth stain. The efficient delivery and retention of such ingredients in the mouth is essential for good performance. The aim of this chapter is to review the literature on the oral pharmacokinetics of, primarily, fluoride but also other active ingredients, mainly anti-plaque agents.
Elevated levels of fluoride have been found in saliva, plaque and the oral soft tissues after use of fluoridated toothpaste, which persist at potentially active concentrations for hours. Both experiment and mathematical modelling suggest that the soft tissues are the main oral reservoir for fluoride. Qualitatively similar observations have been made for anti-plaque agents such as triclosan and metal cations, though their oral substantivity is generally greater.
Scope for improved retention and subsequent efficacy exists. Current models for increasing the anti-caries effects of fluoride F agents emphasize the importance of maintaining a cariostatic concentration of F in oral fluids. The concentration of F in oral fluids is maintained by the release of this ion from bioavailable reservoirs on the teeth, oral mucosa and — most importantly, because of its association with the caries process — dental plaque. The fact that all these reservoirs are mediated by calcium implies that their formation is limited by the low concentration of calcium in oral fluids.
By using novel procedures which overcome this limitation, the formation of these F reservoirs after topical F application can be greatly increased. Although these increases are associated with substantive increases in salivary and plaque fluid F, and hence a potential increase in cariostatic effect, it is unclear if such changes are related to the increases in the amount of these reservoirs, or changes in the types of F deposits formed.
New techniques have been developed for identifying and quantifying these deposits which should prove useful in developing agents that enhance formation of oral F reservoirs with optimum F release characteristics. Such research offers the prospect of decreasing the F content of topical agents while simultaneously increasing their cariostatic effect.
Caries develops when the equilibrium between de- and remineralization is unbalanced favoring demineralization. De- and remineralization occur depending on the degree of saturation of the interstitial fluids with respect to the tooth mineral. This equilibrium is positively influenced when fluoride, calcium and phosphate ions are added favoring remineralization. In addition, when fluoride is present, it will be incorporated into the newly formed mineral which is then less soluble. Toothpastes may contain fluoride and calcium ions separately or together in various compounds remineralization systems and may therefore reduce demineralization and promote remineralization.
Formulating all these compounds in one paste may be challenging due to possible premature calcium-fluoride interactions and the low solubility of CaF2. There is a large amount of clinical evidence supporting the potent caries preventive effect of fluoride toothpastes indisputably.
The amount of clinical evidence of the effectiveness of the other remineralization systems is far less convincing. Evidence is lacking for head to head comparisons of the various remineralization systems. SEM pictures at Hyper-zone showed no evident crystal-like deposits in dentinal tubules and no notable difference when compared to that in sound dentine. EDS analysis demonstrated higher concentrations of Ca and P at Hyper-zone than those in sound dentine, which corresponded to the TMR profile, while the magnesium Mg concentration was low at this zone.
Demineralized dentine lesions exposed to fluoride and remineralization treatments exhibited Hyper-zone beneath the lesion body, in which the mineral density was higher than that of sound dentine. Because dentin is more caries-susceptible than enamel, its demineralization may be more influenced by additional fluoride F.
We hypothesized that a combination of professional F, applied as acidulated phosphate F APF , and use of ppm-F dentifrice would provide additional protection for dentin compared with ppm-F alone. APF gel 1. APF and FD increased F concentration in biofilm fluid and reduced root dentin demineralization, presenting an additive effect. Analysis of the data suggests that the combination of APF gel application and daily regular use of ppm-F dentifrice may provide additional protection against root caries compared with the dentifrice alone.
Incubation of root dentin with fluoridated milk showed a clear effect on root dentin remineralization, and incubation with NaF dissolved in artificial saliva demonstrated a stronger effect. Partial caries removal procedures are used clinically in an attempt to conserve tooth structure and prevent pulp damage. Within this approach, the caries-infected dentin is removed, and the partially demineralized caries-affected dentin is preserved and sealed with materials that enhance remineralization.
Fluoride-releasing glass ionomers have been commonly used for this purpose. Recent studies have shown potential for other cements and bioactive adhesive materials to promote dentin repair through various strategies. These strategies include ion releasing of Ca-P and the guided tissue remineralization or biomimetic remineralization of dentin. The latter is potentially useful in the remineralization of the demineralized acid-etched dentin that is incompletely infiltrated by adhesives in dentin bonding.
The purpose of this Critical Appraisal is to provide the clinician with a summary of current literature that clarifies understanding of the process of dentin remineralization and to describe current strategies in this area. Here, we determine changes in pellicle and bacterial cell surface properties of the strains Actinomyces naeslundii HM1, Streptococcus mutans NS, S. In vitro pellicles had a zeta potential of mV that became less negative upon adsorption of AmF. The chemical functionalities in which carbon and oxygen were involved changed after AmF adsorption and AmF-treated pellicles had a greater surface roughness than untreated pellicles.
Water contact angles in vitro decreased from 56 to 45 degrees upon AmF treatment, which corresponded with water contact angles 44 degrees measured intraorally on the front incisors of volunteers immediately after using an AmF-containing toothpaste. All bacterial strains were negatively charged and their isoelectric points IEP increased upon AmF adsorption. Minimal inhibitory concentrations were smallest for strains exhibiting the largest increase in IEP.
Adhesion to salivary pellicles and biofilm growth of the mutans streptococcal strains were significantly reduced after AmF treatment, but not of A. However, regardless of the strain involved, biofilm viability decreased significantly after AmF treatment. The electrostatic interaction between cationic AmF and negatively charged bacterial cell surfaces is pivotal in establishing reduced biofilm formation by AmF through a combination of effects on initial adhesion and killing. The major effect of AmF treatment, however, was a reduction brought about in biofilm viability. There is substantial evidence that fluoride, through different applications and formulas, works to control caries development.
Other systemic methods to deliver fluoride were later suggested, including dietary fluoride supplements such as salt and milk. The effectiveness of water fluoridation in many geographic areas is lower than in previous eras due to the widespread use of other fluoride modalities. Nevertheless, this evidence should not be interpreted as an indication that systemic methods are no longer relevant ways to deliver fluoride on an individual basis or for collective health programs.
Safe and effective doses of fluoride can be achieved when combining topical and systemic methods. No paper related to the use of fluoridated salt in caries prevention fulfilled the inclusion criteria. The use of milk as a vehicle for providing additional fluoride in a dental public health programme was evaluated in two papers. The consumption of fluoridated milk was an effective measure to prevent caries in the primary teeth.
The use of fluoridated sugar demonstrated a reduction in caries increment in the permanent dentition in one paper. Literature on the effectiveness of fluoridation in foods in caries prevention is scant and almost all the studies have been conducted in children. There is low evidence that the use of milk fluoridation is effective in reducing the caries increment. Seventy-four studies were included. This means that 1.
In populations with caries increment of 1. The effect of fluoride toothpaste increased with higher baseline levels of D M FS, higher fluoride concentration, higher frequency of use, and supervised brushing, but was not influenced by exposure to water fluoridation. There is little information concerning the deciduous dentition or adverse effects fluorosis.
Supported by more than half a century of research, the benefits of fluoride toothpastes are firmly established.
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Taken together, the trials are of relatively high quality, and provide clear evidence that fluoride toothpastes are efficacious in preventing caries. CPP-ACP has a long-term remineralizing effect on early caries lesions in comparison with placebo, although this does not appear to be significantly different from that of fluorides.
High-quality, well-designed clinical studies in this area are still required before definitive recommendations can be made. A 2-year double-blind randomized three-treatment controlled parallel-group clinical study compared the anti-caries efficacy of two dentifrices containing 1. The 6, participants were from Bangkok, Thailand and aged years initially. They were instructed to brush twice daily, in the morning and evening, with their randomly assigned dentifrice. Three trained and calibrated dentists examined the children at baseline and after 1 and 2 years using the National Institute of Dental Research Diagnostic Procedures and Criteria.
The number of decayed, missing and filled teeth DMFT and surfaces DMFS for the three study groups were very similar at baseline, with no statistically significant differences among groups. After 1 year, there were no statistically significant differences in caries increments among the three groups. After 2 years, the two groups using the dentifrices containing 1. The differences between the two groups using the new dentifrices were not statistically significant.
The results of this pivotal clinical study support the conclusion that dentifrices containing 1. Fluoride is a widely used anticaries agent, which promotes tooth hard-tissue remineralization and suppresses bacterial activities. Recent clinical trials have shown that oral hygiene products containing both fluoride and arginine possess a greater anticaries effect compared with those containing fluoride alone, indicating synergy between fluoride and arginine in caries management. Here, we hypothesize that arginine may augment the ecological benefit of fluoride by enriching alkali-generating bacteria in the plaque biofilm and thus synergizes with fluoride in controlling dental caries.
We found that arginine synergized with fluoride in suppressing acidogenic S. Taken together, we conclude that the combinatory application of fluoride and arginine has a potential synergistic effect in maintaining a healthy oral microbial equilibrium and thus represents a promising ecological approach to caries management. There is a lack of clinical studies comparing dentifrices with high fluoride F concentration.
The aim was to evaluate a dentifrice containing 5, ppm F compared to a dentifrice containing 1, ppm F in caries-active adolescents. The subjects were divided into two groups and were given one of the assigned F dentifrices for daily unsupervised toothbrushing: 1 Duraphat 5, ppm F and 2 Pepsodent Superfluor 1, ppm F, both as NaF. The outcome variables were caries incidence and progression of proximal and occlusal caries.
The subjects were asked to fill in a questionnaire to evaluate their compliance and they were divided into two subgroups: subgroup A, excellent compliance, and subgroup B, poor compliance. This may indicate that 5, ppm F toothpaste has a greater impact on individuals who do not use toothpaste regularly or do not brush twice a day. Thus, 5, ppm F toothpaste appears to be an important vehicle for caries prevention and treatment of adolescents with a high caries risk.
Root caries is prevalent in elderly disabled nursing home residents in Denmark. This study aimed to compare the effectiveness of tooth brushing with 5, versus 1, ppm of fluoridated toothpaste F-toothpaste for controlling root caries in nursing home residents. The duration of the study was 8 months. They were randomly assigned to use one of the two toothpastes. Both groups had their teeth brushed twice a day by the nursing staff.
A total of residents completed the study. Baseline and follow-up clinical examinations were performed by one calibrated examiner. Texture, contour, location and colour of root caries lesions were used to evaluate lesion activity. Mean numbers of active root caries lesions at the follow-up examination were 1. To conclude, 5, ppm F-toothpaste is significantly more effective for controlling root caries lesion progression and promoting remineralization compared to 1, ppm F-toothpaste.
Although the anti-caries effects of standard fluoride F toothpastes are well established, their use by preschoolers 2- to 5-year-olds has given rise to concerns regarding the development of dental fluorosis. Thus, a widespread support of low F toothpastes has been observed. A systematic review of clinical trials and meta-analyses were carried out. Two examiners independently screened 1, records and read potentially eligible full-text articles. Data regarding characteristics of participants, interventions, outcomes, length of follow-up and potential of bias were independently extracted by two examiners and disagreements were solved by consensus after consulting a third examiner.
Five clinical trials fulfilled the inclusion criteria. There is no evidence to support the use of low F toothpastes by preschoolers regarding caries and fluorosis prevention. The present systematic review critically summarizes results of clinical studies investigating chemical agents to reduce initiation or inactivation of root caries lesions RCLs. Three electronic databases were screened for studies from to Cross-referencing was used to further identify articles. Article selection and data abstraction were done in duplicate.
Languages were restricted to English and German. Thirty-four articles with 1 or more agents were included; they reported 30 studies with 10, patients who were 20 to y old; and they analyzed 28 chemical agents alone or in combination. Eleven studies investigated dentifrices, 10 rinses, 8 varnishes, 3 solutions, 3 gels, and 2 ozone applications. Regular use of dentifrices containing 5, ppm F - and quarterly professionally applied CHX or SDF varnishes seem to be efficacious to decrease progression and initiation of root caries, respectively.
However, this conclusion is based on only very few well-conducted randomized controlled trials. Scottish children have one of the highest levels of caries experience in Europe. High-caries-risk children should benefit if they brush more often with fluoridated toothpaste. The aim of this clinical trial was to determine the reduction in 2-year caries increment that can be achieved by daily supervised toothbrushing on school-days with a toothpaste containing 1, ppm fluoride as sodium monofluorophosphate and 0.
Five hundred and thirty-four children, mean age 5. Each school had two parallel classes, one randomly selected to be the brushing class and the other, the control. Local mothers were trained as toothbrushing supervisors. Children brushed on school-days and received home supplies. A single examiner undertook 6-monthly examinations recording plaque, caries D 1 level , and used FOTI to supplement the visual caries examination. For children in the brushing classes, the 2-year mean caries increment on first permanent molars was 0.
In conclusion, high-caries-risk children have been shown to have significantly less caries after participating in a supervised toothbrushing programme with a fluoridated toothpaste. Thirty-six studies were included. No significant association between estimates of D M FS prevented fractions and baseline caries severity, background exposure to fluorides, rinsing frequency and fluoride concentration was found in metaregression analyses.
A funnel plot of the 34 studies indicated no relationship between prevented fraction and study precision. There is little information concerning possible adverse effects or acceptability of treatment in the included trials. This review suggests that the supervised regular use of fluoride mouthrinse at two main strengths and rinsing frequencies is associated with a clear reduction in caries increment in children. In populations with caries increment of 0.
There is a need for complete reporting of side effects and acceptability data in fluoride mouthrinse trials. Eleven of the 12 included studies contributed data for the meta-analyses. The separate meta-analyses of fluoride gel or mouthrinse combined with toothpaste versus toothpaste alone favour the combined regimens, but differences were not statistically significant; the significant difference in favour of the combined use of fluoride varnish and toothpaste accrues from a very small trial and appears likely to be a spurious result.
Not all other combinations of possible practical value were tested in the included studies. Topical fluorides mouthrinses, gels, or varnishes used in addition to fluoride toothpaste achieve a modest reduction in caries compared to toothpaste used alone. No conclusions about any adverse effects could be reached, because data were scarcely reported in the trials. For the update of this review, three changes were made to the protocol regarding inclusion criteria.
Fourteen studies included in the previous version of the review were excluded from this update for the following reasons: five previously included studies were quasi-randomised, a further five were split-mouth studies, three measured outcomes on extracted teeth only and in one, the same fluoride intervention was used in each intervention group of the study. Three studies and participants were included in this updated review. One study was assessed at low risk of bias for all domains, in one study the risk of bias was unclear and in the remaining study, the risk of bias was high.
This finding is considered to provide moderate-quality evidence for this intervention because it has not yet been replicated by further studies in orthodontic participants. One small study 37 participants compared the use of an intraoral fluoride-releasing glass bead device attached to the brace versus a daily fluoride mouthrinse.
The study was assessed at high risk of bias because a substantial number of participants were lost to follow-up, and compliance with use of the mouthrinse was not measured. Neither secondary outcomes of this review nor adverse effects of interventions were reported in any of the included studies. This review found some moderate evidence that fluoride varnish applied every six weeks at the time of orthodontic review during treatment is effective, but this finding is based on a single study. Further adequately powered, double-blind, randomised controlled trials are required to determine the best means of preventing DWLs in patients undergoing orthodontic treatment and the most accurate means of assessing compliance with treatment and possible adverse effects.
Future studies should follow up participants beyond the end of orthodontic treatment to determine the effect of DWLs on participant satisfaction with treatment. Twenty-five studies were included, involving children. A funnel plot of the 23 studies indicated a relationship between prevented fraction and study precision. Only two trials reported on adverse events.
There is clear evidence of a caries-inhibiting effect of fluoride gel. There is little information concerning deciduous dentition, on adverse effects or on acceptability of treatment. Future trials should include assessment of potential adverse effects. To determine the effectiveness and safety of fluoride varnishes in preventing dental caries in children and adolescents, and to examine factors potentially modifying their effect.
The aim was to evaluate the efficacy of topical fluoride varnish applications on white spot lesion WSL formation in adolescents during treatment with fixed orthodontic appliances. The study design was a double-blinded randomized placebo-controlled trial with two parallel arms. The subjects were consecutive to year-old children referred for maxillary treatment with fixed orthodontic appliances. The patients were randomly assigned to a test or a control group with topical applications of either a fluoride varnish Fluor Protector or a placebo varnish every 6th week during the treatment period.
The outcome measures at debonding were incidence and progression of WSL on the upper incisors, cuspids and premolars as scored from digital photographs by 2 independent examiners. The mean number of varnish applications was 10 range in both groups. The incidence of WSL during the treatment with fixed appliances was 7. The mean progression score was significantly lower in the fluoride varnish group than in the placebo group, 0.
The results from the present study strongly suggest that regular topical fluoride varnish applications during treatment with fixed appliances may reduce the development of WSL adjacent to the bracket base. Application of fluoride varnish should be advocated as a routine measure in orthodontic practice. This paper aims to assess systematic reviews on the caries-preventive effect of topical fluorides, identifying key content and reporting quality issues to be considered by researchers planning a review in this area.
Published systematic reviews and meta-analyses of any topical fluoride intervention for caries control were included. Relevant databases were searched December , along with reference lists of included publications. Thirty-eight reports were identified and assessed. Less than half reported searching multiple sources and only one third reported a search strategy.
This study shows that some content features have been covered more often than others in existing fluoride reviews, while some relevant features are yet to be addressed. Also, reporting of several methodological aspects are below an acceptable level, except for Cochrane reviews. Current reporting guidelines for systematic reviews of interventions e.
The Cochrane Library should be closely followed to enhance the validity and relevance of future topical fluoride reviews. We found no evidence comparing slow-release fluoride devices against other types of fluoride therapy. We found only one double-blind RCT involving children comparing a slow-release fluoride device glass beads with fluoride were attached to buccal surfaces of right maxillary first permanent molar teeth against control glass beads without fluoride were attached to buccal surfaces of right maxillary first permanent molar teeth.
This study was assessed to be at high risk of bias. The study recruited children from seven schools in an area of deprivation that had low levels of fluoride in the water. The mean age at the beginning of the study was 8. DMFT in permanent teeth or dmft in primary teeth was greater than one at the start of the study and greater than one million colony-forming units of Streptococcus mutans per millilitre of saliva.
Although children were still included in the trial at the two-year completion point, examination and statistical analysis was performed on only the 63 children 31 in intervention group, 32 in control group who had retained the beads retention rate was Among these 63 children, caries increment was reported to be statistically significantly lower in the intervention group than in the control group DMFT: mean difference Harms were not reported within the trial report.
Evidence for other outcomes sought in this review progression to of caries lesion, dental pain, healthcare utilisation data were also not reported. There is insufficeint evidence to determine the caries-inhibiting effect of slow-release fluoride glass beads. The body of evidence available is of very low quality and there is a potential overestimation of benefit to the average child.
The applicability of the findings to the wider population is unclear; the study had included children from a deprived area that had low levels of fluoride in drinking water, and were considered at high risk of carries. Six of identified articles were included. Because the protocols differed, regrouping of data was not possible. The level of evidence was moderate due to imprecise methods. The horizontal technique was found to be the most effective up to 6 to 7 years of age.
For older children, there was no statistical difference between the techniques. No randomised clinical trial assessed different frequencies of toothbrushing. Based on current knowledge, it would appear prudent to propose that, at the stage of the late mixed dentition, the technique adopted by the child be modified to improve brushing quality without favouring a particular technique.
In younger children, the horizontal technique should be advised. The recommendations published via the Internet by national and international associations should be reconsidered. This study aimed to evaluate the progression of sealed non-cavitated dentinal occlusal caries in a randomised controlled clinical trial.
Sixty teeth with non-cavitated dentinal occlusal caries were selected in patients with a high risk for caries. Patients were randomly divided into two groups so that each group included 30 teeth. Patients in the experiment group were given oral hygiene instructions and a fissure sealant. Patients in the control group were given oral hygiene instructions only. Caries progression and sealant loss were monitored over a period of 36 months by clinical and radiographic examinations.
Clinical and radiographic progression of caries was significantly more frequent in the control group than in the experiment group. Three teeth lost their sealant and showed caries progression, but this was apparent only at the month follow-up. At the and month recall appointments, neither sealant loss nor caries progression were observed. The pit and fissure sealant utilised in this study was shown to be effective in arresting carious lesions at 36 months. This meta-analysis investigates the clinical retention of pit and fissure sealants in relation to observation time and material type.
A total of articles included information about sealant retention, with a minimum observation time of 2 years. These publications were analyzed to determine the retention rates of the various materials studied UV-light-, light- and auto-polymerizing resin-based sealants, fluoride-releasing materials, compomers, flowable composites and glass-ionomer-cement-based sealants. Lhuilier et J. Valluy , Autrement, Paris, Bloch On ne saurait mieux dire. Son nom? Bienvenu dans la prestigieuse Revue du droit public et de la science politique. Double comparaison en fait. Spectaculaire et durable involution.
Antiracistes et anticolonialistes? La colonisation est un fait de puissance. Piepers, confirme la permanence de cette organisation. Dans les possessions allemandes enfin, des dispositions voisines sont en vigueur. En rien, nous le savons maintenant. Augouard note. Un chien? Ils le nourrissent, et soignent leur cheval. Nous sommes, pour eux, moins que ces animaux, nous sommes plus bas que les plus bas. En , R.
Couvre-feu raciste, toujours. Nous sommes […] chez un peuple vaincu et, en temps de paix comme en temps de guerre, les faits nous le rappellent. Mesure secondaire? Double peine encore et toujours. Des dispositions voisines existent au Congo belge. Nullement note. Vaine promesse et vrai mensonge, nous le verrons. Il est interdit de traiter aucune question politique note. En vain. Laissons-lui la parole. En , G. Point de trouble donc, ni sur le plan juridique, ni sur le plan politique, ni sur le plan moral.
Inutile de poursuivre. Dure doxa de ces temps? En fait, non! Il y en avait donc? Le chef les abrite, les nourrit. Il leur donne une femme ou deux. Les couples feront des petits ouolosos. Du Congo note! Beaucoup ne partirent que pour soigner, pour enseigner. Ne trichons pas. Audacieuse proposition? La maison Gallimard. La collection? La date de publication? Abbas , Ferhat, 11, 64, Ageron , Charles-Robert, 93, , Arendt , Hannah, 11, 19, 22, Augouard , Prosper-Philippe, Mgr, Badinter , Robert, , Bendjelloul , Mohamed, 64, Billiard , Albert, 32, 48, 49, Bonet-Maury , Gaston, , Bourguiba , Habib, , Clemenceau , Georges, 19, 39, Dareste , Pierre, 13, 24, 62, 75, 89, , Deherme , Georges, , Delafosse , Maurice, 25,