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PubMed1996

Ontario dentists' knowledge and beliefs about selected aspects of diagnosis, prevention and restorative dentistry.

Based on the responses of 1,276 general dental practitioners in Ontario to a mail questionnaire, variations in certain aspects of the dentists' diagnostic, preventive and restorative knowledge and beliefs are examined. Despite recent practice recommendations and guidelines indicating that patient need and service selectivity, rather than traditional, routine prescriptions, should be the guiding principle of practice, many dentists seem to follow tradition in defining optimal intervals for dental examinations and prophylaxes, bitewing radiographs and topical fluoride applications. Although the respondents' knowledge and beliefs were correct and consistent with current evidence in many areas, some large deficiencies were identified. These include: a lack of awareness that professional prophylaxis prior to topical fluoride application is usually unnecessary and that sealant applications to certain teeth are not cost-effective; an over-estimation of the speed at which dental caries progress through the enamel; and, despite good knowledge about the opportunities for the remineralization of enamel lesions with fluorides, a tendency to restore enamel caries. In some instances, practitioner beliefs were shown to influence practice. For example, dentists who knew about the slow progression of approximal surface caries also reported more often that bitewing intervals should be longer, and that the placement of a restoration should be delayed until the caries penetrates the dentin. Similarly, correct knowledge about sealant effectiveness was positively associated with high sealant use. If dentists are to be expected to understand and follow emerging diagnostic, preventive and restorative practice recommendations and guidelines, continuing education is required to correct and update some of their knowledge and beliefs, as displayed in the responses to this questionnaire.

Adolescent↗
PubMed2006

Statistical aspects of design and analysis of clinical trials for the prevention of caries.

This paper considers the methods used in design and analysis of recent clinical trials of topical fluoride interventions designed to prevent the development of dental caries in children, with particular consideration given to issues related to cluster-randomized trials. Studies which met the inclusion criteria were recent clinical trials of topical fluoride interventions published since 1990, conducted in children under 16 years of age, with caries as the outcome variable. Papers not published in English were translated. Information was extracted from the published trial reports on the units of randomization and analysis. The papers were also studied to assess if reporting allowed the assessment of potential consent bias in cluster-randomized trials and the reproduction of sample size calculations. Fifteen trials published since 1990 were included, of which five were cluster randomized. Only 1 of the 5 accounted for the clustering in the analysis. For the other four trials, it was possible to calculate that values from 0.002 (for DMFS) and 0.08 (for being caries free) for the intracluster correlation coefficient within schools could result in statistically non-significant findings. 3 of the 5 cluster-randomized trials did not report the consenting procedure in enough detail to judge whether consent bias could be present. Only 1 of the total 15 trials reported a sample size calculation. In summary, researchers should be aware of the importance of correctly analyzing cluster-randomized data and thorough reporting of clinical trials according to the CONSORT guidelines.

Adolescent↗
PubMed1996

A comparison of moderate and high users of Alberta's universal dental plan for the elderly.

The characteristics and service utilization of 2,071 high and 2,337 moderate users of Alberta's dental plan from 1978-79 to 1990-91 are reported. High users are those who used the plan for 14 consecutive years; moderate users are those who used the plan in seven of the 14 years. Both groups were over 74 years of age in 1991-92. Compared to high users, moderate users lived in less urbanized regions, visited denturists more often and received far more complete dentures and fewer partial dentures. As a percentage of their total annual plan expenditures, moderate users spent less on diagnostic, preventive, periodontal and restorative services and much more on removable prosthodontic and denturists' services. However, during the study period, the moderate users increased their annual relative expenditures for diagnostic, preventive and, especially, periodontal services, and decreased them for prosthodontic services. With respect to specific preventive and periodontal services, the percentage of total annual expenditures for dental prophylaxis, topical fluoride applications, periodontal scaling, gingival curettage, and combinations of these, was much higher for the high user group. Despite these differences favoring the high user group, during the 14 year period, the moderate user group considerably increased its relative expenditures for dental prophylaxis, topical fluoride and periodontal scaling services. While the observed differences in service expenditures between high and moderate users were anticipated, the shift over time to using more preventive and periodontal services by both groups was an encouraging harbinger of the "new elderly" dental patients.

Aged↗
PubMed2001

Fluoride - is it capable of fighting old and new dental diseases? An overview of existing fluoride compounds and their clinical applications.

Since researchers first became aware of the anticaries action of fluoride, they have been investigating the effect of this preventive agent in inhibiting or arresting caries development. Many forms of systemic or topical fluoride have been studied and tested for clinical application. Water, salt, milk fluoridation and the use of fluoride supplements were introduced for systemic fluoridation mainly using sodium fluoride. Solutions, gels, toothpastes and rinses of sodium fluoride, stannous fluoride, amine fluorides, acidulated phosphate fluoride and monofluorophosphate were used for topical fluoridation. More recently nonaqueous fluoride varnishes in an alcoholic solution of natural resins and difluorosilane agents in a polyurethane matrix were introduced. Although all of these fluoridation methods have a caries-preventive action, these benefits and the ease of application is variable. As fluoride is a key component of oral health promotion a coordinated approach on a community and individual basis seems to be needed to maximize the cost-benefit ratio of prevention.

Animals↗
PubMed2003

[The effect of fluoride application in adolescents of lower socio-economic status].

Purpose was to study the effect of professionally applied topical fluoride on oral health status on the population level in adolescents with lower socio-economic status. Adolescents attending dental clinics where professional fluoride application is a routine procedure (high-fluoride group) were compared to adolescents from other clinics (low-fluoride group). The study consisted of a questionnaire, a clinical examination with two bitewing radiographs. X-rays showed no statistically significant differences in the number of DS, FS or DFS. Clinically, there were no statistically significant differences in the number of FS or in the number of DFS. The low-fluoride group had a statistically significant higher number of DS than the high-fluoride group. The results suggest that professionally applied fluoride has a limited effect on caries and treatment experience in a population. These results justify a randomised clinical trial to study the effectiveness of professionally applied topical fluorides.

Adolescent↗
PubMed1996

Fluoridation of hydroxyapatite powder by ammonium hexafluorosilicate.

Diamine silver fluoride [AgF: (NH3)2AgF] is a unique fluoride solution used clinically in Japan for primary teeth. AgF has been shown to reduce dental caries and dentine hypersensitivity. However, AgF also stains teeth black due to sulfide precipitation and thus is unacceptable for permanent teeth. In the present study, the potential value of ammonium hexafluorosilicate [SiF: (NH4)2SiF6], which has a formula similar to that of AgF but contains no Ag, was studied with respect to its ability to fluoridate apatite. Hydroxyapatite [HAP: Ca10(PO4)6(OH)2] powder was treated with several topical fluoride solutions, i.e. neutral sodium fluoride, acidulated phosphate fluoride (APF) along with AgF and SiF. Following treatment, the HAP powders were analyzed for their fluorine content, crystallinity changes, and solubility in acidic solution. The highest level of fluoridated HAP [FAP: Ca10(PO4)6(OH)xF2-x] was observed in HAP powder treated with SiF, even though more total fluorine in the form of FAP and CaF2 was observed in HAP powder samples treated with APF. Presumably as a consequence of this higher level of FAP formation after SiF treatment, the highest level of crystallinity along with the lowest solubility in acidic solution were observed in HAP powder treated with SiF solution. We concluded, therefore, that SiF may have potential value for use as a topical fluoride solution.

Acidulated Phosphate Fluoride↗
PubMedDate not supplied

A review of sodium fluoride varnish.

Fluoride varnish was incorporated into clinical dentistry to reduce caries; its use in the U.S. has increased progressively since it was approved by the FDA in 1994. This paper reviewed clinical studies and found that fluoride varnish's effectiveness in caries prevention, ease of application, and safety give it an advantage over other types of topical fluoride treatments (such as gels and rinses) or other caries management methods. As a result, it is regarded as one of the superior topical fluoride agents for young children.

Cariostatic Agents↗
PubMed1997

Control of occlusal caries in the first permanent molars by oral hygiene.

Caries of the pits and fissures of permanent teeth continues to be a problem for children, newly erupted permanent molars being particularly at risk. Oral hygiene measures have been shown to be able to reduce the incidence of caries. The aim of this study was to compare the caries-preventive effects on newly erupted first permanent molars of a professional tooth cleaning and oral health education program (test) with a standard preventive program (control), comprising selective fissure sealing and application of topical fluorides. School Dental Service clinics of the Health Department of Western Australia, in Perth, were assigned to four test or four control clinics. Schoolchildren, mean age 6.3 +/- 0.3 (s) years with sound, newly erupted first permanent molars were included in the study (207 test, 197 control). After 12 months, 186 test and 163 control children were examined by an examiner who was 'blind' to the test or control status of the children. Caries of the first permanent molars developed in 34 test and 35 control children; the estimated risk ratio was 0.86 (95% CI 0.56, 1.30). Children in the test group had an average DFT score of 0.26 +/- 0.62 compared with 0.29 +/- 0.64 DFT in the control group (t-test, P = 0.67). The 12-month results suggest that there was no statistically significant difference between the caries-preventive effects of a professional tooth cleaning and oral health education program and a program based on selective fissure sealing and application of topical fluorides.

Cariostatic Agents↗
PubMed1990

Relationship of total fluoride intake to beneficial effects and enamel fluorosis.

Recent studies indicate that the prevalence of very mild to moderate dental fluorosis, as classified by Dean, has increased relative to that found in earlier investigations. To date, fluoridated water, fluoride supplements, the diet, fluoride dentifrices, and other topical fluoride applications have been identified as sources of systemic fluoride. Recent evidence suggests that there is a strong association between mild to moderate enamel fluorosis and the use of fluoride supplements during early childhood, and that the presently recommended supplementation schedule for U.S. children above the age of 2 years may be too high. Evidence also suggests that there is a strong association between fluoride dentifrice use during early childhood and enamel fluorosis in fluoridated populations. These findings support the need for a careful review of existing supplementation schedules and early oral hygiene practices. There is a pressing need for additional analytical epidemiological studies to confirm existing findings and to determine whether other fluoride sources may be associated with enamel fluorosis. Further, since exposure to combinations of individual risk factors has been shown to carry more than merely an additive increase in the risk of fluorosis, these studies must be multifactorial in design. There is also a need for more fluorosis prevalence and severity data to be gathered, so that the development of enamel fluorosis as a public health problem can be assessed, and so that the success of measures implemented to maximize efficacy while minimizing unwanted side-effects can be monitored.

Dental Enamel↗
PubMedDate not supplied

Effect of acid-etching on fluoride-treated caries-like lesions of enamel: a SEM study.

Etching patterns by 20 percent phosphoric acid on caries-like lesions of enamel (white spot) untreated and treated with 0.4 APF were studied at 30, 60, 120 seconds of etch-times using the Scanning Electron Microscope (SEM). The surface topography of acid-etched teeth varied according to the etch time. Acid etching of caries-like lesions treated with fluoride showed etching patterns similar to sound enamel. Based on Silverstone's classification, thirty seconds etch-time produced type III pattern of surface morphology, while type I and type II were observed with 60 and 120 seconds of etch time. Fluoride treated lesions showed increased porosity and in addition to a surface coating of numerous small globules of calcium fluoride. Low level of topical fluoride before sealant application should be beneficial, since this allows a more rapid rate and increased degree of remineralization and possible arrest in the progress of caries lesions.

Acid Etching, Dental↗
PubMed1980

Recruitment of a clinical field trial population: reasons for nonparticipation.

Open-ended telephone interviews were conducted with 294 families who refused participation in a school-based program of professionally applied topical fluoride. While the program was conducted in a flouride-deficient community, the level of topical fluoride contact in the homes of the nonparticipants was high. The traditional antifluoridationist reasons for nonparticipation were not expressed with frequency. Instead, the most frequent reason for returning a negative consent form was that the child was already receiving topical flouride applications from the family dentist. The second most frequent reason was that the child did not wish to participate. Many of the reasons given for nonparticipation were not cogent, suggesting that if the parents had been more informed about the nature of the project and about fluoride in general their responses might have been positive.

Attitude↗
PubMed1990

Fluoride in dental plaque after a single toothbrushing with monofluorophosphate dentifrice.

Many studies have shown that topical fluoride applications can produce a fluoride reservoir in dental plaque. Since the most common topical fluoride application is via toothbrushing with fluoridated dentifrices, the aim of this study was to measure fluoride uptake by dental plaque after a single toothbrushing with monofluorophosphate (MFP) toothpaste and to follow the plaque until its fluoride concentration returned to the prebrushing levels. In a fluoridated area, plaque samples were collected from 26 children who brushed with MFP toothpaste, 22 children who brushed with a fluoride-free control toothpaste, before brushing and at intervals of 10 minutes, 1 hour and 2 hours after brushing. A combination fluoride electrode was used to determine the fluoride content of the samples. In conclusion, our study has shown that brushing with fluoridated water has a positive effect on the fluoride level of the plaque and the addition of MFP did not make a significant change, although it had a short term effect. A negative correlation was established between plaque wet weight and its fluoride content whenever the plaque equilibrated.

Adolescent↗
PubMed2005

Controlling the fluoride dosage in a patient with compromised salivary function.

BACKGROUND: High-concentration topical fluorides are used commonly to with compromised salivary function due to irradiation and chemotherapy. CASE DESCRIPTION: The authors describe a 50-year-old man with previously treated cancer who was using tray-applied topical fluoride gel. He complained of gastric symptoms, difficulty in swallowing, leg muscle soreness and knee joint soreness. A computed tomographic scan revealed thickening of the esophageal walls. An upper endoscopy revealed abnormal motility. The motility test indicated high-amplitude peristalsis and hypertensive lower esophageal sphincter, and urine testing indicated high levels of systemic fluoride. The patient's fluoride regimen was altered, and within a short period his urinary fluoride levels returned to normal and his symptoms resolved. CLINICAL IMPLICATIONS: Clinicians prescribing home-applied high-concentration fluorides need to be cognizant of the symptoms of fluoride toxicity, carefully monitor the patient's compliance with the treatment regimen, and adjust the dosage or mode of application to control the total ingested dose of fluoride.

Arthralgia↗
PubMed1993

Root caries: some clinical aspects.

This paper has discussed some aspects of root surface caries which are of special relevance to the clinician. Epidemiological studies have suggested that root caries is not inevitable after gingival recession, but a small number of patients show a propensity for development of new lesions. Several risk factors have been identified. Thorough prophylaxis is essential for accurate diagnosis of root caries lesions, and radiographs can identify lesions which would otherwise be difficult to detect. The activity of any particular lesion can only be evaluated by observation at successive examinations. Fluoridated water may have a role in the prevention of root caries, but the evidence is not conclusive. Other forms of topical fluoride have been demonstrated to be effective. Cleansable and accessible lesions can be arrested with good oral hygiene and topical fluoride therapy. Teeth which require restoration may be restored with GIC, but limitations of the material make this unsuitable for all but readily accessible lesions, or where margins are supragingival. Clinicians should not rely on the fluoride released from GIC in situations where another material may provide a better restoration; in many situations, amalgam may be the material of choice. The longevity of bonded amalgam restorations has not been established, and conventional methods of amalgam retention remain a requirement of every restoration.

Age Factors↗