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PubMed1976

Partial elimination of Streptococcus mutans from selected tooth surfaces after restoration of carious lesions and SnF2 prophylaxis.

This study examined the prevalence of Streptococcus mutans in dental plaque from carious and noncarious sites before and after routine dental treatment in five young men in the US Navy. S mutans was isolated in 96.3% of the samples from carious sites and in 63.3% of the samples from noncarious sites before treatment. After all carious lesions had been restored, the prevalence of S mutans was significantly reduced, but many of the carious and noncarious sites still had detectable levels of S mutans. A further reduction in S mutans was observed after conventional 8.9% stannous fluoride paste prophylaxis and 10% stannous fluoride topical application; however, in no instance was the organism completely eliminated. About 12 to 18 months after the initial examination, new carious lesions were seen in four men who were available for reexamination. Plaque samples of new lesions had high levels of S mutans. Therefore the restorations of lesions and the stannous fluoride prophylaxis treatments given under the conditions of the study were effective but incomplete measures for eliminating S mutans from the tooth surfaces of Navy personnel and were inadequate procedures for arresting the carious process.

Adolescent↗
PubMedDate not supplied

A clinical comparison of glass ionomer, resin-modified glass ionomer and resin composite restorations in the treatment of cervical caries in xerostomic head and neck radiation patients.

Controversy exists as to whether there is less secondary caries at the margins of glass ionomer restorations compared with other materials that do not release fluoride. This study examined the incidence of secondary caries for three types of restorative materials in Class V restorations in xerostomic patients. The study group consisted of 45 high caries-risk adult patients who had undergone head and neck irradiation for the treatment of cancer. All were substantially xerostomic and in need of at least three restorations in the same arch. Every patient received a restoration with each of the test materials, a conventional glass ionomer (GI), a resin modified glass ionomer (RMGI) and a resin composite (C). Patients were instructed in the daily use of a neutral pH sodium fluoride gel in custom trays. Recall appointments were made at 6, 12, 18 and 24 months, and the restorations were examined for material loss, marginal integrity and recurrent caries at the restoration margin. Fluoride compliance was determined at each recall period and recorded as the percentage of recommended use during that interval. Patients were categorized at the end of the study as fluoride non-users if their average compliance was 50% or less. Those with greater than 50% compliance were categorized as fluoride users. In the latter group, no recurrent caries was found for any of the restorations, whereas a material-dependent incidence of recurrent caries was found in the fluoride non-user group. None of the GI, one RMGI and eight C restorations failed due to recurrent caries. For the fluoride non-user patients, Fishers exact test (p=0.05) showed no statistical difference between GI and RMGI but statistical differences were found among those materials and resin composite at each recall period. Recurrent caries reductions for GI and RMGI relative to C were greater than 80% in xerostomic patients not using topical fluoride supplementation.

Adult↗
PubMed2000

Cost minimisation analysis of two occlusal caries preventive programmes.

OBJECTIVE: Fissure sealants have been recommended for the prevention of pit and fissure caries since the 1970s. Few comparative studies have examined the cost-effectiveness of these procedures. This study reports on the cost minimisation analysis conducted as part of a field trial which compared the caries preventive effects of a programme comprising selective fissure sealing and application of topical fluorides on first permanent molars (control) with a programme of professional cleaning and oral health education (test). DESIGN: The carious outcomes from the field trial were used to assign probability values to a hypothetical cohort of 100 children provided with the test or the control treatment. Incremental cost-effectiveness ratios were calculated using a 5% discount rate. Sensitivity analyses were conducted to test the sensitivity of the findings to the discount rate and labour costs. RESULTS: An incremental cost-effectiveness ratio of a $40/child/year after two years for the test programme was found. CONCLUSION: The findings suggest that the test programme comprising professional cleaning and oral health education should not be adopted on economic grounds. A longer period, of observation may be necessary before definitive conclusions regarding the cost-effectiveness of the preventive programmes can be made.

Child↗
PubMed1999

Dental plaque fluoride and pH in children exposed to different water fluoride levels.

The aims of this study were to determine plaque fluoride concentrations in children not exposed to topical fluorides but to different fluoride levels in the drinking water (0.1 and 2.0 ppm), and to observe whether plaque fluoride was related to plaque pH. Twenty-five children (6 to 7 years old) were selected from two rural villages in Brazil. A sub-set of subjects was examined for resting and fermenting plaque pH before sampling. A maximum of 14 sites was studied in each subject (vestibular and interproximal of first molars and central incisors). Plaque fluoride was extracted and measured with an inverted fluoride electrode under oil. Amounts of plaque were determined by protein analysis. Mean values in the 0.1 ppm village were 1.3 ngF/mg of plaque wet weight (SD = 1.1) and in the 2.0 ppm village 2.5 ngF/mg (SD = 2.1) and were not statistically different (Kruskal-Wallis test, P = 0.09). Plaque fluoride varied considerably from site to site in the same mouth. Combining sites in all subjects, plaque fluoride concentrations were positively related to resting and fermenting pH (regression analysis, P< 0.01-0.001, adjR2 = 0.12-0.31). On an individual basis the same trend was found for fermenting, but not for resting pH. In conclusion, our findings showed a moderate influence of water fluoride upon dental plaque fluoride concentrations and give some support to the theory that low fermenting pH may contribute to the release of bound plaque fluoride.

Analysis of Variance↗
PubMed1989

Fluorides and the prevention of dental caries. Part II: The case for water fluoridation.

The evidence is very strong that fluoridation of water, and fluorides in other forms, are the prime reasons for the enormous reduction in decay that has occurred over the past 25-30 years. These advantages must be retained. This can be done most effectively and most economically through a continuation of water fluoridation and the use of fluoride toothpaste. In nonfluoridated areas, professionally applied topical fluorides will continue to be needed, particularly within the School Dental Service, and in those adolescent and adults where the history and clinical picture suggest the individual is at risk. Without fluoride acting to enhance the resistance of the mouth, decay would certainly rise. Although advocacy for a sound diet and the use of fissure sealants is encouraged as part of caries preventive programmes, these alone will not provide adequate protection across the whole community. Fluoridation of public water supplies continues to be endorsed.

Costs and Cost Analysis↗
PubMedDate not supplied

Attitudes of dentists and physicians toward the use of dietary fluoride supplements.

One of the major goals of the reported research was to determine how consistent health practitioners' knowledge, attitudes and practices are with the consensus of the public health and research communities regarding caries prevention. Both professions are aware of current caries preventive methods, but have very mixed reactions toward their relative effectiveness in the United States, today. Dentists and physicians see a great deal of value in community water fluoridation and see some effectiveness from fluoridating school water supplies. They regard the prescription of dietary fluoride supplements as an effective caries prevention measure, but to a much lesser extent, and base their use of these prescriptions on the age of the child and the level of fluoride in the community's water system. Topical fluoride applications and fluoride dentifrices, as well, are thought to be very effective preventive measures by only a small proportion of dentists and physicians, as are fluoride mouth rinses. Dentists and physicians rate systemic fluorides as effective more often than they do other selected methods, as would the research community; but they are not as solidly behind these, as evidence would suggest they should be. Both community water fluoridation and dietary fluoride supplements are known to be very effective caries prevention measures, yet only 66 percent of the physicians think community water fluoridation is very effective and only 37 percent think dietary fluoride supplements are very effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Preventive dentistry for children. 1. The use of fluoride and pit-fissure sealant].

In the past 10 years, the dental caries prevalences of children in developed countries have declined dramatically and the same trend seems to appear for Thailand. This report will review the current knowledge and technology of many modalities in preventive dentistry on which concerted use will bring about the highest efficiency in preventing caries & gingivitis in children. In part one, the etiology of caries & periodontal disease in children will be reviewed. The use of systemic and topical fluoride, pit and fissure sealant are the first two methods of preventive dentistry discussed. The mechanical plaque control, diet modification and infant oral health counseling will be presented in part two.

Child↗
PubMed1993

Role of fluoride toothpastes in a caries-preventive strategy.

While the clinical relevance of fluoride toothpastes per se is firmly established, the multifactorial processes involved in causation and prevention of caries render it difficult to define their exact role in an overall caries-preventive strategy. Therefore, an indirect pragmatic approach was chosen: the interpretation of secular trends in caries prevalence and other parameters is used to estimate the relative importance of this method of topical fluoride administration and to compare it with the contributions by other methods of prevention. All methods of caries prevention, with the exception of population-administered measures such as fluoridation of drinking water or domestic salt, can only work when applied regularly and conscientiously. For this reason behavioural aspects such as compliance and the chances for widespread (if not universal) application have to be considered. There is indirect evidence that toothbrushing with fluoride toothpastes is a highly probable explanation for the decline of caries prevalence in developed countries since the 70s; moreover, toothbrushing, and the use of therapeutic dentifrices, is considered to meet spreading compliance because a 'healthy mouth' becomes more and more socially desirable in growing numbers of subpopulations.

Attitude to Health↗
PubMedDate not supplied

Fluoride exchange from glass ionomer preventive resin restorations.

The purposes of this in vivo study were to determine if placing a sealant over a glass ionomer restoration modifies its fluoride release, and to examine the effect on glass ionomer of a 4-min application of topical fluoride. Fluoride release from glass ionomer preventive resin restorations placed in 21 bovine teeth was measured before and after removing their sealants. Fuji II, Ketac Silver, and Fuji LC were evaluated, representing the three generations of glass ionomers. Fluoride was extracted from the restorations by incubating the specimens in 5 ml deionized water and was measured by specific ion electrodes at 1 and 2 days, then once weekly for 7 weeks. The results indicated that fluoride release was not significantly different in pattern or quantity in the three types of ionomer (P > 0.05). A significant reduction in fluoride release occurred when the restorations were covered with a sealant when compared with control restorations of the same materials (P < 0.001). After removing the sealant from the glass ionomer preventive resin restorations, a significant release of fluoride occurred when compared with sealed restorations (P < 0.001). After 63 days in water, the unsealed restorations were subjected to a 4-min topical APF treatment and reimmersed in water for an additional 27 days to examine the ability of the various materials to absorb fluoride. The fluoride-depleted restorations treated with fluoride released significantly more fluoride than fresh, untreated ionomer restorations (P < 0.001) or amalgam restorations. As a result of fluoride release, the glass ionomer preventive resin restoration may afford chemical protection to the tooth if sealant loss occurs.

Absorption↗
PubMed1985

Effects of suctioning devices on oral fluoride retention.

This study examined the effectiveness of suctioning devices in reducing oral fluoride retention after professional 4-minute applications of a 1.23% fluoride gel. The value of patient expectoration was also evaluated in the child subjects. The suction devices were statistically significant adjuncts in reducing oral-retained fluoride in all cases; however, the oral-retained fluoride doses after the suctioning procedures were still distinct in both adults (10.3 +/- 2.3 mg) and children (7.7 +/- 1.0 mg). These amounts of oral-retained fluoride would result in substantial elevations in body fluid fluoride concentrations. One minute of expectoration after the suctioning procedures in children was a statistically significant method of further reducing oral fluoride retention to a clinically acceptable level (1.6 +/- 0.5 mg). We recommend that suction devices be used during topical fluoride treatments, but most importantly that the patients be requested to expectorate thoroughly after topical treatment.

Adult↗
PubMedDate not supplied

The effect of topical APF foam and other fluorides on veneer porcelain surfaces.

Some topical fluorides cause surface changes in dental materials. The purpose of this study was to compare the effects of a topical acidulated phosphate sodium fluoride (1.23% APF) foam with the effects of other topical fluorides on the surface of veneer porcelain. Forty porcelain specimens (Ceramco) were placed into eight groups (N = 5). Four groups were immersed in either 1.23% APF foam, 1.23% APF gel, 2.0% sodium fluoride (NaF) gel, or water (reference) for 1 min. The other four groups were immersed in one of the above agents for four 1-min immersions. The surface topography of two scanning electron micrographs of each specimen was scored visually by two raters and by computer digital analysis (CDA). Inter-rater reliability was r = 0.67 (intraclass correlation coefficient). There were no significant differences in the mean visual scores or CDA scores among any of the groups immersed for 1 min. Porcelain immersed 4 min in APF gel had significantly greater mean visual scores and CDA scores than the other treatments (P < or = 0.0001; one-way ANOVA and Tukey's Studentized Range Test). The average surface topography scores of veneer porcelain immersed for 1 min in 1.23% APF gel, 2.0% NaF gel, 1.23% APF foam, or water were not significantly different. Significantly greater surface topography scores occurred following 4 min of immersion in 1.23% APF gel than all other agents.

Acidulated Phosphate Fluoride↗
PubMed2000

Fluoride concentration in plaque in adolescents after topical application of different fluoride varnishes.

The aim of the study was to measure the fluoride (F) concentration in plaque after a single topical application of different fluoride varnishes with contrasting levels of F. Thirty adolescents (12-17 years) with fixed orthodontic appliances were randomly assigned to one of three groups: Bifluoride (6% F), Duraphat (2.23% F) and Fluor Protector (0.1% F). The varnishes were applied after professional cleaning in one upper quadrant, leaving the opposite quadrant untreated according to the split-mouth technique. Pooled plaque samples from each quadrant were collected at baseline and 3 days, 7 days and 30 days after the varnish treatment, and fluoride was analysed by microdiffusion. All fluoride varnishes increased the fluoride concentration in plaque compared with baseline, and the mean values varied between 23 and 138 ng F/mg after 3 days, depending on varnish F concentration. Compared with the control quadrant, statistically significant elevations were recorded for Bifluoride after 3 days and 7 days and Duraphat after 3 days, while no significant differences were revealed in the Fluor Protector group. The fluoride concentration in plaque was back to baseline levels for all participants in the Duraphat group after 7 days, while some individuals in the Bifluoride and Fluor Protector groups still registered slightly increased levels after 30 days. The results suggest that fluoride varnish treatments resulted in elevated fluoride levels in plaque adjacent to fixed orthodontic appliances for a period of up to 1 week, although different patterns was disclosed for the various brands.

Adolescent↗
PubMed1988

Comparison of fluoride concentrations in unstimulated whole saliva following the use of a fluoride dentifrice and a fluoride rinse.

Recent evidence has suggested that the cariostatic effects of topical fluoride (F) are related to the presence of low concentrations of ionic F in the oral environment. The purpose of this study was to compare the retention of F in the oral environment over 24-hour periods after the use of a F dentifrice or a F rinse. Groups of ten consenting adult subjects (age 18-52 years) brushed and/or rinsed (B/R) in a standardized manner twice per day in the morning (AM) and before bed (PM) with either a placebo dentifrice (8 ppm F), NaF dentifrice (1100 ppm F), or NaF rinse (225 ppm F). Experiments were performed with placebo dentifrice only (PD); F dentifrice only (FD); F dentifrice followed by F rinse (FD/FR); placebo dentifrice followed by F rinse (PD/FR); and F rinse followed by placebo dentifrice (FR/PD). Unstimulated whole saliva samples were collected at baseline and then at 0, 15, 30, and 45 min, 1, 2, and 8 hr after B/R in the AM, after B/R in the PM and upon rising the following morning. Salivary flow rate and F were determined for each sampling interval. The results of this study suggest that: (1) F rinse may be a more effective way of delivering topical F than F dentifrice; (2) based on F retention, the combination of FD/FR was not more effective than FR only (PD/FR); (3) older individuals with gingival recession retained higher F levels; and (4) bedtime F application resulted in longer F retention than did daytime application, which may have important implications for enamel remineralization.

Adolescent↗
PubMed1975

Effect on dental caries of a dental public health program for Danish schoolchildren.

The effect of a dental public health program comprising schoolchildren under the Danish Act on Child Dental Health has been evaluated after 5 years of operation. The program comprised complete restorative care for all children from kindergarten through the 9th grade (16 years of age), but only children attending kindergarten through third grade (10 years) are included in the present study. Each grade comprised approximately 50 children. A number of preventive procedures such as topical fluoride application, oral hygiene instruction and various other educational procedures have been used. The treatment services resulted in almost complete elimination of the "D" component and the "M" component in the DMFS index. The preventive services resulted in marked reductions in the total DMFS index, and almost complete elimination of new carious lesions after enrollment in the program. The non-experimental nature of the study makes it possible to determine the effect of each one of the preventive procedures used in the program.

Child↗
PubMed1984

Fluoride-treated roots and viability and attachment of human gingival fibroblasts.

Topical fluoride treatment is used to help prevent root caries. It may also be useful in periodontal therapy because of its antimicrobial property. In addition, for therapeutic new attachment to occur, the fibroblasts approximating the treated root surface should remain viable, and should also be able to attach and grow onto the treated root surface. These conditions, at least, are required for fluoride not to interfere with new attachment. This study was designed to determine whether treatment of roots with fluoride adversely affects human gingival fibroblasts in culture; and what effect fluoride treatment has on attachment and growth of cells to the root surface. Cells originally obtained from human gingiva were allowed to grow to confluency in multi-well tissue culture petri dishes, and were then incubated for 24 hr in the presence of root sections as follows: (1) no treatment; (2) root-planed only; (3) 2% NaF only; (4) root-planed + 2% NaF; (5) root-planed + citric acid, pH 1 + 2% NaF. In addition, cells were plated onto roots similarly treated and were subsequently allowed to incubate for 72 hr. Viability of cells was determined by exclusion of vital dye and 51Cr retention. Attachment and growth of cells were determined by histology and scanning electron microscopy. Results indicated that, after 24 hours' exposure, there was little or no difference in cell viability between different treatment groups and control cultures. Also, all roots which had been planed accommodated cell attachment, regardless of additional treatment rendered.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Etching, Dental↗
PubMed1994

In vitro cumulative effect of topical application of fluoride gels on the surface of aesthetic restoration materials.

It has been shown that the application of topical acidulated fluoride products on composite resins and porcelains promotes changes on their surfaces. However, the reduced time of clinic treatment does not always cause significant effects. Therefore, the therapy is normally repeated, suggesting the hypothesis for a cumulative effect. The aim of this study was to examine if the repetition of application can potentiate the effect. Samples of different composite resins received topical application of four fluoridated commercial gel products with neutral and acid pH under different experimental conditions. The samples were subsequently stained to show the degree of surface alteration. A variable superficial alteration was observed in those samples that received the acidulated fluoride compounds.

Acidulated Phosphate Fluoride↗
PubMed1998

Prevalence and severity of dental caries in 12-year-old children in Kaunas, Lithuania 1995.

In order to evaluate suitable strategies for control of dental caries, a longitudinal study of caries progression has been initiated among 12-year-old children in Kaunas, Lithuania. The aim of the present paper was to describe the baseline caries situation in a sample of 12-year-olds, who had been examined using caries diagnostic criteria which differentiate between active and inactive caries lesions at both the cavitated and non-cavitated levels. The mean fluoride concentration in the drinking waters of Kaunas is 0.16 mg/l. A total of 889 children in the 6th grade from seven selected schools were examined. Each tooth surface of all permanent teeth was classified according to one of the following criteria: 0 = sound; 1 = active, surface intact; 2 = active, surface discontinuity; 3 = active, cavity; 4 = inactive, surface intact; 5 = inactive, surface discontinuity; 6 = inactive, cavity; 7 = filled; 8 = filled with inactive lesion; 9 = filled with active lesion; X = extracted. Distinction between active and inactive lesions was made on the basis of a combination of visual and tactile criteria. Virtually all children (99.7%) had experienced at least 1 DMF surface. The mean DMFS was 15.8. Half of the mean caries experience consisted of surfaces with active lesions (7.9), of which two thirds (4.9) were non-cavitated. The mean number of surfaces with non-cavitated inactive lesions was 4.4. The mean DMFT constituted 7.9; 95% of all first molars were affected, followed by the second molars (61%). A comparison of the caries profile according to the present caries diagnostic criteria with those recommended by WHO revealed that the WHO criteria yielded much lower DMFS and DMFT values, because this scoring system does not include non-cavitated caries lesions. The high level of non-cavitated active caries lesions suggests that in this population caries may to a large extent be controlled by simple preventive measures including use of topical fluorides.

Adolescent↗