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998 children aged 6, 8 and 10, from low income families living in the Federal District, Brazil and attending public, first grade, schools, received bi-annual topical APF Gel-Tray applications. The mass methodology proposed by the National Dental Caries Preventive Program of the Brazilian Ministry of Health, without previous prophylaxis, was adopted. After one year, in fluoridated communities the reduction in the incidence of CPOS was of 31.6%, 24.9% and 39.5%, respectively, for the groups aged 6, 8 and 10. In non fluoridated communities the reductions were, respectively, of 24.3%, 26.6% and 27.7%, in every case with statistic significance at the 95% confidence level. Considering the positive results in a developing area, it is recommended that oral health institutions at all levels could adopt a comprehensive and continuous preventive program for children under their responsibility.
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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.
The surface free energy gamma s and its polar and dispersion components gamma Sp and gamma Sd were determined from contact angle measurements on human enamel treated with sodium fluoride, acidulated phosphate fluoride (APF), and aminfluoride solutions. Sodium fluoride solutions only slightly influenced the surface free energy component gamma Sp. The gamma Sp value of the APF-treated human enamel increased from 52 to 66 erg X cm-2. The gamma Sp value after aminfluoride treatment decreased from 52 to 19 erg X cm-2. The gamma Sd values remained about 35 erg X cm-2 for all specimens measured. It is suggested that aminfluoride-treated enamel surfaces may exhibit a reduced tendency for bacterial adhesion.
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.
Prevention of dental caries in patients with hyposalivation due to Sjögren's syndrome requires increasing host resistance and decreasing cariogenic organisms and their substrate. Although plaque control by scrupulous oral hygiene is important, particularly from a periodontal perspective, and restriction of dietary sucrose intake can limit caries, the most successful therapeutic and preventive measure has been the topical application of fluoride to the tooth surface, by the dentist, dental hygienist, dental auxiliary, and the patient. Studies on schoolchildren with normal salivary function who used fluoride dentifrices have shown that efficacy in caries prevention depends on (1) the concentration of fluoride used, (2) the frequency with which it is applied, and, to a certain extent, (3) the specific fluoride compound used. Controlled clinical studies are lacking, however, on patients with hyposalivation due to Sjögren's syndrome, and only limited data are available from patients with radiation-induced hyposalivation. Obviously it is not possible to run placebo control groups; nevertheless, there have been no head-to-head comparisons of fluoride rinses, or of stannous fluoride, acidulated phosphate fluoride, or sodium fluoride gels, and thus no single protocol can be recommended. Accordingly, different centers have used these products interchangeably--for example, selecting a rinse regimen if patients complain of gagging when using a gel applied in a tray, or if the cost of the tray is prohibitive. Recent innovations that show promise for treatment of high-caries-risk patients with hyposalivation are the use of fluoride rinses in combination with chlorhexidine rinses or gels and the professional application of high-concentration chlorhexidine varnishes to the teeth.
Ever since researchers first realized the benefits of fluoride as an anticaries agent, they began investigating the effect of concentrated topical fluoride applications in reducing caries. Many forms of fluoride were studied, including solutions, gels or foams of sodium fluoride, stannous fluoride, organic amine fluoride, acidulated phosphate fluoride, and nonaqueous fluoride varnishes in an alcoholic solution of natural resins and difluorosilane agents covered by a polyurethane coating. All of these professionally applied topical agents have anticaries benefits, although these benefits and the ease of application vary. One trend that stands out in the evolution of professionally applied fluoride agents is the development of increasingly more user-friendly products.
The influence of fluoride solutions on the surface roughness of polished and nonpolished composites with Sof-Lex discs was verified. Concise and Herculite XR samples were exposed to the action of 1.23% acidulated phosphate fluoride rinse, 1.23% acidulated phosphate fluoride gel, and 0.2% neutral phosphate fluoride rinse for 4 min each. The average roughness values obtained by perfilometer showed that all fluoride solutions produced surface alterations in the samples. In the unpolished samples, more roughness was produced in Concise etched by 1.23% acidulated phosphate fluoride rinse. In the polished samples, the 1.23% acidulated phosphate fluoride gel produced greater alterations in Herculite XR, and the neutral rinse in Concise samples.
Two-minute topical applications with four different fluoride compounds, acidulated phosphate fluoride, sodium fluoride, sodium monofluorophosphate and stannous fluoride, were evaluated for ability to reduce the acide solubility of human root surfaces in vitro. Each fluoride was in aqueous solution with the fluoride level adjusted to 1.23 percent and the pH native. Rectangular windows were prepared on root surfaces and control versus test differences were invariably studied within teeth and not between teeth. Sodium fluoride and sodium monofluorophosphate solutions reduced root surface solubility by approximately 30 percent while acidulated phosphate fluoride and stannous fluoride were more than 2.5 times more effective, the solubility reduction exceeding 80 percent. Root surfaces thus are similar to enamel in their reactions to topically applied fluorides. Based upon these results the clinician should choose between acidulated phosphate fluoride and stannous fluoride when making the choice of a single treatment compound for office application.