Potencial remineralizante del fluoruro diamino de plata al 38% en dentina de dientes temporales afectada por caries / Remineralizing potential of 38% silver diamine fluoride in dentin affected by dental caries

Introducción: la caries es una enfermedad compleja que afecta a cualquier edad. La prevalencia es mayor en la primera dentición, sobre todo en población con baja percepción económica. El fluoruro diamino de plata (FDP) al 38% ha sido utilizado como una alter- nativa de tratamiento para esta enfermedad. Funciona como una solución remineralizante y cariostática. Objetivo: evaluar el efecto remineralizante del FDP al 38% en dentina afectada por lesiones de caries en molares temporales. Material y métodos: estudio clínico, epidemiológico, descriptivo, longitudinal y experimental. Se llevó a cabo en molares de primera dentición de niños de tres a cinco años de edad. Los niños seleccionados tenían molares con lesiones cariosas dentinarias, Pitts las denomina D3. No se incluyeron niños con dientes que presentaron patologías pulpares irreversibles. La aplicación del FDP al 38% la efectuó un operador entrenado para esta finalidad. Se utilizaron los criterios de Nyvad para determinar el grado de dureza de la dentina y con ello deducir su remineraliza- ción. Se observó la permanencia de la remineralización efectuada por un periodo de cinco meses. Resultado y conclusión: el FDP es un compuesto eficaz en 91% de los casos en un periodo de cinco meses o más (AU)

Introduction: dental caries is a complex disease that affects any age. The prevalence is higher in primary dentition, especially in a population with low economic perception. 38% silver diamine fluoride (FDP) has been used as an alternative treatment for this disease. It works as a remineralizing and cariostatic solution. Objective: to evaluate the remineralizing effect of 38% FDP on dentin affected by dental caries, in temporary molars. Material and methods: clinical, epidemiological, descriptive, longitudinal and experimental study. It was carried out in temporary molars of children between three and five years of age. The selected children presented molars with dental carious lesions, Pitts calls them D3. Children with teeth that presented irreversible pulp pathologies were not included. The application of the FDP to 38% was carried out by an operator trained for this purpose. The Nyvad criteria were used to determine the degree of hardness of the dentin and thereby deduce its remineralization. The permanence of the remineralization carried out was observed for a period of five months. Result and conclusion: the FDP is an effective compound in 91% of the cases, in a period of five months or more (AU)

Research Trends on Preventive and Therapeutic Use of TIF4 for Dental Caries and Erosion

Abstract Objective: To evaluate TIF4 preventive and therapeutic use in caries and erosive lesions. Material and Methods: Searches were performed in six databases. Studies evaluating TiF4 use in vitro, in situ, and in vivo in caries and erosive lesions were included and imported into VantagePoint™ (VP). Data about publication year, authors, country, journal, study design, outcomes, TIF4 vehicles, application and intervention time, cariogenic challenge, erosive cycles, effects (positive/ negative /null) and approach (preventive/therapeutic) were analyzed through VP and Excel. Results: 93 published studies were included and an increase in publications was observed between 2010 and 2021. Forty-three authors published three or more articles, of which 67.4% were developed in Brazil and published in Caries Research (22.6%). 69.9% were in vitro studies with erosion assays (59.1%) and with preventive approaches (67.4%). The principal vehicle was a solution (69.9%) with a 1-min single application (58.0%) and with an intervention time of 5-7 days (22.6%). The principal cariogenic challenge in vitro was pH cycling (11.8%); in situ was sucrose + biofilm (6.2%); and in vivo, biofilm (6.2%). The most used erosive cycle was 4× per day in in vitro studies (20.4%) and 1× in vivo (2.1%). A positive effect was observed in prevention (41.9%) and treatment (24.7%) studies. Conclusion: TIF4 has shown a positive effect in prevention and therapeutic treatments for dental caries and erosion (AU).

Research progress in ecological prevention of dental caries / 中华口腔医学杂志

Dental caries is one of the most common oral diseases around the world. Dental plaque attached to the surfaces of teeth is the main biological factor leading to caries. Although fluoride is still one of the most commonly used methods to prevent caries, with the change of epidemiological characteristics of caries and the update of the understanding of caries etiology, it is necessary to use other ecological methods such as antimicrobial peptides, arginine, probiotics and natural products, etc. to enhance the effect of fluoride in preventing dental caries. The present article reviews the research progress on the ecological approaches for caries prevention in recent years.

Decurso histórico das políticas de fluoretação como estratégia de enfrentamento à cárie dentária no Poder Legislativo brasileiro, de 1963 a 2019 / History of fluoridation policies as a strategy by the Brazilian Legislative Branch to fight dental caries, 1963 to 2019 / Recorrido histórico de las políticas de fluoración como estrategia de combate a la caries dental en el Poder Legislativo brasileño, de 1963 a 2019

Resumo: O objetivo deste trabalho foi analisar os processos legislativos sobre políticas de fluoretação no Brasil, de 1963 a 2019. Utilizou-se o referencial teórico de Pierre Bourdieu. Foi realizada uma pesquisa documental sobre os processos legislativos que abordam o tema da fluoretação no Brasil como medida de saúde pública e as discussões que ocorreram no Congresso Nacional. As fontes de pesquisa para a construção do artigo foram os sítios eletrônicos oficiais da Câmara dos Deputados e do Senado Federal, para consultar os atos legislativos relacionados à fluoretação no Brasil. De 1963 a 2001 e em 2017, foi constatada uma disputa entre os métodos de fluoretação das águas de abastecimento, água mineral e fluoretação do sal. Entretanto, permeava a compreensão da importância e benefícios acerca da utilização do flúor sistêmico. De 2003 a 2013, os projetos contestavam a utilização do flúor sistêmico, propondo sua utilização apenas em meio tópico. Nos anos 1960, 1970 e em 2017, os atos legislativos apresentavam mais aproximação ao campo científico e foram propostos por parlamentares da oposição. Diferentemente do tema da fluoretação das águas, dos 6 atos legislativos favoráveis à fluoretação do sal, apenas um era proveniente de um profissional da saúde e apenas dois de legisladores do eixo Sudeste. Houve maior participação de projetos de legisladores do Centro-oeste e do Nordeste. Aqueles com formação na saúde apresentaram tomadas de posição em defesa de algum método de fluoretação sistêmica. Esta análise possibilita interpretar o processo histórico de construção em resposta ao problema constituído e suas distintas estratégias de enfrentamento.

Abstract: The aim of this study was to analyze legislative proceedings on fluoridation policies in Brazil from 1963 to 2019. The theoretical reference was Pierre Bourdieu. A document search was performed on legislative proceedings that address the theme of fluoridation in Brazil as a public health measure and the discussions in the National Congress. The sources for the article were the official websites of the Chamber of Deputies (lower house) and the Senate to consult the legislative acts related to fluoridation in Brazil. The study showed that from 1963 to 2001 and in 2017 there was a dispute between fluoridation methods for the water supply, mineral water, and table salt fluoridation. However, there was a crosscutting understanding of the importance and benefits of systemic fluoride use. From 2003 to 2013, the bills challenged the use of systemic fluoride, proposing its use only in topical applications. In the 1960s, 1970, and 2017, the legislative bills showed a closer approach to the scientific field and were submitted by opposition members of Congress. Unlike the issue of water fluoridation, of the 6 legislative bills in favor of salt fluoridation, only one was drafted by a health professional da health, and only two by legislators from the Southeast region. There were more bills by legislators from the Central and Northeast. Those with training in health exhibited positions in defense of some method of systemic fluoridation. The analysis allowed interpreting the historical process of developing the response to the caries problem and the different strategies employed in this process.

Resumen: El objetivo de este trabajo fue analizar los procesos legislativos sobre políticas de fluoración en Brasil, de 1963 a 2019. Se utilizó el marco referencial teórico de Pierre Bourdieu. Se realizó una investigación documental sobre los procesos legislativos que abordan el tema de la fluoración en Brasil, como medida de salud pública, y las discusiones que se produjeron en el Congreso Nacional. Las fuentes de investigación para la construcción del artículo fueron los sitios electrónicos oficiales de la Cámara de los Diputados y del Senado Federal para consultar las acciones legislativas relacionadas con la fluoración en Brasil. De 1963 a 2001 y en 2017 se constató una disputa entre los métodos de fluoración de las aguas de abastecimiento, agua mineral y fluoración de la sal. Mientras tanto, permeaba la comprensión de la importancia y beneficios a cerca de la utilización del flúor sistémico. De 2003 a 2013, los proyectos contestaban la utilización del flúor sistémico, proponiendo su utilización solamente como medio tópico. En los años 1960, 1970 y en 2017 las acciones legislativas presentaban más aproximación al campo científico y fueron propuestos por parlamentarios de la oposición. A diferencia del tema de la fluoración de las aguas, de las 6 acciones legislativas favorables a la fluoración de la sal, solamente una provenía de un profesional de la salud, y solamente dos de legisladores del eje sudeste. Hubo una mayor participación en proyectos de legisladores del Centro-oeste y del Nordeste. Aquellos con formación en salud presentaron toma de posición en defensa de algún método de fluoración sistémica. Este análisis posibilita interpretar el proceso histórico de construcción, en respuesta al problema planteado, y sus distintas estrategias de combate al mismo.

The in vitro remineralizing effect of CPP-ACP and CPP-ACPF after 6 and 12 weeks on initial caries lesion

Abstract Objective: The aim of this in vitro study was to determine the effects of remineralization promoting agents containing casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), or CPP-ACP in combination with fluoride (CPP-ACPF) on artificial white spot lesions (WSLs) after 6 and 12 weeks. Methodology: White spot lesions were created on 123 sectioned premolars (246 specimens) with a demineralization solution during a 96 hours pH-cycling regime. Two experimental groups were created: a CPP-ACP group (Tooth Mousse™), and a CPP-ACPF group (Mi Paste Plus™). Additionally, two control groups were created, one using only a conventional toothpaste (1450 ppm fluoride) and another one without any working agents. All teeth were also daily brushed with the conventional toothpaste except the second control group. Tooth Mousse™ and Mi Paste Plus™ were applied for 180 seconds every day. The volume of demineralization was measured with transverse microradiography. Six lesion characteristics regarding the lesion depth and mineral content of WSLs were also determined. Results: The application of CPP-ACP and CPP-ACPF had a significant regenerative effect on the WSLs. Compared to Control group 1 and 2 the volume of demineralization after 6 weeks decreased significantly for CPP-ACP (respectively p<0.001 and p<0.001) and CPP-ACPF (respectively p=0.001 and p=0.003). The same trend was observed after 12 weeks. For the CPP-ACPF group, WSL dimensions decreased significantly between 6 and 12 weeks follow-up (p=0.012). The lesion depth reduced significantly after application of CPP-ACP and CPP-ACPF but increased significantly in the Control groups. Mineral content increased for CPP-ACP and CPP-ACPF after an application period of 12 weeks, but this was only significant for CPP-ACP. Conclusions: Long-term use of CPP-ACP and CPP-ACPF in combination with a conventional tooth paste shows beneficial effects in the recovery of in vitro subsurface caries lesions.

Microhardness and Ultrastructure of Demineralized Gamma-Irradiated Human Enamel after Diode Laser (980 nm) and Fluoride Surface Treatment

Abstract Quality of life drastically diminished after radiotherapy due to radiation induced oral complications. Fluoride was found to be helpful in decreasing the incidence of radiation caries; however it has not led to elimination of dental caries. Thus, new techniques containing low fluoride concentration or not containing fluoride at all, as laser irradiation, have been studied to prevent the beginning or progression of caries. So the purpose of this study is to investigate the effect of laser surface treatment with or without fluoride on microhardness and ultrastructure of demineralized gamma irradiated enamel; Thirty enamel slabs were allocated into three groups (n=10): G slabs were subjected to gamma irradiation only; GL slabs were subjected to gamma irradiation followed by diode laser and GFL slabs were subjected to gamma irradiation followed by fluoride then diode laser. Slabs were then exposed to demineralizing solution for 72 hours. Examination of slabs was performed using vickers microhardness test and scanning electron microscope; The lowest microhardness was recorded in group G, while inGL and GFL groups it significantly increased. Scanning electron microscope revealed a pronounced loss of central prism core and retention of prism peripheries in group G. Confluence of prismatic and interprismatic structures in GL slabs and irregular rough surface with prismatic boundaries conservation in GFL slabs were detected. Applying laser improved the microhardness and counteracted the adverse effect of gamma radiation. Adding fluoride before laser irradiation had a marked effect on microhardness..

Randomized clinical trial of the effect of NovaMin and CPP-ACPF in combination with dental bleaching

Abstract Objective This randomized, controlled, double-blind clinical study evaluated the effect of calcium sodium phosphosilicate (NovaMin) and casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) on the prevention of post-operative sensitivity and on the effects of clinical bleaching treatment. Material and Methods Sixty volunteers were selected according to inclusion and exclusion criteria and were randomly assigned into three groups (n=20): CG (control group) patients, who were treated with 35% hydrogen peroxide; NOVAG (NovaMin group) patients, who were treated with 35% hydrogen peroxide followed by the application of NovaMin; and CPPG (CPP group) patients, who were treated with 35% hydrogen peroxide followed by the application of CPP-ACPF. Both bioactive agents were applied for five minutes. An evaporative stimulus associated with a modified visual scale was used to analyze sensitivity 24 hours after each bleaching session. The color evaluation was performed on the maxillary central incisors using a spectrophotometer. Associations between the intervention group, bleaching session, and reported sensitivity were tested using Chi-square partitioning. Results Color change values (ΔE) were analyzed using analysis of variance (ANOVA). The significance level used for both tests was 5%. In the intragroup assessment, the Friedman test showed that only the CPP-ACPF group showed no statistically significant difference (p<0.05) between baseline and first bleaching session. In the intergroup assessment, the Kruskal-Wallis test showed that the CPPG had less postoperative sensitivity after the first session, when compared to the other groups (p<0.05). Color change analysis (ΔE) showed a significant difference between the means obtained in the different bleaching sessions in all groups (p<0.05). Conclusions This study showed that the combination of CPP-ACPF with 35% hydrogen peroxide significantly reduced post-operative sensitivity in the first session, compared with the other evaluated treatments. The association of CPP-ACPF and NovaMin did not affect the color change induced by tooth bleaching.

In vitro and in situ evaluation of the effects of high-fluoride and arginine-based toothpastes to control root caries / Avaliação in vitro e in situ do efeito de dentifrícios fluoretados de alta concentração de fluoreto e a base de arginina no controle da cárie radicular

The focus of our studies has been the root substrate dentin, once root caries prevalence has been reported as increasing in part due to people living longer and maintaining their natural teeth into old age. Furthermore, this condition is highly prevalent in patients undergoing head-and-neck radiotherapy (HNR). To better understand the effect of different toothpastes in sound and non-irradiated root dentin, this research was developed in 3 parts with specific objectives, involving both in nonirradiated and irradiated substrates. In study 1, high-F toothpaste (5,000 µg F/g) associated or not with f tri-calcium phosphate (f TCP) were compared in vitro with conventional one (1,450 µg F/g) to control bovine root caries development. The study 2 was conducted to evaluate if the in vitro performance would be similar in a closer clinical situation. An in situ design was performed and the effect of high-F toothpaste combined or not with f TCP comparing to 1,450 µg F/g combined or not with argininebased toothpastes in reducing the net demineralization of sound root dentin and on the remineralization in initial artificial caries lesions was verified. In study 3, the effects of radiation exposure on human root dentin composition, structure and mechanical properties were evaluated. In the first study, our findings highlight the importance of using high-F toothpastes to prevent root caries development. In the second one, the results showed great performance of high-F toothpastes and arginine-based toothpastes, in clinical situations. The results of study 3 showed that radiation exposure changed the composition and structure of human root dentin, which may detrimentally affect its mechanical properties. Overall, the studies suggest that at high-risk population, such as elderly people and patients undergoing HNR, it is important to develop protocols to minimize damages caused by carious lesions, inhibiting the net demineralization of root caries. The current results can clarify the effects of radiation on root dentin to help further studies in this area. We also could observe that conventional toothpaste is not as effective as high-F toothpastes to prevent this condition, in non-irradiated root dentin. This knowledge is of special interest to determine the quality of life of high-risk population to dental caries presenting available tools that can be of at-home use with beneficial effects on demineralization protection and reversion.(AU)

O foco de nossos estudos tem sido o substrato dentinário radicular, uma vez que há relatos do aumento da prevalência de cárie radicular, devido principalmente ao aumento da expectativa de vida da população e a manutenção dos dentes naturais nos idosos. Além disso, essa condição é altamente prevalente em pacientes submetidos à radioterapia de cabeça e pescoço (RCP). Para melhor entendimento do efeito de diferentes dentifrícios em dentina radicular não-irradiada e irradiada, essa pesquisa foi desenvolvida em 3 partes, com objetivos específicos. No estudo 1, dentifrícios de alta concentração de F (5000 µg F/g) associado ou não com tri cálcio fosfato (f TCP) foram comparados in vitro com dentifrícios convencionais (1450 µg F/g) no controle do desenvolvimento de cárie radicular bovina. O estudo 2 foi conduzido para avaliar se os resultados do in vitro seria o mesmo diante de uma situação mais próxima da clínica. Um desenho in situ foi realizado e o efeito de dentifrício de alta concentração de F combinado ou não com f TCP e comparado com dentifrícios convencionais 1450 µg F/g combinado ou não com dentifrícios a base de arginina na redução da desmineralização de dentina radicular hígida e na remineralização de lesões cariosas previamente desenvolvidas foi avaliado. No estudo 3, os efeitos da exposição da dentina humana à radiação na sua composição, estrutura e propriedades mecânicas foram avaliados. No primeiro estudo, os resultados destacam a importância do uso de dentifrícios de alta concentração de F para prevenir o desenvolvimento de cárie radicular. No segundo, os resultados mostraram boa performance clínica dos dentifrícios de alta concentração de F e a base de arginina. O estudo 3 mostrou que a exposição à radiação altera a composição e estrutura da dentina radicular humana. De modo geral, os estudos sugerem que em população de alto risco, como os idosos e pacientes submetidos à RCP, é importante desenvolver protocolos para minimizar danos causados pelas lesões de cárie, inibindo a desmineralização líquida da cárie radicular. Os presentes resultados podem clarificar os efeitos da radiação na dentina radicular e ajudar em estudos posteriores nessa área. Também é possível observar que dentifrícios convencionais não são tão efetivos como os de alta concentração para prevenir essa condição, em dentina radicular não irradiada. Tal conhecimento é de especial interesse para garantir a qualidade de vida da população de alto risco à cárie, apresentando ferramentas disponíveis que podem ser usadas em casa com efeito benéfico na proteção da desmineralização.(AU)

Avaliação in vitro de enxaguatórios experimentais com compostos bioativos na prevenção/remineralização de lesões de mancha branca ativa durante tratamento ortodôntico / In vitro evaluation rinses experiments with bioactive compounds in the remineralization of white spot lesions during orthodontic treatment

O objetivo deste estudo foi avaliar in vitro por meio da Fluorescência de Raios X por Dispersão de Energia (XRF) e Microscopia Eletrônica de Varredura (MEV) o efeito remineralizante de enxaguatórios bucais com compostos bioativos, sendo nanopartículas de hidroxiapatita de cálcio (nanoHAp) associadas ou não a fluoreto, fluoreto de sódio e saliva no esmalte dental bovino. Foram utilizados 15 corpos de prova (CP) a partir de 15 incisivos bovinos que foram divididos aleatoriamente em 3 grupos, com 5 CP cada um. Após colagem dos braquetes, as amostras foram submetidas a um alto desafio de cárie com solução desmineralizante de cloreto de cálcio 2,2 mM, fosfato de sódio monohidratado 2,2 mM e ácido acético 0,05 M, com pH ajustado entre 4,4 e 5,2, permanecendo durante 48 horas em solução desmineralizante, em temperatura ambiente, simulando lesão de mancha branca ativa no esmalte dental bovino ao redor desses braquetes ortodônticos. Em seguida, cada grupo foi denominado conforme os respectivos tratamentos a serem utilizados. Grupo 1 (G1) solução de fluoreto de sódio (0,05%); Grupo 2 (G2) solução aquosa de nanopartículas de hidroxiapatita de cálcio (0,75%) e Grupo 3 (G3) solução aquosa de fluoreto de sódio (0,05%) associada a nanopartículas de hidroxiapatita de cálcio (0,75%). Foram obtidos os valores de XRF e imagens em MEV antes e depois da desmineralização e antes e depois do tratamento. Os dados obtidos foram submetidos à análise estatística pelo teste ANOVA para comparação entre as médias iniciais e finais de cada grupo e para comparação dos grupos de tratamentos distintos com nível de significância de 5% (p ≤ 0,05). Nas leituras por XRF, nenhum dos enxaguatórios testados foram eficientes na remineralização das lesões de mancha branca no período de 5 dias. E nas imagens de MEV, o grupo que recebeu tratamento com a solução de NanoHAp 0,75% (G2) apresentou deposição mineral uniforme na superfície de esmalte desmineralizado, vedando os prismas de esmalte.

The aim of the present study was to assess in vitro, through energy dispersive X-ray fluorescence (XRF) and Scanning Electron Microscopy (SEM), the remineralizing effect of mouth rinses with bioactive compounds, which are calcium hydroxyapatite nanoparticles (nanoHAp) associated or not with fluoride, sodium fluoride and saliva in bovine dental enamel. Fifteen specimens from 15 bovine incisors were used and randomly distributed into three groups, with 5 specimens each. After bonding the brackets, the specimens were subjected to a high caries challenge with 2.2 mM calcium chloride, 2.2 mM sodium phosphatemonohydrate and 0.05 mM acetic acid demineralizing solution, pH adjustedbetween 4.4 to 5.2, kept in demineralizing solution for 48 hours, at room temperature, simulating active white spot lesion on bovine dental enamel around those orthodontic brackets. Then, each group was named according torespective treatments to be used: Group 1 (G1) ­ 0.05% sodium fluoride solution; Group 2 (G2) ­ aqueous solution of 0.75% calcium hydroxyapatite nanoparticles; and Group 3 (G3) ­ aqueous solution of 0.05% sodium fluoride associated with 0.75% calcium hydroxyapatite nanoparticles. The XRF values were obtained and the SEM images were taken before and after the demineralization, and before and after the treatment. Data were submitted to statistical analysis by ANOVA test to compare the initial and final means of each group and to compare the distinct treatment groups with a significance level at 5% (p ≤ 0,05). In the XRF readings, none of the tested mouth rises were efficient in the remineralization of white spot lesions in the period of 5 days. In the SEM images, the group treated with 0.75% NanoHAp solution (G2) showed uniform mineral deposition of the demineralized enamel surface, sealing theenamel prisms

Differential diagnosis of dental fluorosis made by undergraduate dental students / Diagnóstico diferencial de fluorose dentária por discentes de odontologia

ABSTRACT Objective To check knowledge of undergraduate dental students to make diagnosis of dental fluorosis with varying degrees of severity and choose its appropriate treatment. Methods Data were collected using a semi-structured questionnaire addressing knowledge of undergraduates based on ten images of mouths presenting enamel changes. Results Only three images were correctly diagnosed by most undergraduates; the major difficulty was in establishing dental fluorosis severity degree. Conclusion Despite much information about fluorosis conveyed during the Dentistry training, as defined in the course syllabus, a significant part of the students was not able to differentiate it from other lesions; they did not demonstrate expertise as to defining severity of fluorosis and indications for treatment, and could not make the correct diagnosis of enamel surface changes.

RESUMO Objetivo Verificar o conhecimento de discentes de um curso de graduação em Odontologia ao diagnosticar casos de fluorose dentária nos diversos graus de severidade, bem como escolher seu tratamento adequado. Métodos O levantamento dos dados foi realizado por meio um questionário semiestruturado, que abordou o conhecimento dos acadêmicos sobre as imagens de bocas contendo alterações do esmalte dentário. Resultados Apenas três imagens foram diagnosticadas corretamente pela maioria dos acadêmicos; a maior dificuldade foi o diagnóstico da severidade da fluorose dentária. Conclusão Apesar das informações sobre fluorose repassadas no decorrer do curso de Odontologia, definidas pelos conteúdos abordados na matriz curricular, expressiva parte dos alunos ainda não soube diferenciá-la de outras lesões, não demonstrando domínio sobre a severidade e as indicações de tratamento, o que indicou desconhecimento no diagnóstico correto das alterações de superfície de esmalte.

Disponibilidad de Flúor en Saliva y Biofilms en Escolares Expuestos a Leche o Agua Fluorurada / Availability of Fluoride in Saliva and Biofilms in School Children Exposed to Fluoride in Water or Milk

La caries sigue siendo un problema de Salud Pública, por la alta prevalencia y severidad que afecta a la población. En Chile, la incorporación de flúor en el agua y la leche, son medidas de salud pública en la prevención de caries que se distribuye en zonas urbanas y rurales respectivamente. La evidencia científica nos permite sostener que el fluoruro disponible en saliva y placa bacteriana es el principal responsable del efecto preventivo de este compuesto en el proceso de caries. El objetivo fue comparar los niveles de flúor en saliva y placa bacteriana, antes y después de la ingesta de leche, de los escolares que consumen leche fluorurada y de los que consumen leche sin flúor preparada con agua potable fluorurada de la Región de la Araucanía de Chile. Se realizó un estudio de muestras repetidas de saliva y placa bacteriana en 165 niños(as) incorporados(as) en el Programa PAE de 16 escuelas rurales y urbanas. Se tomaron muestras de saliva y placa bacteriana antes del desayuno, muestras de saliva 60 min después y muestras de placa bacteriana 120 minutos después del desayuno. La concentración de fluoruro en saliva se observa muy similar sin importar el vehículo a través del cual se le administre, sea este leche fluorurada o leche sin fluor preparada con agua fluorurada, tanto en las muestras basales como en las muestras obtenidas después del desayuno. En cambio en placa bacteriana si se observan pequeñas diferencias que, siendo estadísticamente significativa, pueden no tener mucha relevancia clínica por ser demasiado pequeñas. Estos resultados refuerzan la hipótesis de que la estrategia de leche fluorurada tiene resultados similares al agua fluorurada.

Caries continue to be a public health problem, due to their high prevalence and their severe effect on people. Currently in Chile, adding fluoride to water and milk are public health measures to prevent caries that are distributed in urban and rural areas respectively. Scientific evidence supports the availability of fluoride in saliva and bacterial plaque being the most effective prevention against caries. The goal was to compare the levels of fluoride in saliva and bacterial plaque before and after drinking milk, among school-children who consume fluoridated milk and those who consume un-fluoridated milk prepared with fluoridated drinking water, in the La Araucanía Region of Chile. A study was conducted of repeated samples of saliva and bacterial plaque in 165 children within the PAE program at 16 rural and urban schools. Saliva and bacterial plaque samples were taken before breakfast, saliva samples were taken 60 minutes after breakfast and bacterial plaque samples were taken 120 min after breakfast. The concentration of fluoride in saliva was found to be very similar regardless of the manner in which it was administered. So it was similar in children drinking fluoridated milk and un-fluoridated milk prepared with fluoridated water, and similar both before and after breakfast. In contrast, we found small differences for bacterial plaque, that are statistically significant. However, they may not be clinically significant as they are too small. These results reinforce the hypothesis that the strategy of adding fluoride to milk has similar results to adding fluoride to water.

Remineralizing efficacy of Calcarea Fluorica tablets on the artificial carious enamel lesions using scanning electron microscope and surface microhardness testing: In vivostudy.

Context: Remineralization is defined as the process whereby calcium and phosphate ions are supplied from a source external to tooth to promote ion deposition into crystal voids in demineralized enamel to produce net mineral gain. The remineralization produced by saliva is less and also a slow process, therefore remineralizing agents are required. Aims: The study was planned to evaluate the effectiveness of homeopathic Calcarea Fluorica (calc‑f) tablets as remineralizing agents on artificial carious lesions using scanning electron microscope (SEM) and surface microhardness (SMH) testing. Subjects and Methods: A total of 24 patients needing removable orthodontic treatment were included in the study. They were divided into two groups of 12 patients each. The Group I consisted of patients in whom no tablets were given while Group II consisted of patients in whom calc‑f tablets were given in a dosage of 4 tablets twice a day. Four enamel samples with the artificial carious lesions were then embedded in the removable appliance for a period of 6 weeks. After 6 weeks, the enamel samples were retrieved and evaluated by SEM and SMH. Statistical Analysis Used: One‑sample Kolmogorov–Smirnov test and Student’s t‑test were applied to analyze the difference in the Vickers microhardness number (VHN) values of remineralized enamel obtained from control and experimental group. Results: The signs of remineralization such as reduction in depth prismatic holes or decrease in porosity, variable sized uneven distribution of deposits and amorphous deposits were seen in enamel samples of both the groups. The mean SMH of remineralized enamel sample of Group I and Group II were 270.48 and 302.06, respectively, and the difference was statistically significant. Conclusions: (1) Remineralization occurred in both the groups as indicated by SEM and the increase in surface hardness values in both the groups. (2) Remineralization of enamel samples in the control group as indicated by SEM and also by increase in VHN values indicated that the saliva has a tendency of remineralizing the early carious lesions. Conclusions drawn from the study are that the calc‑f tablets can be used as safe and cost effective remineralizing agent.

Avaliação do potencial remineralizante de pastas e soluções com compostos bioativos no esmalte dental bovino submetido a ciclos de desafio erosivo / Remineralizing effectiveness of different bioactive principles in bovine enamel subjected to acidic challenges

O objetivo deste estudo foi avaliar in vitro por meio da Fluorescência de Raios X por Dispersão de Energia (XRF), Microdureza Vickers (MV) e Microscopia Eletrônica de Varredura (MEV) o efeito remineralizante de diferentes princípios bioativos, tais quais, nanopartículas de hidroxiapatita de cálcio (nanoHAp) associadas ou não a fluoreto, fosfopeptídeos de caseína do leite e fosfato de cálcio amorfo (CPP-ACP) associados ou não a fluoreto, fluoreto de sódio e saliva no esmalte dental bovino submetido a ciclagem des-remineralizante simulando lesão erosiva por alto desafio ácido. Foram obtidos 58 corpos de prova (CP) a partir de 58 incisivos bovinos que foram divididos aleatoriamente em 8 grupos, com 7 CP cada um e 2 CP para obtenção de imagem em MEV do esmalte hígido. Cada grupo foi denominado conforme os respectivos tratamentos a serem utilizados. Grupo 1 (G1) Controle; Grupo 2 (G2) Desensibilize Nano P experimental (nanopartículas de hidroxiapatita de cálcio); Grupo 3 (G3) Desensibilize Nano P (nanopartículas de hidroxiapatita de cálcio e flúor); Grupo4 (G4) GC Tooth Mousse (CPP-ACP, fosfopeptídios de caseína e fosfato de cálcio amorfo –Recaldent ™); Grupo 5 (G5) GC Tooth Mousse Plus (CPP-ACP, fosfopeptídios de caseína e fosfato de cálcio amorfo –Recaldent ™ + 900 ppm de flúor); Grupo 6 (G6) solução aquosa de fluoreto de sódio (0,05%); Grupo 7 (G7) solução aquosa de nanopartículas de hidroxiapatita de cálcio (0,375%) e Grupo 8 (G8) solução aquosa de nanopartículas de hidroxiapatita de cálcio (0,375%) + flúor (0,05%). Foram obtidos os valores de XRF e MV antes e depois do tratamento. Durante um período experimental de 10 dias, os CPs foram submetidos a um processo cíclico de des-remineralização incluindo vários ataques diários com ácido cítrico 0,05M (pH 2,3), 6 vezes de 2 minutos ao dia, bem como as aplicações das soluções teste e períodos de remineralização em saliva artificial. O tempo entre os ciclos ...

The aim of this study was to evaluate in vitro by X-ray fluorescence technique (XRF), surface microhardness (SMH) and SEM the remineralizing effect of different bioactive principles.We used 58bovine incisors that were sectioned into fragments (CP) and randomly divided into 8 groups. All teeth were initially evaluated to obtain the count of elements phosphorus (P) and calcium (Ca) interpreted from a range of X-Ray Fluorescence obtained by Artax ™ 200 and to obtain the initial SMH. Over a 10-day experimental period, the enamel samples weresubjected to erosive demineralization that was performed by immersion in 250 ml 0.05 M citric acid (pH 2.3) for 6 X 2 min per day. Subsequently, the samples were rinsed with distilled water for 1 min and afterwards received the corresponding treatments Group 1 (G1) Positive control; Group 2 (G2) Experimental Desensibilize Nano P (nanoparticles of calcium hydroxyapatite); Group 3 (G3) Desensibilize Nano P (nanoparticles of calcium hydroxyapatite and Fluor); Group 4 (G4) Recaldent: GC Tooth Mousse (CPP-ACP fosfopeptídios casein and amorphous calcium phosphate-Recaldent ™), Group 5 (G5) GC Tooth Mousse (CPP-ACP fosfopeptides casein and amorphous calcium phosphate-Recaldent ™ and 900 ppm Fluor); Group 6 (G6) NaF aqueous solution; (G7) nanoHAp aqueous solution and Group 8 (G8) nanoHAp + NaF aqueous solution. The samples were rinsed again with distilled water for 1 min and stored in artificial saliva. The time between cycles was 1.5 h. In the control group, the samples were eroded 6 X 2 min per day and stored in artificial saliva. All CP were evaluated again. SEM images for surface analysis were obtained after treatment. Through statistical analysis by Student t test ( p = 0.05 ) , the following results were found: control group had a severe demineralization, there was an increase in the count of P in all treated groups except G1 , that was an increase in Ca count in all treated ...

Avaliação do potencial remineralizante de pastas e soluções com compostos bioativos no esmalte dental bovino submetido a ciclos de desafio erosivo / Remineralizing effectiveness of different bioactive principles in bovine enamel subjected to acidic challenges

O objetivo deste estudo foi avaliar in vitro por meio da Fluorescência de Raios X por Dispersão de Energia (XRF), Microdureza Vickers (MV) e Microscopia Eletrônica de Varredura (MEV) o efeito remineralizante de diferentes princípios bioativos, tais quais, nanopartículas de hidroxiapatita de cálcio (nanoHAp) associadas ou não a fluoreto, fosfopeptídeos de caseína do leite e fosfato de cálcio amorfo (CPP-ACP) associados ou não a fluoreto, fluoreto de sódio e saliva no esmalte dental bovino submetido a ciclagem des-remineralizante simulando lesão erosiva por alto desafio ácido. Foram obtidos 58 corpos de prova (CP) a partir de 58 incisivos bovinos que foram divididos aleatoriamente em 8 grupos, com 7 CP cada um e 2 CP para obtenção de imagem em MEV do esmalte hígido. Cada grupo foi denominado conforme os respectivos tratamentos a serem utilizados. Grupo 1 (G1) Controle; Grupo 2 (G2) Desensibilize Nano P experimental (nanopartículas de hidroxiapatita de cálcio); Grupo 3 (G3) Desensibilize Nano P (nanopartículas de hidroxiapatita de cálcio e flúor); Grupo4 (G4) GC Tooth Mousse (CPP-ACP, fosfopeptídios de caseína e fosfato de cálcio amorfo –Recaldent ™); Grupo 5 (G5) GC Tooth Mousse Plus (CPP-ACP, fosfopeptídios de caseína e fosfato de cálcio amorfo –Recaldent ™ + 900 ppm de flúor); Grupo 6 (G6) solução aquosa de fluoreto de sódio (0,05%); Grupo 7 (G7) solução aquosa de nanopartículas de hidroxiapatita de cálcio (0,375%) e Grupo 8 (G8) solução aquosa de nanopartículas de hidroxiapatita de cálcio (0,375%) + flúor (0,05%). Foram obtidos os valores de XRF e MV antes e depois do tratamento. Durante um período experimental de 10 dias, os CPs foram submetidos a um processo cíclico de des-remineralização incluindo vários ataques diários com ácido cítrico 0,05M (pH 2,3), 6 vezes de 2 minutos ao dia, bem como as aplicações das soluções teste e períodos de remineralização em saliva artificial. O tempo entre os ciclos ...

The aim of this study was to evaluate in vitro by X-ray fluorescence technique (XRF), surface microhardness (SMH) and SEM the remineralizing effect of different bioactive principles.We used 58bovine incisors that were sectioned into fragments (CP) and randomly divided into 8 groups. All teeth were initially evaluated to obtain the count of elements phosphorus (P) and calcium (Ca) interpreted from a range of X-Ray Fluorescence obtained by Artax ™ 200 and to obtain the initial SMH. Over a 10-day experimental period, the enamel samples weresubjected to erosive demineralization that was performed by immersion in 250 ml 0.05 M citric acid (pH 2.3) for 6 X 2 min per day. Subsequently, the samples were rinsed with distilled water for 1 min and afterwards received the corresponding treatments Group 1 (G1) Positive control; Group 2 (G2) Experimental Desensibilize Nano P (nanoparticles of calcium hydroxyapatite); Group 3 (G3) Desensibilize Nano P (nanoparticles of calcium hydroxyapatite and Fluor); Group 4 (G4) Recaldent: GC Tooth Mousse (CPP-ACP fosfopeptídios casein and amorphous calcium phosphate-Recaldent ™), Group 5 (G5) GC Tooth Mousse (CPP-ACP fosfopeptides casein and amorphous calcium phosphate-Recaldent ™ and 900 ppm Fluor); Group 6 (G6) NaF aqueous solution; (G7) nanoHAp aqueous solution and Group 8 (G8) nanoHAp + NaF aqueous solution. The samples were rinsed again with distilled water for 1 min and stored in artificial saliva. The time between cycles was 1.5 h. In the control group, the samples were eroded 6 X 2 min per day and stored in artificial saliva. All CP were evaluated again. SEM images for surface analysis were obtained after treatment. Through statistical analysis by Student t test ( p = 0.05 ) , the following results were found: control group had a severe demineralization, there was an increase in the count of P in all treated groups except G1 , that was an increase in Ca count in all treated ...

The influence of desensitizing dentifrices on pain induced by in-office bleaching

The purpose of this study was to evaluate whether the use of desensitizing dentifrices used 15 days prior to and after in-office tooth bleaching could eliminate or reduce tooth sensitivity. After institutional review board approval and informed consent, 45 subjects were selected and divided into 3 groups according to the dentifrice selected: Colgate Total (CT), Colgate Sensitive Pro-Relief (CS) or Sensodyne ProNamel (SP). The subjects used toothpaste and a toothbrush provided to them for 15 days prior to bleaching. They were then submitted to two in-office bleaching sessions (Whiteness HP Blue Calcium). Their tooth sensitivity was assessed using the Visual Analog Scale (VAS) for a week after each session. Their tooth shade alteration was measured with a Vitapan Classical shade guide to determine if the dentifrices could influence the effectiveness of the bleaching agent. The data were submitted to Wilcoxon, Kruskal-Wallis and Mann-Whitney tests (α = 0.05). The use of desensitizing dentifrices did not affect the bleaching efficacy. In regard to tooth sensitivity, there was a statistically significant difference between the results of the Control Group and Group T2 after the first session (p = 0.048). There was no statistically significant difference in the results for the other groups after the first session. In regard to the second session, there was no statistically significant difference in the results for all the groups. The use of a desensitizing dentifrice containing nitrate potassium reduced tooth sensitivity during the bleaching regimen. Dentifrices containing arginine and calcium carbonate did not reduce tooth sensitivity. Color change was not influenced by the dentifrices used.

In situ protocol for the determination of dose-response effect of low-fluoride dentifrices on enamel remineralization

No in situ protocol has assessed the dose-response effects of fluoride dentifrices involving low-fluoride formulations. Objective: To assess the ability of an in situ remineralization model in determining dose-response effects of dentifrices containing low fluoride concentrations ([F]) on bovine enamel. Material and Methods: Volunteers wore palatal appliances containing demineralized enamel blocks and brushed their teeth and devices with the dentifrices supplied (double-blind, crossover protocol) separately for 3 and 7 days. Surface hardness (SH), integrated subsurface hardness (ΔKHN) and [F] in enamel were determined. Data were analyzed by ANOVA, Tukey's test and Pearson's correlation (p<0.05). Results: Dose-response relationships were verified between [F] in dentifrices and SH, ΔKHN and enamel [F]. Higher correlation coefficients between enamel [F] and SH and ΔKHN were obtained for the 3-day period. Significant differences in SH and ΔKHN were observed among all groups for the 3-day period, but not between 0-275, 275-550, and 550-1,100 µg F/g dentifrices for the 7-day period, nor between 3- and 7-day periods for the 1,100 µg F/g groups. Conclusions: Considering that the peak remineralization capacity of the conventional dentifrice (1,100 µg F/g) was achieved in 3 days, this experimental period could be used in future studies assessing new dentifrice formulations, especially at low-fluoride concentrations. .

Fluoride in pit and fissure sealants: is it a feasible combination? / Flúor em selantes de cicatrículas e fissuras: uma combinação viável?

Dental sealants work on the principle of blocking caries susceptible pits and fissures of teeth thus rendering them caries resistant. Fluoride is another agent that is effective in reducing dental caries. However added benefits of fluoride can be achieved through its topical application. These effects can further be amplified by extended exposure of tooth surface to fluoride releasing agents. Thus the concept of addition of fluoride to pit and fissure sealants was conceived. Until now two methods of fluoride incorporation in pit and fissure sealants have been formulated. First method employs addition of soluble fluoride salts to the unpolymerized resin. Second system of fluoride incorporation uses an organic fluoride compound that can be chemically bound to resin. But the mechanism of fluoride release from fluoridated fissure sealants remains speculative. Fluoride release might occur from the insoluble sealant material as a result of porosity or ion exchange procedure. Several studies have looked at benefits of such combinations, but no study has documented a clear-cut clinical benefit or potential benefit of the same, rather seems a marketing ploy. This paper reviews evidence pertaining to use of combination of fluoride and sealants for caries prevention, their feasibility and effectiveness after addition of fluoride to sealants through in vitro and in vivo studies.

Selantes dentários usam o princípio de bloqueio de fóssulas e fissuras suscetíveis à cárie, tornando-as resistentes à cárie. O flúor é outro agente eficaz na redução da cárie dentária. No entanto, os benefícios adicionais do flúor podem ser alcançados por meio da sua aplicação tópica. Esses efeitos podem ser potencializados por uma exposição prolongada da superfície do dente a agentes de liberação de flúor. Assim, o conceito de adição de flúor a selantes de fóssulas e fissuras foi introduzido. Até agora, dois métodos de incorporação de flúor em selantes de fóssulas e fissuras foram formulados. O primeiro método emprega a adição de sais de fluoreto solúveis na resina não polimerizada. O segundo utiliza um composto de flúor orgânico, que pode ser quimicamente ligado à resina. Mas o mecanismo de liberação de flúor de selantes de fissuras fluoretados permanece desconhecido. A liberação de flúor pode ocorrer a partir do selante insolúvel como resultado de porosidade ou de um processo de troca iónica. Vários estudos analisaram os benefícios de tais combinações, mas nenhum estudo documentou um benefício real ou potencial do mesmo, em vez disso, parece ser mais uma jogada de marketing. Este artigo de revisão traz comentários relativos à utilização da combinação de flúor e selantes para prevenção de cáries, sua viabilidade e eficácia após adição de fluoreto em selantes utilizando estudos in vitro e in vivo.

Desensitizing treatments for dentin hypersensitivity: a randomized, split-mouth clinical trial

The aim of this randomized, controlled, split-mouth, clinical study was to differentiate and clinically qualify the effectiveness of different desensitizing agents in the treatment of painful symptoms caused by cervical dentin hypersensitivity (CDH). Two hundred-and-fifty-two teeth of 42 patients were distributed into seven groups (n = 36): G1 - placebo; G2, G3, G4 and G6 - fluoride varnishes; G5 - sodium fluoride; G7 - potassium oxalate. Three applications were made one week apart. A three-score system (Alfa = 0, Bravo = 2, and Charlie = 3, respectively for no sensitivity, slight sensitivity and high sensitivity) was used to assess CDH after each application and after 30 days. The data were subjected to statistical analysis using the Kruskall-Wallis and Dun tests. After the second week, statistically significant differences were observed for all materials compared with the baseline. After 30 days, Group G7 had presented a significant gradual reduction along all the evaluated time intervals. It was concluded that all the desensitizing agents were capable of reducing dentin hypersensitivity, with the exception of the placebo and the sodium fluoride groups.

Oral health-related knowledge, attitude, and practices among 12-year-old schoolchildren studying in rural areas of Panchkula, India.

Oral health is fundamental to general health and well being. Schools can provide a supportive environment for promoting oral health. School policies and education on health-related matters are imperative for the attainment of good oral health and control of related risk behaviors. Aim: This study was conducted to assess oral health-related knowledge, attitude, and practices among 12-year-old schoolchildren studying in rural areas of Panchkula, India. The ultimate goal was to implement an oral health-promotion program in this area. Materials and Methods: A total of 440 children (216 males and 224 females) from 12 schools were included in this study. All the participants were requested to complete a 13-question closed-ended questionnaire. The statistical significance of any difference between the two genders was determined using the Chi-square test. Results: Only 25% of the participants said that they cleaned their teeth more than once in a day. Thirty-two percent did not clean their teeth daily. Over the preceding 1 year, 45.5% of the childern had had some problem with their teeth and/or gums, but only 35.9% visited the dentist. Among these children, 8.2% used tobacco in some form. Oral health-related knowledge of girls was significantly better than that of boys. Conclusion: Based upon the findings of the present study, the knowledge, attitude, and practices of the surveyed children with regard to oral health is poor. Hence, there is a need for regular oral health education of the children, as well as their parents and school teachers.