Fluoruro de estaño en el control de cavidades sin restauración en dientes temporales / Stannous fluoride in nonrestorative cavity control in primary teeth

Introducción: el control de cavidades sin restauración (NRCC, por sus siglas en inglés), es una opción de tratamiento conservador y no invasivo para dentina cariosa, sobre todo en dentición temporal. Una de las estrategias del NRCC es la remineralización. El fluoruro de estaño (FDE) puede considerarse, como una opción viable ya que existe evidencia de su eficacia cariostática. Objetivo: valorar al FDE como remineralizante alternativo en dentina de molares temporales, asociado al NRCC. Material y métodos: se efectuó un estudio clínico, epidemiológico, y descriptivo con preescolares voluntarios de 3 a 5 años de edad con consentimiento firmado de participación en el estudio, y que presentaron molares con ICDAS 5 y 6. La aplicación del FDE a 0.8%, la evaluación de la dureza de la dentina con los criterios de Nyvad, y el diagnóstico del estado pulpar, la efectuó un operador entrenado para esta finalidad. Se aplicó un análisis estadístico descriptivo y uno no paramétrico. Resultados: el efecto cariostático producido por el FDE a 0.8%, sobre dentina afectada de molares temporales de niños mexicanos fue estadísticamente significativo durante cinco meses. Conclusiones: la aplicación de fluoruro de estaño puede considerarse como una alternativa de tratamiento cariostático asociado al NRCC para niños de 3 a 5 años de edad (AU)

Introduction: nonrestorative cavity control (NRCC), is a conservative and non-invasive treatment option for carious dentin, especially in primary dentition. One of the NRCC strategies is remineralization. Stannous Fluoride (SDF) can be considered as a viable option since there is evidence of its cariostatic efficacy. Objective: to evaluate FDE as an alternative remineralizing agent in the dentin of primary molars, associated with NRCC. Material and methods: a clinical, epidemiological, and descriptive study was carried out with preschool volunteers aged 3 to 5 years with signed consent to participate in the study, and who presented molars with ICDAS 5 and 6. The application of FDE at 0.8%, the evaluation of dentin hardness with the Nyvad criteria, and the diagnosis of pulp status, was carried out by an operator trained for this purpose. A descriptive and non-parametric statistical analysis was applied. Results: the cariostatic effect produced by 0.8% FDE on affected dentin of primary molars of Mexican children was statistically significant for five months. Conclusions: the application of stannous fluoride can be considered as an alternative cariostatic treatment associated with NRCC for children 3 to 5 years of age (AU)

Clinical Findings Arising from the Use of Silver Diamine Fluoride to Prevent or Treat Caries Lesions and Dentinal Hypersensitivity: A Data Mining Analysis

Abstract Objective: To summarize data of clinical trials that used silver diamine fluoride (SDF) to prevent and treat caries lesions and dentinal hypersensitivity. Material and Methods: Six electronic databases were searched in May 2022. The concentration of SDF, type of usage (alone/combined), dentition, anterior/posterior teeth, tooth region, dental tissue, number of the treated surfaces, the intervention environment, participants' age, frequency and duration of SDF application, purpose, and outcome were the extracted variables. The type of study, year of publication, authors, journals, and country were also investigated. Results: From 8860 articles, S3 were selected. Most were randomized (n=38), that applied 38% SDF (n=43), alone (n=44), on multiple surfaces (n=44), only in dentin (n=36), of the crown (n=46) of anterior and posterior (n=36) primary teeth (n=39). The studies were preferably carried out outside the clinic (n=3l), only in children (n=33), with reapplication of SDF (n=30), but did not inform the duration of application (n= 19). SDF was most used to treat (n=46) only caries lesions (n=50). They were published between 2001 and 2022, mainly in the Journal of Dentistry (n=10). China (n=19) and Lo E.GM (n=19) were the countries and authors that published the most, respectively. Conclusion: The silver diamine fluoride 38% alone was most used to treat caries lesions in the dentin of the crown of all primary teeth, preferably applied on multiple surfaces, requiring re application, and outside the clinic.

Efficacy of 30% and 38% Silver Diamine Fluoride in Arresting Caries Lesions After Different Application Times: An in Vitro Study

Abstract Objective: To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dentin caries lesions when applied under different concentrations and times. Material and Methods: Forty-two bovine blocks were selected and fixed in 24-well plates. Each well received a mixed bacterial inoculum added to the culture medium with 5% sucrose. The plates were incubated in microaerophilia (7 days) for caries formation, confirmed by micro-CT (M1). SDF was applied over the carious lesions for different times and concentrations (n=6): SDF 30% - immediate removal, 1 minute and 3 minutes; SDF 38%, - immediate removal, 1 minute and 3 minutes. The group without treatment was the control. Then, the samples were again scanned by micro-CT (M2) and submitted to a second cariogenic challenge for 21 days. Then, a final scan was performed (M3). Results: Mean pH at the culture medium and lesion depth were compared using Kruskal-Wallis and Wilcoxon tests. 38% SDF showed the lowest metabolic activity of the biofilm. All 38% groups and 30% 1 and 3 minutes did not show an increase in mean lesion depth comparing M3 with M1. However, only 30% 3 minutes and 38% 1 and 3 minutes showed a significant reduction of lesion depth. Conclusion: The minimum application time of 30% SDF to arrest dentin caries lesion was 1 minute, while 38% SDF arrested with application and immediate removal.

Fluoride Concentration in SDF Commercial Products and Their Bioavailability with Demineralized Dentine

Abstract The aim of this in vitro study was to determine the fluoride concentration in silver diamine fluoride (SDF) products and their bioavailability with demineralized dentine. The products evaluated (expected fluoride concentrations) were: I: Saforide 38% (45,283 ppm F); II: Advantage Arrest 38.3 to 43.2% (45,283 to 51,013 ppm F); III: Ancárie 12% (14,100 ppm F); IV: Ancárie 30% (35,400 ppm F), V: Cariestop 12% (14,100 ppm F) and VI: Cariestop 30% (35,400 ppm F). The fluoride concentration was evaluated using an ion-specific electrode (ISE) by direct technique, which was confirmed after microdiffusion. The pH of the products was determined with a pH test strip. For the bioavailability test, demineralized dentine slabs were treated with one of the products for 1 min. Loosely (CaF2-like) and firmly-bound fluoride (FAp) were determined. The fluoride concentration found in the products (mean±SD; ppm F) by the ISE direct technique was: I:53,491±554; II:57,249±1,851; III:4,814±268; IV:5,726±43; V:10,145±468; VI:11,858±575; these values were confirmed after microdiffusion (t-test; p>0.05) and disagree with the declared by the manufacturers. The pH of Ancárie 12 and 30% was 6.0 and 4.5, respectively, in disagreement with the alkaline pH expected for SDF solution and found in the other products evaluated. There was no correlation between either CaF2-like (r=0.221; p=0.337) or FAp (r=-0.144; p=0.830) formed in demineralized dentine and fluoride concentration found in the products. The problems of pH and fluoride concentration found in available professional commercial SDF products suggest that they are not under sanitary surveillance.

Resumo O objetivo deste estudo in vitro foi determinar a concentração de fluoreto nos produtos de diamino fluoreto de prata (DFP) e sua biodisponibilidade com dentina desmineralizada. Os produtos avaliados (concentrações esperadas de flúor) foram: I: Saforide 38% (45.283 ppm F); II: Advantage Arrest 38,3 a 43,2% (45.283 a 51.013 ppm F); III: Ancárie 12% (14.100 ppm F); IV: Ancárie 30% (35.400 ppm F), V: Cariestop 12% (14.100 ppm F) e VI: Cariestop 30% (35.400 ppm F). A concentração de fluoreto foi avaliada utilizando um eletrodo íon-específico (EIE) por técnica direta, que foi confirmada após microdifusão. O pH dos produtos foi determinado com uma tira de teste de pH. Para o teste de biodisponibilidade, blocos de dentina desmineralizada foram tratados com um dos produtos por 1 min. Fluoreto fracamente (tipo CaF2) e firmemente ligado (FAp) foram determinados. A concentração de fluoreto encontrada nos produtos (média±DP; ppm F) pela técnica direta com EIE foi: I: 53.491±554; II: 57.249±1.851; III: 4.814±268; IV: 5.726±43; V: 10.145±468; VI: 11.858±575; esses valores foram confirmados após microdifusão (teste t; p>0,05) e discordam dos declarados pelos fabricantes. O pH do Ancárie 12 e 30% foi de 6,0 e 4,5, respectivamente, em desacordo com o pH alcalino esperado para a solução de DFP e encontrado nos demais produtos avaliados. Não houve correlação entre CaF2 (r=0,221; p=0,337) ou FAp (r=-0,144; p=0,830) formados na dentina desmineralizada e concentração de fluoreto encontrada nos produtos. Os problemas de pH e concentração de fluoreto encontrados nos produtos comerciais profissionais disponíveis de DFP sugerem que eles não estão sob vigilância sanitária.

Survey of Knowledge, Attitudes and Practices of Brazilian Dentists Regarding Silver Diamine Fluoride

Abstract Objective: Current acceptability, barriers to use, and clinical/teaching practices of Silver Diamine Fluoride (SDF) among Brazilian dentists were investigated. Material and Methods: A Google forms questionnaire was sent to dentists (n=10,500) to collect information about the use of SDF and the dentists' workplace, experience, specialty, and city of practice. A logistic regression model was performed. Results: From 409 respondents, 13.2% used SDF. Working at universities increased the use of SDF by 2.29 times (p=0.018) compared to private offices. Each training year, the chance of SDF usage increased by 3% (p=0.008). Pediatric dentists are more likely to use SDF (OR=6.76, p<0.001). There is no association between SDF usage and the city of practice. The majority (75.9%) indicated SDF for noncompliant patients. Dentists (75.9%) reported the exclusive use in deciduous teeth, while 24.1% also use in permanent teeth. The main barrier for non-users was a lack of knowledge (58.3%), while for users, tooth staining (90.7%) and parental acceptance (64.8%) were the complaints. Conclusion: The Silver Diamine Fluoride is not a common product used by the dentists from RJ. Its clinical applicability should be further disseminated; thus, lack of scientific knowledge would cease to be a problem in the use of SDF to arrest caries lesions.

Assessment of adherence to preventive treatment of plaque-induced oral diseases using sugar-free gums: a controlled clinical trial / Evaluación de la adhesión al tratamiento preventivo de enfermedades bucales inducidas por placa bacteriana mediante el uso de gomas de mascar sin azúcar: ensayo clínico controlado

Abstract Introduction: the aim of this study was to assess the adherence to a preventive treatment of plaque-induced oral diseases using two sugar-free gums, establishing their effect on cariogenic bacteria counts as a biological marker of treatment response. Methods: a double-blind, randomized, parallel-group, controlled intervention study was conducted in 96 young adult university students in an experimental period of 30 days. Participants were distributed into two groups and given a chewing gum with either pentitol or hexitol + CPP-ACP complex to be taken three times a day for 20 minutes after conventional oral hygiene. Saliva samples were collected at baseline to evaluate counts of Streptococcus mutans (SM) and Lactobacillus spp. A survey was conducted at the end of the experimental period to assess the levels of adherence to treatment, remeasuring bacterial counts. Results: SM counts showed statistically significant differences between the study groups at the end of the experimental period, with a decreasing tendency in both groups. Intragroup difference was observed in patients who took pentitol gum with a marked reduction in SM counts. Conclusion: the final estimate of adherence to treatment showed that the type of chewing gum patients were given had no influence and therefore such gums can be used, considering the therapeutic agents that most contribute to patient's particular case and preferences.

Resumen Introducción: el objetivo consistió en evaluar la adherencia a un tratamiento preventivo de enfermedades bucales inducidas por placa bacteriana, utilizando dos gomas de mascar sin azúcar y establecer su efecto sobre recuentos de bacterias cariogénicas como indicador biológico de los efectos del tratamiento. Métodos: se realizó un estudio de intervención, doble ciego, de grupos paralelos, aleatorizado controlado, en 96 adultos jóvenes universitarios, en un período experimental de 30 días. Los participantes fueron distribuidos en dos grupos con asignación de una goma de mascar con pentitol o con hexitol + complejo CPP-ACP que debían ser consumidas 20 minutos/tres veces al día después de la higiene oral convencional. Al inicio del studio fueron recolectadas muestras de saliva para evaluar recuentos de Estreptococos del grupo mutans (SM) y Lactobacillus spp. Al finalizar el período experimental, se realizó una encuesta para evaluar los niveles deadherencia al tratamiento y los recuentos bacterianos fueron medidos nuevamente. Resultados: Los recuentos de SM mostraron diferencias estadísticamente significativas entre los grupos de estudio al final del período experimental, con tendencia hacia la disminución en ambos grupos. Se observó diferencia intragrupo en los pacientes que consumieron la goma de mascar con pentitol, con marcada reducción de los recuentos de SM. Conclusión: la estimación final de la adherencia al tratamiento mostró que el tipo de goma de mascar asignada al paciente no tuvo influencia y, por lo tanto, estas pueden ser utilizadas teniendo en cuenta los agentes terapéuticos que más aporten al caso particular del paciente y las preferencias del mismo.

In Vitro Evaluation of Fluoride in Saliva After Topical Application of Professional Use Products

Objective: To evaluate in vitro the presence of fluoride in saliva after applying professional use products on the surface of dental enamel. Material and Methods: Experimental groups were composed by: Cariostatic 12% (CA), Fluoridated Varnish 5% (FV), Fluorine Acidulate Gel 1.23% (AG) and Fluorine Neutral Gel 2% (NG). Fluoridated dentifrice (FD) and Artificial Saliva (AS) were used as controls. Products (10 µL) were applied to the surface of bovine enamel blocks (4×4×1 mm, n = 18) and immersed in 10 mL of artificial saliva at room temperature. Aliquots of artificial saliva (750 µL) of each sample were collected 1, 2, 4, 8, 24 and 48 hours after application of the products. Analyses were performed in triplicate, using a fluoride ion-specific electrode coupled to a potentiometer. The equipment was calibrated using a standard curve for fluoride analysis from 0.125 to 64 µgF-/mL. Results: Greater fluoride concentration (µgF-/mL) was observed after 1h application, as follows: 197.40 (NG), 172.21 (AG), 20.25 (CA), 14.49 (FV) e 11.81 (FD). Fluoride concentration increased overtime for all groups. After 48h, the following fluoride concentrations were assessed: 428.12 (AG), 267.25 (NG), 65.36 (FV), and 62.52 (CA). Conclusion: Greater fluoride release was observed for AG and NG groups, mostly after 1h application.

In Vitro Evaluation of the Remineralizing Potential and Antimicrobial Activity of a Cariostatic Agent with Silver Nanoparticles

Abstract Cariostatic treatment has been shown to successfully arrest caries. However, it blackens the carious tooth structure. This study evaluated the effects of an experimental cariostatic agent with silver nanoparticles (Ag-Nano) using microhardness (MH) and microbiological tests. The cariostatic agents tested were: Saforide®, Cariestop®, Ancarie® and Ag-Nano. Sixty-six samples from deciduous enamel were submitted to initial (after pH cycling to obtain initial caries-like lesion) and final (after cariostatic application) MH testing and %MH values were calculated. After longitudinal sectioning, internal (I) MH was evaluated. Strains of Streptococcus mutans, Escherichia coli, and Enterococcus faecalis in brain-heart infusion culture were treated with the cariostatic agents. Agar diffusion tests (ADTs) were performed and minimum inhibitory concentrations were determined. The statistical tests used were: Kruskal-Wallis and Dunn (%MD; ADT; MIC) and ANOVA followed by Tukey's test (I-MH) (p<0.05). The %MH of Saforide® was significantly greater than that of Ag-Nano (p<0.05). Internal MH showed progressive improvement in the enamel remineralization for all cariostatic tested. In ADTs showed greater inhibition of S. mutans, E. faecalis, and E. coli by Saforide® than by Ancarie® and Ag-Nano. Ag-Nano was able to inhibit 100% microorganism growth at a lower concentration than required for the other agents. It was concluded that Ag-Nano treatment promoted remineralization of deciduous tooth enamel with initial caries-like lesion and bactericidal activity.

Resumo O tratamento com cariostático tem demostrado sucesso na paralização da cárie. No entanto, causa escurecimento da estrutura dental cariada. Este estudo avaliou os efeitos de um agente cariostático experimental com nanopartículas de prata (Ag-Nano) através de microdureza (MD) e testes microbiológicos. Os cariostáticos testados foram: Saforide®, Cariestop®, Ancarie® e Ag-Nano. Sessenta e seis amostras de esmalte decíduo foram submetidos a MD inicial (após ciclagem de pH para obtenção da lesão de cárie inicial) e final (após aplicação dos cariostáticos), e os valores da porcentagem (%) de MD foram calculados. Após secção longitudinal, a MD interna (I) foi avaliada. Cepas de Streptococcus mutans, Escherichia coli e E. faecalis foram cultivados em ágar infusão de cérebro e coração (BHI) e submetidos aos cariostáticos testados. Além disso, foram realizados teste de difusão em ágar (TDA) e avaliação da concentração mínima inibitória (CIM) dos cariostáticos. Os testes estatísticos usados foram: Kruskall-Wallis e Dunn (%MD; TDA; CIM) e ANOVA seguido de teste de Tukey (MD-I) (p<0.05). A %MD do Saforide® foi significativamente maior do que a de Ag-Nano (p<0,05). A MD interna apresentou melhora progressiva na remineralização do esmalte para todos os cariostático testados. Os resultados do TDA mostraram que S. mutans, E. faecalis e E. coli sofreram maior inibição pelo Saforide® (p<0,05), em relação ao Ancarie® e Ag-Nano. No entanto, para o teste de CIM o Ag-Nano foi capaz de inibir 100% dos microorganismos, em menor concentração do que os demais cariostaticos. Conclui-se que, o tratamento Ag-Nano foi capaz de promover remineralização do esmalte dental decíduo com lesão de cárie inicial e apresentou atividade bactericida.

AgNPs: The New Allies Against S. Mutans Biofilm - A Pilot Clinical Trial and Microbiological Assay

Abstract: The purpose of this study was to evaluate the antimicrobial properties of a new formulation containing silver nanoparticles, named Nano Silver Fluoride (NSF), to inhibit Streptococcus mutans biofilm formation on children's dental enamel. The variations in dental biofilm pH and in the Simplified-Oral-Hygiene-Index (OHI-S) also were evaluated after the treatment with NSF. This was a randomized, double-blind, crossover and prospective pilot clinical trial study in which 12 schoolchildren, aged between 7-8 years, had their dental enamel treated with two solutions: S1 - Nano Silver Fluoride and S2 - negative control (saline solution), in different experimental moments. The dental biofilm adhered to enamel treated with NSF had lower values of S. mutans viability (absorbance) and colony forming units (CFU) than the S0 (baseline) and S2. There was a statistically significant difference between the OHI-S mean values of S0 and S1. There were no differences between the biofilm pH (both before and after the use of the test substances) and among the different groups. These properties suggest that NSF has bactericidal effect against S. mutans biofilm and it may be used for clinical control and prevention of dental biofilm formation.

Resumo O objetivo do presente estudo foi avaliar as propriedades antimicrobianas de uma nova formulação composta por nanopartículas de prata, denominada nano silver fluoride (NSF), na inibição de biofilme de Streptococcus mutans sobre a superfície do esmalte dentário de crianças. Variações no pH do biofilme dental e nos valores do índice de Higiene Oral Simplificada (IHO-S) também foram avaliadas após o tratamento com NSF. Trata-se de um estudo piloto, randomizado, duplo cego, cruzado e prospectivo. A amostra foi composta por 12 crianças, de ambos os gêneros, com idades entre 7 e 8 anos, as quais utilizaram as duas soluções testes, S1- NSF e S2- controle negativo (solução salina). O biofilme dental tratado com NSF apresentou menores valores de viabilidade de S. mutans (absorbância) e de unidades formadoras de colônias (UFC) do que o biofilme baseline e o biofilme tratado com S2. Houve diferença estatisticamente significativa entre os valores médios de IHO-S dos grupos baseline e S1, com uma redução dos valores. Não houve qualquer variação nos valores de pH do biofilme dental, antes e depois do tratamento com S1 e S2 e entre os diferentes grupos. Estas propriedades sugerem que NSF possui efeito bactericida sobre o biofilme de S. mutans, podendo ser utilizado clinicamente para o controle e prevenção da formação do biofilme dentário.

Evaluación de fluoruro residual en saliva después de la aplicación de barnices fluorados al 2.26 por ciento: estudio comparativo / An evaluation of the residual fluoride in saliva after applying 2.26 per cent fluoride varnishes: a comparative study

El objetivo de este estudio fue comparar la cantidad de fluoruro (F) residual en saliva después de la aplicación de barniz de fluoruro desodio al 5 por ciento y de barniz fluorado con fosfato tricálcico al 5 por ciento en niños de 2 a 5 años de edad. Se recolectó la saliva no estimulada de 24 niños que tenían acceso a sal fluorada diariamente y utilizaban dentífricos infantiles conteniendo 550 ppm F. La primera toma de muestrasalival fue colectada como basal y las siguientes fueron tomadas en diferentes intervalos de tiempo luego de realizar la aplicación del barnizfluorado (15; 30; 60 minutos y 24; 48; 72; 96; 168 horas). Un total de 216 muestras fueron obtenidas, siendo 96 muestras de barniz de Duraphat®, 96 muestras de barniz de ClinproTM WV y 24 muestras muestras basales. Los análisis de laboratorio fueron realizadosen el departamento de Bioquímica de la Facultad de Odontología de Baurú (FOB), Universidad de Sao Paulo. Un electrodo Orión 9409 y un microelectrodo acoplados a un potenciómetro Orion EA 940 se utilizaron para analizar las muestras previa difusión de las muestrascon el método de Taves. La concentración de iones de flúor mostró diferencias estadísticamente significativas entre ambos productos desde las 24 horas (p<0.001), esta característica se repite a las 48 (p=0.003); 96 (p<0.001) y 168 horas (p<0.001). Se utilizó el análisisestadístico de Shapiro Wilks y T de Student. Ambos barnices mostraron un incremento de fluoruro residual en saliva durante los 15; 30 y 60 minutos, sin embargo, posteriormente a estos tiempos, ambos muestran niveles no significativamente diferentes al basal.

The aim of this study was compared the amount of residual fluoride after application of sodium fluoride varnish 5% and application offluoride varnish with phosphate tricalcium 5% in children from 2 to 5 years old. Unstimulated saliva was collected of 24 children who hadaccess to fluoridate salt daily and used children´s tooth pastes containing 550ppm F. The first salivary sample was collected as a base lineand the following were taken at different intervals after making the application of fluoride varnish (15; 30; 60 minutes; 24; 48; 72; 96;168 hours).Children were grouped in two groups according of type of varnish containing fluoride going to be applied. A total of 216samples were obtained, 96 samples from Duraphat® and 96 samples from ClinproTM WV 3M ESPE. The lab analyzes wereconducted in the Department of Biochemistry at the Faculty of Dentistry, Bauru (FOB), University of Sao Paulo. An Orion 9409electrode and a microelectrode coupled to a potentiometer Orion EA 940 analyzed the samples prior dissemination of samples with themethod of work. The fluoride concentration was statistically significant after 24 (p<0.001); 48 (p=0.003); 96 (p<0.001) y 168 hours(p<0.001) for both products. We used Shapiro Wilks and T student test for statistical analysis. Both products showed an increased inresidual fluoride in saliva during the 15; 30 and 60 minutes, however, both showed not differences that baseline levels.

Evidence-based pediatric dental practice within the clinician's reach: the case of the esthetic effect of topical silver diamine fluoride for caries control in primary dentition / Prática odontopediátrica baseada em evidência científica ao alcance do clínico: o caso do efeito estético do uso tópico de diaminofluoreto de prata para o controle da cárie na dentição decídua

ABSTRACT Objective: The aim of this paper was to demonstrate how a general dental practitioner tried to answer, based on scientific evidence, to the question: "Does the darkening of caries lesions caused by silver diamine fluoride treatment contribute to reducing parents' acceptance of such treatment?". Methods: The dentist adopted the following approach: formulation of a specific question; bibliographic search using controlled vocabulary and free terms; selection of full-text articles for reading; reading and critical appraisal of selected articles; summary of the available evidence; translation of the evidence into clinical practice. The dentist identified 45 studies and selected 20 to be read in full, but only three could be used; two controlled trials from China and one from Brazil. Results: Results showed that the esthetic effect was neither a major issue nor a decisive factor for the indication of the proposed treatment. However, although there is robust scientific evidence on the effectiveness of silver diamine fluoride in arresting and preventing caries lesions, there is scarce information about its esthetic effect. Thus, the lack of studies assessing the impact of the darkening of caries lesions and the esthetic effect of the treatment on the quality of life of children and their parents must be emphasized. Conclusion: The dentist concluded that there is insufficient evidence about the esthetic effect of silver diamine fluoride applications on primary teeth and opted to inform it to his/her patients' caregivers and to share with them the decision whether to use it or not in each specific case.

RESUMO Objetivo: Mostrar como um cirurgião-dentista clínico geral procurou responder, com base em evidência científica, à pergunta: "O escurecimento das lesões de cárie em dentes decíduos tratados com diaminofluoreto de prata contribui para a redução da aceitação desse tipo de tratamento pelos pais?". Métodos: O dentista seguiu o seguinte roteiro: formulação de uma pergunta específica; realização da busca bibliográfica utilizando descritores e termos livres; seleção dos artigos científicos completos para leitura; leitura e avaliação crítica dos artigos selecionados; resumo da evidência disponível e aplicação da evidência à sua prática clínica. O dentista localizou 45 trabalhos e selecionou 20 para leitura na íntegra, mas apenas três puderam ser utilizados, sendo dois ensaios controlados realizados na China e um no Brasil. Resultados: Os resultados mostraram que a estética não foi uma questão importante nem um fator decisivo para a indicação do tratamento proposto. No entanto, embora haja evidência científica robusta sobre a efetividade do diaminofluoreto de prata em paralisar e prevenir lesões de cárie, há pouca informação sobre seu efeito estético. Assim, a falta de estudos que avaliam o impacto do escurecimento das lesões de cárie e o efeito estético do tratamento sobre a qualidade de vida das crianças e seus familiares deve ser ressaltada. Conclusão: O dentista concluiu que não existe evidência suficiente sobre o efeito estético das aplicações de diaminofluoreto de prata em dentes decíduos e optou por informar os responsáveis por seus pacientes a respeito e compartilhar com eles a decisão sobre a indicação do mesmo para cada caso específico.

Fluoride-Releasing Materials to Prevent White Spot Lesions around Orthodontic Brackets: A Systematic Review

Abstract The relation between orthodontic fixed appliances use and enamel demineralization is well established. Different preventive approaches have been suggested to this problem, but controversy remains about which is the best. The aim of this study was to perform a systematic review of clinical trials that investigated the effectiveness of materials containing fluorides to lute brackets or cover the bonding interface in order to inhibit the development and progression of white spot lesions. The null hypothesis was that fluoride materials do not affect the incidence of white spot lesions around brackets. A MEDLINE search was conducted for randomized clinical trials evaluating the development of white spot lesions in patients using fixed orthodontic appliances, followed by meta-analysis comparing the results for patients for whom dental materials containing fluorides were used (experimental group) to those for whom these materials were not used (control group). The pooled relative risk of developing white spot lesions for the experimental group was 0.42 (95% confidence interval: 0.25 to 0.72); hence, when fluoride-releasing materials are used, the patient has 58% less risk of white spot lesion development. Regarding white spot lesion extent, the pooled mean difference between the experimental and control groups was not statistically significant (-0.12; 95% confidence interval: -0.29 to 0.04). In conclusion, the results of the present systematic review suggest that fluoride-releasing materials can reduce the risk of white spot lesions around brackets. However, when white spot lesions had already occurred, there is no evidence that fluoride-releasing materials reduce the extent of these lesions.

Resumo A relação entre o uso de aparelhos ortodônticos fixos e desmineralização do esmalte é bem estabelecida. Diferentes abordagens preventivas têm sido sugeridas para este problema, mas ainda permanece controverso qual é o melhor. O objetivo deste estudo foi realizar uma revisão sistemática de ensaios clínicos que investigaram a efetividade de materiais contendo fluoretos para cimentação de bráquetes ou cobrindo a interface de união buscando inibir o desenvolvimento e progressão de lesões de mancha branca. A hipótese nula foi que materiais fluoretados não afetam a incidência de lesões de mancha branca em volta de bráquetes. Uma busca no MEDLINE foi conduzida para ensaios clínicos controlados avaliando o desenvolvimento de lesões de mancha branca em pacientes usando aparelhos ortodônticos fixos, seguido por meta-análise comparando os resultados de pacientes em que materiais usando fluoretos foram utilizados (grupo experimental) com aqueles em que tais materiais não foram usados. O risco relativo agrupado de desenvolvimento de lesões de mancha branca para o grupo experimental foi 0,42 (95% de intervalo de confiança: 0,25 a 0,72); enquanto que, quando materiais liberando fluoretos foram utilizados, o paciente teve 58% menos risco de desenvolver lesões de mancha branca. Em relação à extensão das lesões de mancha branca, a diferença média agrupada entre os grupos experimental e controle não foi estatisticamente significante (-0,12; 95% de intervalo de confiança: -0,29 a 0,04). Em conclusão, os resultados da presente revisão sistemática sugerem que materiais que liberam fluoretos podem reduzir o risco de lesões de mancha branca em volta de bráquetes. Entretanto, quando lesões de mancha branca já ocorreram, não há evidência que materiais que liberam fluoretos reduzem a extensão da lesão.

A Aplicabilidade do Diaminofluoreto de Prata em Crianças de 4 a 10 anos de Idade na Clínica de Odontopediatria da Universidade Federal do Espírito Santo, Brasil / The Applicability of the Silver Diamine Fluoride in Children from 4 to 10 Years Old in the Odontopediatrics Clinic in the Federal University of the Espírito Santo, Brazil

As manifestações da doença cárie é uma condição crítica em crianças, sendo preconizada para a prevenção e o tratamento a utilização decompostos fluoretados. Neste contexto, o Diaminofluoreto de Prata (DFP) é um composto que se destaca por suas propriedades preventivas eanti-cariogênicas e por sua ação bacteriostática, remineralizante e dessensibilizante. O objetivo deste estudo foi avaliar: a utilização do DFPatravés da sua ação cariostática na paralização e remineralização da lesão cariosa; a aceitação dos pais ao tratamento proposto; bem comoa verificação da sua aplicabilidade, na percepção dos alunos de graduação. Para este fim foi aplicado o Cariestop® 12% (Maquira) em 14crianças, com idades de 4 a 10 anos, com lesões cariosas em esmalte de molares decíduos, a cada semana, durante três semanas consecutivas.Foram utilizados dois questionários, um aos responsáveis e outro aos alunos de odontologia, para verificação da aceitação e aplicabilidadedo DFP. Observou-se paralização e remineralização da lesão cariosa em todos os elementos aplicados e aceitação inicial dos pais de 89% aotratamento; 64,3% dos pais perceberam mudança de cor nos elementos, e 100% acreditaram que essa mudança não irá interferir negativamentena estética da criança. Todos os alunos que participaram da pesquisa consideraram a técnica de fácil aplicabilidade e 63,9% determinaram serbom o comportamento da criança durante a aplicação. Conclui-se que a aplicação do DFP apresentou-se clinicamente efetiva na paralisação eremineralização das lesões cariosas em esmalte, tendo uma boa aceitação e podendo ser utilizada como um recurso de mínima intervenção emodontopediatria

The manifestations of dental caries is still a critical condition in children, and it was prescribed for the prevention and treatment the usageof fluoride compounds. In this context, the silver diamine fluoride (SDF) is a compound that stands out for its preventive properties andanti-cariogenic and its bactericidal, bacteriostatic, remineralizing and desensitizing. The aim of this study was to evaluate the use of SDFthrough their cariostatic effect on paralysis and remineralization of caries lesions; acceptance of parents to the proposed treatment, as wellas verification of its applicability, as perceived by students in clinical dentistry. To this purpose we applied the Cariestop ® 12% (Maquira)in 14 children aged from 4 to10 years old with carious lesions in enamel of deciduous molars. The application was given every week for threeconsecutive weeks. Two questionnaires were used, one for the parents and the other for students of dentistry, for verification of the acceptanceand applicability of SDF. It was observed paralysis and remineralization of caries lesions in all elements applied and initial acceptance ofthe parents of 89% of the treatment, whereas 64.3% of parents perceived color change in the elements, and 100% believed that this changedoes not will negatively affect the aesthetics of the child. All students who participated in the survey considered the technique easy to applyand 63.9% determined that child behavior during application was good. Concluding that the application of SDF in children were clinicallyeffective in paralysis and remineralization of carious lesions in enamel, having wide acceptance and can be used as a resource of minimalintervention dentistry.

Quantitative Analysis of Trace Elements in Sound and Carious Enamel of Primary and Permanent Dentitions.

Aims: Quantitative assessment of trace elements in enamel of sound and carious permanent and deciduous teeth, and evaluation of correlation between the presence of caries and trace elements Study Design: Using powdered enamel from extracted primary and permanent human dentitions and graphite furnace atomic absorption spectrophotometry. Place and Duration of Study: Faculty of Dentistry and clinical Dentistry section of the Jordan University Hospital, between October 2014 and May 2015. Methodology: Forty extracted human deciduous and permanent dentitions were collected from patients attended the dental surgery and pedodontic departments of the Jordan University Hospital. After proper cleaning and drying, four groups of ten teeth each from which enamel samples were collected in four containers labelled as, sound permanent, carious permanent, sound primary, and carious primary enamel. In each group the corresponding teeth were mechanically ground using a different bur; the grinding was within the enamel layer and without exposing dentine. The powdered enamel samples were acid-digested and transferred to liquid solutions in order to measure their content of heavy metal ions by means of Atomic Absorption Spectrophotometer (GFAAS). Results: Eight trace elements were detected, namely, Cu, Pb, Sr, Fe, Mn, Zn, Al, and Se and their concentrations were estimated in all four enamel samples. The concentrations of Sr, Cu, and Fe were significantly higher in sound than in carious enamel of primary and permanent teeth. The concentrations of Al, Mn, and Se were significantly higher in carious than in sound enamel of primary and permanent teeth. Zn and Pb demonstrated comparable concentrations in carious and normal enamel of primary and permanent teeth. Conclusions: In the light of the obtained results, it could be concluded that Sr, Cu, and Fe function as cariostatic elements and there presence enhances caries resistance of primary and permanent teeth, whereas, the presence of Al, Mn, and Se is associated with caries.

Patrón de liberación de flúor in vitro en sellantes fluorados de resina / In vitro fluoride-release profile of fluoridated resin-based sealants

Objetivo: Comparar in vitro la cantidad de fluoruros liberados por los principales sellantes de puntos y fisuras basados en resina comercialmente disponibles en Latinoamérica. Material y Métodos: Se evaluó la liberación de fluoruros in vitro en tres sellantes fluorados de puntos y fisuras: Helioseal F (HF), Fissurit F (FF), Clinpro (CF) y Delton (D), sin flúor como control. Se utilizaron 28 discos de 12 mm de diámetro y 2 mm de espesor (n=7 por grupo). Las muestras fueron almacenadas en 5 ml de agua ultra de-ionizada con pH neutro a 37º C por 93 días. La liberación de fluoruros fue medida mediante un electrodo iónico selectivo a los 1, 2, 3, 8, 15, 28 y 93 días. Los datos fueron analizados con el test ANOVA y Tukey (p<0.05). Resultados: El patrón de liberación de flúor fue similar para los tres sellantes fluorados: una alta liberación durante las primeras 24 horas, que disminuyó bruscamente hacia el segundo día. Luego continuó con una disminución progresiva hasta el día 93. El primer día, FF liberó significativamente más fluoruros que HF. Entre los días 2 y 15 FF y HF liberaron significativamente más fluoruros que CF. Desde el día 28 en adelante, las diferencias de liberación de flúor no fueron significativas. Conclusión: El patrón de liberación de flúor in vitro es similar para los sellantes fluorados, con una elevada liberación durante los primeros dos días y luego, una marcada disminución en todos ellos. Este resultado podría explicar la falta de diferencias en la tasa de caries en pacientes tratados con sellantes de resina fluorados y no-fluorados observada en estudios clínicos.

Aim: To compare in vitro the amount of fluoride released from the main pit and fissure sealant resin-based on commercially available in Latin America. Materials and Methods: Twenty-eight samples of 12 x 2 mm were made from three commercial fluoridated resin-based sealants: Helioseal F (HF), Fissurit F (FF), Clinpro (CF) and without fluoride Delton (D), as a control. Samples were stored in 5 ml of deionized water at 37° C and neutral pH. Fluoride releases were measured at 1, 2, 3, 8, 15, 28 and 93 days with an ion-selective electrode. Data were analyzed using ANOVA and one-way and Tukey (p<0.05). Results: Fluoride-release profiles were similar for the three fluoridated sealants: a high release rates during the first 24 hrs and then a drastic drop. Afterward, they continued with a progressive decrease until day 93. The first day, FF release significantly more fluoride than HF. Between days 2 and 15, CF release significantly less fluoride than FF and HF, and later, there was no significant differences between sealants (p>0.05). Conclusion: The fluoride-release profile is similar for the fluoridated resin-based sealants under study: a high release during the first two days and afterwards, a very slow release. These results can explain the lack of differences in caries rate between fluoridated and non-fluoridated resin-based sealants observed in clinical trials.

Experimental brush wear pattern and cariostatic effect of Biscover / 대한치과교정학회지

OBJECTIVE: The aim of this study was to investigate the experimental brush wear pattern of a light cured surface sealant, Biscover (Bisco, Schaumburg, IL), and to evaluate its cariostatic effect. METHODS: Caries- free human premolars were used for the Biscover coating group (n = 90) and the control group (n = 10). The Biscover coating group was randomly assigned to nine subgroups of 10 each and the control group was assigned to two subgroups of 5 each according to the number of brushing strokes. An experimental 3-body wear test was conducted under different strokes of wear test. Tooth-brushing was accomplished with movement of each brush head set at a frequency of 100 rpm under a force of 1.5 N. Surface roughness was tested before, and after Biscover coating, and after brushing. Then, each of the 10 teeth of both groups were placed in artificial caries inducing solution for 7 days. All tooth surfaces were assessed using scanning electron microscopy. RESULTS: Biscover coated surfaces showed a smoother texture than enamel surfaces. The roughness was increased after experimental brushing and after 10,800 brushing strokes, the whole layer of Biscover wore out. However, teeth in the Biscover coating group had a cariostatic effect in cariogenic conditions. CONCLUSIONS: We suggest that white lesions in orthodontic patients can be suppressed by topical applications of Biscover.

Preparation and cariostatic property of sodium fluoride gelatin microspheres / 医学研究生学报

Objectives:To study the preparation techniques of gelatin microspheres encapsulated with sodium fluoride and evaluate the anticaries functions in dental plaque model in vitro. Methods:Fluoride gelatin microspheres were prepared by emulsion polymerisation method. The encapsulation rate and drug contents were tested by ISE. In vitro inhibition of demineralization were also examined. Results:The mean size of fluoride GMS was (16.81?8.77)?m.The encapsulation rate was 76.73%.The drug content was 5.61%.The release profile in vitro showed sustained effects. Fluoride GMS can prevent demineralization more efficiently. Conclusions:Fluoride gelatin microspheres may be an promising topical fluoride release system.