Prevalencia e incidencia de caries dental y efecto del cepillado dental acompañado de barniz de flúor en escolares de Islas Galápagos, Ecuador: protocolo del estudio EESO-Gal / Prevalence and incidence of dental caries associated with the effect of tooth brushing and fluoride varnishing in schoolchildren at Galapagos Islands, Ecuador: Protocol of the EESO-Gal study

INTRODUCCIÓN: La caries dental es la enfermedad bucal más prevalente en Ecuador. En nuestro país no existen estudios que hayan considerado a la población de las Islas Galápagos. La aplicación de flúor sobre lesiones incipientes de caries dental ha demostrado efectividad para evitar ejecutar procedimientos invasivos restauradores. OBJETIVOS: El objetivo del Estudio de Salud Oral Galápagos, EESO-Gal, es determinar la prevalencia e incidencia de caries dental y evaluar el efecto de la acción del cepillado dental supervisado, acompañado de aplicaciones periódicas de flúor en barniz sobre lesiones cariosas incipientes en escolares de las Islas Galápagos. Con este informe se busca reportar el protocolo del Estudio de Salud Oral Galápagos. MÉTODOS: Se plantea realizar una cohorte con los escolares de las Islas Galápagos para determinar la prevalencia e incidencia de caries con evaluaciones cada seis meses durante veinticuatro meses. RESULTADOS: Se espera determinar la prevalencia e incidencia de caries cada seis meses durante veinticuatro meses en escolares de tres a diez años y obtener datos que permitan evidenciar el estado de las condiciones de caries en los escolares de Galápagos con la inclusión del cepillado diario en la escuela, supervisado por el docente, y con la aplicación semestral del barniz de flúor. CONCLUSIONES: La prevalencia de caries dental e incidencia después de las acciones tomadas demostrará la importancia de aplicar acciones de prevención y promoción de la salud oral, para crear hábitos de higiene y salud desde edades tempranas.

INTRODUCTION: Dental caries is the most prevalent oral disease in Ecuador. In our country, there are no studies that have included the population of the Galapagos Islands. Fluoride application to incipient lesions of dental caries has shown to be effective in avoiding the use of invasive restorative procedures. OBJECTIVES: The objective of the EESO-Gal study is to determine the prevalence and incidence of dental caries and to evaluate the effect of supervised dental brushing, accompanied by periodic applications of fluoride varnish on incipient precarious lesions of schoolchildren in the Galapagos Islands. This article presents the protocol of the EESO-Gal study. METHODS: A cohort is planned with Galapagos Islands schoolchildren to determine the prevalence and incidence of dental caries, with assessments every six months, during twenty-four months. RESULTS: We expect to determine the prevalence and incidence of caries every six months, for twenty-four months, in schoolchildren between three and ten years of age, and obtain data to show the state of the caries conditions in Galapagos schoolchildren, with the inclusion of daily brushing at school, supervised by the teacher, and with the application of fluoride varnish every six months. CONCLUSIONS: The prevalence of dental caries and incidence after the program will demonstrate the importance of implementing oral health prevention and promotion actions to create hygiene and health habits from an early age.

Fluoruro diamino de plata comparado con técnica de restauración atraumática para el tratamiento de caries cavitadas en dentición primaria y mixta primera fase / Silver diamine fluoride compared to atraumatic restorative technique for the treatment of caries in primary and mixed first phase dentition

INTRODUCCIÓN: Las lesiones de caries cavitadas en dentición primaria y mixta requieren un tratamiento oportuno, para evitar así la progresión de la caries. El fluoruro diamino de plata ha surgido como una alternativa a la técnica de restauración atraumática debido a su fácil aplicación. Sin embargo, aún existe incertidumbre en relación a su efectividad y seguridad. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos diez revisiones sistemáticas que en conjunto incluyeron dos estudios primarios, ambos ensayos aleatorizados. Concluimos que el fluoruro diamino de plata en comparación a la técnica de restauración atraumática podría aumentar el arresto de caries en dentición primaria y mixta primera fase, pero la certeza de la evidencia ha sido evaluada como baja. Por otra parte, el tratamiento con fluoruro diamino de plata comparado con la técnica de restauración atraumática (ART) probablemente aumenta el riesgo de eventos adversos

INTRODUCTION: Cavitated carious lesions in primary and mixed dentition require prompt treatment to control caries progression. Silver diamine fluoride has emerged as an alternative to the atraumatic restorative technique due to its easy application. However, there is still uncertainty regarding its effectiveness and safety. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a metanalysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified ten systematic reviews, including two studies overall, which are randomized trials. We concluded that silver diamine fluoride compared to the atraumatic restorative technique may increase the arrest of caries in primary and mixed first phase dentition, however, the certainty of the evidence has been assessed as low. On the other hand, treatment with silver diamine fluoride compared to the atraumatic restorative technique (ART) probably increases the risk of adverse events.

Lesiones cervicales no cariosas / Non-carious cervical lesions

El objetivo de este trabajo consiste en describir las distintas lesiones cervicales no cariosas, la abrasión, la erosión y la abfracción. Se desarrollarán en detalle su etiología, localización y características clínicas. Se mencionarán los diferentes procedimientos a realizar para su prevención y los materiales a utilizar para su restauración.

This article describes the different types of non-cariouscervical lesions, for example abrasion, erosionand abfraction. We will discuss their etiology, location and clinical features in detail. We will describe the procedures to prevent them, aswell as the materials used for their restoration.

Effect of 10% fluoride on the remineralization of dentin in situ

ABSTRACT Objective The purpose of this randomized, cross-over, in situ study was to determine the remineralization of demineralized dentin specimens after the application of a 10% fluoride (F-) or a 1% chlorhexidine–1% thymol (CHX–thymol) varnish. Material and Methods Twelve individuals without current caries activity wore removable appliances in the lower jaw for a period of four weeks. Each appliance contained four human demineralized dentin specimens fixed on the buccal aspects. The dentin specimens were obtained from the cervical regions of extracted human third molars. After demineralization, half the surface of each specimen was covered with a nail varnish to serve as the reference surface. The dentin specimens were randomly assigned to one of the three groups: F-, CHX–thymol, and control (no treatment). Before the first treatment period and between the others, there were washout periods of one week. After each treatment phase, the changes in mineral content (vol% µm) and the lesion depths (µm) of the dentin slabs were determined by transverse microradiography (TMR). Data analysis was accomplished by the Kruskal-Wallis test and the Mann-Whitney U test (p<0.05). Results The medians (25th/75th percentile) of integrated mineral loss were 312.70 (203.0-628.7) for chlorhexidine varnish, 309.5 (109.8-665.8) for fluoride varnish, and -346.9 (-128.7 - -596.0) for the control group. The medians (25th/75th percentile) of lesion depth were 13.6 (5.7-34.5) for chlorhexidine varnish, 16.5 (5.6-38.1) for fluoride varnish, and -14.2 (-4.5- -32.9) for the control group. Use of the 10% F- or 1% CHX–1% thymol varnishes resulted in significantly decreased mineral loss and lesion depth in dentin when compared with the control group. There were no statistically significant differences among the test groups. Conclusions Within the limitations of this study, the results suggest that the effect of the treatment of demineralized dentin with 10% F- or 1% CHX–1% thymol is better than without any treatment.

Manejo contemporáneo y preventivo de la caries dental en pacientes pediátricos: revisión de literatura / Contemporary and preventive management of dental caries in pediatric patients: literature review

La caries es una enfermedad infecciosa y contagiosa que por tener un a alta prevalencia a nivel mundial afectando tanto a niños como adultos, es necesario buscar y evaluar nuevas alternativas de tratamiento y prevención, que permitan mejorar la salud bucal de toda la población afectada, en donde el profesional debe estar involucrado.En cuanto a los métodos preventivos se encuentran los barnices con fluoruros y los derivados de la caseína, que se hallan en los productos lácteos, dentífricos y chicles, siendo de gran utilidad para pacientes pediátricos.Aunado a ello, se están utilizando actualmente, diversos métodos para la eliminación de la caries dental que permiten realizar procedimientos poco invasivos y que pueden ser aplicados en pacientes pediátricos o con discapacidad debido a que no requieren la utilización de anestesia local, ni instrumental rotatorio, mejorando la adaptación a la consulta y además obteniendo resultados favorables con respecto a las técnicas convencionales.Los diferentes procedimientos pueden ser mecánicos, químicos-mecánicos y de otros tipos como el láser que en conjunto conforman los métodos no invasivos. Ellos permiten una amplia variedad de opciones dependiendo de la población a la cual vayan dirigidos, tomando en cuenta el acceso a servicios de salud, estatus socio-económico, edad y requerimientos a corto plazo para evitar la extensión de las lesiones que implica perdidas tempranas de estructuras dentales que afectan la salud integral del individuo.

Dental caries is an infectious and contagious disease with an elevated prevalence in children and adults around the world. For that reason it is necessary to evaluate the new methods of prevention and treatment to improve bucal health in this population.In relation to the preventive methods, there are the fluoride varnish and casein derivates that can be in the milk, the tooth pastes and chewing gum and can be use to improve children´s bucal health.Nowadays there are many new methods that are using to eliminate caries in a non-invasive way. Many of them do not need the use of local anesthesia or rotatory handpieces and represent a good alternative to the behavibucal management of pediatric patients.The several methods can be mechanical, chemical & mechanical and others like laser that constitute the non-invasive methods. They give to the professional many options depending to some factors of the patients like age, social and economical status, possibility to access to health services and other requirements to avoid the extension of the caries lesions and the dental structure loss.

Salivary retention after application of fluoride gel using toothbrush or tray: a crossover trial

Currently, there are no studies in the literature evaluating salivary fluoride retention after small amounts of fluoride gel are applied to children's teeth. Therefore, the objective of the present study was to compare salivary retention after gel application using a toothbrush or by traditional application with trays. In this crossover study, children with active caries (n = 10) were randomized into one of the following treatment groups: a) application of fluoride gel using a tray (control), or b) application of fluoride gel with a toothbrush (treatment). After a 7-day washout period, the treatments were inverted. Unstimulated saliva samples were collected at baseline and 0.5, 5, 15, 30, 60 and 120 minutes after acidulated phosphate fluoride (APF) gel application in order to analyze fluoride retention in saliva. The area under the curve (AUC) was also calculated. There were no differences in fluoride retention after application of small amounts of APF with a toothbrush compared to traditional gel application using trays at all time points studied, and no differences in AUC were observed (Student t-test, p > 0.05). These results suggest that application of fluoride gel in children using a toothbrush can be utilized as an option rather than traditional trays, since the same salivary retention of fluoride is obtained using a lower dose.

Avaliação do teor de fluoretos em géis neutros e acidulados de uso tópico profissional / Evaluation of fluoride content in neutral and acidic gels for topical professional use

Os géis fluoretados para aplicação tópica pelo profissional têm sido empregados comoagentes de prevenção da cárie dental, no tratamento da hipersensibilidade dentinária ecomo remineralizadores do esmalte dental. Neste estudo foi analisado in vitro, por meiodo método do fluorímetro com eletrodo específico termo-plus®, o teor de flúor de 10 produtosbrasileiros de gel fluoretados, ( 5 de fluoreto de sódio a 2% em concentração, e 5 deflúor fosfato acidulado a 1,23% em concentração). Os resultados indicaram que todos osprodutos avaliados nesse estudo apresentaram irregularidades no teor de fluoreto, sendoque nove destes apresentavam uma concentração menor que a indicada na embalageme uma apresentou uma concentração maior que o declarado. Com base nessas análises,conclui-se que os produtos avaliados neste trabalho não apresentam a concentração indicadaem suas embalagens.

Fluoride gels for topical application by the professional staff have been employed as preventionof dental caries, in dentin hypersensitivity treatment and as mineralizing enamelagents. The aim of this study was to evaluate in vitro by the method of the fluorometer witha specific electrode termo-plus®, the fluoride concentration of 10 Brazilian products offluoride gel, (5 sodium fluoride at 2% concentration of fluoride and 5 acidulated phosphateto 1.23% in concentration). The results indicated that all the products evaluated in thisstudy showed irregularities in the fluoride content, nine of them had a lower concentrationthan indicated on the package and one of them had a higher concentration than stated.Based on this analysis, we conclude that the products evaluated in this study do not showthe concentration indicated on their packaging.

Efficacy of CPP-ACP and CPP-ACPF on enamel remineralization - An in vitro study using scanning electron microscope and DIAGNOdent®.

Introduction: Remineralization as a treatment procedure has received a lot of attention both from clinicians as well researchers. The objective of this in vitro study was to find out the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) in remineralizing enamel surface on which artificial caries lesion had been created. The changes were analyzed using DIAGNOdent® (KaVo) and scanning electron microscope (SEM). Materials and Methods: Ninety maxillary premolars were selected and divided into three groups of 30 teeth each: A (artificial saliva), B (CPP-ACP), and C (CPP-ACPF). All the samples were assessed using DIAGNOdent® at the baseline and after demineralization and remineralization. Three samples were randomly selected from each group after remineralization for surface evaluation using SEM. Results: Statistical analysis showed that group B {CPP-ACP (4.1±1.8)} and group C {CPP-ACPF (4.8±1.2)} had a significantly higher amount of remineralization than group A (1.7±0.7). Conclusion: All the three groups showed a statistically significant amount of remineralization. However, because of the added benefit of fluoride (NaF 0.2%), CPP-ACPF (Tooth Mousse-Plus®) showed marginally more amount of remineralization than CPP-ACP (Tooth Mousse®).

Evaluation of demineralization adjacent to orthodontic bracket and bond strength using fluoride-releasing and conventional bonding agents.

Background and Objectives: One of the most difficult problems encountered in orthodontic treatment with fixed appliance is the control of enamel demineralization around the brackets. Fluoride-releasing bonding adhesives were introduced to aid in the prevention of demineralization adjacent to orthodontic brackets. Hence, an in vitro study was conducted to evaluate and compare demineralization adjacent to the orthodontic bracket and the bond strength using fluoride-releasing adhesive and conventional adhesive. Materials and Methods: One hundred and twenty healthy extracted premolars were selected for the study and were divided into two groups, each group consisting of 60 teeth. Both groups were further divided into three subgroups consisting of 20 samples each. Samples of subgroups A and B were bonded with two prototypes of fluoride-releasing adhesives (i.e. Rely-a-bond and Tru-bond). Samples of subgroup C (ortho-one) were bonded with conventional non-fluoride-releasing adhesive. Group I samples were subjected to demineralization in an acidic medium (methyl cellulose buffered with acetic acid at a pH of 4.5) for 4 weeks, which were later observed under a stereomicroscope. Group II samples were tested for shear bond strength using the Instron Universal testing machine. Results: Both fluoride-releasing adhesives showed statistically significant lower enamel demineralization around the bracket when compared with the conventional adhesive. There was no statistically significant difference on comparing the demineralization between the two prototypes of fluoride-releasing adhesive. Evaluation of shear bond strength revealed that there was no significant difference between the subgroups. Conclusion: Fluoride-releasing adhesives might aid in the prevention of demineralization adjacent to the orthodontic bracket with acceptable bond strength.

Effect of different frequencies of fluoride dentifrice and mouthrinse administration: an in situ study

The effect of a combination of topical fluoridation methods for inhibition of enamel demineralization in the face of a cariogenic challenge has not been clearly established. This in situ crossover study aimed to assess whether the addition of daily use of fluoride mouthrinse (FR) to that of fluoride dentifrice (FD) is equivalent to increasing the frequency of FD application in terms of the effect on enamel demineralization and fluoride content. Over 3 phases of 14 days each, 12 volunteers wore appliances containing enamel blocks exposed to a 20 percent sucrose solution 8 times/day. During each phase the blocks underwent one of the following treatments: 2x/day FD, 2x/day FD + 1x/day FR, and 3x/day FD. The blocks were assessed for hardness and fluoride content. Three x/day FD did not differ from 2x/day + 1x/day FR, however it enhanced demineralization protection when compared to 2x/day FD. All treatments produced an increase in enamel fluoride content compared to no treatment (sound blocks) (p < 0.05), but the differences between them were not significant. The results of this study suggest that the daily use of fluoride mouthrinse combined with that of fluoride dentifrice has similar effects on enamel demineralization and fluoride content when compared to increasing the frequency of fluoride dentifrice use.

Salivary cortisol response to psychological stress in children with early childhood caries.

Aims and Objectives: Early Childhood Caries (ECC) is a multi-factorial disease and has numerous biological, psychological, and behavioral risk factors. In this study, we have attempted to study psychological stress as a risk factor for early childhood caries by investigating and comparing the response of event-related stress on salivary cortisol level in children with ECC and those without ECC and also compared the adaptability to various dental procedures in children with early childhood caries and without early childhood caries. Materials and Methods: One hundred children aged between four and five years were examined in the school and 16 pairs of children with caries and without caries were selected after cross-matching them on various risk factors for Early Childhood Caries. Oral prophylaxis and topical fluoride treatment procedures were used as stressors and salivary samples were collected at the time of arrival for the treatment, after Oral Prophylaxis and Fluoride treatment. The salivary samples were analyzed by radioimmunoassay for an unbound plasma cortisol level. Results: Statistical analysis was performed using a paired t-test, on the collected data, to compare the mean values of the salivary cortisol across the group and within the groups to evaluate the cortisol response to stress. No significant differences were found between the salivary cortisol levels prior to treatment, post oral prophylaxis, or post fluoride treatment at the first and second appointments of both groups. At the first appointment, the fluoride treatment caused a significant increase in the salivary cortisol level over the pretreatment level, in both the groups, but it was not evident in either of the two groups studied at the second appointment. Conclusion: We have concluded that the stress produced by different dental procedures was similar in children from the two groups studied, and the coping ability of the children was also similar in both the groups. Small sample size may be one of the reasons why no significant differences were found between the groups. Similar study needs to be repeated with a larger sample size.

Fingernail may not be a reliable biomarker of fluoride body burden from dentifrice

Fingernail has been suggested as a biomarker of fluoride (F) body burden, but there is no consensus if it would be a reliable indicator of F exposure from dentifrice. Therefore, the present study was conducted to investigate if fingernails would have sensitivity to detect F exposure from dentifrice in young children. Twenty-three 1-3-year-old children living in the city of Piracicaba (0.72 ppm F in water), Brazil, were enrolled in two phases of different F exposure: in phase A (1st to 11th week), they were exposed to the combination of F from diet (solids and liquids) and dentifrice (1,500 µg F/g as MFP), and in phase B (12th to 29th week), only to F from diet (the use of F dentifrice was interrupted). Fingernails were weekly clipped during 35 weeks for F determination. F intake from diet and dentifrice in each phase was also determined. Both analyses were made with ion-specific electrode. F intake (Mean ± SD) was significantly higher (p<0.01) when the children were exposed to F from diet+dentifrice than only to F from diet (0.086 ± 0.032 and 0.040 ± 0.009 mg F/day/kg body weight, respectively). However, F concentrations in nails collected during the whole experimental period of 35 weeks presented great variation with no trend of decreasing after F dentifrice intake interruption. The findings suggest that fingernail may not be a reliable F biomarker of body burden from dentifrice.

As unhas têm sido consideradas um biomarcador para a exposição ao flúor (F), mas não há consenso se é um indicador confiável para exposição ao F a partir do dentifrício. Vinte e três crianças, com idade entre 1 a 3 anos, moradoras de Piracicaba (0,72 ppm F na água), Brasil, foram submetidas a duas fases de diferentes exposição ao F: fase A (1a a 11a semanas), as crianças foram expostas à combinação de F a partir da dieta (sólidos e líquidos) e dentifrício (1500 µg F/g como MFP); e na fase B (12ª a 29ª semanas), apenas ao F da dieta, uma vez que usaram dentifrício não fluoretado. As unhas das mãos foram coletadas semanalmente durante 35 semanas para determinação de F. A exposição ao F a partir da dieta e dentifrício foi também determinada. Ambas análises foram feitas com eletrodo específico para F. A exposição ao F foi significativamente maior (p<0,001) quando as crianças foram expostas ao F da dieta + dentifrício que ao F da dieta (0,086 ± 0,032 e 0,040 ± 0,009 mg F/kg corpóreo/dia, respectivamente). Entretanto, a concentração de F nas unhas coletadas durante todo o período experimental não diminuiu após a interrupção da ingestão do F a partir do dentifrício. Os resultados sugerem que as unhas das mãos não são um biomarcador confiável para refletir a exposição ao F pelo dentifrício.

Long-term fluoride release from resin-reinforced orthodontic cements following recharge with fluoride solution

The aim of this study was to test the hypothesis that there is no difference in the fluoride release behavior of resin-reinforced glass ionomer cements before or after fluoride recharge. The materials were divided into 5 groups: 2 resin-reinforced glass ionomer cements used for attaching orthodontic bands, that is, group FOB (Fuji Ortho Band) and group MCB (Multi-Cure Glass Ionomer Orthodontic Band Cement); 2 resin-reinforced glass ionomer cements and a composite used for bonding orthodontic brackets, that is, group OGLC (Ortho Glass LC), group FOLC (Fuji Ortho LC), and group TXT (Transbond XT), respectively. Fluoride release was measured during a 60-day period by using selective ion electrodes connected to an ionic analyser. After 4 weeks, the samples were exposed to 0.221 percent sodium fluoride solution. The results showed that cements achieved a maximum fluoride release 24 h after initial setting. No statistically significant differences were observed between groups FOB and OGLC regarding the amount of released fluoride following fluoride recharge from day 31 to day 36 (p>0.05). In conclusion, FOB and OGLC cements showed a higher capacity of capturing and releasing fluoride compared to the other cements studied.

O objetivo deste estudo foi testar a hipótese que não há diferença no desempenho dos cimentos de ionômero de vidro reforçados com resina entre si quanto à liberação de flúor antes e após recarga com flúor. Os materiais foram divididos em 5 grupos: 2 cimentos de ionômero de vidro reforçados com resina utilizados para cimentação de bandas ortodônticas: Grupo FOB (Fuji Ortho Band) e Grupo MCB (Multi-Cure Glass Ionomer Orthodontic Band Cement); 2 cimentos de ionômero de vidro reforçados com resina e 1 compósito utilizados para colagem de bráquetes ortodônticos: Grupo OGLC (Ortho Glass LC), Grupo FOLC (Fuji Ortho LC); e Grupo TXT (Transbond XT), respectivamente. A liberação de flúor foi medida durante 60 dias, através de eletrodo íon seletivo conectado a um analisador de íons. Após 4 semanas, os corpos de prova foram expostos a solução de fluoreto de sódio à 0,221 por cento. Os resultados evidenciaram que os cimentos atingiram o pico máximo de liberação de flúor com 24 h após presa inicial. Não houve diferença estatisticamente significante entre a quantidade de flúor liberado após as recargas de fluoreto de sódio entre os grupos FOB e OGLC do 31° ao 36° dia (p>0.05). Concluindo os cimentos FOB e OGLC apresentaram maior capacidade de captação e liberação de flúor comparada aos outros CIVRRs.

Preventive effect of fluoridated orthodontic resins subjected to high cariogenic challenges

The aim of the present study was to evaluate the in vitro caries preventive effect of fluoridated orthodontic resins under pH cycling with two types of acid demineralizing saliva. Brackets were bonded to 60 bovine incisors, using either Transbond Plus Color Change (n=30) or Orthodontic Fill Magic (n=30) orthodontic resins. Each group of resin was divided into 3 subgroups (n=10): immersion in remineralizing artificial saliva for 14 days, pH cycling with high cariogenic challenge in acid saliva with pH 5.5, and acid saliva with pH 4.5. After 14 days of pH cycling, the caries preventive effect on the development of white spot lesion was evaluated considering the presence of inhibition zones to white spot lesions using two scores: 0= absence and 1= presence. Kruskal Wallis and Mann-Whitney tests (a=0.05) were used. Formation of white spot lesions was observed only under pH cycling using acid saliva with pH 4.5; with Transbond Plus Color Change being significantly more effective (p<0.05) in preventing the appearance of white spot lesions effect than Orthodontic Fill Magic. The acidity of the demineralizing solution influenced the formation of white spot lesions around orthodontic brackets under highly cariogenic conditions. Transbond Plus Color Change resin presented higher caries preventive effect than Orthodontic Fill Magic.

O objetivo do presente estudo foi avaliar in vitro o efeito preventivo a cárie de resinas ortodônticas fluoretadas submetidas à ciclagem de pH utilizando dois tipos de saliva desmineralizadora. Bráquetes de incisivos centrais foram colados em 60 incisivos bovinos, utilizando a resina ortodôntica Transbond Plus Color Change (n=30) ou Fill Magic (n=30). Cada grupo foi dividido em 3 subgrupos (n=10): imersão em saliva artificial remineralizante por 14 dias e simulação de alto desafio cariogênico com ciclagem de pH em saliva ácida com pH 5,5 ou pH 4,5. Após 14 dias de ciclagem de pH, o efeito preventivo de cárie foi avaliado por meio da formação de halo de inibição da mancha branca, adotando-se os escores: 0-ausência e 1-presença. Os testes Kruskal Wallis e Man-Whitney (a=0,05) foram aplicados. A formação de lesões de mancha branca foi observada somente na ciclagem de pH com saliva ácida a pH 4,5; sendo o Transbond Plus Color Change significantemente mais efetivo na prevenção ao desenvolvimento de mancha branca quando comparados ao Fill Magic (p<0,05). O pH da solução desmineralizante influenciou na formação de lesões de mancha branca circunjacentes aos bráquetes em condições de alto desafio cariogênico. A Transbond Plus Color Change apresentou maior efeito preventivo de cárie em relação ao Fill Magic.

Ingestão de fluoreto por crianças em idade de risco de desenvolvimento de fluorese dental com o uso de dentifrícios infantil e regular: um estudo experimental cruzado / Fluoride intake by children at ages susceptible to the risk of developing dental fluorosis through the use of children's and regular dentrifices: an experimental crossover study

Este estudo teve como objetivo comparar a dose e a quantidade de fluoreto (F) ingerido por meio de dentifrícios formulados para crianças (infantis) com aqueles para dulto (regular), usando como indicadores de exposição o Fluoreto Total (FT( e Fluoreto Solúvel Total (FST), bem como avaliar a concentração do FT, FST e fluoreto iônico (FI) em dentifrícios usados habitualmente pelas crianças...

Estado del arte de indicadores para la medición de caries dental / State of the art for dental caries measurement

Para enfocar la solución de los problemas de salud, es necesario indentificar los cambios en las necesidades, las demandas y las expectativas referidas a salud, así como los cambios en las respuestas sectoriales y en su financiamiento Las herramientas que se utilizan-indicadores- se ajustan al marco teórico desde el cual se formulan los estudios. Los indicadores disponibles pueden ser simples o complejosy sistematizarse constituyendo índices específicos que permiten alcanzar precisión en el diagnóstico,identificar grupos especiales y tomar decisiones terapéuticas. Los diversos indicadores pueden reconocer (a) la historia pasada de caries (CPOD, CPOS, ceod, ceos y sus derivados) (b) los factores de riesgo (el Cariograma) (c) la necesidad de tratamiento (Índicede necesidad de tratamiento para caries dental) y (d) el proceso de desarrollo de la caries dental (Índice de Nyvad, el ICDAS II, el índice de Mount y Hume).La aplicación rigurosa de cualquiera de los instrumentos mencionados requiere cumplir con un proceso que incluye: (1) el conocimiento teórico del indicadory los puntos de corte entre sus categorías, (2) el reconocimientopráctico en situaciones “en papel” y clínica y (3) la estandarización propiamente dicha estableciendolas diferencias inter-examinador entre el“gold standard” o “examinador de referencia” y el examinador a entrenar y las diferencias intra-examinador,es decir las variaciones que se registran entre las observaciones de un mismo profesional. El objetivo de la presente revisión es describir los instrumentosdisponibles destinados a identificar y cuantificar los diferentes momentos del proceso de caries dental es decir los puntos de corte entre las categoríasque mide.

Therapeutic effect of two fluoride varnishes on white spot lesions: a randomized clinical trial

The aim of this randomized clinical trial study was to evaluate the therapeutic effect of two varnish formulations (G1 = 5 percent NaF, G2 = 6 percent NaF + 6 percent CaF2) on the remineralization of white spot lesions (WSL). The sample was composed of 15 (7- to 12-year-old) children with 45 active WSL in anterior permanent teeth. The children were randomly divided into two groups providing 22 lesions for G1 and 23 for G2. The children were submitted to weekly varnish applications 4 times. The WSL were evaluated twice: baseline and on week 4. Maximum lesion dimensions (mesiodistal and incisogingival) were measured in millimeters and classified in four grades of size. WSL were also assessed regarding lesion activity by one calibrated examiner. The Pearson chi-square and Fisher's exact tests were used (P < 0.01). WSL reductions were observed in both varnish groups (Chi-square = 0.15, d.f. = 1, P = 0.90), and with similar magnitude (in mm): 1.19 and 1.29 for G1 and G2, respectively. Thirty-six WSL (15 in G1 and 21 in G2) were classified as inactive on week 4, reaching an overall value of 80 percent. No difference was observed between G1 and G2 regarding activity scores (Fisher's exact test, p > 0.01). It was concluded that after 4 applications the two varnish formulations tested produced similar clinical effects, indicating the reduction and the control of carious activity in most WSL.

Urinary fluoride output in children following the use of a dual-fluoride varnish formulation

OBJECTIVE: This study evaluated the bioavailability of fluoride after topical application of a dual-fluoride varnish commercially available in Brazil, when compared to DuraphatTM. MATERIAL AND METHODS: The urinary fluoride output was evaluated in seven 5-year-old children after application of the fluoride varnishes, in two different phases. In the first phase (I), children received topical application of the fluoride varnish Duofluorid XII (2.92 percent fluorine, calcium fluoride + 2.71 percent fluorine, sodium fluoride, FGM TM). After 1-month interval (phase II), the same amount (0.2 mL) of the fluoride varnish Duraphat (2.26 percent fluorine, sodium fluoride, ColgateTM) was applied. Before each application all the volunteers brushed their teeth with placebo dentifrice for 7 days. Urinary collections were carried out 24 h prior up to 48 h after the applications. Fluoride intake from the diet was also estimated. Fluoride concentration in diet samples and urine was analyzed with the fluoride ion-specific electrode and a miniature calomel reference electrode coupled to a potentiometer. Data were tested by ANOVA and Tukey's post hoc test (p<0.05). RESULTS: There were significant differences in the urinary fluoride output between phases I and II. The use of Duofluorid XII did not significantly increase the urinary fluoride output, when compared to baseline levels. The application of Duraphat caused a transitory increase in the urinary fluoride output, returning to baseline levels 48 h after its use. CONCLUSIONS: The tested varnish formulation, which has been shown to be effective in in vitro studies, also can be considered safe.