Milk fluoridation for the prevention of dental caries.

UNLABELLED: The aim of this review is to give an overview of 55 years experience of milk fluoridation and draw conclusions about the applicability of the method. Fluoridated milk was first investigated in the early 1950s, almost simultaneously in Switzerland, the USA and Japan. Stimulated by the favourable results obtained from these early studies, the establishment of The Borrow Dental Milk Foundation (subsequently The Borrow Foundation) in England gave an excellent opportunity for further research, both clinical and non-clinical, and a productive collaboration with the World Health Organization which began in the early 1980s. Numerous peer-reviewed publications in international journals showed clearly the bioavailability of fluoride in various types of milk. Clinical trials were initiated in the 1980s - some of these can be classed as randomised controlled trials, while most of the clinical studies were community preventive programmes. CONCLUSION: These evaluations showed clearly that the optimal daily intake of fluoride in milk is effective in preventing dental caries. The amount of fluoride added to milk depends on background fluoride exposure and age of the children: commonly in the range 0.5 to 1.0 mg per day. An advantage of the method is that a precise amount of fluoride can be delivered under controlled conditions. The cost of milk fluoridation programmes is low, about € 2 to 3 per child per year. Fluoridation of milk can be recommended as a caries preventive measure where the fluoride concentration in drinking water is suboptimal, caries experience in children is significant, and there is an existing school milk programme.

Fluoride toothpastes and fluoride mouthrinses for home use.

OBJECTIVE: To provide a brief commentary review of fluoride-containing toothpastes and mouthrinses with emphasis on their use at home. Toothpastes and mouthrinses are just two of many ways of providing fluoride for the prevention of dental caries. The first investigations into incorporating fluoride into toothpastes and mouthrinses were reported in the middle 1940s. Unlike water fluoridation (which is 'automatic fluoridation'), fluoride-containing toothpastes and fluoridecontaining mouthrinses are, primarily, for home use and need to be purchased by the individual. By the 1960s, research indicated that fluoride could be successfully incorporated into toothpastes and clinical trials demonstrated their effectiveness. By the end of the 1970s, almost all toothpastes contained fluoride. The widespread use of fluoride- containing toothpastes is thought to be the main reason for much improved oral health in many countries. Of the many fluoride compounds investigated, sodium fluoride, with a compatible abrasive, is the most popular, although amine fluorides are used widely in Europe. The situation is similar for mouthrinses. Concentrations of fluoride (F), commonly found, are 1500 ppm (1500 µg F/g) for toothpastes and 225 ppm (225 µg F/ml) for mouthrinse. Several systematic reviews have concluded that fluoride-containing toothpastes and mouthrinses are effective, and that there is added benefit from their use with other fluoride delivery methods such as water fluoridation. Guidelines for the appropriate use of fluoride toothpastes and mouthrinses are available in many countries. CONCLUSION: Fluoride toothpastes and mouthrinses have been developed and extensive testing has demonstrated that they are effective and their use should be encouraged.

Effects of amine and stannous fluorides on plaque accumulation and gingival health in orthodontic patients treated with fixed appliances: a pilot study.

AIM: The aim of this pilot study was to evaluate the effects of different use of amine and stannous fluoride (AmF/SnF2)- containing toothpaste with and without a mouthrinse (Meridol®) on plaque accumulation and gingival health after four weeks' use in patients wearing fixed orthodontic appliances. METHODS: Plaque accumulation and periodontal variables were recorded in 40 volunteers (mean age: 20.1±5.6 years), who were randomly divided into two groups. They refrained from oral hygiene two days before each assessment. The test group brushed with AmF/SnF2 toothpaste twice daily for three minutes and rinsed with an AmF/SnF2 mouthrinse for 30 seconds. The control group used only the AmF/SnF2 toothpaste twice daily, toothbrushing for three minutes. RESULTS: Baseline values for plaque index (PI) and gingival index (GI) were 2.21±0.52 and 1.98±0.58 (mean±SD) in the test group, 2.29±0.42 and 2.02±0.44 in the control group. After four weeks, PI and GI were 1.32±0.42 and 0.93±0.59 in the test group, and 1.27±0.52 and 1.09±0.51 in the control group, respectively. Bleeding on probing at baseline was 40% in the test group and 37.5% for the controls; at the final evaluation, these values were 10.1% and 12.7%, respectively. All of the indices were reduced significantly in both groups. There was no statistically significant difference between the groups (P<0.05). CONCLUSIONS: Based on the findings of this pilot study, it is suggested that the use of AmF/SnF2-containing products resulted in beneficial clinical effects on plaque accumulation and gingival health after placement of fixed orthodontic appliances. These beneficial effects may be more pronounced after long-term and combined use of these products. A six-month duration study with a larger sample of participants is needed to confirm the promising results from this pilot.

[The dental aspects of public health in Hungary. Review article]. / Magyarország népegészségügyi helyzetének fogorvosi vonatkozásai. Osszefoglaló közlemény.

Despite great improvements in the oral health status of the population, public health and dental public health continue to be a major problem in society. A number of epidemiologic studies revealed the importance of the social, behavioral and environmental factors contributing to inequalities in the maintenance and restoration of oral health. Dental public health is the science and art of preventing oral diseases, promoting oral health and improving the quality of life through the organized efforts of the public. The aim of the authors was to provide an overview about the development and the functions of the Hungarian public health and dental public health system, its associations with international dental public health organizations and about the present dental public health status of the Hungarian population. According to WHO pathfinder studies, the Hungarian population has a usual cariologic and periodontal status in Europe, but a number of WHO statistical analyses reveal the sad situation regarding the high frequency of oral malignancies in our country. The social support system is given, the tasks are in front of us, and Hungary intends to follow the oral health strategies of the WHO for 2020 in order to improve the dental public health status of the nation, but it is necessary to declare that not only behavioral but also political decisions are necessary for that goal.

Caries prevention through the fluoridation of milk. A review.

The aim of this review is to give an overview of 50 years experience of milk fluoridation and draw conclusions about the applicability of the method. Fluoridated milk was first investigated in the early 1950s, almost simultaneously in Switzerland, the USA and Japan. Stimulated by the favourable results obtained from these early studies, the establishment of The Borrow Dental Milk Foundation (subsequently The Borrow Foundation) in England gave an excellent opportunity for further research, both clinical and non-clinical, and a productive collaboration with the World Health Organization from the early 1980s onwards. Numerous peer-reviewed publications in international journals showed clearly the bioavailability of fluoride in milk, and increased concentrations of fluoride in saliva, dental plaque, dental enamel and dentine, and urine, after consumption of fluoridated milk. Clinical trials were initiated in the 1980s--some of these can be classed as randomised controlled trials, while most of the clinical studies were community preventive programs. These evaluations showed clearly that the optimal daily intake of fluoride in milk is effective in preventing dental caries. At present, milk fluoridation programs are running continuously in about ten countries of the world. Fluoridation of milk can be recommended as a caries preventive measure where the fluoride concentration in drinking water is suboptimal, caries experience in children is significant, and there is an existing school milk program. The program should aim to provide fluoridated milk for at least 200 days per year and should commence before the children are 4 years of age.

Effect of pH of amine fluoride containing toothpastes on enamel remineralization in vitro.

BACKGROUND: One of the important factors of the demineralization and remineralization equilibrium of enamel is the pH of the surrounding solutions. Effort has been laid in the formulation of different fluoride compounds and the fluoride content in toothpastes but much less is known about the influence of the pH of the toothpastes on their effectiveness. It was therefore the aim of this study to investigate the influence of different pH levels on enamel remineralization in an in vitro experiment using polarization light microscopy and EDX quantitative element analysis. METHODS: A 5 x 5 mm window on the enamel surface of 40 caries free extracted human premolars was demineralized in a hydroxyethylcellulose solution at pH 4.8. The teeth were divided into 8 groups and the lower half of the window was covered with varnish serving as control. Each group was then immersed in toothpaste slurry containing amine fluoride (1400 ppm) at pH 4.1, 4.5, 5.1 and 6.9 or control toothpaste slurry without fluoride at pH 4.3, 4.7, 5.3 and 7.0. Serial sections were cut through the lesions and investigated with polarization light microscopy and quantitative EDX element analysis. RESULTS: The PLM results showed a decreased porous volume of the body of the lesion after incubation with fluoridated toothpaste at pH 4.53 and 5.16. No differences between the experimental window and the control window were found in the other groups. The quantitative element analysis showed no differences in the element content of any of the groups. CONCLUSION: From the results it can be concluded that slightly acidified fluoridated dentifrices may have a certain positive effect on enamel remineralization.

[Oral cancer screening: how to develop a country-wide opportunistic system in Hungary]. / Szájüregi szurovizsgálatok: tervek az alkalomszeru szurés kiterjesztésére Magyarországon.

In Hungary, oral cancer represents a very heavy public health problem. Even epidemiological evidence in support of the effectiveness of organized screening for early detection does not exist, the efforts to detect the precancerous lesions and early cancers of oral cavity must be continued. The mass screening component of the National Public Health program provides a good opportunity for that. Following the Government decision, a multidisciplinary Working Group has been brought together, and a proposal made to develop a country-wide opportunistic system to regularly examine those at high risk for oral cancer. In addition to dentists, primary care personnel as well as the occupational health service have a lot to offer to the desired effect: reduction of mortality from oral cancer.

[Model program for screening oral cancers in the Roma population]. / Modellprogram ajak-szájüregi daganatok szûrôvizsgálatára roma populációban.

Oral cancer has been identified as a significant public health threat. It is reported that about 3,800 new cases of oral cancer are diagnosed in Hungary each year with approximately 1,700 associated deaths. Oral cancer is the 6th most common cancer in men. Most oral cancers are preventable; 75% of oral cancers are related to tobacco use, alcohol use, or use of both substances together. While there is insufficient evidence to support or refute the use of visual examination as a method of screening for oral cancer in the general population, screening in high-risk populations is highly recommended. It was presumed that high-risk behavior including tobacco and alcohol use is one of the characteristics of Roma people. The main aim of the study was to elaborate a screening model program for the Roma population to determine risk factors of oral cancer and establish early diagnosis hence to reduce morbidity and mortality. In the program we planned to survey the risk factors in the target population, establish the diagnosis of oral cancer and/or pre-cancer and direct the patients to health care facilities. First we determined the target population in four Hungarian towns with the help of Roma social workers and local public health officers. We assembled a questionnaire on risk factors. Training for Roma social workers and screening personnel was also accomplished. Screening for oral precancerous lesions and cancer and survey the risk factors in the target population were performed at the same time. Patients screened to be positive were referred to specialists. Altogether 1,146 persons, 656 male and 490 female (age 20-77 years, mean 40 years), participated in the screening; 84% of them reported on some kind of complaints. We have got valid data on risk factors in connection with oral cancer. More than fifty percent of participants did not clean their teeth regularly, 75% were smokers, while 45% drunk alcohol regularly. 1,6% of screened participants had oral lesions that did not require referral to a specialist, while 2.3% of the screened subjects had referable oral mucosal lesions including leukoplakia. The overwhelming majority (93%) of participants screened to be positive did not see dentist regularly. As a conclusion, we elaborated a screening model program, which is applicable for disadvantaged (e.g. Roma) population to determine risk factors of oral cancer and establish early diagnosis hence to reduce morbidity and mortality. We surveyed the risk factors in the target population, established the diagnosis of oral cancer and/or pre-cancer lesions and directed the patients to care facilities. We also assisted them to get appropriate long-term care and follow-up. The importance of screening activities targeted on high-risk population was underlined.

Effect of fluoride toothpastes on enamel demineralization.

BACKGROUND: It was the aim of this study to investigate the effect of four different toothpastes with differing fluoride compounds on enamel remineralization. METHODS: A 3 x 3 mm window on the enamel surface of 90 human premolars was demineralized in a hydroxyethylcellulose solution at pH 4.8. The teeth were divided into 6 groups and the lower half of the window was covered with varnish serving as control. The teeth were immersed in a toothpaste slurry containing: placebo tooth paste (group 1); remineralization solution (group 2); Elmex Anticaries (group 3); Elmex Sensitive (group 4); Blend-a-med Complete (group 5) and Colgate GRF (group 6). Ten teeth of each group were used for the determination of the F- content in the superficial enamel layer and acid solubility of enamel expressed in soluble phosphorus. Of 6 teeth of each group serial sections were cut and investigated with polarization light microscopy (PLM) and quantitative energy dispersive X-ray analysis (EDX). RESULTS: The PLM results showed an increased remineralization of the lesion body in the Elmex Anticaries, Elmex Sensitive and Colgate GRF group but not in the Blend-a-med group. A statistically significant higher Ca content was found in the Elmex Anticaries group. The fluoride content in the superficial enamel layer was significantly increased in both Elmex groups and the Blend-a-med group. Phosphorus solubility was significantly decreased in both Elmex groups and the Blend-a-med group. CONCLUSION: It can be concluded that amine fluoride compounds in toothpastes result in a clearly marked remineralization of caries like enamel lesions followed by sodium fluoride and sodium monofluorophosphate formulations.

[Evaluation of clinical effects of amine fluoride/stannous fluoride containing toothpaste and mouthrinse]. / Aminfluorid/ónfluorid tartalmú szájápoló szerek klinikai hatásának értékelése.

The aim of the study was to evaluate the effects of amine fluoride (AmF)/stannous fluoride (SnF2) containing toothpaste and mouthrinse on gingival health of young adults. Altogether 42 persons participated in the study (mean age: 28.3 +/- 7.2) and were evaluated for Plaque Index (PI) (Silness and Löe, 1963) and Gingival Index (GI) (Löe and Silness, 1964). The probands were randomly divided into two groups, both of them used AmF/SnF2 containing toothpaste twice a day for three minutes toothbrushing. One group (combined group) after toothbrushing rinsed with mouthrinse containing AmF/AnF2 combination. After four weeks the participants were re-examined. At the end of the study statistically significant decrease was found in dental plaque (PI) and gingival index (GI) values. Values of PI and GI in the group using only toothpaste were as follows (mean +/- S.D.): PI values-baseline: 1.03 +/- 0.20; final: 0.60 +/- 0.13; p<0.001; GI values-baseline: 0.87 +/- 0.22; final: 0.505 +/- 0.22; p<0.01. The values of PI and GI in the combined group were as follows: PI values-baseline: 1.10 +/- 0.20; final: 0.52 +/- 0.10; p<0.001; GI values- baseline: 1.05 +/- 0.27; final: 0.50 +/- 0.17; p< +/- 0.001. The reduction of PI and GI values was significant in all groups but it was higher in the combined (toothpaste + mouthrinse) group than in the one using toothpaste only. It is concluded that regular use of AmF/AnF2 toothpaste has a beneficial effect for reduction of plaque accumulation but its effect can be enhanced with additional use of Am/SnF2 containing mouthrinse.

[History of fluoride prevention: successes and problems (literature review)]. / A fluoridprevenció története: sikerek és problémák (irodalmi áttekintés).

Fluoride prevention has a significant role in complex caries prevention, together with the appropriate diet and oral hygiene. The aim of the present review is--considering mainly the public health aspects--to give information on changes of the methods of fluoride prevention, and the changing views on pathomechanisms, as well as statements in the course of the last 50 years, based on present scientific evidence. The first great breakthrough in caries prevention was the introduction of water fluoridation between 1945-1950 in the USA and Canada. The measure was adopted in other countries and resulted in significant caries reduction. In the fifties and sixties fluoride tablets were widely used in many countries and brought good results, mainly in well-controlled smaller communities. Salt fluoridation has been initiated in Switzerland in 1955, and introduced in numerous countries in the eighties. The concept of a strong protective systemic effect of fluorides in the early eighties gave place to ideas on mainly topical effects, playing a decisive role in toothpastes, gels, acting topically on the enamel of the erupted teeth. Therefore many water fluoridation projects, mainly in Central- and Eastern Europe--where the prevalence of dental caries is still very high--were cancelled after 1990. Tablet fluoridation became questionable due to the fear of the possibility of dental fluorosis. Recent scientific views, however, confirmed a weak pre-, and peri-eruptive, as well as a strong posteruptive effect of systemically applied fluorides. In countries where caries prevalence is high, but the majority of the population cannot afford fluoridated toothpastes due to low socio-economic conditions, the introduction and extension of salt fluoridation to the whole population is well founded and recommended from a public health view.

The permeability of oral leukoplakia.

The significant increase in oral cancer mortality necessitates further research on the mechanisms of tumorigenesis. It was the aim of this study to compare the permeability, lipid composition and histopathological characteristics of oral leukoplakia with non-lesional specimens of the same region in 30 cases as well as 11 specimens originating from healthy control buccal mucosa. The permeability (Kp) of tissue biopsies to tritiated nitrosonornicotine was determined in a continuous through-flow perfusion system, lipids were extracted and identified by thin-layer chromatography, and thickness of epithelium and keratin layer assessed by histopathological methods. Results of the measurements showed that the permeability to the tobacco carcinogen, nitrosonornicotine for leukoplakic tissue was higher than for normal control buccal specimens. Non-lesional areas of buccal mucosa, adjacent to leukoplakias, showed hyperplasia and significantly higher permeability values than both leukoplakic and normal buccal control mucosa. The lipid content of the non-lesional sites was intermediate between the increased values of the leukoplakic lesion and of normal control mucosa. The data strongly suggest that the presence of tobacco in the oral cavity may bring about generalized changes even in regions that do not show leukoplakia.

[Significance of assessing risk factors for caries in their prevention]. / A cariesrizikó-tényezók vizsgálatának jelentósége a caries megelózésében.

INTRODUCTION: Besides the main etiological factors other factors are also involved in development of caries. Bacteria (Streptococcus mutans, lactobacilli) and saliva (its buffering capacity, and rate of secretion) are also risk factors in the development of caries. MATERIAL, METHOD, RESULTS: The authors were the first in Hungary to use the Dentocult kits for assessing the number of lactobacilli in saliva, to use the Oricult-N plate for the determination of the number of Candida, and the medium containing Dentocult-SM plates in the assessment of the number of Streptococcus mutans colonies in saliva. Children in Fót were divided into two groups: children who consumed sorbitol-containing sweets, and another consisting of children who consumed sucrose-containing sweets. The number of lactobacilli, as well as the caries-index was determined. The proportion of children with high lactobacillus counts was significantly lower in the sorbitol group than in the sucrose group. Caries prevalence and salivary lactobacillus counts were determined in 140 second and third graders and 150 adults. The difference between caries-active and caries-inactive subjects was statistically significant in both age groups. A relationship between lactobacillus and Candida albicans counts was found in 396 children between the ages of 6 and 11 living in children's homes. The microbiological assessment of the saliva of 269 children, from seven different children's home, all between the ages of 7 and 12, who were included in the WHO's three-year xylitol caries-preventive program, was also done. Cariological, saliva and microbiological investigations were carried out on 349 adolescents secondary school students. The amount of bacteria and yeasts showed a strong relationship with the caries mean values. The saliva of 210 fixed orthodontic appliances wearing--using amine fluoride-containing products--children, was investigated. According to the results, amine fluoride has a pronounced effect on the mouth's microflora, especially on the number of lactobacilli and Candida.

Effect of amine fluoride toothpaste and gel in high risk groups of Hungarian adolescents: results of a longitudinal study.

The aim of the study was to establish a preventive program with the combined use of amine fluoride toothpaste and gel in groups of adolescents living in different locations in Hungary. Caries and oral hygiene examinations were performed at the beginning of the study and repeated after 1 and 2 years. The adolescents were divided into 3 groups: 1 control and 2 test groups. The control group continued its usual oral care habits. One of the test groups received Elmex toothpaste for unsupervised home use daily and Elmex gel for use once a week, and the other test group received Elmex toothpaste and only placebo gel. The combined use of amine fluoride-containing toothpaste and gel provided a significant reduction in DMFS mean values (38% including white spot lesions, 34% not including white spot lesions, p < 0.05) and in visible plaque index values (18%, p < 0.05) compared to the control group.

[Effect of chewing sugar-free gum on dental caries]. / Cukormentes rágógumi hatása a dentális cariesre.

Previous in vivo studies have demonstrated that chewing sugar-free gum after eating reduces the development of dental caries. To investigate the extrapolation of these findings, a two-year clinical study was conducted on 547 schoolchildren in Budapest. Subjects in the "gum" (test) group were instructed to chew one stick of commercially available sorbitol-sweetened chewing gum for 15-20 minutes after meals, three times daily. The "control" group was not provided with chewing gum. After two years, excluding white spots, the "gum" group exhibited a 38.7% caries increment reduction compared to the "control" group. Including white spots, a corresponding 33.1% reduction was indicated. These results clearly suggest that even in a population with moderate caries prevalence and normal oral hygiene habits (including the use of fluoride dentifrices), an after-meal gum chewing regimen can significantly reduce the rate of caries development.

[Dentin hypersensitivity and its significance in dental practice]. / A dentin-túlérzékenység--és jelentósége a fogorvosi gyakorlatban.

Dentin hypersensitivity is not a new disease, more than a hundred years ago Gysi, later Brännström and many others were dealing with the problems of its symptoms, pathomechanism, differential diagnosis and therapy. The growing interest today maybe attributed to improving oral health, and to the presence of more teeth in older age, as a consequence of decreasing caries prevalence. The exposure of dentine surfaces due to gingival recession, erosion and abrasion may cause serious complaints, occurs in about 40% of the adult population, however, few of them turn to the dentist. Therefore, practising dentists should be aware of the possibilities of treatment, managing strategies and prevention. New aspects are the appropriate timing of toothbrushing after consumption of acidogenic, erosive foods and beverages, non-invasive (desensitizing, potassium-nitrate/fluoride containing toothpastes), and invasive (reconstruction with fillings, coverage of the exposed roots) treatment options. Continuous care of patients suffering in dentine hypersensitivity--in order to prevent more serious consequences (irritation of the pulp)--is advisable.

Leucoplaquia bucal. estudio epidemiológico en pacientes que solicitan atención estomatológica / Oral leukoplakia: epideiologic study in patients asking for stomatologic care

Esta investigación se realizó con el propósiton de evaluar kla frecuencia de leucoplaquia y la interacción de algunas variables etiológicas en la población. Se llevó a cabo en 36 clínicas estomatológicas distribuidas en todo el país. Los encuestadores fueron estudaintes del internado de estomatología, adiestrados y calibrados convenientemente. Se utilizó como definición operacional de leucopla la acordada por el seminario internacional de Mälmo de 1983. Se estudiaron 22 741 personas de más de 10 años de edad y se encontró una frecuencia del 5,42

de preleucoplaquia y 1,52

de leucoplaquia. El hombre fue aproximadamente 3 veces más afectado que la mujer, por lo que se evidenció en relación con la edad, que la frecuencia se incrementa notablement después de los 40 años. La mucosa del carrillo fue la región anatómica más afectada con el 44,08

seguida de la encia con el 30,42

. El 86,27

de las lesiones aparecieron en una sola localización anatómica; se registró que sólo el 0,31

de las leucoplaquias eran del tipo idiopático y se evidenció una relación directa, en el caso de la leucoplaquia asociada al consumo de tabaco , con la duración del hábito, la cantidad y características del mismo