The effect of silver diammine fluoride on In Vitro Enamel caries lesion remineralization and staining as a function of lesion baseline mineral distribution.

OBJECTIVES: to investigate whether baseline mineral distribution modulates the ability of silver diammine fluoride (SDF) to remineralize and stain enamel caries lesions. METHODS: This laboratory study followed a 3 [treatment: SDF/fluoride varnish (FV)/deionized water (DIW)] ×3 [lesion protocol: methylcellulose (MeC)/hydroxyethylcellulose (HEC)/Carbopol 907 (C907)] factorial design. Lesions were created in bovine enamel specimens (n = 20). Treatments were applied and lesions remineralized in artificial saliva. Digital transverse microradiography (TMR-D) was used to analyze lesions. Lesion color was monitored spectrophotometrically. The effects of lesion protocol and treatment on changes in lesion depth (ΔLD), mineral loss (ΔΔZ), maximum mineral density at the surface zone (ΔSZmax), and color changes related to remineralization (ΔL*remin) were analyzed using two-way ANOVA. RESULTS: The treatment×lesion protocol interaction was significant for ΔΔZ (p < 0.01) and ΔL*remin (p < 0.01), however not for ΔLD (p = 0.23) or ΔSZmax (p = 0.91). There were no differences in ΔΔZ between treatments in HEC and C907 lesions. However, DIW resulted in more remineralization than both SDF (p < 0.01) and FV (p = 0.01) in MeC lesions. Considering changes from lesion baseline after remineralization in MeC lesions, SDF treatment resulted in the highest mineral gain in the surface zone. However, DIW revealed the highest mineral gain after remineralization in the lesion body. SDF stained lesions with the intensity increasing after remineralization in C907 lesions, whereas staining decreased in MeC and HEC lesions. CONCLUSION: High fluoride treatments can interfere with continuous remineralization of caries lesions due to partial arrest. Baseline lesion mineral distribution affects SDF's ability to enhance remineralization and the staining caused by SDF. CLINICAL SIGNIFICANCE: SDF is being used to arrest active caries lesions extending into dentin and to treat dentin hypersensitivity. This study shed light on SDF's effect on an isolated process in dental caries only, remineralization. It achieved this by examining enamel caries lesions with differing mineral distributions and assessing their staining properties.

Physical properties and enamel remineralization potential of arginine-fluoride varnishes.

OBJECTIVE: The study objectives were to examine the physical properties and enamel remineralization potential of fluoride (F) varnishes incorporated with arginine (Arg). METHODS: Four commercial F varnishes: 1) Duraphat®; 2) Flúor Protector®, 3) Fluor Protector S®, and 4) Fluorimax™ were supplemented with 2% w/v. Arg. The control/experimental varnishes underwent rheometric analysis to assess varnish density (δ), velocity (ν), and associated viscosity, both quantitatively (ν/δ) and qualitatively based on determined mass, volume, distance flow, and time under experimentation. The varnish wet/dry weights (at 2 h) were also analysed. Further, sound enamel specimens (T0) with artificial incipient caries-like lesions (T1) were treated with control/experimental varnishes and subjected to remineralization assay with artificial saliva for 6 h. Thereafter (T2), the specimens were characterized to estimate precipitated Ca and net enamel F uptake. Additionally, mineral density (MD) was assessed using micro-CT at T0, T1, and T2 to derive mineral gain (MG) and % remineralization for the treatment groups. RESULTS: When Arg is incorporated, the physical properties of the F-containing varnishes undergo a significant transformation, resulting in higher density, varnish weight, dry varnish weight, and viscosity compared to their respective control varnishes (p < 0.05). Incorporating Arg-in Duraphat®, Fluor Protector S®, and Fluorimax™ significantly improved both enamel Ca precipitation and F uptake compared to the respective controls (p < 0.05). Additionally, the enamel F uptake was significantly higher with all the tested varnishes when enriched with Arg (p < 0.05). The combined data for MD, MG, and % remineralization suggests that the remineralization potential of F-varnishes significantly increased when enriched with Arg (p < 0.05). CONCLUSION: Incorporating Arg in inorganic F varnishes improves their physical properties and enhances the enamel remineralization potential of the varnishes. CLINICAL SIGNIFICANCE: This study highlights the possibility of incorporating Arg in distinct F-source varnishes. The synergism between active components (Arg-F) aids in enhanced remineralization and superior varnish physical properties, demonstrating a promising approach for high caries-risk patients.

Fluoride release potential of arginine-incorporated fluoride varnishes.

The study aimed to examine the fluoride (F) release potential of arginine (Arg)-incorporated F varnishes. Four commercially available F varnishes were included in the study: Duraphat® (5% NaF), Flúor Protector® (0.9% SiH2F2), Fluor Protector S® (NH4F), and Fluorimax™ (2.5% NaF). L-arginine (2% w/v.) was incorporated in these varnishes to estimate F release at 1 h, 4 h, 6 h, 24 h, 3 days, and 7 days using an F-ion selective electrode. The media pH of eluded varnishes was estimated and primary inorganic F extraction was performed. The main effects pH, F release, and computed integrated mean/cumulative F release for experimental groups were significantly higher than the controls (p<0.01). The primary extracted F concentrations for the Arg-containing groups were significantly lower than the control groups (p<0.001) demonstrating a chemical interplay with Arg incorporation. To conclude, irrespective of the inorganic F content, incorporating Arg in F-containing varnishes increases their F release potential.

Review on fluoride varnishes currently recommended in dental prophylaxis.

In dentistry, fluoride compounds play a very important role in the development of teeth hard tissue. They have been modifying the development of the carious process for many years in accordance with the principles of minimally invasive therapy. Studies have confirmed their effectiveness in the prevention and treatment of carious lesions and erosion of deciduous and permanent teeth, as well as in the dentin hypersensitivity treatment. Typically, each varnish consists of 3 basic components, i.e., a resin usually in the form of mastic, shellac and/or rosin, an alcohol-based organic solvent (usually ethanol) and active agents. In the first-generation varnishes, the active agent is fluorine compounds, most often in the form of 5% NaF, while in second-generation varnishes, the composition is further enriched with calcium and phosphorus compounds in the form of CPP-ACP/CPP-ACPF, ACP, TCP, fTCP, CSPS, TMP, CXP, or CaGP. This influences the bioavailability of fluoride in the oral environment by increasing both its release from the product and its subsequent accumulation in enamel and plaque, promotes more efficient closure of dentinal tubules, and facilitates pH buffering in the oral cavity.

Remineralization effect of NaF, NaF with TCP, NaF with CPP-ACP and NaF with CXP varnishes on newly erupted first permanent molars: A randomized controlled trial.

INTRODUCTION: The aim of this study was to evaluate the remineralization effect of NaF, NaF with TCP, NaF with CPP-ACP and NaF with CXP varnishes on newly erupted first permanent molars using laser fluorescence (LF) method. The study was a randomized, double-blind, controlled trial with four parallel groups. METHODS: The study was carried out in 48 high caries-risk children (DMFS >8), aged 6-7 years with newly erupted permanent first molars (initial lesion with 13 < LF value<30). A total of 140 teeth were divided randomly into four groups (n = 35): G1.Duraphat Varnish containing 5% NaF, G2. Clinpro™ White Varnish containing 5% NaF with TCP, G3.Embrace™ Varnish containing 5% NaF with CXP, G4. MI Varnish containing 5% NaF with CPP-ACP. All dental treatments of the patients were completed before the varnish application. The varnishes were applied to the targeted teeth at baseline, 1 and 3 months. Patients were called for follow-up appointments at 1, 3 and 6 months, and LF scanning was used to monitor mineralization changes. Data were analysed statistically by Wilcoxon signed-rank and Mann-Whitney U-tests. RESULTS: In total, 40 children (122 teeth) completed the trial. At the end of 6 months, the amount of reduction in LF values (indicating remineralization) are as follows: NaF with CXP(6.87 ± 4.32) < NaF with TCP(7.36 ± 7.05) < NaF(7.40 ± 7.03) < NaF with CPP-ACP(8.33 ± 4.90). All of the varnishes resulted in significant decrease in LF measurements and there was no significant difference between control (NaF alone) group and other groups. Only MI varnish had a significantly greater remineralization effect than Embrace™ Varnish (p < 0.05). CONCLUSION: As a non-invasive approach, CPP-ACP, TCP and CXP containing NaF varnishes have the potential to remineralize initial caries lesions on permanent first molars in high caries-risk children.

An economic evaluation of pit and fissure sealants and fluoride varnishes in preventing dental caries: a systematic review.

The aim was to systematically evaluate the cost-effectiveness of pit and fissure sealants (PFSs) compared with that of fluoride varnishes (FVs) in dental caries prevention. We searched four electronic databases including the Cochrane Oral Health Group's Trials Register (till 03 June 2022), Web of Science (from 1945 to 03 June 2022), PubMed (from 1996 to 03 June 2022), and EMBASE via Ovid (from 1980 to 03 June 2022) to identify the cost and effectiveness of PFSs and FVs in decreasing dental caries incidence. Two researchers independently screened search results, extracted data from the included studies, and conducted the risk of bias assessments. The main characteristics of the included studies were extracted and analyzed. The initial search produced 874 articles. After removing duplicates and full-text review, 19 studies were included. In this study: nine studies were on PFSs comparison with control; five on PFSs comparison with FVs; and five on FVs comparison with control. Regarding the type of economic evaluation (EE), 13 studies conducted cost-effectiveness analysis, five conducted cost-utility analyses, and one conducted both cost-effectiveness analysis and cost-utility analyses. The cost-effectiveness evaluation of PFSs and FVs in the available studies was limited. The prevalence of dental caries, payers' willingness to pay, length of follow-ups, delivery settings, retention rate of PFS, and application intervals of FV can affect the economic evaluation of these two methods for dental caries prevention. Therefore, more studies in the future are need to draw clear conclusions about which method is more cost-effective for the two preventive interventions in future.

Stradivari's Varnish Revisited: Feature Improvements Using Chemical Modification.

The most widespread varnish formulations used by master violin-makers of the "Italian Golden Age", including Antonio Stradivari, were based on mixtures of siccative oils (e.g., linseed oil) and natural resins (e.g., colophony). Similar formulations are still used for the finish of contemporary instruments. Although most precious violins made by Stradivari and other Cremonese Masters are kept in museums, several instruments are still played and their finish may undergo deterioration due to contact with the players. Moreover, the decay of the traditional varnish may occur due to mechanical stress and natural aging caused by environmental agents (e.g., exposure to uncontrolled light, humidity, and temperature changes). The main aim of this research work is to investigate the possible improvement of varnish resistance to the decay induced by different aging processes. For this purpose, the traditional varnish (linseed oil/colophony 3:1 w/w) was recreated in the laboratory following an ancient recipe and then it was functionalized with a cross-linking agent (3-Glycidyloxypropyltrimethoxysilane, GLYMO). Plain and functionalized varnishes underwent artificial aging (UV light, temperature, and humidity variations), and their properties were comparatively studied using different techniques. All the results suggest that the functionalized varnish displays improved resistance to the aging process and particularly enhanced photostability and increased hardness (resistance to scratches).

Efficacy of S-PRG filler varnishes on enamel caries remineralization.

OBJECTIVES: To evaluate the remineralizing effect of varnishes containing different concentrations of S-PRG filler or sodium fluoride on enamel caries lesions. METHODS: Enamel specimens were obtained from bovine incisors, flattened and polished. Half of the surface was protected, and artificial caries lesion was created in the unprotected area. They were assigned into six groups (n=20) according to the varnish applied: four containing S-PRG filler with different concentrations (10%, 20%, 30% and 40% w/w), one containing 5% sodium fluoride (5%NaF) as positive control, and one without treatment as a negative control (NC). Varnishes were applied on specimen's caries-affected surface and removed after 24 h. Varnish application and pH cycling (8 days) were performed twice. Cross-sectional microhardness was measured (10-100 µm depth). Knoop microhardness percentage (KHN%) of caries affected/treated area in relation to the sound enamel area at the same depth was calculated. The area under the curve (AUC) and the ΔAUC were also calculated. Statistical analysis was performed by two-way ANOVA for KHN% and one-way ANOVA for ΔAUC, followed by Tukey test (α=5%). RESULTS: Significant differences were found for the factors "treatment" (p=0.0001) and "depth" (p=0001). For the factor "treatment", the results of the Tukey test were: NC-62.2(10.3)a, 10%S-PRG-69.2(9.3)b, 20%S-PRG-71.8(9.7)bc, 30%S-PRG-74.5(9.4)c, 5%NaF-79.6(8.7)d, 40%S-PRG-85.6(8.4)e. In relation to ΔAUC, significant differences were observed among the groups (p=0.0001) and better results for 40% S-PRG and 5%NaF. CONCLUSIONS: The varnish containing 40% S-PRG fillers was the most effective to promote the enamel caries remineralization, followed by the one containing 5% sodium fluoride. CLINICAL SIGNIFICANCE: The varnish containing 40% of S-PRG fillers represents an alternative for initial enamel caries remineralization, since it was more effective than the conventional 5% NaF based product.

Effect of Fluoride-based Varnishes with Added Calcium and Phosphate on Microhardness of Esthetic Restorative Materials: An In Vitro Study.

Background and objectives: Fluoride varnishes are being used to prevent caries in children. The high concentration of fluoride in varnishes apart from caries prevention may cause changes in surface properties of esthetic restorations. The study aims to evaluate and compare the effect of four commercially available fluoride varnishes with added calcium and phosphate on microhardness of three esthetic materials namely conventional GIC (Fuji II), high viscosity GIC (Fuji IX), and nanocomposite (Filtek Z350). Materials and methods: A total of 28 pellets were made of each material and stored in distilled water at 37 °C for 48 hours. The microhardness of the pellets was tested which served as a baseline. These were then randomly divided into four subgroups. In one subgroup Profluorid varnish was applied, second subgroup MI varnish was applied, third subgroup Embrace varnish was applied, and in the fourth subgroup Enamel Pro varnish was applied as per protocol. Thereafter, all the pellets were subjected to microhardness testing (load = 100 g for 15 seconds). Results: The fluoride varnishes increased the microhardness of conventional GIC (Fuji II) whereas in case of high viscosity GIC (Fuji IX) the application of varnishes reduced the microhardness. In case of nanocomposite restorative material (Filtek Z350) only Profluorid varnish increased its microhardness. Conclusion: Fluoride varnish and calcium-phosphate containing fluoride varnish effect on the microhardness of restorative material is material dependent. So, the choice of fluoride varnish with or without proprietary additives depends on the nature and composition of the restorative material. How to cite this article: Shetty RS, Bhat SS, HK Sundeep, et al. Effect of Fluoride-based Varnishes with Added Calcium and Phosphate on Microhardness of Esthetic Restorative Materials: An In Vitro Study. Int J Clin Pediatr Dent 2022;15(2):187-193.

Effects of Fluoride and Calcium Phosphate-Based Varnishes in Children at High Risk of Tooth Decay: A Randomized Clinical Trial.

BACKGROUND: The aim of this study was to investigate the effect of the application of two varnishes-MI Varnish (5% sodium fluoride with CPP-ACP) and Clinpro White Varnish (5% sodium fluoride with fTCP)-applied every three months in children with high caries risk for 12 months on plaque indexes, salivary pH, salivary lactic acid and chemical elements concentrations. METHODS: We included 58 children aged 4-12 years, assigned to control (placebo), Clinpro and MI groups. Baseline and three-month saliva samples were taken. We assessed changes in pH, lactic acid concentrations and chemical elements in saliva. RESULTS: At 12 months, all groups showed a nonsignificant increase in pH levels and a reduction in lactic acid, which was greatest in the placebo group. There was a significant reduction in 24Mg (p = <0.001), 31P (p = 0.033) and 66Zn (p = 0.005) levels in the placebo group (p ≤ 0.05), but not in the other elements studied: 23Na, 27Al, 39K, 44Ca, 52Cr, 55Mn, 57Fe, 59Co, 63Cu, 75As, 111Cd, 137Ba, 208Pb and 19F. CONCLUSIONS: Neither pH, lactic acid concentrations or most salivary chemical elements were useful in defining patients at high risk of caries or in monitoring the effect of MI Varnish and Clinpro White Varnish after three-month application for 12 months. However, the appearance of new cavities was stopped, and the hygiene index improved, probably due to hygienic and dietary measures and the use of fluoridated toothpaste. TRIAL REGISTRATION: ISRCTN registry, ISRCTN13681286.

Topical fluoride varnishes promote several biological responses on human gingival cells.

OBJECTIVE: To compare the in vitro cytotoxicity of four commercial topical fluoride varnishes widely used in daily dental practice for the prevention of caries on human fibroblasts: Cervitec F, Fixofluor, Fluor Protector S and Duraphat. MATERIAL AND METHODS: Human gingival fibroblasts (hGF) were exposed to different concentrations of fluoride varnishes extracts. Biological assays, including MTT and IC50 value determination, annexin-V/7-AAD staining, cell migration and F-actin staining with phalloidin were carried out. Statistical analyses were performed using one-way ANOVA and Tukey's post hoc test. RESULTS: At 4% concentration, all of the fluoride varnishes extracts affected fibroblasts metabolic activity, exhibiting a high degree of cytotoxicity at all measured time points. At 0.1% and 1%, Duraphat and Fixofluor or Fluor Protector S and Cervitec F exerted the lowest or highest cytotoxic effects, respectively. Similar effects were evidenced when induction of apoptosis/necrosis and cell migration assays were analyzed. Immunocytochemical assays revealed a similar number of fibroblasts, without changes in the morphology and F-actin content at 0.1% concentration of all tested materials, while at 1% concentration, Fluor Protector S and Cervitec F showed few cells with aberrant morphology or non-adhered cells, respectively. CONCLUSIONS: Different commercial topical fluoride varnishes with the same therapeutic indication may exhibit different biological effects and cytotoxicity on fibroblasts.

Clinical Effect of Two Fluoride Varnishes in Caries-Active Preschool Children: A Randomized Controlled Trial.

The prevention of dental caries in preschool children is a priority for dental services. The aim of the study was to investigate the caries-preventive effect of 2 fluoride varnishes in caries-active preschool children, and then compare the outcome with a non-varnish control group. After screening, 180 preschool children aged 36-71 months, with at least 1 noncavitated lesion, were enrolled and randomly allocated into 3 parallel groups, namely A: 1.5% ammonium fluoride varnish (Fluor Protector S), B: 5% NaF varnish (Duraphat), and C: professional tooth-cleaning. All children were recalled every third month for intervention and their parents were instructed to have them brush their teeth with a 1,000-ppm fluoride toothpaste twice daily. Caries were recorded at baseline and after 12 months by a calibrated examiner and the incidence was scored on noncavitated (d2) and cavitated (d3) level. We tested differences between the groups with the χ2 and two-sided t tests. One hundred and seventy-two children (95.6%) completed the trial and 56 (32.6%) and 35 (19.2%) developed new d2 and d3 lesions, respectively. Both varnishes reduced the incidence of caries compared with the control group, but there was no significant difference between group A and group B. Compared with group C, the relative risk for developing cavitated lesions was 0.39 (95% CI 0.22-0.62) in group A and 0.26 (95% CI 0.14-0.50) in group B. The total prevented fraction (Δd2d3mft) for group A and group B was 19.9 and 22.5% (p < 0.05), respectively. No adverse effects were observed or reported during the study period. In conclusion, the 2 fluoride varnishes demonstrated an equal capacity to reduce the incidence of caries in caries-active preschool children over a 12-month period in comparison with a control group.

The GREEN RESCUE: a 'green' experimentation to clean old varnishes on oil paintings.

In cultural heritage, several initiatives are promoted to transfer the green chemistry in replacing traditional and toxic methods and products, and in ensuring safety of both artworks and restorers during cleaning operations. This study is aimed to establish the validity of new green solvents to replace toxic solvents, commonly used, to remove old paint varnishes. In particular, the research is focused on the use of acetals to remove old varnishes paintings. The acetals are common functional groups in natural products which are generated by reactions between alcohols and aldehydes. The tests were performed on four different resins (DAMAR, RETOUCHER, PVA and PMMA). Several samples were prepared to reproduce the common stratigraphy succession of the oil painting. The performances of the solvents were monitored by visible light/UV light, photography and optical microscopy, spectro-colorimetric analysis. Then, FTIR spectra of the cleaned surface have been acquired to detect the residues after cleaning.

Efficacy of fluoride varnishes with different compositions on white spot lesions remineralization / Eficácia de vernizes fluoretados com diferentes composições na remineralização de manchas brancas

Objective: To evaluate the efficacy of different fluoride varnishes on white spot lesions (WSL) remineralization. Material and Methods: Polished bovine enamel specimens were obtained (n = 60) and had their initial surface Knoop microhardness (SMH) determined. WSL were created and the SMH was measured again. Then, specimens were allocated into six groups: C ­ Control (without varnish); BF ­ Bifluorid 12 (6% NaF + 6% CaF2); DP ­ Duraphat (5% NaF); PF ­ Profluorid (5% NaF); FP - Fluor Protector (0.2% NaF + 0.9% difluorsilane); CW - Clinpro White Varnish (5% NaF + 5% TCP). After varnishes application, specimens were immersed in artificial saliva for 24 h. Then, pH-cycling was performed for 8 days and SMH was measured. Data were analyzed by one-way ANOVA and Tukey's test. Results: Non-significant differences were observed among the groups at baseline (p = 0.187) and after WSL formation (p = 0.999). After treatments, significant differences were observed among the groups (p = 0.001). Mean % of alteration (SD) and results of Tukey test were: C- 92.40 (12.10)a; PF- 88.66 (10.66)a; FP- 85.90 (14.49)ab; BF- 67.85 (17.86)bc; CW- 66.60 (18.48)c; DP- 58.62 (8.69)c. Conclusion: Bifluorid 12, Clinpro White Varnish, and Duraphat showed higher efficacy than artificial saliva in promoting the remineralization of WSL, nevertheless, none of the treatments were able to recover sound enamel baseline microhardness (AU)

Objetivo: Avaliar a eficácia de diferentes vernizes fluoretados na remineralização de lesões de mancha branca (LMB). Material e métodos: Espécimes de esmalte bovino polido (n = 60) foram submetidos à análise de microdureza superficial Knoop (KMH) inicial. Foram então criadas LMB artificialmente e os espécimes foram alocados em seis grupos: C ­ Controle (sem aplicação de verniz); BF ­ Bifluorid 12 (6% NaF + 6% CaF2); DP ­ Duraphat (5% NaF); PF ­ Profluorid (5% NaF); FP - Fluor Protector (0.2% NaF + 0.9% difluorsilano); CW - Clinpro White Varnish (5% NaF + 5% TCP). Após a aplicação dos vernizes, os espécimes ficaram imersos em saliva artificial por 24h e uma ciclagem de pH foi realizada por 8 dias. Após a ciclagem, KMH final foi realizada. Os dados foram analisados por ANOVA e teste de Tukey (5%). Resultados: Não foi observada diferença significante para os grupos após a KHM inicial (p = 0.187) e após a formação de LMB (p = 0.999). Após os tratamentos, diferenças significativas foram observadas entre os grupos (p = 0.001). Valores de média de % de alteração superficial (desvio-padrão) e resultados do teste de Tukey foram: C- 92.40 (12.10)a; PF- 88.66 (10.66)a; FP- 85.90 (14.49)ab; BF- 67.85 (17.86)bc; CW- 66.60 (18.48)c; DP- 58.62 (8.69)c. Conclusão: Os vernizes Bifluorid 12, Clinpro White Varnish e Duraphat apresentaram maior eficácia na remineralização das LMB quando comparados à saliva artificial, entretanto, nenhum dos produtos testados foi capaz de recuperar os valores iniciais de microdureza. (AU)

Antibacterial activity of fluoride varnishes containing different agents in children with severe early childhood caries: a randomised controlled trial.

OBJECTIVES: The aim of this study was to compare the antibacterial activity of fluoride varnishes containing different agents in children with severe early childhood caries (S-ECC). MATERIALS AND METHODS: The study was conducted in 92 children with S-ECC. Patients who completed dental treatment under general anaesthesia were included in the study. Patients were divided randomly into four groups: 5% sodium fluoride (SF) control group (n = 23), 5% SF with tricalcium phosphate (TCP) (n = 23), 5% SF with xylitol-coated calcium and phosphate (CXP) (n = 23) and 5% SF with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (n = 23). Saliva mutans streptococci (MS) and lactobacilli (LB) levels were evaluated by taking saliva samples at baseline (T0), 1 month (T1) and 3 months (T2) after treatment. RESULTS: All groups showed a significant decrease in MS and LB levels at T1 (P < 0.05) except the CXP group. Only the TCP group exhibited significantly decrease MS and LB levels indicating less than 105 CFU at both T1 and T2 compared with the other groups (P < 0.05). CONCLUSION: Fluoride varnish with TCP provided significantly more reduction in MS and LB levels than other fluoride varnishes. CLINICAL RELEVANCE: Fluoride varnish with TCP had a significant antibacterial effect against cariogenic bacteria until the end of the third month. Long lasting antibacterial effect provides additional advantage for reducing bacteria levels in children. CLINICAL TRIALS REGISTRATION NUMBER: NCT03625310.

Surface-Specific Caries Preventive Effect of an Intervention Comprising Fissure Sealant, Povidone-Iodine and Fluoride Varnish in a Remote Indigenous Community in Australia.

This study evaluates the effect of a topical intervention comprising of fissure sealant, povidone-iodine, and fluoride varnish in preventing caries on occlusal, approximal, and smooth surfaces. This three-year clinical trial was conducted in a remote Indigenous community of Australia. All schoolchildren (age range: 4-17) were invited to participate; those with parental consents to receive three-annual epidemiological examinations and interventions constituted the experimental group, while those with consents for only the epidemiological examination formed a comparison group. The intervention group received an annual application of fissure sealant, povidone-iodine and fluoride varnish for two consecutive years along with the restoration of any cavitated lesions, while the comparison group did not receive any intervention except for the usual care that included emergency treatment and restorations. Incipient and advanced caries were recorded in the permanent dentition while data on confounding variables were collected through questionnaires. Caries increment and progression were the outcome variables. A total of 408 children participated in the baseline examination, 208 finished the study. After adjusting for confounders, the prevented fraction (PF) on occlusal surfaces for advanced caries in the experimental group was 76.1% (mean difference- -0.35, 95% CI: -0.67-0.04), while the PF for progression from incipient to advanced caries was 100%(mean difference- -0.30, 95% CI: -0.52-0.09). The mean number of smooth surfaces that progressed from incipient to advanced caries in the comparison group was more than twice that of the experimental group, the mean difference was -0.25 (95% CI: -0.46--0.03) with a PF of 61%. The intervention was only effective in preventing advanced caries on occlusal surfaces and in halting the progression of caries on occlusal and smooth surfaces but not on approximal caries.

Does Applying Fluoride Varnish Every Three Months Better Prevent Caries Lesions in Erupting First Permanent Molars? A Randomised Clinical Trial.

PURPOSE: To determine the effectiveness of fluoride varnish (FV) in preventing caries lesions on the erupting first permanent molars (FPM) of high-risk children. MATERIALS AND METHODS: A randomised parallel-blinded clinical trial was conducted with a sample of 180 children between 6 and 7 years of age with at least one sound erupting FPM attending a public school in the Dominican Republic. Children were randomly assigned to three groups, one control and two experimental groups, which received FV application every 3 or 6 months. All the children received fluoride toothpaste (1450 ppm), toothbrush, diet counseling, and oral health recommendations every three months. The development of caries lesions was assessed at twelve months using ICDAS. RESULTS: A total of 157 children completed the study, of which 51.0% were female. At the end of the study, 53 participants comprised the control group, 54 were included in the every-3-months (3-month) FV group, and 50 belonged to the every-6-months (6-month) FV group. Adjusted ORs were calculated to compare lesion development between the groups. The results showed that the control group was more likely to develop caries lesions in comparison to the 3-month FV group, with an associated AOR of 1.46 (95% CI: 1.18 to 1.81, p = 0.001). Likewise, applying FV every six months as opposed to every three increased the odds of developing caries with a significant AOR of 1.29 (95% CI: 1.03 to 1.64, p = 0.029). CONCLUSION: FV application every three months can be recommended to prevent caries lesions on the erupting first permanent molars of high-risk populations.

Comparison between micro-computed tomography and transverse microradiography of sound dentine treated with fluorides and demineralized by microcosm biofilm.

The study aimed to apply micro-computed tomography (micro-CT) and transverse microradiography (TMR) to measure dentine demineralization and to test the preventive effect of titanium tetrafluoride (TiF4 ) under microcosm biofilm. Sound dentine specimens from bovine root were treated for 6 h with: (i) 4.0% titanium tetrafluoride (TiF4 ) varnish [pH 1.0, 2.45% fluoride (F-); (ii) 5.42% sodium fluoride (NaF) varnish (pH 5.0, 2.45% F); (iii) 2% chlorhexidine (CHX) gel (pH 7.0); (iv) placebo varnish (pH 5.0); or (v) no agent (untreated). Dentine specimens were then exposed to human saliva mixed with McBain saliva for 8 h. Thereafter, McBain saliva containing 0.2% sucrose was applied daily, for 5 d, onto dentine specimens to stimulate formation of microcosm biofilm. Although a high correlation was found between the results of both methods regarding integrated mineral loss, the results of the methods did not show good agreement in Bland-Altman plots, with significant biases in calculations of lesion depth. Fluoride varnishes were able to reduce dentine demineralization (P < 0.05), while CHX failed to do so. Fluorides are still the best option to reduce dentine demineralization. Micro-CT may be used to measure dentine mineral loss, but not the lesion depth, for which TMR is superior.

School-based fluoride varnish programs: a national survey.

PURPOSE: To identify and describe school-based fluoride varnish (FV) programs in K-12 grades children in the United States. METHODS: This cross-sectional study utilized an online, self-administered survey to identify and describe school-based FV programs in 2016. Several public health directories, mainly The Association of States and Territorial Dental Directors directory, were contacted to identify FV programs. The survey's questionnaire included 23 closed-ended questions regarding program description, assessment, and process. RESULTS: Of 85 identified programs, 52 responded (response rate = 61 percent) with 40 school-based FV programs in operation in 27 states. About 85 percent of responding programs apply FV as part of an existing school-based program. Dental sealants on permanent teeth are the most common procedure provided in addition to FV (92 percent). One-third of programs apply FV once a year versus 28 percent that apply FV twice a year. CONCLUSIONS: Evidence-based guidelines for FV in school-based programs are needed to ensure cost-effectiveness and continuity.

Cost-effectiveness analysis of two caries prevention methods in the first permanent molar in children.

BACKGROUND: Evidence supports two methods for preventing dental caries lesions in children: pit and fissure sealants (PFS) and fluoride varnishes (FV). The aim of this study was to compare the cost-effectiveness of these two strategies in preventing dental caries lesions on the occlusal surface of the first permanent molar in children. METHODS: A Markov model was used to simulate the progression of dental caries on the occlusal surface of the first permanent molar in a hypothetical cohort of children over a 9-year period. Transition probabilities were extracted from the published literature and costs were calculated from a payer's perspective. Two scenarios were evaluated based on the probability of replacing a failed PFS. Sensitivity analysis was performed to test the robustness of the model. RESULTS: Over the 9-year study period PFS were less expensive and more effective than FV in preventing occlusal dental caries lesions. For the base case scenario the probability of replacing a failed PFS was 100 percent and the Incremental Cost-Effectiveness Ratio (ICER) for PFS was $156.87 per first episode of caries lesion averted. For the second scenario, the probability of replacing a failed PFS was lowered to 50 percent. Here, the ICER dropped to $113.00 per first episode of caries lesion averted and remained the dominant strategy. CONCLUSION: PFS should be the preferred method for the prevention of dental caries lesion on the occlusal surface of the first permanent molar, especially in children who are at high risk and have barriers of access to dental care.