Antibacterial Activity of a Bioactive Tooth-Coating Material Containing Surface Pre-Reacted Glass in a Complex Multispecies Subgingival Biofilm.

Bioactive materials were developed with the ability to release fluoride and provide some antimicrobial potential, to be widely used in dentistry today. However, few scientific studies have evaluated the antimicrobial activity of bioactive surface pre-reacted glass (S-PRG) coatings (PRG Barrier Coat, Shofu, Kyoto, Japan) on periodontopathogenic biofilms. This study evaluated the antibacterial activity of S-PRG fillers on the microbial profile of multispecies subgingival biofilms. A Calgary Biofilm Device (CBD) was used to grow a 33-species biofilm related to periodontitis for 7 days. The S-PRG coating was applied on CBD pins from the test group and photo-activated (PRG Barrier Coat, Shofu), while the control group received no coating. Seven days after treatment, the total bacterial counts, metabolic activity, and microbial profile of the biofilms were observed using a colorimetric assay and DNA-DNA hybridization. Statistical analyses were applied; namely, the Mann-Whitney, Kruskal-Wallis, and Dunn's post hoc tests. The bacterial activity of the test group was reduced by 25.7% compared with that of the control group. A statistically significant reduction was observed for the counts of 15 species: A. naeslundii, A. odontolyticus, V. parvula, C. ochracea, C. sputigena, E. corrodens, C. gracilis, F. nucleatum polymorphum, F. nucleatum vincentii, F. periodonticum, P. intermedia, P. gingivalis, G. morbillorum, S. anginosus, and S. noxia (p ≤ 0.05). The bioactive coating containing S-PRG modified the composition of the subgingival biofilm in vitro, thereby decreasing colonization by pathogens.

Cost-effectiveness of probiotics and fluoride varnish in caries prevention in preschool children.

OBJECTIVES: The purpose of this study was to evaluate the cost-effectiveness of two preventive interventions aimed at increasing the proportion of caries-free preschool children of low socioeconomic status using a decision analytic model. METHODS: Two scenarios were tested, one with a school milk program (SMP) and one without (non-SMP). Fluoride varnish (FV) and a probiotic (PB) were compared to a do-nothing alternative among children in public nurseries/schools over a 4-year period. FV was applied biannually and a PB (Lactobacillus rhamnosus) added to milk powder prepared daily. A Markov decision tree model was utilized. Several sources of data were used to populate the model. Probabilistic and deterministic sensitivity analyses were performed, and a public provider perspective was used. RESULTS: In the SMP scenario, PB was more effective and less costly than FV and, compared with do-nothing, increased the proportion of caries-free children by 14.5%, with a cost of USD 12.5 per child (June 2018). PB presented an incremental cost-effectiveness ratio (ICER) or cost per extra caries-free child of USD 86.2. In the non-SMP scenario, both interventions were cost-effective. FV (compared with do-nothing) increased the percentage of caries-free children by 8.3% with an ICER of USD 338.3 and PB (compared with FV) increased the effect by 6.2% with an ICER of USD 1400.2. CONCLUSIONS: The findings showed that PB was most effective and less costly than FV in the SMP scenario only. This type of analysis and its results provide essential information for decision-makers to improve the oral health of preschool children.

Anti-erosive profile of an experimental 5% SnCl₂ varnish containing different concentrations of NaF

Abstract This in vitro study evaluated the anti-erosive effect of an experimental varnish containing 5% stannous chloride (SnCl₂) associated with different concentrations of NaF (NaF-free, 2.5% NaF, or 5.2% NaF) on bovine enamel and root dentin. One hundred samples were pre-eroded (0.3% citric acid, pH 2.6, 10 min) and randomized into five groups (n=10 for each substrate): Negative control - milli-Q water; NaF-free - Experimental varnish SnCl₂-free and NaF-free; 2.5 NaF - Experimental varnish 5% SnCl₂ associated with 2.5% NaF; 5.2 NaF: Experimental varnish 5% SnCl₂ associated with 5.2% NaF and positive control - Commercial varnish containing 5% NaF (Duraphat). After the varnishes were applied, the erosive and abrasive challenges were carried out for five days. Loss of tooth structure (TSL) was determined by optical profilometry, and the loss of calcium (ΔCa2+) using atomic absorption spectroscopy. Dentin analysis was also performed by SEM. A one-way ANOVA/Bonferroni test was performed to analyze the data (α=0.05). The experimental 2.5 NaF and 5.2 NaF groups showed greater effectiveness in preventing TSL when compared to the other groups (p <0.05), regardless of the substrate. In addition, these groups showed lower loss in Ca2+ content when compared to the other groups (p <0.05), for enamel and dentin. Dentin showed greater TSL and ΔCa2+ loss when compared to enamel in all treatments (p <0.05). The 5.2% and 2.5% NaF-containing experimental varnishes showed promising results in both, the prevention of TSL and the loss of Ca2+, regardless of the substrate studied.

Resumo Este estudo in vitro avaliou o efeito anti-erosivo de um verniz experimental contendo 5% de cloreto estanoso (SnCl₂) associado a diferentes concentrações de NaF (sem NaF, 2,5% NaF ou 5,2% NaF) sobre esmalte e dentina radicular bovinos. Cem amostras foram pré-erodidas (ácido cítrico 0,3%, pH 2,6, 10 min) e randomizadas em cinco grupos (n=10 para cada substrato): Controle negativo - água milli-Q; Sem NaF - Verniz experimental sem SnCl2 e sem NaF; 2,5 NaF - Verniz experimental 5% SnCl2 associado a 2,5% NaF; 5,2 NaF: Verniz experimental 5% SnCl2 associado a 5,2% NaF e controle positivo - Verniz comercial contendo 5% NaF (Duraphat). Após a aplicação dos vernizes, os desafios erosivos e abrasivos foram realizados por cinco dias. A perda de estrutura dentária (PED) foi determinada por perfilometria óptica e a perda de cálcio (ΔCa2+) por espectroscopia de absorção atômica. A análise da dentina também foi realizada por MEV. Um teste ANOVA/Bonferroni de uma via foi realizado para analisar os dados (α=0,05). Os grupos experimentais 2,5 NaF e 5,2 NaF apresentaram maior eficácia na prevenção de PED quando comparados aos demais grupos (p<0,05), independentemente do substrato. Além disso, esses grupos apresentaram menor perda no teor de Ca2+ quando comparados aos demais grupos (p<0,05), para esmalte e dentina. A dentina apresentou maior PED e de ΔCa2+ quando comparada ao esmalte em todos os tratamentos (p<0,05). Os vernizes experimentais contendo NaF 5,2% e 2,5% apresentaram resultados promissores tanto na prevenção de PED quanto na perda de Ca2+, independente do substrato estudado.

Efficacy of a calcium-phosphate/fluoride varnish and ionomeric sealant on cervical dentin hypersensitivity: A randomized, double-blind, placebo-controlled clinical study.

BACKGROUND: Dentin hypersensitivity (DH) is a common problem in the population that can have a significant impact on the quality of life of those who suffer from the condition. OBJECTIVES: Compare the efficacy of two treatments for DH: Ca/PO4 - /F- varnish (Clinpro White Varnish) and ionomeric sealant (IS) (Clinpro XT Varnish) with a placebo. METHODS: Participants (121) with at least one tooth with visual analogue scale (VAS) score of 4 and above were randomly and blindly allocated to the groups. Treatments were performed by a trained researcher. DH was evaluated by another blind researcher after the treatment and after 1 week, 4 weeks, 3 months and 6 months. After 4 weeks, placebo received the DH treatment with IS; thus, the participants were not assessed after 3 and 6 months. Primary outcome was DH reduction after 4 weeks. Differences in VAS scores in the other time intervals and entire values of VAS were considered secondary outcomes. Comparisons were made among the groups (α = 0.05). RESULTS: IS showed the highest VAS value difference between baseline and 4 weeks (mean ± SD: 3.7 ± 2.2), differing significantly from placebo (2.3 ± 1.7) and Ca/PO4/F- varnish (2.6 ± 2.0). Ca/PO4- /F- varnish did not differ from placebo. In all time intervals, VAS values of all groups were significantly lower than the baseline value, without differences among groups. For the long-term differences in VAS values (3 and 6 months), the IS exhibited significantly higher values than Ca/PO4- /F- varnish. CONCLUSIONS: The IS was the most efficacious product for reducing DH, whereas Ca/PO4- /F- varnish did not differ from placebo. Registered in ClinicalTrials.gov (NCT04591444).

Prevention of non-cavitated lesions with fluoride and xylitol varnishes during orthodontic treatment: a randomized clinical trial.

OBJECTIVE: Fixed orthodontic appliances impair oral hygiene increasing the risk of non-cavitated lesions (NCLs) and tooth decay. The aim of this study was to compare the outcomes of fluoride and xylitol varnishes in preventing NCLs during comprehensive orthodontic treatment. MATERIALS AND METHODS: The sample comprised 55 volunteers from 15 to 20 years of age under orthodontic treatment that were randomly divided into three groups: Fluoride Group (FG; n=17), Xylitol Group (XG; n=19), and Placebo Group (PG; n=19). The patients in each group received two applications of the following varnishes: DuraphatTM (5% NaF), 20% xylitol, and placebo (no F/Xylitol) in the three groups, respectively. The varnishes were applied in the first appointment (T0) and 3 months later (T1). Clinical examinations were carried out at T0 and 6 months after (T2) using the ICDAS index and the QLF system (fluorescence difference). The intergroup comparisons were performed by ANOVA/Tukey's or Kruskal-Wallis/Dunn's tests (P<0.05). RESULTS: There was no significant intergroup difference regarding ICDAS index changes from T0 to T2. Fluoride varnish produced significantly greater increase in fluorescence of NCLs (mean change of -0.65 +0.78 and -0.56 +0.83, for maxilla and mandible, respectively) in comparison to the other groups. The majority of non-cavitated lesions improved in the fluoride and xylitol varnish groups. CONCLUSIONS: Fluoride varnish produced significantly greater increase in enamel fluorescence compared to xylitol and placebo varnishes. In short term, both fluoride and xylitol varnishes produced remineralization of NCLs in orthodontic patients. CLINICAL RELEVANCE: Non-cavitated lesions can be effectively controlled in high-risk orthodontic patients by means of fluoride varnishes. CLINICAL TRIAL REGISTRATION: ReBEC Identifier: RBR-6mdxfq; Date of Register: March 19th, 2020. Retrospectively Registered.

Infiltración de resina y barniz de flúor para el tratamiento de caries interproximales no cavitadas en dentición temporal / Resin infiltration plus fluoride varnish for non-cavitated proximal caries in primary dentition

RESUMEN: Introducción: Con el fin de prevenir la progresión de la caries interproximal no cavitada en dientes temporales, se ha generalizado el uso de estrategias mínimamente invasivas como la aplicación de sellantes, barniz de flúor o la resina infiltrante, ya sea combinadas o como monoterapia. Pese a lo anterior, hay incertidumbre con relación al efecto de la infiltración de resina en combinación con el barniz de flúor en dientes temporales. 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 metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Se identificaron nueve revisiones sistemáticas que en conjunto incluyeron tres estudios primarios que corresponden a ensayos clínicos aleatorizados. Se concluye que la infiltración de resina probablemente reduce el riesgo de la progresión de la caries interproximal no cavitada en dientes temporales. No se encontraron estudios que evaluaran los eventos adversos. Palabras claves: caries, infiltración de resina, caries interproximal, barniz de flúor, tratamiento mínimamente invasivo, Epistemonikos, GRADE.

ABSTRACT: Introduction: Minimally invasive techniques are widely used in non-cavitated interproximal caries treatment in primary dentition. Sealants, fluoride varnish, or resin infiltration can be applied in conjunction or as monotherapy. There is uncertainty regarding the effect of resin infiltration in conjunction with fluoride varnish in primary dentition. 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 meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 9 systematic reviews including three studies overall, of which all were randomized trials. We conclude that resin infiltration plus fluoride varnish probably decreases the risk of progression of non-cavitated interproximal caries in primary dentition. No studies were found that looked at adverse effects.

Dose-response Evaluation of Propolis Dental Varnish in Children: A Randomized Control Study.

BACKGROUND: Early childhood caries is a sugar-dependent disease with multifactorial modulating factors affecting deciduous dentition. It is defined as the presence of at least one decayed tooth, absence of a tooth due to caries or the existence of a temporary restoration in a tooth in a child between zero and 71 months of age. No BRP varnish was found in intellectual property banks, therefore it was registered and deposited with patent number BR1020160190142. OBJECTIVE: The objective of this study was to evaluate the dose-response concentration of alcoholic extract of Brazilian red propolis (BRP), in the form of dental varnish, against Streptococcus mutans (S. mutans) in children. METHODS: Twenty-four children, aged between 36 and 71 months, of both genders and without caries, were selected to participate in this pilot study and grouped randomly into four groups to receive different concentrations of BRP varnish (1%, 2.5%, 5% and 10%). The varnish was applied to the surface of all second deciduous molars. The antimicrobial activity was observed in saliva, which was collected in two phases: before applying the BRP varnish and after use. RESULTS: There was microbiological reduction of S. mutans in the oral cavity of the children in all the tested concentrations. The highest percentage reduction of S. mutans was observed at the concentration of 2.5% (P = 0.0443). CONCLUSION: The BRP extract in the form of dental varnish has antimicrobial activity against S. mutans and constitutes a possible alternative in the prevention of dental caries.

In vitro remineralization of primary teeth with a mineralization-promoting peptide containing dental varnish

Abstract Mineralization-promoting peptides are attractive candidates for new remineralization systems. In previous studies, peptides have been applied as aqueous solutions, which is not a clinically relevant form. Objective This study aims to investigate the efficiency of a mineralization-promoting peptide, applied in varnish, on remineralizing artificial caries on primary teeth. Methodology 55 primary molars were collected. Specimens were immersed in a demineralizing solution for 7 days and then, divided into 7 groups: Baseline: No-remineralization, Placebo: Blank colophony, F: Colophony 5% fluoride, P: Colophony 10% peptide, P+F: Colophony 5% fluoride and 10% peptide, Embrace: Embrace™ varnish, Durashield: Durashield™ varnish. A mixture of 35% w/v colophony varnishes were prepared in ethanol and applied accordingly. Specimens were immersed in a remineralization solution for 4 weeks and it was evaluated using PLM and SEM. Lesion depth reduction was examined by one-way ANOVA. Results There was no significant difference in mean lesion depths between baseline (147.04 ± 10.18 µm) and placebo groups (139.73 ± 14.92 µm), between F (120.95 ± 12.23 µm) and Durashield (113.47 ± 14.36 µm) groups and between P (81.79 ± 23.15 µm) and Embrace (90.26 ± 17.72 µm) groups. Lesion depth for the P+F group (66.95±10.59 µm) was significantly higher compared to all other groups. All groups contained samples with subsurface demineralized regions. Number of subsurface demineralized regions were higher in fluoride-containing groups. Conclusions We conclude that the mineralization-promoting peptide (MPP3) is effective in this in vitro study and the peptide shows benefits over fluoride as it yields less subsurface demineralized regions.

Efeito de vernizes fluoretados suplementados com nanopartículas de trimetafosfato de sódio sobre o desgaste dental erosivo in vitro e in situ / Effect of fluoride varnishes supplemented with nanosized Sodium Trimetaphosphate on enamel erosive wear in vitro and in situ

O presente estudo avaliou o efeito de vernizes fluoretados suplementados com nanopartículas de Trimetafosfato de Sódio (TMP) sobre o desgaste erosivo do esmalte dental bovino, em protocolos in vitro e in situ. Para a 1ª fase, blocos de esmalte dental bovino (n=100) foram selecionados por meio de dureza de superfície (DS) e aleatoriamente divididos em 5 grupos experimentais (n=20/grupo), de acordo com os vernizes testados: (a) Placebo (Pla - sem F ou TMP), (b) 5% NaF, (c) 5% NaF + 5% TMP microparticulado (5% Micro), (d) 5% NaF + 2,5% TMP nanoparticulado (2,5% Nano), (e) 5% NaF + 5% TMP nanoparticulado (5% Nano). Os blocos receberam uma única aplicação dos vernizes e foram imersos em saliva artificial por 6 h. Em seguida, os vernizes foram removidos e todos os blocos, submetidos a 4 desafios erosivos diários durante 5 dias (ERO, imersão em ácido cítrico 0,05 M, pH 3,2, 90 s/ciclo, sob agitação). Após ERO, metade dos blocos foi submetida a abrasão por escovação (15 s/ciclo) com dentifrício placebo (ERO+ABR). Os blocos foram analisados por perfilometria, dureza de superfície (DS) e dureza em secção longitudinal (ΔKHN). Os dados foram submetidos a ANOVA a dois critérios e Teste de Fisher LSD (p< 0,05). O desgaste do esmalte foi significativamente menor para ERO comparado a ERO+ABR para todos os vernizes testados (p< 0,001), seguindo o padrão 5% Nano < 5% Micro < 5% NaF < 2,5% Nano < Pla (ERO e ERO+ABR). A maior perda de DS foi observada para o Pla e a menor para 5% NaF (ERO) e 2,5% Nano (ERO+ABR), sem diferenças significativas entre 2,5% Nano, 5% NaF e 5% Micro. Os maiores valores de ΔKHN foram observados para 5% Micro e 5% Nano a 5-30 µm, com diferenças menos acentuadas entre os grupos a 30-70 µm (ERO e ERO+ABR). Para a 2ª fase, blocos de esmalte bovino (n=224) foram selecionados por DS e distribuídos aleatoriamente entre os grupos: (a) Placebo (Pla - sem F ou TMP), (b) 5% NaF, (c) 5% NaF + 5% TMP microparticulado (5% Micro), e (d) 5% NaF + 5% TMP nanoparticulado (5% Nano). Os blocos foram inseridos em dispositivos acrílicos palatinos (n=4/dispositivo), e tratados com os vernizes uma única vez, permanecendo na cavidade bucal dos voluntários (n=14) por 6 h. Em seguida, os vernizes foram removidos e os blocos, submetidos à ERO (imersão ex vivo em ácido cítrico 0,05 M, pH 3,2, 90 s, 4x/dia), enquanto dois blocos foram adicionalmente submetidos a abrasão por escovação com dentifrício fluoretado (ERO+ABR), totalizando 5 dias em cada etapa experimental, seguindo um protocolo duplo-cego e cruzado. As análises dos blocos e dos dados foram idênticas às da 1ª fase. Os valores do desgaste seguiram um padrão similar em ambas as condições experimentais (ERO ou ERO+ABR), com 5% Nano < 5% Micro < 5% NaF < Pla. Um padrão similar foi observado para dureza em secção longitudinal (ΔKHN), apesar de não serem verificadas diferenças significativas entre 5% Micro×5% Nano (5-30 µm). Quanto à perda de DS, o maior valor foi observado para Pla e o menor para 5% Nano (ERO ou ERO+ABR), sem diferenças significativas entre Pla×5% NaF (ERO), 5% NaF×5% Micro (ERO+ABR), e 5% Micro×5% Nano (ERO+ABR). Diante dos resultados, conclui-se que a adição de TMP a vernizes fluoretados melhorou significativamente a proteção contra o desgaste erosivo do esmalte in vitro e in situ. O uso de 5% de TMP em escala nanométrica aumentou ainda mais esses efeitos(AU)

The present study evaluated the effect of fluoride (F) varnishes supplemented with sodium trimetaphosphate (TMP) nanoparticles on erosive tooth wear, using in vitro and in situ protocols. For the first phase, bovine enamel blocks (n=100) were selected by surface hardness (SH) and randomly divided into 5 experimental groups (n=20/group), according to the varnishes tested: (a) Placebo (Pla - without F or TMP), (b) 5% NaF, (c) 5% NaF + 5% micrometric TMP (5% Micro), (d) 5% NaF + 2.5% nano-sized TMP (2.5% Nano), (e) 5% NaF + 5% nano-sized TMP (5% Nano). Blocks received a single varnish application, and were immersed in artificial saliva for 6 h. Varnishes were then removed and all blocks, subjected to 4 daily erosive challenges during for 5 days (ERO, immersion in 0.05 M citric acid, pH 3.2, 90 s/cycle, under agitation). After ERO, half of the blocks were subjected to abrasion by brushing (15 s/cycle) with placebo dentifrice (ERO+ABR). Blocks were analyzed by profilometry, surface hardness (SH) and cross-sectional hardness (ΔKHN). The data were submitted to 2-way ANOVA and Fisher's LSD test (p< 0.05). Enamel wear was significantly lower for ERO compared to ERO+ABR for all varnishes tested (p< 0.001), following the pattern 5% Nano < 5% Micro < 5% NaF < 2.5% Nano < Pla (ERO and ERO+ABR). The highest SH loss was observed for Pla, and the lowest for 5% NaF (ERO) and 2.5% Nano (ERO+ABR), without significant differences between 2.5% Nano, 5% NaF and 5% Micro. The highest values of ΔKHN were observed for 5% Micro and 5% Nano at 5-30 µm, with less marked differences between the groups at 30-70 µm (ERO and ERO+ABR). In the second phase, bovine enamel blocks (n=224) were selected by SH and randomly distributed among the groups: (a) Placebo (Pla - without F or TMP), (b) 5% NaF, (c) 5% NaF + 5% micrometric TMP (5% Micro), and (d) 5% NaF + 5% nano-sized TMP (5% Nano). The blocks were inserted in acrylic palatal devices (n=4/device), and treated with the varnishes only once, remaining in the oral cavity of the volunteers (n=14) for 6 h. Then, the varnishes were removed and the blocks, subjected to ERO (ex vivo immersion in 0.05 M citric acid, pH 3.2, 90 s, 4x/ day), while two blocks were additionally subjected to abrasion by brushing with fluoride dentifrice (ERO+ABR), totaling 5 days in each experimental stage, following a double-blind, crossover protocol. The blocks and the data were analyzed as described for the first phase. The wear values followed a similar pattern under both experimental conditions (ERO or ERO+ABR), with 5% Nano < 5% Micro < 5% NaF < Pla. A similar pattern was observed for hardness in depth (ΔKHN), although no significant differences were found between 5% Micro×5% Nano (5-30 µm). As for SH loss, the highest value was observed for Pla, and the lowest for 5% Nano (ERO or ERO+ABR), without significant differences between Pla×5% NaF (ERO), 5% NaF×5% Micro (ERO+ABR), and 5% Micro×5% Nano (ERO + ABR). In view of the results, it was concluded that the addition of TMP to fluoride varnishes significantly improved protection against erosive enamel wear in vitro and in situ. The use of 5% nano-sized TMP further increased these effects(AU)

Effect of TiF4 varnish on microbiological changes and caries prevention: in situ and in vivo models.

OBJECTIVE: The aim of this study was to evaluate microbiological changes, oral soft tissue toxicity, and caries-preventive effect of an experimental titanium tetrafluoride (TiF4) varnish compared with a commercially available fluoride varnish (NaF), using in situ and in vivo models. MATERIALS AND METHODS: The treatment groups were the following: TiF4 varnish (experimental varnish), Duraphat® (fluoride positive control), placebo varnish (no fluoride), and no treatment (negative control). The varnishes were applied once over the enamel surface using a microbrush. For the in vivo study, 48 Wistar rats were infected with Streptococcus sobrinus 6715, received a treatment, and were submitted to a cariogenic challenge. After 4 weeks, S. sobrinus, oral soft tissue toxicity, presence, and severity of caries were evaluated. For the in situ study, 12 volunteers took part in this randomized crossover, double-blind study performed in four phases of 14 days each. They used intraoral appliances containing four enamel specimens that received the varnish according treatment group. After 24 h, the varnish was removed and plaque accumulation was allowed. A 20% sucrose solution was dripped over the enamel blocks (10×/day for 5 min each). Total streptococci, S. mutans, Lactobacillus, Candida spp. counts, and presence of white spot lesions were evaluated. Lesion depth was also quantified by micro-CT. RESULTS: For the in vivo study, the fluoride (F-varnishes) showed a statistically significant reduction in the percentage of S. sobrinus compared to the negative control (p < 0.05). Toxicological analysis revealed no abnormalities in oral tissues of rats from all groups, and both F-varnishes reduced the number and severity of caries lesions, without significant differences (p < 0.05). No statistical differences in microbiological counts were seen for the in situ experiment (p > 0.05). However, the specimens treated with TiF4 exhibited lower percentage of white spot lesions and the lesion depth was significantly reduced by F-varnishes (p < 0.05). CONCLUSIONS: F-varnishes showed reduction in the percentage of S. sobrinus in vivo, no oral soft tissue toxicity, and a caries-preventive effect in vivo and in situ. CLINICAL RELEVANCE: NaF varnish is largely used due its capacity to form CaF2-like layer on enamel. Therefore, development of studies focused on other fluoride compounds such as a TiF4 varnish, which may have greater efficacy than NaF against tooth demineralization, is important.

Effectiveness of fluoride varnish in preventing early childhood caries in rural areas without access to fluoridated drinking water: A randomized control trial.

OBJECTIVES: Early childhood caries (ECC) constitutes a serious public health issue, especially in communities without water fluoridation. We assessed the effectiveness of biannual fluoride varnish applications to prevent ECC in children from nonfluoridated rural areas. METHODS: A triple-blind randomized control trial with two parallel arms was conducted with 275 two- to three-year-old children without cavitated carious lesions from 28 rural public preschools in Chile. The preschools were located in areas of low socioeconomic status without access to fluoridated water. An oral health education component was administered to children, parents and educators. A new toothbrush and toothpaste for each child was delivered to the parents at baseline and at four follow-up visits. The participants were randomly allocated to receive fluoride varnish or placebo applications every six months. Trained, calibrated dentists blind to the treatment arm performed visual dental assessments at 6, 12, 18 and 24 months. The primary endpoint was the development of cavitated carious lesions in children during the 24-month follow-up period using WHO criteria, and the secondary outcomes were an increase in caries measured as a change in the index of decayed, missing or filled teeth (dmft) since the beginning of the study and the development of adverse effects. An intention-to-treat (ITT) approach was used for the primary analysis. RESULTS: We included 131 participants in the intervention group and 144 participants in the placebo group; of these children, 89 (67.9%) in the intervention group and 100 (69.4%) in the control group completed the protocol. The comparative ITT analysis of caries incidence after 24 months of follow-up showed a between-group prevention fraction of 18.9% (-2.9%-36.2%). Caries incidence was 45.0% for the experiment group and 55.6% for the control group (P = .081), with a mean dmft of 1.6 (SD = 2.4) and 2.1 (SD = 2.5), respectively. No adverse effects were reported. CONCLUSIONS: In conclusion, biannual fluoride varnish application is not effective in preschool children from rural nonfluoridated communities at a high risk of caries.

Efeito das aplicações periódicas de verniz fluoretado na prevenção de cárie dentária em pré-escolares: revisão sistemática e meta-análise / Effect of periodic fluoride varnish applications on caries prevention in preschoolers: systematic review and meta-analysis

O objetivo desta revisão sistemática com meta-análises foi avaliar o efeito das aplicações de verniz fluoretado na prevenção de cárie dentária em pré-escolares. A busca eletrônica foi realizada em sete bases de dados, sem restrição de idiomas, e em banco de teses e registros de ensaios clínicos controlados entre outubro e novembro de 2016. A busca manual foi feita em onze periódicos especializados sendo dois deles da área médica e incluiu resumos apresentados em congressos da International Association for Dental Research (IADR) e da European Organisation for Caries Research (ORCA). Foram incluídos ensaios clínicos controlados e randomizados ou quasi-randomizados de estudos com crianças de zero a 71 meses de idade, que avaliaram o efeito anticárie da aplicação profissional de verniz fluoretado versus placebo, nenhuma intervenção ou cuidado padrão. O risco de viés dos estudos foi avaliado de acordo com o instrumento da Cochrane. Os desfechos de interesse foram a incidência de cárie dentária em dentina, medida pelo incremento de lesões de cárie e pela proporção de crianças que desenvolveram novas lesões de cárie, o número de internações hospitalares devido à cárie dentária e os efeitos adversos relacionados ao uso do produto. Os dados foram sintetizados e analisados através de meta-análise. Após exclusão das duplicatas, 2070 títulos e resumos foram lidos de forma independente por dois avaliadores previamente treinados para a identificação dos estudos que preenchessem os critérios de inclusão. Destes, 77 artigos foram selecionados para serem lidos na íntegra. Esta revisão incluiu 19 estudos que cumpriram os critérios de inclusão. A avaliação do risco de viés identificou um estudo com baixo risco. As meta-análises apontaram que o uso do verniz fluoretado não apresentou diferença estatisticamente significativa quando comparado ao uso do placebo ou a não intervenção quanto ao incremento de cárie no nível do dente (-0,31; IC 95% -1,67 a 1,06) e mostrou diferença estatisticamente significativa entre esses grupos, mas com pequena importância clínica, no nível de superfície (-0,68; IC 95% -1,01 a -0,35). O risco relativo combinado em estudos que utilizaram placebo também não apresentou diferença estatisticamente significativa (0,87; IC 95% 0,74 a 1,03). Por outro lado, o risco relativo global apontou o benefício do uso do verniz e uma proteção de 12% (0,88; IC 95% 0,81 a 0,96). De acordo com os resultados observados no gráfico de funil e na regressão de Egger, o viés de publicação não pode ser descartado. Assim, novos ensaios clínicos de melhor qualidade ainda são necessários para que se alcance uma evidência conclusiva sobre o tema(AU)

The aim of theses systematic review and meta-analyses was to evaluate the effect of fluoride varnish applications on the prevention of dental caries in preschoolers. The electronic search was performed in seven databases, without language restriction, as well as in thesis database and registries of controlled clinical trials between October and November 2016. Handsearching was performed in eleven specialized journals, two of them from the medical area and also included abstracts presented at The International Association for Dental Research (IADR) and the European Organization for Caries Research (ORCA). Controlled randomized or quasi-randomized clinical trials with children ranging from zero to 71 months, evaluating the anticaries effect of the professional application of fluoride varnish versus placebo, no intervention or usual care were included. The risk of bias in the studies was assessed according to the Cochrane tool. The outcomes of interest were the incidence of dental caries in dentin, measured by the increase of caries lesions and the proportion of children who developed new caries lesions, and the number of hospital admissions due to dental caries, as well as adverse effects related to the use of the product. Data were synthesized and analyzed through meta-analysis. After exclusion of the duplicates, 2070 titles and abstracts were independently assessed by two evaluators previously trained to identify the studies that meet the inclusion criteria. Of these, 77 articles were selected to be read in full. This review included 19 studies that fulfilled the inclusion criteria. The risk of bias assessment identified one study with low risk. Meta-analyses showed that the use of fluoride varnish did not present a statistically significant difference when compared to the use of placebo or no intervention in the increase of caries at the tooth level (-0.31; 95% CI -1.67 to 1.06) and showed a statistically significant difference between these groups, with little clinical importance, at surface level (-0.68; 95% CI -1.01 to -0.35). The pooled relative risk in studies using placebo also showed no statistically significant difference (0.87; 95%CI 0.74 to 1.03). On the other hand, the overall relative risk pointed to the benefit of using the varnish and a 12% protection (0.88; 95% CI 0.81 to 0.96). According to the results observed in the Funnel Plot and Egger regression, the publication bias cannot be dismissed. Thus, better quality clinical trials are still needed to reach conclusive evidence on this issue(AU)

Analysis of the antimicrobial and anti-caries effects of TiF4 varnish under microcosm biofilm formed on enamel

Abstract Titanium tetrafluoride (TiF4) is known for interacting with enamel reducing demineralization. However, no information is available about its potential antimicrobial effect. Objectives This study evaluated the antimicrobial and anti-caries potential of TiF4 varnish compared to NaF varnish, chlorhexidine gel (positive control), placebo varnish and untreated (negative controls) using a dental microcosm biofilm model. Material and Methods A microcosm biofilm was produced on bovine enamel previously treated with the varnishes, using inoculum from human saliva mixed with McBain saliva, under 0.2% sucrose exposure, for 14 days. All experiments were performed in biological triplicate (n=4/group in each experiment). Factors evaluated were: bacterial viability (% dead and live bacteria); CFU counting (log10 CFU/mL); and enamel demineralization (transverse microradiography - TMR). Data were analysed using ANOVA/Tukey's test or Kruskal-Wallis/Dunn's test (p<0.05). Results Only chlorhexidine significantly increased the number of dead bacteria (68.8±13.1% dead bacteria) compared to untreated control (48.9±16.1% dead bacteria). No treatment reduced the CFU counting (total microorganism and total streptococci) compared to the negative controls. Only TiF4 was able to reduce enamel demineralization (ΔZ 1110.7±803.2 vol% μm) compared to both negative controls (untreated: ΔZ 4455.3±1176.4 vol% μm). Conclusions TiF4 varnish has no relevant antimicrobial effect. Nevertheless, TiF4 varnish was effective in reducing enamel demineralization under this model.

Effect of Erosion/Abrasion Challenge on the Dentin Tubule Occlusion Using Different Desensitizing Agents

The aim of the study was to evaluate dentinal tubule occlusion, measuring the dentin permeability (Lp) and using different desensitizing agents before and after abrasive/erosive challenge. Dentin discs from 42 healthy human third molars were obtained. Minimum Lp was measured after a smear layer simulation using #600 SiC paper and maximum Lp after an immersion in 0.5 M EDTA. The specimens were treated with different desensitizers: two varnishes (Clinpro XT Varnish-CV, Fluor Protector-FP), a paste (Desensibilize Nano P-NP) and a gel (Oxa Gel-OG). The Lp of each specimen was measured immediately after the desensitizers’ application. The discs were subjected to erosion/abrasion cycles for 7 days, with 0.5% citric acid solution (6x/day) and tooth brushing (3x/day). Lp was measured after the first, fourth and seventh day of the challenge. The data were analyzed by 3-way ANOVA with repeated measurements and by a Games-Howell test (α=5%). FP and CV did not show significant differences in Lp immediately after application until the 7th day (p<0.05). OG showed a significant increase in Lp after the 4th and 7th days. NP resulted in a significantly higher permeability compared to the other materials immediately after the application and after the 1st day of challenge. All the desensitizers reduced the dentin permeability immediately after application. However, only the varnishes were able to maintain the occlusive effect after the erosion/abrasion challenge.

Resumo O objetivo do estudo foi avaliar a permeabilidade da dentina (Lp) usando diferentes agentes dessensibilizantes antes e depois de um desafio abrasivo/erosivo. Discos de dentina foram obtidos a partir 42 terceiros molares humanos. Lp mínima foi medida após uma simulação de smear layer usando lixa de SiC # 600 e a Lp máxima foi medida após imersão em EDTA 0,5 M. As amostras foram tratadas com diferentes dessensibilizantes: dois vernizes (Fluor Protector-FP, Clinpro XT Varnish-CV), uma pasta (Desensibilize Nano P-NP) e um gel (Oxa Gel-OG). A Lp de cada amostra foi medida imediatamente após a aplicação dos dessensibilizantes. Os discos foram submetidos a um ciclo de erosão/abrasão durante 7 dias, com uma solução de 0,5% de ácido cítrico (6x/dia) e escovação (3x/dia). Lp foi medida do primeiro ao sétimo dia do desafio. Os dados foram analisados por ANOVA a 3 critérios com medidas repetidas e teste de Games-Howell (α=5%). FP e CV demonstraram Lp semelhante imediatamente depois da aplicação até 7 dias (p<0,05). OG apresentou um aumento significativo na Lp depois do 4º e 7º dias. NP resultou numa permeabilidade significativamente mais elevada comparada com a dos outros materiais imediatamente após a aplicação e após o primeiro dia de desafio. Todos os dessensibilizantes reduziram a permeabilidade da dentina imediatamente após a aplicação. No entanto, apenas os vernizes foram capazes de manter o efeito oclusivo após o desafio da erosão/abrasão.

Evaluación clínica de barniz de flúor en el manejo de la hipersensibilidad dentinaria / Clinical evaluation fluoride varnish in the management of dentin hypersensitivity

La Hipersensibilidad Dentinaria (HD) se define como un corto y fuerte dolor generado por la exposición de dentina, que surge de un estímulo químico, térmico, táctil u osmótico, el cual no puede catalogarse como una patología dental propiamente tal. La teoría hidrodinámica de Brännström es la más aceptada en la actualidad para explicar la etiopatogenia de esta afección. Muchos productos han sido elaborados con el fin de combatir la HD, pero no todos constan de la efectividad deseada para atenuarla. El objetivo del presente estudio es evaluar la efectividad inmediata y mediata (posterior a 2 semanas), de un barniz de flúor (Flúor Protector®) utilizado en la problemática. El estudio es un ensayo clínico no controlado. La muestra consistió de 30 pacientes, sin distinción de género, de entre 20 a 60 años, atendidos en las clínicas de la Facultad de Odontología de la Universidad Andrés Bello, cuyo diagnóstico fue HD, en al menos un diente, con recesión gingival de al menos 2 mm, la cual presento dentina expuesta desde la unión amelocementaria, y además que respondieron a 3 o más puntos en la Escala Numérica (EN), cuando fue aplicado el estímulo evaporativo. Los datos fueron recogidos, en una ficha diseñada para el estudio, la cual incluyo datos del paciente y 9 EN, con las cuales se cuantifico la percepción de dolor de los pacientes frente a 3 estímulos: evaporativo, táctil y térmico. Estadísticamente se utilizó análisis de tipo descriptivo y de varianza de Friedman. Se obtuvieron resultados estadísticamente significativos (p<0.05) en la disminución casi completa de la HD frente al tratamiento inmediato (mediana< 3), además de la mantenida reducción de la misma en el control posterior a 2 semanas de aplicada la terapia. En conclusión, la terapia con flúor barniz es efectiva en el tratamiento inmediato y mediato de la HD.

Dentin Hypersensitivity (DH) is defined as a short, sharp pain generated by exposure of dentin, which arises from a chemical stimuli, thermal, tactile or osmotic, which can't be categorized as a dental pathology as such. Brännström hydrodynamic theory is widely accepted today to explain the pathogenesis of this condition. Many products have been developed to combat DH, but not all consist of the desired effectiveness to attenuate. The aim of the present study is to evaluate the effectiveness immediate and mediate (after two weeks), a fluoride varnish (Fluor Protector), used in the management of patients with this problem. The present study is an uncontrolled clinical trial. The sample consisted of 30 patients, regardless of gender, aged 20 to 60, treated at the clinics of the Faculty of Dentistry at the "Universidad Andres Bello", whose diagnosis was DH, in a least one tooth with gingival recession at least 2 mm, which exposed dentin present from the CEJ, and also responding to three of more points on the Numeric Scale (NS), when the stimulus was applied evaporative. Data were collected after approval and written informed consent, in a form designed for the study, which included data from the patient and 9 NS, which was quantified with pain perception of patients versus 3 stimuli: evaporative, touch and heat. For statistical analysis we used descriptive analysis and variance of Friedman. Regarding the 3 stimuli under study results were statistically significant (p< 0.05) decrease in the almost complete DH versus immediate treatment (median < 3), besides the maintained reduction thereof in the inspection after 2 weeks of therapy applied. In conclusion, treatment with fluoride varnish is effective in treating the immediate and mediate DH.

Effect of xylitol varnishes on remineralization of artificial enamel caries lesions in situ.

OBJECTIVES: Analyze the effect of varnishes containing xylitol compared to commercial fluoridated varnishes on the remineralization of artificial enamel caries lesions in situ. METHODS: Twenty subjects took part in this crossover, double-blind study performed in four phases of 5days each. Each subject worn palatal appliances containing four predemineralized bovine enamel specimens. Artificial caries lesions were produced by immersion in 30ml of lactic acid buffer containing 3mM CaCl2·2H2O, 3mM KH2PO4, 6µM tetraetil metil diphosphanate (pH 5.0) for 6days. The specimens in each subject were treated once with the following varnishes: 20% xylitol (experimental); Duofluorid™ (6% NaF, 6% CaF2), Duraphat™ (5% NaF, positive control) and placebo (no-F/xylitol, negative control). The varnishes were applied in a thin layer and removed after 6h. Fifteen subjects were able to finish all phases. The enamel alterations were quantified by surface hardness and transversal microradiography. The percentage of surface hardness recovery (%SHR), the integrated mineral loss and lesion depth were statistically analyzed by Friedmann and Dunn's tests test (p<0.05). RESULTS: Enamel surface remineralization was significantly increased by Duraphat™, Duofluorid™ and 20% xylitol formulations. Significant subsurface mineral remineralization could also be seen for the experimental and commercial varnishes, except for Duraphat™, when the parameter "lesion depth" was considered. CONCLUSIONS: 20% xylitol varnish seem to be a promising alternative to increase surface and subsurface remineralization of artificial caries lesions in situ. CLINICAL SIGNIFICANCE: effective vehicles are desirable for caries control. Xylitol varnishes seem to be promising alternatives to increase enamel remineralization in situ, which should be confirmed by clinical studies.

Effect of Fluoride Varnish Combined with Er:YAG Laser on the Permeability of Eroded Dentin: An In Situ Study

This study evaluated the combined effect of fluoride varnish and Er:YAG laser on the permeability of eroded bovine root dentin. After initial erosive challenge followed by a remineralization period, the specimens were divided in two groups according to the treatment - fluoride varnish and non-fluoride varnish - and were subdivided according to the irradiation protocol: Er:YAG laser (100 mJ, 3 Hz, 12.8 J/cm2per pulse, non-contact and defocus mode) and non-irradiated. After a lead-in period, 7 volunteers wore a palatal device containing 4 specimens that were subjected to erosive challenges. At the first experimental phase, 4 volunteers used specimens treated with fluoride varnish and fluoride varnish+Er:YAG laser and 3 volunteers used specimens treated with non-fluoride varnish and non-fluoride varnish+Er:YAG laser. After a washout period, volunteers were crossed to treatments, characterizing a 2x2 crossover experiment. At the end of the experimental phase, the quantitative response variable was obtained by permeability analysis and the qualitative response by scanning electron microscopy (SEM). Two-way ANOVA and Tukey-Kramer's test revealed that specimens treated with fluoride varnish+Er:YAG laser showed the lowest permeability and a significant difference was found between this group and the others. When varnish (fluoride/non-fluoride) was applied in the absence of Er:YAG laser, higher permeability was found when compared to the laser-treated groups. SEM evaluations showed partially or completely obliterated dentinal tubules when specimens were treated with fluoride varnish+Er:YAG laser. It may be concluded that Er:YAG laser was able to control the permeability of eroded root dentin and the combination with fluoride varnish increased laser action.

Resumo Esse estudo avaliou o feito combinado do verniz fluoretado ao laser de Er:YAG na permeabilidade da dentina radicular erodida. Fragmentos de dentina radicular bovina, foram submetidos a um desafio erosivo inicial com ácido cítrico, que foi seguido por um período de remineralização. Posteriormente, os espécimes foram divididos em relação aos tratamentos: verniz (fluoretado e não fluoretado) e subdivididos de acordo com a irradiação: laser de Er:YAG (100 mJ, 3 Hz, 12.8 J/cm2 por pulso, sem contato e modo não focado) e não irradiado. Após um período de lead in, 7 voluntários utilizaram um dispositivo palatino contendo 4 espécimes que foram submetidos a desafios erosivos. Na primeira fase do experimento, 4 voluntários utilizaram dispositivos com fragmentos tratados com verniz fluoretado e verniz fluoretado+laser de Er:YAG e 3 voluntários utilizaram espécimes tratados com verniz não fluoretado e verniz não fluoretado+laser de Er:YAG. Depois de um período de wash-out, os voluntários foram cruzados em relação aos tratamentos, caracterizando um experimento cross-over 2x2. Ao final de cada fase experimental, a variável resposta quantitativa foi obtida através da análise de permeabilidade e a qualitativa por microscopia eletrônica de varredura (MEV). A ANOVA dois critérios e teste de Tukey-Kramer revelou que as amostras tratadas com verniz fluoretado+laser de Er:YAG mostraram menor permeabilidade e uma diferença significativa foi encontrada entre este grupo, quando comparado aos demais grupos. Quando o verniz (fluoretado/não fluoretado) foram aplicados na ausência do laser de Er:YAG maiores valores de permeabilidade foram encontrados quando comparados com os grupos irradiados com o laser. A MEV demostrou túbulos dentinários parcialmente ou completamente ocluídos quando as amostras foram tratadas com verniz fluoretado+laser de Er: YAG. Pode-se concluir que o laser de Er:YAG foi capaz de controlar a permeabilidade da dentina radicular erodida e essa ação é aumentada quando o laser está associado ao verniz fluoretado.

In situ remineralizing effect of fluoride varnishes containing sodium trimetaphosphate.

OBJECTIVE: This study analyzed the effects of a fluoride (F) varnish supplemented with sodium trimetaphosphate (TMP) on the remineralization of caries-like lesions in situ. MATERIALS AND METHODS: Twelve subjects used palatal devices with demineralized enamel discs for 3 days, following a double-blind, crossover protocol. Test groups included placebo (no F or TMP), 5% NaF and 5% NaF/5% TMP varnishes. The percentage of surface hardness recovery (%SHR) and cross-sectional hardness (ΔKHN) were determined. RESULTS: Significant differences were observed among all varnishes regarding %SHR and ΔKHN. The highest %SHR and the lowest ΔKHN were seen for the 5% NaF/5% TMP varnish, followed by 5% NaF and placebo. CONCLUSION: The remineralizing effect of a 5% NaF varnish is significantly enhanced when associated with TMP. CLINICAL RELEVANCE: The reduction in the subsurface lesion area of enamel treated with the TMP-containing varnish implies that cavities would take longer to develop or might not develop at all depending on individual factors, resulting in lower net caries increments at individual and population levels.

Protective effect of fluoride varnish and fluoride gel on enamel erosion: roughness, SEM-EDS, and µ-EDXRF studies.

OBJECTIVES: The effects of fluoride treatment on bovine enamel subjected to acid erosion were studied by roughness (Ra) measurements, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), and microenergy-dispersive X-ray fluorescence spectrometry (µ-EDXRF). MATERIALS AND METHOD: Enamel samples (63) were divided into nine groups (n = 7): artificial saliva (AS), Pepsi Twist(®) (PT), orange juice (OJ), Duraphat(®) + Pepsi Twist(®) (DPH/PT), Duraphat(®) + orange juice (DPH/OJ), Duofluorid(®) + Pepsi Twist(®) (DUO/PT), Duofluorid(®) + orange juice (DUO/OJ), fluoride gel + Pepsi Twist(®) (FG/PT), and fluoride gel + orange juice (FG/OJ). Fluoride was applied and the samples were submitted to six cycles (demineralization: Pepsi Twist(®) or orange juice, 10 min; remineralization: saliva, 1 h). The enamel surface in depth was exposed and 63 line-scan maps were performed. RESULTS: The elemental analysis by EDS revealed that only fluoride treated groups had any detectable fluorine after erosion cycles (DPH/PT: 3.50 wt%; DPH/OJ: 3.37 wt%; DUO/PT: 2.69 wt%; DUO/OJ: 3.54 wt%; FG/PT: 2.17 wt%; FG/OJ: 2.77 wt%). PT treatment resulted in significantly higher Ra values than the artificial saliva (P < 0.001). Scanning electron microscopy (SEM) analysis of fluoride protected enamel showed areas with some globular structures or a residual layer of varnish. The enamel thickness was significantly lower in PT (0.63 ± 0.087 mm) than in DPH/PT (0.87 ± 0.16 mm) and DUO/PT (0.92 ± 0.14 mm) groups (P < 0.01). CLINICAL RELEVANCE: Fluoride treatments protected enamel without Ra increase and loss of enamel tissue.

Effect of xylitol varnishes on remineralization of artificial enamel caries lesions in vitro.

OBJECTIVES: Analyse the effect of varnishes containing xylitol alone or combined with fluoride on the remineralization of artificial enamel caries lesions in vitro. METHODS: Bovine enamel specimens were randomly allocated to 7 groups (n=15/group). Artificial caries lesions were produced by immersion in 30 mL of lactic acid buffer containing 3mM CaCl2·2H2O, 3mM KH2PO4, 6 µM tetraetil metil diphosphanate (pH 5.0) for 6 days. The enamel blocks were treated with the following varnishes: 10% xylitol; 20% xylitol; 10% xylitol plus F (5% NaF); 20% xylitol plus F (5% NaF); Duofluorid™ (6% NaF, 2.71% F+6% CaF2), Duraphat™ (5% NaF, positive control) and placebo (no-F/xylitol, negative control). The varnishes were applied in a thin layer and removed after 6h. The blocks were subjected to pH-cycles (demineralization-2h/remineralization-22 h during 8 days) and enamel alterations were quantified by surface hardness and transversal microradiography. The percentage of surface hardness recovery (%SHR), the integrated mineral loss and lesion depth were statistically analysed by ANOVA/Tukey's test or Kruskal-Wallis/Dunn's test (p<0.05). RESULTS: Enamel surface remineralization was significantly increased by Duraphat™, 10% xylitol plus F and 20% xylitol plus F formulations, while significant subsurface mineral remineralization could be seen only for enamel treated with Duraphat™, Duofluorid™ and 20% xylitol formulations. CONCLUSIONS: 20% xylitol varnishes seem to be promising alternatives to increase remineralization of artificial caries lesions. CLINICAL SIGNIFICANCE: effective vehicles are desirable for caries control. Xylitol varnishes seem to be promising alternatives to increase enamel remineralization in vitro, which should be confirmed by in situ and clinical studies.