Effects of self-applied topical fluoride preparations in orthodontic patients.

The purpose of this study was to compare the effectiveness of toothbrushing followed by fluoride rinsing, fluoride gel brushing, or fluoride gel dentifrice brushing alone in controlling the demineralization that often follows orthodontic treatment. Seventy-eight consecutive adolescent patients undergoing orthodontic care were divided into 3 groups: group 1 (control) used a low-potency, high-frequency fluoride rinse; group 2 used a high-potency, high-frequency fluoride brush-on gel; and group 3 used a high-potency, high-frequency fluoride gel dentifrice. When pretreatment levels of demineralization were subtracted from posttreatment values, both gel groups displayed a significant difference (P < .05) in smooth surface demineralization sites when compared to controls. Reversal of white-spot lesions occurred in 15% of sites that exhibited pathology as a result of the fluoride and preventive regimen. These results indicate that a daily use of a 5000-ppm fluoride gel along with toothbrushing with a fluoride paste or brushing twice daily with a 5000-ppm fluoride dentifrice alone provides greater protection beyond that of tooth-brushing with a fluoride paste (1000 ppm) and rinsing with a 0.05% sodium fluoride rinse.

Sealants revisted: an update of the effectiveness of pit-and-fissure sealants.

The first sealant clinical trials used cyanoacrylate-based materials. These were replaced by dimethacrylate-based products which were marketed. A major difference between marketed sealants is their method of polymerization. First-generation sealants were initiated by ultraviolet light, second-generation sealants are autopolymerized, and third-generation sealants use visible light. Over time, clinical retention was found to be greater for second generation as compared with first-generation sealants. Five to 7 years after initial application the pits and fissures of approximately one third of teeth treated with first-generation sealants were fully protected as compared with two thirds of the teeth treated with second-generation sealants. First-generation, ultraviolet light initiated, sealants are no longer marketed. Clinical reports indicate that retention is similar for second- and third-generation systems, but longer clinical evaluations are necessary. A recent innovation is the addition of fluoride to sealants. Fluoride release to the saliva from a fluoride sealant system is rapid, but clinical studies are needed to determine if the fluoride addition improves caries inhibition.

A half-century of community water fluoridation in the United States: review and commentary.

The nearly 50-year history of community water fluoridation is reviewed with the major emphasis on the benefits and safety of fluoridation. Other aspects of water fluoridation also described include the apparent reduction in measurable fluoridation benefits because of the abundance of other fluoride sources, the diffusion of fluoridation effects into fluoride-deficient communities, preeruptive and posteruptive effects, technical and cost aspects, sociopolitical and legal issues that affect the successful fluoridation of communities, and alternatives to community water fluoridation. The majority of studies have evaluated the effectiveness of water fluoridation on the permanent teeth of children, while there are fewer studies on deciduous teeth and in adults; the relationship between fluoride ingestion and bone health needs further clarification; the sociopolitical issues of fluoridation need to be better understood.

Rinses for the control of dental caries.

Fluoride mouthrinsing at two different strengths and two different rinse frequencies has proven a versatile method of caries control for individual home-based programmes and community school-based programmes. An advantage of mouthrinsing is that the vehicle is not complex and does not interfere with the intraoral distribution of fluoride ions to caries predilection sites. An average caries reduction of about 30 per cent can be expected from use of this method. The percentage caries reduction, which is a relative figure, is considered to be a property that is intrinsic to the preventive regimen itself, in this case fluoride mouthrinsing, and is unaffected by the caries attack rate of the population being served. On the other hand, the benefit of the procedure is a function of the numerical caries reduction achieved by the intervention. Numerical reductions are absolute figures which do depend upon the caries rate of the population. High caries attack rates increase the numerical caries reduction because there are more lesions to inhibit; low attack rates produce low numerical reductions and consequently low benefits. Therefore, the decision to use fluoride mouthrinsing for either an individual or a community must be based upon knowledge of the caries risk of the targeted individual or group.

Preventive resin restorations: indications, technique, and success.

Although preventive resin restorations have been reported since 1977, there is little uniformity concerning the indications for this procedure, nor is there a standard technique. This article proposes diagnostic criteria for pit and fissure occlusal caries and diagnosis-related considerations for treatment planning for preventive resin restorations. A step-by-step "laminate" technique, which includes, successively, a glass-ionomer cement liner, a posterior composite resin, and a sealant, is described. The success rates reported for several clinical studies of preventive resin restorations are presented, although the criteria for this restoration, treatment methodology, and the determinates of success vary from study to study.

Nursing caries in Head Start children, St. Thomas U.S. Virgin Islands: assessed by examiners with different dental backgrounds.

The purposes of this study were to determine the prevalence of nursing caries in 3- to 5-year-old Head Start (HS) children on St. Thomas, U.S. Virgin Islands and to assess the reliability of examiners with different dental backgrounds. A dentist, hygienist, and nondental HS personnel participated in a 1/2 day training session (lecture and workshop) and then independently conducted visual examinations for caries of the maxillary anterior teeth including nursing caries. Twenty-three HS personnel examined a total of 375 children; the dentist and hygienist examined a random sample of 74 and 73 children, respectively. Seventy-one children received all three independent examinations. Reliability was assessed by percent agreement, sensitivity, specificity, and kappa value. The dentist found 41% of the children had caries of the maxillary incisors, which included nursing caries. The percentage of children with nursing caries was 12%. There was strong-to-good diagnostic agreement between the dentist and hygienist. The HS personnel also found that 12% of the children had nursing caries, but the diagnostic agreement between the dentist and HS personnel was only good-to-fair.

Dental materials related to prevention--fluoride incorporation into dental materials: reaction paper.

Rather than a specific commentary to Dr. Rawls' presentation, this reaction paper discusses the general concept of fluoride addition to dental materials. The genesis of the concept is reviewed, but more important is a critique of the rationale for the deliberate addition of fluoride to dental materials. Researchers and practicing dentists should realize that if the principal reason for the addition of fluoride is to prevent dental caries, the ultimate test of that rationale is a controlled clinical trial. Thus, although a number of questions need to be answered when fluoride is introduced into dental materials, the most important is: Does it inhibit dental caries?

Caries prevalence, treatment level, and sealant use related to school lunch program participation.

A total of 2,753 schoolchildren (8-11 years old) from two school districts received visual-tactile examinations for caries. The school districts were approximately 15 miles apart and located in fluoride-deficient (F less than 0.3 ppm) Long Island, New York. The higher socioeconomic community (HSES) had 9.2 percent of its students enrolled in the free or reduced-payment school lunch program; the lower socioeconomic community (LSES) had 50.3 percent enrolled. The LSES community had a higher caries prevalence, more untreated lesions, fewer caries-free children, and fewer children treated with sealants. School lunch programs provide an index to identify communities for dental programs.

A critique of topical fluoride methods (dentifrices, mouthrinses, operator-, and self-applied gels) in an era of decreased caries and increased fluorosis prevalence.

Within the last 20 years there has been a decrease in the caries prevalence of US schoolchildren, a change in the intraoral caries pattern, and a slowing of the progress of lesions. Simultaneously, the prevalence of enamel milder, cosmetically acceptable forms and is more noticeable in fluoride-deficient communities than those with optimal or above-optimal water fluoride concentrations. Circumstantial evidence indicates that a principal contributor to the caries decline is the extensive use of fluoride dentifrices. Conversely, although use of a fluoride dentifrice can add to the total daily amount of ingested fluoride in preschool children, there is little evidence to suggest that dentifrice ingestion is a principal factor causing the fluorosis increase. The value of fluoride methods may be assessed in relative or absolute terms. The relative, or percentage, caries reduction attributed to fluoride mouthrinses and gels appears to be a property intrinsic to the methods themselves and generally is little affected by the caries activity of the population being treated. Conversely, the absolute, or numerical, caries reduction is dependent upon the level of disease in the population. Thus, the reported caries decline reduces the number of surfaces prevented from developing caries, even though the percentage reduction remains substantially unchanged. Although inadvertent ingestion of fluoride can result from the use of mouthrinses and gels, there is little evidence to suggest that they have contributed to the fluorosis increase. When using topical methods, prudence should prevail to avoid ingestion of fluoride. Fluoride dentifrices should continue to be used routinely, and although lower potency dentifrices may be considered, the literature does not provide strong support for their need. Use of fluoride mouthrinses and gels for individual patients should be predicted upon their caries activity or risk. Use of these methods in public health programs is a matter of cost-effectiveness, which will be influenced by the caries prevalence of the target population.

An evaluation of the use of professional (operator-applied) topical fluorides.

Application of fluoride solutions, gels, varnishes, and prophylaxis pastes is reviewed as well as the sequential APF/SnF2 office-rinse method. The most widely-used technique is with 1.23% APF gel (12,300 ppm F) in trays. Clinical results from this method are similar to those achieved with an APF solution of the same fluoride concentration. A professional APF gel/tray application need not be preceded by a prophylaxis, should last four min, and should not be followed by a water rinse for 30 min. Fluoride varnishes are newer topical fluoride agents, but their relative efficacy, compared with other proven caries-inhibitory methods, remains to be fully determined. In general, fluoride prophylaxis pastes have not been shown to inhibit caries; however, their use is justified by the ability of some to replenish fluoride lost from the abrasive action of the paste on tooth enamel. The sequential office-rinse method has not been tested in randomized clinical trials, and its use cannot be recommended.

Clinical study of the anticaries efficacy of three fluoride dentifrices containing anticalculus ingredients: three-year (final) results.

A 3-year double blind clinical trial was conducted to compare the caries inhibition of an A.D.A.-accepted fluoride dentifrice to the caries inhibitions provided by three fluoride dentifrices containing anticalculus agents. All dentifrices used a compatible silicon dioxide abrasive system. The initial mean age of the subjects was 9.9 yrs and they resided in F-deficient (F less than 0.3 ppm) communities on Long Island, NY. Caries activity in all groups was low with the average annual increment being less than one surface. There were no statistically significant differences in any of the dental parameters tested, DMFS, DMFT, and buccolingual, mesiodistal and occlusal surface increments. It was concluded that the presence of anticalculus agents, specifically soluble pyrophosphates, zinc chloride and zinc oxide, do not interfere with the caries inhibition benefits of fluoride in a compatible dentifrice formulation.

Review of the anticaries effectiveness of professionally applied and self-applied topical fluoride gels.

Of the five types of topical fluoride gel products available in the United States, two have not been clinically tested in randomized double blind clinical trials. For those tested, the averaged results of clinical trials involving schoolchildren in fluoride-deficient communities indicate a caries reduction of approximately 26 percent from either a professional or self-administered program. A similar relative reduction can be expected from programs conducted in fluoridated communities, but the absolute caries inhibition is less. Twice-a-year professional applications are more effective than once-a-year applications, and self-applications using trays are more effective than applying the gel on a toothbrush. For subjects beyond school age, there are few clinical studies of either self-applied or professionally applied gels; however, current epidemiological evidence does not indicate a need for public health caries preventive programs for healthy employed adults. For medically compromised patients, especially those exhibiting rampant caries associated with radiation-induced xerostomia, a variety of topical gel procedures appear to be effective in limiting caries.

Clinical studies of high-potency fluoride dentifrices: a review.

A review of clinical studies indicates that increasing the fluoride content above 1,000 ppm in dentifrices containing sodium monofluorophosphate increases the mean caries reduction by approximately 12%. The results of studies testing high-potency mixed-fluoride dentifrices containing both sodium fluoride and sodium monofluorophosphate are less conclusive.

Three-year root caries increments: an analysis of teeth and surfaces at risk.

Seven hundred and ninety-six adult subjects (mean age 39.9 years) received visual-tactile examinations for root caries over a three-year period. All subjects were employed or the spouses of employees and resided in fluoride-deficient communities on Long Island, New York. Incremental caries data were analyzed to provide descriptive information about the susceptibility of individual teeth and surfaces to root caries. Molars were most prone to root caries/fillings, followed in decreasing order by premolars, canines and incisors. While canines and incisors had a nearly identical increment, since there are half as many canines as incisors in a mouth, canines are actually twice as susceptible to root caries/fillings. Facial surfaces comprised 53 percent of the increment followed by distal, lingual and mesial surfaces. Approximately 70 percent of the DFS for facial and lingual surfaces were fillings, compared to approximately 50 percent for mesial and distal surfaces, suggesting that part of the increment for facial-lingual surfaces may be treated abrasion areas rather than caries.

Three-year root caries increments: implications for clinical trials.

Seven hundred and ninety-six adult subjects (mean age, 39.9 years) received visual-tactile examinations for root caries over a three-year period. All subjects were employed or were the spouses of employees and resided in fluoride-deficient communities on Long Island, New York. During the three-year observation period, 81.4 percent of the subjects did not develop root caries. The 18.6 percent who developed root caries averaged 0.8 DFS/year. The subjects' ages and baseline root DFS status were associated with the development of a root DFS increment. The older the patient, especially aged 45 and older, the greater was the risk of developing root lesions or having root fillings placed. Subjects who had a root DFS score at baseline also were more likely to experience a root DFS increment. It is recommended that when designing clinical trials of agents purported to inhibit root caries, preselection criteria for the study population should consider the subjects' ages and past history of root lesions.

Longitudinal study of the caries susceptibility of occlusal and proximal surfaces of first permanent molars.

Ten- to 13-year-old children were examined annually for three years to determine the caries activity in the proximal and occlusal surfaces of first permanent molars. Almost every tooth with an unsound (carious or filled) proximal surface also had an unsound occlusal surface. Caries scores in proximal surfaces remained relatively constant and low. The percentage of teeth with occlusal caries or fillings increased throughout the study, even though the teeth had been erupted for seven to ten years by the end of the study. Within the age range studied, the time that teeth were in the mouth had little effect on the vulnerability of occlusal surfaces to caries attack.

Caries inhibition of mixed NaF-Na2PO3F dentifrices containing 1,000 and 2,500 ppm F: 3-year results.

The 3-year DMFS increments of 2,509 children were compared. Group 1 used a conventional Na2PO3F dentifrice (1,000 ppm F) and served as the active control. Groups 2 and 3 used mixed-fluoride dentifrices containing equimolar amounts of NaF and Na2PO3F, providing total fluoride concentrations of 1,000 and 2,500 ppm F, respectively. Dentifrice use was unsupervised in the subjects' homes. There were no statistically significant differences (F-test) between the 3-year DMFS increments of the dentifrice groups, nor were there any significant differences between the dentifrice groups when the analysis included subject compliance and caries risk.