An Alternative Technique for Topical Application of Acidulated Phosphate Fluoride (APF) Gel: A Two-Years Double-Blind Randomization Clinical Trial (RCT).

Background and Objectives: Dental caries is still a dramatic public health problem. The effectiveness of an alternative technique using acidulated phosphate fluoride (APF) gel pH 3.5 was evaluated and compared with conventional treatments in reducing dental caries incidence. Materials and Methods: A double-blind randomized controlled trial was conducted, involving 180 children aged 4-11 years. Three groups were formed: NaF varnish (NaFV), APF in tray (APFt), and APF in toothbrush (APFtbru). Clinical examinations were performed using standardized criteria and the ICDAS Index was assessed. The Caries Treatment Needs Index (CTNI) was calculated. Dental examinations were conducted at baseline, 12 months, and 24 months. Results: At baseline, 16,719 dental surfaces were included, with 15,434 surfaces being sound. After 24 months, the Kaplan-Meier analysis showed significant differences between the APFtbru group and the other two groups (p = 0.03). Cox regression analysis revealed that the surfaces treated with NaF varnish had the lowest survival rates (HR = 0.51 95%CI = 0.33/0.81). Occlusal surfaces had the lowest cumulative survival, while other tooth surfaces showed similar performance. Conclusions: The alternative technique of APF gel application with a toothbrush resulted in maintaining dental health over 24 months. This technique can be cost-effective and may offer advantages over traditional fluoride varnish application.

Correlation between dental professionally topical fluoride application and children's dental use for dental caries under the National Health Insurance system in Taiwan from 2008 to 2021.

Background/purpose: Dental caries is one of the most common oral diseases in children worldwide, especially in Taiwan. This study investigated dental professionally topical fluoride application (PTFA) and children's dental use for dental caries under the National Health Insurance (NHI) system in Taiwan from 2008 to 2021. Materials and methods: The population data and medical records of the NHI system were obtained from the websites of the Ministry of the Interior and the Ministry of Health and Welfare, respectively. The dental PTFA services and dental use indicators for dental caries were analyzed from 2008 to 2021. Results: The number of out-patient visits for dental PTFA services increased from 221,675 in 2008 to 1,078,099 in 2021. The total increase of the out-patient visits was 856,424 with a total increase rate of 386.34%. The one-year increase was 65,879 with a one-year increase rate of 29.72%. Among the 3 age groups of children, their dental use indicators almost presented decreasing trends from 2008 to 2021. Moreover, in general, the dental use indicators showed a negative correlation with the number of the overall out-patient visits for dental PTFA services from 2008 to 2021. Conclusion: In Taiwan, there is a negative correlation between the dental use indicators in NHI system and the number of the overall out-patient visits for dental PTFA services from 2008 to 2021. However, the problem of dental caries in children is still serious and there is still a space for improvement in the oral health education for child caregivers and children.

Overview of dental professionally topical fluoride application in public health measure in Taiwan in 2021.

Background/purpose: In Taiwan, it has been 16 years since the policy of children's dental professionally topical fluoride application (PTFA) services was implemented. This study investigated the differences in the number of children's dental PTFA outpatient visits among cities and counties or different regions of Taiwan in 2021. Materials and methods: The population data and medical records of the number of children's dental PTFA outpatient visits were obtained from the websites of Ministry of the Interior and Ministry of Health and Welfare, respectively. The secondary data were divided by cities and counties to analyze the urban-rural gap and regional differences in the number of children's dental PTFA outpatient visits in Taiwan in 2021. Results: In Taiwan, municipalities had the largest number of dental PTFA visits (721,338, 66.91% of the total dental PTFA visits), while remote and outlying island counties had the smallest number of dental PTFA visits (84,509, 7.84%). The northern region had the largest number of dental PTFA visits (466,728, 43.29%), while outlying islands had the smallest number of dental PTFA visits (25,055, 2.32%). Based on the children aged 3-5 years, municipalities had the lowest dental PTFA use rate (171.70%), while remote and outlying island counties had the highest dental PTFA use rate (482.96%). Conclusion: In Taiwan, there is a higher number of children's dental PTFA outpatient visits in municipalities than in non-municipalities or remote and outlying island counties as well as in northern region than in each of other four regions (central, southern, and eastern regions and outlying islands).

Effect of topical fluoride applications on residual monomer release from resin-based restorative materials.

BACKGROUND: The effects of topical fluoride applications on the release of monomer ingredients from resin-based dental materials by immersion in various extraction solutions are unclear. The aim of this study was to determine the effect of topical fluorides (APF and NaF) on the elution of residual monomers (Bis-GMA, TEGDMA, UDMA, and HEMA) from resin-based materials. METHODS: Ninety specimens were prepared, 30 bulk-fill composite resin, 30 nanohybrid universal composite resin, and 30 polyacid-modified composite resin (compomer). These were randomly divided into three groups based on fluoride application procedures. Each specimen was kept in 75% ethanol solution, and residual monomers released from materials were analyzed using high-performance liquid chromatography (HPLC) after 10 min, 1 h, 24 h, and 30 days. The groups were compared using the Mann Whitney U and Kruskal Wallis tests. Measurements were analyzed using the Friedman and Wilcoxon signed-rank tests. RESULTS: Fluoride applications generally had no considerable effect on the amount of residual monomer released from resin-based restorative materials. The amount of monomer release after topical APF application was similar to the release in the control group and was lower than the release in the NaF group. The release of monomers from the resin-based material used in the study did not approach toxic levels at the applied time intervals. The compomer released lower amounts of monomer than other resin-based materials. CONCLUSIONS: Fluoride applications do not increase monomer release from resin-based restorative materials. However, compomers should be employed by clinicians due to their lower monomer release compared to other resin restorative materials. The release of monomers from all the resin-based materials did not approach toxic levels at the applied time intervals.

Development of small-scale water fluoridation equipment.

PURPOSE: A water fluoridation program launched in the United States in 1945 has become a worldwide application for caries prevention. Although such a program is important in Japan, water fluoridation in large communities has not been established. This study aimed to develop safe small-scale water fluoride equipment that can be easily used to carry out water fluoridation programs in areas with children in long-term care facilities, and in developing countries without water supply facilities. METHODS: Batch-type NaF addition adjustment equipment was manufactured as small-scale water fluoride equipment. The fluoride concentration of the adjusted water with this equipment was measured using an ion meter and a fluoride composite electrode. All 51 water quality standards set by the Ministry of Health, Labour, and Welfare of Japan were tested. RESULTS: The fluoride ion concentration of the adjusted water was 0.7 mg/L and it was constant and stable. The adjusted water conformed to the water quality standard values of the Japanese Water Supply Law. CONCLUSION: Water produced with small-scale water fluoridation equipment had a fluoride concentration of 0.7 mg/L, which is the recommended concentration for caries prevention. The fluoride concentration was stable.

Regional variations in caries experience, predictors, and follow-up among children and adolescents in Western Norway.

OBJECTIVE: To identify regional differences in, and determinants of dental caries among children in western Norway. MATERIAL AND METHODS: We studied dental caries in 705 children aged 12 years and 18 years living in the southern region (n = 403) and other parts of Hordaland County (n = 302) in Norway. Information on oral hygiene, fluoride intake, and sugar consumption was collected using questionnaires. We also collected information from the Public Dental Service (PDS) on the history of decayed, missing, or filled teeth; professional fluoride application; recall and regular check-up intervals and treatment visits. Residence (southern region versus the rest of Hordaland, the reference) was the independent variable. We analysed regional differences in (i) caries prevalence and severity, (ii) potential contributors to caries, and (iii) procedures and routines in PDS. RESULTS: Caries prevalence and severity were higher in the southern region (67% and 24%, respectively). Self-reported brushing habits, fluoride use, and sugar consumption patterns were similar between regions. We observed more frequent application of professional fluoride (incidence rate ratio [IRR] = 3.05, 95% CI: 1.99-4.66], fewer check-ups [IRR = 0.88, 95% CI: 0.81-0.95], and fewer treatment visits [IRR = 0.77, 95% CI: 0.60-0.98] among participants in the southern region, compared to the rest of Hordaland. The recall intervals in the southern region were 10% longer among 12-year-olds and 10% shorter among 18-year-olds, compared to their respective counterparts in Hordaland. CONCLUSIONS: The observed regional gradients in caries experience mirrored regional differences in dental routines and procedures. Caries-related risk behaviours did not explain the observed differences in caries experience.

Characterizing Socioeconomic Inequalities in Professionally Applied Topical Fluoride Treatment Courses in Schoolchildren from a Developing Country.

The objective of the present study was to characterize socioeconomic inequalities in the patterns of professionally applied topical fluoride (PATF) in Mexican schoolchildren. A cross-sectional study was carried out on 3029 Mexican schoolchildren. A questionnaire was administered to caregivers to determine sociodemographic, socioeconomic, and behavioral variables. The dependent variable was prevalence of PATF, coded as 0 = without PATF and 1 = with PATF, at any point in life, and separately, in the previous year. Various indicators of socioeconomic position were included. Logistic regression was used in the final multivariate analysis. The prevalence of PATF any time in life was 33.8%, while in the previous year it was 11.4%. The variables associated (p < 0.05) with PATF any time in life were child's older age (OR = 1.12), older age when tooth brushing started (OR = 1.57), higher brushing frequency (OR = 1.60), having health insurance [public (OR = 1.61) or private (OR = 1.45)], if family owned a car (OR = 1.29) and better socioeconomic position [parents' education, second (OR = 1.48) and third (OR = 1.75) tertile]. For PATF in the previous year, the variables associated were older age of mother (OR = 1.03), older age when tooth brushing started (OR = 1.99), higher brushing frequency (OR = 1.68), having health insurance [public (OR = 1.62)] and better socioeconomic position (parents' education, second (OR = 1.57) and third (OR = 1.97) tertile). This study suggests the existence of socioeconomic inequalities in PATF, manifested through socioeconomic position, access to health insurance and household having a car. Identifying and addressing PATF inequalities would improve oral health in the child population.

The additional benefit of professional fluoride application for children as an adjunct to regular fluoride toothpaste: a systematic review and meta-analysis.

OBJECTIVE: To assess whether professional fluoride application (PFA) used in addition to regular fluoride toothpaste (RFT, ≥ 1,000 ppm) is more effective than RFT alone in children. MATERIALS AND METHODS: A systematic search was conducted using the PubMed, Embase, Google Scholar and CENTRAL databases. Randomized controlled trials (RCTs) comparing the effectiveness of RFT + PFA and RFT alone were included. Meta-analyses with random-effects models were performed. The certainty of evidence was assessed using the GRADE approach. RESULTS: A total of 2,729 records were identified from electronic and manual searches, which were screened by two reviewers independently and in duplicate. Six RCTs (5,034 participants) were included, of which four had high risk of bias and two had unclear risk of bias. The PFA used in all these trials was fluoride varnish (FV). In meta-analyses, no significant difference was observed between participants receiving FV + RFT and RFT alone of d(m/e)fs increment (mean difference (MD) - 0.17, 95% confidence interval (CI) - 0.60 to 0.26, P = 0.43, I2 = 38%; 6 trials, 5,034 participants, moderate certainty evidence), incidence of caries (risk ratio (RR) 0.91, 95% CI 0.80 to 1.05, P = 0.21, I2 = 41%; 4 trials, 4,487 participants, moderate certainty evidence) or changes in prevalence of caries (RR 0.89, 95% CI 0.78 to 1.01, P = 0.07, I2 = 0%, 4 trials, 4,189 participants, low certainty evidence). CONCLUSIONS: Low to moderate certainty evidence suggests that FV does not have significant additional caries-preventive benefit for children (under 8 years old) when provided as an adjunct to daily tooth brushing with RFT (≥ 1,000 ppm). There is insufficient evidence regarding the additional benefit of other PFA interventions. CLINICAL RELEVANCE: The decision to apply FV to children needs to be made in light of their actual usage of RFT. TRIAL REGISTRATION: PROSPERO (CRD42020165270).

The effect of topical fluoride application on the number of salivary streptococcus mutans in orthodontic patients / 대한치과교정학회지

The effect of topical application on the number of S. mutans was tested in a group of 44 orthodontic patients (mean age, 12Y 3M). They were divided into 5 groups according to the method using NaF and SnF2. The number of S. mutans CFU were counted in stimulated saliva of each subject at baseline, and after one, two, three, and eight weeks. The following results were obtained. 1. In NaF rinsing group, and NaF topical application and NaF rinsing group, the number of S. mutans per ml saliva was not significantly changed. 2. In SnF2 topical application group, and SnF2 topical and NaF rinsing group, the number of S. mutans per ml saliva was significantly reduced. 3. After 8 weeks, there were no significant reduction of the number of S. mutans in comparison with baseline.