Health professionals' recommendations on the use of fluoride varnish for caries prevention in preschool children.

BACKGROUND: Fluoride varnish (FV) is widely recommended for caries prevention in preschool children, despite its anticaries benefits being uncertain and modest. Dentists often report using clinical practice guidelines (CPGs) as a source of scientific information. AIM: To identify and analyze recommendations for clinical practice on the use of FV for caries prevention in preschool children and to assess the methodological quality of the CPG on this topic. DESIGN: Two researchers independently used 12 search strategies and searched the first five pages of Google Search™ and three guideline databases for recommendations freely available to health professionals on the use of FV for caries prevention in preschoolers. Then, they retrieved and recorded recommendations that met the eligibility criteria and extracted the data. A third researcher resolved disagreements. Each included CPG was appraised using the AGREE II instrument. RESULTS: Twenty-nine documents were included. Recommendations varied according to age, patients' caries risk, and application frequency. Of the six CPGs, only one scored above 70% in the AGREE II overall assessment. CONCLUSION: Recommendations on the use of FV lacked scientific evidence, and CPGs were of poor quality. Application of FV is widely recommended despite recent evidence showing an uncertain, modest, and possibly not clinically relevant anticaries benefit. Dentists should be aware that it is necessary to critically appraise CPGs since they may be of poor quality.

A prognosis and cost-effectiveness systematic review of non-invasive treatments for root caries / Revisão sistemática de prognóstico e custo-efetividade de tratamentos não invasivos para cárie radicular

Aim: to evaluate the prognosis of root cariestreatment with non-invasive methods, as well as to compare non-invasive therapies as viable alternatives for clinicians, indicating their cost-effectiveness.Literaturereview: Data collected were number of active lesions at baseline(BL) and in the last clinical assessment after follow-up(FL), and the follow-up period in months(P). The outcome was the monthly progression rate of the lesions that was calculated by (FL­BL)/P. A negative progression rate means the arrestment of the lesions. A cost-effectiveness rate was calculated. Results: From 596 titles retrieved in the search, 8 studies were included in a qualitative synthesis after assessed for eligibility. The monthly progression rate of lesions of home-based treatments (toothpastes, mouth rinses, supplemented milk intake) was an average of -0.79 (-3.68 to 2.3), while the office-based treatments (varnish, topic solutions) was 0.07 (-0.01 to 0.51), suggesting a better prognosis of the home-based treatments. The lowest monthly progression rate was -3.97 (toothpaste 5000ppm/F) while the highest was 2.31 (conventional toothpaste). The cost-effectiveness rate was better for treatments with toothpastes with 5000ppm/F (BRL21.78) when compared to mouthwashes (BRL579.47). Discussion: A better prognosis was found for toothpastes with a high fluoride concentration (5000ppm/F) compared to other therapies, as well as a better cost-effectiveness when compared to mouthwashes. Conclusion: Home-based therapiesrepresented the highest rates of good prognosis for treating root caries lesions within the available scientific evidence. Although 5000ppm/F toothpastes have a very high cost for the Brazilian market, this treatment presented the highest cost-effectiveness when compared to mouthrinses(PROSPERO:CRD42019136035).

Objetivo: avaliar o prognóstico do tratamento da cárie radicular com métodosnão invasivos, bem como comparar as terapias não invasivas como alternativas viáveis para os clínicos, indicando seu custo-efetividade. Revisão deliteratura: os dados coletados foram o número de lesões ativas no início do estudo(BL) e na última avaliação clínica após o acompanhamento(FL), e o período de acompanhamento em meses(P). O desfecho foi a taxa de progressão mensal das lesões calculada por (FL­BL)/P. Uma taxa de progressão negativa significou a inativação das lesões. Uma taxa de custo-efetividade foi calculada.Resultados: Dos 596 títulos recuperados na busca, 8 estudos foram incluídos em uma síntese qualitativa após avaliação de elegibilidade. A taxa de progressão mensal das lesões dos tratamentos caseiros (dentifrícios, enxaguatórios bucais, ingestão de leite complementado) foi em média -0,79 (-3,68 a 2,3), enquanto os tratamentos de consultório (verniz, soluções tópicas) foi de 0,07 (-0,01 a 0,51), sugerindo um melhor prognóstico dos tratamentos domiciliares. A menor taxa de progressão mensal foi de -3,97 (dentifrício 5000ppm/F), enquanto a maior foi de 2,31 (dentifrício convencional). A taxa de custo-efetividade foi melhor para tratamentos com dentifrícios com 5000ppm/F(R$21,78) quando comparados aos bochechos (R$579,47). Discussão: Foi encontrado melhor prognóstico para dentifrícios com alta concentração de flúor(5000ppm/F) em comparação com outras terapias, bem como melhor custo-efetividade quando comparados aos bochechos. Conclusão: As terapias domiciliares representaram as maiores taxas de bom prognóstico para o tratamento de lesões de cárie radicular dentro das evidências científicas disponíveis. Embora dentifrícios de 5000ppm/F tenham um custo muito alto para o mercado brasileiro, este tratamento apresentou o maior custo-efetividade quando comparado aos enxaguatórios bucais(PROSPERO:CRD42019136035).

Caries incidence after professional fluoride treatment: A systematic review / Incidência de cárie após tratamento profissional com fluoretos: uma revisão sistemática

Aim:The purpose of this studywas to assess whether individuals with active caries lesions treated with professional topical application of fluoride at high concentrations show a lower incidence of caries than individuals who have not received professional treatment with fluoridated products. Literature review:Randomized clinical trials in which patients were followed up for at least 6 months were included. Studieswere identified with MEDLINE, Embase, LILACS, SCOPUS, and Cochrane Database of Systematic Reviews. Pairs of reviewers independently conducted study selection, data extraction, and risk-of-bias assessments. Eight trials, which included 5018 children and adolescents, were eligible. Results were evaluated by calculating the preventive fraction to standardize the outcomes.Results:Fluoride varnish yielded a better preventive fraction (90.18% to 14.6%) in both primary and permanent dentitions in comparison with methods using gel (22.3% to 6%) and foam (24%) after a mean follow-up period of 20.6 months. Regardless of the product used, increased frequency of application yielded greater benefit. Discussion:Theseresults do not agree with previous findings that, in 8 weeks periods, did not observe an additional effect of the professional use of fluorides over the control treatments(biofilm control). The presentreview indicatesthe need for long-term monitoring of the effect of treatment, whereby the effects of high fluoride concentrations may appear. Conclusion:Professional fluoride treatment proved to be effective in preventing new long-term injuries in both primary and permanent dentition, irrespective of the vehicle used (varnish, gel, or foam). (PROSPERO Register number CRD42021210740).

Objetivo:Avaliar se indivíduos com lesões ativas de cárie tratadas com aplicação tópica profissional de fluoretos em altas concentrações apresentam menor incidência de cárie do que indivíduos que não receberam este tratamento. Revisão da literatura:Ensaios clínicos randomizados, com acompanhamento de pelo menos 6 meses foram incluídos. Os estudos foram identificados nas bases de dados MEDLINE, Embase, LILACS, SCOPUS e Cochrane Database of Systematic Reviews. Pares de revisores conduziram de forma independente a seleção de estudos, extração de dados e avaliações de risco de viés. Oito estudos, que incluíram 5.018 crianças e adolescentes, foram elegíveis. Os resultados foram avaliados por meio do cálculo da fração preventiva. Resultados:O verniz fluoretado apresentou melhor fração preventiva (90,18% a 14,6%), tanto na dentição decídua quanto na permanente, em comparação com os métodos com gel (22,3% a 6%) e espuma (24%) após um período médio de seguimento de 20,6 meses. Independentemente do produto utilizado, o aumento da frequência de aplicação apresentou maior benefício. Discussão:Estes resultados diferem de achados anteriores em que, em períodos de 8 semanas, não houve efeito adicional do uso profissional de fluoretos em relação ao tratamento controle. A presente revisão indicou a necessidade de monitoramento a longo prazo do efeito do tratamento, quando os efeitos do fluoreto de alta concentração podem aparecer. Conclusão:O tratamento profissional com flúor mostrou-se eficaz na prevenção de novas lesões a longo prazo, tanto na dentição decídua quanto na permanente, independente do veículo utilizado (verniz, gel ou espuma). (Número de registro PROSPERO CRD42021210740).

Efficacy of ClinproTMXT Varnish surrounding brackets on the enamel surface of white spot lesion

Abstract Orthodontics patients usual develop demineralization and present cavity caries lesions after six months. Minimally invasive procedures have been the goal in modern dental practice. The aim of this study was to evaluate the effect of ClinproTMXT Varnish, on the enamel surface roughness and severity of white spot lesions. Twenty premolars were submitted to bond brackets and experimental induction of demineralization and randomly divided into 2 groups: GI - fluoride varnish (Colgate Duraphat®); GII - Ionomeric Sealant (ClinproTMXT Varnish). The treatment was applied around the brackets. The surface roughness of specimens was analyzed, before treatment and 12 weeks after treatment by laser confocal microscopy, and the severity of the white spot lesion was by laser fluorescence device. The data were analyzed by non-parametric Wilcoxon and Mann-Whitney Test, at 5% significance, roughness percentage reduction was performed. The severity of demineralization decreased in both, GI (p = 0.005) and GII (p = 0.019). Enamel superficial roughness levels decreased in GI and GII. As well as the roughness percentage, being more expressive in the ClinproTMXT Varnish group (85,09%). Colgate Duraphat® or Clinpro™ XT Varnish reduced the severity of the demineralization and decreased the superficial roughness on the enamel. The Clinpro™ XT Varnish was superior to superficial roughness on enamel.

Resumo Pacientes ortodônticos geralmente desenvolvem desmineralização e apresentam lesões de cárie após seis meses de tratamento. Procedimentos minimamente invasivos têm sido o objetivo na prática odontológica moderna. O objetivo deste estudo foi avaliar o efeito do ClinproTM XT selante ionomérico, ao redor do bráquete, com relação a rugosidade superficial do esmalte e a severidade da lesão induzida. Vinte pré-molares foram submetidos a colagem de bráquetes e indução experimental de desmineralização e divididos aleatoriamente em 2 grupos: GI - verniz fluoretado (Colgate Duraphat®); GII - Selante Ionomérico (ClinproTM XT). O tratamento foi aplicado ao redor dos bráquetes. A rugosidade da superfície dos espécimes foi analisada, antes do tratamento e 12 semanas após o tratamento por microscopia confocal a laser e severidade da lesão de mancha branca por dispositivo de fluorescência a laser. Os dados foram analisados pelo teste não paramétrico de Wilcoxon e Mann-Whitney, a 5% de significância. A taxa de redução da lesão foi calculada. A severidade da desmineralização diminuiu tanto no GI (p = 0,005) quanto no GII (p = 0,019). Os níveis de rugosidade superficial do esmalte diminuíram no GI e GII, assim como o percentual de rugosidade, sendo mais expressivo no grupo ClinproTMXT (85,09%). Colgate Duraphat® e Clinpro™ XT reduziram a severidade da desmineralização e diminuíram a rugosidade superficial do esmalte. O selante ionomérico Clinpro™ XT foi superior na redução percentual de rugosidade.

Economic evaluation of fluoride varnish application in preschoolers: A systematic review.

BACKGROUND: Fluoride varnish (FV) is a convenient way of professionally applying fluoride in preschoolers. However, its modest anticaries effect highlights the need for economic evaluations. AIM: To assess economic evaluations reporting applications of FV to reduce caries incidence in preschoolers. DESIGN: We included full economic evaluations with preschool participants, in which the intervention was FV and the outcome was related to dentin caries. We searched in CENTRAL; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; and BVS Economia em saúde, OpenGrey, and EconoLit. Clinical trial registers, thesis and dissertations, and meeting abstracts were hand searched, as well as 11 dental journals. Risk of bias in the included studies was assessed using the Philips' and Drummond's (full and simplified) tools. RESULTS: Titles and abstracts of 2871 articles were evaluated, and 200 were read in full. Eight cost-effectiveness studies were included: five modeling and three within-trial evaluations. None of the studies gave sufficient information to allow a thorough assessment using the bias tools. We did not combine the results of the studies due to the great heterogeneity among them. Four studies reported that FV in preschool children was a cost-effective measure, but in one of these studies, sealants and fluoride toothpaste were more cost-effective measures than the varnish, and three studies used limited data that compromised the generalizability of their results. The other four studies showed a large increase in costs due to the application of varnish and/or low cost-effectiveness. CONCLUSION: We did not find convincing overall evidence that applying FV in preschoolers is an anticaries cost-effective measure. The protocol of this systematic review is available at Open Science Framework (https://osf.io/xw5va/).

Non-Invasive Methods and the Use of Infiltrating Resins for the Control of Caries Progression in Deciduous Teeth: A Systematic Review and Meta-Analysis

ABSTRACT Objective: To evaluate the influence of non-invasive treatment associated with the use of infiltrating resin for managing caries lesions in primary teeth. Material and Methods: A systematic review was performed by selecting articles from 6 online databases, using a search algorithm and eligibility criteria for data extraction and data synthesis for the papers included. Clinical trials involving primary teeth with incipient caries lesions (1/2 of the enamel or 1/3 of the outer dentin) were included, presenting full text and answering the study's guiding question. This study used the RoB 2 tool for the risk of bias assessment and GRADE for certainty of evidence. Random effects meta-analyses were implemented, and lesion progression treatment effects were estimated through relative risk (RR) and associated 95% confidence intervals. Results: A total of 440 studies were found. After analyzing the inclusion criteria and removal of duplicates, eight studies were analyzed for quality evidence. Five of the eight studies included in this review contributed to the meta-analysis, all with some reflections regarding the risk of bias. Overall, the results of the meta-analysis showed that non-invasive treatment, when associated with the use of infiltrating resins, significantly reduced the risk of caries progression in relation to the treatment without this addition for follow-up periods ranging from 12 months to 2 years (RR 0.51 [0.40-0.65]). Conclusion: There is moderate certainty of evidence that the use of infiltrating resins associated with non-invasive treatments decreases the risk of caries progression in primary teeth with incipient caries lesions (1/2 of the enamel or 1/3 of the dentin outer) when combined with non-invasive control methods alone.

Randomized controlled trial on the effectiveness of silver diamine fluoride in arresting caries in Lagos, Nigeria

Treatment of dental caries in children still remains challenging due to lack of cooperation with conventional treatment modalities. Recently, the use of Silver Diamine Fluoride (SDF) has proved useful in addressing this challenge. Aim: This clinical trial aimed to evaluate the effectiveness of Silver Diamine Fluoride (SDF) in arresting caries in children in Lagos, Nigeria. Methods: This was a phase III balanced randomized controlled school based interventional study on 240 children. The study group was treated with SDF while GIC was used in the control group. Follow up visits in 2 weeks, 1 month, and 3 months were carried out to assess the treatment outcome. Inferential statistics with the use of Pearson Chi-square test and Independent Student t-test were used at 5% level of significance. Results: There was significant relationship between SDF and caries arrest in 2 weeks, 1 month and 3 months' assessment period (p = 0.001). The control group showed continuous decline (71.7%, 54.3% and 50.9%) in restorative success from 2 weeks to 3 months respectively. The mean ± SD and Confidence Interval (CI) of arrested caries in the SDF group were 113± 1.24 and 113.1 ­ 113.5 respectively. In the control group the mean ± SD and CI of restorative success were 69.3±11.8 and 67.2 ­ 71.4. The effect size was 5.24. Conclusion: The result of the study showed that SDF was effective in arresting caries in children without any harm and there was statistically significant difference in the use of 38% SDF in arresting caries in children

A Titanium Tetrafluoride Experimental Gel Combined with Highly Concentrated Hydrogen Peroxide as an Alternative Bleaching Agent: An In Vitro Study.

This in vitro study evaluated color change, mineral content, and morphology of enamel, pH and cytotoxicity of experimental bleaching agents containing 35% hydrogen peroxide (HP), titanium tetrafluoride (TiF4), Natrosol, and Chemygel. Sixty enamel/dentin blocks were randomly treated with (n = 10) HP; HP+Natrosol+Chemygel with different TiF4 concentrations: 0.05 g HPT0.5, 0.1 g HPT1, 0.2 g HPT2, 0.3 g HPT3, 0.4 g HPT4. Bleaching was performed in three sessions (3 × 15 min application). Color change (CIELab-ΔEab, CIEDE2000-ΔE00, ΔWID) and Knoop microhardness (KHN) were evaluated. Enamel morphology and composition were observed under scanning electron microscopy and energy-dispersive spectrometry (EDS), respectively. Cell viability of keratinocyte cells was evaluated using MTT assay. Data were analyzed by one-way ANOVA and LSD and Tukey tests, and two-way repeated measures ANOVA and Bonferroni (α = 5%). The pH and EDS were analyzed descriptively. Lightness-L* increased, and a* and b* parameters decreased, except for HPT3 and HPT4 (b*). HPT0.5, HPT1, and HPT2 exhibited ΔEab and ΔWID similar to HP. ΔE00 did not present statistical difference. HP, HPT0.5, and HPT1 promoted higher KHN. HPT0.5 exhibited no changes on enamel surface. Keratinocyte cells were viable when treated with T0.5, and weak viable for T1. Experimental agents exhibited acidic pH and Ti elements. HPT0.5 exhibited bleaching efficacy, maintained KHN without enamel alterations, and did not increase cytotoxicity.

Is professionally applied topical fluoride effective in treating incipient caries? A systematic review

Abstract The present systematic review aimed to investigate the effectiveness of professionally applied topical fluoride as therapeutic agent for incipient carious lesions in permanent teeth. Randomised clinical trials (RCTs) comparing the effectiveness of professionally applied topical fluoride (varnish or gel) with that of placebo, no intervention, and toothbrushing (control group) in the treatment of incipient carious lesions in permanent dentition were included. An electronic search was performed in the PubMed, Web of Science, Scopus, Virtual Health Library, Embase, and Cochrane databases, in the grey literature, and in clinical trials registered until January 2021. Two reviewers independently screened titles and abstracts and assessed the risk of bias using the Cochrane tool. The certainty of evidence was classified using GRADE. A total of 2,223 articles were screened using titles/abstracts. After full-text reading of the 22 selected studies, nine RCTs were included. Five RCTs found that topical fluoride may be effective in reversing incipient carious lesions in permanent teeth. Overall, five studies were classified as having a low risk of bias and four as having some concerns. Only descriptive analysis was performed because of the heterogeneity of the data. Studies comparing fluoride varnish with usual home care oral hygiene have demonstrated topical fluoride does not appear to be more effective in improving the appearance of incipient carious lesions. Therefore, usual home care oral hygiene with fluoride toothpaste may be sufficient to treat incipient carious lesions in permanent dentition. Further studies with greater methodological rigor are, however, required to reduce bias, to allow a meta-analysis, and to draw well-founded conclusions (CRD42019120406).

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)

Efficacy of 1.23% APF gel applications on incipient carious lesions: a double-blind randomized clinical trial

The aim of this double-blind randomized clinical trial was to evaluate the efficacy of 1.23% APF gel application on the arrest of active incipient carious lesions in children. Sixty 7- to 12-year-old children, with active incipient lesions were included in the study. Children were divided randomly into 2 groups: 1.23% APF gel and placebo gel applications. Each group received 8 weekly applications of treatment. The lesions were re-evaluated at the 4th and 8th appointments. Poisson regression analysis was used to estimate relative risks of the presence of active white spot lesions. Groups showed similar results (PR = 1.67; CI 95% 0.69–3.98). The persistence of at least 1 active lesion was associated with a higher number of lesions in the baseline (PR = 2.67; CI 95% 1.19–6.03), but not with sugar intake (PR = 1.06; CI 95% 0.56–2.86) and previous exposure to fluoride dentifrice (PR = 1.26; CI 95% 0.49–2.29). The trial demonstrates the equivalence of the treatments. The use of the APF gel showed no additional benefits in this sample of children exposed to fluoridated water and dentifrice. The professional dental plaque removal in both groups may also account for the resulting equivalence of the treatments.

Uso de vernizes fluoretados na avaliação do índice sangramento gengival em crianças: estudo in vivo / Use of fluoride varnishes in assessment of gingival bleeding index in children: in vivo study

Objetivo - Verificar o uso de dois vernizes fluoretados e a presença de sangramento gengival. Métodos - Participaram da pesquisa 28 crianças, de ambos os gêneros, de 8 a 12 anos de um município sem fluoretação das águas. Utilizou-se os códigos e critérios para diagnóstico de cárie do SB Brasil (2003) e índice de sangramento gengival (ISG). As crianças foram divididas em dois grupos: G1 (n = 13) Duraphat® e G2 (n = 15) Clinpro®. Inicialmente era registrado o ISG, profilaxia profissional e aplicados os vernizes (durante três sessões semanais). O exame foi realizado por apenas um examinador, previamente calibrado. O nível de significância adotado foi de 95%. Resultados - O ceod médio foi de 1,8 (± 2,0) e o CPO-D foi de 2,6 (± 2,3). Observou-se diminuição do ISG nos tempos 7, 14 e 21 dias, embora menor para o G1 do que para G2. A redução foi mais expressiva no G2 (p < 0,05). Conclusão - Dessa forma, ambos os vernizes fluoretados estudados proporcionaram redução do ISG ao longo do tempo.

Objective - The purpose of this study was to evaluate the therapeutic effect of two different fluoride varnishes and the presence of gingival bleeding. Methods - The sample consisted of 28 students of both genders, 8-12 years old of a public school from a city without fluoride water. The codes and criteria used for caries diagnosis were SB BRASIL (2003) and gingival bleeding index (GBI). The children were divided in two groups: G1 (n = 13) Duraphat® and G2 (n = 15) Clinpro®. Before applying the varnishes, the gingival bleeding index (GBI) was recorded, prophylactic performed with prophylactic paste and then varnishes applied in three sessions followed at weekly intervals. The examination was accomplished by one examiner, previously calibrated. The level of significance was set at 95% (CI). Results - The mean dmft index was1.8 (± 2.0) and DMFT was 2.6 (± 2.3). There was a decrease of GBI times 7, 14 and 21 days, although lower for G1 than for G2. The reduction was greater in G2 (p<0.05). Conclusion - Thus, both fluoride varnishes studied caused gingival bleeding reduction over time.

Fluoride: its role in dentistry

In spite of decades of research on fluoride and the recognition of its role as the cornerstone of dental caries reduction in the last fifty years, questions still arise on its use at community, self-applied and professional application levels. Which method of fluoride delivery should be used? How and when should it be used? How can its benefits be maximized and still reduce the risks associated with its use? These are only some of the challenging questions facing us daily. The aim of this paper is to present scientific background to understand the importance of each method of fluoride use considering the current caries epidemiological scenario, and to discuss how individual or combined methods can be used based on the best evidence available.

Anticariogenic effect of fluoride-releasing elastomers in orthodontic patients

This in vivo experimental study evaluated the efficacy of fluoride-releasing elastomers in the control of Streptococcus mutans levels in the oral cavity. Forty orthodontic patients were recruited and divided into two groups of 20. Fluoride-releasing elastomeric ligature ties (Fluor-I-Ties, Ortho Arch Co. Inc., USA) were used in the experimental group, and conventional elastomeric ligature ties (D. Morelli, Brazil), in the control group. Two initial samples of saliva were collected at a 14-day interval to determine the number of colony forming units (CFU) of Streptococcus mutans. Immediately after collecting the second sample, fluoride-releasing elastomeric ligature ties were placed in the patients of the experimental group, and conventional ligature ties, in the patients of the control group. Seven, 14 and 28 days after placement of the elastomeric ligature ties, saliva and plaque surrounding the orthodontic appliance were collected for microbiologic analysis. There were no significant differences in the number of Streptococcus mutans CFUs in saliva or plaque in the area surrounding the fluoride-releasing or conventional elastomeric ligature ties. Thus, fluoride-releasing elastomeric ligature ties should not be indicated to reduce the incidence of enamel decalcification in orthodontic patients. Since there was no significant reduction in S. mutans in saliva or plaque, other means of prevention against enamel decalcification should be indicated for these patients.

Esta pesquisa in vivo teve como objetivo avaliar a eficácia dos elastômeros liberadores de fluoreto estanoso no controle dos níveis de Streptococcus do grupo mutans na cavidade oral. Utilizou-se uma amostra de 40 pacientes ortodônticos, dividida em dois grupos de vinte indivíduos cada. No grupo experimental, foi utilizada ligadura elástica com liberação de fluoretos (Fluor-I-Ties, Ortho Arch Co. Inc., EUA) e, no grupo controle, foi utilizada ligadura elástica convencional (D. Morelli, Brasil). Para determinação do número de unidades formadoras de colônia (UFC) de Streptococcus do grupo mutans, foram realizadas duas coletas iniciais de saliva com intervalo de catorze dias. Logo após a segunda coleta de saliva, foram colocados os elastômeros liberadores de fluoretos nos pacientes do grupo experimental e, nos pacientes do grupo controle, foram inseridos os elastômeros convencionais. Nos 7°, 14° e 28° dias, saliva e biofilme ao redor do acessório ortodôntico foram coletados para análise microbiológica. Constatou-se que não houve diferenças estatisticamente significantes no número de UFC de Streptococcus do grupo mutans encontradas na saliva e no biofilme ao redor dos elastômeros com ou sem fluoretos. Dessa forma, os elastômeros liberadores de fluoreto não podem ser utilizados para reduzir a incidência de descalcificação do esmalte em pacientes ortodônticos. Como não houve redução significativa na quantidade de S. mutans na saliva e no biofilme, torna-se necessário indicar outros meios de prevenção da descalcificação do esmalte para esses pacientes.