Community Dent Oral Epidemiol

Community Dent Oral Epidemiol. 2010 Aug 5. [Epub ahead of print]

Effect of health promotion and fluoride varnish on dental caries among Australian Aboriginal children: results from a community-randomized controlled trial.

Slade GD, Bailie RS, Roberts-Thomson K, Leach AJ, Raye I, Endean C, Simmons B, Morris P.

Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

Objectives: We tested a dental health program in remote Aboriginal communities of Australia's Northern Territory, hypothesizing that it would reduce dental caries in preschool children. Methods: In this 2-year, prospective, cluster-randomized, concurrent controlled, open trial of the dental health program compared to no such program, 30 communities were allocated at random to intervention and control groups. All residents aged 18-47 months were invited to participate. Twice per year for 2 years in the 15 intervention communities, fluoride varnish was applied to children's teeth, water consumption and daily tooth cleaning with toothpaste were advocated, dental health was promoted in community settings, and primary health care workers were trained in preventive dental care. Data from dental examinations at baseline and after 2 years were used to compute net dental caries increment per child (d(3)mfs). A multi-level statistical model compared d(3)mfs between intervention and control groups with adjustment for the clustered randomization design; four other models used additional variables for adjustment. Results: At baseline, 666 children were examined; 543 of them (82%) were re-examined 2 years later. The adjusted d(3)mfs increment was significantly lower in the intervention group compared to the control group by an average of 3.0 surfaces per child (95% CI = 1.2, 4.9), a prevented fraction of 31%. Adjustment for additional variables yielded caries reductions ranging from 2.3 to 3.5 surfaces per child and prevented fractions of 24-36%. Conclusions: These results corroborate findings from other studies where fluoride varnish was efficacious in preventing dental caries in young children.

Oral Health Prev Dent. 2010;8(2):159-64.

Is titanium tetrafluoride (TiF4) effective to prevent carious and erosive lesions? A review of the literature.

Wiegand A, Magalhes AC, Attin T.

Clinic for Preventive Dentistry, Periodontology and Cariology, University of Zrich, Zrich, Switzerland. annette.wiegand@zzmk.unizh.ch

Abstract

The present review summarises the effects of titanium tetrafluoride (TiF(4)) on the development and progression of carious and erosive lesions. The mode of action of TiF(4) is due to the formation of an acid-stable surface layer, which provides mechanical protection to the surface, and to an increased fluoride uptake, which might chemically reduce demineralisation of dental hard tissues. Most in vitro studies showed that TiF(4) is effective in reducing the formation of carious and erosive enamel and dentine lesions. Thereby, TiF(4) was equally or more effective than sodium fluoride (NaF), amine fluoride (AmF) or stannous fluoride (SnF(2)). While clinical data confirm the caries-preventive effect, clinical trials analysing the anti-erosive effect of TiF(4) are lacking. Few data available from in situ studies revealed conflicting results by showing either no effect or a beneficial effect of TiF(4) on enamel erosion. Even though research focused on TiF(4), there is also evidence to show that other metal fluorides, such as zirconium and hafnium tetrafluorides, affect enamel and dentine demineralisation. CONCLUSION: The potential of TiF(4) to prevent acid demineralisation requires further research to confirm the promising in vitro results obtained by in situ studies and clinical trials

SADJ. 2010 Mar;65(2):60-4, 66-7.

Salt fluoridation: a meta-analysis of its efficacy for caries prevention.

Yengopal V, Chikte UM, Mickenautsch S, Oliveira LB, Bhayat A.

Community Dentistry, Division of Public Oral Health, University of the Witwatersrand Johannesburg, 7 York Rd, Parktown, Johannesburg 2193, South Africa. veerasamy.yengopal@wits.ac.za

Abstract

The aim of this meta-analysis was to assess the caries preventive effect of Salt fluoridation (SF) in the permanent dentition in children. THE OBJECTIVES WERE TO COMPARE: (1) the caries preventive effects of SF versus no exposure in different age cohorts (6-8; 9-12; and 13-15 years old); (2) SF versus other community based interventions (milk or water fluoridation [WF]).

METHODS: 9 English and 2 non-English databases were searched for papers that reported on the caries preventive effect of groups (with controls) that were exposed to SF in the form of mean DMFT scores with standard deviations. Differences in exposed and nonexposed groups were computed on the basis of weighted mean differences (WMDs) with 95% confidence intervals (CIs).

RESULTS: For 6-8 year olds, the pooled reduction in DMFT scores was -0.98 [95% CI: -1.68 to -0.29]; for 9-12 year olds, it was -2.13 [95% CI: -2.55 to -1.70] and for the 13-15 year old groups, -4.22 [95% CI: -6.84 to -1.55]. All the analyses favoured the SF groups (p 0.05). It can be concluded that a CMC-based solution actually unsaturated with respect to octacalcium phosphate (S2) shows most pronounced remineralization capability under the conditions chosen. This might be explained by a more favorable balance between calcium bound to CMC in an adsorbed layer at the enamel-liquid interface and heterogeneous nucleation of calcium phosphates within a solution compared to solutions either supersaturated or having lower levels of saturation.

Am J Dent. 2009 Oct;22(5):315-20.

Comparing the effects of brushing with a new gel-to-foam dentifrice to brushing with regular fluoride control dentifrices on viable bacteria levels in saliva.

Santos D, Schaeffer L, Du-Thumm L, Vandeven M, Cummins D.

Colgate-Palmolive Technology Center, 909 River Road, PO Box 1343, Piscataway, NJ 08855-1343, USA.

Abstract

PURPOSE: To compare the effects of a new gel-to-foam dentifrice to two standard fluoride control dentifrices on foam generation, levels of total viable anaerobes and total viable volatile sulfur compound (VSC)-producing bacteria in expectorate after brushing.

METHODS: 36 subjects participated in this investigator-blind, randomized, crossover study. After a 1-week wash-out period prior to each product use, participants reported to the test site having refrained from oral hygiene, eating and drinking on the morning prior to the visit. Subjects brushed with a full ribbon of assigned dentifrice (Aquafresh Iso-active, Aquafresh Extreme Clean or Aquafresh Fresh & Minty), then expectorated the slurry into a collection vessel after 30 and 60 seconds of supervised brushing. Total foam volume was immediately measured. Subjects then rinsed with sterile water for 10 seconds and expectorated into the same vessel, which was processed for microbiological analysis. Total viable anaerobes and total viable VSC-producing bacteria were enumerated using appropriate selective media.

RESULTS: No statistically significant difference was indicated between the gel-to-foam dentifrice and either of the control dentifrices with respect to the level of total viable anaerobes (P > 0.05). The level of total viable VSC-producing bacteria was statistically significantly lower for the gel-to-foam dentifrice (Aquafresh Iso-active) than for one of the control dentifrices (Aquafresh Fresh & Minty) (P < 0.05), and numerically lower for the gel-to-foam dentifrice than for the other control dentifrice (Aquafresh Extreme Clean) (P = 0.0526). Use of the gel-to-foam dentifrice resulted in statistically significantly greater (P < 0.05) foam generation than the two control dentifrices

Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007868.

Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents.

Walsh T, Worthington HV, Glenny AM, Appelbe P, Marinho VC, Shi X.

School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH.

Comment in:

Evid Based Dent. 2010;11(1):6-7. Abstract

BACKGROUND: Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). The use of fluoride toothpaste is the primary intervention for the prevention of caries.

OBJECTIVES: To determine the relative effectiveness of fluoride toothpastes of different concentrations in preventing dental caries in children and adolescents, and to examine the potentially modifying effects of baseline caries level and supervised toothbrushing.

SEARCH STRATEGY: A search was undertaken on Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and several other databases. Reference lists of articles were also searched. Date of the most recent searches: 8 June 2009.

SELECTION CRITERIA: Randomised controlled trials and cluster-randomised controlled trials comparing fluoride toothpaste with placebo or fluoride toothpaste of a different concentration in children up to 16 years of age with a follow-up period of at least 1 year. The primary outcome was caries increment in the permanent or deciduous dentition as measured by the change in decayed, (missing), filled tooth surfaces (D(M)FS/d(m)fs) from baseline.

DATA COLLECTION AND ANALYSIS: Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were resolved by discussion and consensus or by a third party. The primary effect measure was the prevented fraction (PF), the caries increment of the control group minus the caries increment of the treatment group, expressed as a proportion of the caries increment in the control group. Where it was appropriate to pool data, network meta-analysis, network meta-regression or meta-analysis models were used. Potential sources of heterogeneity were specified a priori and examined through random-effects meta-regression analysis where appropriate.

MAIN RESULTS: 75 studies were included, of which 71 studies comprising 79 trials contributed data to the network meta-analysis, network meta-regression or meta-analysis.For the 66 studies (74 trials) that contributed to the network meta-analysis of D(M)FS in the mixed or permanent dentition, the caries preventive effect of fluoride toothpaste increased significantly with higher fluoride concentrations (D(M)FS PF compared to placebo was 23% (95% credible interval (CrI) 19% to 27%) for 1000/1055/1100/1250 parts per million (ppm) concentrations rising to 36% (95% CrI 27% to 44%) for toothpastes with a concentration of 2400/2500/2800 ppm), but concentrations of 440/500/550 ppm and below showed no statistically significant effect when compared to placebo. There is some evidence of a dose response relationship in that the PF increased as the fluoride concentration increased from the baseline although this was not always statistically significant. The effect of fluoride toothpaste also increased with baseline level of D(M)FS and supervised brushing, though this did not reach statistical significance. Six studies assessed the effects of fluoride concentrations on the deciduous dentition with equivocal results dependent upon the fluoride concentrations compared and the outcome measure. Compliance with treatment regimen and unwanted effects was assessed in only a minority of studies. When reported, no differential compliance was observed and unwanted effects such as soft tissue damage and tooth staining were minimal.

AUTHORS' CONCLUSIONS: This review confirms the benefits of using fluoride toothpaste in preventing caries in children and adolescents when compared to placebo, but only significantly for fluoride concentrations of 1000 ppm and above. The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration. The decision of what fluoride levels to use for children under 6 years should be balanced with the risk of fluorosis