Resident’s Name: Jessica Wilson
Program: Lutheran Medical Center - Providence
Article title: The atraumatic restorative treatment (ART) approach for primary teeth: review of literature.
Author(s): Smales, RJ and Yip, HK.
Journal: American Academy of Pediatric Dentistry
Year. Volume (number). Page #’s: 2000. 22(4). 294-297.
Major topic: ART approach and its effectiveness
Overview of method of research: Literature Review
Findings:
-Older Glass Ionomer Cements (GIC) w/ larger particle sizes had higher failure rates than newer, more esthetic GIC made specifically for ART. These newer GIC have only been researched in short term studies.
-Class I & V: highest survival rates (80-90% after 12 mo.)
-Class II: moderate survival rates (55-75%)
-Class III & IV: lowest survival rates (35-55%)
-Premature loss of restoration due to shallow or non-retentive preps, bulk fracture of multi-surface restorations and restoration wear.
-Although resin modified GIC offer more fracture resistance and adhesion, they also have higher wear rates.
-Recurrent caries not been shown as a problem at this time.
Key points/Summary:
-ART gaining interest & acceptance in treating primary dentition.
-ART involves removal of caries w/ hand instruments & sometimes slow speed. Not necessary or desired to remove all caries as intended to be pain-free procedure. Conditioner and GIC are then placed to seal preparation and adjacent pits and fissures. Excess material pressed into preparation w/ lubricated gloved finger.
-GICs release fluoride, have high pulpal biocompatibility and provide chemical adhesion to tooth structure.
-Most important factor in preparation is providing mechanical retention (most common cause of failure) as well as moisture control. Avoiding premature occlusal contacts is also especially important in GIC restorations due to their low fracture resistance.
-Need further research on long term clinical studies of cost-effectiveness of ART.
-ART is saving many teeth around the WORLD!
Assessment of Article: Unfortunately based on 10 studies done over 10 years ago, but we get the gist of it. Good summary article.
Thursday, August 19, 2010
Bond Strength of 4 Sealants Using Conventional Etch and a Self-etching Primer
Resident: Roberts
Date: 8/20/10
Article title: Bond Strength of 4 Sealants Using Conventional Etch and a Self-etching Primer
Author: Sarheed, Maha
Journal: Journal of Dentistry for Children
Volume: 73:1 Pages: 37-41
Year: 2006
The purpose of this study was to determine and compare the shear bond strength of 4 fissure sealant systems (Dyract Seal, Concise, Visio-Seal, Helioseal) to enamel using conventional etch and self-etching primer (Prompt L Pop).
56 newly extracted noncarious 1st permanent molars were used and embedded in a Teflon mold. Mesial surfaces were exposed to a flattened area of enamel and then dried and washed. The teeth were divided into 8 groups, each consisting of 7 specimens stored in 37 C distilled water for 24 hours. Then specimens were tested in a shear mode at a crosshead speed of .5mm/minute. The mean and standard deviations were subjected to an analysis of variance.
Results: The average bond strengths using the L pop were 1. Dyract Seal 20.61 Mpa, 2. Concise 23.42 MPa 3. Visio- Seal 2.94 MpA and 4. Helioseal 1.83Mpa These values were higher than and statistically different from those of Dryract Seal 10.18 Mpa and Concise 9.14Mpa when the conventional etch system was used.
Conclusion: The bond strengths of L pop in conjunction with Dyract Seal and Concise fissure sealant materials, exceeded those of convention.
Date: 8/20/10
Article title: Bond Strength of 4 Sealants Using Conventional Etch and a Self-etching Primer
Author: Sarheed, Maha
Journal: Journal of Dentistry for Children
Volume: 73:1 Pages: 37-41
Year: 2006
The purpose of this study was to determine and compare the shear bond strength of 4 fissure sealant systems (Dyract Seal, Concise, Visio-Seal, Helioseal) to enamel using conventional etch and self-etching primer (Prompt L Pop).
56 newly extracted noncarious 1st permanent molars were used and embedded in a Teflon mold. Mesial surfaces were exposed to a flattened area of enamel and then dried and washed. The teeth were divided into 8 groups, each consisting of 7 specimens stored in 37 C distilled water for 24 hours. Then specimens were tested in a shear mode at a crosshead speed of .5mm/minute. The mean and standard deviations were subjected to an analysis of variance.
Results: The average bond strengths using the L pop were 1. Dyract Seal 20.61 Mpa, 2. Concise 23.42 MPa 3. Visio- Seal 2.94 MpA and 4. Helioseal 1.83Mpa These values were higher than and statistically different from those of Dryract Seal 10.18 Mpa and Concise 9.14Mpa when the conventional etch system was used.
Conclusion: The bond strengths of L pop in conjunction with Dyract Seal and Concise fissure sealant materials, exceeded those of convention.
Xylitol, Sweeteners, and Dental Caries
Author(s): Ly, et al.
Resident: Cho
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2006. 28. 154-263.
Major topic: Xylitol, Dental Caries
Minor topic: Sweeteners
Type of Article: Conference Paper/Report
Main Purpose: The main purpose of this article was to provide an overview of xylitol and other sweeteners and how they affect the risk of dental caries.
Findings:
Xylitol, sorbitol, mannitol, and maltitol are all part of the sugar alcohol (polyol) family. These products are widely used in chewing gums, candies, and toothpastes and advertised as “sugar-free” products. Sugar alcohols are shown to be noncariogenic. In addition, xylitol has shown to reduce tooth decay by reducing the levels of Streptococcus mutans in plaque and saliva and by reducing the level of lactic acid produced by these bacteria. The main side effect associated with these products is osmotic diarrhea, which occurs when it is consumed large quantities (4 to 5 times greater than the amount to prevent dental caries).
- Participants in groups consuming 100% xylitol had greater reductions in caries or S. Mutans levels that those that consumed a combination of xylitol and sorbitol. Those that consumed xylitol and sorbitol had a greater reduction of caries that those who consumed 100% sorbitol.
- At a University of Washington, Seattle study, participants were put in 4 groups and given 12 pellets of xylitol gums to be divided evenly into four doses per day with varying levels of xylitol. MS levels were reduced with increasing doses of xylitol, with the effect leveling off between 6.88g/day and 10.32g/day.
- In an intensive xylitol chewing gum study, it was found that chewing a maximum of 14g/day of xylitol was not significantly different from chewing 10g/day upon analysis of DMFS scores.
- Two retrospective studies showed that xylitol use is associated with greater reduction in caries and suggested that a frequency of less than 3 times per day may not be effective.
- Study of 3 to 6 year olds comparing xylitol chewing gum and tooth-brushing using fluoridated toothpaste was conducted. Children brushed once after lunch or chewed xylitol gum 3 times each day during daycare hours. The children brushed as they normally would at home. The xylitol gum group had a better oral health status than the group that brushed after lunch.
- In Finland, a study was conducted with a group of mothers who had high S. Mutans levels. They were treated with either chlorhexidine varnish, fluoride varnish, or 100% xylitol gum. The children of mothers treated with xylitol had the lowest levels of S. Mutans.
Key points/Summary:
1. Xylitol content in products should be labeled so that consumers can make informed decisions to use these products for the prevention of tooth decay.
2. Recommendations of efficacious dose and frequency of xylitol use should be more clearly stated.
3. The effective daily dose of xylitol is 6 to 10g.
4. The effective frequency of consumption of xylitol is 3 to 5 times per day.
5. The effectiveness of xylitol is greater the higher the frequency and the higher the dose of xylitol.
6. There is a ceiling effect for the dose of xylitol, which is 10g per day.
Assessment of Article:
This article was informative. I was surprised by the amount of xylitol that needed to be consumed in order to have an effect on dental caries. Perhaps xylitol-containing products should be promoted to wean children off sugary snacks.
Author(s): Ly, et al.
Resident: Cho
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2006. 28. 154-263.
Major topic: Xylitol, Dental Caries
Minor topic: Sweeteners
Type of Article: Conference Paper/Report
Main Purpose: The main purpose of this article was to provide an overview of xylitol and other sweeteners and how they affect the risk of dental caries.
Findings:
Xylitol, sorbitol, mannitol, and maltitol are all part of the sugar alcohol (polyol) family. These products are widely used in chewing gums, candies, and toothpastes and advertised as “sugar-free” products. Sugar alcohols are shown to be noncariogenic. In addition, xylitol has shown to reduce tooth decay by reducing the levels of Streptococcus mutans in plaque and saliva and by reducing the level of lactic acid produced by these bacteria. The main side effect associated with these products is osmotic diarrhea, which occurs when it is consumed large quantities (4 to 5 times greater than the amount to prevent dental caries).
- Participants in groups consuming 100% xylitol had greater reductions in caries or S. Mutans levels that those that consumed a combination of xylitol and sorbitol. Those that consumed xylitol and sorbitol had a greater reduction of caries that those who consumed 100% sorbitol.
- At a University of Washington, Seattle study, participants were put in 4 groups and given 12 pellets of xylitol gums to be divided evenly into four doses per day with varying levels of xylitol. MS levels were reduced with increasing doses of xylitol, with the effect leveling off between 6.88g/day and 10.32g/day.
- In an intensive xylitol chewing gum study, it was found that chewing a maximum of 14g/day of xylitol was not significantly different from chewing 10g/day upon analysis of DMFS scores.
- Two retrospective studies showed that xylitol use is associated with greater reduction in caries and suggested that a frequency of less than 3 times per day may not be effective.
- Study of 3 to 6 year olds comparing xylitol chewing gum and tooth-brushing using fluoridated toothpaste was conducted. Children brushed once after lunch or chewed xylitol gum 3 times each day during daycare hours. The children brushed as they normally would at home. The xylitol gum group had a better oral health status than the group that brushed after lunch.
- In Finland, a study was conducted with a group of mothers who had high S. Mutans levels. They were treated with either chlorhexidine varnish, fluoride varnish, or 100% xylitol gum. The children of mothers treated with xylitol had the lowest levels of S. Mutans.
Key points/Summary:
1. Xylitol content in products should be labeled so that consumers can make informed decisions to use these products for the prevention of tooth decay.
2. Recommendations of efficacious dose and frequency of xylitol use should be more clearly stated.
3. The effective daily dose of xylitol is 6 to 10g.
4. The effective frequency of consumption of xylitol is 3 to 5 times per day.
5. The effectiveness of xylitol is greater the higher the frequency and the higher the dose of xylitol.
6. There is a ceiling effect for the dose of xylitol, which is 10g per day.
Assessment of Article:
This article was informative. I was surprised by the amount of xylitol that needed to be consumed in order to have an effect on dental caries. Perhaps xylitol-containing products should be promoted to wean children off sugary snacks.
Effect of Preparation Technique, Fissure Morphology, and Material Characteristics on the In Vitro Margin Permeability of Pit and Fissure Sealants
Resident: Adam J. Bottrill
Date: 20AUG10
Region: Providence
Article title: Effect of Preparation Technique, Fissure Morphology, and Material Characteristics on the In Vitro Margin Permeability of Pit and Fissure Sealants
Author(s): Selecman, James et al
Journal: Pediatric Dentistry
Page #s: 308-314
Year: V29/No4 Jul/Aug 2007
Major topic: Pit and Fissure Sealants
Minor topic(s): NA
Type of Article: Comparative Study
Main Purpose: To evaluate the effect of material characteristics, preparation techniques and fissure morphology on the microleakage and penetrability of pit and fissure sealants.
Key points in the article discussion:
I General:
A. Pit and fissure caries comprise >80% of all childhood carious lesions.
B. Definition of Sealant: material that is introduced into the occlusal pits and fissures of caries-susceptible teeth forming a micro-mechanically bonded, protective layer, cutting access of caries-producing bacteria from their source of nutrients.
II. Methods:
A. Sealants used:
1. Aegis, Conseal, Admira Seal, Triage, Delton Opaque.
B. 100 extracted permanent molars randomly assigned to 10 groups and sealed.
1. Pumice prophy and air abrasion
C. Following sealant placement:
1. Thermal cycling
2. Dye immersion
3. Invested in Acrylic
4. Sectioned
5. Assessed for dye penetration
II. Results:
A. Aegis showed significantly less leakage than other brands
B. Delton and Triage showed superior sealant penetration.
C. Fissure morphology not significant WRT microleakage but DID effect penetrability (U-type = most penetrable)
D. No correlation between microleakage and sealant penetrability.
III. Conclusions!
A. Material characteristics and fissure morphology were significant factors regarding sealant success while surface preparation did not play a significant role in sealant microleakage or penetrability.
Assessment of article: Shenanigans... seems to me there are huge holes in this study. More than one practitioner placed the sealants and they were not done in the mouth. I'm not sold on the results.
Date: 20AUG10
Region: Providence
Article title: Effect of Preparation Technique, Fissure Morphology, and Material Characteristics on the In Vitro Margin Permeability of Pit and Fissure Sealants
Author(s): Selecman, James et al
Journal: Pediatric Dentistry
Page #s: 308-314
Year: V29/No4 Jul/Aug 2007
Major topic: Pit and Fissure Sealants
Minor topic(s): NA
Type of Article: Comparative Study
Main Purpose: To evaluate the effect of material characteristics, preparation techniques and fissure morphology on the microleakage and penetrability of pit and fissure sealants.
Key points in the article discussion:
I General:
A. Pit and fissure caries comprise >80% of all childhood carious lesions.
B. Definition of Sealant: material that is introduced into the occlusal pits and fissures of caries-susceptible teeth forming a micro-mechanically bonded, protective layer, cutting access of caries-producing bacteria from their source of nutrients.
II. Methods:
A. Sealants used:
1. Aegis, Conseal, Admira Seal, Triage, Delton Opaque.
B. 100 extracted permanent molars randomly assigned to 10 groups and sealed.
1. Pumice prophy and air abrasion
C. Following sealant placement:
1. Thermal cycling
2. Dye immersion
3. Invested in Acrylic
4. Sectioned
5. Assessed for dye penetration
II. Results:
A. Aegis showed significantly less leakage than other brands
B. Delton and Triage showed superior sealant penetration.
C. Fissure morphology not significant WRT microleakage but DID effect penetrability (U-type = most penetrable)
D. No correlation between microleakage and sealant penetrability.
III. Conclusions!
A. Material characteristics and fissure morphology were significant factors regarding sealant success while surface preparation did not play a significant role in sealant microleakage or penetrability.
Assessment of article: Shenanigans... seems to me there are huge holes in this study. More than one practitioner placed the sealants and they were not done in the mouth. I'm not sold on the results.
The Effectiveness of a Novel Infant Tooth Wipe in High Caries-risk Babies 8-15 Months Old
Meghan Sullivan Walsh August 19, 2010
Literature Review - LMC/ Providence Pediatric Dentistry
The Effectiveness of a Novel Infant Tooth Wipe in High Caries-risk Babies 8-15 Months Old
Resident: Meghan Sullivan Walsh
Program: Lutheran Medical Center - Providence
Article Title: The Effectiveness of a Novel Infant Tooth Wipe in High Caries-risk Babies 8-15 Months Old
Authors: Anna Galgany Almeida, DDS, DScD; Melissa C. Quelroz, DDS; Alvaro Jorge M. Leite, MD
Journal: Pediatric Dentistry
Volume Number, Month, Year, Pages ; Volume 29/Number 4, July/August Issue 2007, Pages 337-341
Major Topic: Infant tooth wipes, Spiffies, efficacy in plaque removal as well as the baby and parent’s satisfaction of this product.
Overview of Method od Research: Dental plaque index scores as well questionnaires were used to collect data.
Findings: 35 high-caries risk babies ages 8-15 months were identified and selected from a hospital in Fortaleza, Brazil. These infants selected went to bed routinely with a bottle containing milk and had at least two anterior teeth. None of the babies had visited a dentist, had their teeth cleaned, nor had their parents receive any oral hygiene instruction. A Pediatric Dentist would perform a lap to lap intra-oral exam and extra-oral exam and place disclosing solution on the children’s teeth. A photo was taken of the children at this time. The parents were then randomly assigned into the control group of tooth brushing or into the ‘Spiffies Baby Tooth Wipes’ group. (Spiffies are fiber towelletes saturated with xylitol and sorbitol.) Little instruction was given to the parents on how to brush their children’s teeth. After performing the parental cleaning another digital photograph was taken. The parents were instructed to brush their children’s teeth once on the night of day one right before bed and cease tooth cleaning afterwards for the next 48-72 hours. They were also instructed to resume their regular night time feeding. The babies and their parents then returned for a second visit and the same procedures were performed however each parent used the alternative method, (Spiffies or toothbrushing.) Dental plaque index scores were utilized in both cases from the intra-oral photos.
Afterwards the parents were handed a questionnaire asking their satisfaction and perceived acceptance of their child to either cleaning method.
Results: In both the tooth brushing and Spiffies group plaque index scores were significantly reduced with no significant difference between the two groups. Overall, however, the parents and their babies were more satisfied with Spiffies for nighttime tooth cleaning rather than tooth brushing. During the day there was no preferences for the parent or child towards tooth brushing or Spiffies.
Key Points: Spiffies or dental wipes are a preferred method of cleaning for infants and their parents for nighttime tooth cleaning. Both Spiffies and tooth brushing provide adequate plaque removal on smooth surface teeth for infants ages 8-15 months.
Assessment of the Article: It should be noted that the author does agree that tooth wipes are not a sufficient means for cleansing teeth with pits and fissures. Thus, once a child shows eruption of a molar it should be insisted that parents move to tooth brushing. Because tooth wipes appear to be an appropriate cleansing method and parents seem content and satisfied with this product, this would be a great addition for a Pediatric Dental practice. Especially for infant/toddler exams and early introduction to the dental office, tooth wipes would be a great beginning for infants and their caregivers into forming a healthy opinion of the dentist as well as reducing a child’s caries risk.
Compomer as a Pit and Fissure Sealant: Effectiveness and Retention after 24 Months
Resident: J. Hencler
Date: 08/20/2010
Article title: Compomer as a Pit and Fissure Sealant: Effectiveness and Retention after 24 Months
Author(s): Puppin-Rontani et al.
Journal: Journal of Dentistry for Children-73: 1, 2006
Major topic: Sealants
Type of Article: Clinical Study
Main Purpose:
To verify the retention and effectiveness of caries prevention in the occlusal surfaces after the use of 2 fluoride-containing materials: 1) FluroShield, a resin-based sealant and 2) Compoglass, a polyacid-modified, resin based composite.
Overview of method of research:
A convenience sample from 57 children aged 7-9 years were selected from an elementary school from a community with a fluoridated water supply. 228 sound permanent molars were chosen from the sample. The 228 teeth were divided into 2 grps. Group 1: #14 and 30 were sealed using a resin-based sealant, FluroShield and Group 2: #3 and 19 were sealed using a compomer, Compoglass. The teeth were cleaned using a child-sized toothbrush and water before applying sealants under relative isolation (cotton rolls and portable saliva ejector). The retention was assessed at 6, 12, 24 months. The incidence of caries was also reported at 12 and 24 months.
Findings:
There was a significant difference between lower and upper teeth for both materials concerning total retention. (See tables for specific values)
Key points in the article discussion:
Sealed pits and fissures have reduced the incidence of dental caries in occlusal surfaces. Compomers combine the best properties of composites and glass ionomers. Characteristics include better adhesion to enamel and dentin, lower water solubility, low dehydration susceptibility, and fluoride release at the tooth sealant interface. The total retention rate for FluroShield, the resin-based sealant used in this study, was similar to that found for Compoglass, a polyacid-modified, resin-based composite. Although the total retention rates could be considered low, an increase in dental caries was not observed during the study period. This could be due to sealant remaining in the microporosities, even after it had been considered clinically lost. In these situations, the resin tags embedded in the etched enamel may still offer bacterial invasion protection to the pits and fissures. Considering the overall low retention rates in this study, the authors report that the tooth-color appearance of the sealant material tested may have made clinical detection of the sealant at follow up more difficult and led to an under estimation of the sealant retention. In addition the authors also report that due to the isolation technique chosen in this study, the upper arch presented a greater moisture control problem compared to the lower arch. This study was poorly designed. Read on for amazing conclusions.
Summary of conclusions:
When evaluated at 24 months, total sealant retention was significantly different b/t FluroShield and Compoglass concerning upper and lower teeth. FluroShield showed significantly higher total retention rates when applied in lower teeth and Compoglass showed significantly higher total retention rates when applied in upper teeth. During the follow-up period, both materials effectively prevented caries in occlusal surfaces, although both showed low retention rates.
Assessment of article:
One of many major flaws in this study is that a rubber dam was not used during sealant application. How can these authors draw any solid conclusions about sealant retention when they were not applied under RDI? Double shenanigans!
Date: 08/20/2010
Article title: Compomer as a Pit and Fissure Sealant: Effectiveness and Retention after 24 Months
Author(s): Puppin-Rontani et al.
Journal: Journal of Dentistry for Children-73: 1, 2006
Major topic: Sealants
Type of Article: Clinical Study
Main Purpose:
To verify the retention and effectiveness of caries prevention in the occlusal surfaces after the use of 2 fluoride-containing materials: 1) FluroShield, a resin-based sealant and 2) Compoglass, a polyacid-modified, resin based composite.
Overview of method of research:
A convenience sample from 57 children aged 7-9 years were selected from an elementary school from a community with a fluoridated water supply. 228 sound permanent molars were chosen from the sample. The 228 teeth were divided into 2 grps. Group 1: #14 and 30 were sealed using a resin-based sealant, FluroShield and Group 2: #3 and 19 were sealed using a compomer, Compoglass. The teeth were cleaned using a child-sized toothbrush and water before applying sealants under relative isolation (cotton rolls and portable saliva ejector). The retention was assessed at 6, 12, 24 months. The incidence of caries was also reported at 12 and 24 months.
Findings:
There was a significant difference between lower and upper teeth for both materials concerning total retention. (See tables for specific values)
Key points in the article discussion:
Sealed pits and fissures have reduced the incidence of dental caries in occlusal surfaces. Compomers combine the best properties of composites and glass ionomers. Characteristics include better adhesion to enamel and dentin, lower water solubility, low dehydration susceptibility, and fluoride release at the tooth sealant interface. The total retention rate for FluroShield, the resin-based sealant used in this study, was similar to that found for Compoglass, a polyacid-modified, resin-based composite. Although the total retention rates could be considered low, an increase in dental caries was not observed during the study period. This could be due to sealant remaining in the microporosities, even after it had been considered clinically lost. In these situations, the resin tags embedded in the etched enamel may still offer bacterial invasion protection to the pits and fissures. Considering the overall low retention rates in this study, the authors report that the tooth-color appearance of the sealant material tested may have made clinical detection of the sealant at follow up more difficult and led to an under estimation of the sealant retention. In addition the authors also report that due to the isolation technique chosen in this study, the upper arch presented a greater moisture control problem compared to the lower arch. This study was poorly designed. Read on for amazing conclusions.
Summary of conclusions:
When evaluated at 24 months, total sealant retention was significantly different b/t FluroShield and Compoglass concerning upper and lower teeth. FluroShield showed significantly higher total retention rates when applied in lower teeth and Compoglass showed significantly higher total retention rates when applied in upper teeth. During the follow-up period, both materials effectively prevented caries in occlusal surfaces, although both showed low retention rates.
Assessment of article:
One of many major flaws in this study is that a rubber dam was not used during sealant application. How can these authors draw any solid conclusions about sealant retention when they were not applied under RDI? Double shenanigans!
Friday, August 13, 2010
Resident: Adam J. Bottrill
Date: 13AUG10
Region: Providence
Article title: The Efficiency of Semiannual Silane Fluoride Varnish Applications: A Two-year Clinical Study in Preschool Children
Author(s): Petersson, Lars et al
Journal: Journal of Public Health Dentistry
Page #s: 57-60
Year: Winter 1998
Major topic: Fluoride Varnish Application
Minor topic(s): NA
Type of Article: Community Demonstration Trial
Main Purpose: To study the caries inhibitory effects of semiannual applications of fluoride varnish in preschool children.
Key points in the article discussion:
I General:
A. In Sweden all children under 20yo are guaranteed free dental care. Yet... by age 6yo >50% have clinical caries.
B. Fluoride varnish has been accepted as effective for permanent dentition, but the effects have not been described as in depth for primary dentition.
I. Methods:
A. 24 Public health clinics in Sweden
1. Pts: 5137 pre-school children between 4 and 5 yo.
2. Children split into two groups
a. fluoride varnish group treated every 6mo with topical silane fluoride varnish.
b. reference group treated with no fluoride varnish.
3. Both groups received regular preventive visits and were followed for 2 years.
a. annual, dietary counseling, OHI
b. exams performed with mirror and explorer
4. Data collected WRT caries level
II. Results:
A. Caries prevalence not different at baseline.
B. No statistical significance in the difference of overall carious lesions after 2 yrs, although the fluoride group's number was lower.
C. Difference in the levels of interproximal carious lesions WAS statistically significant. (more in the NON-fluoride group)
D. Children with DFS score of >1 showed statistically significant reduction of interproximal caries when compared to reference group.
III. Conclusions!
A. Preschool children 4-5 yo with clinical caries who receive semiannual topical application of fluoride varnish (.1% F) experience a reduced incidence of approximal caries over two years.
Assessment of article: I guess this was something I was HOPING someone proved at some point but had never actually seen an article explaining the benefit. We were all taught the scientific explanation for topical F but it's good to see some actual clinical application.
This is EITHER:
1. The article to end all articles...
OR
2. An irrefutable breakthrough that will shock the world...
OR
3. An article describing stuff we sort of already knew...
....YOU DECIDE
Date: 13AUG10
Region: Providence
Article title: The Efficiency of Semiannual Silane Fluoride Varnish Applications: A Two-year Clinical Study in Preschool Children
Author(s): Petersson, Lars et al
Journal: Journal of Public Health Dentistry
Page #s: 57-60
Year: Winter 1998
Major topic: Fluoride Varnish Application
Minor topic(s): NA
Type of Article: Community Demonstration Trial
Main Purpose: To study the caries inhibitory effects of semiannual applications of fluoride varnish in preschool children.
Key points in the article discussion:
I General:
A. In Sweden all children under 20yo are guaranteed free dental care. Yet... by age 6yo >50% have clinical caries.
B. Fluoride varnish has been accepted as effective for permanent dentition, but the effects have not been described as in depth for primary dentition.
I. Methods:
A. 24 Public health clinics in Sweden
1. Pts: 5137 pre-school children between 4 and 5 yo.
2. Children split into two groups
a. fluoride varnish group treated every 6mo with topical silane fluoride varnish.
b. reference group treated with no fluoride varnish.
3. Both groups received regular preventive visits and were followed for 2 years.
a. annual, dietary counseling, OHI
b. exams performed with mirror and explorer
4. Data collected WRT caries level
II. Results:
A. Caries prevalence not different at baseline.
B. No statistical significance in the difference of overall carious lesions after 2 yrs, although the fluoride group's number was lower.
C. Difference in the levels of interproximal carious lesions WAS statistically significant. (more in the NON-fluoride group)
D. Children with DFS score of >1 showed statistically significant reduction of interproximal caries when compared to reference group.
III. Conclusions!
A. Preschool children 4-5 yo with clinical caries who receive semiannual topical application of fluoride varnish (.1% F) experience a reduced incidence of approximal caries over two years.
Assessment of article: I guess this was something I was HOPING someone proved at some point but had never actually seen an article explaining the benefit. We were all taught the scientific explanation for topical F but it's good to see some actual clinical application.
This is EITHER:
1. The article to end all articles...
OR
2. An irrefutable breakthrough that will shock the world...
OR
3. An article describing stuff we sort of already knew...
....YOU DECIDE
Evidence-Based Use of Fluoride in Contemporary Pediatric Dental Practice
Resident: Swan
Article Title:
Evidence-Based Use of Fluoride in Contemporary Pediatric Dental Practice
Author: Steven M. Adair
Journal: Pediatric Dentistry 2006 28:2 pgs 133-140
Major Topic: Science-based recommendations for dentists regarding fluoride use in contemporary practice.
Article Type: Conference Paper--mainly reviews of meta-analyses and systematic reviews
Findings: The traditional view of fluoride's systemic effect is waning considerably, and there's really no direct evidence of fluoride having a pre-eruptive effect on teeth. The paradigm of fluoride's effect has shifted from systemic to topical effects on enamel, along with the biological effects fluoride has on cariogenic bacteria. With this change in mind, systemic fluoride supplements should be given following these recommendations:
- Give supplements only to those children who live in fluoride deficient communities and are high risk for caries
- Delay supplement use until after eruption of first permanent molars-fluorosis risk is highest from age 3-6.
- Supplements should be chewed and swished in mouth to enhance topical effect.
Guidelines for use of:
Fluoride toothpaste:
- Advise use in children 2 and older, due to fluorosis risk (although data are scarce to support the actual risk).
- Brushing needs to be supervised by an adult to be effective. Use pea-sized dabs.
- Twice daily brushing. 2x daily is more effective than 1, benefit from brushing more than 2x not well established.
Fluoride Mouthrinses:
- Advise daily use of .05% NaF mouthrinse in moderate to high-risk children, including kids undergoing orthodontic tx and those with reduced salivary flow
- Swish and spit rinses are as effective as those that are swallowed
- Use with low risk kids shows little benefit.
- Alcohol free rinses preferred
Fluoride gels/foams:
- Consider prescribing self-applied gels for high risk kids in fluoride deficient areas (5,000 ppm)
- Apply based on caries assessment.
- Professionally, apply following prophy (12,300). This replaces the surface fluoride layer that is removed.
- Use properly fitting trays, filled only enough to cover teeth, for max of 4 minutes
- Pt can spit after application. No eating/drinking for 30 minutes
Professionally applied fluoride varnish:
- Apply at 6 months intervals, for kids living in fluoridated and non-fluoridated areas.
- No eating/drinking for 30 min, no brushing until next morning.
- Apply frequently to open carious lesions in very young children (used with ART)
- Varnish may be more effective than gels and foams
Summary/Assessment: Good article that gives the current guidelines for use of all fluoride modalities. Ironically, all the studies mentioned in this article showed fluoride’s positive effect in the permanent teeth--there’s virtually no evidence to support fluoride’s use for primary teeth, but we logically assume the same benefits exist.
Thursday, August 12, 2010
Policy on Use of Fluoride/ Guideline on Fluoride Therapy
Department of Pediatric Dentistry
Resident’s Name: Jessica Wilson
Program: Lutheran Medical Center - Providence
Article title: Policy on Use of Fluoride/ Guideline on Fluoride Therapy
Author(s): AAPD, Council on Clinical Affairs
Journal: Reference Manual/Clinical Guidelines
Year. Volume (number). Page #’s: 2007-2008. 29(7). 34.
Clinical Guidelines. 2007. 111-113.
Major topic: Fluoride Recommendations
Overview of method of research:
A systematic literature review as well as expert opinions and best current practices were used to establish this policy/guideline.
Findings:
1. AAPD encourages optimal water supply fluoridation.
2. If water supply not optimal (<0.6ppm) including other dietary ingestion of fluoride, supplements should be administered according to AAPD Guidelines (see TABLE 1. of Guidelines).
3. Dentist should educate other medical professionals about the possible effects of excess fluoride ingestion prior to enamel maturation.
4. Further research to be carried out on causes of fluorosis.
5. Prenatal fluoride supplements not advised.
Key points/Summary:
Fluoridation of community water is the cheapest and most effective way to prevent caries (55-60%).
If supplements indicated, children should chew or suck on fluoride tablets in order to optimize topical exposure.
Professionally applied topical fluoride should be administered to mod-high risk children every 3-6mo. accordingly.
Fluoridated toothpaste recommended twice daily under supervision of parent/guardian. Additional at-home therapy may be advised for high risk children (rinse or gels).
Severity of fluorosis dependant on dose, duration and timing of intake.
Assessment of Article:
Good simplification of recommendations and reminders of importance of systemic intake of fluoride. Perhaps we should be taking a closer look at our patient population and educating parents about their children’s dental development needs!
Resident’s Name: Jessica Wilson
Program: Lutheran Medical Center - Providence
Article title: Policy on Use of Fluoride/ Guideline on Fluoride Therapy
Author(s): AAPD, Council on Clinical Affairs
Journal: Reference Manual/Clinical Guidelines
Year. Volume (number). Page #’s: 2007-2008. 29(7). 34.
Clinical Guidelines. 2007. 111-113.
Major topic: Fluoride Recommendations
Overview of method of research:
A systematic literature review as well as expert opinions and best current practices were used to establish this policy/guideline.
Findings:
1. AAPD encourages optimal water supply fluoridation.
2. If water supply not optimal (<0.6ppm) including other dietary ingestion of fluoride, supplements should be administered according to AAPD Guidelines (see TABLE 1. of Guidelines).
3. Dentist should educate other medical professionals about the possible effects of excess fluoride ingestion prior to enamel maturation.
4. Further research to be carried out on causes of fluorosis.
5. Prenatal fluoride supplements not advised.
Key points/Summary:
Fluoridation of community water is the cheapest and most effective way to prevent caries (55-60%).
If supplements indicated, children should chew or suck on fluoride tablets in order to optimize topical exposure.
Professionally applied topical fluoride should be administered to mod-high risk children every 3-6mo. accordingly.
Fluoridated toothpaste recommended twice daily under supervision of parent/guardian. Additional at-home therapy may be advised for high risk children (rinse or gels).
Severity of fluorosis dependant on dose, duration and timing of intake.
Assessment of Article:
Good simplification of recommendations and reminders of importance of systemic intake of fluoride. Perhaps we should be taking a closer look at our patient population and educating parents about their children’s dental development needs!
Risk of Fluorosis Associated With Infant Formulas Prepared With Bottled Water
Resident: Roberts
Date: 5/13/10
Article title: Risk of Fluorosis Associated With Infant Formulas Prepared With Bottled Water
Author: Buzalef Marilia et al.
Journal: Journal of Dentistry for Children
Volume #: 71 number: 2
Pages: 110-113
Year: 2004
Purpose:
The purpose of this study was to evaluate the daily consumption of fluoride in the diet of an infant using infant formula with fluoridated and non-fluoridated water.
Methods:
Four infant formulas(Enfanmil Lacto-free, Soy infant formula; Enfamil Prosobee, Prosobee RTF) were prepared according to manufacturer instructions using deionized water and 5 brands of bottled water(Danon, Crystal Geyeser, Pure American, Ice Mountain, Nursery Water). Possible fluoride ingestion per kg body mass was estimated, based on suggested volumes of formula consumption, for infants 1 and 12 months.
Results/Discussion:
Fluoride concentrations ranged from .076 to .214 ppm and .092 to 1.053 ppm for formulas prepared with deionized and bottled water. When prepared with deionized water, none of the formulas provided a Fl intake above the suggested threshold for fluorosis. When prepared with some brands containing .623 and .893 ppm, all of them did prove to provide sufficient fluoride intake to cause fluorosis.
Conclusion:
The threshold for fluorosis is .07 mg/kg/day of Fl. Some brands of bottled water provide in excess when combined with infant formula the necessary fluoride daily intake. As health care providers we should be conscious of these dietary effects on teeth and make recommendation to parents based on this knowledge.
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