Abstract
Objective: To compare the root carious lesion arrest of chlorhexidine (CHX) and silver diamine fluoride (SDF) varnishes and/or sodium fluoride rinses (NaF) in vitro. Background: Effective and easily applicable interventions for treating root carious lesions are needed, as these lesions are highly prevalent amongst elderly individuals. Methods: In 100 bovine dentin samples, artificial root carious lesions were induced using acetic acid and a continuous-culture Lactobacillus rhamnosus biofilm model. One quarter of each induced lesion was excavated and baseline dentinal bacterial counts assessed as Colony-Forming-Units (CFU) per mg. Samples were allocated to one of four treatments (n = 25/group): (1) untreated control; (2) 38% SDF or (3) 35% CHX varnish, each applied once, plus 500 ppm daily NaF rinse in the subsequent lesion progression phase; and (4) daily NaF rinses only. Samples were re-transferred to the biofilm model and submitted to a cariogenic challenge. After six days, another quarter of each lesion was used to assess bacterial counts and the remaining sample was used to assess integrated mineral loss (ΔZ) using microradiography. Results: ΔZ did not differ significantly between control (median (25th/75th percentiles): 9082 (7859/9782) vol % × µm), NaF (6704 (4507/9574) and SDF 7206 (5389/8082)) (p < 0.05/Kruskal–Wallis test). CHX significantly reduced ΔZ (3385 (2447/4496)) compared with all other groups (p < 0.05). Bacterial numbers did not differ significantly between control (1451 (875/2644) CFU/µg) and NaF (750 (260/1401)) (p > 0.05). SDF reduced bacterial counts (360 (136/1166)) significantly compared with control (p < 0.05). CHX reduced bacterial counts (190 (73/517)) significantly compared with NaF and control (p < 0.05). Conclusion: CHX varnish plus regular NaF rinses arrested root carious lesions most successfully.
Highlights
In many countries, the prevalence of root caries lesions among the elderly is high [1].Several factors contribute to this
From 100 samples, nine samples were lost during preparation for TMR (Figure 1). ∆Z did not differ significantly between control, NaF and adjusted silver diamine fluoride (SDF) (p > 0.05/Kruskal–Wallis)
When not adjusting SDF values for possible artifacts, SDF showed significantly reduced mineral loss compared with control, but not NaF
Summary
The prevalence of root caries lesions among the elderly is high [1]. As a result of this demographic trend, the population of elderly within nursing care is growing, with many patients being unable to perform regular oral hygiene (via tooth brushing) on their own, while tooth brushing by nursing staff is oftentimes inadequate [6,7,8,9] While this calls for effective and easy to apply preventive regimens, there is great need for managing existing root caries lesions [5]. Provision of sodium fluoride rinses (NaF) has been shown to both prevent and arrest root caries lesions by preventing demineralization and facilitating remineralization of lesions [11,12,13] Antibacterial substances such as chlorhexidine (CHX) have been found efficacious as well, especially in the absence of regular oral hygiene via tooth brushing [12,14,15]. Our secondary null-hypothesis was that none of the treatments exerted any antibacterial effects on root caries lesions
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