Atraumatic Restorative Treatment Research Articles

Adherence to the CONSORT statement of randomized clinical trials on ART restorations in children: current status and reporting characteristics.

Appropriate research reports are important to facilitate the evaluation of studies and the decision-making by dentists and policymakers. This meta-research study assessed the conformity of randomized clinical trials (RCTs) on atraumatic restorative treatment (ART) restorations with the CONSORT recommendations and their risk of bias (RoB). Cochrane Library, MEDLINE, BBO, LILACS, Scopus, and Web of Science databases were searched from April 2019 to June 2021 for RCTs that assessed the longevity of ART restorations in children. A specific tool was used to assess adherence to the CONSORT recommendations; RoB was evaluated with the Cochrane risk-of-bias tool. Descriptive analyses included the number of studies by journal, follow-up period, country, and quality assessments. A total of 2,181 papers were retrieved and 36 of them were analyzed qualitatively. The overall CONSORT mean score (CONms) was 22.52 ± 6.17 out of 32 points. The best described items were intervention and outcomes, whereas allocation concealment was described in only 22% of the papers. Significant differences in CONms were detected in the analysis by country and publication dates. High CONms were observed in recently published papers (26.7 ± 3.1) when compared to first ART studies (18.1 ± 4.6; p < 0.001). RoB was low in four studies, unclear in 11, and high in 21. Adherence of the papers to the CONSORT recommendations was not fully achieved and most of the papers had unclear and high RoB (PROSPERO registration #CRD42020201460).

ART restorations for occluso-proximal cavities in primary molars: a two-year survival and cost analysis of an RCT comparing two GIC brands

There are many glass ionomer cements available on the Brazilian market for Atraumatic Restorative Treatment (ART), however, there is still a gap in the literature regarding their cost-effectiveness. Objectives To evaluate the influence of restorative materials (Ketac Molar, 3M ESPE; and Vitro Molar, Nova DFL) in the two-year survival rate and cost-effectiveness of occluso-proximal ART restorations in primary molars. Methodology A total of 117 children (aged four to eight years) with at least one occluso-proximal carious lesion in primary molars were selected and randomly divided in treatment groups (KM or VM) in this parallel randomized controlled trial. Treatments followed ART premises and were conducted in public schools by trained operators in Barueri, Brazil. A trained, calibrated, and blinded examiner performed the evaluations after two, six, 12, and 24 months (k=0.92). Kaplan-Meier survival analysis was used to estimate restoration survival and Cox regression was used to test the association with clinical factors (α=5%). For cost analysis, material and professional costs were considered. Monte Carlo analysis was used to generate a cost-effectiveness plane and bootstrapping was used to compare material costs over the years. Results The overall survival rate was 36.9% after two years (48.6% for KM and 25.4% for VM). Restorations with VM failed more than those with KM (HR=1.70; 95% CI=1.06–2.73; p=0.027). VM presented lower initial cost, but no difference was observed between groups considering the two-year incremental cost. Conclusion After a two-year evaluation, KM proved to be a better option than VM for occluso-proximal ART restorations in primary molars. ClinicalTrials.gov: NCT02267720

Dentist´s attitude and criteria in the diagnosis and treatment of caries lesions: Survey about a clinical case.

BackgroundThe diagnosis of caries, the stage of the disease and the indication of treatment are among the most controversial issues in dentistry. Studies comparing the diagnosis and treatment indication of different professionals show the lack of a unifying criterion in the diagnosis and treatment plan of the disease. The Objectives of this research is to evaluate the attitude of a group of odontostomatologists to a clinical case with lesions compatible with caries, evaluating whether their criteria and attitude in diagnosis and treatment depend on their academic level, years of professional practice, the application of minimal intervention dentistry criteria and the usual practice in conservative restorative treatments. Material and MethodsA survey was applied to dentists registered at the Illustrious Official College of Dentists of the Balearic Islands. The questionnaire was developed by the researchers from a real clinical case. A descriptive statistical analysis was performed of all the generated data and, to evaluate the association between the survey responses and the variables of interest, the χ^2 of independence test was performed. In addition, tests comparing the corresponding proportions were conducted using Fisher’s exact test. ResultsRegarding pit and fissure significant differences were found in the diagnosis in 46 in terms of dentists’ qualifications and in the treatment between the application of minimal intervention dentistry criteria and the usual practice in conservative restorative treatments. No significant differences were found in the other variables analyzed. As regards caries lesions on proximal surfaces, no significant differences were found in the diagnosis or treatment in any of the variables analyzed. ConclusionsThat there is no change in the professional attitude towards the diagnosis and treatment of caries lesions in this group of professionals, having very interventionist criteria and attitudes in all variables analyzed. Key words:Atraumatic restorative treatment, caries detection, demineralization, non-cavitated caries lesions, radiography.

Resistência à tração diametral de cimentos de ionômero de vidro convencionais modificados na razão de pó para uso em tratamento restaurador atraumático

ABSTRACT Objective: To identify the diametral tensile strength of Brazilian brands of conventional glass ionomer cements (GIC) when modified powder ratio in their composition compared to each other, and with high viscosity glass ionomer cement for Atraumatic Restorative Treatment (ART). Methods: Experimental study with five groups (n=10 each) and specimens (2.5 mm in height and 5.0 mm in diameter), considering G1 (Maxxion R-MR), G2 (Vidrion R-VR) and G3 Vitro molar (VM-control) according to manufacturer recommending powder/liquid (1:1), G4 (MR) and G5 (VR) plus powder (2:1). The specimens were stored in an oven at 37 ± 1 ° C for 1 day. Diametral Tensile Test was performed by the Instron model 4444. Means differences were tested by Student´s T-Test (α = 5%). Results: There significant differences were in the means (standard deviation) of diametral tensile strength of MR (1:1) 4.24 (±1.47) and MR (2:1), 5.74 (±1.51) (p=0.039) and VR (1:1) 4.50 (±1.27) and VR (2:1) 6.20 (±1.89) (p=0.029). When comparing MR and VR (2:1) with MV (1:1) 4.82 (±1.17), VR 2: 1, 6.20 (±1.89) showed significant differences (p=0.0336). Conclusion: There was a significant increase in the means of diametral tensile strength of Brazilian brands conventional GICs when powder increment, approaching the performance observed by the high viscosity GIC.

Anxiety perception among children following two different restorative modalities – A noninferiority randomized clinical trial

Background: Anxiety perception among children plays a significant part in providing oral health care since both are interlinked. Perception refers to the ways or means by which anything is perceived or interpreted. Perception is awareness of the elements of the environment through physical sensation. As part of oral health-care initiation, the present study aimed to compare the anxiety perception among children following two different restorative modalities of atraumatic restorative treatment versus chemomechanical caries removal (CMCR). Methodology: A nonrandomized clinical trial was conducted over 2 months between February 20, 2021 and April 22, 2021, to compare the anxiety perception among children. Children below 14 years were selected for the study purpose. Results: Poisson regression analysis was used to evaluate the association between outcome and the variables. The results showed that the majority of children had dental anxiety issues, who were willing to improve their cooperative levels during dental treatment appointments. No statistically significant association was seen between the two different restorative modalities. Lower heart rate was observed when CMCR was used (P = 0.013). Conclusion: Anxiety perception among children plays a significant part in providing oral health care. The effectiveness of implementation was appropriate with regard to choosing the right treatment modalities among clinicians. Both the techniques showed minimal or lesser anxiety levels, but on a comparative note, CMCR was better, both in terms of patient acceptance and ease of performance.

Tratamento restaurador em paciente com Síndrome de Williams: relato de caso

ABSTRACT In Dentistry, any user with one or more limitations, of temporary or permanent mental nature, of physical, sensory, emotional or medical growth, is considered to be a Patient with Special Needs, preventing him from being subjected to a conventional dental situation. These patients form a group which may be considered at high risk for the development of oral diseases, according to the kind of pathogen. Among them, is the Williams-Beuren Syndrome, a rare congenital disease with cardiovascular involvement, mental retardation, dysmorphic face, idiopathic hypercalcemia, musculoskeletal problems, dental and growth anomalies. Familial and sporadic cases are thought to result from deletion of genetic material from adjacent genes located on the long arm of chromosome 7. This article reports a clinical case involving a four-year-old boy with Williams-Beuren Syndrome, referred to the clinic of the Specialization Course for Patients with Special Needs, at the São Leopoldo Mandic Dental Research Center, Campinas (SP). As the patient was resistant to dental care, in order to reduce anxiety and increase collaboration in clinical sessions, the Hixizine® medication was administered. For atraumatic restorative treatment and restorations, the following materials were used: Cleanjoy®, Futurabond DC®, Ionofil Plus® Grandioso®, Grandio® and Profluorid®. As result, it was possible to reach a level of excellence using the indicated materials and specific protocols. Based on this work and the lived experience, it can be observed that these patients can receive welcoming dental care in specialized clinics.

Impact of direct restorative dental materials on surface root caries treatment. Evidence based and current materials development: A systematic review.

This systematic review provides an update on the development and efficacy of direct restorative dental materials for root caries interventions from in vitro and clinical studies. PubMed, Embase, and Web of Science were searched using specific MeSH keywords. Full articles from September 1990 to October 2021 were collected. Additional articles were identified by reference retrieval and manual searching. Studies not related to restorative materials for root caries treatment, case reports, non-original articles, and/or articles not written in English were excluded. Bias risk assessment was performed for the clinical studies. Forty-two articles (eleven clinical studies and thirty-one in vitro studies) were included for analysis. Most in vitro studies indicated an excellent cariostatic effect of glass ionomer cement. Resin-modified glass ionomer restorations also presented reduced recurrent caries activity but had a lower efficacy than glass ionomer cement restorations. For composite resin restorations, the main material development strategies are to strengthen the tooth structure and integrate antimicrobial activity. The clinical studies offered limited data, so the most appropriate material for surface root caries treatment is still inconclusive. However, atraumatic restorative treatment (ART) is an alternative treatment for patients with limiting conditions. Further clinical studies are required to confirm the efficacy of bioactive materials.

Effect of Resin Coating on Surface Roughness and Microhardness of High Viscous Glass Ionomer Cements

High viscous glass ionomer cement (HVGIC) was recently developed for atraumatic restorative treatment (ART). However, its moisture sensitivity remains a limitation thus protective coating application is recommended. This study investigated the effect of resin coating on the surface roughness and microhardness of two HVGICs (Riva Self Cure HVGIC [RV] and Equia® Forte Fil [EQ]) conditioned in food-simulating liquids (FSLs). Fifty standard disc-shaped samples were fabricated using customised stainless-steel mould (10 × 2 mm). Coating was applied on top surface of all samples and subsequently divided into five groups: air (control), distilled water, 0.02 N citric acid, heptane and 50% ethanol-water solution. The samples were conditioned in FSLs at 37°C for seven days. Subsequently, the surface roughness and microhardness of samples were measured using optical profilometry and microhardness tester, respectively. SEM analysis was done for qualitative observation of surface morphological changes. Data were analysed using one-way ANOVA, two-way ANOVA and posthoc Tukey’s test (α = 0.05). Interestingly, the results revealed that surface roughness was significantly influenced by FSLs immersion, presence of coating and the materials itself (p &lt; 0.001). The lowest surface roughness was found on control coated samples: RV (50.98±4.25) nm and EQ (62.77±3.92) nm, while the highest values seen on uncoated surfaces in citric acid: RV (505.26±31.10) nm and EQ (350.33±15.36) nm. RV samples had the lowest microhardness of 54.97±2.48 Vickers hardness number (VHN) post-immersion in citric acid. In conclusion, with the exception of RV conditioned in heptane and ethanol, the uncoated HVGICs generally had higher surface roughness than the coated HVGICs. HVGICs conditioned in citric acid showed the most significant increase in surface roughness and reduction in microhardness.

Minimally Invasive Therapies for the Management of Dental Caries—A Literature Review

In recent years, due to a better understanding of the caries pathology and advances in dental materials, the utilization of non-invasive and minimally invasive techniques that delay/obviate the need for traditional restorations has started gaining momentum. This literature review focuses on some of these approaches, including fluoride varnish, silver diamine fluoride, resin sealants, resin infiltration, chemomechanical caries removal and atraumatic restorative treatment, in the context of their chemistries, indications for use, clinical efficacy, factors determining efficacy and limitations. Additionally, we discuss strategies currently being explored to enhance the antimicrobial properties of these treatment modalities to expand the scope of their application.

Antibacterial Effect of Azadirachta Indica (Neem Extract) and Antibacterial Effect of Azadirachta Indica (Neem Extract) and Chlorhexidine as Cavity Disinfectants in Primary Teeth in a Group Chlorhexidine as Cavity Disinfectants in Primary Teeth in a Group of Egyptian Children (A Randomized Clinical Trial)

Introduction: The prevention and control of caries requires the eradication of cariogenic microorganisms that produce acids responsible for reducing the pH and starting the demineralization process. With the increasing incidence of drug resistance in the prevalent pathogens and an associated risk with chemotherapeutic agents, it is essential to find an alternative to existing drugs. Aim: The aim of this study was to investigate the effect of neem extract and 2% chlorhexidine (CHX) as cavity disinfectants in the reduction of total viable count in Atraumatic Restorative Treatment (ART) in children. Subjects and Methods: The study included two test groups, Group I (2% chlorhexidine) and Group II (neem extract). Nine patients with at least one tooth with a carious lesion suitable for ART were selected for each group; samples of dentin were collected using sterile spoon excavators at three stages from each tooth: pre-excavation, post-excavation and post-disinfection of the cavities. These dentinal samples were subjected to microbiological analysis for Total Viable Count (TVC). The data collected were statistically analysed using ANOVA and Shapiro-Wilk tests. Results: The results of present study showed that there was a statistically significant reduction in TVC when compared between pre and post excavation in both groups. Conclusion: Natural antibacterial agents like neem could be effectively used as cavity disinfectant which will help in minimizing secondary caries and rendering a long term restorative success

Parent perceptions of minimally invasive dental treatment of Australian Aboriginal pre-school children in rural and remote communities.

Aboriginal* children in rural and remote communities in Australia have a higher burden of dental decay and poorer access to dental services than their non-Aboriginal counterparts. In the Kimberley region of Western Australia (WA), Aboriginal children experience six times the rate of untreated dental decay of non-Aboriginal children. Access to dental care is challenged by the availability and appropriate delivery of services in remote locations. This study elicited the experiences and perceptions of parents and carers who participated in a project that tested the minimally invasive atraumatic restorative treatment and the Hall technique approaches (ART-HT) to manage early childhood dental caries among Australian Aboriginal preschool children. The core study design was a stepped-wedge, cluster-community-randomised controlled trial. Consenting communities in the Kimberley region of WA were randomised into early and delayed intervention groups. Children were clinically examined at study commencement; the early intervention group was offered dental treatment using the ART-HT approach, and the delayed group was advised to seek dental care from their usual service provider. At the 12-month follow-up, children in both groups were re-examined and offered care using the minimally invasive model of care, and parents and carers were invited to take part in focus group or one-to-one interviews. Semistructured interviews, guided by the yarning approach, were conducted with consenting parents and carers in community locations of convenience to participants. The same open-ended questions were asked of all participants, and the interviews were audio-recorded with permission and transcribed by an independent agency. Thematic analysis was undertaken, the transcripts were coded by NVivo software, and emergent themes were identified and developed. One-to-one interviews were conducted with 29 parents and carers (10 from five test communities; 19 from eight control communities). Interview participants consisted of 3 males and 26 females. Following thematic analysis, three main themes (and subthemes) were identified: (1) access to care (barriers, service availability, impact on family due to lack of access); (2) experience of care (cultural safety, child-centred care, comprehensiveness of care); (3) community engagement (service information, engagement, oral health education). Structural and system factors as well as geography were identified as barriers by parents and carers in accessing timely and affordable dental care in culturally safe environments; parents and carers also identified the impacts from lack of access to care. They valued comprehensive care delivered within community, underpinned by child- and family-centred care. Of equal importance was the holistic approach adopted through the building of community engagement and trusting relationships. A high level of satisfaction was reported by parents and carers with their experience of dental care for their children with the minimally invasive approach. Satisfaction was expressed around ease of accessing services delivered in a child- and family-centred manner, and that were well supported by appropriate engagement between service providers, communities and families. The findings from this study suggest a minimally invasive dental care model can be considered effective and culturally acceptable and should be considered in delivering oral health services for young children in rural and remote locations. * The term Aboriginal is inclusive of Aboriginal and Torres Strait Islander peoples.

Influence of Cavity Size on the Survival of Single Surface Atraumatic Restorative Treatment Using Glass Ionomer Cement with or without Chlorhexidine Diacetate—A Randomized Trial

The purpose of the present study was to assess the influence of cavity size on the survival of conventional and CHX modified GIC in single surface primary molars receiving Atraumatic Restorative Treatment (ART). A randomized controlled trial with a split-mouth design was conducted on 90 children with symmetrical bilateral single surface carious lesions on primary molars. The teeth were randomly allotted to the conventional GIC group (group 1, n = 90) and CHX modified GIC group (group 2, n = 90). Both groups received atraumatic restorative treatment under rubber dam isolation. The cavity size was measured in terms of depth, mesiodistal, and buccolingual dimensions. The survival of ART restorations was measured after 6, 12, 18, and 24 months. The difference in proportion was tested using the Kruskal–Wallis H test, and survival curve estimation was carried out using the Kaplan–Meier method. The overall survival of all ART restorations was 83.3% at 24 months for the total sample. The survival of conventional GIC at 24 months was 83.9%, and for CHX-modified GIC was 82.7% (p &gt; 0.05). The collective overall success of 65.1% was seen in the cavity volume category of 10–29.9 mm3. CHX modified GIC showed high survival percentage (60%) with depth &gt;3 mm. To conclude, no significant difference was observed in the overall survival percentage of conventional and CHX modified GIC. Survival percentage was highest for cavities with a volume of 10–19.9 mm3.

Management of initial carious lesions of hypomineralized molars (MIH) with silver diamine fluoride or silver-modified atraumatic restorative treatment (SMART): 1-year results of a prospective, randomized clinical trial.

ObjectivesThis study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH).MethodsOne hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher’s exact test, Kaplan–Meier analysis, Mann–Whitney U test, and Friedman test.ResultsTwenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively.ConclusionsIn hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application.Clinical SignificanceBoth SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars.Trial registrationClinical Trials Registration Number: NCT03862014.

Restaurações atraumáticas : usos e limitações

The Atraumatic Restorative Treatment are internationally known through their initials (A.R.T.) were recommended by the World Health Organization for dental caries treatment in places with no dental offices. Since then, other possibilities of use are appearing. This article presents a review of its uses and limitations in and out of the dental clinic.

Atraumatic restorative treatment restorations performed in different settings: systematic review and meta-analysis.

There are potential barriers to using the atraumatic restorative treatment (ART) approach in conventional dental offices, as many professionals assume that it is only used for field conditions. This systematic review and meta-analysis evaluated the survival data of ART restorations in permanent and primary teeth when performed in and out of the conventional environment. Searches were performed on PubMed/MEDLINE, Scopus, Web of Science, and Open Grey databases up to April 2020. Studies that evaluated ART restorations were prospective and had survival rate data were included. The risk of bias was evaluated by Rob 2.0 and ROBINS-I tools. Meta-analyses were carried out considering as outcome the survival rate of primary and permanent teeth. Subgroups analysis was performed for setting and type of cavity (occlusal or multi-surface). Thirty-four studies were included. For primary teeth, in general, the overall percentage of survival rate was not influenced by setting, ranging up to 71% in 12 months to 65% in 36 months. Similarly, for permanent teeth, the overall percentage of survival rate was not influenced by setting, ranging up to 96% in 12 months to 61% in 36 months. ART is a feasible approach for field settings as well as conventional dental offices. CRD42020184680.

An Efficacy Study between High Viscosity Glass Ionomers and Resin Sealants in Fissure Caries Prevention: A 2-Year Split Mouth Randomized Controlled Trial.

Objectives This clinical trial compared the efficacy of atraumatic restorative treatment (ART) sealants against resin-based sealants in terms of their retention and fissure caries preventive benefits over a period of 24 months among a section of school children in the Southern Indian state of Telangana. Materials and Methods A split mouth clinical trial employed 198 children, who received these sealants on their lower permanent first molars. Retention was assessed 6 monthly and caries annually Statistical Analysis Chi-square tests were utilized to analyze the retention rate and the incidence of dental caries between the two groups. Kaplan–Meier survival analysis plotted the cumulative survival percentage of partially, and fully retained sealants and the survival of dentin carious free pits and fissures among both the groups. A linear binary logistical regression analysis calculated the odds ratio. Results A statistical significant difference was observed in the retention rate between these sealants at every follow-up stage. The cumulative survival percentage of ART and resin sealants was calculated to be 30.9 and 37.5% by the end of 2 years. The Kaplan–Meier analysis showed no significant difference with regard to the survival of dentin carious free pits and fissures. The odds ratio for this trial was 0.747 (95% confidence interval: 0.493–1.13) Conclusion Resin sealants fared better than ART sealants in the field of retention. However, no significant differences were observed with regard to fissure caries prevention by the end of the study period.

Atraumatic restorative treatment

Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments only, without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers). The ART approach so far has mainly used high-viscosity glass-ionomer as the sealant and restorative material.

Silver Diamine Fluoride Versus Atraumatic Restorative Treatment in Pediatric Dental Caries Management: A Systematic Review and Meta-analysis.

ABSTRACTIntroduction:The objective was to compare the clinical efficacy of silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) in arresting active caries in primary teeth and first permanent molars in children.Materials and Methods:The study protocol was registered in PROSPERO (CRD42020205675). A systematic search was performed in PubMed, Scopus, Embase, Cochrane Library, and gray literature for randomized controlled trials (RCTs) published in English language with a minimum follow-up of 6 months, comparing the caries arrest potential of SDF with ART in primary teeth and first permanent molars in children. The risk of bias and quality assessment of the studies was done using the Cochrane Collaboration Tool and Joanna Briggs Institute Critical Appraisal Tool. Data analysis was performed using RevMan software; the outcomes were summarized in meta-analysis (MA) using the random-effects model, and the odds ratio (OR) at 95% confidence interval (CI) was computed.Results:A total of 1059 studies were identified, out of which 562 remained after removal of duplicates. Eight studies were considered for full-text eligibility, and four studies were included in the qualitative review. Three out of four studies were conducted on primary dentition, whereas one study was done on erupting first permanent molars in children. MA of the two studies compared 30% SDF with ART in primary molars at 12 months and revealed the OR to be 2.02 (95% CI: 0.86–4.71; I2 = 62%; P = 0.10).Conclusion:The current review points to the lack of solid evidence comparing SDF with ART for arresting active caries in primary teeth, especially in the first permanent molars. No statistically significant difference between 30% SDF and ART in primary molars at 12 months was found in the present review. Well-designed RCTs are required to determine a minimum concentration of SDF which is effective and safe for caries arrest in children.

Comparison of Efficacy of Diode Laser and Grape Seeds Extract as Cavity Disinfectants in Primary Teeth- an in vitro study

Purpose: Cavity disinfection is an essential procedure for success of Atraumatic restorative treatment. This study was designed to test the efficacy of diode laser and grape seeds extract as primary teeth cavity disinfectants. Methods: A total of 96 sound primary molars were divided into two groups according to the test performed (n=48); antimicrobial effect/ shear bond strength. Each group was subdivided into four subgroups according to cavity disinfectants: (n=12); group1: Control (no treatment), group 2: 2% chlorhexidine gluconates (CHX), group 3: diode laser, group 4: 5%w/v grape seed extract (GSE). Occlusal cavities were inoculated with the Streptococcus mutans (S.mutans) suspension and incubated under aerobic conditions. Dentine chips were collected and S.mutans colony forming units were counted. For shear bond strength, cylindrical glass ionomer specimens were bonded to dentine surface then loaded at tooth-restoration interface till debonding. Results: Diode laser exhibited the highest antibacterial effect. No difference was detected in mean values of shear bond strength in diode laser (5.88±1.28) and GSE (3.47±1.55) groups when compared to the negative control group (4.97±1.80). Conclusion: Diode laser system is preferred over GSE and CHX as a potent cavity disinfectant for primary teeth. GSE can be used as a natural alternative for CHX

Strategic Management of Early Childhood Caries in Thailand: A Critical Overview.

The aim of this report was to advocate early childhood caries (ECC) and share strategic management in Thailand, despite over two decades of free Universal Health Coverage including oral healthcare. The recent Thai national oral health survey in 2017 indicates the very high prevalence of ECC, with an average of three carious teeth affected in 53% of 3-year-old children. This is despite the efforts of the Ministry of Public Health that has launched several interventional programs ranging from an upstream policy that prohibits sugar additions in baby formula milk to downstream remediations such as advocating and encouraging toothbrushing with fluoride toothpastes. Nevertheless, ECC is strongly predicated by other key factors including the family and community commitment and participation, as embodied in the current World Health Organization guidelines. These encompass three different tiers of community-level prevention: primary, secondary, and tertiary. Accordingly, the following strategies for ECC management in Thailand should be based at primary care clusters (PCC) in sub-district health centers, with the assistance of inter-professional health teams. These include community education on the importance of deciduous teeth and effective toothbrushing with fluoride toothpaste (primary prevention), regular examination and detection of ECC lesions and early intervention (secondary prevention), insertion of non-invasive preventive restorations using cost-effective atraumatic restorative treatment (ART) or simplified and modified ART (SMART) (tertiary prevention), and, finally, effective follow-up and monitoring systems. It is anticipated that this triple tier approach to ECC management will improve not only the oral health but also the overall children's health.