Fluoride Toothpaste Research Articles

NATIONAL DENTAL HEALTH MONTH PROGRAM 2022 SCHOOL HEALTH PROGRAM WITH ITS KINDERGARTEN

Dental and oral health in Indonesia is still a health problem that needs attention. The most concerning thing is that as many as 93% of school-age children experience dental and mouth problems. This can be caused by a lack of knowledge and awareness of dental hygiene. One of the efforts made to increase knowledge and awareness of dental hygiene is by holding an educational activity called the "School Health Program". This activity was carried out in several schools, one of which was TK ITS. This activity began with the Training of Trainer Program given by dentists to teacher cadres and parents of students/students/students about the benefits of good oral hygiene and how to brush your teeth twice a day with fluoride toothpaste. Dentists provide educational materials using power point media and educational videos through the zoom application. There were 5 cadres consisting of 2 teachers and 3 guardians of students who attended this activity. After that, the teacher cadres and parents of the students/students disseminate information to other parents of students/students so that they can become mentors to their children to apply good and correct behavior of brushing their teeth twice a day for 21 days with the method recorded on the given calendar. The hope is that after this program ends, students at ITS Kindergarten have the behavior of maintaining oral hygiene by brushing their teeth twice a day with fluoride toothpaste.

Development and feasibility of an oral health e-learning program for long-term Japanese overseas workers: a pilot randomized controlled trial

BackgroundThis study aimed to assess the feasibility and acceptability of an oral health self-care e-learning intervention for overseas workers as well as the research procedures for a future controlled trial.MethodsWe randomly allocated participants to either the intervention (n = 48) or control (n = 51) group. The intervention group received a standardized leaflet plus a theory-based oral health e-learning program. The control group received only the standardized leaflet. We assessed health behaviour related to fluoride toothpaste use, oral care knowledge, motivation, oral care self-efficacy, and oral health related quality of life (QoL). Chi-square and t test analyses were performed to make comparisons between the two groups. To evaluate the research process, participants in the intervention group were asked open-ended questions to assess the acceptability and feasibility of the research procedures in practice.ResultsA total of 82 participants (Intervention = 36, Control = 46) were included in the analysis. The dropout rate was 17.2%. The modal time taken to complete the e-learning intervention was more than 30 min (33.3%). Of the 36 respondents in the intervention group, 27 (70.4%) said that the e-learning intervention had changed their behaviour. At the three months follow-up, oral care knowledge alone was improved in the e-learning group.ConclusionThis pilot study provides evidence that the theory-based self-care for oral health e-learning intervention is feasible in overseas workers. Next, this feasible and acceptable pilot study should be used with an appropriate sample size in a randomized controlled trial.Trial registrationThe trial protocol was registered with UMIN-CTR (ID: UMIN000045883) on 27/10/2021.

A PhD completed. Prevention and oral hygiene: instructions, toothbrush and mouthwash

Circa 35% of English-language professional dental care associations' websites provide advice and/or information on toothbrushing. Although the advice and information given varies considerably, there is consensus on the importance of brushing twice daily with a manual toothbrush and fluoride toothpaste. Alignment of national and international information on preventive oral care provided on websites, e.g. from the World Dental Federation and the International Federation of Dental Hygienists, seems necessary. It was also found that the oral hygiene behaviour of patients with periodontitis changed after initial treatment: they brushed longer daily and used an electric toothbrush, wooden toothpicks, and interdental brushes more often. Based on research with single-brushing exercises the electric toothbrush was found to be more effective than the manual toothbrush with respect to plaque reduction. If a chlorhexidine mouthwash is recommended, it can be used without creating problems before or after toothbrushing with a sodium lauryl sulphate dentifrice. Chlorhexidine and sodium fluoride may be simultaneously present in the same mouthwash without reducing chlorhexidine efficacy.

SCHOOL HEALTH PROGRAM AS AN EDUCATIONAL FACILITY IN INCREASING KNOWLEDGE ABOUT DENTAL AND ORAL HEALTH AT BUNGA BANGSA ELEMENTARY SCHOOL

Dental and oral health in Indonesia is still a health problem that requires attention. To address dental and oral health problems in Indonesia, particularly in school-age and adult groups, it is necessary to carry out promotive-preventive activities by inviting local universities and business entities that focus on dental and oral health. The most common dental and oral diseases are caries and periodontal disease. One of the strategies of the Ministry of Health of the Republic of Indonesia in reducing the number of dental caries sufferers is by declaring the "Carry Free Indonesia 2030" program. The lack of knowledge and awareness of the Indonesian population regarding dental hygiene and the difficulty of reaching information due to the geographical conditions in several regions in Indonesia which make it impossible to hamper the distribution of education. The Training of Trainer Program targets teachers and parents for 21 days of morning and evening toothbrushes, teaching children and adults about the benefits of good oral hygiene and showing them how to brush their teeth twice a day with fluoride toothpaste. This program aims to provide comprehensive, applicable and sustainable education and knowledge about dental and oral health to school-age children in Indonesia.

A Scoping Review of Early Childhood Caries Experience Assessment Tools Used for Studies in Nigeria

This scoping review provides an overview of the tools used to assess for early childhood caries (ECC) in Nigeria. A search of the literature in African Journals Online, Google Scholar, Medline, and Cochrane database was conducted in June 2023 using the PRISMA-ScR guidelines. A combination of keywords related to caries risk assessment, preschool children, and evaluation tools was used for the search. Studies reported in English and assessing ECC were extracted. Descriptive statistics were used to summarise the information on study characteristics, types of caries assessment tools, and study outcome. Caries assessment tools were divided into behavioural, social, and biological. After screening 964 potential studies, 16 were included in the review. ECC assessment tools were categorised into behavioural (snacking, frequency of consumption of refined carbohydrate in-between-meals, dental service utilisation, frequency of tooth brushing, use of fluoridated toothpaste, breast and bottle feeding patterns and duration), biological (birth rank, age, sex, anthropometric measures, molecular characterisation of isolated organisms, presence of plaque), and social (socioeconomic status of the child’s household, mother’s level of education, maternal income, occupation of the father, maternal decision-making ability). Twelve studies used behavioural assessment tools, 11 used biological, and 11 used social tools. Furthermore, 11 (70.1%) used a combination of tools, four (25.0%) used only biological tools, and one (6.2%) used only behavioural tools to assess ECC experience. No study screened for the risk of caries. In conclusion, we identified the need for comprehensive studies to identify the risk indicators of ECC in Nigeria. This will support the development of a caries risk assessment tool appropriate for the country context.

Comparative evaluation of four treatments for postorthodontic white spot lesions: a randomized controlled trial.

To evaluate the treatment efficacy of fluoride toothpaste alone and those of adjunctive use of resin infiltration, sodium fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSLs). Seventy-nine patients (356 teeth) with WSLs after orthodontic treatment were randomly allocated into four groups. The WSLs of the participants received resin infiltration only at baseline, and the other groups received fluoride varnish, CPP-ACP mousse, and placebo treatment every 6months, respectively. A toothpaste containing 1400ppm fluoride and toothbrushes were distributed to all participants, and oral hygiene instructions were provided. Photos of the teeth with WSL were taken to compare the change between groups which was measured by ImageJ software. Twelve months later, different degrees of reduction in the area of WSLs were observed in all groups. The percentage of lesion area reduction in WSLs in the resin infiltration group was 46.6%, which was significantly higher than that in fluoride varnish group (26.6%), CPP-ACP group (28.6%), and control group (29.8%), and the differences were statistically significant (p < 0.001). This study shows that after 1-year follow-up, the use of fluoride toothpaste, with or without the use of fluoride varnish or CPP-ACP, can reduce the area of WSLs. While resin infiltration can immediately improve dental aesthetics and continuously improved in 12months, resin infiltration groupshowed much better results than other groups. Clinical Trials Registration Number: ChiCTR2000032516. The use of fluoride toothpaste, with or without adjunctive use of fluoride varnish and CPP-ACP, can reduce the area of WSLs, while resin infiltration treatment has additional effect and can immediately improve dental aesthetics.

The efficacy of combined arginine and probiotics as an add-on to 1450 ppm fluoride toothpaste to prevent and control dental caries in children – A randomized controlled trial

ObjectivesTo determine how daily consumption of a lozenge combining arginine and two probiotic strains affects the Relative Risk Reduction (RRR) in children regarding dental caries transitions and lesion activity at tooth surface level during 10–12 months. MethodsA total of 21,888 tooth surfaces in 288 children were examined. The intervention group (n = 141) received a lozenge containing 2% arginine, Lacticaseibacillus rhamnosus, LGG® (DSM33156), and Lactobacillus paracasei subsp. paracasei, L. CASEI 431® (DSM33451). The placebo group (n = 147) received a placebo lozenge. Both groups received 1,450 ppm F- toothpaste. Primary canines, molars, and first permanent molars were examined clinically (ICDAS0–6) and radiographically (R0–6) at baseline and follow-up. Sealed, filled, and missing surfaces were also included. Caries activity was computed as a sum of each caries lesion's location, color, texture, cavitation, and gingival bleeding. RRRs were computed with cluster effect on surface level. ICH-GCP was followed, including external monitoring. ResultsA total of 19,950 surfaces were analyzed after excluding 1,938 tooth surfaces. No statistically significant differences were found between the groups. The RRRs showed less caries progression (13.6%, p = 0.20), more regression (0.3%, p = 0.44), and fewer active caries lesions (15.3%, p = 0.15) in the intervention group. ConclusionDaily consumption of a lozenge combining arginine and probiotics for 10–12 months given to 5–9-years-old children characterized being with low caries risk demonstrated a marked, though not statistically significant RRR for caries progression, regression, and number of active lesions in the intervention group compared to the placebo-group. ClinicalTrials.gov (NCT03928587). Clinical significanceSince all the RRRs were in favor of the intervention group and the PF of combined arginine and probiotics is high (81.6%) compared to fluoride toothpaste (24.9%) and arginine-fluoride toothpaste alone (19.6%) the combined pre-and probiotics approach may be a future additional tool regarding caries prevention and control.

Behavioral Outcomes of a Pragmatic Early Childhood Caries Management Trial.

To evaluate a preventative behavioral intervention for managing early childhood caries (ECC) in a cohort of high-risk children. This pragmatic trial of the MySmileBuddy Program (MSB) evaluated preventive behavioral outcomes in a 1-y community health worker-delivered intervention to prevent ECC progression. Pre-/postintervention surveys assessed parent-reported child engagement in therapeutic toothbrushing (i.e., adult-assisted brushing with fluoridated toothpaste twice daily) and caries-related dietary behaviors and barriers. Generalized linear model with identity link for continuous variables and logit link for dichotomous outcomes evaluated pre-/postintervention comparisons and generalized estimating equations accounted for within-participant correlation (α = 0.05). Among 1,130 children with postintervention data, the average age was 3.97 y, 99% were Medicaid insured, and 88% were Hispanic. Most parents (95%) were mothers/grandmothers, married or in a committed partnership (75%), unemployed (62%), and with modest education (80% high school degree or less). The odds of reported therapeutic brushing nearly doubled (n = 864; odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.46, 2.20, P < 0.001); day and night bottle/sippy cup frequencies dropped 0.29 units (n = 871; 95% CI = -0.37, -0.33, P < 0.001) and 0.22 units (n = 1,130; 95% CI = -0.30, -0.15, P < 0.001); nighttime breastfeeding reduced 0.15 units (n = 870; 95% CI = -0.21, -0.10, P < 0.001); sharing utensils reduced 0.30 units (n = 572; 95% CI = -0.39, -0.21, P < 0.001); not using sugary foods to calm child improved 0.37 units (n = 664; 95% CI = 0.31, 0.44, P < 0.001); odds of eating meals and snacks at a table increased (n = 572; OR = 1.57, 95% CI = 1.28, 1.93, P < 0.001; n = 572; OR = 1.80, 95% CI = 1.50, 2.15, P < 0.001) respectively; and reducing barriers to behaviors improved 0.38 units for toothbrushing (n = 666; 95% CI = 0.31, 0.44, P < 0.001) and 0.33 units for diet (n = 668; 95% CI = 0.29, 0.38, P < 0.001). Despite limitations inherent to pragmatic trials, significant behavioral changes suggest that MSB yielded an important salutary impact. Forthcoming mediation analyses will explore causal pathways. Findings support integration of MSB's behavior change program in caries management initiatives. The results of this study can be used by clinicians, public health leaders, and researchers to inform the development and implementation of community-based, preventative behaviorally focused early childhood caries prevention programs. Study findings may enhance the understanding of the impact of behavioral interventions that engage parents of young children and could lead to more effective prevention for populations at high-risk of caries.

Effect of high-fluoride toothpaste and mouth rinse on the prevention of demineralized lesions during orthodontic treatment: a randomized controlled trial.

To evaluate the effect of high-fluoride mouth rinse and high-fluoride toothpaste on the development of demineralized lesions (DLs) during orthodontic treatment. Three-armed parallel-group randomized controlled trial. The trial was performed with 270 adolescent orthodontic patients. Randomization was performed in blocks of 30, enrolling the patients into one of the following groups: the fluoride mouth rinse (FMR) group receiving 0.2% sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; high-fluoride toothpaste (HFT) group receiving 5000 ppm F toothpaste; and the Control (CTR) group receiving 1450 ppm F toothpaste. Inclusion criteria were patients scheduled for treatment in both arches with fixed appliances and age between 12 and 20 years. The primary outcome variable was the proportion of participants with at least one new demineralized lesion as assessed on digital photos taken before and after treatment, analysed by a blinded clinician. The analysis included all teeth or teeth in the aesthetic zone, i.e. all central incisors, lateral incisors, and canines. A random sample of 30 participants was assessed to check intra- and inter-reliability. For pairwise comparison between groups, Fisher's non-parametric permutation test was used for continuous variables. Blinding was employed during the caries registration and data analysis. October 2010 to December 2012. In total, 270 patients were randomized, of which 22 were excluded during treatment. Therefore, 248 participants were included in the study. The number of patients with an increase of ≥1 DL, including only central- and lateral incisors and canines, during orthodontic treatment, was significantly lower in the HFT group, 51/85 60%, compared to the CTR group, 64/82 78%, RR 0.77 (CI 0.62; 0.95), P = .01 and in the FMR group, 47/81 58%, compared to the CTR group, RR 0.74 (CI 0.60; 0.92), P < .01. To prevent demineralized lesions in the aesthetic zone, high-fluoride mouth rinse and high-fluoride toothpaste may be recommended. The protocol was not registered, and the present study did not use a double-blinded design.

Oral Health Knowledge and Habits of Hungarian Monozygotic and Dizygotic Twins: A Pilot Study

The aim of this research was to collate and analyse the data on the oral health knowledge and the related habits of a Hungarian cohort of monozygotic (MZ) and dizygotic (DZ) twins using the newly developed World Health Organisation Oral Health Questionnaire for Adults (Annex 7). A total of 15 sets of MZ twins and 14 sets of DZ twins (58 individuals) aged between 18 and 71 years were enrolled in the study. Each participant had to fill out a web-based questionnaire which comprised 23 questions (Google Forms). The data were collated and the oral health/hygiene habits of MZ and DZ twins were compared. No significant differences were detected between MZ and DZ twins with regards to their daily tooth-cleaning habits or the tooth-cleaning products used by the 2 groups. For instance, when asked how often they clean their teeth, 80% of MZ twins and 71% of DZ twins responded similarly. Further, both groups provided similar responses when questioned about the use of fluoride toothpaste, frequency of dental visits, and dental counselling received as well as a number of other parameters such as snacking of sweets and fear of visiting dentists. Our pilot analysis of the questionnaire responses from MZ and DZ twins in Hungary did not indicate any significant differences in their oral care habits in general. Further studies with a large cohort are required to confirm or refute our findings.

Burnout: A predictor of oral health impact profile among Nigerian early career doctors.

There have been reported association of oral health disorders with burnout, stress, and mental health. Arguably, with these reported associations, and the current prevalence of burnout amongst Nigerian doctors, exploring the role of burnout on oral health amongst Nigerian doctors is timely. This study aims to determine the relationship between burnout and oral health-related quality of life amongst Early Career Doctors (ECDs) in Nigeria, while also identifying the role other possible predictors plays in this relationship. This was a cross-sectional study conducted amongst Nigerian ECDs as part of Challenges of Residency Training in Nigeria (CHARTING) II project. A total of 632 ECDs were recruited across thirty-one tertiary hospitals in the 6 geopolitical zones of the country using a multistage cluster sampling technique. A self-administered paper-based semi-structured questionnaire was given to each participant that consented. The tools used to assess burnout and Oral health-related quality of life (OHRQoL) were Copenhagen Burnout Inventory (CBI) and Oral Health Impact Profile (OHIP-14) respectively. Independent samples T-test, ANOVA and Multiple linear regression were used to draw inferences from the data collected. Overall mean OHIP-14 score of all participants was 11.12 (±9.23). The scores for the 3 dimensions of burnout were below 50% with CBI-Personal Burnout having the highest score of 49.96 (±19.15). Significant positive correlations (p < 0.001) were found between OHIP-14 and all the dimensions of burnout, as the burnout scores were increasing, there was a corresponding increase in the OHIP scores thus poorer OHRQoL. The regression model shows that the predictors of OHIP were CBI-PB (p = 0.003), use of fluoride paste (p = 0.039), use of tobacco (p = 0.005) and being a denture user (p = 0.047). This study shows a positive correlation between burnout and OHIP of ECDs. We found that as burnout was increasing, OHIP increased thus implying poorer oral health related quality of life amongst ECDs. The use of fluoride toothpaste, tobacco and denture are other factors we found that could affect the OHIP of ECDs.

Remineralization potential of apacider mangosteen adhesive pastes on artificial carious lesions

Background/purposeAttention to caries administration has altered toward an early finding of lesions and targeted to noninvasive management with a remineralizing agent. This study compared the remineralization potential of apacider mangosteen adhesive pastes (AMAP), 500-ppm fluoride toothpaste (FT500), and 1000-ppm fluoride toothpaste (FT1000) on artificial caries. Materials and methodsArtificial caries were generated to enamel of eighty extracted human premolars. The specimens were allocated to four groups and subjected to pH-cycling with the application of testing agents (2 min each, for 10 days): (1) AMAP, dairy, (2) FT500, twice a day, (3) FT1000, twice a day, and (4) no treatment (NT). The surface microhardness was determined before demineralization, after demineralization, and after application of pH-cycling. The hardness, percent of hardness recovery (%HR), and percent of remineralization potential (%RP) were analyzed with ANOVA and Bonferroni's test (α = 0.05). Polarized light microscopy (PLM) was assessed for lesion depth. ResultsSignificant differences in remineralization were observed upon various agents compared to NT (P < 0.05). A significant difference in remineralization was found among AMAP, FT1000, and FT500 (P < 0.05). No significant difference in %HR and %RP was observed between AMAP and FT1000 (P > 0.05). PLM signified greater decrease in depth for AMAP, compared to FT1000 and FT500, but no depth reduction for NT. ConclusionAMAP possesses comparable remineralization ability to FT1000. However, decreasing in depth of carious lesions was evinced with using AMAP more than FT1000 and FT500. AMAP was recommended as a potential remineralization material for handling initial caries.

Combined use of stannous fluoride-containing mouth rinse and toothpaste prevents enamel erosion in vitro

ObjectiveTo compare the protective effect of commercial stannous-containing mouth rinses on enamel erosion in a simulated 5-day in vitro cycling model.Materials and methods81 human enamel specimens were embedded in resin blocks and divided into nine groups as follows; group 1: stannous fluoride (1000SnF2) toothpaste; groups 2,3, and 4 were the same as group 1 plus Elmex®, PerioMed™, and Meridol®, respectively, group 5: stannous fluoride (1450SnF2) toothpaste, groups 6, 7, and 8 were the same as group 5 plus Elmex®, PerioMed™, and Meridol®, respectively, group 9: negative control. An erosive challenge was induced with a 1 min hydrochloric acid (0.01 M, pH 2.2) treatment 3 times per day. Each cycle included immersing in the toothpaste slurry twice for two minutes and a one-minute rinse. The enamel slabs were immersed in artificial saliva between each erosive cycle and incubated overnight at 37 °C. Surface hardness loss and enamel loss were determined by Knoop surface hardness and non-contact profilometry, respectively. Finally, enamel surfaces were analyzed by scanning electron microscopy and X-ray energy dispersive spectroscopy (SEM/EDS).ResultsAll three mouth rinses had similar protective effects against erosion when using adjunct with 1000 SnF2 toothpaste (p > 0.05). With 1450 SnF2 toothpaste, Elmex® presented significantly lower surface hardness loss than Meridol® (p < 0.05). The combined use of Elmex® or PerioMed™ with toothpaste provided significantly better erosion protection than toothpaste alone, either 1000 or 1450 SnF2. In addition, 1000SnF2 toothpaste adjunct with mouth rinse is comparable to 1450 SnF2 toothpaste alone in preventing enamel erosion.ConclusionAll three mouth rinses reduced enamel erosion. The additional use of a high concentration stannous containing mouth rinse with 1450 SnF2 toothpaste increases the protective effect against enamel erosion in vitro.Clinical significanceTo date, no standard protocol for preventing dental erosion is available. There are three stannous-containing mouth rinses on the market; however, no study compared their efficacy or indicated whether using adjuncts with anti-erosion toothpaste provides additional benefits. This study found that adding stannous mouth rinse to twice-daily toothpaste increases erosion protection.

An In-Vitro Comparative Study of Fluoride Varnish and Two Calcium-Containing Fluoride Products on the Remineralization of Primary Teeth Enamel.

Objectives: To compare the effectiveness of fluoride varnish and two calcium-based fluoride products on the remineralization of primary teeth enamel. Materials and Methods: Surface-microhardness (SMH) of 36 extracted anterior primary teeth was measured by Vickers test (50gr/5 seconds) to provide a baseline for later comparisons. All teeth were immersed in demineralizing solution for 96 hours to create caries-like lesions and SMH was determined for the artificially-induced caries. The teeth were randomly assigned to three groups consisting of 5% fluoride varnish once daily/10 seconds, Clinpro™ 5000 toothpaste once daily/2 minutes, and Remin Pro cream once daily/3 minutes for 28 days. All specimens were kept in artificial saliva with pH cycling during the study period. After remineralization, SMH was evaluated for the last time. Data were analyzed by one-way ANOVA, Mauchly's sphericity, and RM-ANOVA with Bonferroni correction for inter-and- intra-group comparisons at the three stages of the study. Results: Neither the baseline SMH nor the SMH of the artificially created caries showed significant differences among the samples (P>0.05). The post-treatment SMH was highest in the Clinpro group (296.4±73.1kgf/mm2), followed by Remin Pro (283.8±119.3kgf/mm2), and varnish (270.9±78.3 kgf/mm2). There was no significant difference among the groups after treatment (P>0.05). We also did not observe a significant difference among the three different study stages (P>0.05). Conclusion: Within the limitations of this in-vitro study, daily application of low fluoride-calcium compound seems to be as effective as the professional use of fluoride varnish or high-content fluoride toothpaste in remineralizing initial caries of primary teeth.

A survey of white spot lesion prevention and resolution in the US dental school curricula.

White spot lesions (WSLs) are opaque white lesions on smooth tooth surfaces as a result of demineralization. Proven methods of prevention and resolution of these lesions are available yet the incidence rate, especially in orthodontic patients, is still high. Perhaps the way dental schools are educating students on the topic is insufficient. The purpose of this study was to determine if and how predoctoral dental students are taught about the prevention and resolution of WSLs. An electronic survey was developed and sent out to each of the 66 accredited dental schools in the United States and Puerto Rico. The survey consisted of 13 questions and inquired about whether the school includes instruction of WSLs in its predoctoral curriculum. If the school indicated instruction WSLs was in the predoctoral curriculum, further questions were asked pertaining to the content and method of the instruction. Demographic data was also gathered from each institution. Twenty-eight of the 66 schools responded for a 42% response rate. Eighty-two percent of schools indicated they were teaching about prevention of WSLs, while 50% indicated they were teaching about resolution, or treatment, of WSLs. The most commonly taught methods were patient education, over-the-counter fluoride mouthrinse, toothpaste, or gel, and high fluoride content toothpaste. The majority of responding dental schools are at least including some instruction of WSLs in the predoctoral curriculum. Many of the known prevention and treatment measures available, however, are not routinely taught.

In vitro study on the preventive effect of children’s toothpastes on erosive tooth wear of primary bovine enamel and dentin

This in vitro study aimed to analyse the effect of various children’s toothpastes on erosive tooth wear of primary bovine enamel and dentin. Enamel and dentin specimens (n = 12) were cyclically eroded (6 × 60 s/d, citric acid, pH 2.4) and brushed (2 × 15 s/d, 2 N) over 5 days. Nine fluoride toothpastes (500 to 1450 ppm) and eight toothpastes containing no fluoride or other active ingredients (hydroxyapatite and/or xylitol) were tested. Unbrushed specimens served as control. Tissue loss was quantified using widefield confocal microscopy and statistically analysed using two-way and one-way ANOVAs followed by Scheffe’s (enamel) or Tamhane’s (dentin) post-hoc tests (p < 0.05). Only one fluoride toothpaste (1400 ppm) was able to reduce erosive wear of enamel significantly by 15% compared to the control (padj. = 0.002). All fluoridated toothpastes reduced dentin surface loss significantly by 32 to 69% compared to the control (padj. ≤ 0.001), while fluoride-free toothpastes were unable to reduce dentin loss significantly (padj. ≥ 0.971). Most fluoridated toothpastes caused less erosive wear compared to fluoride-free toothpastes. Children toothpastes containing fluoride were more effective in reducing erosive wear compared to toothpastes containing no fluoride or other active ingredients.

Mouthwashes: a review on its efficacy in preventing dental caries

Background: Biofilm plays an important role in the etiology of caries, and can be removed through chemical approach using mouthwash, which has some advantages over the mechanical one. Nowadays, there are a lot of mouthwashes with many active ingredients that have been developed. Aim: To review some mouthwashes’ efficacy in preventing dental caries.Discussion: As recent studies showed that Streptococcus mutans can’t be the sole predictor of caries risk, it is suggested that the mouthwashes are also tested on the other cariogenic bacteria, to better estimate its role in reducing caries risk. It has also been proven that as an adjunctive method, mouthwashes has the ability to decrease oral microbial load and cariogenic plaque, even though the most effective way in controlling caries is still mechanical tooth brushing with fluoride toothpastes. However, long-term clinical studies are still needed to confirm the efficacy of some mouthwashes in caries prevention.Conclusion: Mechanical tooth cleaning using fluoride toothpastes remains the main and most effective way in controlling caries. The use of mouthwash, despite its potential in reducing caries risk, is limited to some people with certain conditions as an alternative method, or as an adjunction to the mechanical tooth cleaning for increasing its efficacy.

Comparative Evaluation of Remineralization and Antimicrobial Efficacy of Maximum Fluoride Containing Toothpastes Available in India - In-Vivo Study

Background: Early childhood caries (ECC) is a common type of dental caries with an overall prevalence of 49.6% in India. Dentifrices- containing 1000-1500ppm concentration of fluorides and certain remineralizing agents are known to be effective in reversal of early enamel lesions and reduction of dental caries prevalence. However, in India, the mean fluoride content of dentifrices available for children is only 449.5 ± 26.1 ppm. Only very few toothpastes with the recommended concentration of fluoride is available in the Indian market, for children below the age of 6 years. Aims: To compare and evaluate the remineralization potential and antimicrobial efficacy of toothpaste with highest amount of fluoride, available in India for children below 6years of age, with non-fluoridated remineralizing children’s toothpaste. To assess the Total Soluble Fluoride (TSF) concentration of fluoridated toothpastes. Methodology: 95 extracted or naturally exfoliated human primary teeth were decoronated and sectioned mesiodistally. Specimens were demineralized and randomly divided into six groups (3 fluoridated and 3 non-fluoridated remineralising toothpaste groups): group 1: Omnident®- 917ppm, group 2: AquaFresh®™ little teeth- 1450ppm, group 3: Colgate kids®- 1000ppm, group 4: Enafix® (Ca. orthophosphate + Ca. Sucrose phosphate), group 5: Aclaim® (Nano HAP) and group 6: Shy-NM® (Novamin). The samples were placed in the demineralizing solution for 48h and subjected to Vickers hardness test (VHT) and SEM to obtain the baseline values. Then the samples were remineralized using the respective toothpastes and were subjected to SEM and VHT at 21days, 3months and 6months intervals. Antimicrobial activity of all the dentifrices was determined by agar well diffusion method and selective ion electrode analysis was used to evaluate the Total Fluoride (TF) and Total Soluble Fluoride (TSF) concentrations among the three fluoridated toothpastes. The data obtained were statistically analysed. Results: SEM images showed mineral deposition in all the groups obliterating the defects caused due to demineralization at various intervals. Remineralising agents showed significantly higher remineralisation especially SHY-NM when compared to Fluoridated toothpastes. However they did not show any antimicrobial efficacy. Fluoridated toothpastes showed antimicrobial efficacy against S. mutans and the highest antimicrobial efficacy was seen with Aquafresh followed by Omnident and Colgate Kids which was directly proportional to the TSF concentration of the toothpastes. Conclusions: Highest remineralisation of artificial enamel lesions was shown by non- fluoridated remineralising toothpaste, however, the fluoridated dentifrices displayed both antimicrobial and remineralising properties. The Total Soluble Fluoride (TSF) concentration of fluoride toothpastes were generally slightly less than the Total Fluoride (TF) concentration (TSF/F (%): 97%- AquaFresh®TM, 61.1%-Colgate kids® and 96.5% in Omnident®), which can be correlated to the dose-dependant antimicrobial efficacy as well as remineralisation of the fluoridated toothpastes. Keywords: remineralization potential, antimicrobial efficacy, toothpaste with highest amount of fluoride, dental caries.

Execution of anticipatory guidance and the knowledge and practice gap among caregivers in Southern Taiwan: A retrospective study

This study examined the practice rate of Anticipatory Guidance (AG) and the gap between knowledge and practice among caregivers. We retrospectively collected data from caregivers who brought their children for seven age-based well-child visits (birth to 7 years old) and seven corresponding AG checklists for practice (each ranged from 16 to 19 guidance items, 118 items in total) between 2015 and 2017. Practice rates of guidance items and their association with children's sex, age, residence, and body mass index were collected and analyzed. We enrolled 2310 caregivers (330 per well-child visit). Average practice rates of guidance items in the seven AG checklists were 77.6%-95.1%, generally without significant differences between urban/rural or male/female children. However, lower (<80%) rates were observed for 32 items, including dental check-ups (38.9%), use of fluoride toothpaste (44.6%), screen time (69.4%), and drinking less sugar-sweetened beverages (SSBs) (75.5%), with corresponding knowledge-to-practice gap rates of 55.5%, 47.9%, 30.3%, and 23.8%, respectively. "Drinking less SSBs" was the only item with a higher obesity rate in the non-achieved group versus the achieved group (16.7% vs. 7.4%, p=0.036; odds ratio: 3.509, 95% CI: 1.153-10.677, p=0.027). Caregivers in Taiwan practiced most AG recommendations. However, dental check-ups, fluoride toothpaste use, drinking less SSBs, and limiting screen time were less executed items. A higher obesity rate was found among 3-7-year-old children whose caregivers failed to practice the "Drink less SSBs" guidance. Strategies to overcome the gap between knowledge and practice are needed to improve these less-achieved guidance items.

The effect of a lozenge combining prebiotic arginine and probiotics on caries increment in children during 10–12 months, a randomized clinical trial

ObjectivesTo investigate the effect of daily use of a lozenge containing arginine and probiotics for 10–12 months on caries increment, gingivitis- and plaque occurrence in children aged 5–9 years. MethodsIn this placebo-controlled, double-blinded, parallel-grouped randomized clinical trial, 343 children were randomly assigned to one of the study arms (1:1). The intervention group (n = 172) received a lozenge containing Lacticaseibacillus rhamnosus, LGG® (DSM33156), Lactobacillus paracasei subsp. paracasei, L. CASEI 431® (DSM33451) and prebiotic (arginine 2%). The placebo group (n = 171) received an identical lozenge without arginine or probiotics. Primary canines and molars, and permanent first molars were examined clinically (d/D= ICDAS1–6) and radiographically (d/D = R1–6) at baseline and follow-up. Missing (m/M), sealed (s/S), and filled (f/F) surfaces (-s/-S) in both dentitions were also included. Utilizing clinical and radiographic scorings, caries experience was classified as dICDAS1–6msf-s (primary teeth), DICDAS1–6MSF-S (permanent teeth), d/DICDAS1–6 m/M-s/S-f/F-s/S (mixed dentition). A weighted and an unweighted score system was applied. ResultsThe study was completed by 288 children. The dropout rate was 15%. The increase in ∆mean dICDAS3–6msf-s and ∆mean d/DICDAS3–6m/M-s/S-f/F-s/S was lower in the intervention group (p = 0.007). No differences were found for gingivitis- and plaque occurrence. No product-related side effects were reported. This study followed ICH-GCP including external monitoring. ConclusionDaily consumption of a lozenge containing prebiotic arginine and two strains of probiotics showed safe use and statistically significantly reduction in caries incrementbut no effect on the mean plaque or gingivitis occurrence in children. The use of a lozenge with arginine and probiotics combined has a promising potential as a supplementary tool for future management of caries. www.ClinicalTrials.gov (NCT03928587). Clinical significanceThe combination of prebiotic arginine and probiotics shows clinical potential as a supplementary approach to toothbrushing with fluoride toothpaste in managing caries increment in children. A new era in the management of caries may be emerging.