Fluoride Gel Research Articles

Improving Enamel Acid Resistance by an Intraoral Fluoride-Release Device Incorporating Cationic Hydroxy Cellulose Gel Using 3D Printer Molding

An intraoral fluoride-releasing device (IFRD) is a cost-effective tool for introducing fluoride into the oral cavity. It allows prolonged uptake of low concentrations of fluoride into teeth. We developed a new IFRD using 3D additive manufacturing and a new low-release fluoride gel. Gels for IFRDs were synthesized from hydroxyethyl cellulose (SE600) and cationic hydroxyethyl cellulose (L200). We compared the effects of the new cationic fluoride slow-release gel and non-cationic gel on enamel acid resistance in vitro. Cationization significantly increased fluoride ion concentration, as evident from its concentrations of 0.68 ± 0.08 ppm for SE600 and 4.24 ± 0.83 ppm for L200 after 60 min of immersion in distilled water. In addition, the acid resistance of bovine tooth enamel post-application was analyzed by measuring tooth loss, mineral loss (ΔZ), and lesion depth (Ld) using polarized light microscopy, electron microscopy, and micro-radiography. Compared to the SE600 group, the cationic L200 group had significantly reduced ΔZ and Ld, enhancing enamel acid resistance. This device could be implemented in areas where adequate oral care is challenging, including preventive dentistry, ward management, nursing homes, and dental clinic visits.

Effect of Acidulated Phosphate Fluoride Gel on Zirconia Intaglio Surface: An In-Vitro Study

Abstract Aim: To evaluate the micro-shear bond strength (µ-SBS) of resin-modified glass ionomer cement and to assess the chemical and topographical changes in the zirconia fitting surface induced by acidulated phosphate fluoride (APF) gel using scanning electron microscope (SEM) analysis and Fourier transform infrared (FTIR) spectroscopy. Materials and Methods: Thirty-two samples were prepared from two zirconia materials, UPCERA HT White and BruxZir® Solid Zirconia, milled by a computer-aided design/computer-aided manufacturing system. From each zirconia sample, six plates were prepared for FTIR and SEM testing. Following sintering, the samples were divided into control and test groups for each material. The APF gel (1.23%) was applied to the intaglio surface of each test group. To measure the µ-SBS between the zirconia materials and luting cement, 20 rectangular samples of zirconia material were prepared. Ten samples were obtained from Upcera and ten from Bruxzir, with five assigned to the control and five to APF groups. Statistical Analysis: For the µ-SBS test, independent samples t test was conducted to determine the level of significance between the tested groups. Results: FTIR spectroscopy revealed new bands for Upcera and Bruxzir zirconia owing to ion exchange between the formed sodium phosphate and the zirconia surface and the formation of zirconium phosphate by an ester reaction. SEM assessment identified lines, scratches, or surface dissociation that appeared on the intaglio–zirconia surface after conditioning. The µ-SBS test, as indicated by the independent samples t test, showed a significant increase in bond strength of 1.266 and 1.566 MPa for Upcera and Bruxzir zirconia, respectively. Conclusion: This study offers new practical, cost-effective, and accurate tests to enhance the µ-SBS of luting cement to yttria-stabilized tetragonal zirconia polycrystal ceramics.

The Surface Deterioration of Prefabricated Zirconia Crowns on Exposure to Acidulated Phosphate Fluoride Gel: An In Vitro Study.

Introduction Zirconia is a widely used restorative material in dentistry due to its superior aesthetic and mechanical properties. The oral cavity is a complex ecosystem with various components, which affect the teeth, as well as artificial restorative materials. Various personal and professional interventions carried out can severely affect the properties of restorative materials, thus altering the longevity of the prosthesis; 1.23% acidulated phosphate fluoride (APF) gel is one such professionally applied topical fluoride agent used to prevent caries. The interaction of this APF gel with highly aesthetic restorative material such as zirconia crowns is unknown. Objective The objective of this study is the evaluation of the surface deterioration of prefabricated zirconia crowns on exposure to deionised water and 1.23% acidulated phosphate fluoride (APF) gel with field emission scanning electron microscope (FE-SEM) and mass loss analysis. Material and method Sixty prefabricated paediatric zirconia crowns were taken, 10 samples were immersed in deionised water, 40 samples were immersed in 1.23% APF gel and 10 samples were used ascontrol. Surface morphology and mass loss analysis were carried out at time intervals of four minutes, 24 hours, 48 hours and 72 hours using FE-SEM and digital weighing machine. Results No visual change was observed in the samples immersed in deionised water at the time interval of 72 hours. There was a marked visual change in samples immersed in 1.23% APF gel at the time interval of four minutes to 72 hours; this change involved a loss of gloss to the appearance of chalkiness. FE-SEM analysis for the control group and samples immersed in deionised water showed a smooth, continuous, undisrupted top layer, while samples immersed in 1.23% APF gel showed changes ranging from surface etching, to pinhole porosities, to crack formation and disruption of the surface depending upon the exposure time. Conclusions On the immersion of zirconia crowns in an aqueous acidic medium of 1.23% APF gel, the crowns showed flaws, imperfectionsand uneven superficial layers. It has been observed that surface grains are disrupted and micropores have been formed. This degraded superficial surface when undergoes cyclic mechanical loading can accelerate the ageing phenomenon of zirconia. Mechanical forces along with a dynamic electrochemical environment can degrade the material properties of zirconia.

EVALUATING THE EFFICACY OF 38% SDF VS 5% NAF VS APF GEL IN ARRESTING DENTAL CARIES AND REDUCING BACTERIAL ACTIVITY: AN IN-VIVO STUDY

Background: The study was formulated to compare the efficacy of 38% SDF as a caries arresting agent as well as antibacterial and antiplaque agent in vivo with 5% sodium fluoride varnish (NaF) and 1.23% acidulated phosphate fluoride (APF) gel. Study Design: Total of 74 children aged 6-9 years (boys = 34, girls = 40) who had active caries with dmfs/DMFS score equal to or more than 1 were included in the study for a period of 12 months. Children were divided into three different groups-Group 1: 38%SDF Group 2: 5% fluoride varnish and Group 3: 1.23% APF gel. Fluoride application was done at baseline, 6th month and 12th month. Saliva collection was done at baseline, after 72 hrs, 6th month and12thmonth.Tryptone-yeastcysteine-sucrose-bacitracin agar (TYCSB) was used inoculate salivary Streptococcus mutans and incubated at 37°C for 72 hrs.The colony characteristics were studied and number of colony forming units of Streptococcus mutans (CFU/ml) of saliva were counted using digital colony counter.All subjects were evaluated for caries arrest status and plaque score (Silness&Loe index)at 6th and 12thmonthas well as Streptococcus mutans counts in saliva at 72 h, 6th and 12thmonth. Results: Significant reduction was found in caries arrest status plaque score as well as S. mutans counts in Group 1 as compared with Groups 2 and 3. Conclusion: In vivo application of SDF is effective in controlling progression of caries, decreases plaque score and S. mutans counts in saliva as compared to fluoride varnish and APF gel.

An SEM study on the effect of 9.3-µm CO2 laser on dentinal tubules for hypersensitivity treatment.

In-vitro studies were performed on dentin of extracted human molars to investigate the effectiveness of 9.3μm CO2 laser irradiation to occlude dentinal tubules. The observed occlusion of dentinal tubules with the irradiation was compared with application of three reagents: 2% Sodium Fluoride gel, an aqueous solution of hydroxyapatite nanoparticles and an equal mix of the two. We show that 9.3μm CO2 laser irradiation occludes dentinal tubules, and the use of laser irradiation produces better occlusion of the opened tubules compared to the use of topical reagents. Nine extracted and cleaned human molars were cut to obtain dentin disks of thickness of 3-5mm. Each disc was divided into four quarters, and each quarter served as two samples corresponding to irradiated and non-irradiated group counterparts. Five disks were used to study the effect of various laser irradiation energies on the dentinal tubules to find a good pulse fluence for occlusion of the dentinal tubules, and four disks were used for studying the effects of reagents and irradiation at the pulse fluences found in the first part of the study. The samples were irradiated with a beam diameter of 1mm (1/e2) at 15Hz pulse repetition rate, scanned automatically using a set of scanning mirrors. Samples were imaged using Scanning Electron Microscope (SEM) which were processed to determine tubule diameter. Safety of the irradiation treatment was investigated on 6 samples by measuring pulpal temperature rise. The effect of three topical reagents corresponding to 2% Sodium Fluoride gel (F), Hydroxyapatite nanoparticles (HA) and an equal mix of F and HA (HAF) on dentinal tubule occlusion was evaluated and compared with the laser irradiation. In all examined cases, laser irradiation at a fluence of 0.81J/cm2 resulted in a temperature increase less than 3°C which is safe, and no surface cracking was observed. There is a threshold pulse fluence of 0.27J/cm2 above which, laser produced surface melting. At a pulse fluence of 0.81J/cm2 a layer of recast of melted dentin was formed. Under this layer, peritubular dentin melting and occluding of the dentinal tubules was observed. Application of either F or HA or HAF did not produce visible occlusion effect on open tubules after washing and microbrushing with excess distilled water. 9.3μm CO2 laser irradiation on extracted human molar dentin at pulse fluence of 0.81J./cm2 resulted in tubule area reduction by 97% without rising pulpal temperatures to unsafe levels.

Parental Acceptance of Dental Treatment Options for Primary Teeth

Introduction: Due to the importance of preserving baby teeth, it is necessary for parents to have correct information about dental services for these teeth, the present study was conducted with the aim of investigating the acceptance of suggested treatments for baby teeth by parents. Methods: In this descriptive-cross-sectional study, 218 parents of children under 12 years old who were referred to the Pediatric Dentistry Department of Yazd Faculty of Dentistry in 2022 were randomly included in this study. The acceptance rate of dental treatments was asked by a checklist with 7 comprehensive questions and the answers were recorded. Data were analyzed using SPSS version 16 and Chi-square statistical test. Results: Out of 218 parents who participated in this study, 38 (17.4%) were male and 180 (82.6%) were female. The most acceptable treatments by parents were: pulp treatment (98.6%), dental radiographs (97.7%), tooth extraction (97.2%) and stainless-steel crowns (95%). The lowest rate of acceptance was for general anesthesia (23.4 %), fissure sealant (30.7 %) and sedation technique (36.2 %), respectively. Acceptance of fluoride gel and sedation by mothers was significantly higher than fathers (P <0.05). No statistically significant difference was observed in terms of the age and gender of the child with the acceptance of treatment by their parents (P<0.05). Conclusion: Based on the findings of the present study, the most and the least acceptable treatments according to parents were pulp therapy and general anesthesia services, respectively. Parents' level of education, monthly income, child's age،, and gender did not have a significant impact on parents' acceptance of treatment.

Assessment of the effect of experimental gel of pregabalin associated with 35% hydrogen peroxide bleaching on bovine dental enamel: an in vitro study.

To assess the effect of bleaching with gel of pregabalin associated with 35% hydrogen peroxide on the mechanical and chemical properties and ultramorphology of dental enamel. Thirty-six (36) specimens of bovine dental incisors were obtained and divided into three groups (n = 12), namely: CG = bleaching with 35% hydrogen peroxide; KFG = bleaching with 5% potassium nitrate and 2% sodium fluoride gel + 35% hydrogen peroxide; and PGG = bleaching with experimental gel of pregabalin + 35% hydrogen peroxide. The specimens were assessed with respect to Knoop microhardness, surface roughness, and colour change, before and after bleaching. They were also assessed using scanning electron microscopy and energy-dispersive spectroscopy after treatments. All groups exhibited an increase in surface roughness and a reduction in Knoop microhardness after the protocols. There was colour change in all groups, with no difference between them. In addition, there were changes in enamel morphology and non-significant loss of calcium and phosphorus. The experimental gel of pregabalin did not influence the action of 35% hydrogen peroxide, yielding results similar to those of the other groups assessed in all the parameters. Therefore, the gel of pregabalin can be an alternative for topical application on the surfaces of the teeth in association with bleaching treatments.

Polyvinylidene fluoride gel‐polyethylene composite separator optimizing the interface compatibility between the separator and the electrode

AbstractThe interface issue concerning lithium dendrite formation between the separator and electrode remains a significant impediment to the further advancement of lithium‐ion batteries (LIB). Due to the inadequate interface compatibility between the conventional polyolefin separator and the electrode, there is a propensity for lithium dendrite growth. In this work, the surface of the polyethylene (PE) separator is coated with polyvinylidene fluoride (PVDF) gel using a simple phase transformation method, resulting in the preparation of a composite separator consisting of PE and PVDF. The results demonstrate an enhanced interface compatibility following the introduction of the gel layer, with a polarization voltage as low as 0.14 V observed after 250 h of cycling. Additionally, the ionic conductivity of the PE/PVDF composite separator (1.77 mS cm−1) is enhanced, attributed to the incorporation of F functional group in PVDF gel, which could facilitate the formation of a rapid ion transport pathway through the interaction between F functional group and Li+. After the introduction of the gel layer, the discharge capacity of the battery after 250 cycles measures ~1.28 mAh, with a mere 27% decay in capacity. This study presents a novel concept for the design of composite separator in LIB.

Evaluation of the Caries-Arresting Potential of Silver Diamine Fluoride Gel With Potassium Iodide Versus Sodium Fluoride Varnish: An Observational Study.

Introduction Silver diamine fluoride (SDF) with potassium iodide (KI) has emerged as a promising, aesthetic, non-invasive management by limiting the staining caused by SDF. However, no studies are comparing the caries-arresting potential of SDF gel with KI. The study aims to observe and evaluate the caries-arresting potential of SDF gel with KI compared to sodium fluoride (NaF) varnish. Materials and methods The present observational study was conducted with a split-mouth design. A total of 33 participants, in the age group of two to six years, with occlusal caries of the International Caries Detection and Assessment System (ICDAS) I and II involving both right and left upper or lower primary molar teeth, were included. SDF gel with KI and fluoride varnish (FV) was applied to the contralateral teeth on the same arch. Participants were recalled at 3, 6, 9, and 12-month intervals to monitor the progression or arrest of carious lesions. Result At the end of 12 months, 66.7% and 70.5% of the teeth showed arrest of caries with SDF gel with KI and FV, respectively. Intra-group analysis using the Friedman test shows significant differences in both groups across the timeline (p=0.001). Intergroup analysis using the Whitney U test reveals no significant difference in caries-arresting potential between the groups at various timelines (p=0.231). Conclusion There was no significant difference in arresting enamel caries of primary teeth between the use of 5% NaF and 38% SDF with KI. However, there was a significant difference within the group between the 3rd and 12th-month follow-up. Hence, the biannual application is recommended in both FV and SDF with KI.

Fluoride Varnish Intervention for Caries Prevention in Resource-Limited African Settings- A review

Background: Fluoride may not be available to some children in African countries due to the non-use of fluoride containing toothpaste, parental perception and awareness of the benefits of fluoride in caries prevention and non-availability of fluoride in community and school water. Fluoride may also not be affordable for children of low socio-economic status in remote areas, slums areas and rural areas. Topical and systemic sources of fluoride, like fluoride drops, fluoride gel,fluoride solution, fluoride mouthrinses, fluoride tablets, and fluoride lozenges, may not be available in resource-poor countries. Method: An electronic literature search in Google Scholar, African journals online, Science direct and Google was done in August , 2023 using the Population, Concept and Context framework. Search terms and keywords were combined by Boolean operators. Two independent investigators screened titles, abstracts and accessible full texts of publications on fluoride varnish use among African children. Results: Full text was screened using inclusion criteria. Three articles were included as they were assessed to meet the aim of the review. They were hospital based and school-based studies with comparative, prospective, interventional, and randomized clinical trial and cluster-randomized controlled community trials, respectively Conclusion: Fluoride varnish can be an intervention for underserved children with white spot carious lesion in remote areas, slums areas and rural areas, and for non-cavitated carious lesions in resource poor settings. It is simple to use with simple armamentarium, More studies from diverse ethnic population in African countries will fill the gaps in knowledge. Update Dent. Coll. j: 2024; 14(1):28-30

Evaluation of incipient enamel-carious–like lesion treated with hydroxyapatite-chitosan nanocomposite hydrogel

Non-invasive restoration of tooth enamel is a topic of high relevance in dental material science. Multiple approaches have been proposed to reach optimum reconstruction results. The current study was performed to evaluate the cross-sectional microhardness besides mineral quality and content in artificially induced carious enamel after treatment with hydroxyapatite-chitosan (HAp-CS) nanocomposite gel. Artificially carious lesions were induced by immersion of teeth in acidic carboxymethyl cellulose gel (pH 4.95-5) for 24- and 72-hours periods. Two different compositions of HAp-CS nanocomposite hydrogel were prepared with two different ratios 50/50 (%) and 70/30 (%), respectively. Additionally, sodium fluoride gel (1000 ppm concentration) was prepared and used as reference. Gels were applied to carious lesions twice/day for 3 min/each. After 45 days of application, surface morphology, energy dispersive x-ray spectroscopy, micro-Raman analysis in addition to cross-sectional microhardness were evaluated. Statistical analysis was performed using two-way ANOVA and Tukey's post hoc statistical tests. Surface morphological evaluation of treated surfaces showed obliteration of surface irregularities. Groups demineralized for 24 hours and treated with 70/30 (HAp-CS) showed highest significant cross-sectional-microhardness (P ≤ 0.05). Evaluated subsurface cross-sectional microhardness showed better mineral quality for groups demineralized for 24 hours and treated with HAp-CS nanocomposite gels. Nanocomposite gel with 70/30 (HAp-CS) could efficiently improve cross-sectional microhardness and both minerals composition and quality for lesions demineralized for 24 hours. More severely induced lesions, as demineralized for 72 hours, need more powerful agent compositions and/or prolonged application protocols for improvement.

Remineralizing pretreatment using casein phosphopeptide-amorphous calcium phosphate fluoride, self-assembling peptide, and nanohydroxyapatite gel activation via invisible infrared light on the dentin microhardness and micro shear bond strength to the composite restoration

AimDifferent remineralizing pretreatments Casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF), tricalcium phosphate fluoride (TCP-F), self-assembling peptide (SAP) P11-4 and 10 % Nanohydroxyapatite (nHA) gel activation via invisible infrared light on the dentin microhardness (MH) and micro shear bond strength (µSBS) of composite restoration. MethodsSeventy-five human molar teeth were collected and the dentinal surface of all the samples was exposed to different demineralizing solutions. (n = 15) Group 1 (demineralized dentin), Group 2 (CPP ACP), Group 3 (TCP-F), Group 4 (SAP P11-4), Group 5 (nHA gel activation via invisible infrared light). MH assessment was performed using Vickers hardness. Each group of 10 samples was subjected to composite restoration buildup and µSBS were tested. The debonded samples were then observed under a stereo-microscope for failure analysis. ANOVA was conducted, along with Tukey's post hoc analysis, to examine the µSBS of composite and MH of the remineralized surface. ResultsnHA gel activation via invisible infrared light pretreated specimens showed the maximum outcomes of surface hardness (331.2 ± 77.3) and bond strength (10.38 ± 2.77). However, Group 4 (SAP P11-4) (148.3 ± 29.2) remineralized dentin displayed minimum scores of MH and µSBS (5.88 ± 1.01). ConclusionRemineralizing pretreatment nHA gel activation via invisible infrared light and casein phosphopeptide-amorphous calcium phosphate fluoride seem to improve the dentin MH and µSBS of the composite restoration.

Preventive and restorative alternatives to caries by irradiation: a scoping review.

This study is to conduct a comprehensive scoping review to map scientific evidence and clarify concepts regarding the commonly recommended preventive and restorative dental treatments for patients diagnosed with head and neck cancer (HNC) and subjected to radiotherapy. This systematic scoping review was performed under the PRISMA-ScR guidelines. The study's experimental design was registered in the Open Science Framework. In vitro studies that evaluated preventive and restorative dental treatment over 50Gy radiation doses were included. The search was conducted in November 2023 in five electronic databases (PubMed, Scopus, Web of Science, Cochrane Library, and Embase) without language or date restriction. A search strategy was applied based on keywords, MeSh terms, or synonyms. A descriptive analysis was conducted. A total of 49 studies, out of 3679 original articles identified, were included and reviewed. Of the included studies, three evaluated saliva stimulants and 35 evaluated fluoride-based preventive materials: gel (n = 18) toothpaste (n = 11) mouth rinse (n = 8) and varnish (n = 5) while 14 evaluated restorative materials: resin composite (n = 12) glass ionomer cement (n = 6) and amalgam (n = 1) Of those studies, 36 were clinical trials and 13 were in vitro studies. Fluoride gel was the most frequently recommended preventive material for preventing radiation caries with supportive clinical evidence. Resin composite and glass ionomer were the most frequently used restorative materials, respectively. However, there is not yet clinical evidence to support the use of resin composite in irradiated teeth.

Supragingival dental biofilm profile and biofilm control during orthodontic treatment with fixed orthodontic appliance: A randomized controlled trial

ObjectiveThe effectiveness of supragingival dental biofilm control during orthodontic treatment and changes in the bacterial profile were analyzed. DesignSixty-four participants aged 12–22 years (57% female) were included in the study. Participants underwent orthodontic treatment with fixed appliances and were randomly assigned to one of the three groups, which during a period of one month: (I) used chlorhexidine digluconate (CHX), (II) used high concentration of fluoride (F) gel and (III) performed standard oral hygiene. The plaque and gingivitis index, pH of biofilm and white spot lesions (WSL) were assessed. Changes of the bacteria in the biofilm were analyzed by the quantitative polymerase chain reaction ResultsIncrease in the plaque index, pH of biofilm, and WSL was observed during orthodontic treatment with standard oral hygiene. Large interindividual variability was present, and the effects of one-month use of fluorides and CHX on clinical parameters were not significant. Despite standard hygiene the abundance of studied biofilm bacteria increased - the most Streptoccocus mutans (14.2x) and S. salivarius (3.3x), moderate Veillonella parvula (3x) and the least S. sobrinus (2.3x) and Agregatibacter actinomycetemcomitans (1.9x). The use of CHX reduced S. sobrinus (2.2x) and A. actinomycetemcomitans (1.9x). Fluoride use reduced A. actinomycetemcomitans (1.3x) and S. sobrinus (1.2x). Fluorides better controlled S. mutans than CHX. ConclusionBacterial biomass in supragingival biofilm increased during treatment with metal orthodontic appliances, with greater increase in cariogenic bacteria than periopathogens. Fluoride controlled S. mutans, while CHX S. sobrinus and A. actinomycetemcomitans.

In vitro effect of fluoride gels supplemented with nano-sized sodium trimetaphosphate on enamel erosive wear

ObjectiveTo assess the protective effect of fluoride (F) gels supplemented with micrometric or nano-sized sodium trimetaphosphate (TMPmicro and TMPnano, respectively) against enamel erosion in vitro. MethodsBovine enamel blocks (n = 140) were selected according to their surface hardness, and randomly divided into seven groups (n = 20/group), according to the gels tested: Placebo (without F/TMP), 4,500 μg F/g (4500F), 9,000 μg F/g (9000F), 4500F plus 2.5 % TMPnano (2.5 % Nano), 4500F plus 5 % TMPnano (5 % Nano), 4500F plus 5 % TMPnano (Micro 5 %) and 12,300 μg F/g (Acid gel). Blocks were treated once during one minute with the gels, and submitted to erosive (ERO, n = 10/group) or erosive plus abrasive (ERO+ABR, n = 10/group) challenges 4 times/day, for 90 s for each challenge (under reciprocating agitation), during consecutive 5 days. Blocks were analyzed by profilometry, and by surface (SH) and cross-sectional hardness (∆KHN). Data were submitted to two-way ANOVA, and Fisher's LSD test (p < 0.05). ResultsFor ERO, both TMPnano-containing gels promoted enamel wear significantly lower than Placebo and 4500F, reaching levels similar to both positive controls (9000F and acid gel); significantly lower softening was observed for enamel treated with 4500F+5 % Micro and 4500F+2.5 % Nano. Also, the lowest ∆KHN values were observed for 4500F+2.5 % TMPnano among the TMP-containing gels. For ERO+ABR, the lowest enamel wear was achieved by the use of 4500F+5 % Nano among all gels, including both positive controls; lower softening was observed for Placebo and 9000F groups. ConclusionThe addition of 5 % nano-sized TMP to a low-fluoride gel produced superior protective effects for enamel under both challenges conditions, when compared with micrometric TMP, reaching values similar to or superior than both positive controls, respectively for ERO and ERO+ABR. Clinical significanceThe supplementation of low-F gels with TMP was shown to significantly improve their effects on enamel erosive wear, and the use of nano-sized TMP further enhances this protective action.

Professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries: Systematic review.

This systematic review aimed to review the safety and effectiveness of professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries (LMICs). Randomized controlled trials conducted in LMICs, in which professionally applied fluorides were compared with placebo/no treatment/health education only or usual care with a minimum one-year follow-up period, were included. Any topically applied fluoride agents such as sodium fluoride (NaF), acidulated phosphate fluoride, silver diamine fluoride (SDF), and nano silver fluoride (NSF) were included. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched in May 2022. Meta-analysis was conducted using a random effect model. This review included 33 studies for qualitative synthesis, encompassing 16,375 children aged between 1.5 and 14 years. Nevertheless, the meta-analysis focused on only 17 studies, involving 4067 children. Fourteen papers assessed potential adverse events, none of which was reported as major adverse events. SDF and NSF were identified as effective in arresting caries on primary teeth (p < 0.05) compared with a placebo or no treatment. Fluoride varnish and gel were identified as effective in reducing new caries development on primary teeth (p < 0.05) but not on permanent teeth (p > 0.05). The certainty of the generated evidence obtained is low. The review provides valuable insights into the use of professionally applied fluorides in LMICs and contributes to recommendations for their use. However, the limited rigorous evidence suggests the need for further research to strengthen these findings and draw more robust conclusions.

Influence of fluoride characteristics on tooth surface protection in an erosive condition: A multifaceted characterization approach.

To evaluate the effect of fluoride consistency and composition to protect enamel and dentin against the dental erosion. Bovine enamel and dentin specimens were treated with artificial saliva, neutral fluoride gel (NFG), acidulated phosphate fluoride gel (AFG), neutral fluoride foam (NFF), and acidulated phosphate fluoride foam. The samples were subjected to cycling. Micro energy-dispersive X-ray fluorescence spectrometry, surface roughness (Ra), contact angle (CA), and scanning electron microscopy (SEM) were performed. Composition, CA and Ra data were analyzed by ANOVA and multiple comparison test (p < 0.05). The dentin protected had a significantly higher mineral content than in the control. Eroded unprotected enamel had higher Ra values than normal surfaces. Fluoride treatments increased the Ra in dentin samples. AFG increased the CA in enamel. Fluoride foams increased CA in dentin with reduced mineral loss. SEM analysis found a deposited layer on enamel treated with AFG and remnants of deposits on dentin treated with NFG and NFF. Regardless of the form of application, fluoride provided protection against erosion, however with different levels. Applying the adequate fluoride form is relevant since the formulations have different effects on both enamel and dentin.

Comparative Evaluation of Antibacterial Efficacy and Remineralization Potential of Acidulated Phosphate Fluoride Gel with Herbal Dental Gel Containing Zingiber officinale, Salvadora persica, and Cinnamomum zeylanicum: An In Vitro Study.

The aim of the study is to evaluate and compare the antibacterial efficacy and remineralization potential of acidulated phosphate fluoride (APF) gel with herbal dental gel containing Zingiber officinale, Salvadora persica, and Cinnamomum zeylanicum. Ethanolic extracts of Z. officinale, S. persica, and C. zeylanicum were prepared. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of these extracts were determined against Streptococcus mutans and Lactobacillus acidophilus using the resazurin method and agar plate streaking method, respectively. The herbal dental gel was formulated, and its cytotoxicity was evaluated using an 3-(4,5-dimethythiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. The antibacterial susceptibility of APF gel and the herbal dental gel was assessed using the agar well diffusion method and time-kill assay. The remineralizing potential was evaluated using a stereomicroscope. Herbal dental gel showed better antibacterial efficacy as depicted by the zone of inhibition of 20 and 21 mm obtained against S. mutans and L. acidophilus, respectively, compared to 11.50 and 16.50 mm zone of inhibition obtained by APF gel. The herbal dental gel also showed better remineralization potential than APF gel after a time interval of 24 and 48 hours, as depicted with a statistically significant p-value of 0.0061 and 0.0219, respectively. In the cytotoxicity test, the fibroblasts showed 100% viability in the presence of both study groups. The results of our study concluded that herbal dental gel is safe and nontoxic, having anticariogenic potential due to its good antibacterial action and remineralization potential as compared to conventional APF gel. Kohli N, Hugar SM, Hallikerimath S, et al. Comparative Evaluation of Antibacterial Efficacy and Remineralization Potential of Acidulated Phosphate Fluoride Gel with Herbal Dental Gel Containing Zingiber officinale, Salvadora persica, and Cinnamomum zeylanicum: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(3):307-315.

The Influence of Fluoride Gels on the Physicochemical Properties of Tooth Tissues and Dental Materials-A Systematic Review.

The aim of the presented systematic review is to update the state of knowledge and relate the properties and composition of fluoride gels to their potential application. This article aims to explore the effect of fluoride gel application on changes in the properties of dental biomaterials and tooth tissues. The review includes articles assessing studies on the effects of fluoride gel on dental tissues and materials. Employing the PRISMA protocol, a meticulous search was conducted across the PubMed, Scopus, and Web of Science databases, utilizing keywords such as fluoride, gel, and properties. The publications were selected without limitation by the year of publication, and then Cohen's κ test was used to assess the agreement of the respondents. Exclusion criteria included non-English studies, opinion pieces, editorial papers, letters to the editor, review articles and meta-analyses, clinical reports, studies lacking full-text accessibility, and duplicates. The quality of the chosen papers was assessed by two independent reviewers. A total of 2385 were located in databases, of which only 17 met the inclusion criteria. All publications showed increased surface mineralization, and seven studies showed the effect of fluoride gel on the surface of dental tissues. Three articles stated a negative effect of fluoride gels on titanium and stainless steel alloys and glass ionomer fillings. The effects on shear bond strength and plaque deposition require further investigation because the study results are contradictory.

Red fluorescence intensity as a criterion for assessing remineralization efficacy in early carious lesions

ObjectivesEvaluating early carious lesion activity with an objective and clinically valid approach is crucial for developing effective treatment plans. Therefore, we here assessed the activity of non-cavitated carious lesions using a quantitative light-induced fluorescence-digital (QLF-D) camera and compared the remineralization efficiency after fluoride treatment according to the lesion's activity level. MethodsRed fluorescence emission rate (ΔR) and fluorescence loss (ΔF) were evaluated in 44 non-cavitated carious lesions by using a QLF-D camera. Based on the ΔR level, the lesions were classified into 22 active (ΔR ≥37.55) and 22 inactive carious lesions (ΔR <37.55). Each lesion was treated with 1.23 % fluoride gel for 60 s and then immersed into artificial saliva for 7 days. Subsequently, ΔR and ΔF changes in the lesions were measured. ResultsSignificant interactions between lesion activity and time were found for both ΔR and ΔF (p < 0.001). ΔR of active lesions declined faster and ΔF increased more steeply than did inactive lesions. Specifically, on day 7 post-fluoride treatment, the ΔR reduction rate was 1.40-times higher in active lesions, and the ΔF recovery rate was 2.50-times higher, indicating that active lesions respond more markedly to fluoride application. ConclusionsThis study highlighted the significance of ΔR in predicting remineralization efficiency in non-cavitated carious lesions after fluoride application. It underscored the importance of accurately assessing caries activity when formulating effective treatment plans. Lesion activity, as determined by ΔR, not only influences the outcome of remineralization treatments but also provides a more objective measure for tailoring caries management strategies.