Topical Fluoride Treatment Research Articles

Clinical effectiveness/child-patient and parent satisfaction of two topical fluoride treatments for caries: a randomised clinical trial

Knowledge gaps exist regarding optimal silver diammine fluoride (SDF) regimens and the efficacy of new products for arresting dental caries in young children. We evaluated the effectiveness of 38%-SDF (SDI-RivaStar), Tiefenfluorid (TF) comparing with Placebo (P), all in conjunction with behavioural modification (BM), in preventing major complications (endodontic/extractions/pain)—a patient-centred outcome—due to early childhood caries over 12 months in children under 71-months. A six-arm, patient/parent-blinded, superiority, placebo-controlled randomised control trial at the university clinic in Riga, Latvia, from 1/9/20-31/8/22 (Protocol registration ISRCTN17005348). The trial tested six protocols, using three compounds (P/SDF/TF) under two regimes: annual and biannual (P1/P2/TF1/TF2/SDF1/SDF2) for major complications. Secondary outcomes included minor complications and parental satisfaction. All groups received BM. 373/427 randomised children (87.3%) completed the study. SDF2 had a significantly lower rate and risk of major (21.5%, OR = 0.28, 95%CI [0.11, 0.72], p < 0.05) and minor complications (OR = 0.16 (95%CI [0.05, 0.50], p = 0.002). Overall satisfaction was 96% (p > 0.05). SDF biannual application with BM effectively prevented major complications of early childhood caries and was well accepted by children and their parents. Trial registration number: ISRCTN17005348, principal investigator: Ilze Maldupa, registration date: 30/06/2021.Clinical trial registration number: ISRCTN registry: ISRCTN17005348, https://doi.org/10.1186/ISRCTN17005348, registration date: 30/06/2021.

KNOWLEDGE ATTITUDE AND AWARENESS REGARDING FLUORIDE VARNISHES AMONG UNDERGRADUATE DENTAL STUDENTS

Background: Fluoride varnishes are increasingly becoming the standard for topical fluoride treatments. While awaiting FDA approval for their use as caries preventiveagents,theyarecurrentlyconsideredoff-labelforthispurpose.This article focuses on the effectiveness of fluoride varnishes in preventing dental caries and introduces readers to various commercially available options. With ongoing clinical trials in the United States shedding light on their efficacy, it is evident that fluoride varnishes will play a vital role in our preventive strategies against dental caries.A cross-sectional study was conducted among undergraduate dental students at Mamatha dental college. Aim:KnowledgeAttitudeandAwarenessRegardingFluorideVarnishesAmong Undergraduate Dental Students. Objective:AnalyzinganddeterminingtheKnowledgeAttitudeandAwareness Regarding Fluoride Varnishes Among Undergraduate Dental Students. Method: A cross sectional study was conducted among the dental students ( II, III,IV,interns) in atertiarycareteaching hospital,Khammam, usingaweb-based tool called forms pro, a semi-structural online questionnaire was designed and distributedtothestudentsinordertofill.Descriptivestatisticsandchi-squaretest were calculated using SPSS verson-29. A p- value &lt;0.05 was used to evaluate statistical significance. Result: A total of 220 students took part with females (85.9%) and males (14.1%).Ageofparticipantsrangesfrom19-25years.Amongallthestudents Interns have more knowledge, followed by II-BDS, IV-BDS and III-BDS. Conclusion:Thestudyresultsuggeststhatknowledgeandawarenesslevelof Fluoride Varnishes is adequate.

Effects of topical fluoride treatment on the bond strength of pit and fissure sealants: A systematic review.

This systematic review aimed to evaluate the available scientific evidence concerning the effects of topical fluoride treatment on the bond strength of pit and fissure sealants. Prevention of dental caries is one of the crucial issues in pediatric dentistry. Pit and fissure sealant and fluoride therapies are two caries prevention procedures that may be performed in one session. However, fluoride therapy may affect the bond strength of pit and fissure sealants. An electronic search for in vitro studies published in English and Persian on topical fluoride therapy and the bond strength of pit and fissure sealants was performed via PubMed/ Medline, Web of Science, Google Scholar, Embase, and Scopus databases until May 2022. The articles were independently reviewed for quality by two reviewers. Textual data were analyzed manually, and the bond strength of sealants placed after fluoride application was compared with control groups. A total of 8482 articles were initially identified and reviewed by two independent reviewers, and 13 were selected for full-text evaluation. Finally, six articles were included in the systematic review. A total of 250 teeth were studied, 148 of which were in the case group (fluoride group) and 102 in the control group. Tensile and shear bond strengths were compared between groups in the studies. In the studies in which the tooth surfaces were washed after applying fluoride, there was no change in the fissure sealant bond strength. However, in studies in which fluoride was not washed, the bond strength decreased significantly, independent of the fluoride type.

Topical fluoride treatment effectiveness: a systematic review

Relevance. The systematic review aimed to evaluate the effectiveness of topical fluoride in children based on the analysis of modern randomized clinical trial (RCT) data.Materials and methods. This review was carried out using the PRISMA checklist (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The proposed criteria determined the quality of the studies for inclusion in the review and then during the result summary. A preliminary search was conducted among articles published between 2013 and 2023 where fluoride varnishes were one of the preventive products. The search included MeSH terms, the keywords "fluorides", "fluorine varnish", "caries prevention", "remineralisation", and "children". A preliminary search found 346 studies. After excluding duplicates and irrelevant studies, two independent reviewers analysed nine RCTs based on the PRISMA criteria.Results. Children aged eight months to five years old participated in five out of nine RCTs on the fluoride varnish application included in the review, and four studies included adolescents aged 14–20 y.o. The duration of the studies ranged from 2 months to 3.5 years. Six studies described the use of fluoride varnish in children, and three studies reported on the application of calcium phosphate gels with fluoride versus fluoride varnish. Various ways determined enamel condition, namely, visual method, digitally processed photography, analysis of radiographs, QLF (quantitative light fluorescence method), and laser fluorescence analysis method (Diagnodent). The dmft, ICDAS indices, caries increment, the WSL (white spot lesion) index, and the assessment of changes in the tooth damage area evaluated the prevalence and intensity of caries. In the control groups, most studies used 1000 to 1500 ppm fluoride toothpastes according to the usual scheme. None of the studies statistically proved the additional preventive effectiveness of the fluoride varnishes.Conclusions. The analysis of RCTs did not reveal the advantages of fluoride varnishes for caries prevention in children and adolescents compared to standard oral hygiene procedures using fluoride toothpastes.

Remineralizing Effect from Topical Fluoride Treatment on Inicial Lesion of Early Childhood Caries

The starting phase on early childhood caries or circular caries is an initial lesion, known as macula Alba or white spot, which is reversible, stops or reverses (perform biological repairs). In the initial lesion stage (macula alba) with the removal of caries the causative agent (dental plaque) on the one hand, and taking maximum preventive measures on the other hand: proper nutrition of the young child, salivation with normal pH and saliva composition, adequate mechanical and chemical control of dental plaque, by maintaining proper oral hygiene and topical application of fluoride preparations in various forms, conditions are created for the predominance of remineralization processes in relation to demineralization, which compensates for the insufficiency of minerals and may lead to the disappearance of the initial lesion (restutio ad integrum). Purpose of the Study investigation: Evaluation of ultra-structural enamel changes in the enamel in the starting phase on initial lesion of circular caries - Early childhood caries. It is done with Scanning Electronic Microscope (SEM) evaluation of remineralizing effects in enamel ultrastructure at the stage of initial lesion and superficial form, after topical application of fluoride-based preparation (p-p amino fluoride). Material and method: The investigation was done on laboratory tests on extracted 20 healthy lower incisions and two more groups with 10 upper incisions, where some have topical fluoride compression treatment with SEM (Scanning Electron Microscope), and the others did not have the treatment. After that, we have analysis of the remineralizing effect of fluorides with SEM photo attachments. Results: In some dental samples we managed to get almost healthy enamel, i.e. complete remineralization process of the inicial lesion. Conclusion: Once again, we have confirmation of one of the many benefits of fluoride in dentistry which is long been known.

Knowledge, attitude and practice of various types of topical fluoride for prevention of caries

Background: The expression ‘topical fluoride treatment’ refers to methods that provide a high concentration of fluoride to exposed tooth surfaces for a local protective effect. The most popular topical fluoride agents are toothpastes (dentifrices), mouthrinses, gels and varnishes that contain fluoride. These may be used separately or in combination. Topical fluoride application will be a simple but important procedure that is nominated by dental care professionals. Topical fluoride applications using fluoride varnish are recommended between two and four times for children annually and twice for adults for treatment of dental caries. Materials and methods: The study was done as an online setting, the responses were obtained from 110 dental professionals from the Chennai sub population. A self structured questionnaire comprising about 12 questions and circulated as a link to the participants. The responses were exported to google sheets and data was retrieved and analysed in SPSS software version 26. The results were obtained from SPSS software. Results: From the results analysed, it has been found that male participants (57.27%) and undergraduates (77.27%) took the majority party in the study.

Topical Fluoride Applications Related Posts Analysis on Twitter Using Natural Language Processing.

Social media is today a comprehensive source of data that can serve as a guide to professionals in issues related to public health. The purpose of this paper is to investigate the content of topical fluoride-related Twitter posts made over a 3-year period in order to improve our understanding of Twitter users' perceptions and treatment experiences. A continuous cross-sectional sample of Tweets on the subject of 'approaches to the topical fluoride treatment of tooth decay' was collected from the Twitter social networking platform between 1 January 2017 and 1 January 2020 using a software application developed for this research that makes use of the Twitter advanced search API. The words and phrases used for the identification of related Tweets were determined through a screening of the topical fluoride keywords of previous studies, and a search was conducted in the English language. To better arrange the collected Tweets and to make the data more meaningful, firstly one of the natural language process techniques - Tokenization - was applied, after which the Tweets were converted into a set of meaningful words and regular expressions. The Tweets were then compared with each other, word-by-word, with the help of a word-based Levenshtein distance algorithm, after which two experts in the computational social science domain labelled each Tweet. A total of 132,358 Tweeter posts referencing topical fluoride applications were collected, of which 110,847 were eliminated through the use of a word-based Levenshtein distance algorithm, and the remaining corpus of 21,511 posts was analysed and evaluated for specific content. Within the garnered data, 48.5% (n = 10,428) of the Tweeter posts concerned topical fluoride treatments, and 7% (n = 1,507) reported experiences with topical fluoride treatment. Negative Tweeter posts about topical fluoride treatment (5,679, 26.4%) vastly outnumbered those that were positive (3,897, 18.1%). The current study achieved its main objectives of analysing topical fluoride application-related posts made on social media. From the garnered Twitter data, it can be understood that Twitter users regularly share their concerns and negative sentiments about the side effects of topical fluoride treatments on the platform. Future explorations of social media may aid public health and dental professionals in the development of strategies to educate the public and to raise awareness of the importance of topical fluoride applications.

Practices of oral health maintenance, caries protective factors and caries experience in adults in Sekeloa Region

Introduction: Dental caries is still the most common oral disease experienced in Indonesia. Caries is caused by various factors. Practices in maintaining proper oral health are urgently needed to maintain healthy teeth and mouth to avoid various diseases, including caries. Caries prevention is inseparable from the role of protective factors that maintain the caries balance. This study was aimed at discovering the level of oral health maintenance practices, caries protective factors, as well as caries experience in adults in Sekeloa Region. Methods: The research method was descriptive cross-sectional with purposive sampling technique. The sample consisted of 61 permanent residents aged 35-44 years in South Sekeloa. Data was collected through questionnaire and DMF-T index examination. Discussion: Dental health maintenance practices including frequency, times, duration, techniques, type of brush bristles, use of brushes according to its lifetime, use of fluoride-containing toothpaste, use of interdental cleaning tools, frequency of dental visits, frequency of scaling procedures, and food consumption along with caries protective factors including the consumption of non-cariogenic snacks, xylitol chewing gum, use of chlorhexidine or fluoride mouthwash, pit and fissure sealant and topical fluoride treatments play an important role in preventing caries. Results: This study shows that subjects performed good practices of oral health maintenance (47.54%), adequate (50.82%), bad (1.64%), and good caries protective factors (1.64%), adequate (52.46%), bad (45.90%). The caries experience degree reached 9.13 and was categorized as moderate. Conclusion: The degree of caries experience in adults aged 35-44 years in the Sekeloa Region was moderate, oral health maintenance practices and caries protective factors were adequate.

Comparison Adhesive strength of Resin Composite between Total-etch and Self-etch Techniques on Enamel After Fluoride Application

Background : White Spot Lesion (WSL) is caused by Streptococcus Mutan which causes demineralization of teeth. One of the treatments of WSL is topical application of fluoride which aims to remineralize the teeth. However, if topical fluoride treatment does not give satisfactory results, alternative treatments can be made using restorative treatments, one of which is veneers. The procedure for applying veneers requires the application of an adhesive system. The adhesive system used to apply veneers is self-etch and total-etch. Several references state that the application of fluoride which aims to remineralize teeth can influence the adhesiv strength of the restorative material using self etch and total-etch techniques. Purpose : To determine the effect of composite resin adhesion strength between total-etch and self etch techniques on enamel after fluoride application. Review : Literature sources used in the preparation of the article through several databases with descriptions of the effects of fluoride application before total-etch and/or self etch administration. From the existing references, it was found that the application of fluoride before the total-etch system had a less significant effect on the adhesiv strength. Whereas in the self etch system, fluoride application has a significant effect on the adhesiv strength. Conclusion : More references say that the application of fluoride before the total-etch system has a better adhesive strength than the application of fluoride before the self etch system

Characterizing Socioeconomic Inequalities in Professionally Applied Topical Fluoride Treatment Courses in Schoolchildren from a Developing Country.

The objective of the present study was to characterize socioeconomic inequalities in the patterns of professionally applied topical fluoride (PATF) in Mexican schoolchildren. A cross-sectional study was carried out on 3029 Mexican schoolchildren. A questionnaire was administered to caregivers to determine sociodemographic, socioeconomic, and behavioral variables. The dependent variable was prevalence of PATF, coded as 0 = without PATF and 1 = with PATF, at any point in life, and separately, in the previous year. Various indicators of socioeconomic position were included. Logistic regression was used in the final multivariate analysis. The prevalence of PATF any time in life was 33.8%, while in the previous year it was 11.4%. The variables associated (p < 0.05) with PATF any time in life were child's older age (OR = 1.12), older age when tooth brushing started (OR = 1.57), higher brushing frequency (OR = 1.60), having health insurance [public (OR = 1.61) or private (OR = 1.45)], if family owned a car (OR = 1.29) and better socioeconomic position [parents' education, second (OR = 1.48) and third (OR = 1.75) tertile]. For PATF in the previous year, the variables associated were older age of mother (OR = 1.03), older age when tooth brushing started (OR = 1.99), higher brushing frequency (OR = 1.68), having health insurance [public (OR = 1.62)] and better socioeconomic position (parents' education, second (OR = 1.57) and third (OR = 1.97) tertile). This study suggests the existence of socioeconomic inequalities in PATF, manifested through socioeconomic position, access to health insurance and household having a car. Identifying and addressing PATF inequalities would improve oral health in the child population.

In Vitro Surface Investigation of Calcium Fluoride-like Precipitation on Human Enamel after Topical Treatment with the Organic Fluoride Nicomethanol Hydrofluoride.

The topical fluoride treatment of teeth can lead to a formation of CaF2-like material, which is considered to play a significant role in caries prevention. Different types of fluoride sources are applied. The aim of this study was to analyse the in vitro fluoridation effect of the lesser known organic fluoride compound nicomethanol hydrofluoride (NH) regarding fluoride accumulation and morphological changes on dental enamel surfaces. Materials and Methods: The fluoridation effect was investigated by scanning electron microscopy (SEM) and energy dispersive x-ray analysis (EDX) after treatment with fluoride solutions at a concentration of 1350 ppm F - and a pH value of 5.5. NH was tested against inorganic sodium fluoride (NaF) as reference. Fluoridation was done on pellicle-free and pellicle-covered enamel. Results: Formation of globular CaF2-like material was observed for both fluoride types. However, NH led to considerably higher calcium fluoride accumulation on the enamel surface as shown by both EDX and SEM. The globule diameters varied between 0.2 and 0.8 µm. Cross-sectional analysis revealed that the globular precipitates lay directly on the enamel surface; only the very surface-near volume was affected. No statistically significant difference of the fluoridation effect was measured with vs without saliva pre-treatment. Conclusion: The experiments showed a 6 times greater F - surface uptake on dental enamel with NH compared to sodium fluoride, thus suggesting an important role of NH during remineralization phases, fostering equilibrium between de- and remineralization.

Comparison of Enamel Fluoride Uptake from Five Fluoride-Containing Topical Treatment Products

Topical fluoride treatments have been established to reduce caries in children by as much as 25 percent [1]. Alongside fluoridated water supplies and fluoride-containing toothpaste, products specifically designed for fluoride delivery including varnishes, gels, and foams have become widespread. By introducing fluoride into outer layers of enamel (that is, 6-8% replacement of OH- by F - in hydroxyapatite) [2], the fluoridated apatite (fluorapatite) has been shown to be more resistant to acid attack than untreated enamel and inhibit bacterial enzymes [3]. Furthermore, 5% NaF varnishes have been demonstrated to improve surface micro-hardness of enamel by incorporating fluoride and phosphate into the mineral structure [4]. Fluoride varnishes have been found to be as cariostatically efficacious as other preventive agents across numerous laboratory and clinical studies [5].

Combined effects of a topical fluoride treatment and 445 nm laser irradiation of enamel against a demineralization challenge: A light and electron microscopic ex vivo study.

This study investigated the caries-preventive effect of 445 nm laser radiation in combination with fluoride on the prevention of white spot lesions. Previously, several studies have indicated the ability of 488 nm argon ion laser irradiation to reduce early enamel demineralization. A diode laser (445 nm) could be an alternative technology for possible caries-preventive potential. Each sample of a group of seventeen caries-free bovine teeth was treated in four different ways on four different zones of the labial surface: control/no treatment (C), laser irradiation only (L) (0.3 W, 60 s and applied dose of 90 J/cm2), amine fluoride application only (10,000 ppm and pH 3.9) (F), and amine fluoride application followed by laser irradiation (FL). After treatment, the teeth were subjected to a demineralization solution (pH 4.3 for 48 h at 37 °C) to induce subsurface lesions. After sectioning, the teeth were examined by light microscopy. Three teeth were analyzed by scanning electron microscopy (SEM). The depths of the subsurface lesions in the C, L, F, and FL groups were 103.01 (± 13.04), 96.99 (± 14.51), 42.59 (± 17.13), and 24.35 (± 11.38) μm, respectively. The pairwise group comparison showed the following results: p < 0.001 for FL versus C, FL versus L, F versus C, and F versus L, p = 0.019 for FL versus F and p = 0.930 for L versus C. The SEM micrographs support the light-microscopic examination. The results of the current study have shown that using relatively low irradiation settings of 445 nm laser on fluoridated enamel may be effective for prevention of white spot lesions.

Artificial Caries Resistance in Enamel after Topical Fluoride Treatment and 445 nm Laser Irradiation.

Objective This in vitro study is aimed at investigating the caries preventive effectiveness of 445 nm diode laser in combination with topical fluoridation. Materials and methods A total of 30 caries-free bovine teeth were used in this study. Eighteen teeth were covered with nail varnish except four windows on the labial surface. The windows were assigned to no treatment/control (C), laser (L) (0.3 W, 60 s, and 90 J/cm2), fluoride (F), and fluoride followed by laser (FL) treatment groups. Artificial caries lesions were created, and the teeth were sectioned and investigated under polarized light microscopy for quantitative measurement of the resulted lesion depth. Ten teeth were used for surface temperature measurement and two teeth for scanning electron microscopy (SEM). Extra twelve human molars were used for the intrapulpal temperature measurement. The absorbance of fluoride at 445 nm was measured. Results The means of lesion depth for the C, L, F, and FL groups were 123.48 (±21.93), 112.33 (±20.42), 99.58 (±30.68), and 89.03 (±30.38) μm, respectively. The pairwise differences of the L, F, and FL groups compared with the C group were significant (p < 0.05). The differences between groups were tested: FL versus L p=0.02, F versus L p=0.16, and FL versus F p=0.91, and the difference of the F versus FL was not significant (p=0.91). Temperature increment at the enamel surface and pulp roof were ∆T = 16.67 (±4.11) and 2.12 (±0.66)°C, respectively. The topical fluoride absorbance at 445 nm is five orders higher than that at 810 nm. SEM shows that after laser irradiation the enamel surface was intact and without thermal damage. Conclusions The 445 nm laser irradiation may be useful for caries prevention, and its effectiveness is lower than those previously achieved using the argon ion laser.

Polish School Nurses' Opinion and Knowledge towards Topical Fluoride Treatment.

AimThe aim of this study was to evaluate the Polish school nurses’ opinion on the topical fluoride treatment and their knowledge about fluoride safety.MethodsA cross-sectional study with the use of a self-administered questionnaire was conducted on 164 school nurses. The questionnaire concerned previous training in caries prevention, action taken at schools with regard to caries prevention, cooperation with dentists, opinion on the topical fluoride application program and nurses’ knowledge about fluoride safety.Results93.9% of nurses included oral health in their duties and 81.7% accomplished the topical fluoride treatment. 52.1% never attended any training concerning dental issues. Nurses from cities and villages more often than those from towns provided lectures on caries prevention and fluoride topical applications (respectively p= 0.033 and p=0.021, chi2 test). The nurses had a positive opinion on the effectiveness and safety of topical fluoride application. Only a half of respondents knew the fluoride probable toxic dose and one fifth of them did not know the concentration of fluoride in gel. The knowledge was statistically dependent on the level of nurses’ education (p=0.019, Kruskal-Wallis test). Nurses with a low level of knowledge were not aware of a potential harm effect of fluoride and they had negative opinion about the effectiveness of fluoride program at school.ConclusionPolish school nurses had a positive opinion on topical fluoride treatment. However, there are gaps in their knowledge and the institutional training is needed.

Parents' attitudes towards topical fluoride and vaccines for children: Are these distinct or overlapping phenomena?

Despite attention paid to parental refusal of child vaccines, the phenomenon of topical fluoride refusal is poorly understood. We examine the extent to which parent attitudes and Internet use regarding topical fluoride treatment and vaccines may overlap and, in turn, uniquely or distinctly correlate with fluoride and vaccine refusal for the child. In 2017, we analyzed data collected from 2011 to 12 for 361 children from three Washington state dental clinics. The instrument included analogous measures of topical fluoride and vaccine safety concerns, perceived severity of preventable cavities/disease, and Internet use for fluoride/vaccine information; and measures of non-fluoridated toothpaste use, attitudes towards dental x-rays and amalgam and composite fillings. We assessed dental chart-based topical fluoride refusal occurring in 2009 or 2010 and parent-reported vaccine refusal. All analogous fluoride and vaccine items were substantively correlated. However, in a series of adjusted models, none of these items were significantly associated with fluoride refusal. Multiple fluoride and vaccine items were associated with vaccine refusal in unadjusted models; but only vaccine safety concerns, perceived severity of a preventable cavity, and Internet use for vaccine information remained significant in adjusted models. Although there is concordance between the two refusal behaviors as well as analogous attitudes and Internet use, these findings challenge the idea that fluoride refusal should be addressed with interventions focusing on vaccine refusal. Further research is required on the factors underlying refusal of preventive dental care.

Oral Hygiene Index in Early Childhood Caries, Before and After Topical Fluoride Treatment.

BACKGROUND:Circular caries occurs in the earliest age of the children (1 - 1.5 year), immediately after the eruption of the deciduous teeth. During this period, children are too young to be able to properly implement oral hygiene. Consequently, it is at a negligible level, with plenty of soft plaque on the deciduous tooth surfaces.OBJECTIVE:The main objective of this clinical trial was to determine the correlation between oral hygiene shown with Oral Hygiene index, and the initial stages of circular caries (initial lesion and superficial form), before and after topical fluoride treatment.MATERIAL AND METHODS:For determination of the OHI - index we used the method of Green - Vermillion. It was determined two times in 117 patients, during the first visit and immediately before physiological replacement of deciduous teeth. Patients were two to three years old and diagnosed with initial stages of circular caries. Amino fluoride solution was applied once a week, during six months.RESULTS:We obtained statistically significant improvement of OHI - index at the end of the test, among treated subjects from both major groups.CONCLUSION:It can be concluded that the level of oral hygiene is correlated with the progression of changes in enamel. Topical fluoride treatment has a positive impact on reducing ECC.

Effects of Different Stain Removal Protocols on Bonding Orthodontic Brackets to Enamel

To evaluate the effect of different stain removal protocols with or without topical fluoride application on the bond strength of orthodontic brackets to enamel. Eighty extracted premolars were randomly assigned into four groups according to the stain removal protocol. The stain removal protocols were (1) using rubber cup with prophylaxis paste in (G1, n = 20), (2) air-abrasion with prophy-jet polishing system (G2, n = 20), (3) micro-abrasion with opalusture polishing paste (G3, n = 20), and (4) macro-abrasion with ultrafine diamond finishing tips (G4, n = 20). Ten teeth in each group (SG1, n = 10) had no topical fluoride treatment after stain removal protocol, while the rest (SG2, n = 10) were subjected to topical fluoride application. After bonding the orthodontic brackets, all specimens were thermocycled before testing their bracket-enamel bond strength. The debonded bracket and enamel surfaces of each specimen were also assessed to determine the adhesive remnant index (ARI) for each subgroup. Specimens in G2, G3, and G4 recorded lower shear bond strength as compared with G1 (p < 0.05). For all groups, specimens in SG2 demonstrated lower bond strength than their counterpart in SG1 (p < 0.05). No significant differences were detected between the ARIs of different subgroups (p > 0.05). Bonding orthodontic brackets is affected by the protocol of removing enamel stains. The use of the rubber cup with prophylaxis paste provided the highest bracket-enamel bond strength. Topical fluoride application usually complicates the bonding process of orthodontic brackets to cleaned enamel surfaces. The results of the current study indicate higher bracket bond strength to enamel surfaces treated with different stain removal protocols than the clinically acceptable values (5.9-7.8 MPa). However, the more aggressive enamel pretreatment methods should not be considered unless the clinical situation necessitates such action. Postponing the topical fluoride application is advisable to follow the bracket bonding procedure. This action would prevent the negative effect of topical fluorides on bracket-enamel bond strength.

Non-operative control of cavitated approximal caries lesions in primary molars: a prospective evaluation of cases.

The effect of non-operative caries control at cavity level is often questioned. This prospective study of cases aimed to evaluate the suitability of non-operative treatment of active cavitated approximal caries lesions in primary molars by assessing clinical changes of lesions over time. Further, we evaluate children's and parents' attitudes in response to non-operative cavity treatment. Thirty-nine children attending a community dental service, aged 5-11 years, joined the evaluation based on the following criteria: (i) the presence of at least one active cavitated caries lesion in the distal surface of first primary molar or mesial surface of the second primary molar extending up to two-thirds into dentin assessed radiographically, (ii) the absence of spontaneous pain, (iii) the absence of pulpal or periapical pathology. After informed consent, one randomly selected lesion per child had overhanging enamel margins adjusted and was treated non-operatively by the child/parent performing daily site-specific oral hygiene with a fluoridated toothpaste, supplemented by professional topical fluoride treatment and dietary advice. Nine lesions/children dropped out. Fifteen lesions survived without pulpal or periapical pathology for an average of 26 m (range 9-44). Lesion failure was associated with poor compliance or lesions not suited for the method. Children and parents were highly satisfied with the treatment. Our study identifies key factors in the performance of non-operative cavity treatment in a dental practice setting. It is concluded that non-operative cavity treatment can be a helpful method to control caries lesion progression in primary teeth and may familiarise the child with dental treatment.

Effect of Fluoride Treatments on Bleached Enamel Microhardness and Surface Morphology.

To evaluate the effect of three different fluoride treatments on the surface microhardness and morphology of human enamel exposed to two different bleaching agents. Twenty-three extracted human third molars were sectioned to obtain 90 enamel fragments, mounted on acrylic resin supports, polished and randomly divided into 9 groups (n = 10). The specimens were exposed to a combination of two bleaching agents (22% carbamide peroxide [CP] and 38% hydrogen peroxide [HP]) and three fluoride treatments (0.05% NaF daily, 0.2% NaF weekly and 5% NaF final topical fluoridation). The positive control group specimens were not exposed to bleaching agents or fluoride treatments. The negative control group specimens were exposed to the bleaching agents but none of the fluoride treatments. All specimens were stored in artificial saliva during the entire experiment, and enamel microhardness was evaluated. Surface microhardness data were statistically analysed using two-way ANOVA and Tukey's post-hoc test at a significance level of α = 0.05. Additionally, three specimens of each experimental group were examined under SEM. Two-way ANOVA revealed significant differences between the experimental groups (p < 0.05). The bleached group specimens which did not receive fluoride treatment exhibited significantly lower microhardness than those treated with fluoride (p < 0.05). Varying degrees of surface changes were observed among the experimental groups. Both bleaching agents significantly reduced enamel microhardness and the topical fluoride treatments after bleaching significantly enhanced the surface microhardness of the enamel. The surface morphology of the enamel was altered after bleaching and fluoride treatments.