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OBJECTIVES: This cluster-randomized controlled community trial aimed to assess the efficacy and costs of fluoride varnish (FV) application for caries prevention in a high-risk population in South Africa. METHODS: 513 children aged 4-8 years from two schools in a township in South Africa were randomly allocated by class to the FV or Control (CO) groups. In addition to supervised toothbrushing with fluoridated toothpaste in both groups, FV was applied in 3-month intervals by trained local non-professional assistants. Intraoral examinations were conducted at baseline, 12, 21 and 24 months. Primary outcome was the increment of teeth with cavitated lesions (i.e. newly developed or progressed, formerly non-cavitated lesions), requiring restoration or extraction over the study period. Additionally, treatment and re-treatment costs were analyzed. RESULTS: 513 children (d1-4 mft 5.9 ± 4.3 (mean ± SD)) were randomly allocated to FV (n = 287) or CO (n = 226). 10.2% FV and CO teeth received or required a restoration; 3.9% FV and 4.1% CO teeth were extracted, without significant differences between groups. While FV generated high initial costs, follow-up costs were comparable in both groups, resulting in FV being significantly more expensive than CO (1667 ± 1055 ZAR vs. 950 ± 943 ZAR, p < .001). CONCLUSIONS: Regular FV application, in addition to daily supervised toothbrushing, had no significant caries-preventive effect and was not cost-effective in a primary school setting within a peri-urban, high-risk community in South Africa. Alternative interventions on community or public health level should be considered to reduce the caries burden in high-risk communities.

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Objective In December 2019, a novel coronavirus (SARS-CoV-2) caused a disease outbreak that soon became a global pandemic. Dentists are potentially exposed to infectious microorganisms, including SARS-CoV-2, by virtue of the transmission routes and work environment. This study aims to determine the infection load in a dental healthcare setting during the onset of the pandemic in the UK, as well as to evaluate the effectiveness of recommended test regimens in order to estimate potential risks for caregivers and patients in a dynamically changing pandemic environment.Methods Twenty-four persons (dental personnel of one dental office and family contacts) were included in this pilot study, and their infection load was determined between March and May 2020 using antigen and antibody tests.Results Of the 24 subjects, three tested positive for SARS-CoV-2 and were quarantined accordingly. After six weeks, they tested negative for the virus, had built antibodies and had no remaining symptoms, enabling an efficient return to work.Conclusion This paper outlines the results of COVID-19 testing in a dental practice during the onset of the pandemic, and discusses possible strategies and protocols to gain certainty in the dental practice, assessing possible testing scenarios that can be performed in a primary healthcare setting.

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Dental caries continues to affect the British population, despite advances in prevention and management options. There are many treatment and preventive treatment strategies to address dental caries. Silver diamine fluoride (SDF) is a colourless alkaline solution containing silver and fluoride, which forms a complex with ammonia and has proven to be effective in management of dental caries. Additional dental benefits of SDF continue to be explored and discussed in the literature. SDF is a relatively new material which can be used to reduce and crystallise dental caries in a simple non-invasive treatment modality without the use of local anaesthetic. It can thus be well tolerated by children as a treatment technique and can be quickly applied to the isolated tooth without the need for extensive excavation. Currently, SDF is classified in the UK as a desensitising agent; however, it may be reclassified as a caries treatment agent at some stage and thus provide an effective non-invasive treatment for children's tooth decay. This would prevent the multiple admissions for dental extraction under general anaesthetic, as a simpler approach can be provided. This article will evaluate and review the literature behind SDF and provide details on its use and clinical application.

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The single discoloured tooth poses an aesthetic dilemma. While several treatment approaches are available, bleaching offers a minimally invasive, aesthetic treatment modality. Predictability and success with bleaching stems from correct diagnosis, didactic treatment planning and the utilisation of appropriate techniques. This article aims to discuss the aetiologies of a single discoloured tooth and, through evaluation of the literature and discussion of clinical cases, explore the theory, safety and bleaching techniques available.

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Charcoal toothpastes and powders are fashionable oral hygiene products, intended for toothbrushing, extrinsic stain removal and, it is claimed, 'tooth whitening'. The popularity of charcoal toothpastes is believed to be increasing in many countries across the world, including the UK, US, Japan, India, Thailand, Lithuania, Australia, Hong Kong, China, Korea and Switzerland, where charcoal-based toothpastes have been reported to be produced. It is understood that many patients ask members of their dental team for advice on the use and benefits of charcoal toothpastes and powders, and that such advice is often empirical. The purpose of this article is to provide an overview of the current knowledge and understanding of charcoal toothpastes and powders, including consideration of the strength of the evidence to support claims made by the manufacturers of these products.

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Introduction EU council directive 2011/84/EU resulted in a demand for over the counter (OTC) bleaching products. The industry has latched onto this renewed demand by developing a range of non-hydrogen peroxide OTC products. Aims To determine whether non-hydrogen peroxide OTC whitening products available in the UK are safe and to determine the lightening effect of those products. Materials and methods A total of 21 extracted teeth (11 incisors and ten premolars) were collected and stored in chloramine-T solution. Five days before the study, all teeth were immersed in 5 ml of a standard green tea solution at room temperature (22±2 °C). Roots were sectioned from the teeth and cleaned using an ultrasonic bath. Teeth were then embedded in epoxy resin and sectioned inciso-gingivally to serve as paired test and control specimens. A positive control of 10% carbamide peroxide was used while saline was used as a negative control. Five OTC products were selected from two major British consumer outlets. Initially, products were applied to the teeth samples for two one-hour cycles, followed by the equivalent of one-week's application, according to the manufacturer's instruction. Samples were stored overnight in saline to minimise any effects of dehydration. Shades of teeth were taken blindly by a single trained clinician in a natural light environment against a grey background before and after application of the products. Vickers microhardness tests and scanning electron microscopy (SEM) analysis were undertaken. Results SEM analysis showed surface morphology alterations to varying degrees, with several samples demonstrating a distinct etching pattern post-exposure to the OTC products. Sample three ('Brilliant 5 minute kit') and sample five ('iWhite instant teeth whitening') produced the most extensive surface alterations. Samples three and five also resulted in a significant reduction (p = 0.008) in Vickers microhardness. Two OTC products resulted in a lightening effect less than the negative control saline, whereas two other OTC products resulted in a lightening effect greater than carbamide peroxide. Conclusion This study suggests that non-hydrogen peroxide OTC products have the potential to damage enamel and lighten teeth. The lightening effect of the OTC products is variable, however, it is most likely to occur in sodium chlorite based products.

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White lesions occur commonly on the anterior teeth. There are numerous reasons why these lesions appear in the anterior dentition, and these reasons will be discussed in detail. For some patients, these white lesions may be considered unsightly and the patients may seek treatment to have them removed; other patients are not concerned about their presence on their anterior teeth. Some of the white lesions are caused by demineralization and occur because of poor oral hygiene. For the purpose of this article, developmental white lesions will be discussed in detail, along with the options for treatment of these lesions.

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