RESUMO

Introducción: el control de cavidades sin restauración (NRCC, por sus siglas en inglés), es una opción de tratamiento conservador y no invasivo para dentina cariosa, sobre todo en dentición temporal. Una de las estrategias del NRCC es la remineralización. El fluoruro de estaño (FDE) puede considerarse, como una opción viable ya que existe evidencia de su eficacia cariostática. Objetivo: valorar al FDE como remineralizante alternativo en dentina de molares temporales, asociado al NRCC. Material y métodos: se efectuó un estudio clínico, epidemiológico, y descriptivo con preescolares voluntarios de 3 a 5 años de edad con consentimiento firmado de participación en el estudio, y que presentaron molares con ICDAS 5 y 6. La aplicación del FDE a 0.8%, la evaluación de la dureza de la dentina con los criterios de Nyvad, y el diagnóstico del estado pulpar, la efectuó un operador entrenado para esta finalidad. Se aplicó un análisis estadístico descriptivo y uno no paramétrico. Resultados: el efecto cariostático producido por el FDE a 0.8%, sobre dentina afectada de molares temporales de niños mexicanos fue estadísticamente significativo durante cinco meses. Conclusiones: la aplicación de fluoruro de estaño puede considerarse como una alternativa de tratamiento cariostático asociado al NRCC para niños de 3 a 5 años de edad (AU)

Introduction: nonrestorative cavity control (NRCC), is a conservative and non-invasive treatment option for carious dentin, especially in primary dentition. One of the NRCC strategies is remineralization. Stannous Fluoride (SDF) can be considered as a viable option since there is evidence of its cariostatic efficacy. Objective: to evaluate FDE as an alternative remineralizing agent in the dentin of primary molars, associated with NRCC. Material and methods: a clinical, epidemiological, and descriptive study was carried out with preschool volunteers aged 3 to 5 years with signed consent to participate in the study, and who presented molars with ICDAS 5 and 6. The application of FDE at 0.8%, the evaluation of dentin hardness with the Nyvad criteria, and the diagnosis of pulp status, was carried out by an operator trained for this purpose. A descriptive and non-parametric statistical analysis was applied. Results: the cariostatic effect produced by 0.8% FDE on affected dentin of primary molars of Mexican children was statistically significant for five months. Conclusions: the application of stannous fluoride can be considered as an alternative cariostatic treatment associated with NRCC for children 3 to 5 years of age (AU)

Assuntos

RESUMO

Abstract Objective: To summarize data of clinical trials that used silver diamine fluoride (SDF) to prevent and treat caries lesions and dentinal hypersensitivity. Material and Methods: Six electronic databases were searched in May 2022. The concentration of SDF, type of usage (alone/combined), dentition, anterior/posterior teeth, tooth region, dental tissue, number of the treated surfaces, the intervention environment, participants' age, frequency and duration of SDF application, purpose, and outcome were the extracted variables. The type of study, year of publication, authors, journals, and country were also investigated. Results: From 8860 articles, S3 were selected. Most were randomized (n=38), that applied 38% SDF (n=43), alone (n=44), on multiple surfaces (n=44), only in dentin (n=36), of the crown (n=46) of anterior and posterior (n=36) primary teeth (n=39). The studies were preferably carried out outside the clinic (n=3l), only in children (n=33), with reapplication of SDF (n=30), but did not inform the duration of application (n= 19). SDF was most used to treat (n=46) only caries lesions (n=50). They were published between 2001 and 2022, mainly in the Journal of Dentistry (n=10). China (n=19) and Lo E.GM (n=19) were the countries and authors that published the most, respectively. Conclusion: The silver diamine fluoride 38% alone was most used to treat caries lesions in the dentin of the crown of all primary teeth, preferably applied on multiple surfaces, requiring re application, and outside the clinic.

Assuntos

RESUMO

PURPOSE: This study evaluated whether the presence of the salivary acquired pellicle (AP) had any effect on the dentin's darkening and on the caries arresting effect after the use of SDF + KI, in a cariogenic challenge. METHODS: Human dentin specimens were standardised, submitted to artificial caries lesion formation, and divided into five groups (n = 20): C: control group-no treatment, SDF: 38% SDF, APSDF: SDF 38% and AP, KISDF: 38% SDF and KI, and APKISDF: 38% SDF, KI and AP, that were submitted to pH cycling. Colour evaluation (CIE L*a*b* system) and surface hardness were performed before and after the treatments/pH cycling. RESULTS: SDF and APSDF groups showed no difference in colour. KISDF and APKISDF groups showed significantly different colours than the groups without KI. SDF, APSDF, and APKISDF groups had less mineral loss than C and KISDF. SDF, APSDF, and APKISDF revealed significantly greater mineral recovery, compared to KISDF and C. CONCLUSION: The AP did not influence the dentin´s colour after SDF + KI, but had a protective role in modulating the dentin´s mineral gain/loss. KI used after SDF decreased the dentin´s darkening, and did not interfere with the dentin de/remineralization process.

Assuntos

RESUMO

PURPOSE: This in vitro study evaluated the microshear bond strength (µSBS) of a universal adhesive after silver diammine fluoride (SDF) application at different concentrations on carious dentinal lesions in primary teeth. METHODS: Flat dentin carious-induced surfaces from 40 primary molars were randomly assigned to four experimental groups: without SDF treatment (control), 12% SDF, 30% SDF, or 38% SDF application. After 14 days of storage in artificial saliva at 37 °C, a universal adhesive system (Scotchbond Universal, 3 M ESPE) was applied in the etch-and-rinse mode and resin composite cylinders were built (0.72 mm2). After 24 h of water storage, the µSBS test was performed and the failure mode was determined. Data were analysed using one-way ANOVA and Tukey's post hoc tests (α = 0.05). RESULTS: The application of 38% SDF resulted in higher µSBS mean than control and use of 12% SDF (p = 0.006). No significant differences were observed among control, 12% SDF, and 30% SDF. All specimens tested showed adhesive/mixed failure. CONCLUSION: The use of SDF does not jeopardise the bonding of a universal adhesive applied in the etch-and-rinse mode to carious dentinal lesions in primary teeth, irrespective of the product concentration.

Assuntos

RESUMO

This study investigated the teaching and use of silver diamine fluoride (SDF) in Pediatric Dentistry in undergraduate Brazilian dental schools through a questionnaire-based cross-sectional analysis. Two-hundred and thirty-five questionnaires were e-mailed to directors of Pediatric Dentistry of undergraduate Brazilian dental schools. The details of the teaching and use of SDF in clinical practice were asked. Obtained data were analyzed descriptively and using the chi-square test. A total of 149 complete questionnaires were returned (63.4%). Most of schools taught SDF in lectures (73.8%, p <0.001). The majority use SDF in clinical practice (64.4%, p <0.001), but its use is not frequent (11.4%, p<0.001). All dental schools reported that SDF is applied in primary teeth, and few reported its use for permanent teeth (36.4%, p = 0.01). SDF has been used mainly for cavitated caries in primary teeth of children aged 0 to 3 years (93.7%, p<0.001), with restricted use in posterior teeth (42.7%, p <0.001). Although SDF is teaching and used in clinical practice in Pediatric Dentistry in most Brazilian undergraduate schools, its use is not frequent. Furthermore, SDF is not considered an option for caries lesions in some dental schools (AU).

Este estudo investigou o ensino e a utilização do diamino fluoreto de prata (DFP) em Odontopediatria em cursos de graduação em Odontologia brasileiros por meio de uma análise transversal baseada em questionário. Duzentos e trinta e cinco questionários foram enviados por e- mail a professores responsáveis pela disciplina de Odontopediatria de cursos de Odontologia brasileiros. Os detalhes do ensino e uso de DFP na prática clínica foram solicitados. Os dados obtidos foram analisados descritivamente e por meio do teste do qui-quadrado. Um total de 149 questionários completos foram devolvidos (63,4%). A maioria das escolas ensina sobre o DFP em aulas teóricas (73,8%, p <0,001). A maioria usa o DFP na prática clínica (64,4%, p <0,001), mas seu uso é pouco frequente (11,4%, p <0,001). Todas as escolas de Odontologia relataram que o DFP é aplicado em dentes decíduos, e poucas relataram seu uso em dentes permanentes (36,4%, p = 0,01). O DFP tem sido usado principalmente em lesões de cárie cavitadas em dentes decíduos de crianças de 0 a 3 anos (93,7%, p <0,001), com uso restrito aos dentes posteriores (42,7%, p <0,001). Embora o DFP seja tópico de ensino e utilizado na prática clínica em Odontopediatria na maioria dos cursos de graduação brasileiros, seu uso é pouco frequente. Além disso, o DFP não é considerado uma opção para lesões de cárie em algumas escolas avaliadas (AU).

Assuntos

RESUMO

Abstract Objective: To evaluate the efficacy of silver diamine fluoride (SDF) in arresting dentin caries lesions when applied under different concentrations and times. Material and Methods: Forty-two bovine blocks were selected and fixed in 24-well plates. Each well received a mixed bacterial inoculum added to the culture medium with 5% sucrose. The plates were incubated in microaerophilia (7 days) for caries formation, confirmed by micro-CT (M1). SDF was applied over the carious lesions for different times and concentrations (n=6): SDF 30% - immediate removal, 1 minute and 3 minutes; SDF 38%, - immediate removal, 1 minute and 3 minutes. The group without treatment was the control. Then, the samples were again scanned by micro-CT (M2) and submitted to a second cariogenic challenge for 21 days. Then, a final scan was performed (M3). Results: Mean pH at the culture medium and lesion depth were compared using Kruskal-Wallis and Wilcoxon tests. 38% SDF showed the lowest metabolic activity of the biofilm. All 38% groups and 30% 1 and 3 minutes did not show an increase in mean lesion depth comparing M3 with M1. However, only 30% 3 minutes and 38% 1 and 3 minutes showed a significant reduction of lesion depth. Conclusion: The minimum application time of 30% SDF to arrest dentin caries lesion was 1 minute, while 38% SDF arrested with application and immediate removal.

Assuntos

RESUMO

OBJECTIVES: The aim of the current study is to investigate the effect of different anticaries agents, such as experimental agents based on silver nanoparticles (SNPs) and silver diamine fluoride (SDF), on the micro-shear bond strength (µ-SBS) of composite resin applied to intact enamel (IE) or demineralized enamel (DE). MATERIALS AND METHODS: Sixty dental enamel fragments were collected from human third molars and categorized into 6 groups (n = 10): positive control (IE), negative control (DE), IE + SDF, DE + SDF, IE + SNP and DE + SNP. Samples from DE, DE + SDF and DE + SNP groups were subjected to pH cycling; superficial microhardness test was performed to confirm demineralization. Resin composite build-ups were applied to the samples (0.75-mm diameter and 1-mm height) after the treatments (except for IE and DE groups); µ-SBS was also evaluated. Samples were analyzed under a stereomicroscope at 40× magnification to identify failure patterns. Data were subjected to one-way analysis of variance, followed by Tukey's and Dunnett's tests (p < 0.05). RESULTS: There was no significant difference among the IE, IE + SNP, DE + SDF, and DE + SNP groups. The IE + SDF and DE groups recorded the highest and the lowest µ-SBS values, respectively. Adhesive-type failures were the most frequent for all treatments. CONCLUSIONS: Anticaries agents did not have a negative effect on the µ-SBS of composite resin when it was used on IE or DE.

RESUMO

Abstract The aim of this in vitro study was to determine the fluoride concentration in silver diamine fluoride (SDF) products and their bioavailability with demineralized dentine. The products evaluated (expected fluoride concentrations) were: I: Saforide 38% (45,283 ppm F); II: Advantage Arrest 38.3 to 43.2% (45,283 to 51,013 ppm F); III: Ancárie 12% (14,100 ppm F); IV: Ancárie 30% (35,400 ppm F), V: Cariestop 12% (14,100 ppm F) and VI: Cariestop 30% (35,400 ppm F). The fluoride concentration was evaluated using an ion-specific electrode (ISE) by direct technique, which was confirmed after microdiffusion. The pH of the products was determined with a pH test strip. For the bioavailability test, demineralized dentine slabs were treated with one of the products for 1 min. Loosely (CaF2-like) and firmly-bound fluoride (FAp) were determined. The fluoride concentration found in the products (mean±SD; ppm F) by the ISE direct technique was: I:53,491±554; II:57,249±1,851; III:4,814±268; IV:5,726±43; V:10,145±468; VI:11,858±575; these values were confirmed after microdiffusion (t-test; p>0.05) and disagree with the declared by the manufacturers. The pH of Ancárie 12 and 30% was 6.0 and 4.5, respectively, in disagreement with the alkaline pH expected for SDF solution and found in the other products evaluated. There was no correlation between either CaF2-like (r=0.221; p=0.337) or FAp (r=-0.144; p=0.830) formed in demineralized dentine and fluoride concentration found in the products. The problems of pH and fluoride concentration found in available professional commercial SDF products suggest that they are not under sanitary surveillance.

Resumo O objetivo deste estudo in vitro foi determinar a concentração de fluoreto nos produtos de diamino fluoreto de prata (DFP) e sua biodisponibilidade com dentina desmineralizada. Os produtos avaliados (concentrações esperadas de flúor) foram: I: Saforide 38% (45.283 ppm F); II: Advantage Arrest 38,3 a 43,2% (45.283 a 51.013 ppm F); III: Ancárie 12% (14.100 ppm F); IV: Ancárie 30% (35.400 ppm F), V: Cariestop 12% (14.100 ppm F) e VI: Cariestop 30% (35.400 ppm F). A concentração de fluoreto foi avaliada utilizando um eletrodo íon-específico (EIE) por técnica direta, que foi confirmada após microdifusão. O pH dos produtos foi determinado com uma tira de teste de pH. Para o teste de biodisponibilidade, blocos de dentina desmineralizada foram tratados com um dos produtos por 1 min. Fluoreto fracamente (tipo CaF2) e firmemente ligado (FAp) foram determinados. A concentração de fluoreto encontrada nos produtos (média±DP; ppm F) pela técnica direta com EIE foi: I: 53.491±554; II: 57.249±1.851; III: 4.814±268; IV: 5.726±43; V: 10.145±468; VI: 11.858±575; esses valores foram confirmados após microdifusão (teste t; p>0,05) e discordam dos declarados pelos fabricantes. O pH do Ancárie 12 e 30% foi de 6,0 e 4,5, respectivamente, em desacordo com o pH alcalino esperado para a solução de DFP e encontrado nos demais produtos avaliados. Não houve correlação entre CaF2 (r=0,221; p=0,337) ou FAp (r=-0,144; p=0,830) formados na dentina desmineralizada e concentração de fluoreto encontrada nos produtos. Os problemas de pH e concentração de fluoreto encontrados nos produtos comerciais profissionais disponíveis de DFP sugerem que eles não estão sob vigilância sanitária.

Assuntos

RESUMO

BACKGROUND: Silver diammine fluoride (SDF) applied before a restoration may prevent recurrent caries; therefore, its effect on the bonding of restorative materials is contradictory. AIM: To assess through a systematic review and meta-analysis the influence of SDF on the bonding performance of adhesive materials to dentine. DESIGN: A systematic search was carried out in PubMed, Web of Science, LILACS, and Scopus. Studies comparing bond strength of adhesive systems or glass ionomer cement to SDF-treated and -untreated (control) dentine were included. Global analysis comparing the bond strength data was performed, separately for adhesive systems and glass ionomer cement, using RevMan5.1, with a random-effect model, at a 5% significance level. RESULTS: Eleven studies were included in the review and ten in the meta-analyses. Overall pooled effect for glass ionomer cement has shown no significant difference between the groups (Z = 0.47; P = .64). SDF treatment significantly impairs the bonding of adhesive systems to dentine (Z = 2.11; P = .03); this effect can be eliminated by the rinsing step (Z = 0.85; P = .40). CONCLUSIONS: The previous application of SDF does not influence the dentine bond strength of glass ionomer cement, but compromises the bonding of adhesive systems.

Assuntos

RESUMO

Este estudo objetivou: (1) investigar a eficácia in vitro do diamino fluoreto de prata (DFP) em paralisar lesões de cárie em dentina após diferentes concentrações e tempos de aplicação; (2) comparar o impacto do DFP e do tratamento restaurador atraumático (TRA) na qualidade de vida relacionada à saúde bucal (QVRSB) de préescolares; e (3) avaliar a eficácia do DFP comparado ao TRA, em paralisar lesões de cárie, por meio de um ensaio clínico controlado e randomizado após 2 anos de acompanhamento. Para o objetivo 1, blocos de dentina (n=42) foram fixados em placas de poliestireno. Um inóculo bacteriano misto (1,5x108 UFC/mL) foi adicionado ao meio de cultura com sacarose 5%, contido nas placas, que foram incubadas para a formação de biofilme. As amostras foram escaneadas em micro CT (M1) e tratadas com DFP de acordo com os grupos (n=6): DFP 30%, aplicação imediata; DFP 30%, 1'; DFP 30%, 3'; DFP 38%, aplicação imediata; DFP 38%, 1'; DFP 38%, 3'. Um grupo controle, sem tratamento, também foi preparado. Após o escaneamento (M2), os blocos foram submetidos a um desafio cariogênico (21 dias) e novamente escaneados (M3). O pH do meio de cultura e a profundidade das lesões inter e intra grupos foram comparados pelos testes de Kruskal-Wallis e Wilcoxon. Para os objetivos 2 e 3, préescolares com ao menos uma lesão de cárie ativa na oclusal de seus molares decíduos foram randomicamente alocados em dois grupos: DFP e TRA. Os índicesceo-d/CPO-DICDAS foram usados para detecção da presença e atividade de cárie. O B-ECOHIS foi usado para avaliar a QVRSB antes (M1), 15 dias (M2) e 3 meses (M3) após os tratamentos. O sucesso clínico foi avaliado após 6, 12, 18 e 24 meses. Foram ainda avaliados: tempo do procedimento, efeitos adversos/percepção estética e ansiedade. No estudo in vitro, em M1 e M2, não houve diferença na profundidade das lesões entre os grupos (p>0,05). Em M3, o DFP 38% apresentou menor pH do biofilme e os grupos que receberam aplicação por 1' e 3', em ambas as concentrações, não apresentaram aumento na profundidade da lesão em relação ao M1. DFP e TRA não diferiram quanto ao B-ECOHIS total, CIS e FIS em M2 e M3 e o B-ECOHIS total diminuiu de M1 para M2 e M3 em ambos os grupos (p<0,05). Após 2 anos, não houve diferença entre os tratamentos quanto à paralisação da cárie (p=0,072) e o tempo de tratamento para o DFP foi menor (p<0,001). Não houve diferença entre os grupos quanto aos efeitos adversos/percepção estética observados pelo operador (p=0,816) e pelos pais (p=1,000). A ansiedade não mudou após os tratamentos (p=0,583). Assim, o tempo mínimo de aplicação do DFP 30% para paralisar lesões de cárie foi de 1', enquanto o 38% paralisou com aplicação imediata, in vitro. Tanto o DFP quanto TRA melhoraram a QVRSB dos pré-escolares, sem diferença entre eles. Ainda, o DFP mostrou-se semelhante ao TRA na paralisação de cárie, ansiedade e efeitos adversos, requerendo menor tempo de cadeira. (AU)

This study aimed to: (1) investigate the in vitro efficacy of silver diamine fluoride (SDF) in arresting dentin caries lesions after different concentrations and application times; (2) compare the impact of SDF and atraumatic restorative treatment (ART) on the oral health-related quality of life (QHRQoL) in preschoolers; and (3) to evaluate the effectiveness of SDF compared to ART, in arresting caries lesions, through a controlled randomized clinical trial after 2 years of follow-up. For objective 1, dentin blocks (n=42) were fixed in polystyrene plates. A mixed bacterial inoculum (1.5x108 CFU/mL) was added to the culture medium with 5% sucrose, in the plates; that were incubated for biofilm formation. The samples were scanned on micro CT (M1) and treated with SDF according to the groups (n=6): SDF 30%, immediate application; SDF 30%, 1'; SDF 30%, 3'; SDF 38%, immediate application; SDF 38%, 1'; SDF 38%, 3'. A control group, without treatment, was also prepared. After scanning (M2), the blocks were submitted to a cariogenic challenge (21 days) and scanned again (M3). The pH of the culture medium and the depth of lesions between and within the groups were compared using the Kruskal-Wallis and Wilcoxon tests. For objectives 2 and 3, preschoolers with at least one active caries lesion on the occlusal surface of their primary molars were randomly allocated into two groups: SDF and ART. The indexes dmft/DMFT and ICDAS were used to detect the presence and activity of caries. B-ECOHIS was used to assess the QHRQoL of children before (M1), 15 days (M2) and 3 months (M3) after treatments. Clinical success was assessed after 6, 12, 18 and 24 months. Were also evaluated: time of the procedure, adverse effects/aesthetic perception and the child's anxiety. In the in vitro study, in M1 and M2, there was no difference in the depth of the lesions between the groups (p>0.05). In M3, SDF 38% had a lower pH of the biofilm and the groups that received application for 1' and 3', in both concentrations, did not present an increase in the depth of the lesion in relation to M1. SDF and ART did not differ in total B-ECOHIS, CIS and FIS in M2 and M3; and the total B-ECOHIS decreased from M1 to M2 and M3 for both groups (p<0.05). After 2 years, there was no difference between treatments regarding caries arrest (p=0.072) and the treatment time for SDF was shorter (p<0.001). There was no difference regarding the adverse effects/aesthetic perception observed by the operator (p=0.816) and reported by the parents (p=1.000), according to the groups. Anxiety did not change either before or after treatments (p=0.583). Thus, the minimum time of application of SDF 30% to arrest dentin caries was 1', while SDF 38% arrested with immediate application, in vitro. Both SDF and ART improved the QHRQoL of preschoolers, with no difference between them. Still, SDF was similar to ART in arresting caries, anxiety and adverse effects, requiring less chair time. (AU)

Assuntos

RESUMO

Abstract Objective: Current acceptability, barriers to use, and clinical/teaching practices of Silver Diamine Fluoride (SDF) among Brazilian dentists were investigated. Material and Methods: A Google forms questionnaire was sent to dentists (n=10,500) to collect information about the use of SDF and the dentists' workplace, experience, specialty, and city of practice. A logistic regression model was performed. Results: From 409 respondents, 13.2% used SDF. Working at universities increased the use of SDF by 2.29 times (p=0.018) compared to private offices. Each training year, the chance of SDF usage increased by 3% (p=0.008). Pediatric dentists are more likely to use SDF (OR=6.76, p<0.001). There is no association between SDF usage and the city of practice. The majority (75.9%) indicated SDF for noncompliant patients. Dentists (75.9%) reported the exclusive use in deciduous teeth, while 24.1% also use in permanent teeth. The main barrier for non-users was a lack of knowledge (58.3%), while for users, tooth staining (90.7%) and parental acceptance (64.8%) were the complaints. Conclusion: The Silver Diamine Fluoride is not a common product used by the dentists from RJ. Its clinical applicability should be further disseminated; thus, lack of scientific knowledge would cease to be a problem in the use of SDF to arrest caries lesions.

Assuntos

RESUMO

Abstract Introduction: the aim of this study was to assess the adherence to a preventive treatment of plaque-induced oral diseases using two sugar-free gums, establishing their effect on cariogenic bacteria counts as a biological marker of treatment response. Methods: a double-blind, randomized, parallel-group, controlled intervention study was conducted in 96 young adult university students in an experimental period of 30 days. Participants were distributed into two groups and given a chewing gum with either pentitol or hexitol + CPP-ACP complex to be taken three times a day for 20 minutes after conventional oral hygiene. Saliva samples were collected at baseline to evaluate counts of Streptococcus mutans (SM) and Lactobacillus spp. A survey was conducted at the end of the experimental period to assess the levels of adherence to treatment, remeasuring bacterial counts. Results: SM counts showed statistically significant differences between the study groups at the end of the experimental period, with a decreasing tendency in both groups. Intragroup difference was observed in patients who took pentitol gum with a marked reduction in SM counts. Conclusion: the final estimate of adherence to treatment showed that the type of chewing gum patients were given had no influence and therefore such gums can be used, considering the therapeutic agents that most contribute to patient's particular case and preferences.

Resumen Introducción: el objetivo consistió en evaluar la adherencia a un tratamiento preventivo de enfermedades bucales inducidas por placa bacteriana, utilizando dos gomas de mascar sin azúcar y establecer su efecto sobre recuentos de bacterias cariogénicas como indicador biológico de los efectos del tratamiento. Métodos: se realizó un estudio de intervención, doble ciego, de grupos paralelos, aleatorizado controlado, en 96 adultos jóvenes universitarios, en un período experimental de 30 días. Los participantes fueron distribuidos en dos grupos con asignación de una goma de mascar con pentitol o con hexitol + complejo CPP-ACP que debían ser consumidas 20 minutos/tres veces al día después de la higiene oral convencional. Al inicio del studio fueron recolectadas muestras de saliva para evaluar recuentos de Estreptococos del grupo mutans (SM) y Lactobacillus spp. Al finalizar el período experimental, se realizó una encuesta para evaluar los niveles deadherencia al tratamiento y los recuentos bacterianos fueron medidos nuevamente. Resultados: Los recuentos de SM mostraron diferencias estadísticamente significativas entre los grupos de estudio al final del período experimental, con tendencia hacia la disminución en ambos grupos. Se observó diferencia intragrupo en los pacientes que consumieron la goma de mascar con pentitol, con marcada reducción de los recuentos de SM. Conclusión: la estimación final de la adherencia al tratamiento mostró que el tipo de goma de mascar asignada al paciente no tuvo influencia y, por lo tanto, estas pueden ser utilizadas teniendo en cuenta los agentes terapéuticos que más aporten al caso particular del paciente y las preferencias del mismo.

Assuntos

RESUMO

The aim of this study was to assess the effectiveness of fluoride varnish (FV) in reducing dentine caries at the patient, tooth, and surface levels as well as caries-related hospitalizations in preschoolers. We performed a systematic review of clinical trials of FV, alone or associated with an oral health program, compared with placebo, usual care, or no intervention. Bibliographical search included electronic searches of seven databases, registers of ongoing trials, and meeting abstracts, as well as hand searching. We performed random-effects meta-analyses and calculated confidence and prediction intervals. The search yielded 2,441 records; 20 trials were included in the review and 17 in at least one meta-analysis. Only one study had low risk of bias in all domains. We found no study reporting on caries-related hospitalizations. At the individual level, the pooled relative risk was 0.88 (95% confidence interval [CI] 0.81, 0.95); this means that in a population of preschool children with 50% caries incidence, we need to apply fluoride varnish in 17 children to avoid new caries in one child. At the tooth level, the pooled weighted mean difference was -0.30 (95% CI -0.69, 0.09) and at the surface level -0.77 (95% CI -1.23, -0.31). Considering the prediction intervals, none of the pooled estimates were statistically significant. We conclude that FV showed a modest and uncertain anticaries effect in preschoolers. Cost-effectiveness analyses are needed to assess whether FV should be adopted or abandoned by dental services.

Assuntos

RESUMO

Objective: To evaluate in vitro the presence of fluoride in saliva after applying professional use products on the surface of dental enamel. Material and Methods: Experimental groups were composed by: Cariostatic 12% (CA), Fluoridated Varnish 5% (FV), Fluorine Acidulate Gel 1.23% (AG) and Fluorine Neutral Gel 2% (NG). Fluoridated dentifrice (FD) and Artificial Saliva (AS) were used as controls. Products (10 µL) were applied to the surface of bovine enamel blocks (4×4×1 mm, n = 18) and immersed in 10 mL of artificial saliva at room temperature. Aliquots of artificial saliva (750 µL) of each sample were collected 1, 2, 4, 8, 24 and 48 hours after application of the products. Analyses were performed in triplicate, using a fluoride ion-specific electrode coupled to a potentiometer. The equipment was calibrated using a standard curve for fluoride analysis from 0.125 to 64 µgF-/mL. Results: Greater fluoride concentration (µgF-/mL) was observed after 1h application, as follows: 197.40 (NG), 172.21 (AG), 20.25 (CA), 14.49 (FV) e 11.81 (FD). Fluoride concentration increased overtime for all groups. After 48h, the following fluoride concentrations were assessed: 428.12 (AG), 267.25 (NG), 65.36 (FV), and 62.52 (CA). Conclusion: Greater fluoride release was observed for AG and NG groups, mostly after 1h application.

Assuntos

RESUMO

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Silver Diamine Fluoride Has Efficacy in Controlling Caries Progression in Primary Teeth: A Systematic Review and Meta-Analysis. Chibinski AC, Wambier LM, Feltrin J, Loguercio AD, Wambier DS, Reis A. Caries Res 2017;51(5):527-41. SOURCE OF FUNDING: This study was partially supported by the Brazilian Government Organization-National Council for Scientific and Technological Development (CNPq)-under grants 304105/2013-9 and 305588/2014-1 TYPE OF STUDY/DESIGN: Systematic review and meta-analysis.

Assuntos

RESUMO

Abstract Cariostatic treatment has been shown to successfully arrest caries. However, it blackens the carious tooth structure. This study evaluated the effects of an experimental cariostatic agent with silver nanoparticles (Ag-Nano) using microhardness (MH) and microbiological tests. The cariostatic agents tested were: Saforide®, Cariestop®, Ancarie® and Ag-Nano. Sixty-six samples from deciduous enamel were submitted to initial (after pH cycling to obtain initial caries-like lesion) and final (after cariostatic application) MH testing and %MH values were calculated. After longitudinal sectioning, internal (I) MH was evaluated. Strains of Streptococcus mutans, Escherichia coli, and Enterococcus faecalis in brain-heart infusion culture were treated with the cariostatic agents. Agar diffusion tests (ADTs) were performed and minimum inhibitory concentrations were determined. The statistical tests used were: Kruskal-Wallis and Dunn (%MD; ADT; MIC) and ANOVA followed by Tukey's test (I-MH) (p<0.05). The %MH of Saforide® was significantly greater than that of Ag-Nano (p<0.05). Internal MH showed progressive improvement in the enamel remineralization for all cariostatic tested. In ADTs showed greater inhibition of S. mutans, E. faecalis, and E. coli by Saforide® than by Ancarie® and Ag-Nano. Ag-Nano was able to inhibit 100% microorganism growth at a lower concentration than required for the other agents. It was concluded that Ag-Nano treatment promoted remineralization of deciduous tooth enamel with initial caries-like lesion and bactericidal activity.

Resumo O tratamento com cariostático tem demostrado sucesso na paralização da cárie. No entanto, causa escurecimento da estrutura dental cariada. Este estudo avaliou os efeitos de um agente cariostático experimental com nanopartículas de prata (Ag-Nano) através de microdureza (MD) e testes microbiológicos. Os cariostáticos testados foram: Saforide®, Cariestop®, Ancarie® e Ag-Nano. Sessenta e seis amostras de esmalte decíduo foram submetidos a MD inicial (após ciclagem de pH para obtenção da lesão de cárie inicial) e final (após aplicação dos cariostáticos), e os valores da porcentagem (%) de MD foram calculados. Após secção longitudinal, a MD interna (I) foi avaliada. Cepas de Streptococcus mutans, Escherichia coli e E. faecalis foram cultivados em ágar infusão de cérebro e coração (BHI) e submetidos aos cariostáticos testados. Além disso, foram realizados teste de difusão em ágar (TDA) e avaliação da concentração mínima inibitória (CIM) dos cariostáticos. Os testes estatísticos usados foram: Kruskall-Wallis e Dunn (%MD; TDA; CIM) e ANOVA seguido de teste de Tukey (MD-I) (p<0.05). A %MD do Saforide® foi significativamente maior do que a de Ag-Nano (p<0,05). A MD interna apresentou melhora progressiva na remineralização do esmalte para todos os cariostático testados. Os resultados do TDA mostraram que S. mutans, E. faecalis e E. coli sofreram maior inibição pelo Saforide® (p<0,05), em relação ao Ancarie® e Ag-Nano. No entanto, para o teste de CIM o Ag-Nano foi capaz de inibir 100% dos microorganismos, em menor concentração do que os demais cariostaticos. Conclui-se que, o tratamento Ag-Nano foi capaz de promover remineralização do esmalte dental decíduo com lesão de cárie inicial e apresentou atividade bactericida.

Assuntos

RESUMO

A systematic review was performed to evaluate the efficacy of silver diamine fluoride (SDF) in controlling caries progression in children when compared with active treatments or placebos. A search for randomized clinical trials that evaluate the effectiveness of SDF for caries control in children compared to active treatments or placebos with follow-ups longer than 6 months was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and grey literature. The risk of bias tool from the Cochrane Collaboration was used for quality assessment of the studies. The quality of the evidence was evaluated using the GRADE approach. Meta-analysis was performed on studies considered at low risk of bias. A total of 5,980 articles were identified. Eleven remained in the qualitative synthesis. Five studies were at "low," 2 at "unclear," and 4 studies at "high" risk of bias in the key domains. The studies from which the information could be extracted were included for meta-analysis. The arrestment of caries at 12 months promoted by SDF was 66% higher (95% CI 41-91%; p < 0.00001) than by other active material, but it was 154% higher (95% CI 67-85%; p < 0.00001) than by placebos. Overall, the caries arrestment was 89% higher (95% CI 49-138%; p < 0.00001) than using active materials/placebo. No heterogeneity was detected. The evidence was graded as high quality. The use of SDF is 89% more effective in controlling/arresting caries than other treatments or placebos. The quality of the evidence was graded as high.

Assuntos

RESUMO

Abstract: The purpose of this study was to evaluate the antimicrobial properties of a new formulation containing silver nanoparticles, named Nano Silver Fluoride (NSF), to inhibit Streptococcus mutans biofilm formation on children's dental enamel. The variations in dental biofilm pH and in the Simplified-Oral-Hygiene-Index (OHI-S) also were evaluated after the treatment with NSF. This was a randomized, double-blind, crossover and prospective pilot clinical trial study in which 12 schoolchildren, aged between 7-8 years, had their dental enamel treated with two solutions: S1 - Nano Silver Fluoride and S2 - negative control (saline solution), in different experimental moments. The dental biofilm adhered to enamel treated with NSF had lower values of S. mutans viability (absorbance) and colony forming units (CFU) than the S0 (baseline) and S2. There was a statistically significant difference between the OHI-S mean values of S0 and S1. There were no differences between the biofilm pH (both before and after the use of the test substances) and among the different groups. These properties suggest that NSF has bactericidal effect against S. mutans biofilm and it may be used for clinical control and prevention of dental biofilm formation.

Resumo O objetivo do presente estudo foi avaliar as propriedades antimicrobianas de uma nova formulação composta por nanopartículas de prata, denominada nano silver fluoride (NSF), na inibição de biofilme de Streptococcus mutans sobre a superfície do esmalte dentário de crianças. Variações no pH do biofilme dental e nos valores do índice de Higiene Oral Simplificada (IHO-S) também foram avaliadas após o tratamento com NSF. Trata-se de um estudo piloto, randomizado, duplo cego, cruzado e prospectivo. A amostra foi composta por 12 crianças, de ambos os gêneros, com idades entre 7 e 8 anos, as quais utilizaram as duas soluções testes, S1- NSF e S2- controle negativo (solução salina). O biofilme dental tratado com NSF apresentou menores valores de viabilidade de S. mutans (absorbância) e de unidades formadoras de colônias (UFC) do que o biofilme baseline e o biofilme tratado com S2. Houve diferença estatisticamente significativa entre os valores médios de IHO-S dos grupos baseline e S1, com uma redução dos valores. Não houve qualquer variação nos valores de pH do biofilme dental, antes e depois do tratamento com S1 e S2 e entre os diferentes grupos. Estas propriedades sugerem que NSF possui efeito bactericida sobre o biofilme de S. mutans, podendo ser utilizado clinicamente para o controle e prevenção da formação do biofilme dentário.

Assuntos

RESUMO

O objetivo do presente estudo foi investigar o conhecimento, atitudes e práticas clínicas dos dentistas do estado do Rio de Janeiro (RJ) sobre o diamino fluoreto de prata (DFP) através de uma pesquisa de opinião; além da sua eficácia em paralisar lesões de cárie em molares decíduos de pré-escolares, através de um ensaio clínico controlado e randomizado. Um questionário Google Forms foi elaborado e enviado aos dentistas (n=10.500) para verificar a associação entre o uso do DFP e algumas variáveis: local de trabalho; experiência profissional; especialidade, entre outras; utilizando-se um modelo de regressão logística bivariada. Pré-escolares, com pelo menos uma lesão de cárie ativa na face oclusal de molares decíduos, sem sinais clínicos e radiográficos de envolvimento pulpar e sintomas de dor, foram alocadas, randomicamente, em dois grupos: teste ­ DFP e controle ­ tratamento restaurador atraumático (TRA). Os índices de dentes cariados, perdidos e obturados para dentes decíduos (ceo-d) e International Caries Detection and Assessment System (ICDAS) foram seguidos para diagnóstico e atividade de cárie das lesões. O sucesso clínico foi avaliado após 3, 6 e 12 meses de acompanhamento, para detecção da paralisação da lesão de cárie. Como desfechos secundários, foram investigados: o tempo de atendimento, possíveis efeitos adversos e percepção estética, a ansiedade da criança e a qualidade de vida relacionada à saúde bucal (QVRSB). O questionário Early Childhood Oral Health Impact Scale validado no Brasil (B-ECOHIS) foi utilizado para avaliar a QVRSB. Testes estatísticos específicos, incluindo a análise Bootstrap, foram empregados. Responderam à pesquisa 409 dentistas e, destes, 13,2% reportaram usar o DFP. Trabalhar em universidade aumenta a chance de uso do DFP em 2,29 vezes (p=0,018) comparado ao consultório particular. Cada ano de experiência aumenta em 3% a chance de usá-lo (p=0,008). Odontopediatras são os que mais o utilizam (OR=6,76, p<0,001). A maioria dos dentistas respondentes (75,9%) indica o DFP para pacientes não colaboradores. A maior barreira para os que não usam é a falta de conhecimento (58,3%), enquanto que, entre os que usam, é o enegrecimento dos dentes (90,7%) e a aceitação dos pais (64,8%). Para o ensaio clínico, 68 pacientes [3,62(1,07) anos] foram randomizados e alocados nos grupos DFP (n=34) e TRA (n=34). O número médio de dentes tratados por criança foi 2,42 (1,04) no grupo DFP e 2,09 (1,18) no grupo TRA (p=0,074). Comparando os grupos, a média da diferença de lesões paralisadas foi 0,04 (0,02) em 3 meses; 0,06 (0,06) em 6 meses e 0 (0,09) em 12 meses. O menor tempo de tratamento foi observado no grupo do DFP (p<0,001), porém não houve diferença quanto ao percentual de efeitos adversos e percepção estética (p=0,709), nem quanto à mudança de ansiedade (p=0,155). Houve um menor impacto na QVRSB no grupo TRA, considerando o setor da família (ES=0.86) e a subescala ansiedade dos pais (ES=0.83). O DFP não é um produto habitualmente utilizado entre os dentistas do RJ, devendo ser mais disseminado para que a falta de conhecimento científico deixe de ser uma barreira ao uso. O tempo de tratamento com DFP foi menor comparado ao do TRA. Contudo, foi similar ao TRA quanto à paralisação das lesões de cárie, ansiedade, eventos adversos, percepção estética, e qualidade de vida. (AU)

The objective of the present study was to investigate the knowledge, attitudes and practices of the dentists from Rio de Janeiro (RJ) concerning silver diamine fluoride (SDF) through an opinion survey; as well as its effectiveness in arresting dental caries lesions in primary molars of preschool children, through a randomized controlled clinical trial. A Google Forms questionnaire was sent to dentists (n=10,500) to determine the association between the use of SDF and the dentists' workplace, experience, specialty, among others. A logistic regression model was performed. Preschoolers with at least one active caries lesion on the occlusal surface of primary molars, without clinical and radiographic signs of pulp involvement or symptoms, were randomly assigned into the groups: test - SDF and control - atraumatic restorative treatment (ART). The decayed, missing and filled primary teeth (dmf-t) and International Caries Detection and Assessment System (ICDAS) indexes were followed for diagnosis and caries activity of the lesions. Clinical success was assessed after 3, 6 and 12 months of follow-up, to detect caries lesion arrestment. As secondary outcomes, the time of treatment, adverse events and aesthetic perception, the child's anxiety and the oral health-related quality of life (OHRQoL) were investigated. The validated Brazilian Early Childhood Oral Health Impact Scale (B-ECOHIS) was used to evaluate the OHRQoL. Specific statistical tests, including the Bootstrap analysis, were employed. From 409 respondents, 13.2% used SDF. Working at universities increased the chance of using SDF by 2.29 times (p=0.018), compared to a private office. Each training year, the chance of SDF usage increased by 3% (p=0.008). Pediatric dentists are more likely to use SDF (OR=6.76,p<0.001). The majority (75.9%) indicated SDF for noncompliant patients. The main barrier for non-users was a lack of knowledge (58.3%), while for users, tooth staining (90.7%) and parental acceptance (64.8%) were the complaints. For the clinical trial, 68 patients [3.62(1.07) years] were randomly allocated to the DFP (n=34) and ART (n=34) groups. The mean number of teeth treated per child was 2.42 (1.04) in the SDF group and 2.09(1.18) in the ART group (p=0.074). The mean of the arrested lesion difference between the groups was 0.04 (0.02) at 3 months; 0.06 (0.06) at 6 months and 0 (0.09) at 12 months. The lowest treatment time was observed in the SDF group (p<0.001), but there was no difference in the percentage of adverse effects and aesthetic perception (p=0.709), nor in the change of anxiety (p=0.155). There was a smaller impact on OHRQoL in the ART group, considering the family section (ES=0.86) and the parents' distress subscale (ES=0.83). SDF is not a common product used by dentists from RJ. It should be more widespread so that lack of scientific knowledge would cease to be a problem in the use of SDF in arresting dental caries. The time of treatment with SDF was smaller compared to that of the ART. However, it was similar to ART in terms of caries lesion arrestment, anxiety, adverse events and aesthetic perception, and quality of life. (AU)

Assuntos

RESUMO

ABSTRACT Objective: The aim of this paper was to demonstrate how a general dental practitioner tried to answer, based on scientific evidence, to the question: "Does the darkening of caries lesions caused by silver diamine fluoride treatment contribute to reducing parents' acceptance of such treatment?". Methods: The dentist adopted the following approach: formulation of a specific question; bibliographic search using controlled vocabulary and free terms; selection of full-text articles for reading; reading and critical appraisal of selected articles; summary of the available evidence; translation of the evidence into clinical practice. The dentist identified 45 studies and selected 20 to be read in full, but only three could be used; two controlled trials from China and one from Brazil. Results: Results showed that the esthetic effect was neither a major issue nor a decisive factor for the indication of the proposed treatment. However, although there is robust scientific evidence on the effectiveness of silver diamine fluoride in arresting and preventing caries lesions, there is scarce information about its esthetic effect. Thus, the lack of studies assessing the impact of the darkening of caries lesions and the esthetic effect of the treatment on the quality of life of children and their parents must be emphasized. Conclusion: The dentist concluded that there is insufficient evidence about the esthetic effect of silver diamine fluoride applications on primary teeth and opted to inform it to his/her patients' caregivers and to share with them the decision whether to use it or not in each specific case.

RESUMO Objetivo: Mostrar como um cirurgião-dentista clínico geral procurou responder, com base em evidência científica, à pergunta: "O escurecimento das lesões de cárie em dentes decíduos tratados com diaminofluoreto de prata contribui para a redução da aceitação desse tipo de tratamento pelos pais?". Métodos: O dentista seguiu o seguinte roteiro: formulação de uma pergunta específica; realização da busca bibliográfica utilizando descritores e termos livres; seleção dos artigos científicos completos para leitura; leitura e avaliação crítica dos artigos selecionados; resumo da evidência disponível e aplicação da evidência à sua prática clínica. O dentista localizou 45 trabalhos e selecionou 20 para leitura na íntegra, mas apenas três puderam ser utilizados, sendo dois ensaios controlados realizados na China e um no Brasil. Resultados: Os resultados mostraram que a estética não foi uma questão importante nem um fator decisivo para a indicação do tratamento proposto. No entanto, embora haja evidência científica robusta sobre a efetividade do diaminofluoreto de prata em paralisar e prevenir lesões de cárie, há pouca informação sobre seu efeito estético. Assim, a falta de estudos que avaliam o impacto do escurecimento das lesões de cárie e o efeito estético do tratamento sobre a qualidade de vida das crianças e seus familiares deve ser ressaltada. Conclusão: O dentista concluiu que não existe evidência suficiente sobre o efeito estético das aplicações de diaminofluoreto de prata em dentes decíduos e optou por informar os responsáveis por seus pacientes a respeito e compartilhar com eles a decisão sobre a indicação do mesmo para cada caso específico.