Duangporn Duangthip

A randomized clinical trial on arresting dentine caries in preschool children by topical fluorides—18 month results

OBJECTIVES This study aimed to compare the effectiveness of three topical fluoride application protocols in arresting dentine caries in primary teeth of preschool children in a fluoridated area. METHODS Children aged 3-4 years who had at least one active dentine caries lesion were randomly allocated into three intervention groups: Group 1-application of 30% silver diammine fluoride (SDF) solution every 12 months; Group 2-three applications of 30% SDF solution at weekly interval at baseline; and Group 3-three applications of 5% sodium fluoride (NaF) varnish at weekly interval at baseline. A masked examiner carried out follow-up examinations every 6 months to assess whether the treated lesions had become arrested. RESULTS A total of 304 children with 1670 tooth surfaces with dentine caries received treatment at baseline. After 18 months, 275 children (91%) remained in the study. The caries arrest rates at tooth surface level were 40%, 35% and 27% for Groups 1, 2 and 3, respectively (p<0.001). Result of the multi-level survival analysis showed that the two SDF application protocols could shorten the time to arrest of dentine caries compared with the NaF application protocol. Presence of plaque on lesion surface, tooth type and tooth surface all had significant effects on caries arrest rates. CONCLUSIONS Annual or three consecutive weekly applications of SDF solution is more effective in arresting dentine caries in primary teeth than three consecutive weekly applications of NaF varnish. CLINICAL SIGNIFICANCE In a water fluoridated area, application of SDF solution, either three weekly applications at baseline or annually, can arrest active dentine caries lesions in primary teeth faster than three weekly applications of NaF varnish at baseline.

Clinical Trials of Silver Diamine Fluoride in Arresting Caries among Children A Systematic Review

This review aims to investigate the clinical effectiveness of silver diamine fluoride (SDF) in arresting dental caries among children. A systematic search of publications was conducted with the key words “silver diamine fluoride,” “silver diammine fluoride,” “silver fluoride,” “diamine silver fluoride,” or “diammine silver fluoride” as well as their translation in Chinese, Japanese, Portuguese, and Spanish in 7 databases: PubMed (English), Embase (English), Scopus (English), China National Knowledge Infrastructure (Chinese), Ichushi-web (Japanese), Biblioteca Virtual em Saude (Portuguese), and Biblioteca Virtual en Salud Espana (Spanish). Duplicated publications were deleted. The title and abstract were screened and irrelevant publications were excluded. The full text of the remaining publications was retrieved. Prospective clinical studies of SDF that reported a caries-arresting effect among children were included. Meta-analysis was performed for quantitative analysis. A total of 1,123 publications were found, including 19 publications of clinical trials. Sixteen clinical trials studied the caries-arresting effect on primary teeth, and 3 clinical trials were on permanent teeth. Fourteen studies used 38% SDF, 3 used 30% SDF, and 2 used 10% SDF. Meta-analysis was performed on extracted data from 8 studies using 38% SDF to arrest caries in primary teeth. The overall percentage of active caries that became arrested was 81% (95% confidence interval, 68% to 89%; P < 0.001). Apart from staining the arrested lesion black, no significant complication of SDF use among children was reported. SDF was commonly used at 38%. It was effective in arresting dentine caries in primary teeth among children. Knowledge Transfer Statement: This systematic review found that 38% silver diamine fluoride (SDF) can effectively arrest caries among children. SDF treatment is noninvasive and easily operated. It can be a promising strategy to manage dental caries in young children or those who have special needs.

Arresting Dentine Caries with Different Concentration and Periodicity of Silver Diamine Fluoride

Different regimens of silver diamine fluoride (SDF) have been used to manage early childhood caries. So far, there is limited information regarding the concentrations and frequency of applications for effective caries control in primary teeth. This study aimed to compare the efficacy of 2 commercially available SDF solutions at preprepared concentrations of 38% and 12% when applied annually or biannually over 18 mo in arresting dentine caries in primary teeth. This randomized double-blinded clinical trial recruited kindergarten children aged 3 to 4 y who had at least 1 tooth with dentine caries. The children were randomly allocated to receive 4 treatment protocols: group 1, annual application of 12% SDF; group 2, biannual application of 12% SDF; group 3, annual application of 38% SDF; and group 4, biannual application of 38% SDF. Clinical examinations at 6-mo intervals were conducted to assess whether active carious lesions became arrested. Information on the children’s background and oral hygiene habits was collected through a parental questionnaire at baseline and follow-up examinations. A total of 888 children with 4,220 dentine carious tooth surfaces received treatment at baseline. After 18 mo, 831 children (94%) were examined. The caries arrest rates were 50%, 55%, 64%, and 74% for groups 1, 2, 3, and 4, respectively ( P < 0.001). Lesions treated with SDF biannual application had a higher chance of becoming arrested compared with those receiving SDF annual application (odds ratio, 1.33; 95% confidence interval, 1.04–1.71; P = 0.025). The interaction between concentration and lesion site was statistically significant ( P < 0.001). Compared with 12% SDF, the use of 38% SDF increased a chance of becoming arrested ( P < 0.05), except lesions on occlusal surfaces. Based on the 18-mo results, SDF is more effective in arresting dentin caries in the primary teeth of preschool children at 38% concentration than 12% concentration and when applied biannually rather than annually. Knowledge Transfer Statement: The results of this study can be used by clinicians and dental public health professionals when deciding which concentrations and frequency of application of silver diamine fluoride solution should be adopted for arresting dentine caries. With consideration of caries arrest treatment with silver diamine fluoride, which is painless, simple, and low cost, this information could lead to more appropriate therapeutic decisions for caries control in young children or those who lack access to affordable conventional dental care.

Early childhood caries among 5- to 6-year-old children in Southeast Asia.

Objective The aim of this study was to examine the prevalence and experience of early childhood caries among 5‐ to 6‐year‐old children in Southeast Asia. Methods A literature search was conducted of three electronic databases (PubMed, EMBASE and ISI Web of Science) to identify publications from the years 2006 to 2015. Additional hand searches of government reports and national studies were performed. Both primary and secondary data sources were included in the study. The inclusion criterion was the findings reported on the caries prevalence and/or caries experience in decayed, missing or filled tooth (dmft) or decayed, missing or filled surface (dmfs) scores of 5‐ to 6‐year‐old children in Southeast Asian countries. The papers retrieved were assessed by two independent reviewers, and the final decision was made by consensus. Results The search identified 320 papers for screening; 293 were excluded and 27 full papers were retrieved and reviewed. Of those, 12 were included. Among the countries, variations were found in caries prevalence and caries experience. The caries prevalence of 5‐ to 6‐year‐old children ranged from 25% to 95%, and the caries experience (given as mean dmft score) ranged from 0.9 to 9.0. The median caries prevalence and caries experience (mean dmft score) of children 5–6 years of age were 79% and 5.1, respectively. Conclusion Based on the included studies, which are limited in quality and quantity, there is evidence that caries prevalence and experience are high amongst preschool children in Southeast Asia.

Randomized Clinical Trial of 12% and 38% Silver Diamine Fluoride Treatment:

This 30-mo randomized clinical trial compared the effectiveness of 2 concentrations (12% or 38%) of silver diamine fluoride (SDF) and 2 periodicity of application (once or twice a year) in arresting cavitated dentin caries in primary teeth. Children aged 3 to 4 y who had at least 1 active cavitated caries lesion were enrolled and randomly allocated into 4 groups for intervention. Group 1 had 12% SDF applied annually (every 12 mo), group 2 had 12% SDF applied semiannually (every 6 mo), group 3 had 38% SDF applied annually, and group 4 had 38% SDF applied semiannually. Clinical examinations were performed semiannually in kindergarten by a single examiner to investigate whether the SDF-treated caries became arrested. A total of 888 children with 4,220 decayed tooth surfaces received SDF application at baseline, and 799 (90.0%) children with 3,790 surfaces (89.8%) were evaluated at the 30-mo examination. The caries arrest rates were 55.2%, 58.6%, 66.9%, and 75.7% for groups 1, 2, 3, and 4, respectively (P < 0.001). Caries treated with 38% SDF had a higher chance of becoming arrested than those treated with 12% SDF (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.51–2.60, P < 0.001). The interaction between frequency of SDF application and visible plaque index (VPI) score was significant (P = 0.017). Among those children who received annual SDF application, children with a higher VPI score had a lower chance to have their caries become arrested (OR, 0.59, 95% CI, 0.49–0.72). In conclusion, SDF at a concentration of 38% is more effective than that of 12% in arresting active caries in primary teeth. For children with poor oral hygiene, caries arrest rate of SDF treatment can be increased by increasing the frequency of application from annually to semiannually (ClinicalTrials.gov NCT02385474).

Mechanisms of silver diamine fluoride on arresting caries: a literature review

OBJECTIVE To review the evidence regarding the mechanisms of silver diamine fluoride (SDF) for arresting caries. METHODS A literature search was conducted using the keywords silver diamine fluoride, and its alternative names, in seven databases: PubMed, Embase and Scopus (English); China National Knowledge Infrastructure (Chinese); Bilioteca Virtual em Saude (Portuguese); Biblioteca Virtual en Salud Espana (Spanish); and Ichushi-Web (Japanese). The titles and abstracts were screened. Full texts were retrieved for publications that studied mechanisms of actions of SDF, including its effects on remineralisation of carious lesions and on cariogenic bacteria. RESULTS A total of 1,123 publications were identified. Twenty-nine articles were included and they investigated the effect of SDF on cariogenic bacteria and dental hard tissues. Eleven studies investigated the antibacterial properties of SDF. They found that SDF was bactericidal to cariogenic bacteria, mainly Streptococcus mutans. It inhibited the growth of cariogenic biofilms on teeth. Twenty studies reported the remineralisation of demineralised enamel or dentine by SDF. They found that mineral loss of demineralised enamel and dentine was reduced after SDF treatment. A highly mineralised surface rich in calcium and phosphate was formed on arrested carious lesions. Four studies examined the effect of SDF on dentine collagen. They found that SDF inhibited collagenases (matrix metalloproteinases and cysteine cathepsins) and protected dentine collagen from destruction. CONCLUSION SDF is a bactericidal agent and reduces the growth of cariogenic bacteria. It inhibits demineralisation and promotes the remineralisation of demineralised enamel and dentine. It also hampers degradation of the dentine collagen.

Adverse Effects of Silver Diamine Fluoride Treatment among Preschool Children

This randomized clinical trial aimed to compare the adverse effects and parental satisfaction following the different regimes of silver diamine fluoride (SDF) treatment among preschool children. A total of 888 preschool children who had active dentin caries received different SDF application regimes: group 1, 12% SDF applied annually; group 2, 12% SDF applied semiannually; group 3, 38% SDF applied annually; and group 4, 38% SDF applied semiannually. Information on adverse effects—including tooth or gum pain, gum swelling, gum bleaching, and systemic toxicity—was collected through a parent-reported questionnaire within 1 wk after every SDF or placebo application. Information of parental satisfaction on children’s dental appearance was collected at baseline and 30-mo examination. At the 30 mo, 799 children (90%) remained in the study. No acute systemic illness or major adverse effect was reported. No differences of all minor adverse effects among the 4 groups were found (P > 0.05). Overall, prevalence of tooth and gum pain as perceived by patients and reported by parents was 6.6%, while gum swelling and gum bleaching were 2.8% and 4.7%, respectively. Blackening of carious lesions was common among all groups, with 36.7%, 49.5%, 65.6% and 76.3% in groups 1 to 4, respectively (χ2 test, P < 0.001). The proportion of parents who were satisfied with their children’s dental appearance in groups 1 to 4 was as follows: 67.6%, 61.5%, 70.8%, and 62.3%, respectively (χ2 test, P > 0.05). Based on parental reporting, SDF does not cause acute systemic illness. Tooth or gum pain, gum swelling, and gum bleaching were uncommon and not significantly different among the study groups. Parental satisfaction with children’s dental appearance was similar among all groups. The use of SDF following the study protocol for caries arrest is safe for preschool children. Collecting information on parental satisfaction and adverse effects is beneficial for dental professionals when deciding to adopt SDF treatment for preschool children (ClinicalTrials.gov NCT02385474).

Revitalising Silver Nitrate for Caries Management

Silver nitrate has been adopted for medical use as a disinfectant for eye disease and burned wounds. In dentistry, it is an active ingredient of Howe’s solution used to prevent and arrest dental caries. While medical use of silver nitrate as a disinfectant became subsidiary with the discovery of antibiotics, its use in caries treatment also diminished with the use of fluoride in caries prevention. Since then, fluoride agents, particularly sodium fluoride, have gained popularity in caries prevention. However, caries is an infection caused by cariogenic bacteria, which demineralise enamel and dentine. Caries can progress and cause pulpal infection, but its progression can be halted through remineralisation. Sodium fluoride promotes remineralisation and silver nitrate has a profound antimicrobial effect. Hence, silver nitrate solution has been reintroduced for use with sodium fluoride varnish to arrest caries as a medical model strategy of caries management. Although the treatment permanently stains caries lesions black, this treatment protocol is simple, painless, non-invasive, and low-cost. It is well accepted by many clinicians and patients and therefore appears to be a promising strategy for caries control, particularly for young children, the elderly, and patients with severe caries risk or special needs.

Managing Early Childhood Caries with Atraumatic Restorative Treatment and Topical Silver and Fluoride Agents

Early childhood caries (ECC) is a significant global health problem affecting millions of preschool children worldwide. In general, preschool children from families with 20% of the lowest family incomes suffered about 80% of the ECC. Most, if not all, surveys indicated that the great majority of ECC was left untreated. Untreated caries progresses into the dental pulp, causing pain and infection. It can spread systemically, affecting a child’s growth, development and general health. Fundamental caries management is based on the conventional restorative approach. Because preschool children are too young to cope with lengthy dental treatment, they often receive dental treatment under general anaesthesia from a specialist dentist. However, treatment under general anaesthesia poses a life-threatening risk to young children. Moreover, there are few dentists in rural areas, where ECC is prevalent. Hence, conventional dental care is unaffordable, inaccessible or unavailable in many communities. However, studies showed that the atraumatic restorative treatment had a very good success rate in treating dentine caries in young children. Silver diamine fluoride is considered safe and effective in arresting dentine caries in primary teeth. The aim of this paper is to review and discuss updated evidence of these alternative approaches in order to manage cavitated ECC.

Caries arrest by topical fluorides in preschool children: 30-month results

OBJECTIVE To compare the effectiveness of three applications of silver diammine fluoride (SDF) solution at yearly interval and three applications of SDF solution or sodium fluoride (NaF) varnish at weekly interval at baseline in arresting active caries in the primary teeth of preschool children. METHODS Children aged 3-4 years (n = 371) who had at least one active caries lesion (ICDAS codes 3-6) in their primary teeth were randomly allocated into three groups: Group 1 - annual application of 30% SDF solution; Group 2 - three applications of 30% SDF at weekly intervals; and Group 3 - three applications of 5% NaF varnish at weekly intervals. Follow-up examinations were performed every 6 mo nths by the same masked examiner. RESULTS After 30 months, 309 (83%) children with 1877 caries lesions remained in the study. For cavitated lesions (ICDAS code 5 or 6), the caries arrest rate of Group 1 (48%) was significantly higher than those of Group 2 (33%) and Group 3 (34%), (p < 0.001). Results of multi-level survival analysis showed that the arrest times of cavitated lesions in both SDF groups (Groups 1 and 2) were significantly shorter than that of the NaF varnish group. For moderate caries lesions without visible dentine (ICDAS code 3 or 4), the caries arrest rates were 45%, 44% and 51% in Groups 1, 2 and 3, respectively (p > 0.05). Presence of plaque on caries lesion, tooth type and tooth surface type had an influence on caries arrest. CONCLUSION Over a 30-month period, annual applications of SDF solution is more effective than three weekly applications of NaF varnish or SDF solution at baseline in arresting active cavitated dentine caries lesions in primary teeth. CLINICAL SIGNIFICANCE As annual application of SDF solution was found to be more effective than 3 weekly applications of NaF varnish or SDF solution at baseline in arresting active cavitated dentine caries lesions, the former application protocol is preferred for young children who are available for regular caries arrest treatment.