Folke Lagerlöf

Caries-preventive effect of fluoride toothpaste: a systematic review

With a questionnaire addressed to general dental practitioners in Sweden, the Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on various caries preventive methods. The aim of this article was to report findings concerning the caries preventive effect of fluoride toothpastes in various age groups, with special emphasis on fluoride concentration and supervised versus non‐supervised brushing. A systematic search in electronic databases for articles published between 1966 and April 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years follow‐up and caries increment in the permanent (ΔDMFS/T) or primary (Δdmfs/t) dentition as endpoint. Out of 905 articles originally identified, 54 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A–C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF), expressed as percent. The results revealed strong evidence (level 1) (i) for the caries preventive effect of daily use of fluoride toothpaste compared to placebo in the young permanent dentition (PF 24.9%), (ii) that toothpastes with 1,500 ppm of fluoride had a superior preventive effect compared with standard dentifrices with 1,000 ppm F in the young permanent dentition (PF 9.7%), and (iii) that higher caries reductions were recorded in studies with supervised toothbrushing compared with non‐supervised (PF 23.3%). However, incomplete evidence (level 4) was found regarding the effect of fluoride toothpaste in the primary dentition. In conclusion, this review reinforced the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long‐term studies in age groups other than children and adolescents are still lacking.

Caries-preventive effect of fissure sealants: a systematic review

The objectives of this study were to evaluate systematically the evidence of the caries‐preventive effect of fissure sealing of occlusal tooth surfaces and to examine factors potentially modifying the effect. The search strategies included electronic databases, reference lists of articles, and selected textbooks. Inclusion criteria were randomized or quasi‐randomized clinical trials or controlled clinical trials comparing fissure sealing with no treatment or another preventive treatment in children up to 14 years of age at the start; the outcome measure was caries increment; the diagnostic criteria had been described; and the follow‐up time was at least 2 years. Inclusion decisions were taken and grading of the studies was done independently by two of the authors. The main measure of effect was relative risk reduction. Thirteen studies using resin‐based or glass ionomer sealant materials were included in the final analysis. The results showed that most studies were performed during the 1970s and a single application had been utilized. The relative caries risk reduction pooled estimate of resin‐based sealants on permanent 1st molars was 33% (relative risk=0.67; CI=0.55-0.83). The effect depended on retention of the sealant. In conclusion, the review suggests limited evidence that fissure sealing of 1st permanent molars with resin‐based materials has a caries‐preventive effect. The evidence is incomplete for permanent 2nd molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations with a low and a high caries risk, respectively.

Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults

OBJECTIVES Several studies have been conducted on the prevalence of hyposalivation in older adults but no population-based studies in younger adults. Therefore, our aims were to determine the prevalence of very low and low unstimulated (UWSFR) and stimulated (SWSFR) whole salivary flow rates in different age groups between 20 and 69 years, and to analyse the relationship between hyposalivation, subjective oral dryness and predictors of reduced flow rate. METHODS A randomized and stratified cross-sectional study including 1427 dental patients was conducted. UWSFR and SWSFR were measured, numbers of remaining teeth recorded and a questionnaire answered regarding subjective oral dryness, general diseases, use of drugs, body mass index (BMI) and use of tobacco. RESULTS The prevalence of very low (<0.1 ml/min) and low (0.10-0.19 ml/min) UWSFR was similar for different age groups up to 50 years, ranging between 10.9-17.8% and 17.3-22.7%, respectively. The prevalence of very low UWSFR was significantly higher for women aged 50-69 years than for younger women. For men, prevalence of very low UWSFR was higher at 60-69 years. The prevalence of very low (<0.7 ml/min) and low (0.70 - 0.99 ml/min) SWSFR was between 0-5.5% and 0.8-8.2%, respectively, for the different age groups 20-69 years. Multiple logistic regression revealed that age above 50 years, female gender, having fewer than 20 teeth, and taking xerogenic drugs significantly increased the risk of very low UWSFR. For very low SWSFR, only having fewer than 20 teeth and taking more than two drugs were significant. In the younger individuals (<50 years) only BMI > 25 for very low UWSFR and diagnosed disease for very low SWSFR were found significant. In this younger subset, female gender combined with having fewer than 27 teeth was significant for low UWSFR. CONCLUSIONS Hyposalivation is prevalent in younger adults, among whom it is associated with diagnosed disease and high BMI, while after age 50 years it is associated with medication. It is also associated with gender and with fewer remaining teeth.

Economic evaluation of dental caries prevention: a systematic review.

The aim of the present study was to perform a systematic review of economic evaluations of caries prevention. A search in Medline from 1966 until May 2003 and a manual search in a number of journals identified 154 references, 74 of which were included. There were 17 original studies including an economic evaluation, and these form the basis of the present article. The rest were reviews, model studies and reports concerning economic practice in dentistry. The results show that the reviewed original studies on economic evaluation of caries prevention do not provide support for the economic value of caries prevention. The scarcity of well‐conducted studies, as well as contradictory evidence in the reviewed articles, makes it difficult to judge the health‐economic effect of the studied caries‐prevention methods.

Effect of Salivary Flow Rate on Salivary Fluoride Clearance after Use of a Fluoride-Containing Chewing Gum

The fluoride concentration in whole saliva and the effect of variations in salivary flow rate were studied in 5 volunteers after use of a chewing gum (Fluomin®) containing 0.25 mg fluoride as sodium f

The effect of salivary clearance of sucrose and fluoride on human dental plaque acidogenicity

Ten subjects rinsed with a 20% (0.58 M) sucrose solution with or without 0.2% NaF (905 parts/10(6) F-) added in two separate experiments. Saliva and plaque were collected before rinsing and after 2, 5, 10 and 30 min. Sucrose and fluoride concentrations in saliva and acid anion and fluoride concentrations in plaque were analysed. There was a statistically significant and positive correlation between the concentration of sucrose in the saliva 2 min after the rinse and the subsequent concentrations of lactate in plaque at 10 and 30 min after the rinse with sucrose alone but not in the presence of fluoride. Salivary fluoride concentrations during 2-30 min after the sucrose rinse were significantly correlated with plaque fluoride concentrations during the same time. The addition of fluoride to the sucrose rinse significantly inhibited lactate production.

Effects of Inorganic Orthophosphate and Pyrophosphate on Dissolution of Calcium Fluoride in Water

Calcium and fluoride release from excess solid calcium fluoride was monitored for 15-30 min in aqueous solutions containing various concentrations of inorganic orthophosphate and pyrophosphate. Low concentrations of these ions (1-10 μmol/L) considerably inhibited the rate of dissolution of calcium fluoride. This inhibition was pH-dependent, being reduced at pH values below 5. It is suggested that a reduced calcium fluoride dissolution rate, in the presence of phosphate, can account for the relatively slow loss of calcium fluoride from dental enamel observed in recent clinical studies. It also appears that calcium fluoride coated with phosphate may provide a pH-controlled slow release of fluoride that may be of clinical significance and a major component of the cariostatic mechanism of topically applied fluoride.

Physiological Factors Influencing Salivary Clearance of Sugar and Fluoride

The salivary clearance of sugar and fluoride is influenced by several physiological factors not yet fully investigated or understood. There are reasons to believe that these factors influence both the acid production by sugar fermentation in the dental plaque and the cariostatic action of fluoride on the enamel surface and its immediate environment. This paper presents theoretical and experimental considerations of physiological factors which influence the kinetics of sugar and fluoride in the oral cavity.

Effect of combined caries-preventive methods: a systematic review of controlled clinical trials.

The aim of this systematic review was to evaluate the caries‐preventive effect of combined caries‐preventive methods, defined as two or more different interventions in combination, each expected to prevent dental caries. The Medline database was searched for articles published in the period January 1966 to June 2003. Twenty‐four controlled studies met the inclusion criteria, and their value as evidence was assessed according to predetermined criteria. The level of evidence for the overall conclusion regarding each method was graded according to the protocol of the Swedish Council on Technology Assessment in Health Care. The scientific evidence for the combination of treatments involving fluoride that had a preventive effect on caries in children and adolescents was graded as moderate. However, for elderly patients the scientific evidence for the caries‐preventive effect of different combinations of treatments was found to be incomplete. No conclusion could be drawn regarding the evidence for combinations of treatments being effective for groups at high caries risk, as the results from the identified clinical studies were conflicting.

Effect of Citric Acid Clearance on the Saturation with Respect to Hydroxyapatite in Saliva

Citric acid contained in beverages and foods is one of the main causes of enamel erosion. It was hypothesized that the clearance of citric acid from saliva would influence the degree of salivary saturation with respect to hydroxyapatite (OHAp). Ten subjects rinsed with 2% citric acid, pH 2.1, for 5s. Before and at 1,2, 5, 10 and 15 min after the rinse, a small saliva sample was collected. The sample pH, ionic strength and the concentrations of ionized calcium, inorganic phosphate and citric acid were determined. The pH of the saliva decreased from 7.21 + or - 0.40 (mean + or - SD) at time zero to a minimum of 6.46 + or - 0.88 at 1 min after the rinse. It was back to baseline value after 15 min. The saliva was supersaturated with respect to OHAp at time zero. After the rinse with the citric acid the saturation level shifted to undersaturation in all individuals except one. At 1 and 2 min after the rinse the saliva was, on average, undersaturated. After 5 min the average saturation level was back to supersaturation. The individual differences were large. The correlations between the rate of clearance of citric acid during the 1 minute and the minimum degree of saturation with respect to OHAp at 1,2 and 5 min after the rinse were significant (r 0.84, r 0.76 and r 0.79, respectively). In conclusion, rinsing with citric acid will cause a decrease in the saturation level with respect to OHAp in a highly individual pattern.