Lars G. Petersson

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.

Pharmacokinetics of Fluoride Gels in Children and Adults

Plasma fluoride (F) concentration and urinary F excretion were studied in 8 children and 5 adults following topical application of three different types of F gel, (Luride® 1.23% F, Gel II® 1.23% F, Fl

Effect of school-based fluoride varnish programmes on approximal caries in adolescents from different caries risk areas

The aim was to evaluate, in a 3-year RCT study, school-based fluoride varnish programme on approximal caries incidence and approximal caries progression in 13- to 16-year-olds in high, medium and low caries risk areas on the Swedish west coast. Seven hundred and fifty-eight (89%) fulfilled the trial. Using a simple mobile unit, 2 dental nurses treated the adolescents with F varnish: (1) twice a year at 6-month intervals, (2) 3 times a year within 1 week, (3) 8 times per year during the semesters with 1-month intervals, and (4) no treatment (control). Radiographic caries recording was performed blindly by one of the authors. Concerning total approximal caries incidence, control groups in all areas developed more caries than F varnish groups, with the largest difference in the high risk area: 3.05 ± 3.37 new approximal caries lesions (mean ± SD) compared to 0.54 ± 1.26 for group 3, 0.95 ± 1.67 for group 1 and 1.40 ± 1.89 for group 2 (p < 0.001). More than 90% of the new approximal lesions in all the groups and in all areas consisted of new enamel lesions. Regarding progression of enamel lesions, there were only significant differences between groups 1–3 and group 4 in the high caries risk area. Prevented fraction for fluoride varnish treatment twice a year at 6-month intervals was 69% in high, 66% in medium and 20% in low risk areas. To conclude, school-based F varnish treatment every 6 months in 13- to 16-year-olds is excellent to prevent approximal caries in medium and high caries risk areas.

Reversal of primary root caries lesions after daily intake of milk supplemented with fluoride and probiotic lactobacilli in older adults

Abstract Objective. To evaluate the effect of milk supplemented with fluoride and/or probiotic bacteria on primary root caries lesions (PRCL) in older adults. Materials and methods. After informed consent, 160 healthy subjects, 58–84 years of age, with at least two PRCL were recruited and randomly assigned to one of four parallel study groups drinking 200 ml milk once daily for 15 months. Group A consumed standard milk (placebo); Group B ingested milk supplemented with 5 ppm F and probiotic bacteria (Lactobacillus rhamnosus LB21, 107 CFU/mL); Group C drank milk with only probiotic bacteria and group D milk contained only fluoride. Primary endpoints were Root Caries Index (RCI) and electric resistance measurements (ECM) carried out by one blinded single examiner. Secondary endpoints were mutans streptococci and lactobacilli counts in saliva and plaque estimated with chair-side tests. Data were compared within and between groups with non-parametric tests. Results. The drop out rate was 38%. At baseline there were no statistical differences between the groups. Significantly higher numbers of RCI reversals were found in groups B, C and D compared with group A (p < 0.05). The mean ECM values increased significantly (p < 0.05) in all groups except for the placebo group A, indicating that remineralization occurred. The effect was most beneficial in the two groups that contained fluoride. No significant alterations were displayed regarding the microbial counts. No severe adverse effects were reported during intervention. Conclusion. Daily intake of milk supplemented with fluoride and/or probiotic bacteria may reverse soft and leathery PRCL in older adults.

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.

Plasma Fluoride Concentration and Urinary Fluoride Excretion in Children following Application of the Fluoride-Containing Varnish Duraphat®

Plasma fluoride (F) concentration and urinary output of F were studied in 4 children, 4, 5, 12 and 14 years of age, after oral application of a F-containing varnish (Duraphat®). The F dose was found t

Caries Incidence in Relation to Salivary Mutans Streptococci and Fluoride Varnish Applications in Preschool Children from Low- and Optimal-Fluoride Areas

Caries incidence during a 2-year period was studied in 4- to 5-year-old children from three areas with contrasting levels of natural fluoride (F) in the drinking water and different regimens of topical fluoride varnish applications; group A (n = 448) was from an area with a low level of F (0.1 ppm) and semi-annual applications of fluoride varnish; group B (n = 374) was from a low F area (0.1 ppm) and no fluoride varnish treatments; group C (n = 206) was from an area with optimal F (1.2 ppm) and fluoride varnish treatments. All children were clinically assessed at baseline and after 2 years according to WHO criteria. The number of salivary mutans streptococci was estimated and scored at baseline and after 2 years with the Strip mutans method. The varnish containing 0.1% F was applied every 6 months on all accessible tooth surfaces after cleaning with a pumice paste. Basic preventive care was given to all children and restorative treatment on individual indications. Higher levels (p < 0.05) of salivary mutans streptococci were found in the low-fluoride areas compared to the optimal fluoride area at baseline and after 2 years. The caries incidence (mean dft +/- SD) in the different groups was A: 0.65 +/- 1.40; B: 1.09 +/- 1.85; C: 0.53 +/- 1.09. The difference between group B and groups A and C was statistically significant (p < 0.05). A positive relationship (p < 0.05-0.001) between salivary mutans streptococci scores at baseline and caries incidence was found in all three groups. This study confirms the close association between salivary mutans streptococci and caries incidence in preschool children and suggests a caries-reducing effect of topical applications of the fluoride silane varnish.

Plasma Fluoride Concentrations in Pre-School Children after Ingestion of Fluoride Tablets and Toothpaste

Plasma fluoride (F) concentration and urinary F excretion were studied in 5 children, age 3–4 years, after intake of F tablets (0.5 mg) and 0.6 g of two NaF toothpastes containing 0.1 and 0.025% F – c

EFFECT OF DIFFERENT CHLORHEXIDINE VARNISH REGIMENS ON MUTANS STREPTOCOCCI LEVELS IN INTERDENTAL PLAQUE AND SALIVA

The aim of the present study was to evaluate and compare the effects of an intensive and a monthly mode of antibacterial varnish application on the levels of mutans streptococci (MS) in interdental plaque and whole saliva. Eighty-eight healthy schoolchildren (11-13 years) with high scores of salivary MS were selected by a screening procedure and randomised into two groups, MS were enumerated at all mesial interdental sites of the first permanent molars with the aid of a modified chair-side technique, disclosing a total of 161 sites with moderate or high colonisation levels. The subjects were treated with a 1% chlorhexidine-thymol-containing varnish (Cervitec) either in an intensive mode (IM) with 3 applications within a 2-week period or in a monthly mode (MM) during a 3-month period. The varnish was applied with a miniball burnisher after the teeth had been cleaned interdentally with dental floss and dried with air. Follow-up samples of saliva and plaque from the interdental areas were collected after 1, 3 and 6 months. Both groups exhibited a statistically significant (p > 0.05) reduction of interdental MS after 1 month when compared with baseline. An eliminated MS growth appeared more frequently following the IM compared with the MM. After 3 months, a significant reduction compared with baseline was still found in the IM group but not in the MM group. No reduction was found in either group after 6 months. MS levels in saliva were mainly unaffected at the follow-up samplings, with the exception of a slight reduction in the IM group after 1 month. In conclusion, the results suggest that an intensive mode of chlorhexidine-thymol varnish application is more effective against interdental MS than the monthly mode of application. Bacterial growth should be monitored in a site-specific way, since interdental reductions were not adequately reflected in whole saliva samples.