Sherry Shiqian Gao

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.

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.

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.

Managing Early Childhood Caries for Young Children in China

The latest national survey found that 70% of 5-year-old children in China had dental caries. The prevalence of early childhood caries (ECC) may not only be attributed to poor oral hygiene and unhealthy diet, but also to limited access to and availability of dental care. The prevailing preventive measures adopted by industrialised countries for ECC management are neither practical nor affordable in China. Hence, an alternative approach to ECC management is necessary. Atraumatic restorative treatment (ART) has been advocated because the simple and short operative time renders ART affordable. However, the success rate of ART in restoring anterior primary teeth is unfavourable. Although there is no water fluoridation in China, topical fluorides may be used to manage ECC. Tooth brushing with fluoride toothpaste is effective for caries control, but not all toothpastes in China are fluoridated. Professionally applied fluorides such as sodium fluoride varnish can be a cost-effective treatment for managing the high prevalence of ECC in China. Silver diamine fluoride (SDF) at 38% is suggested to be effective in arresting ECC in China. It can be a simple, non-invasive and low-cost treatment. However, it stains caries black. Children and their parents must be well informed before SDF treatment.

The caries-arresting effect of incorporating functionalized tricalcium phosphate into fluoride varnish applied following application of silver nitrate solution in preschool children: study protocol for a randomized, double-blind clinical trial

BackgroundDental caries in primary teeth is prevalent, affecting millions of children around the world. Functionalized tricalcium phosphate (fTCP) has been incorporated into sodium fluoride (NaF) varnish to enhance the remineralization process. NaF varnish with the adjunctive application of silver nitrate (AgNO3) solution is effective in arresting dentine caries. So far, there is no published randomized clinical trial investigating the effectiveness of the adoption of AgNO3 solution and NaF varnish containing fTCP in arresting dentine caries in preschool children. The objective of this study is to compare the effectiveness of a 25% AgNO3 solution plus a 5% NaF varnish containing fTCP and a 25% AgNO3 solution plus a 5% NaF varnish in arresting coronal dentine caries among preschool children when applied semi-annually over a 30-month period.Methods/designThis is a randomized, double-blind controlled trial. The null hypothesis tested is that no difference exists between the effectiveness of a 25% AgNO3 solution plus a 5% NaF varnish with fTCP and a 25% AgNO3 solution plus a 5% NaF varnish in arresting dentine caries in preschool children when applied semi-annually. According to the sample size calculation, approximately 2000 3- to 4-year-old kindergarten children will be screened, and at least 408 children with coronal dentine caries will be recruited. The children will be randomly allocated to two treatment groups via stratified randomization: group A – biannual application of a 25% AgNO3 solution followed by a 5% NaF varnish, and group B – biannual application of a 25% AgNO3 solution followed by a 5% NaF varnish with fTCP. Clinical examinations will be conducted every 6 months to assess whether the carious lesions have become arrested (primary outcome). Confounding factors, such as demographic background and oral hygiene behaviors, will be collected through a parental questionnaire.DiscussionThe effectiveness of the topical application of a 25% AgNO3 solution followed by a 5% NaF varnish with fTCP in arresting coronal dentine caries among preschool children remains unknown. Because the proposed caries-arresting methods are simple, noninvasive and low cost, these can be widely recommended for caries control in young children.Trial registrationClinicalTrials.gov (U.S.): NCT03423797 on 6 February 2018.

Risk factors of early childhood caries among young children in Hong Kong – a cross-sectional study

OBJECTIVE Early childhood caries (ECC) was prevalent in Hong Kong. Children with ECC risk should be identified early for prevention. This study aimed to identify common risk factors of ECC in Hong Kong 3-year-old children. STUDY DESIGN Sample size calculation showed at least 6,321 of 3-year-old children should be invited in this study. A consent form and a questionnaire enquiring the childrens oral health behaviours and social-economic background were distributed to their parents. Children with parental consent were examined by a trained dentist. Caries status was recorded in dmft index. Chi-square test and logistic regression analysis were performed to identify the risk factors of ECC. RESULTS A total of 5,167 children from the 6,331 children invited were examined. Among them, 1,130 children (22%) had ECC (dmft>0). Logistic regression analysis found age of starting tooth brushing, snack-intake frequency, dental visit experience, birthplace, family monthly income, primary caretaker, and mothers education level were factors associated with ECC of the children. CONCLUSIONS Children who started tooth brushing later, had higher snack-intake frequency, were not born in Hong Kong, and whose family monthly income was lower, mothers education level was lower, primary caretaker was not domestic helper, had a statistically significant higher chance of having ECC.