BACKGROUND: Topically-applied fluoride varnishes have been used extensively as an operator-applied caries-preventive intervention for over three decades. This review updates the first Cochrane review of fluoride varnishes for preventing dental caries in children and adolescents, which was first published in 2002. OBJECTIVES: To determine the effectiveness and safety of fluoride varnishes in preventing dental caries in children and adolescents, and to examine factors potentially modifying their effect. SEARCH METHODS: We searched the Cochrane Oral Health Group's Trials Register (to 13 May 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 4), MEDLINE via OVID (1946 to 13 May 2013), EMBASE via OVID (1980 to 13 May 2013), CINAHL via EBSCO (1980 to 13 May 2013), LILACS and BBO via the BIREME Virtual Health Library (1980 to 13 May 2013), ProQuest Dissertations and Theses (1861 to 13 May 2013), and Web of Science Conference Proceedings (1945 to 13 May 2013). A search for ongoing trials was undertaken on ClinicalTrials.gov on 13 May 2013. There were no restrictions on language or date of publication in the search of the electronic databases. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials with blind outcome assessment used or indicated, comparing topically-applied fluoride varnish with placebo or no treatment in children up to 16 years during at least one year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces in both permanent (D(M)FS) and primary (d(e/m)fs) teeth. DATA COLLECTION AND ANALYSIS: At least two review authors assessed all search results, extracted data and undertook risk of bias independently. Study authors were contacted for additional information. The primary measure of effect was the prevented fraction, that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. The caries increments nearest to three years were used from each included study. Random-effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random-effects meta-regression analyses. Adverse effects information was collected from the included trials. MAIN RESULTS: Twenty-two trials with 12,455 participants randomised (9595 used in analyses) were included. For the 13 that contributed data for the permanent tooth surfaces meta-analysis, the pooled D(M)FS prevented fraction estimate comparing fluoride varnish with placebo or no treatment was 43% (95% confidence interval (CI) 30% to 57%; P < 0.0001). There was substantial heterogeneity, confirmed statistically (P < 0.0001; I(2) = 75%), however this body of evidence was assessed as of moderate quality. The pooled d(e/m)fs prevented fraction estimate was 37% (95% CI 24% to 51%; P < 0.0001) for the 10 trials that contributed data for the primary tooth surfaces meta-analysis, also with some heterogeneity (P = 0.009; I(2) = 59%). Once again this body of evidence was assessed as of moderate quality. No significant association between estimates of D(M)FS or d(e/m)fs prevented fractions and the pre-specified factors of baseline caries severity, background exposure to fluorides, application features such as prior prophylaxis, concentration of fluoride, frequency of application were found. There was also no significant association between estimates of D(M)FS or d(e/m)fs prevented fractions and the post hoc factors: whether a placebo or no treatment control was used, length of follow-up, or whether individual or cluster randomisation was used, in the meta-regression models. A funnel plot of the trials in the main meta-analyses indicated no clear relationship between prevented fraction and study precision. In both methods, power is limited when few trials are included. There was little information concerning possible adverse effects or acceptability of treatment. AUTHORS' CONCLUSIONS: The conclusions of this updated review remain the same as those when it was first published. The review suggests a substantial caries-inhibiting effect of fluoride varnish in both permanent and primary teeth, however the quality of the evidence was assessed as moderate, as it included mainly high risk of bias studies, with considerable heterogeneity.

/pdf/fluoride-varnishes-for-preventing-dental-caries-in-children-3tv0b9jl4u.pdf

Fluoride varnishes for preventing dental caries in children and adolescents.

A systematic literature review from 1966 to 2000 revealed 2,730 English-language publications on the role of bacteria in human primary dental caries in vivo. The most pertinent 313 papers were analyzed in evidence tables accessible online (http://www.nidcr.nih.gov). The search targeted all bacterial types implicated previously in caries and asked two questions. First, what is the association of specific bacteria with tooth decay and can causation be attributed to any of those bacteria? Retrieved studies were categorized as randomized-blinded-interventional, longitudinal, case-control, and cross-sectional and were weighted in descending order in terms of significance. Although many studies, due to ethical requirements, had confounding variables, they still indicate strongly: 1) the central role of the mutans streptococci in initiation of caries of smooth surfaces and fissures of crowns of teeth and suggests their potent role in induction of root surface caries; and 2) that lactobacilli are implicated as important contributory bacteria in tooth decay, but their role in induction of lesions is not well supported. Second, what is the source of infection by cariogenic bacteria? Molecular/genetic studies of implicated bacteria isolated from humans, randomized-blinded-interventional, and longitudinal studies indicate that mutans streptococci are spread vertically among humans, mostly from mothers to their children. Implications of these conclusions are briefly discussed. The most significant problems of literature interpretation include the benefits/shortcomings of salivary and plaque monitoring of the flora, the role of sugar(s) in decay as it influences the flora, and modeling strategies to predict lesion score increments as distinct from determination of the etiological role of specific bacteria. Future directions for microbiological clinical caries research are suggested, and the use of the term "caries" to describe the disease, not its lesions, is urged.

The microbiology of primary dental caries in humans.

Background Topical fluoride therapy (TFT) in the form of varnish, gel, mouthrinse or toothpaste has been used extensively as a caries-preventive intervention for over three decades. Objectives To determine the effectiveness and safety of fluoride varnishes, gels, mouthrinses, and toothpastes in the prevention of dental caries in children and to examine factors potentially modifying their effect. Search strategy We searched the Cochrane Oral Health Group's Trials Register (May 2000), CENTRAL (The Cochrane Library Issue 2, 2000), MEDLINE (1966 to January 2000), plus several other databases. We handsearched journals, reference lists of articles and contacted selected authors and manufacturers. Selection criteria Randomized or quasi-randomized controlled trials with blind outcome assessment, comparing fluoride varnish, gel, mouthrinse, or toothpaste with placebo or no treatment in children up to 16 years during at least 1 year. The main outcome was caries increment measured by the change in decayed, missing and filled tooth surfaces (D(M)FS). Data collection and analysis Inclusion decisions, quality assessment and data extraction were duplicated in a random sample of one third of studies, and consensus achieved by discussion or a third party. Authors were contacted for missing data. The primary measure of effect was the prevented fraction (PF) that is the difference in mean caries increments between the treatment and control groups expressed as a percentage of the mean increment in the control group. Random effects meta-analyses were performed where data could be pooled. Potential sources of heterogeneity were examined in random effects metaregression analyses. Main results There were 144 studies included. For the 133 that contributed data for meta-analysis (involving 65,169 children) the D(M)FS pooled prevented fraction estimate was 26% (95% CI, 24% to 29%; p Reviewer's conclusions The benefits of topical fluorides have been firmly established on a sizeable body of evidence from randomized controlled trials. While the formal examination of sources of heterogeneity between studies has been important in the overall conclusions reached, these should be interpreted with caution. We were unable to reach definite conclusions about any adverse effects that might result from the use of topical fluorides, because data reported in the trials are scarce.

/pdf/topical-fluoride-toothpastes-mouthrinses-gels-or-varnishes-3nj92a08qp.pdf

Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents

Dental caries and periodontal disease are associated with oral pathogens. Several plant derivatives have been evaluated with respect to their antimicrobial effects against such pathogenic microorganisms. Lippia sidoides Cham (Verbenaceae), popularly known as "Alecrim-pimenta" is a typical shrub commonly found in the Northeast of Brazil. Many plant species belonging to the genus Lippia yield very fragrant essential oils of potential economic value which are used by the industry for the commercial production of perfumes, creams, lotions, and deodorants. Since the leaves of L. sidoides are also extensively used in popular medicine for the treatment of skin wounds and cuts, the objective of the present study was to evaluate the composition and antimicrobial activity of L. sidoides essential oil. The essential oil was obtained by hydro-distillation and analyzed by GC-MS. Twelve compounds were characterized, having as major constituents thymol (56.7%) and carvacrol (16.7%). The antimicrobial activity of the oil and the major components was tested against cariogenic bacterial species of the genus Streptococcus as well as Candida albicans using the broth dilution and disk diffusion assays. The essential oil and its major components thymol and carvacrol exhibited potent antimicrobial activity against the organisms tested with minimum inhibitory concentrations ranging from 0.625 to 10.0 mg/mL. The most sensitive microorganisms were C. albicans and Streptococcus mutans. The essential oil of L. sidoides and its major components exert promising antimicrobial effects against oral pathogens and suggest its likely usefulness to combat oral microbial growth.

pdf/antimicrobial-activity-of-the-essential-oil-from-lippia-16dswotxxa.pdf

Antimicrobial activity of the essential oil from Lippia sidoides, carvacrol and thymol against oral pathogens.

Dental enamel is the hardest and most mineralized tissue in extinct and extant vertebrate species and provides maximum durability that allows teeth to function as weapons and/or tools as well as for food processing. Enamel development and mineralization is an intricate process tightly regulated by cells of the enamel organ called ameloblasts. These heavily polarized cells form a monolayer around the developing enamel tissue and move as a single forming front in specified directions as they lay down a proteinaceous matrix that serves as a template for crystal growth. Ameloblasts maintain intercellular connections creating a semi-permeable barrier that at one end (basal/proximal) receives nutrients and ions from blood vessels, and at the opposite end (secretory/apical/distal) forms extracellular crystals within specified pH conditions. In this unique environment, ameloblasts orchestrate crystal growth via multiple cellular activities including modulating the transport of minerals and ions, pH regulation, proteolysis, and endocytosis. In many vertebrates, the bulk of the enamel tissue volume is first formed and subsequently mineralized by these same cells as they retransform their morphology and function. Cell death by apoptosis and regression are the fates of many ameloblasts following enamel maturation, and what cells remain of the enamel organ are shed during tooth eruption, or are incorporated into the tooth’s epithelial attachment to the oral gingiva. In this review, we examine key aspects of dental enamel formation, from its developmental genesis to the ever-increasing wealth of data on the mechanisms mediating ionic transport, as well as the clinical outcomes resulting from abnormal ameloblast function.

Dental enamel formation and implications for oral health and disease.

The major route of early acquisition of mutans streptococci in humans is a vertical transmission from mother to child. The purpose of this longitudinal study was to examine the acquisition, distributi

Colonization of Streptococcus mutans and Streptococcus sobrinus genotypes and caries development in children to mothers harboring both species.

– The caries preventive effect of topical application of fluoride varnish (Duraphat), ferric-aluminum-fluoride solution (FeAlF) and chlorhexidine gel was compared in a 2-yr clinical study. Children with more than 106 mutans streptococci per ml saliva were selected and a total of 189 13-yr-old children participated in the study. The children in the fluoride groups were treated every third month with either Duraphat or FeAlF-solution. In the chlorhexidine group children with more than 2.5 × 105 mutans streptococci per ml of saliva were treated every third month. The mean number of new decayed and filled tooth surfaces was 3.06 in the chlorhexidine group, 5.88 in the Duraphat group, 5.33 in the FeAlF group, and 6.34 in the control group. Thus supervised antimicrobial treatment can significantly reduce the incidence of dental (caries) in children with high numbers of mutans streptococci.

Effect of different carriers preventive measures in children highly infected with mutans streptococci.

The relationship between the salivary concentration of mutans streptococci and their prevalence on different tooth surfaces was studied in 114 subjects. Plaque samples were obtained from all tooth surfaces in the dentition and the infection magnitude of mutans streptococci was determined. The salivary concentrations of mutans streptococci correlated significantly with the number of colonized tooth surfaces and with the infection level of mutans streptococci for individual teeth or groups of tooth surfaces. The highest correlation values were found for buccal and approximal surfaces and for molars followed by premolars and anterior teeth. The 10 tooth surfaces best reflecting the salivary levels of mutans streptococci were 5 buccal and 5 approximal sites, 6 of them localized on maxillary posterior teeth. A significant positive relationship was noted between the prevalence of mutans streptococci in saliva and on the dorsum of the tongue.

Relationship between mutans streptococci in saliva and their colonization of the tooth surfaces.

The distribution and prevalence of Streptococcus mutans and Streptococcus sobrinus were determined in plaque samples from the cervical areas of all buccal, lingual and approximal tooth surfaces and from the fissures of all occlusal sites in 40 subjects harboring both species. S. mutans was detected more often and in higher numbers than S. sobrinus. There were more teeth detected with S. mutans only than with S. sobrinus only. Most teeth harbored both of these mutans streptococci species, indicating a positive association. The highest numbers of CFU for both species were detected on the molars, with the lowest incidence on the anterior teeth. The presence of S. mutans was relatively similar on all teeth tested, while the presence of S. sobrinus was relatively higher on the molars compared to the anterior teeth. S. mutans and S. sobrinus were found to colonize the buccal surfaces in almost equal numbers. On all other surfaces, S. mutans was detected more frequently or in higher numbers compared to S. sobrinus. No significant differences could be found in the relative proportions of S. mutans and S. sobrinus between sound, decayed or filled tooth surfaces.

Dental location of Streptococcus mutans and Streptococcus sobrinus in humans harboring both species.

The aim of the present study was to compare the use of toothpicks with other sampling methods for determination of mutans streptococci on different tooth surfaces. In nine persons with > 105 CPU per ml saliva of mutans streptococci, plaque samples were taken from 90 buccal and lingual surfaces. 108 occlusal surfaces and 90 approximal surfaces with toothpicks. The prevalence of mutans streptococci on these tooth surfaces was compared with samples taken at four 1-week intervals on the same tooth surfaces with a carver (buccal/lingual surfaces), a needle (occlusal surfaces) or a dental floss (approximal surfaces). Each sample was plated on MSB agar and the presence of mutans streptococci was expressed on a scale varying from 0 to 4. On two of the sampling occasions the amount of plaque, mirrored by total viable counts on blood agar, was also determined. Only for buccal/lingual plaque samples was a difference in total counts between methods noted and then with higher total recoveries obtained after sampling with toothpicks. More surfaces were found to be positive for mutans streptococci when samples were taken with a toothpick than with a carver, needle or floss. On surfaces positive for mutans streptococci the colonization score was higher in samples taken with a toothpick than with a carver or a needle while samples taken with a floss showed a tendency to higher levels of mutans streptococci than samples collected with a toothpick. The data indicate that the results obtained by using toothpicks for evaluating the prevalence of mutans streptococci an individual tooth surfaces compare favorably with the other methods tested

The toothpick method in relation to other plaque sampling techniques for evaluating mutans streptococci

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