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Objectives: to investigate whether baseline mineral distribution modulates the ability of silver diammine fluoride (SDF) to remineralize and stain enamel caries lesions., Methods: This laboratory study followed a 3 [treatment: SDF/fluoride varnish (FV)/deionized water (DIW)] ×3 [lesion protocol: methylcellulose (MeC)/hydroxyethylcellulose (HEC)/Carbopol 907 (C907)] factorial design. Lesions were created in bovine enamel specimens (n = 20). Treatments were applied and lesions remineralized in artificial saliva. Digital transverse microradiography (TMR-D) was used to analyze lesions. Lesion color was monitored spectrophotometrically. The effects of lesion protocol and treatment on changes in lesion depth (ΔLD), mineral loss (ΔΔZ), maximum mineral density at the surface zone (ΔSZ max ), and color changes related to remineralization (ΔL* remin ) were analyzed using two-way ANOVA., Results: The treatment×lesion protocol interaction was significant for ΔΔZ (p < 0.01) and ΔL* remin (p < 0.01), however not for ΔLD (p = 0.23) or ΔSZ max (p = 0.91). There were no differences in ΔΔZ between treatments in HEC and C907 lesions. However, DIW resulted in more remineralization than both SDF (p < 0.01) and FV (p = 0.01) in MeC lesions. Considering changes from lesion baseline after remineralization in MeC lesions, SDF treatment resulted in the highest mineral gain in the surface zone. However, DIW revealed the highest mineral gain after remineralization in the lesion body. SDF stained lesions with the intensity increasing after remineralization in C907 lesions, whereas staining decreased in MeC and HEC lesions., Conclusion: High fluoride treatments can interfere with continuous remineralization of caries lesions due to partial arrest. Baseline lesion mineral distribution affects SDF's ability to enhance remineralization and the staining caused by SDF., Clinical Significance: SDF is being used to arrest active caries lesions extending into dentin and to treat dentin hypersensitivity. This study shed light on SDF's effect on an isolated process in dental caries only, remineralization. It achieved this by examining enamel caries lesions with differing mineral distributions and assessing their staining properties., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Assessed the effect of dental products containing nano-hydroxyapatite (nano-HA) + fluoride on the remineralization of white spot lesions (WSL) in vivo or in situ., Methods: Seven databases were explored using a two-pronged approach (intervention/treatment). After screening, full-text assessment, and further exclusion, the qualitative synthesis of five studies (four clinical and one in situ) was performed. Based on the Cochrane collaboration guidelines relevant data of the studies were collected and summarized. The Cochrane risk of bias tool for randomized trials (RoB 2.0) was used to appraise the studies' methodological quality and the GRADE guidelines to assess their level of evidence. The RoB 2.0 domains were rated on their risk of bias (RoB) as low, high, or with some concerns, and an adaptation of the tool was used to the in situ study., Results: The included studies assessed 151 WSL in anterior permanent teeth, on patients with varying ages. The protocol application, treatment length (7d-12 w), and control groups varied greatly between the studies making the performance of a quantitative analysis unfeasible. The general RoB of the clinical studies was classified as being of low risk (n = 2) or some concerns (n = 2). The in situ study was considered as being of low risk. The level of the evidence was moderate. Most of the studies found moderate evidence regarding the superiority of this association in clinical settings., Conclusion: Even with the nano-HA + fluoride promising results for the remineralization treatment of WSL, due to the restricted number of studies and types of products, its extended use cannot be recommended based on the current systematic review, especially when considering the moderate level of the evidence found., Clinical Significance: Due to the biocompatibility and higher surface coverage of nano-HA and the remineralization capacity of fluoride formulations, the association of these elements to remineralize WSL has been positively reported. After the collection and qualitative appraise of the data, the clinical evidence of the use of these dental products is promising but limited., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study aimed to evaluate in vitro the effect protocols and anticaries agents containing casein amorphous calcium fluoride phosphopeptide-phosphate (CPP-ACPF, MI Paste Plus), sodium trimetaphosphate (TMP) and fluoride (F), in remineralization of caries lesions. Bovine enamel blocks with initial caries lesions were divided into groups (n = 12): 1) Toothpaste without F-TMP-MI Plus (Placebo); 2) Toothpaste 1100 ppm F (1100F), 3) 1100F + MI Paste Plus (1100F-MI Paste Plus), 4) Toothpaste with 1100F + Neutral gel with 4,500 ppm F + 5%TMP (1100F + Gel TMP) and 5) Toothpaste with 1100F + Neutral gel with 9,000 ppm F (1100F + Gel F). For the 4 and 5 groups the gel was applied only once for 1 minute, initially to the study. For the 3 group, after treatment with 1100F, MI Paste Plus was applied 2x/day for 3 minute. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); profile and depth of the subsuperficial lesion (PLM); concentrations of F, calcium (Ca) and phosphorus (P) in enamel was determined. The data were analyzed by ANOVA (1-criterion) and Student-Newman-Keuls test (p < 0.001). Treatment with 1100F alone led to ~ 28% higher remineralization when compared to treatment with 1100F associated with MI Paste Plus (p < 0.001). The 1100F and 1100F + Gel F groups showed similar values for %SHR (p = 0.150). 1100F + Gel TMP treatment also remineralized the enamel surface by ~ 30% and 20% when compared to the 1100F + Gel F and 1100F groups (p < 0.001). The lower lesion depth (ΔKHN) was observed for the 1100F + Gel TMP group (p < 0.001), where it was 54% and 44% lower in comparison to the 1100F and 1100F + Gel F groups (p < 0.001). Polarized light microscopy photomicrographs showed subsurface lesions in all groups, but these lesions were present to a lower extent in the 1100F + Gel TMP group (p < 0.001). Treatment with 1100F + Gel TMP promoted an increase in the concentration of Ca in the enamel by ~ 57% and ~ 26% when compared to the 1100F and 1100F + MI Paste Plus groups (p < 0.001), respectively. There were no significant differences between the 1100F, 1100F + MI Paste Plus and 1100F + Gel F groups (p > 0.001). Similar values of P in the enamel were observed in the 1100F, 1100F + MI Paste Plus and 1100F + Gel F groups (p > 0.001), except for the 1100F + Gel TMP group, which presented a high concentration (p < 0.001). We conclude that the 1100F+TMP gel treatment/protocol led to a significant increased remineralization when compared to the other treatments/protocols and may be a promising strategy for patients with early caries lesions.

Knowledge gaps exist regarding optimal silver diammine fluoride (SDF) regimens and the efficacy of new products for arresting dental caries in young children. We evaluated the effectiveness of 38%-SDF (SDI-RivaStar), Tiefenfluorid (TF) comparing with Placebo (P), all in conjunction with behavioural modification (BM), in preventing major complications (endodontic/extractions/pain)-a patient-centred outcome-due to early childhood caries over 12 months in children under 71-months. A six-arm, patient/parent-blinded, superiority, placebo-controlled randomised control trial at the university clinic in Riga, Latvia, from 1/9/20-31/8/22 (Protocol registration ISRCTN17005348). The trial tested six protocols, using three compounds (P/SDF/TF) under two regimes: annual and biannual (P1/P2/TF1/TF2/SDF1/SDF2) for major complications. Secondary outcomes included minor complications and parental satisfaction. All groups received BM. 373/427 randomised children (87.3%) completed the study. SDF2 had a significantly lower rate and risk of major (21.5%, OR = 0.28, 95%CI [0.11, 0.72], p < 0.05) and minor complications (OR = 0.16 (95%CI [0.05, 0.50], p = 0.002). Overall satisfaction was 96% (p > 0.05). SDF biannual application with BM effectively prevented major complications of early childhood caries and was well accepted by children and their parents. Trial registration number: ISRCTN17005348, principal investigator: Ilze Maldupa, registration date: 30/06/2021.Clinical trial registration number: ISRCTN registry: ISRCTN17005348, https://doi.org/10.1186/ISRCTN17005348 , registration date: 30/06/2021., (© 2024. The Author(s).)

Purpose: While silver diamine fluoride has been used extensively for caries arrest and desensitising, silver fluoride (AgF) at neutral pH may also have value as a minimally invasive dental caries treatment. This study explored the effectiveness of two AgF products (AgF/KI and AgF/SnF 2 ) when used in adult patients with special needs (SN) who had high caries risk and salivary gland hypofunction., Methods: This split-mouth clinical study, over two appointments 3-months apart, compared the impact of a single application of AgF/KI (Riva Star Aqua, SDI) and AgF/SnF 2 (Creighton Dental CSDS, Whiteley) on matched carious lesions in the same arch, by clinical visual-tactile (cVT) assessment of caries status and laser fluorescence (LF, DIAGNOdent) evaluation of bacterial load in the lesions, using repeated measures analysis., Results: Twelve participants were recruited in the study. A total of 56 teeth (28 pairs) were included. Both AgF products gave a significant decrease in caries activity as measured by cVT (P < 0.0001) and LF (P = 0.0027). There were no statistically significant differences between the two AgF treatments, with response rates for improvements in active lesions of 92% in the AgF/KI arm, and 96% in the AgF/SnF 2 arm. There was no effect of tooth type, lesion type, arch type, plaque metabolism and plaque area at the site level on outcomes, nor was there a clustering effect of sites in a patient level analysis. Overall, LF was superior to cVT for detecting lesions that still progressed despite treatment (P = 0.0027)., Conclusion: A single application of AgF/KI or AgF/SnF 2 has high predictability (over 90%) for achieving arrest in active caries lesions in adult patients with SN and high caries risk. Clinical assessment should use visual-tactile examination combined with LF readings to detect lesions that are still progressing and that require additional treatments. Future studies should compare these AgF modalities with SDF and explore factors such as time between applications and the need for repeated applications., Trial Registration: The study was registered with the Australian Clinical Trials Registry (ACTRN12621001139864p) on 23/08/2021., (© 2024. The Author(s).)

Objectives: To compare the level of acceptance of silver diamine fluoride (SDF) treatment between different functional groups of older adults aged 65-years-old and above., Methods: Three groups were recruited representing functionally-independent ("Community dwelling"), frail ("Nursing home"), and functionally-dependent older adults ("Caregiver": proxy respondent involved in caring for an older adult of all functional levels). Participants viewed a video on SDF and an interviewer-led questionnaire collected demographics, dental experience and perception on SDF use., Results: The study recruited 201 participants (100 "Community dwelling", 51 "Nursing home", 50 "Caregiver"). Overall, 73 % of participants were accepting of SDF treatment. Those in the "Community dwelling" group were most accepting (85 %), followed by the "Nursing home" group (61 %) and "Caregiver" group (60 %) (p<0.001). Participants were more accepting of SDF use on posterior (73 %) compared to anterior teeth (46 %). They were more accepting when SDF was presented as a treatment to avoid infection and pain (87 %), and general anesthesia (78 %). In a regression analysis, "Nursing home" and "Caregiver" participants were three times less likely to accept SDF (OR 0.27 [95 % CI: 0.13 to 0.60], and OR 0.27 [95 % CI: 0.12 to 0.58] respectively) compared to "Community dwelling" participants. After adjusting for other factors, only the "Caregiver" group remained significant (Adjusted OR 0.32 [95 % CI: 0.13 to 0.78])., Conclusions: Older adults were accepting of SDF and this treatment modality has the potential to be a routine treatment option in dental caries management in this population. However, this was less certain among frail and functionally dependent older adults., Clinical Significance: An SDF program to manage caries is likely to be well-received by functionally-independent older adults. However, the acceptance among frail and functionally-dependent older adults were lower even though SDF is mostly likely to benefit these populations. There is a need to investigate this relatively lower levels of acceptance., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: Silver diamine fluoride (SDF) is a medication used for the arrestment of dental caries. This study aims to determine the pharmacokinetics (PK) of silver and fluoride following SDF application in healthy children with dental caries., Methods: A total of 15 subjects, aged 4 to 10 years, with at least one cavity on a primary tooth, were recruited for this study. Urine samples were collected at baseline, first 24 h (F1) and second 24 h (F2) after SDF treatment for analysis of silver and fluoride content. Hair samples were also collected at baseline and at 7, 14, 30, 60, 75, and 90 days after SDF treatment to analyze silver content., Results: Participants with under or over-collection of urine, or failure to provide urine collection were excluded for fluoride analysis. As a result, eight subjects' urine samples were eligible for fluoride analysis. Significant correlations were observed between baseline urinary fluoride levels and F1/F2 levels. Pairwise comparisons from Friedman's test showed significant differences between baseline and F1 fluoride levels. For silver analysis, 15 subjects were studied. F1 urinary silver levels were higher than baseline and F2 levels. Subsequent to SDF treatment, hair silver levels displayed fluctuations around the baseline. None of the participants reported adverse effects, and all caries teeth ceased progression within 30 days., Conclusions: The urinary fluoride levels after SDF treatment, although higher, were not clinically significant. Urinary and hair silver levels were negligible. Therefore, SDF appears safe to be used among children., (© 2023. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Objective: White spot lesions (WSLs), the earliest evidence of enamel demineralization, are considered amenable to intervention to achieve a remineralized or arrested state of caries. The management of WSLs is quite challenging, and there is no definitive cure as yet. We performed a network meta-analysis to assess the efficacy of seven therapies for WSLs and gave a hierarchy of them., Materials and Methods: We systematically searched the PubMed, EMBASE, Cochrane, and Web of Science databases (last search: July 2022) to identify all relevant studies. We limited our search to studies published in English. Randomized controlled designed in vitro/clinical trials related to the efficacy of the seven therapies for WSLs were included. Data extraction was performed independently by two reviewers. The risk of bias (ROB) 2.0 tool from Cochrane and a previous in vitro methodological tool will be used for the quality assessment. Variations in quantitative light-induced fluorescence (QLF), laser fluorescence (LF), and lesions area were the primary outcome measures. Standard mean difference (SMD) was used as the effect size for the Network meta-analysis (NMA). Consistency and inconsistency tests were conducted. The hierarchy of 7 treatment effects was evaluated using surface probabilities under cumulative ranking (SUCRA). Publication bias was evaluated using a bias plot., Results: Forty-two articles were included in the systematic review. Thirty-one of them, with a total of 1906 participants, were included in the network meta-analysis. The studies owned a low and moderate risk of bias. This analysis does not suffer from significant inconsistency. The difference between 4 groups 'self-assembled peptide (SAP) P11-4', 'P11-4 + Fluoride Varnish (FV)', 'Resin Infiltration (RI)', 'casein phosphor peptides-amorphous calcium fluoride phosphate (CPP-ACFP)' and the 'Control' group was found to be statistically significant. Compared to the 'FV' and 'casein phosphor peptides-amorphous calcium phosphate (CPP-ACP)' groups, the 'P11-4 + FV" group and 'RI" group made a significant difference. The hierarchy was evident in the SUCRA values of 7 therapies. P11-4 + FV and RI were considered effective therapies compared to the control group or the FV group (gold standard group)., Conclusions: The available evidence suggests that resin infiltration and P11-4 in combination with fluoride varnish had advantages over gold standard (FV). The effect of tricalcium phosphate-based drugs and fluoride is not very noticeable. Overall, drugs based on P11-4 and resin infiltration will be better therapies. Using more than two drugs in combination also would increase efficacy., (© 2023. The Author(s).)

Purpose: To assess the acceptance of silver diamine fluoride (SDF) application on children's teeth among parents and children in the United Arab Emirates (UAE)., Materials and Methods: A pre-tested questionnaire and clinical photographs of SDF-treated teeth were employed to determine preferences among 370 parents for its use in managing dental caries in their children's teeth. A similar number of children ages 4 to 8 years were also interviewed, and their reaction to SDF was assessed through a facial image scale after showing pictures of pre- and post-SDF treated primary teeth., Results: 265 mothers and 105 fathers participated in this study. The Χ2 test was used to test for the statistically significant differences between parental perceptions. Almost all parents responded that SDF was either unacceptable or extremely unacceptable for their children's anterior teeth in comparison to 63% for posterior teeth (p = 0.009). Fathers were more comfortable with SDF treatment for posterior teeth on a scale of 3.1 out of 4, in comparison to 1.8 for mothers (p = 0.007). Parents with limited education (up to primary school) showed greater SDF acceptance in comparison to college-graduate parents (p = 0.000). The level of parental SDF acceptance increased with the children's behavioural barriers. The older children had a lower acceptance rate, at 1.2 and 2.5 for anterior and posterior teeth, respectively (p = 0.000)., Conclusions: SDF was acceptable to UAE-based parents for posterior teeth; however, they preferred it for anterior teeth only when advanced behavioural management (e.g., sedation) was advocated. Socioeconomic factors moderated their SDF preference regarding the location of tooth and treatment difficulty. Younger children were relatively more receptive to SDF use than were older children.

Objective: To investigate the effect of a novel mineral containing toothpaste in comparison to a fluoride toothpaste in children with white spot lesions., Methods: The clinical study was conducted from 2016 to 2018 at Marmara University Department of Pediatric Dentistry Clinic after approval from the ethics review committee of Yeditepe University, Istanbul, Turkey and comprised children of either gender aged 4-5 years having white spot lesions. They were randomly allocated into two groups. The FT (Fluoridated Toothpaste) group was given a 500ppm fluoridated toothpaste, while the Mineral Containing Toothpaste (MCT) group was given toothpaste containing calcium glycerophosphate, magnesium chloride, and 12% xylitol. The white spot lesions were examined using Laser Fluorescence (LF) at baseline and after a month of usage. The two readings were compared. Stimulated saliva was collected for measuring the salivary potential of hydrogen, buffering capacity, and streptococcus mutans. Data was analysed using SPSS 19., Results: Of the 26 children, 10(38%) were girls and 16(62%) were boys. The overall mean age was 4.77±0.54 years. There were 13(50%) subjects in each of the two groups. Of the 381 measurements done, 198(52%) were in the MCT group and 183(48%) in the FT group. LF scores decreased in both the groups (p=0.001). The remineralising potential was not significantly different (p=0.866), while salivary buffering capacity and potential of hydrogen increased in both the groups but the change was not significant (p>0.05). The number of children positive for streptococcus mutans decreased in both the groups (p>0.05)., Conclusions: The toothpaste containing calcium glycerophosphate, magnesium chloride and 12% xylitol had the remineralization properties needed for the prevention of gwhite spot lesions in children.

Background: There is limited information on the effectiveness of 38% silver diamine fluoride (SDF) in managing enamel caries. Objective: This study aimed to compare effectiveness of 38% SDF and 5% Sodium fluoride (NaF) varnish in arresting enamel caries in young children when applied semiannually over 18 months. Methods: A randomized controlled trial was conducted on children aged 1−3 years who had at least one active carious surface. They were allocated into two groups: Group 1 (38% SDF) and Group 2 (5% NaF varnish). Visual-tactile examination was used to assess extent of carious lesions. Enamel caries that did not progress to dentin were classified as having caries arrest. Intention-to-treat analysis was performed. Results: At baseline, 290 children with 1974 tooth surfaces with enamel caries were recruited. Caries arrest rates at the tooth surface level in Group 1 and Group 2 were 59.1% and 58.8%, respectively (p = 0.873), at 18 months. The multilevel logistic regression analysis revealed that tooth position, tooth surface, extent of enamel caries at baseline, caries experience, and brushing with fluoride toothpaste influenced caries arrest (p < 0.05). Conclusion: The semiannual application of 38% SDF and 5% NaF varnish had comparable effectiveness in arresting enamel caries in primary teeth.

The present systematic review aimed to investigate the effectiveness of professionally applied topical fluoride as therapeutic agent for incipient carious lesions in permanent teeth. Randomised clinical trials (RCTs) comparing the effectiveness of professionally applied topical fluoride (varnish or gel) with that of placebo, no intervention, and toothbrushing (control group) in the treatment of incipient carious lesions in permanent dentition were included. An electronic search was performed in the PubMed, Web of Science, Scopus, Virtual Health Library, Embase, and Cochrane databases, in the grey literature, and in clinical trials registered until January 2021. Two reviewers independently screened titles and abstracts and assessed the risk of bias using the Cochrane tool. The certainty of evidence was classified using GRADE. A total of 2,223 articles were screened using titles/abstracts. After full-text reading of the 22 selected studies, nine RCTs were included. Five RCTs found that topical fluoride may be effective in reversing incipient carious lesions in permanent teeth. Overall, five studies were classified as having a low risk of bias and four as having some concerns. Only descriptive analysis was performed because of the heterogeneity of the data. Studies comparing fluoride varnish with usual home care oral hygiene have demonstrated topical fluoride does not appear to be more effective in improving the appearance of incipient carious lesions. Therefore, usual home care oral hygiene with fluoride toothpaste may be sufficient to treat incipient carious lesions in permanent dentition. Further studies with greater methodological rigor are, however, required to reduce bias, to allow a meta-analysis, and to draw well-founded conclusions (CRD42019120406).

Background: Evidence-based information should be provided to clinicians to explain the effectiveness of hydrophilic and hydrophobic forms of resin based sealants (RBSs)., Aim: To assess and evaluate the retention and cariostatic effect of hydrophilic and hydrophobic RBSs in primary and/ or permanent teeth with at least a follow-up period of 3 months., Materials and Methods: Five databases were searched up to September 2021 for randomized and non-randomized clinical trials (RCTs and non-RCTs) that evaluated the retention and cariostatic effect of hydrophilic and hydrophobic RBSs. Two authors nominated the papers, extracted data, and assessed the risk of bias., Results: By comparing the retention rate and caries incidence between groups, pooled-effect estimates of included articles were generated. After removing duplicates from the 2,810 titles found, only 1938 remained. Twelve of these were thoroughly examined. A total of 12 papers met the inclusion criteria in qualitative analysis: seven RCTs and five non-RCTs. Only ten studies were included in the meta-analysis: five RCTs and five non-RCTs. After 12 months of follow-up, no significant difference was found in the retention of hydrophilic and hydrophobic RBSs with and without a bonding agent. After 12 months of follow-up, no significant difference was found in the cariostatic effect of hydrophilic and hydrophobic RBSs., Conclusion: There was no statistically significant difference in retention and the cariostatic impact was found between hydrophilic and hydrophobic RBSs., Competing Interests: None

Objectives: The aim of this randomized, double-blind, two-arm crossover in situ study was to investigate whether nano-hydroxyapatite (nanoHAP) dental lotion (Apagard Deep Care) applied immediately after tooth-brushing with nanoHAP toothpaste (Apagard M-plus) enhances the remineralization promotion and the demineralization inhibition efficacies of nanoHAP toothpastes., Methods: 64 sound enamel blocks and 64 blocks bearing artificially-produced initial caries were produced from human permanent molar teeth. During each treatment period, lasting 14 days per arm, two blocks, one sound and one lesion-bearing, were exposed to either 5% nanoHAP-containing or placebo dental lotion after tooth-brushing with 5% nanoHAP toothpaste, via an intra-oral appliance worn by 30 adults in each of the study groups. Baseline and post-test mineral loss were quantified using transverse microradiography (TMR). One-sided t-test of one group mean was used for intragroup comparison, while two-sided t-test of two independent means was used to compare the two dental lotions., Results: Pairwise comparison (baseline vs. post-test) indicated significant (p<.001) remineralization by nanoHAP toothpaste in both groups. However, when compared against each other, there was a significantly (p<.001) greater percentage of remineralization with nanoHAP lotion [58.4(±1.8)%] than with placebo lotion [37.7(±2.2)%]. TMR examination showed absolute demineralization inhibition in sound enamel blocks exposed to either lotions., Conclusions: Toothpaste containing 5% nanoHAP effectively remineralized initial caries and inhibited demineralization of healthy enamel; however, the application of a dental lotion containing 5% nanoHAP after brushing resulted in superior remineralization compared to a placebo lotion., Clinical Significance: Dental lotion containing 5% nanohydroxyapatite used immediately after toothbrushing with 5% nanohydroxyapatite toothpaste can serve as an adjunct to enhance the clinical benefits of the toothpaste., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Despite growing evidence to support the use of silver diamine fluoride (SDF) for managing carious lesions, and the increased interest in SDF worldwide, uptake in the UK remains limited. This study explored parents' and children's views and acceptability of SDF for the management of carious lesions in children., Methods: Eleven semi-structured face-to-face interviews were conducted with 11 parent-child dyads recruited from patients attending Dundee Dental Hospital and School. Interviews were transcribed verbatim, coded and thematically analysed., Results: Previous dental experience varied across all child participants. Of the 11 children, five had undergone general anaesthesia (GA) for multiple primary tooth extractions. Two had received SDF treatment. Child participants expressed concerns about being picked on by their peers, if they had discoloured anterior teeth. Younger children appeared less concerned about the discolouration and child's gender did not appear to influence parents' decision-making, nor the child's preferences regarding the use of SDF. Parents considered SDF to be particularly useful for anxious or uncooperative children but raised concerns about potential bullying at schools due to the unacceptable dental aesthetics when SDF is applied to anterior teeth. They believed they may be judged by others as neglecting their child's oral health due to the black staining. Both parents and children were more accepting of the SDF when applied to less-visible posterior teeth. Parents accepted the use of SDF if such treatment avoided extractions under GA., Conclusion: Despite the unfavourable aesthetics of SDF (black staining), parents appreciated SDF treatment, especially for uncooperative or younger children. However, both parents and children shared concerns about bullying at schools as a consequence of the black staining. Raising awareness about SDF was identified as one approach to encourage the uptake of SDF., (© 2021. The Author(s).)

Objective: To evaluate the effects of combination of treatments with fluoridated toothpastes supplemented with sodium trimetaphosphate (TMP) and casein phosphopeptide-amorphous calcium phosphate (MI Paste Plus®), on the remineralization of dental enamel., Design: Enamel blocks with artificial caries were randomly allocated into six groups (n = 12), according to the toothpastes: 1) without F-TMP-MI Paste Plus® (Placebo); 2) 1100 ppm F (1100 F), 3) MI Paste Plus®, 4) 1100 F + MI Paste Plus® (1100 F-MI Paste Plus®), 5) 1100 F + 3% TMP (1100 F-TMP) and 6) 1100 F-TMP + MI Paste Plus® (1100 F-TMP-MI Paste Plus®). Blocks were treated 2×/day with slurries of toothpastes (1 min). Furthermore, groups 4 and 6 received the application of MI Paste Plus® for 3 min. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); profile analysis and lesion depth subsurface through polarized light microscopy (PLM), confocal laser scanning microscopy (LSCM), scanning electron microscopy (SEM), fluoride (F), calcium (Ca), phosphorus (P) concentrations in the enamel were determined. The data were analyzed by ANOVA (1-criterion) and Student-Newman-Keuls test (p < 0.001)., Results: 1100 F-TMP-MI Paste Plus® group showed the best results of %SHR, ΔKHN and PLM (p < 0.001). F concentration was similar between the 1100 F, 1100 F-MI Paste Plus®, and 1100 F-TMP-MI Paste Plus® groups (p > 0.001). 1100 F-TMP-MI Paste Plus® group showed the highest concentration of Ca and P in the enamel (p < 0.001)., Conclusion: The association of 1100 F-TMP and MI Paste Plus® led to a significant increase in the remineralization of initial carious lesions., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Because of excellent biocompatibility, antioxidant activity, and anti-caries ability, epigallocatechin-3-gallate (EGCG) has been widely studied in the treatment of oral diseases, such as periodontal disease, oral cancer, and dental caries. To reach the site of the lesion or achieve sustained release, play the role of anti-caries, anti-inflammatory, or to maintain or improve the physical properties of the modified material，EGCG need to be cross-linked or embedded with dental adhesives, barrier membranes, bone replacement materials, tissue regeneration materials, and antimicrobial anti-caries materials to better prevent or treat oral diseases. This article reviews the applications of EGCG in oral materials, involving various areas of the oral cavity, reveals their excellent potential, and sees shortcomings in these research to promote the better development of EGCG applications in oral materials such as oral repair materials, bone tissue engineering materials and antibacterial and anti-caries materials., (© 2020 Wiley Periodicals LLC.)

To investigate the safety and efficacy of Self-Assembling Peptide P 11 -4 (SAP P 11 -4) compared to placebo or fluoride varnish (FV), a randomized, controlled, blinded, split-mouth study with sequential design was conducted. Subjects presenting two teeth with White-Spot-Lesions (WSLs) were included and teeth were randomly assigned to test or control. Control received placebo at baseline (D0) and test SAP P 11 -4, all received FV at Day 90 (D90). Standardized photographs were taken at each visit, and WSL size changes were morphometrically assessed. Hierarchical Linear Modelling, considering paired and sequential design, was used to test four hypotheses. SAP P 11 -4 lesions (test, D90-D0) showed significant WSL size reduction compared to placebo (control, D90-D0; p = 0.008) or FV (control, D180-D90; p = 0.001). Combination of SAP P 11 -4 and delayed FV after 90 days (test, D180-D0), showed a significant difference compared to FV alone (control D270-D90; p = 0.003). No significant difference on FV efficacy was found when SAP P 11 -4 was applied 3 months before FV (test D270-D90; control D270-D90, p = 0.70). SAP P 11 -4 treatment resulted in superior caries regression compared to either placebo or FV, and FV efficacy seems not to be affected by SAP P 11 -4. SAP P 11 -4 was found to be a safe and effective WSL treatment.

Caries is the most common and extensive oral chronic disease. Due to the lack of anti-caries properties, traditional caries filling materials can easily cause secondary caries and lead to treatment failure. Nanomaterials can interfere with the bacteria metabolism, inhibit the formation of biofilm, reduce demineralization, and promote remineralization, which is expected to be an effective strategy for caries management. The nanotechnology in anti-caries materials, especially nano-adhesive and nano-composite resin, has developed fast in recent years. In this review, the antibacterial nanomaterials, remineralization nanomaterials, and nano-drug delivery systems are reviewed. We are aimed to provide a theoretical basis for the future development of anti-caries nanomaterials.

Enamel demineralisation can occur as a side effect during orthodontic treatment with fixed appliances. This study aimed to evaluate the efficacy of the self-assembling peptide P 11 -4 for remineralisation combined with fluorides, compared to application of fluoride varnish alone. De- and remineralisation was assessed by Quantitative light-induced fluorescence (QLF). Orthodontic brackets were bonded on 108 human enamel samples and white spot lesions were created. The samples were allocated randomly into three groups: Group I received no treatment, group II had a single application of fluoride varnish (22,600 ppm), and group III was treated with P 11 -4 following a single application of fluoride varnish. Quantitative light-induced fluorescence (QLF) measurements were performed at baseline, after demineralisation and after storage in remineralisation solution for 7 and 30 days. Non-parametric tests (Kruskal-Wallis test and Friedman test) were used for further analysis. After demineralisation, all samples showed a median ΔF -9.38% ± 2.79. After 30 days median ΔF values were as followed: group I = -9.04% ± 2.51, group II = -7.89 ± 2.07, group III = -6.08% ± 2.79). The median ΔF values differed significantly between all groups at all investigation times (p < 0.00001). Application of P 11 -4 with fluoride varnish was superior to the use of fluorides alone for remineralisation of enamel adjacent to brackets.

Objective: To explore the anti-caries efficacy of three fluoride compounds at increasing maturation of a microcosm biofilm., Design: Microcosm biofilm, obtained from saliva collected from three donors (IRB #1406440799), was grown on enamel samples (n = 18/group) for 24-h (Brain Heart Infusion; 0.2 % sucrose). Then, pH cycling model started. Three maturations were explored (4d, 8d, and 12d). The pH cycling consisted of daily 2 × 5 min treatments (NaF, SnF 2 , AmF: 287.5 ppm F, and de-ionized water [DIW]), 4 × 10 min remineralization (BHI, no sucrose, pH 7.0), and 3 × 2:15 h demineralization (BHI, 1% sucrose, pH 4.5). We analyzed the enamel (surface microhardness [VHN change ], integrated mineral loss [ΔZ], lesion depth [L]), and the biofilm (viability [log 10 CFU/mL], lactic acid production [LDH], and exopolysaccharide [EPS] amount). Data were analyzed using two-way ANOVA (p = 0.05)., Results: The interaction between tested variables was significant for VHN change , viability, LDH, EPS (p = 0.0354, p = 0.0001, p < 0.0001, p < 0.0001), but not for L (p = 0.2412) or ΔZ (p = 0.6811). LDH and EPS analyses exhibited more tolerance of mature biofilm against NaF (LDH and EPS p < 0.0001); NaF-treated groups demonstrated significantly lower results than the control in the 12d group. The effect of SnF 2 and AmF continued over time. VHN change , L, and ΔZ: The effect of SnF 2 and AmF was higher than NaF and DIW. L and ΔZ did not result in significant differences over time (all treatments). Within each maturation, fluoride compounds demonstrated statistically significantly lower L and ΔZ values than DIW., Conclusions: Biofilm's maturation may influence the selection of fluoride compounds to achieve an optimum cariostatic effect., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: The study aimed to compare the effectiveness of 38% silver diamine fluoride (SDF) solution, and 5% sodium fluoride (NaF) varnish applied semiannually in arresting dentin caries in young children with high caries risk., Methods: Children aged 1-3 years who had at least one active dentin carious lesion were randomly allocated into 2 groups as follows: Group 1 = 38% SDF (Topamine), and Group 2 = 5% NaF varnish (Duraphat). Both agents were applied every 6 months onto the carious surface. Lesion activity was assessed by the visual-tactile examination. Baseline and follow-up examinations were conducted by the same examiner. The children's demographic background, oral health-related habits, and oral hygiene practices, as well as parental satisfaction with children's dental appearance were collected at baseline and the 12-month follow-up., Results: At baseline, 153 and 149 children were recruited in Group 1 and Group 2, respectively. The mean dmfs scores in Groups 1 and 2 were 8.89 and 9.79, respectively. After 12 months, 87.1% remained in the study. The caries arrest rate of Group 1 (35.7%) was significantly higher than that of Group 2 (20.9%) (p < 0.001). The results of the multilevel logistic regression analysis confirmed that the treatment in Group 1 was more effective in arresting dentin carious lesions than that of Group 2 (OR = 2.04; 95% CI, 1.41-2.96). The presence of plaque on caries lesions, tooth type, tooth surface type, frequency of milk feeding, snack taking, and family income influenced on caries activity. Regardless of the intervention groups, there were no differences in parental satisfaction with on the child's dental appearance before and after receiving the intervention., Conclusion: Based on the 12-month results, 38% SDF is more effective than 5% NaF varnish in arresting dentin carious lesions in young children. SDF has no negative impact on parental satisfaction with the child's dental appearance., Clinical Significance: To control dentin carious lesions in young children with high caries risk, 38% SDF is more effective than 5% NaF varnish., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Farnesol is a sesquiterpene from propolis and citrus fruit that shows promising anti-bacterial activity for caries treatment and prevention, but its hydrophobicity limits the clinical application. We aimed to develop the novel polymeric micelles (PMs) containing a kind of derivative of farnesol and a ligand of pyrophosphate (PPi) that mediated PMs to adhere tightly with the tooth enamel., Results: Farnesal (Far) was derived from farnesol and successfully linked to PEG via an acid-labile hydrazone bond to form PEG-hyd-Far, which was then conjugated to PPi and loaded into PMs to form the aimed novel drug delivery system, PPi-Far-PMs. The in vitro test about the binding of PPi-Far-PMs to hydroxyapatite showed that PPi-Far-PMs could bind rapidly to hydroxyapatite and quickly release Far under the acidic conditions. Results from the mechanical testing and the micro-computed tomography indicated that PPi-Far-PMs could restore the microarchitecture of teeth with caries. Moreover, PPi-Far-PMs diminished the incidence and severity of smooth and sulcal surface caries in rats that were infected with Streptococcus mutans while being fed with a high-sucrose diet. The anti-caries efficacy of free Far can be improved significantly by PPi-Far-PMs through the effective binding of it with tooth enamel via PPi., Conclusions: This novel drug-delivery system may be useful for the treatment and prevention of dental caries as well as the targeting therapy of anti-bacterial drugs in the oral disease.

Background: The use of silver-formulation as microbicide to arrest dentinal caries is gaining popularity. The primary objective of the present appraisal was to systematically review the clinical (in vivo) applications and antimicrobial potential of silver-containing formulations in arresting dentinal caries. Our secondary aim was to sum up the available in vitro applications of silver-containing formulations against cariogenic microbes isolated from dentine lesions., Methods: Ovid MEDLINE, EBSCO host, Web of Science, and Cochrane Library databases was searched between January 2009-May 2019., Results: In vivo: We observed conflicting evidence of antimicrobial efficacy of SDF on a diverse array of microbial taxa present in carious dentine of primary and permanent teeth. Moreover, there is insufficient evidence on the application of AgNP-fluoride as an effective microbicidal against cariogens of dentine lesions. In vitro: We found a good evidence of microbicidal efficacy of silver diamine fluoride (SDF) on selective cariogenic microbes in human dentine model. Additionally, a good evidence was noted of in vitro application of silver nanoparticles (AgNPs) as a useful microbicidal against S. mutans adhesion, growth and subsequent biofilm formation in human dentine models., Conclusions: Taken together, in vitro evidence indicates the promising antimicrobial potential of silver-based formulations (SDF and nanosilver) against the predominant cariogenic flora, particularly from dentine lesions. Post-treatment clinical data of either the bactericidal and bacteriostatic effects of SDF or nanosilver are sparse. Furthermore, the current understanding of the specific size, concentration, antimicrobial mechanisms, and toxicological aspects of nano-silver compounds is inadequate to draw firm conclusions on their clinical utility.

Objectives: The aim of this study was to compare the antibacterial activity of fluoride varnishes containing different agents in children with severe early childhood caries (S-ECC)., Materials and Methods: The study was conducted in 92 children with S-ECC. Patients who completed dental treatment under general anaesthesia were included in the study. Patients were divided randomly into four groups: 5% sodium fluoride (SF) control group (n = 23), 5% SF with tricalcium phosphate (TCP) (n = 23), 5% SF with xylitol-coated calcium and phosphate (CXP) (n = 23) and 5% SF with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) (n = 23). Saliva mutans streptococci (MS) and lactobacilli (LB) levels were evaluated by taking saliva samples at baseline (T 0 ), 1 month (T 1 ) and 3 months (T 2 ) after treatment., Results: All groups showed a significant decrease in MS and LB levels at T 1 (P < 0.05) except the CXP group. Only the TCP group exhibited significantly decrease MS and LB levels indicating less than 10 5  CFU at both T 1 and T 2 compared with the other groups (P < 0.05)., Conclusion: Fluoride varnish with TCP provided significantly more reduction in MS and LB levels than other fluoride varnishes., Clinical Relevance: Fluoride varnish with TCP had a significant antibacterial effect against cariogenic bacteria until the end of the third month. Long lasting antibacterial effect provides additional advantage for reducing bacteria levels in children., Clinical Trials Registration Number: NCT03625310.

Background: Dental caries is one of the most prevalent chronic oral diseases worldwide. Dental caries is mainly associated with Streptococcus mutans and the Lactobacillus species. A specific relationship was found between nicotine and S. mutans growth as the presence of nicotine increased S. mutans biofilm formation. Nicotine is able to increase the number of S. mutans and extracellular polysaccharide (EPS) synthesis. Among the widely used herbs and spices is cinnamon which demonstrated a strong antibacterial activity against a wide variety of bacteria including S. mutans and showed the ability to inhibit S. mutans biofilm formation. Cinnamon essential oil, obtained from the leaves of C. zeylanicum, has been demonstrated to be effective against S. mutans and Lactobacillus acidophilus, which are partially responsible for dental plaque formation and caries development. The aim of this study was to identify the effects of nicotine exposure on the inhibitory effects of cinnamon water extract on S. mutans biofilm formation., Materials and Methods: A 24-h culture of S. mutans UA159 in microtiter plates was treated with varying nicotine concentrations (0-32 mg/ml) in Tryptic Soy broth supplemented with 1% sucrose (TSBS) with or without a standardized concentration (2.5 mg/ml) of cinnamon water extract. A spectrophotometer was used to determine total growth absorbance and planktonic growth. The microtiter plate wells were washed, fixed and stained with crystal violet dye and the absorbance measured to determine biofilm formation., Results: The presence of 2.5 mg/ml cinnamon water extract inhibits nicotine-induced S. mutans biofilm formation from 34 to 98% at different concentrations of nicotine (0-32 mg/ml)., Conclusion: The results demonstrated nicotine-induced S. mutans biofilm formation is decreased from 34 to 98% in the presence of 2.5 mg/ml cinnamon water extract. This provides further evidence about the biofilm inhibitory properties of cinnamon water extract and reconfirms the harmful effects of nicotine.

To find the best option to treat White Spot Lesion in existing caries treatments, and to identify the selected articles discussing etiology of caries along with White spot lesion. Null hypothesis was that "Only anticariogenic agent can cure White Spot Lesion". PRISMA guidelines were used to conduct the systematic analysis. An electronic customized search was performed using mesh terminologies on PubMed database based on inclusion criteria that included studies with; any treatment option that can treat or prevent WSL; and minimally invasive treatment options that may be altered to treat WSL. While exclusion criteria comprised studies with treatment of rampant caries, severe early childhood caries and root caries. Inclusion criteria for etiological factors incorporated studies with factors that lead to white spot lesion or carious lesion. Finally, therapeutic agents of dental caries were analyzed. Only the use of anti-cariogenic agent cannot cure White Spot Lesion. Hence study fails to prove the null hypothesis. Although combination of anti-cariogenic agents with a re-mineralizing agent can provide additional options for the treatment or prevention of WSL.

Objectives: To find out the effects of placement of atraumatic restorative treatment (ART) restorations on parental satisfaction and oral health related quality of life (OHRQoL) of preschool children with SDF-treated or untreated dentine caries lesions., Methods: In a randomized controlled trial conducted in Hong Kong, preschool children who had cavitated dentine caries lesions were randomly assigned to receive application of silver diamine fluoride (SDF) solution or placebo (tonic water) on their caries lesions 10 weeks before receiving ART restorations. Parents were asked to rate their satisfaction with their child's teeth using a 5-point scale (5 = very satisfied, 1 = very dissatisfied) before and six months after the restorative treatment. Besides, the Chinese version of Early Childhood Oral Health Impact Scale (C-ECOHIS) was used to assess the children's OHRQoL., Results: A total of 194 children participated in this study, with 101 and 93 children receiving SDF and placebo application before ART restorations, respectively. There was no significant difference in parental satisfaction and C-ECOHIS score between the SDF and placebo groups at baseline. At the 6-month follow-up, the mean parental satisfaction score regarding their child's dental health status increased significantly (p < 0.001) from 2.2 ± 0.7 to 2.8 ± 1.0 in the SDF group and from 2.3 ± 0.8 to 2.7 ± 0.9 in the placebo group. However, no significant changes (p > 0.05) in C-ECOHIS scores were found in either of the two groups after ART restoration placement., Conclusions: Placement of ART restorations can improve parental satisfaction with the health and appearance of their child's teeth but has no significant effect on the OHRQoL., Clinical Significance: This study provides valuable information about the effects of ART restoration placement on SDF-treated or untreated dentine caries lesions regarding parental satisfaction and OHRQoL of preschool children., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: This clinical trial investigated the efficacy of silver diamine fluoride (SDF) in arresting dentine caries in primary molars of preschoolers. Time required for treatment, adverse effects, parental aesthetic perception, anxiety and oral health related to quality of life (OHRQoL) was evaluated., Materials and Methods: Children, 2-5 years old, with active dentine caries lesions on the occlusal surface of primary molars were randomly allocated to test group (SDF) or control group (atraumatic restorative treatment/ART). The dmf-t/DMF-T and ICDAS indexes determined the presence of caries and activity. The main outcome after 3, 6 and 12-month follow-up was assessed by a blind examiner. The time required to perform the treatments was recorded and a facial image scale was applied to assess anxiety before and after treatment. Adverse events and aesthetic perception were assessed through questions addressed to caregivers; and the OHRQoL through the B-ECOHIS questionnaire., Results: In 68 patients that were randomized, the mean number of treated teeth per child was 2.42(1.04) and 2.09(1.18) in the SDF and ART groups (p = 0.074), respectively. The mean difference of arrested lesions between the groups after 12 months was -0,07(0.05; - 0.17-0.30). The time required to treat with SDF was lower than the ART (p < 0.001). There was no difference in the percentage of adverse events + aesthetic perception (p = 0.709), and the change in anxiety (p = 0.155). There was a less impact in OHRQoL after ART treatment, but only when the parents' distress subscale was considered (p = 0.012)., Conclusion: SDF requires much less chair-time and have similar results as ART in arresting caries lesion, anxiety, adverse effects, aesthetic perception and quality of life., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The aim of this study was to evaluate soluble and insoluble fluoride concentrations in commercial varnishes, and their remineralization effect on artificial caries enamel lesions using surface and cross-sectional microhardness evaluations. Forty bovine enamel blocks were separated into four groups (n=10): control (no treatment), Enamelast (Ultradent Products), Duraphat (Colgate-Palmolive) and Clinpro White Varnish (3M ESPE). Surface enamel microhardness evaluations were obtained, artificial enamel caries lesions were developed by dynamic pH-cycling, and the varnishes were then applied every 6 days, after which the enamel blocks were submitted to dynamic remineralization by pH cycles. After removal of the varnishes, the enamel surfaces were reassessed for microhardness. The blocks were sectioned longitudinally, and cross-sectional microhardness measurements were performed at different surface depths (up to 300 μm depth). Polarized light microscopy images (PLMI) were made to analyze subsurface caries lesions. The fluoride concentration in whole (soluble and insoluble fluoride) and centrifuged (soluble fluoride) varnishes was determined using an extraction method with acetone. The data were analyzed to evaluate the surface microhardness, making adjustments for generalized linear models. There was a significant decrease in enamel surface microhardness after performing all the treatments (p<0.0001). Enamelast and Duraphat showed significantly higher enamel microhardness values than the control and the Clinpro groups (p = 0.0002). Microhardness loss percentage was significantly lower for Enamelast (p = 0.071; One-way ANOVA). PLMI showed that subsurface caries lesions were not remineralized with the varnish treatments. No significant differences in the in-depth microhardness levels (p = 0.7536; ANOVA) were observed among the treatments. Enamelast presented higher soluble and insoluble fluoride concentrations than the other varnishes (p < 0.0001; Kruskal-Wallis and Dunn tests). Enamelast and Duraphat varnishes promoted enamel surface remineralization, but no varnish remineralized the subsurface lesion body. Although insoluble and soluble fluoride concentration values did not correspond to those declared by the manufacturer, Enamelast presented higher fluoride concentration than the others.

Objective: The aim of this in vitro study was to determine the effects of remineralization promoting agents containing casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), or CPP-ACP in combination with fluoride (CPP-ACPF) on artificial white spot lesions (WSLs) after 6 and 12 weeks., Methodology: White spot lesions were created on 123 sectioned premolars (246 specimens) with a demineralization solution during a 96 hours pH-cycling regime. Two experimental groups were created: a CPP-ACP group (Tooth Mousse™), and a CPP-ACPF group (Mi Paste Plus™). Additionally, two control groups were created, one using only a conventional toothpaste (1450 ppm fluoride) and another one without any working agents. All teeth were also daily brushed with the conventional toothpaste except the second control group. Tooth Mousse™ and Mi Paste Plus™ were applied for 180 seconds every day. The volume of demineralization was measured with transverse microradiography. Six lesion characteristics regarding the lesion depth and mineral content of WSLs were also determined., Results: The application of CPP-ACP and CPP-ACPF had a significant regenerative effect on the WSLs. Compared to Control group 1 and 2 the volume of demineralization after 6 weeks decreased significantly for CPP-ACP (respectively p<0.001 and p<0.001) and CPP-ACPF (respectively p=0.001 and p=0.003). The same trend was observed after 12 weeks. For the CPP-ACPF group, WSL dimensions decreased significantly between 6 and 12 weeks follow-up (p=0.012). The lesion depth reduced significantly after application of CPP-ACP and CPP-ACPF but increased significantly in the Control groups. Mineral content increased for CPP-ACP and CPP-ACPF after an application period of 12 weeks, but this was only significant for CPP-ACP., Conclusions: Long-term use of CPP-ACP and CPP-ACPF in combination with a conventional tooth paste shows beneficial effects in the recovery of in vitro subsurface caries lesions.

Dental caries can compromise quality of life and is associated with demineralization of tooth structure by organic acids produced by microorganisms. This study systematically reviewed the dentine caries arrest capabilities of silver diamine fluoride (SDF) and sodium fluoride (NaF). A comprehensive search strategy was developed to identify the relevant publications in electronic databases and hand searched journals and reviews (to March 2018). By applying strict inclusion and exclusion criteria, only six papers (two randomized controlled trials, two follow-up articles and two secondary statistical analysis studies) were considered for full text qualitative and quantitative assessment. The included studies were critically appraised and statistically evaluated. Only four articles were considered for meta-analysis, as the other two were secondary analyses of included studies. When comparing the caries arrest lesions of SDF and NaF, SDF was found to be statistically more effective in dentine caries arrest of primary teeth during the 18 and 30 month clinical examinations. The weighted total effect size of the differences between SDF and NaF regarding arrested caries surfaces was calculated and showed nearly double the effectiveness of SDF to NaF at 30 months. Therefore, SDF is a more effective caries management reagent than NaF. Further clinical research is needed to consolidate the findings of this systematic review.

Background: Dental caries is a bacterially mediated disease characterised by demineralisation of the tooth surface, which may lead to cavitation, discomfort, pain and eventual tooth loss. Ozone is toxic to certain bacteria in vitro and it has been suggested that delivering ozone into a carious lesion might reduce the number of cariogenic bacteria. This possibly could arrest the progress of the lesion and may, in the presence of fluoride, perhaps allow remineralisation to occur. This may in turn delay or prevent the need for traditional dental conservation by 'drilling and filling'., Objectives: To assess whether ozone is effective in arresting or reversing the progression of dental caries., Search Methods: We searched the Cochrane Oral Health Group's Trials Register (to 7 November 2003); Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2003, Issue 3); MEDLINE and PREMEDLINE (OVID) (1966 to November 2003); EMBASE (OVID) (1980 to November 2003); CINAHL (OVID) (1982 to November 2003); AMED (OVID) (1985 to November 2003). Quintessence was handsearched through 2002 and KaVo were contacted as manufacturers of the HealOzone apparatus for any additional published or unpublished trials., Selection Criteria: Inclusion was assessed independently by at least two reviewers. Trials were only included if they met the following criteria: randomisation in a controlled trial; single surface in vivo carious lesion accessible to ozone application; clear allocation concealment; ozone application to the lesions in the intervention group; no such application of ozone in the control group; outcomes measured after at least 6 months., Data Collection and Analysis: Reviewers independently extracted information in duplicate. A paucity of comparable data did not allow meta-analytic pooling of the included studies., Main Results: Three trials were included, with a combined total of 432 randomised lesions (137 participants). Forty-two conference papers, abstracts and posters were excluded (from an unknown number of studies). The risk of bias in all studies appeared high. The analyses of all three studies were conducted at the level of the lesion, which is not independent of the person, for this reason pooling of data was not appropriate or attempted. Individual studies showed inconsistent effects of ozone on caries, across different measures of caries progression or regression. Few secondary outcomes were reported, but one trial reported an absence of adverse events., Authors' Conclusions: Given the high risk of bias in the available studies and lack of consistency between different outcome measures, there is no reliable evidence that application of ozone gas to the surface of decayed teeth stops or reverses the decay process. There is a fundamental need for more evidence of appropriate rigour and quality before the use of ozone can be accepted into mainstream primary dental care or can be considered a viable alternative to current methods for the management and treatment of dental caries.

Objectives: To investigate whether silver diamine fluoride (SDF) is effective in preventing new caries lesions in primary teeth when compared to placebo or active treatments., Methods: Systematic review (CRD42016036963) of controlled clinical trials. Searches were performed in 9 electronic databases, 5 registers of ongoing trials, and reference lists of identified review articles. Two researchers carried out data extraction and quality appraisal independently. The primary outcome was the difference in caries increment (decayed, missing, and filled surfaces or teeth - dmfs or dmft) between SDF and control groups. These differences were pooled as weighted mean differences (WMD) and prevented fractions (PF)., Results: Searches yielded 2,366 unique records; 6 reports of 4 trials that randomized 1,118 and analyzed 915 participants were included. Two trials compared SDF to no treatment, 1 compared SDF to placebo and sodium fluoride varnish (FV), and 1 compared SDF to high-viscosity glass ionomer cement (GIC). All studies had at least 1 domain with unclear or high risk of bias. After 24 months of follow-up, in comparison to placebo, no treatment, and FV, SDF applications significantly reduced the development of new dentin caries lesions (placebo or no treatment: WMD = -1.15, PF = 77.5%; FV: WMD = -0.43, PF = 54.0%). GIC was more effective than SDF after 12 months of follow-up but the difference between them was not statistically significant (WMD, dmft: 0.34, PF: -6.09%)., Conclusion: When applied to caries lesions in primary teeth, SDF compared to no treatment, placebo or FV appears to effectively prevent dental caries in the entire dentition. However, trials specifically designed to assess this outcome are needed., (© 2018 S. Karger AG, Basel.)

Silver diamine fluoride (SDF), a low-cost topical agent used in many countries to arrest dental caries, was cleared as a desensitizing agent by the Food & Drug Administration for the U.S. market in 2014. The aim of this study was to survey U.S. dental schools regarding their teaching of SDF. Email invitations were sent to all accredited U.S. predoctoral dental education programs (n=66) in September 2016. Deans, chairs, and selected faculty members were asked to respond or forward the survey-link provided to the appropriate person in their school. Under the assumption that some respondents from the same school were unaware of SDF implementation across departments, multiple responses from the same school were collapsed for analysis. A total of 62 schools (94% response rate) responded to the survey, and 67.7% of them reported that SDF was part of their curricula. There was a wide variation across dental schools' teaching about SDF indications and protocols of application. All but one school consistently agreed on using SDF for arresting caries on primary teeth. Only 18 respondents were able to confirm if there was an existing protocol at their school for the use of SDF. When re-application after initially arresting caries with SDF was taught, 50% of respondents advocated 2×/year re-application. Schools not teaching SDF (n=20) planned on including it in their curricula in the future. These findings suggest that, with the use of SDF increasing rapidly in the U.S. and its adoption in most dental schools, there is a need for the development of standardized evidence-based protocols.

Aim: To clinically assess the efficacy of resin infiltration versus fluoride varnish for arresting white spot lesions (WSLs) on permanent teeth in children., Subjects and Methods: Among the children referred to the our University, Faculty of Dentistry, Department of Pediatric Dentistry, 23 aged between 8-14 with 81 anterior WSLs were included in the study. The participants were randomly assigned to either the resin infiltration group or the fluoride varnish group. WSLs were assessed using a laser fluorescence device (DIAGNOdent pen, Kavo, Germany) and were characterized at baseline, immediately following resin infiltration application and at a 6-month follow-up. For the statistical analyses, the IBM SPSS Statistics 22 (IBM SPSS, Turkey) program was used to assess the findings of the study., Results: Participant retention was 100% at 6 months. There was no significant difference between the two groups when baseline DIAGNOdent (DD) values were compared (P > 0.05). The reduction in 6-month follow-up DD values were statistically significant in both groups relative to baseline values. The 6-month values of the resin infiltration group were statistically lower than those of the fluoride varnish group (P = 0.028, P < 0.05)., Conclusions: Resin infiltration and fluoride varnish are clinically feasible and efficacious methods for the treatment of anterior WSLs. The inhibition of caries progression by resin infiltration should now be considered an alternative to fluoride treatment., Competing Interests: There are no conflicts of interest

Background: Casein-phosphopeptide-amorphous-calcium-fluoride-phosphate (CPP-ACFP) can remineralize subsurface lesions. It is the active ingredient of MI-Paste-Plus® (MPP). The long-term remineralization efficacy is unknown., Objective: To evaluate the long-term effect of MPP versus a placebo paste on remineralization of enamel after fixed orthodontic treatment over a 12-month period., Design: This trial was designed as a prospective, double-blinded, placebo-controlled RCT., Methods: Patients with subsurface lesions scheduled for removal of the appliance were included. They applied either MPP or control paste once a day at bedtime for 12 months, complementary to normal oral hygiene., Main Outcome Measures: Changes in enamel lesions (primary outcome) were fluorescence loss and lesion area determined by quantitative light-induced fluorescence (QLF). Secondary outcomes were Microbial composition, by conventional plating, and acidogenicity of plaque, by capillary ion analysis (CIA), and lesion changes scored visually on clinical photographs., Randomization: Participants [age = 15.5 years (SD = 1.6)] were randomly assigned to either the MPP or the control group, as determined by a computer-randomization scheme, created and locked before the start of the study. Participants received neutral-coloured concealed toothpaste tubes marked A or B., Blinding: The patients and the observers were blinded with respect to the content of tube A or B., Results: A total of 51 patients were analysed; MPP (n = 25) versus control group (n = 26); data loss (n = 14). There was no significant difference between the groups over time for all the used outcome measures. There was a significant improvement in enamel lesions (fluorescence loss) over time in both groups (P < 0.001 and P < 0.001), with no differences between groups., Limitations: Being an in vivo study, non-compliance of the subjects could have influenced the result., Conclusion: The additional use of MPP in patients with subsurface enamel lesions after orthodontic fixed appliance treatment did not improve these lesions during the 1 year following debonding., Registration: This trial is registered at the medical ethical committee of the VU Medical Centre in Amsterdam (NL.199226.029.07).

Aims: Recently, there has been interest in biological approaches for caries management, with techniques such as interim therapeutic restorations and Hall technique crowns showing comparative effectiveness against conventional restorative methods. One of these approaches is the use of silver diamine fluoride (SDF) as a restorative option. In this invited review, the aim was to critically appraise the currently available literature with regards to the indication, technique and outcome of SDF., Methods: A review of the literature on SDF with a focus on its use in the primary dentition was conducted., Results: There has been a recent explosion in the literature regarding the use of SDF, from in vitro studies on the mechanism to clinical studies on the effectiveness and patient acceptance of the technique. A systematic review in 2016 concluded that SDF application resulted in caries arrest in 81% of active lesions in primary teeth over 30 months. Additionally, over 60% of parents reported being satisfied with the aesthetic outcome with most children finding the procedure to be acceptable, comfortable and relatively pain-free., Conclusions: Silver diamine fluoride is a safe and effective alternative technique to caries management in the paediatric population. Given the ongoing worldwide debate on cost-effectiveness of biological approaches coupled with the increasing concerns and limited accessibility of treatment under general analgesia, SDF should form an important addition to every dentist's armamentarium.

The study aimed to evaluate the efficacy of the combination of CPP-ACP and fluorides compared with fluorides monotherapy on patients with early caries lesions. The Medline, Embase and Cochrane databases up to August 2017 were scanned, with no restrictions. Studies satisfied the guideline of randomised controlled trials (RCTs), the patients with early caries lesions and data considering the efficacy of fluorides and CPP-ACP versus fluorides alone were selected. There was no language restriction during the literature search process, however, only papers in English or Chinese were included during the selection process. Outcome variables include laser fluorescence, quantitative light-induced fluorescence, lesion area and visual inspection scores. Mean differences were calculated during the data extraction process. Ten studies including 559 patients were selected in the meta-analysis. Fluorides combined with CPP-ACP achieved the same efficacy for early caries lesions on smooth surfaces compared with fluorides monotherapy (mean difference: -13.90, 95% confidence interval: [-39.25, 11.46], P = 0.28), and the combination treatment showed significantly better efficacy than fluorides monotherapy for occlusal early caries lesions (mean difference: -21.02, 95% confidence interval: [-27.94, -14.10], P<0.01). However, further well-designed studies are still needed.

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., (© 2017 FDI World Dental Federation.)

Purpose: To perform a systematic review of articles related to the clinical efficacy of topical fluoride varnishes/gels, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and other remineralisation agents of white spot lesions (WSL) in primary teeth., Materials and Methods: Electronic and manual searches were conducted through diverse electronic databases. The search was limited to randomised, clinical, controlled trials, and quasi-experimental papers in full-text version. Suitable individual studies were evaluated through a previously reported quality system, their data extracted and carefully analysed., Results: The search identified 298 citations, and 95 were chosen and reviewed in full text. Nine relevant citations met the eligibility criteria for inclusion in the systematic review. Pair comparisons were made between fluoride varnishes, CPP-ACP, dental lasers, and control interventions., Conclusions: Clinicians are encouraged to discuss more high-quality studies in order to provide sufficient evidence and to confirm the clinical utility of remineralisation agents of WSL in primary teeth.

Aim: The aim of the present study was to compare the remineralizing efficacy of novamin and tricalcium phosphate (TCP)., Materials and Methods: Nail varnish was coated to a total of 30 sound human premolars except for 5 mm × 5 mm window. Baseline microhardness was measured for all test samples. Artificial carious lesions were created for all teeth by subjecting them to demineralization process. Then microhardness of demineralized lesion was measured. Later artificial caries teeth were equally divided into two groups to treat with remineralization solution for 10 days; group I: novamin and group II: TCP. After 10 days of pH cycling, microhardness was measured. The data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) statistical software from Chicago SPSS Inc., version 21 and using analysis of variance (ANOVA) post hoc multiple comparisons test for intergroup and significant difference at p < 0.05., Results: In the present study, group I indicated a higher value for remineralization compared with group II (p < 0.05)., Conclusion: The present study showed that both novamin and TCP were effective in remineralizing the carious lesions., Clinical Significance: This study evaluates the remineralizing potential of novamin and TCP on initial carious lesions.

Objective: To describe the histological characteristics of a human primary tooth with deep caries next to the dental pulp 6 months after being treated with silver diamine fluoride (SDF)., Study Design: A tooth that was considered to be not restorable 6 months after being treated with SDF was examined with light microscopy., Results: the histologic examination revealed no carious pulp exposure, tertiary dentin, a flattened odontoblastic layer adjacent to irregular tertiary dentin, dentinal tubules with silver deposits to a depth of 1 mm and no bacteria, and a pulp with no significant inflammation., Conclusions: The use of silver diamine fluoride as an interim treatment of deep caries on vital carious primary teeth of children, leads to histologic changes that prevent pain and pulp deterioration, and most likely facilitate pulp healing. These unique findings expand the knowledge about the effect of SDF on the human dental tissues.

Sugar-free chewing gum containing polyols has been demonstrated to reduce caries experience in randomised controlled clinical trials. A range of polyols (mannitol, sorbitol, xylitol and maltitol) can be found in sugar-free gums and it has been claimed that they can facilitate calcium uptake into enamel subsurface lesions promoting remineralisation., Objectives: The aim of this study was to compare the effect of polyols on remineralisation of enamel subsurface lesions in vitro by artificial saliva (AS) and by AS containing the salivary biomimetic casein phosphopeptide amorphous calcium phosphate (CPP-ACP)., Methods: The polyols (12.6% w/v) and CPP-ACP (0.376% w/v) were used at physiologically relevant concentrations approximating those released into saliva during chewing a CPP-ACP/polyol chewing gum. Enamel subsurface lesions were exposed to one of the polyols (xylitol, sorbitol, maltitol, mannitol) in AS or AS containing CPP-ACP for 7days at 37°C with a change of solution each day. Remineralisation of the enamel subsurface lesions was measured by transverse microradiography., Results: A statistical test for equivalence showed there was no difference in remineralisation between the AS solutions with or without any of the polyols. The AS+CPP-ACP solution substantially promoted remineralisation over AS alone independently of any polyol added., Conclusion: This controlled in vitro study showed that polyols at physiologically relevant concentrations did not promote remineralisation of enamel subsurface lesions by facilitating calcium uptake into the lesion., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Dental caries occurs as a result of dysbiosis among commensal and pathogenic bacteria leading to demineralization of enamel within a dental biofilm (plaque) as a consequence of lower pH in the oral cavity. In our previous study, we have reported 1,3-disubstituted ureas particularly, 1,3-di-m-tolylurea (DMTU) could inhibit the biofilm formation along with lower concentrations of fluoride (31.25 ppm) without affecting bacterial growth. In the present study, RT-qPCR analysis showed the target specific molecular mechanism of DMTU. In vivo treatment with DMTU, alone or in combination with fluoride, resulted in inhibition of caries (biofilm development of Streptococcus mutans ) using a Wistar rat model for dental caries. The histopathological analysis reported the development of lesions on dentine in infected subjects whereas the dentines of treated rodents were found to be intact and healthy. Reduction in inflammatory markers in rodents' blood and liver samples was observed when treated with DMTU. Collectively, data speculate that DMTU is an effective anti-biofilm and anti-inflammatory agent, which may improve the cariostatic properties of fluoride.

Background: White spot lesions (WSL) frequently occur as side-effect of multibracket appliance treatment. The clinical effects of local fluoridation on post-orthodontic WSL and oral health development are however inconclusive., Objective: In vivo monitoring of clinical WSL and oral health changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment., Trial Design: Randomized, single-centre, double-blind, parallel-group, placebo-controlled study., Participants: Patients with not less than 1 WSL (modified score 1 or 2) on not less than 1 upper front teeth after debonding., Interventions: Professional fluoride/placebo gel application during weeks 1-2; self-administered home application (weeks 3-24)., Outcomes: Clinical evaluation of WSL index, lesion activity, plaque index, gingival bleeding index, and decayed, missing, and filled teeth index as well as saliva buffer capacity and stimulated salivary flow rate (T0-T5)., Randomization: Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each)., Recruitment: The clinical study duration lasted from March 2011 to September 2013., Blinding: Unblinding was performed after complete data evaluation., Numbers Analysed: Intention-to-treat analysis set comprised 39 participants (test: n = 21, placebo: n = 18)., Outcome: No clinical parameter except stimulated salivary flow rate (fluoride group: 1.1ml/min, placebo group: 0.74ml/min; P = 0.022) showed a statistically significant group difference after 24 weeks., Harms: Several adverse events occurred similarly frequent in both groups; none was classified as possibly related to the study product., Limitations: The number of dropouts was higher than expected and the socio-economic status was not assessed. Furthermore, the unknown level of compliance during the home application phase must be considered as limitation., Conclusion: Based on the results of this study, no clinical effect of post-orthodontic high-dose fluoride treatment on WSL and oral health changes could be detected., Registration: The study was registered with ClinicalTrials.gov (Identifier: NCT01329731)., Protocol: The protocol wasn't published before trial commencement., (© The Author 2016. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com)

Background: White spot lesions (WSLs) are a frequent side-effect of multibracket appliance treatment. The effect of local fluoridation on post-orthodontic WSL is however inconclusive., Objective: Assessment of WSL changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment., Trial Design: Randomized, single-centre, double-blind, parallel-group, placebo-controlled study., Participants: Patients with not less than 1 WSL (modified score 1 or 2) on not less than 1 upper front teeth after debonding., Interventions: Professional fluoride/placebo gel application during weeks 1-2; self-administered home application (weeks 3-24)., Outcomes: Photographic WSL assessment (dimension and luminance) of the upper front teeth (T0-T5)., Randomization: Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each)., Recruitment: The clinical study duration lasted from March 2011 to September 2013., Blinding: Unblinding was performed after complete data evaluation., Numbers Analysed: Intent-to-treat analysis set comprising 39 participants (test: n = 21, placebo: n = 18)., Outcome: Dimensional WSL quantification showed limited reliability. Luminance improvement (%) of WSL, however, was seen after 6 months (test/placebo: tooth 12, 24.8/18.0; tooth 11, 38.4/35.4; tooth 21, 39.6/38.3; and tooth 22, 15.2/25.0). No statistically significant group difference existed. Data suggest that WSLs are difficult to measure with respect to reliability and repeatability and methods for monitoring WSLs in clinical trials require improvement/validation., Harms: Similar adverse events occurred in both groups; none was classified as possibly related to the study product., Limitations: The number of dropouts was higher than expected and the socio-economic status was not assessed. Furthermore, the unknown level of compliance during the home application phase must be considered as limitation., Conclusion: Based on the results of this study, no difference could be detected with respect to the development of WSL under post-orthodontic high-dose fluoride treatment., Registration: The study was registered with ClinicalTrials.gov (Identifier: NCT01329731)., Protocol: The protocol wasn't published before trial commencement., (© The Author 2016. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com)

Introduction: Studies have shown that cross-polarization optical coherence tomography (CP-OCT) can be used to image the internal structure of carious lesions in vivo. The objective of this study was to show that CP-OCT can be used to monitor changes in the internal structure of early active carious lesions on smooth surfaces during non-surgical intervention with fluoride., Methods: Lesions on the smooth surfaces of teeth were imaged using CP-OCT on 17 test subjects. Lesion structural changes were monitored during fluoride varnish application at 6-week intervals for 30 weeks. The lesion depth (L d ), integrated reflectivity (ΔR), and surface zone thickness (S z ) were monitored., Results: A distinct transparent surface zone that may be indicative of lesion arrestment was visible in CP-OCT images on 62/63 lesions before application of fluoride varnish. The lesion depth and internal structure were resolved for all the lesions. The overall change in the mean values for L d , ΔR, and S z for all the lesions was minimal and was not significant during the study (P > 0.05). Only 5/63 lesions manifested a significant increase in S z during intervention., Conclusion: Even though it appears that most of the lesions manifested little change with fluoride varnish application in the 30 weeks of the study, CP-OCT was able to measure the depth and internal structure of all the lesions including the thickness of the important transparent surface zone located at the surface of the lesions, indicating that CP-OCT is ideally suited for monitoring lesion severity in vivo. Lasers Surg. Med. 48:915-923, 2016. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objectives: The purpose of this study was to investigate the effect of five commercially available fluoride varnishes (FV) on caries lesions., Materials and Methods: Ninety bovine enamel specimens were assigned to five varnish groups (n = 18). Early caries lesions were created in the specimens and characterized using Vickers surface microhardness number (VHN). FV was applied to each group of specimens. Immediately afterwards, 7.5 ml of artificial saliva (AS) were pipetted over each group of specimens, collected and renewed every 15 min for 6 h. AS samples were analyzed for fluoride using an ion-specific electrode. Enamel fluoride uptake (EFU) was determined using the acid etch technique. Each group was then subjected to a pH cycling regimen for 5 days after which VHN was determined again. One-way analysis of variance (ANOVA) was used for data analysis., Results: FVs differed in their rehardening capability (highest mean value was for Enamel Pro = 32.3 ± 5.8 and lowest mean value was for Vanish = 18.9 ± 11.3). No significant difference in EFU was found among groups. Total fluoride release over 6 h was in the order of MI Varnish (303 μg/ml) > Enamel Pro (217 μg/ml) > Flor-Opal (153 μg/ml) > PreviDent(84 μg/ml) > Vanish(28 μg/ml)., Conclusions: ΔVHN and fluoride release characteristics differ among FV products. These differences may be attributed to the different compositions and physical properties of the tested FV., Clinical Relevance: Fundamental, comparable research on FV and how different formulations affect early caries lesion rehardening, fluoride release into saliva, and uptake by teeth is scarce.