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Objective: This study aimed to examine the global research trend and frontiers in the field of root caries. Methods: Two independent investigators searched the Web of Science Core Collection to include journal articles published on root caries from 1994 to 2023. They examined citation trends of the selected publications and performed bibliometric analysis using VOSviewer. Cooccurrence and cocitation analysis were used to calculate the burst strength of the most cited keywords and the most cited publications. Results: This study included 1144 publications (1004 scientific research articles and 140 review articles) for bibliometric analysis. The number of publications from 2018 to 2023 was 404, accounting for 35% (404/1144) over the last 30 years. The annual citation count showed a gradual upward trend with a surge from 2018. The cooccurrence analysis classified the publications into four clusters which were in vitro studies, prevention, microbiology, and epidemiology. Cocitation analysis revealed silver diamine fluoride, systematic review, and randomized clinical trial were the three main keywords; and their citation burst strength (period) were 17.2 (2017-2023), 9.4 (2015-2023), and 6.9 (2018-2023), respectively. Noninvasive treatment of root caries (narrative review), aetiology of root caries (narrative review), and use of silver diamine fluoride in arresting root caries (clinical trial) were the topics (publication type) of the three most cited publications; and their burst strength (period) were 8.9 (2017-2020), 5.9 (2017-2021), and 4.7 (2015-2018), respectively. Conclusion: This study highlights the recent growing research interest in root caries, particularly on its microbiology, prevention, and the use of silver diamine fluoride.

Abstract Background Increasing studies have shown that poor oral health contributes to the progression of dementia. It is meaningful to find out the role of oral health interventions in maintaining people’s cognition levels and delaying the progression of dementia. Thus, we conducted this review to summarize the present evidence on the effect of oral health interventions on the cognition change of people with dementia. Methods Literature search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane library, and Dentistry and Oral Sciences by two independent reviewers from inception to 6 March 2024. Clinical studies such as randomized controlled trials reporting on the effect of oral health interventions on the cognition of people with dementia were included in this review. Mini-Mental State Examination (MMSE) scores were used to measure cognition level. The mean deviation (MD), generated by subtracting the baseline MMSE score from the MMSE score at follow-up was used to assess the change in cognition. Studies with oral hygiene practice as an oral health intervention were further conducted with a meta-analysis. Results A total of 6646 references were identified by the literature search, and 5 studies were eligible to be included in this review. Among the included studies, 4 studies reported the cognition change after having various oral hygiene practice as oral health intervention, while the other study adopted oral exercises as the intervention. Two studies presented positive MD values after intervention provided, indicating improved cognition level at follow-up (MD = 0.6, MD = 0.9, respectively). Another two studies reported less cognition deterioration with smaller absolute MD values in the intervention group, (intervention vs. control, -0.18 vs. -0.75, p

Streptococcus mutans (S. mutans) is the main pathogenic bacterium causing dental caries, and the modes in which its traits, such as acid production, acid tolerance, and adhesion that contribute to the dental caries process, has been clarified. However, a growing number of animal experiments and clinical revelations signify that these traits of S. mutans are not restricted to the detriment of dental tissues. These traits can assist S. mutans in evading the immune system within body fluids; they empower S. mutans to adhere not merely to the surface of teeth but also to other tissues such as vascular endothelium; they can additionally trigger inflammatory reactions and inflict damage on various organs, thereby leading to the occurrence of systemic diseases. These traits mostly originate from some correlative findings, lacking a comprehensive evaluation of the impact of S. mutans on systemic diseases. Therefore, this review mainly centers on the dissemination route of S. mutans: “Entering the blood circulation - Occurrence of tissue adhesion - Extensive possible proinflammatory mechanisms - Concentration in individual organs” and analyses the specific effects and possible mechanisms of S. mutans in systemic diseases such as cerebral hemorrhage, inflammatory bowel disease, tumors, and infective endocarditis that have been identified hitherto.

BackgroundN-acyl homoserine lactones (AHLs) are small signalling molecules predominantly secreted in Gram-negative bacteria.ObjectiveThe aim is to provide a comprehensive overview of AHLs in oral health.MethodsTwo independent researchers conducted a systematic search of English language publications up to 30 June 2024 in PubMed, Scopus and Web of Science. They screened the title and abstract to retrieve and map out relevant studies on AHLs in oral health, in order to identify key concepts, gaps in knowledge, and areas for further research.ResultsThis study identified 127 articles and included 42 articles. These studies identified AHLs in human oral samples like saliva, dental plaque, tongue swabs, and dentin caries. The studies also found that AHLs regulate cell-to-cell communication of bacteria (quorum sensing) in mature biofilm fostering the production of virulence factors that damage the immune system. AHLs also exert biological effects on human cells and influence oral diseases such as periodontitis and oral squamous carcinoma. Researchers developed AHL inhibitors to interfere with the quorum sensing process and interrupt the communication between bacteria. These inhibitors can be classified into three main categories based on their mechanisms of action to AHLs: AHL synthesis disruptors, AHL competitive inhibitors and AHL enzymatic degraders. These AHL inhibitors can be important tools in the fight against bacterial infections, particularly those caused by Gram-negative bacteria.ConclusionThe literatures indicate that AHLs, as quorum sensing molecules, influence bacterial communication. AHLs have a significant impact in bacterial pathogencity and play a potential role in the pathogenesis of oral diseases. Researchers have developed AHL inhibitors to disrupt bacterial quorum sensing, preventing bacteria from forming biofilms or expressing virulence factors. These studies on AHLs represent a new research direction to develop novel therapeutic strategies to manage oral diseases.

This study explored the knowledge, attitude, and practice towards silver diamine fluoride (SDF) therapy among dentists in Hong Kong. The quantitative component was an online closed-ended questionnaire survey through the Society of Preventive Dentistry of Hong Kong. The qualitative component involved individual in-depth interviews with selected dentists. Descriptive analysis was performed on the quantitative data, whereas thematic analysis was performed on the qualitative data. The quantitative study invited 173 dentists, and 86 completed the questionnaire survey (86/173; 50%). All respondents were familiar with SDF and 73 (73/86; 85%) used SDF. They agreed that SDF therapy was simple (84/86; 98%), non-invasive (84/86; 98%), timesaving (82/86; 96%), effective (81/86; 94%), and painless (79/86; 92%). However, they expressed concerns about SDF's unaesthetic staining (81/86; 94%) and used it for primary teeth (77/86; 89%). The qualitative study conducted 12 individual interviews. Dentists asserted that SDF therapy is an evidence-based practice for arresting caries, including root caries. They acknowledged SDF therapy is straightforward and cost-effective. It is particularly useful for children or people with disabilities and can be used in community service. They considered the application skills, close monitoring and maintaining good oral hygiene to be vital for the success of SDF therapy. However, they noted that black staining of the carious lesions could cause patient dissatisfaction. They suggested that a guideline is warranted for SDF use. Hong Kong dentists are aware of the indications, merits and limitations of SDF therapy. They use SDF therapy for caries control, especially for children, elderly and those with disabilities, and consider it cost-effective for community dental care.

Silver metal and compounds have antibacterial properties, although their action's mechanisms are not fully understood. Scientists generally consider that silver disrupts the bacterial cell wall. It causes a structural change in the bacterial cell membrane and cytoplasm. It also stops deoxyribonucleic acid replication, resulting in inactivating enzymatic activity and cell death. The antimicrobial effect of silver-containing compounds relies on the release of bioactive silver ions. Hence, silver metal and compounds have been used in medicine to prevent infection for hundreds of years. Silver metal and compounds are also used as antibacterial agents in dentistry. Studies have shown that silver compounds are effective in the management of dental caries. Fluoride-containing silver compounds have been found in experiments to be beneficial at remineralising dental cavities. Silver diamine fluoride (SDF) can assist in preventing and arresting tooth cavities. The World Health Organization included SDF in its Model List of Essential Medicine for both adults and children in 2021. Clinicians also use SDF to manage dentine hypersensitivity as well as to inhibit growth of periodontal pathogens. However, traditional silver compounds cause tooth discolouration because of the silver-staining effect. These side effects of their applications depend on the amount applied and the frequency of application. Researchers are developing nanosilver fluoride and silver nanoparticles to overcome the staining. This review gives an overview of the antibacterial mechanism of silver compounds, namely silver nitrate, silver fluoride, SDF, silver nanoparticles, and nano silver fluoride for caries management. The outlook for the future development of silver compounds will be discussed.

The objective of this study was to investigate the relationship amongst early childhood caries (ECC), economic development, and dental public health programmes in Hong Kong. We searched exhaustively qualitative and quantitative data on the oral health policy, dental service, public health strategies of caries control and epidemiologic surveys on ECC. We then performed meta-regression to explore the impact of the Human Development Index (HDI), gross domestic product (GDP) growth, water fluoridation, oral health promotion, dental school establishment, free education, and dental workforce on ECC prevalence in 5-year-olds. We found that the first government oral health survey was conducted in 1960, when Hong Kong experienced significant growth, as the HDI indicated. The survey revealed that 97% of 6- to 8-year-old children experienced ECC. Water fluoridation was implemented in 1961 at 0.7 ppm (0.9 ppm in winter) to prevent caries. The government offered free 9-year education in 1978. In 1981, the government established a dental school to improve a low dentist-to-population ratio of 1:9000. The ECC prevalence amongst 5- to 6- year-old children was reduced from 84% in 1968 to 63% in 1986. The Department of Health created an oral health education division in 1989. The ECC prevalence for 5-year-old children was further reduced to 44% in 1997. The ECC prevalence amongst 5-year-old children was stabilised at 51% both in 2001 and 2011. However in 2021, the prevalence of untreated ECC increased to 57% during the outbreak of COVID-19. Meta-regression analysis showed that ECC prevalence was not linked to GDP growth but decreased with improvements in HDI, the provision of 9-year free education, the establishment of a dental school, fluoridation of water supply, and implementation of territory-wide oral health promotion. In conclusion, better education, living conditions, and dental public health programmes have improved children's oral health in Hong Kong.

Objectives: This study aimed to systemically review the tools developed for evaluating oral health–related quality of life (OHRQoL) in preschool children. Methods: Two reviewers systematically searched English-language publications within PubMed, Embase, Scopus, and Web of Science. They screened the titles and abstracts and retrieved the full texts of the selected publications. Studies which developed, validated, or culturally adapted an OHRQoL tool used in preschool children were included. They recorded information regarding tool characteristics, item configuration, discriminative validation, the aim of assessment, and the target group. Results: The study included 59 publications and identified 12 tools for assessing OHRQoL in preschool children. Seven tools were tailored for preschool ages. Most of the scales were generic oral health measures. Dental caries was the most commonly used oral condition for assessing a tool's discriminative validity. Eight tools required parental proxy reports. Three tools were both child-administrated and parent-administrated. One tool was designed to be answered solely by children. Ten tools assessed the oral health–related impact on children, including oral condition–related, functioning, environmental, and emotional/social domains. Four tools included items regarding the impact on both children and family. Conclusions: This review identified 12 tools developed for evaluating OHRQoL in preschool children, 7 of which were tailored for preschool age. The 12 tools were validated but incomprehensive due to the subjective and multidimensional nature of the OHRQoL concept. Researchers can choose a suitable tool for their studies by understanding the basic characteristics and item setting of the tools. Researchers can have an overview of the tools developed for evaluating OHRQoL in preschool children. They can use the findings from this review to choose a suitable tool for their studies regarding the OHRQoL in preschool children.

Objective: This study aims to determine the stability, alkalinity, and fluoride and silver ion concentrations of 5 commercially available 38% silver diamine fluoride (SDF) solutions—namely Advantage Arrest, e-SDF, Riva Star, Saforide, and Topamine—in 180 days. Methods: Alkalinity was determined using a pH electrode. The fluoride and silver ion concentrations were obtained using a calibrated ion-selective electrode and optical emission spectrometer, respectively. Six bottles of each product were examined on days 0 (freshly opened), 30, 60, 90, and 180. The time taken for each freshly opened product to form a black silver precipitate under room light (500 lx) and 25 °C was also recorded. Results: For 180 days, Advantage Arrest, e-SDF, Riva Star, Saforide, and Topamine had the pH range of 9.8–9.8, 10.5–10.6, 13.0–13.1, 9.8–9.8, and 9.3–9.4; fluoride ion concentration range (nearest 1000 ppm) of 40.9%–42.4%, 46.7%–50.9%, 37.0%–39.0%, 37.0%–45.7%, and 47.7%–53.4%; silver ion concentration range (nearest 1000 ppm) of 283.4–307.0, 307.3–315.4, 418.6–435.7, 266.3–281.0, and 416.2–456.1 ppm; and precipitation time (nearest hour) of 17, 12, 6, 7, and 7 hours, respectively. The percentage change of fluoride and silver could be more than 5% after 60 days. Conclusions: The alkalinity of the 5 SDF solutions remained stable after 180 days. In addition, their fluoride and silver concentrations decreased substantially after 60 days. The freshly opened SDF solutions did not precipitate within 5 hours under ambient room conditions. The alkalinity and fluoride and silver concentrations of the 38% SDF solutions could be less stable after 60 days; thereafter, the fluoride and silver concentrations decreased. Thus, the SDF solution should be used within 60 days after opening.

Abstract Background Parents of preschool children have inadequate oral health knowledge in Hong Kong. Parents play a critical role in preschool children’s dietary patterns and oral health behaviors. A school-based oral health promotion (OHP) for parents of preschoolers was developed and investigated. Objectives The objective of this study was to evaluate effects of the school-based OHP for parents of preschool children on parents’ oral health knowledge and preschool children’s early childhood caries (ECC). Materials and methods This was a quasi-experimental study. Parents of preschool children were divided into the intervention group (IG) and the control group (CG) according to their own selection. Parents in the IG participated in a structured school-based OHP workshop, while those in the CG did not attend the OHP workshop. Parents in both groups were invited to complete a questionnaire assessing their oral health knowledge before (T0), one month after (T1), and twelve months after (T2) the OHP workshop. Preschool children’s caries was examined via dmft score at T0 and T2. Results Parents’ oral health knowledge was negatively correlated with preschool children’s dmft scores (R = -0.200, P

Abstract Background Using silver diamine fluoride (SDF) for caries management has raised dentists’ interests in Southeast Asia (SEA). However, information about the teaching of SDF in dental schools in SEA is limited. Therefore, this survey aimed to describe the extent to which SDF had been introduced into the education of undergraduate students in the dental schools in SEA. Methods An online questionnaire survey was conducted on the duration, method, contents, and barriers regarding the teaching of SDF. Teachers in charge of undergraduate program in pediatric dentistry and those in community dentistry in all the 90 dental schools in SEA were approached and we required each department to reply once only. Descriptive statistics and Chi-square test were used to describe and assess the differences between the two departments in the teaching of SDF. Results A total of 81 responses from the departments of 49 schools were received, giving a school-level response rate of 54% (49/90). SDF was taught in the undergraduate program in 86% (42/49) of the respondent schools, and 50% (21/42) of these schools had included SDF in the teaching for five or more years. Almost all (98%) of the departments taught SDF through lectures. Furthermore, 55% of them adopted SDF in clinical practice. Regarding the teaching content, the use of SDF for arresting cavitated caries lesion was the most commonly covered (82–97%), followed by for arresting early noncavitated lesions (69–82%), for preventing new caries development (66–79%) and for treating dental hypersensitivity (77%). There were variations in the post-treatment instruction taught. For the departments not teaching SDF, the most common reason (10/19, 53%) was that SDF was not available. Conclusion SDF is covered in the undergraduate program in most of the dental schools in SEA. The use of SDF to arrest cavitated caries lesions in primary teeth is usually taught. However, other applications of SDF, such as for prevention of caries and treatment of dental hypersensitivity, are less commonly mentioned in the teaching.

Objective: This clinical trial aimed to compare the caries-preventive effect of annual application of 38% silver diamine fluoride solution (SDF) with 5% sodium fluoride varnish (FV) to the anterior primary teeth of children. The hypothesis was that SDF was superior to FV at 1 year. Secondary objectives were to determine the child's cooperation and the parent's satisfaction and assess adverse effects. Method: We recruited 688 3- to 4-year-old children and randomly allocated them to receive SDF or FV (positive control) on their 6 upper anterior teeth. Tooth-surface status was recorded using the decayed, missing, and filled surfaces index. A trained observer rated the child's cooperation as “totally cooperative” or “not totally cooperative.” We used a questionnaire to determine the parent's satisfaction as “satisfied,” “neutral,” or “dissatisfied.” Adverse effects (yes/no) were evaluated 1 day and about 1 year after treatment. Results: Of the children, 434 (SDF, n = 209; FV, n = 225) completed the trial. The mean new decayed tooth surfaces developed for SDF and FV groups were 0.4 ± 1.5 and 0.4 ± 1.3, respectively (P = .65). Child's cooperation for SDF and FV therapy was 71% (244/344) and 70% (241/344), respectively (P = .89). Parent's satisfaction for SDF and FV therapy was 71% (148/209) and 69% (155/225), respectively (P = .29). Adverse effects were found neither at 1 day nor at about 1 year after treatment for either treatment arm. Conclusions: SDF is not superior to FV for caries prevention in primary upper anterior teeth at 1-year follow-up. Child's cooperation and parent's satisfaction were similarly high with SDF and FV therapy at 1-year follow-up. Neither short-term nor long-term adverse effects were observed. This study is registered at ClinicalTrials.gov (NCT04399369).

Early childhood caries (ECC) is prevalent and affects more than half of 5-year-old children in Hong Kong. This study aims to report the development of an outreach dental service using silver diamine fluoride (SDF) to arrest ECC amongst kindergarten children in Hong Kong. A pilot outreach service was initiated in 2008 in 14 kindergartens. The pilot service provided screening to 1,749 3- to 5-year-old children. SDF was applied to 3,262 carious teeth of 786 children with parental consent. No significant complications were reported. The pilot service's success allowed the service to expand to 100 kindergartens in 2013. From 2010 to 2019, the service delivered 161,354 dental screenings and SDF therapy on 218,333 carious primary teeth in 53,821 children. ECC prevalence amongst the participating children declined from 43% in 2010 to 34% in 2019. A follow-up of 222 3-year-old children revealed that annual SDF therapy arrested 67% of ECC over 3 years. The children's participation rate and their parents’ satisfaction rate with the service were greater than 90% each year. Moreover, the acceptance rate of SDF therapy to control ECC was 88%, although SDF stained carious lesions black. No adverse effects of SDF therapy were reported. A cross-sectional survey on a sample of 498 3- to 5-year-old children showed that 96% of the participating children had no dental fear or anxiety in this service, with encouragement and support from their peers and teachers. In 2019, the service was made available to all 1,024 kindergartens in Hong Kong. This kindergarten outreach dental service (Case Study HKU/04/003) was selected as an Impact Case Study in the thematic report “Health & Healthcare” by the Hong Kong University Grant Council (UGC). The UGC publishes thematic reports to give members of the public some concrete idea on what contributions academic research has brought to the society.

Silver nanoparticles have unique physical, chemical, and biological properties that make them attractive for medical applications. They have gained attention in dentistry for their potential use in caries management. This study reviews the different synthesis methods of silver nanoparticles and the application of them for caries management. Silver nanoparticles are tiny silver and are typically less than 100 nanometres in size. They have a high surface area-to-volume ratio, making them highly reactive and allowing them to interact with bacteria and other materials at the molecular level. Silver nanoparticles have low toxicity and biocompatibility. Researchers have employed various methods to synthesise silver nanoparticles, including chemical, physical, and biological methods. By controlling the process, silver nanoparticles have defined sizes, shapes, and surface properties for wide use. Silver nanoparticles exhibit strong antibacterial properties, capable of inhibiting a broad range of bacteria, including antibiotic-resistant strains. They inhibit the growth of cariogenic bacteria, such as Streptococcus mutans. They can disrupt bacterial cell membranes, interfere with enzyme activity, and inhibit bacterial replication. Silver nanoparticles can inhibit biofilm formation, reducing the risk of caries development. Additionally, nano silver fluoride prevents dental caries by promoting tooth remineralisation. They can interact with the tooth structure and enhance the deposition of hydroxyapatite, aiding in repairing early-stage carious lesions. Silver nanoparticles can also be incorporated into dental restorative materials such as composite resins and glass ionomer cements. The incorporation can enhance the material’s antibacterial properties, reducing the risk of secondary caries and improving the longevity of the restoration.

This concise review provides an update on the use of calcium-based materials for the prevention of dental caries. Some calcium-based materials promote remineralization and neutralize bacterial acids, disrupting cariogenic biofilms and inhibiting bacterial growth. Medical Subject Headings of [Dental Caries] and [Calcium] were adopted to search publications. Information related to the aim of this review was extracted and summarized. Common calcium-based materials are calcium phosphate, hydroxyapatite, calcium carbonate, calcium fluoride and casein phosphopeptide–amorphous calcium phosphate (CPP-ACP). Calcium phosphate is commonly used in toothpaste. It provides calcium and phosphate ions, enhances the incorporation of fluoride into caries lesions and increases mineral density. Hydroxyapatite is a form of calcium phosphate that is chemically similar to the mineral found in teeth. It can be applied on teeth to prevent caries. Calcium carbonate can be found in toothpastes. It neutralizes bacterial acids and acts as a calcium reservoir during remineralization. Calcium fluoride is found in dental products and promotes remineralization as a source of fluoride, which can be incorporated into tooth enamel, forming fluorapatite and increasing resistance to caries. CPP-ACP is derived from milk proteins. It contains calcium and phosphate, which help to remineralize tooth enamel. CPP-ACP inhibits cariogenic bacteria. It also interacts with bacterial biofilms and disrupts their formation. These calcium-based materials can be used to boost the preventive effect of fluorides or, alternatively, as a therapy for caries prevention.

The objective of this prospective 12-month observational study is to examine the oral health-related quality of life (OHRQoL) among Hong Kong young children aged 3–4 years old receiving silver diamine fluoride (SDF) therapy for carious upper anterior primary teeth. A parental questionnaire was used to collect each child’s sociodemographic background and oral health habits at baseline. Data on parents’ satisfaction with their child’s dental aesthetics were collected at baseline and during a 12-month visit. The Chinese Early Childhood Oral Health Impact Scale (C-ECOHIS) was used to measure OHRQoL. A trained dentist performed examinations and recorded caries experience (dmft) and oral hygiene (visible plaque index) at baseline and 12 months. SDF was applied to the carious lesions. Out of 286 invited children, 248 (87%, 248/286) participated, and 211 (85%, 211/248) attended the 12-month examination. All SDF-treated carious lesions were discoloured at the 12-month examination. Regression analysis showed that the baseline C-ECOHIS score was associated with dmft (p < 0.001). The baseline and 12-month C-ECOHIS scores were 4.6 ± 5.5 and 5.0 ± 5.6, respectively (p = 0.42). The scores for parental satisfaction with dental aesthetics at baseline and 12 months were 59% to 46% (p < 0.001). Satisfaction was negatively associated with the number of discoloured upper anterior teeth (p < 0.001). In conclusion, SDF discoloured the carious upper anterior teeth of the Hong Kong kindergarten children. However, the discoloured lesions had no significant effects on the OHRQoL of these children. However, more parents became dissatisfied with their child’s dental aesthetics after SDF therapy. Hence, clinicians should inform parents well before they perform SDF therapy on children.

Abstract Aim The objective of this scoping review is to present current evidence regarding the association between early childhood caries (ECC) and maternal-related gender inequality. Methods Two independent reviewers performed a comprehensive literature search using three databases: EMBASE, PubMed, and Web of Science. Literature published in English from 2012 to 2022 was included in the search and was restricted to only primary research by using the following key terms: "dental caries", "tooth decay", "gender", "sex", "preschool", "toddler," and "infant". The included studies were limited to those reporting an association between ECC and maternal aspects related to gender inequality. Titles and abstracts were screened, and irrelevant publications were excluded. The full text of the remaining papers was retrieved and used to perform the review. The critical appraisal of selected studies was guided by the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results Among 1,103 studies from the three databases, 425 articles were identified based on publication years between 2012 and 2022. After full-text screening, five articles were included in the qualitative analysis for this review. No published study was found regarding a direct association between ECC and maternal gender inequality at the level of individuals. Five included studies reported on the association between ECC and potential maternal-gender-related inequality factors, including the mother’s education level (n = 4), employment status (n = 1), and age (n = 1). Regarding the quality of the included studies, out of five, two studies met all JBI criteria, while three partially met the criteria. Conclusions Based on the findings of this scoping review, evidence demonstrating an association between gender inequality and ECC is currently limited.

Silver diamine fluoride (SDF) is a topical solution used for managing dental caries. The mixed-methods study consists of a quantitative study (questionnaire survey) and a qualitative study (in-depth interview) to explore the knowledge, attitudes, and practices towards SDF among dentists in Vietnam. A descriptive approach and a thematic approach were performed to analyze data, respectively. The questionnaire survey invited 436 licensed dentists registered for the national annual dental meeting and 226 dentists participated (response rate: 52%). Among them, 174 (77%, 174/226) dentists knew SDF, and 69 (40%, 69/174) dentists used SDF for caries management. Most of them considered SDF therapy as non-invasive (84%, 146/174) and simple (80%, 140/174). However, most of them expressed concern that SDF could discolor the tooth (74%, 128/174). Their most preferred teeth for SDF therapy were primary posterior teeth (92%, 160/174). The in-depth interview consulted 16 dentists to reach data saturation. They learned about SDF from outside curriculum resources as an effective anti-caries agent. They understood the advantages (simple, non-invasive, timesaving) and disadvantages (tooth discoloring, ammonia odor) of SDF. They used SDF to arrest caries in uncooperative children in the clinic and people living in rural areas in outreach services. Most dentists in Vietnam are supportive of SDF therapy, and they know its advantages and disadvantages for caries management. The results addressed the aim of the study to investigate Vietnamese dentists’ perspectives towards SDF.

Non-communicable diseases (NCDs), which contribute significantly to global morbidity, are largely preventable through behavioral changes. As with other NCDs, periodontitis is associated with modifiable risk factors such as smoking and stress and is linked to multiple adverse health outcomes through a shared pathway of chronic systemic inflammation. While the health benefits of physical activity have been widely promoted in public health and extensively studied for other systemic conditions, its impact on periodontal health has only recently started to gain attention. This article critically evaluates the current literature on the relationship between physical activity and periodontitis. While cross-sectional studies have shown an inverse association between physical activity levels and periodontitis risk in the general population, clinical oral health surveys of elite athletes with high levels of physical activity have nonetheless revealed poor periodontal conditions. Although causality has not been determined, physical activity could positively impact periodontitis directly, by reducing inflammatory biomarkers, and indirectly, through its modulatory effects on insulin sensitivity, obesity, bone density, stress, and other health promoting behaviors. Given the importance of risk factor control during initial periodontal therapy, understanding the role of physical activity as a potential behavioral risk modifier is paramount. The findings of this review provide an evidence-based overview of how physical activity could influence periodontitis. There is a need for longitudinal cohort studies to verify the temporality of the reported associations and exclude confounders, while interventions are needed to assess the efficacy of physical activity on periodontal treatment outcomes.

Objectives: The objectives of this study were to compare the amount of fluoride delivered via a topical application of 38% silver diamine fluoride (SDF) solution and 5% sodium fluoride (NaF) varnish as well as to determine the amount of 38% SDF solution delivered using various micro-applicators. Methods: The weights of 38% SDF (Saforide) and 5% NaF (Duraphat) applied to the occlusal surface of an extracted human upper first premolar with a regular-size (2.50-mm tip diameter) micro-applicator were measured using an electronic-analytical balance. Afterwards, the weight of 38% SDF applied to a premolar using the micro-applicators of 5 common brands (Premium Plus, 3M, Dentsply, Elevate Oral Care, and SDI) were studied. The tip diameter of each micro-applicator was measured under a microscope. The weights of the delivered fluoride and silver were also calculated. Results: The mean weights of the fluoride delivered via the SDF solution and NaF varnish were 0.25 ± 0.07 mg and 0.49 ± 0.08 mg, respectively (P < .001). In addition, the tip diameters of the micro-applicators ranged from 1.89 ± 0.03 mm to 2.76 ± 0.02 mm. The mean weights of the fluoride delivered per application of 38% SDF using different applicators ranged from 0.13 ± 0.06 mg to 0.30 ± 0.09 mg, whereas the mean weights of the silver ranged from 0.76 ± 0.32 mg to 1.68 ± 0.50 mg. The weights of the delivered 38% SDF solution varied with the brand and with the tip diameters of the dental micro-applicators (P < .001). Conclusions: The fluoride of the 38% SDF solution delivered topically was significantly less than that of 5% NaF varnish. Moreover, the amount of SDF solution delivered depends on the brand and size of the micro-applicators.

Objective: The aim of this work was to determine the free fluoride and silver ion concentrations and the alkalinity of 4 commercially available 38% silver diamine fluoride (SDF) solutions. Methods: Four common brands of 38% SDF solutions, namely Saforide, Advantage Arrest, e-SDF, and Topamine, were selected. Three bottles of each brand of SDF solution from the same lot were assessed. Measurements of the silver and fluoride content and alkalinity were performed directly when a bottle was opened. Each measurement was repeated to recheck its reliability. The free fluoride ion concentrations were measured using a calibrated ion-selective electrode. The free silver ion concentrations were measured using optical emission spectrometry. The alkalinity of the SDF solution was determined with a pH electrode. Results: The mean concentrations of fluoride ions of the Saforide, Advantage Arrest, e-SDF, and Topamine were 43,233 ppm, 44,333 ppm, 51,370 ppm, and 54,400 ppm, respectively; their percentage differences from the expected value (44,800 ppm) were 3.5%, 2.4%, 14.7%, and 21.4%, respectively. The mean concentrations of silver ions of the Saforide, Advantage Arrest, e-SDF, and Topamine were 258,841 ppm, 260,016 ppm, 336,149 ppm, and 319,966 ppm, respectively; their percentage differences from the expected value (253,900 ppm) were 3.2%, 5.8%, 32.4%, and 25.9%, respectively. The 4 products had pH values of 9.2, 9.1, 9.2, and 9.0, respectively. Conclusions: This study showed differences between the claimed and measured fluoride and silver ion concentrations in 4 common 38% SDF products, which were alkaline with a pH value of 9.

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is used to control early childhood caries, arrest root caries, prevent fissure caries and secondary caries, desensitise hypersensitive teeth, remineralise hypomineralised teeth, prevent dental erosion, detect carious tissue during excavation and manage infected root canals. SDF is commonly available as a 38% solution containing 255,000 ppm silver and 44,800 ppm fluoride ions. Silver is an antimicrobial and inhibits cariogenic biofilm. Fluoride promotes remineralisation and inhibits the demineralisation of teeth. SDF also inactivates proteolytic peptidases and inhibits dentine collagen degradation. It arrests caries without affecting dental pulp or causing dental fluorosis. Indirect pulp capping with SDF causes no or mild inflammatory pulpal response. However, direct application of SDF to dental pulp causes pulp necrosis. Furthermore, SDF stains carious lesions black. Patients must be well informed before SDF treatment. SDF therapy is simple, painless, non-invasive, inexpensive, and requires a simple armamentarium and minimal support. Both clinicians and patients generally accept it well. In 2021, the World Health Organization included SDF as an essential medicine that is effective and safe for patients. Moreover, it can be used for caries control during the COVID-19 pandemic because it is non-aerosol-generating and has a low risk of cross-infection.

Objective: The aim of this work was to review the protocol of the use of silver diamine fluoride (SDF) for arresting caries, specifically the application time. Method: Two researchers searched manufacturers’ instructions, YouTube videos, and 5 databases (Embase, Medline, PubMed, Scopus, and Web of Science). Manufacturers’ instructions, videos from national dental organisations, and peer-reviewed journal articles that published the SDF application protocol in English for arresting caries were selected. Results: The review included 14 protocols from 15 publications from 4 manufacturers, 3 dental associations, and 7 author teams (one team had 2 articles). The American Dental Association and the British Society of Paediatric Dentistry provided their SDF application protocols on YouTube. The American Academy of Paediatric Dentistry and 7 author teams published their protocols in journal articles. Seven publications suggested an SDF application time of 60 seconds. Seven publications suggested a time range of 10 seconds to 240 seconds. Two publications suggested caries excavation, but 4 publications suggested no caries excavation before SDF application. The procedures from at least 5 publications involved protecting the gingiva with petroleum jelly, isolating the carious tooth with cotton rolls, drying the carious lesion with a 3-in-1 syringe, applying SDF solution with a micro brush for 60 seconds, removing excess SDF solution with gauze, and applying fluoride varnish to the SDF-treated lesion. Conclusions: Although the SDF application protocol is simple and straightforward, the published protocols could be different. Most publications suggested an SDF application time of 60 seconds, which can be long, particularly for young children and older adults.

Introduction: Tooth wear is a prevalent dental condition among older adults, leading to pain and adversely affecting aesthetics, functionality, and their overall quality of life. This review aims to update the information on tooth wear in older adults from the past five years and to provide guidance on the clinical management of tooth wear in older adults. Methods: A literature search was conducted in three electronic databases, Scopus, Pubmed, and Embase, for English publications from January 2019 to December 2023 on clinical studies with participants aged 65 or above on tooth wear. A total of 307 articles were retrieved and 14 articles were finally included as references for this study. Results: This review highlights the common causes of tooth wear and various risk factors, such as medical conditions, hyposalivation, dietary habits, oral hygiene practices, parafunctional habits, and occlusal factors, associated with tooth wear. It is crucial for oral health care professionals to diagnose and manage tooth wear at an early stage through a risk assessment and a clinical examination to avoid complex restorative procedures. Tooth wear management should prioritize prevention, aiming to control etiological and risk factors while employing non-restorative treatments. Restorative intervention, if indicated, should be simple, minimally invasive, and cost-effective. Tooth wear progression should be monitored regularly to determine if a further intervention is needed. Conclusion: Since the clinical studies on tooth wear in older adults over the past five years are limited and mainly cross-sectional, more interventional clinical studies are warranted to provide more clinical guidance on tooth wear management in older adults.

Abstract Backgroud Root caries in aging population was prevalent worldwide. Due to the absence of enamel and specific structure of dentine, bacteria are able to penetrate further into dentine at an earlier stage of lesion development. The aim of this study was to investigate the effect of adding of a strontium-doped bioactive glass-ceramic (HX-BGC) to a fluoride-free toothpaste on prevention of formation of artificial dentine caries. Methods Thirty-six human tooth specimens were allocated to three groups (n = 12 per group). Group 1 treated with slurry containing a fluoride-free toothpaste and 5% HX-BGC, Group 2 was treated with fluoride-free toothpaste slurry, and Group 3 received deionized water as a negative control. The specimens were subjected to four cycles (15 h demineralization and 8 h remineralization for one cycle) of biochemical cycling. A mixed suspension of five bacteria species (Streptococcus mutans, Streptococcus sobrinus, Lactobacillus acidophilus, Lactobacillus rhamnosus, and Actinomyces naeslundii) were prepared in brain heart infusion broth with 5% sucrose and used as acidic challenge in biochemical cycling. Subsequently, surface morphology of the dentine lesion was assessed by scanning electron microscopy, while the lesion depths and mineral loss were assessed by micro-computed tomography. Results The mean lesion depths in dentine in Groups 1 to 3 were 87.79 ± 16.99 μm, 101.06 ± 10.04 μm and 113.60 ± 16.36 μm, respectively (p = 0.002). The mean amounts of mineral loss in Groups 1 to 3 were 0.82 ± 0.10 g/cm3, 0.89 ± 0.09 g/cm3 and 0.96 ± 0.11 g/cm3, respectively (p = 0.016). No obvious differences in the surface morphology were seen among the groups. Conclusion Addition of strontium-doped bioactive glass-ceramic to fluoride-free toothpaste has potential to reduce formation of dentine lesions.

The purpose of the study is to develop a novel peptide for caries management. Gallic-Acid-Polyphemusin-I (GAPI) was synthesised by grafting Polyphemusin I (PI) and gallic acid (GA). Biocompatibility was evaluated using a Cell Counting Kit-8 Assay. Antimicrobial properties were assessed using minimum inhibitory concentration (MIC) and minimum bactericidal/fungicidal concentration (MBC/MFC). The bacterial and fungal morphology after GAPI treatment was investigated using transmission electron microscopy (TEM). The architecture of a consortium biofilm consisting of Streptococcus mutans, Lacticaseibacillus casei and Candida albicans was evaluated using scanning electron microscopy (SEM) and confocal laser scanning microscopy. The growth kinetics of the biofilm was examined using a propidium monoazide–quantitative polymerase chain reaction. The surface and calcium-to-phosphorus molar ratio of GAPI-treated enamel after pH cycling were examined with SEM and energy-dispersive X-ray spectroscopy. Enamel crystal characteristics were analysed using X-ray diffraction. Lesion depths representing the enamel’s mineral loss were assessed using micro-computed tomography. The MIC of GAPI against S. mutans, L. casei and C. albicans were 40 μM, 40 μM and 20 μM, respectively. GAPI destroyed the biofilm’s three-dimensional structure and inhibited the growth of the biofilm. SEM showed that enamel treated with GAPI had a relatively smooth surface compared to that treated with water. The calcium-to-phosphorus molar ratio of enamel treated with GAPI was higher than that of the control. The lesion depths and mineral loss of the GAPI-treated enamel were less than the control. The crystallinity of the GAPI-treated enamel was higher than the control. This study developed a biocompatible, mineralising and antimicrobial peptide GAPI, which may have potential as an anti-caries agent.

Abstract Background To study the caries lesion activity response to topical 38% silver diamine fluoride (SDF) therapy with increasing treatment application time. Methods/design The design is a stratified-randomised, double-blind, active-controlled, parallel-group clinical trial with nine treatment arms. The trial will involve recruiting at least 414 3- to 5-year-old kindergarten children with caries, who will receive approximately 0.004 mL of 38% SDF (the typical amount applied per the manufacturer’s instructions) to treat each caries lesion. The children will be stratified by caries status, randomised by blocks, and allocated to nine groups of SDF application times: 3, 5, 10, 15, 30, 45, 60, 120, and 180 s. The outcome measure is caries lesion activity (active/arrest) at the tooth-surface level at 6 months post-initial treatment. A calibrated dentist will conduct the blinded clinical examinations at baseline and at the 6-month follow-up. In addition, the parents will be surveyed to examine the effects of the moderating variables, such as oral hygiene, on caries lesion activity. The hypothesis is that a monotonically increasing trend can be found between the SDF application time and the proportion of caries lesions that are arrested. The Cochran-Armitage test for trends in proportions, corrected for clustering within children, will be used to determine the relationship between the exposure to SDF (the SDF application time) and the response (proportion of lesions arrested) in children, taking into consideration the effect of the moderating variables as well as the nesting of multiple caries lesions within an individual child. An EC 80 analysis (an 80% maximal concentration) will be used to determine the exposure (the SDF application time) for 80% caries lesion arrest. Bootstrap methods will be used for clustered data and will be resampled by clustering to determine the 95% confidence interval. Discussion This study will help with determining the optimal application time for SDF treatment. It will provide an evidence-based protocol for the use of SDF to arrest tooth decay in the primary teeth of young children. The results will inform an evidence-based SDF protocol to arrest caries, which affects 573 million children with tooth decay worldwide. Trial registration ClinicalTrials.gov NCT04655430 . Registered on 7th December 2020.

Dental graduates have a variety of career-path choices. After graduation, they may join private dental practice, government- or hospital-based dental care services, research groups, academia, business or industry. With globalization and frequent international exchange, dental graduates nowadays can explore careers outside their home country. However, dental education systems and job opportunities vary widely across different regions and countries. Diversity of accreditation in dental education, different licensure requirements, and lack of global competencies in dental care often limit the globalization, operation and survival of dental practice and education worldwide. The requirements for professional education and practice can be quite diverse, and these differences will be barriers to dental graduates seeking career development outside their home home country. Fresh dental graduates have minimal experience in job hunting. More specifically, they are unfamiliar with potential career paths. This paper was based on the 4th trilateral symposium 2022 organized by The University of Hong Kong, Tohoku University, and Fujian Medical University, which offered a lecture to discuss career paths for dental graduates in Hong Kong, Japan, and mainland China. The aim of this paper was to provide dentists, particularly fresh graduated dental students, with practical insight into different career paths in Hong Kong (Special Administrative Region of China, SAR), Japan and mainland China, and factors that may influence their career options. It assists dental students in exploring possibilities in dentistry and preparing for their career development after graduation from dental school.

Diet, nutrition, and oral health are closely linked. Malnutrition is a challenging health concern in older adults that is associated with physical decline affecting their daily activities and quality of life. The aim of this review is to provide an evidence-based summary of the relationship between diet and nutrition and oral health in older adults and its implications. The World Health Organization has declared healthy ageing a priority of its work on ageing. The American Dental Association confirmed the bidirectional relationship between diet and nutrition and oral health. The literature shows that diet and nutrition are related to oral diseases, including dental caries, periodontal diseases, tooth wear, and even oral cancer. Insufficient nutritional intake and poor dietary habits increase the risk of oral diseases, such as dental caries, in older adults. On the other hand, in older adults, poor oral conditions such as periodontal disease may induce pain, infection, and tooth loss, affecting nutritional intake. Surveys have shown that older adults, in particular, those in disadvantaged communities, suffered from nutritional deficiencies or imbalances affecting their oral health. In addition, the current literature shows that malnutrition is associated with frailty, hospitalization, mortality, and morbidity. Good oral health and functional dentition are essential to maintain sufficient nutritional intake among older adults and reduce the risk of malnutrition. Therefore, integrating oral health into general health care service in older adults is imperative to improve their nutritional and oral health status to achieve healthy ageing.

A novel antimicrobial peptide, GAPI, has been developed recently by grafting gallic acid (GA) to polyphemusin I (PI). The objective of this study was to investigate the antibacterial effects of GAPI on common oral pathogens. This laboratory study used minimum inhibitory concentrations and minimum bactericidal concentrations to assess the antimicrobial properties of GAPI against common oral pathogens. Transmission electron microscopy was used to examine the bacterial morphology both before and after GAPI treatment. The results showed that the minimum inhibitory concentration ranged from 20 μM (Lactobacillus rhamnosus) to 320 μM (Porphyromonas gingivalis), whereas the minimum bactericidal concentration ranged from 80 μM (Lactobacillus acidophilus) to 640 μM (Actinomyces naeslundii, Enterococcus faecalis, and Porphyromonas gingivalis). Transmission electron microscopy showed abnormal curvature of cell membranes, irregular cell shapes, leakage of cytoplasmic content, and disruption of cytoplasmic membranes and cell walls. In conclusion, the GAPI antimicrobial peptide is antibacterial to common oral pathogens, with the potential to be used to manage oral infections.

Abstract Background Silver diamine fluoride (SDF) and sodium fluoride (NaF) are widely used for caries management. The objectives of this study are (i) to compare the caries-arresting and caries-preventive effects of SDF and NaF in young children, (ii) to determine children’s and parents’ acceptance of these fluoride therapies and (iii) to investigate the short-term (1 day) and long-term (1 year) adverse effects of these fluoride therapies. Methods/design This is a randomised, double-blind, active-controlled clinical trial to be conducted in Hong Kong kindergartens. The study has received approval from the local institutional review board. Written consent will be obtained from the parents/guardians before the study. The study will recruit at least 688 healthy 3-year-old children. This sample size is sufficient for an appropriate statistical analysis. Stratified randomisation will be performed for intervention allocation. The two intervention groups are 38% SDF and 5% NaF varnish applied on six primary upper anterior teeth. At baseline, one trained examiner will perform clinical examinations of the children in the kindergartens. The caries experience and oral hygiene status of each child will be recorded using the decayed, missing (due to caries) and filled primary tooth index and visual plaque index, respectively. Then, an independent operator will apply the assigned fluoride after the dental examinations. The examiner, the children and their parents will be blinded to the intervention allocation. In addition, a research assistant will evaluate the child’s acceptance using interval rating scales for children’s uncooperative behaviour. The examiner will then visit the children the next day to study the short-term potential adverse effects of the fluoride therapies. The same examiner will perform a follow-up examination after 1 year to evaluate the children’s caries experiences, their oral hygiene statuses and the adverse effects of the fluoride. Parental questionnaires will be used to assess parental satisfaction and concerns about the fluoride therapies. Discussion This study provides essential information about using SDF in an outreach kindergarten service for caries management from different aspects, which include the caries-arresting and caries-preventive effects, the adverse effects and children’s and parents’ acceptance. The success of the service can help to increase the adoption of SDF to reduce the global burden of early childhood caries. Trial registration ClinicalTrials.gov NCT04399369 . Registered on May 2020

In this 12-month randomized active-controlled clinical trial, we compare two post-treatment instructions for silver diamine fluoride (SDF) therapy in arresting dentine caries. The trial will include at least 254 kindergarten children with active dentine caries. The children will be randomized into two groups and receive a 38% SDF solution applied topically to their carious lesions. Children in Group A will rinse immediately, whereas those in Group B will refrain from rinsing, eating, and drinking for 30 min. One trained examiner will perform the dental examination at baseline and every six months. The primary outcome measurement will be the proportion of caries lesions that become arrested at the 12-month examination. Potential confounding factors and parents’ satisfaction with SDF therapy at baseline and after 12 months will be collected using parental questionnaires. This trial will provide evidence-based information for clinical practitioners to give post-treatment instructions for SDF therapy. This study is registered at ClinicalTrial.gov (USA) (registration number: NCT05655286).

Abstract Background Lisu is an ethnic minority group and most of them are living in Yunnan, China. This study investigated the oral health status among 12-year-old Lisu children in Yunnan. Method This survey employed a multistage sampling method to recruit 12-year-old Lisu children. Two calibrated dentists performed the oral examinations in the primary schools. They examined dental caries, gingival bleeding and dental fluorosis using the diagnosis criteria recommended by the World Health Organization. A self-administrated questionnaire was distributed to the children to collect their sociodemographic background information and oral health-related behaviours. A chi-square test, the Mann–Whitney U test, zero-inflated negative binomial (ZINB) regression and multivariate logistic regression were used for statistical analysis. Results This survey invited 512 children, and 482 children (48% boys) participated in the study (response rate: 94%). Their caries prevalence was 35% and their caries experience in mean (SD) DMFT scores was 0.63 (0.10). The mean (SD) DT score was 0.60 (1.10), consisting 95% of the mean DMFT scores. No dental fluorosis was observed; whereas 426 children (88%) had gingival bleeding. Results of ZINB model indicated sex and sugary-snacking habits were related to the dental caries experience (p

BackgroundTooth decay is a significant public health problem globally. The caries-arrest effectiveness of 38% silver diamine fluoride (SDF) has been well documented. However, information on the caries-preventive effect of SDF on primary teeth is insufficient. ObjectiveThe aim of this trial is to investigate the effectiveness of semiannual application of 38% SDF and that of 5% sodium fluoride (NaF) varnish when compared with placebo control for preventing occlusal caries in the primary molars of preschool children over 30 months. MethodsThis 3-arm, parallel design, double-blind, randomized controlled trial involves 791 preschool children. Children are randomly allocated to receive 1 of 3 interventions as follows: Group 1, 38% SDF; Group 2, 5% NaF varnish; and Group 3, placebo control (tonic water). The intervention and dental examination will be carried out every 6 months. A parent-administered questionnaire, including the children’s demographic background and oral health–related behaviors, has been collected at baseline. Follow-up examinations to detect new caries development will be conducted every 6 months by a masked examiner. Caries development will be diagnosed at the cavitation level. Chi-square tests and logistic regression analyses will be adopted. A 2-level logistic regression analysis will be performed to investigate the effects of the study interventions and other potential confounding factors on the development of occlusal caries. ResultsThis study was started on September 1, 2020, and the recruitment process ended on September 30, 2021. At present, a total of 791 children are participating in the study. This 30-month clinical trial is expected to be completed in March 2024. ConclusionsIf SDF application is more effective than NaF varnish for preventing caries on occlusal surfaces of primary teeth, it can be a preferred choice for caries prevention in a kindergarten-based program. Results of this trial will provide valuable clinical evidence for the development of oral health strategies and policies on the promotion of child oral health. Trial RegistrationHKU Clinical Registry HKUCTR-2844, https://tinyurl.com/bdhz9yuk; ClinicalTrials.gov NCT05084001, https://clinicaltrials.gov/ct2/show/NCT05084001 International Registered Report Identifier (IRRID)DERR1-10.2196/35145

Abstract Background Silver diamine fluoride (SDF) solution is effective in arresting early childhood caries (ECC). Previous studies have suggested that it might exert a preventive effect in managing ECC. However, no well-designed clinical trials have yet been performed to study the effect of SDF on caries prevention. The objective of this randomised clinical trial is to determine whether 38% SDF solution is superior to 5% sodium fluoride (NaF) varnish in preventing new carious lesions in primary anterior teeth. Methods/design This is a phase II, single-centre, randomised, double-blind, active-controlled, parallel-group pragmatic trial. The hypothesis tested is that 38% SDF would be more effective than 5% NaF in preventing new caries development in primary anterior teeth. Approximately 730 3-year-old children who are generally healthy and with parental consent will be recruited from Hong Kong kindergartens. This sample size will be sufficient for appropriate statistical analysis of a superiority trial with 90% power, allowing for a 20% drop-out rate. Stratified randomisation will be adopted for allocating the intervention. The intervention will either be 38% SDF or 5% NaF (as a positive control) therapy on primary upper anterior teeth. A single trained examiner will conduct a dental examination every 6 months until 30 months in kindergarten. Another operator will provide fluoride therapy immediately after each dental examination. The examiner, children and children’s parents will be blinded to the treatment allocation. A questionnaire survey will be conducted to study the children’s oral health-related behaviours and socioeconomic backgrounds. Chi-square tests, t tests, regression analyses and survival analyses will be adopted for data analysis. Discussion The effectiveness of 38% SDF in preventing ECC remains uncertain. If the results are as anticipated, care standards using 5% NaF for ECC prevention will be changed. In addition, the results will be widely available and increase the adoption of SDF in other countries to reduce the global burden of ECC. Trial registration ClinicalTrials.gov, NCT04075474. Registered on 30 Aug 2019.

Abstract Background Silver diamine fluoride (SDF) solution gains increasing popularity in arresting dentine caries in clinical practice. The aim of this systematic review was to summarize the findings from laboratory studies on the influence of SDF application on the bond strength of dentine to various adhesives and to glass ionomer cements (GICs). Methods Two independent reviewers conducted a literature search in the databases Medline, Ovid, PubMed and Web of Science until 15th August 2019 using the search keywords [‘bond strength’] AND [‘silver diamine fluoride’ OR ‘silver diammine fluoride’ OR ‘SDF’ OR ‘silver fluoride’ OR ‘diamine silver fluoride’]. Articles investigating the effect of SDF application on the bond strength of dentine to various adhesives and to GICs were included in this review. Information on how SDF application influenced the bond strength was extracted from the included articles. Besides, related information, e.g. test method of bond strength, concentration and brand of SDF, type of adhesive system and GIC, testing dental substrate, protocol of specimen preparation, and failure mode was also reviewed. Results A total of 13 articles were included in this review, with 8 and 6 studies investigating the effect of SDF application on the bond strength of dentine to various adhesives and to GICs, respectively. Sound dentine as well as demineralized dentine created by chemical methods, e.g. immersing in a demineralizing solution, was commonly adopted as the testing dental substrate. The microtensile bond strength (mTBS) test was the predominant method employed. However, the bond strength values had large variations among studies, ranging from

Abstract Background This study investigated the remineralisation effect of bioactive glass on artificial dentine caries. Methods Dentine disks with artificial caries were treated with bioactive glass (group BAG), casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) (group CPP-ACP), sodium fluoride glycerol (group F) or deionized water (group W). All disks were subjected to pH cycling for 28 days subsequently. The topography, microhardness and remineralisation depth of the dentine carious lesion were assessed by atomic force microscopy (AFM), microhardness testing and confocal laser scanning microscope (CLSM), respectively. Results AFM images indicated mineral depositions on the surface of the carious lesion in group BAG. The changes of Vickers hardness number (ΔVHN, mean ± SD) after pH cycling were 9.67 ± 3.60, 6.06 ± 3.83, 5.00 ± 2.19 and − 1.90 ± 2.09 (p

Researchers have developed novel bioactive materials for caries management. Many clinicians also favour these materials, which fit their contemporary practice philosophy of using the medical model of caries management and minimally invasive dentistry. Although there is no consensus on the definition of bioactive materials, bioactive materials in cariology are generally considered to be those that can form hydroxyapatite crystals on the tooth surface. Common bioactive materials include fluoride-based materials, calcium- and phosphate-based materials, graphene-based materials, metal and metal-oxide nanomaterials and peptide-based materials. Silver diamine fluoride (SDF) is a fluoride-based material containing silver; silver is antibacterial and fluoride promotes remineralisation. Casein phosphopeptide-amorphous calcium phosphate is a calcium- and phosphate-based material that can be added to toothpaste and chewing gum for caries prevention. Researchers use graphene-based materials and metal or metal-oxide nanomaterials as anticaries agents. Graphene-based materials, such as graphene oxide-silver, have antibacterial and mineralising properties. Metal and metal-oxide nanomaterials, such as silver and copper oxide, are antimicrobial. Incorporating mineralising materials could introduce remineralising properties to metallic nanoparticles. Researchers have also developed antimicrobial peptides with mineralising properties for caries prevention. The purpose of this literature review is to provide an overview of current bioactive materials for caries management.

The prevalence of oral diseases in the older adult population remains high worldwide and is expected to surge in the coming decade. The World Health Organization (WHO) has listed the oral health of older adults as one of its pivotal concerns. Oral health affects general health, and oral diseases increase mortality and morbidity in older adults. Integrating oral health into the general health service with a patient-centred approach can be an effective way to improve oral and systemic health for older adults simultaneously. This integration tackles the shared risk factors of both oral and noncommunicable diseases, aids in the early detection of systemic disease, strengthens health surveillance, enhances efficient data sharing, and allows for the better allocation of resources and the workforce in the healthcare system. However, the oral healthcare sector operates as an isolated field, with an emphasis on intervention rather than prevention, which presents a key challenge to the success of integration. Therefore, refocusing oral healthcare service on prevention is paramount. In addition, approaches taken in clinical practice implementation, interprofessional education and training, technology and innovation, research and evaluation, advocacy by national professional oral healthcare organizations, and policy making will ensure the efficient, effective, and long-term integration of oral and general health services. Integrating these services would foster the accessibility and affordability of oral healthcare services for older adults to improve their oral health and overall well-being in the coming decade. This review aims to discuss the merits and outline the challenges of integrating oral health into general health services for older adults and to propose the approaches that could be taken.

Challenge-based learning (CBL) is a novel learning framework for a collaborative and multidisciplinary learning experience. It allows students, teachers, stakeholders, researchers, families, and society to work together to identify and solve real-world challenges. CBL helps students develop a deeper knowledge of the subjects they are studying. The concepts of CBL originate from a variety of educational theories and approaches, such as problem-based learning and inquiry-based learning. The precursor to the CBL framework is problem-based learning. However, unlike in problem-based learning and other approaches, students formulate the challenges they will address in CBL. Furthermore, students need to create a solution resulting in concrete action. CBL takes into account the social impact of an idea rather than just the corporate benefits. Therefore, it can help students expand the scope and depth of learning, encourage teamwork capabilities, and raise their awareness about considering quality and ethics in decision-making. CBL is implemented in universities, schools, and institutions worldwide and its use is well-recognized in science, engineering, and medicine, but it has not been translated into dentistry. The aim of this paper is to describe the concept of inclusion, principles and design, implementation, and supervision of the CBL framework in a dental course for the adaption of this learning framework to dental education.

Ceramic nanomaterials are nanoscale inorganic metalloid solids that can be synthesised by heating at high temperatures followed by rapid cooling. Since the first nanoceramics were developed in the 1980s, ceramic nanomaterials have rapidly become one of the core nanomaterials for research because of their versatility in application and use in technology. Researchers are developing ceramic nanomaterials for dental use because ceramic nanoparticles are more stable and cheaper in production than metallic nanoparticles. Ceramic nanomaterials can be used to prevent dental caries because some of them have mineralising properties to promote the remineralisation of tooth tissue. Ceramic minerals facilitate the remineralisation process and maintain an equilibrium in pH levels to maintain tooth integrity. In addition, ceramic nanomaterials have antibacterial properties to inhibit the growth of cariogenic biofilm. Researchers have developed antimicrobial nanoparticles, conjugated ceramic minerals with antibacterial and mineralising properties, to prevent the formation and progression of caries. Common ceramic nanomaterials developed for caries prevention include calcium-based (including hydroxyapatite-based), bioactive glass-based, and silica-based nanoparticles. Calcium-based ceramic nanomaterials can substitute for the lost hydroxyapatite by depositing calcium ions. Bioactive glass-based nanoparticles contain surface-reactive glass that can form apatite crystals resembling bone and tooth tissue and exhibit chemical bonding to the bone and tooth tissue. Silica-based nanoparticles contain silica for collagen infiltration and enhancing heterogeneous mineralisation of the dentin collagen matrix. In summary, ceramic nanomaterials can be used for caries prevention because of their antibacterial and mineralising properties. This study gives an overview of ceramic nanomaterials for the prevention of dental caries.

Objective: Researchers are studying the use of antimicrobial peptides as functional biomaterials to prevent and treat dental caries. This study aims to investigate the global research interest in antimicrobial peptides for caries management. Methods: Two independent investigators systematically searched with keywords (‘Caries’ OR ‘Dental caries’) AND (‘Antimicrobial peptide’ OR ‘AMP’ OR ‘Statherin’ OR ‘Histatin’ OR ‘Defensin’ OR ‘Cathelicidin’) on Web of Science, PubMed and Scopus. They removed duplicate publications and screened the titles and abstracts to identify relevant publications. The included publications were summarized and classified as laboratory studies, clinical trials or reviews. The citation count and citation density of the three publication types were compared using a one-way analysis of variance. The publications’ bibliometric data were analyzed using the Bibliometrix program. Results: This study included 163 publications with 115 laboratory studies (71%), 29 clinical trials (18%) and 19 reviews (11%). The number of publications per year have increased steadily since 2002. The citation densities (mean ± SD) of laboratory study publications (3.67 ± 2.73) and clinical trial publications (2.63 ± 1.85) were less than that of review articles (5.79 ± 1.27) (p = 0.002). The three publication types had no significant difference in citation count (p = 0.54). Most publications (79%, 129/163) reported the development of a novel antimicrobial peptide. China (52/163, 32%) and the US (29/163, 18%) contributed to 50% (81/163) of the publications. Conclusion: This bibliometric analysis identified an increasing trend in global interest in antimicrobial peptides for caries management since 2002. The main research topic was the development of novel antimicrobial peptides. Most publications were laboratory studies, as were the three publications with the highest citation counts. Laboratory studies had high citation counts, whereas reviews had high citation density.

Background: Dentine hypersensitivity on an exposed root surface induces pain, affects daily oral hygiene practice, limits dietary choices and negatively affects quality of life. Silver diamine fluoride is marketed in the United States as a desensitising agent, but well-designed clinical trials are limited. This study evaluates the anti-hypersensitivity effect of silver diamine fluoride on hypersensitive teeth due to an exposed root surface in older Chinese adults. Methods/design: We will conduct a randomised double-blind clinical trial with a sample size of at least 148 Chinese older adults aged 65 or above who have dentine hypersensitivity due to an exposed root surface. We will collect written consent before the study. A trained examiner will examine the participants’ teeth with a blast of compressed air from a 3-in-1 syringe. Those adults who report a self-perceived sensitivity score (SS) (0 to 10) of 8 or more on at least one tooth with an exposed root surface will be recruited. The recruited older adults will be randomly allocated into two groups using a block randomisation of six. Group 1 participants will receive the application of 38% silver diamine fluoride solution every 4 weeks. Group 2 participants will receive the application of 5% potassium nitrate solution every 4 weeks. Dietary advice, oral hygiene instruction and fluoride toothpaste at 1450 ppm will be provided to participants in both groups. The same trained examiner will perform follow-up examinations for the participants and determine the dentine hypersensitivity in SS of the most hypersensitive tooth (with the highest pre-treatment SS) immediately after the intervention and at 4-week and 8-week intervals. Discussion: There is no consensus on the standard of care for a professionally applied desensitising agent in older adults. This trial will provide evidence for clinicians to devise an effective dental care plan for older adults with dentine hypersensitivity. Trial registration: NCT05392868 Registered on 22 May 2022.

The aim of this study was to present a concise summary of the oral health policies and oral healthcare schemes for older adult populations in a number of selected countries around the world. In this paper, the current and planned national/regional oral health policies and oral healthcare schemes of nine countries (Australia, Brazil, China including Hong Kong, India, Japan, Switzerland, Thailand, the United Kingdom, and the United States) are reported. Barriers and challenges in oral health promotion in terms of devising oral health policies, implementing oral health schemes, and educating the future dental workforce are discussed. In response to the aging of population, individual countries have initiated or reformed their healthcare systems and developed innovative approaches to deliver oral health services for older adults. There is a global shortage of dentists trained in geriatric dentistry. In many countries, geriatric dentistry is not formally recognized as a specialty. Education and training in geriatric dentistry is needed to produce responsive and competent dental professionals to serve the increasing number of older adults. It is expected that oral health policies and oral healthcare services will be changing and reforming in the coming decades to tackle the enduring oral health challenges of aging societies worldwide.

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is a clear solution containing silver and fluoride ions. Because of its anti-bacterial and remineralizing effect, silver diamine fluoride has been used in managing dental caries for decades worldwide. This paper aims to summarize and discuss the global policies, guidelines, and relevant information on utilizing SDF for caries management. SDF can be used for treating dental caries in most countries. However, it is not permitted to be used in mainland China. Several manufacturers, mainly in Australia, Brazil, India, Japan, and the United States, produce SDF at different concentrations that are commercially available around the world. The prices differ between contents and brands. Different government organizations and dental associations have developed guidelines for clinical use of SDF. Dental professionals can refer to the specific guidelines in their own countries or territories. Training for using SDF is part of undergraduate and/or postgraduate curriculums in almost all countries. However, real utilization of SDF of dentists, especially in the private sector, remains unclear in most places because little research has been conducted. There are at least two ongoing regional-wide large-scale oral health programs, using SDF as one of the components to manage dental caries in young children (one in Hong Kong and one in Mongolia). Because SDF treatment does not require caries removal, and it is simple, non-invasive, and inexpensive, SDF is a valuable strategy for caries management in young children, elderly people, and patients with special needs. In addition, to reduce the risk of bacteria or virus transmission in dental settings, using SDF as a non-aerosol producing procedure should be emphasized under the COVID-19 outbreak.

Abstract Background This study aimed to evaluate the prevalence of tooth wear among preschool children in Jakarta, Indonesia, and examine the risk factors associated with its occurrence. Methods An epidemiological survey was conducted with a cross-sectional study design. The participants were recruited via cluster sampling. Tooth wear was clinically assessed by one examiner using the Basic Erosive Wear Examination (BEWE) criteria. The children’s caries experience was also recorded. The parents of the participating children completed a self-administered questionnaire to answer demographic questions about the children and gather information about the children’s diet and oral health behaviors as well as the parents’ dental health-related knowledge. The data were analyzed using the Chi-square test and binary logistic regression. Results A total of 752 five-year-old children were invited to participate, with 691 (92%) enrolling in the study. Tooth wear occurred in 23% (161/691, BEWE > 0) of the participants, in which 78% (125/161) had at least one moderate tooth wear status (BEWE = 2). The consumption of citrus drinks, fruit juice, and vitamin C supplement drinks, together with the child’s caries experience, the father’s education level, and the family’s socioeconomic status, were significantly associated with tooth wear. Conclusions The five-year-old preschool children in Jakarta had a relatively low prevalence of tooth wear. Those consuming more acidic drinks, those with a higher socioeconomic status, and those with an absence of caries experience had a higher risk of tooth wear.

Abstract Background Medical-dental collaboration expands patients’ access to health services, improves healthcare outcomes, and reduces the burden and cost of care, especially for those with chronic diseases. The aim of the present study is to investigate the attitude toward and awareness of medical-dental collaboration among medical and dental students attending the Universitas Indonesia. Methods All medical and dental students at the Universitas Indonesia were invited to participate in a web-based questionnaire survey that contained eight questions on attitudes toward medical-dental collaboration and two questions regarding awareness of dental-medical collaborative practices. The demographic backgrounds of all participants were obtained. The chi-square test and logistic regression analysis were employed for data analysis. Results A total of 1,432 questionnaires were distributed, and 1,137 (79%) were appropriately completed. In general, 992 (87%) students had a positive attitude toward medical-dental collaboration. Dental students had a more positive attitude than medical students (odds ratio [OR] = 2.694; p = 0.001), and senior students had a more positive attitude than junior students (OR = 2.271; p = 0.001). Most students (86%) were aware of medical-dental collaboration at the Universitas Indonesia and reported that emergency medicine, surgery, and otolaryngology were the three most common medical disciplines that entailed medical-dental collaboration. Conclusions: In general, the medical and dental students demonstrated positive attitudes and awareness of medical-dental collaboration at the Universitas Indonesia. Positive attitude and awareness can establish an essential foundation for fostering collaboration between medicine and dentistry, which is vital to improve resource efficiency and healthcare standards.

Graphene is a single-layer two-dimensional carbon-based nanomaterial. It presents as a thin and strong material that has attracted many researchers’ attention. This study provides a concise review of the potential application of graphene materials in caries and periodontal disease management. Pristine or functionalized graphene and its derivatives exhibit favorable physicochemical, mechanical, and morphological properties applicable to biomedical applications. They can be activated and functionalized with metal and metal nanoparticles, polymers, and other small molecules to exhibit multi-differentiation activities, antimicrobial activities, and biocompatibility. They were investigated in preventive dentistry and regenerative dentistry. Graphene materials such as graphene oxide inhibit cariogenic microbes such as Streptococcus mutans. They also inhibit periodontal pathogens that are responsible for periodontitis and root canal infection. Graphene-fluorine promotes enamel and dentin mineralization. These materials were also broadly studied in regenerative dental research, such as dental hard and soft tissue regeneration, as well as periodontal tissue and bone regeneration. Graphene oxide-based materials, such as graphene oxide-fibroin, were reported as promising in tissue engineering for their biocompatibility, bioactivity, and ability to enhance cell proliferation properties in periodontal ligament stem cells. Laboratory research showed that graphene can be used exclusively or by incorporating it into existing dental materials. The success of laboratory studies can translate the application of graphene into clinical use.

Aim: Early childhood caries (ECC) has significant public health implications but has received inadequate global attention. There is limited information regarding the success of oral health policies implemented to address the challenges of ECC. This review aimed to summarize such policies to tackle ECC from different countries/regions.Method: Independent collaborators from 14 countries/regions (Australia, Brazil, Cambodia, China, Hong Kong, Egypt, India, Indonesia, Japan, Nigeria, Thailand, UK, USA, and Venezuela) collected the data. The ECC status, dental workforce, oral health policies on ECC prevention in different countries/regions were summarized by each country.Results: The findings indicated that ECC prevalence varied in different countries/regions. The lowest prevalence of ECC among 5-year-old children was found in Nigeria (7%), and the highest was found in Indonesia (90%). The existing dental workforce and resources are limited in most countries. The smallest dentist to population ratio was reported by Nigeria at 1:48,400, whereas the highest ratio was in Brazil (1:600). Out of 14, three (21%) countries namely India, Venezuela and Cambodia had no national oral health policies addressing ECC and four (29%) countries (Cambodia, China, India, Venezuela) had no publicly funded dental care program for 0–5-year-old children. Water fluoridation is available in four countries/regions (Australia, Brazil, Hong Kong, USA).Conclusion: ECC remains a global health challenge and dental workforce is limited. National/regional programs to tackle ECC are not yet prioritized in many countries/regions. Evidence to support demonstration projects is limited. Further research on the cost-effectiveness of interventions strategies is required for policymakers.