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Background: Silver diamine fluoride (SDF) is employed in caries prevention and treatment; however, tooth discoloration post treatment is a significant disadvantage, which can be reduced using glutathione (GSH), a water soluble tripeptide., Aim: To evaluate and compare the effect of glutathione biomolecule (GSH) and potassium iodide (KI) along with SDF on tooth discoloration and shear bond strength of glass ionomer cement (GIC) on the tooth surface., Methods: Artificial caries were created on 48 extracted unblemished premolars and divided into four groups (SDF, SDF + KI, SDF + GSH, and Water). The solutions were applied according to the manufacturer's instructions, and the samples were incubated for 24 hours. The color assessment was recorded on days 1, 7, and 14 by using a spectrophotometer. Following the color assessment, all the treated samples were bonded with GIC. The shear bond strength was evaluated using a universal testing machine., Results: Mixing SDF with GSH initially reduced tooth discoloration. Although there was an increase in the discoloration after 2 weeks, it was still less when compared to the SDF group. The application of GSH and KI post SDF application had no significant difference in the shear bond strength of GIC on the tooth surface., Conclusions: The use of GSH along with SDF helps in reducing the discoloration without compromising the shear bond strength., (Copyright © 2024 Nigerian Journal of Clinical Practice.)

Objective: To assess the fluoride and silver ion release of glass ionomer cement (GIC) restorations, including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations, with 38 % silver diamine fluoride (SDF) solution dentin pretreatment., Methods: Eighty dentin blocks were allocated into 4 groups and restored with SDF+CGIC, CGIC, SDF+RMGIC and RMGIC, respectively. Each block was stored in deionized water at 37 °C for 2 years. Fluoride and silver ion concentration in storage solution was measured using ion-selective electrode and inductively coupled plasma-optical emission spectrometry for up to 2 years. The cross-sectional surfaces of restored dentin blocks were assessed by X-Ray diffraction analysis (XRD), scanning electron microscope (SEM) with energy-dispersive X-ray spectroscopy (EDS) after 1 week and 2 years, respectively., Results: The mean ± standard deviation (SD) of accumulative fluoride releasing in SDF+CGIC, CGIC, SDF+RMGIC and RMGIC for 2 years were 0.13±0.005 mg, 0.09±0.006 mg, 0.15±0.008 mg and 0.05±0.003 mg, respectively (Groups SDF+RMGIC > SDF+CGIC > CGIC >RMGIC, p < 0.05). The mean ± SD of accumulative silver releasing in SDF+CGIC, CGIC, SDF+RMGIC and RMGIC for 2 years were 0.03±0.009 mg, 0.00±0.00 mg, 0.01±0.003 mg, and 0.00±0.00 mg, respectively (Groups SDF+CGIC > SDF+RMGIC > CGIC&RMGIC, p < 0.05). Groups SDF+CGIC and SDF+RMGIC showed sustainably higher fluoride and silver releasing compared to Groups CGIC and RMGIC (p < 0.05). XRD analysis indicated the fluorapatite and silver chloride were observed only in Groups SDF+CGIC and SDF+RMGIC, but not in Groups CGIC and RMGIC. SEM images of the cross-sectional view of the dentin blocks showed silver crystals within dentinal tubules 1 week and 2-year in Groups with SDF pretreatment., Conclusion: The 38 % SDF dentin pretreatment sustainably increased the fluoride and silver release of GIC and RMGIC restorations for up to 2 years., Competing Interests: Declaration of competing interest The authors state that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: Colour stability is important in the long-term aesthetic success of restorative materials and is affected by both internal and external factors. Internal discolourations are due to the properties of the restorative materials. External discolourations can be associated with frequent consumption of food and beverages and the use of suspensions or syrups containing colourants/additives. Fluoride varnish application has an important place in preventive dentistry. The purpose of the research was to examine the protective effect of fluoride varnish application on the colour change on polyacid-modified composite resin restorative materials caused by the use of various paediatric drugs., Methods: Two hundred ten discs were prepared from polyacid-modified composite resin material and divided into two groups: flouride varnish was applied to one group and flouride varnish was not applied to the other group. The groups were further divided into seven subgroups and the samples were kept in artificial saliva, amoxicillin + clavulanic acid, cefuroxime axetil, clarithromycin, paracetamol, ibuprofen, and iron supplement drug solutions. The colour change values of the discs were measured using a spectrophotometer device before immersion in the drug solutions and on the 7th, 14th, 21st, and 28th days after the immersion. The obtained data were calculated and statistically evaluated using IBM SPSS V23 software., Results: It was found that the application of fluoride varnish in the iron supplement drug group prevented the colour change of the polyacid-modified composite resins for 28 days. In the amoxicillin + clavulanic acid, cefuroxime axetil, and paracetamol groups, the fluoride varnish did not prevent colour change in the polyacid-modified composite resin restorative materials at the end of the 14th day., Conclusion: It is thought that fluoride varnish application may be beneficial as a preservative in the colour change of polyacid-modified composite resins due to the use of various paediatric drugs, and this protective feature may be effective for a specific period of time., (© 2024. The Author(s), under exclusive licence to European Academy of Paediatric Dentistry.)

Purpose: The purpose of this study was to investigate the microleakage of atraumatic glass ionomer restorations with and without silver diammine fluoride (SDF) application. Restorations with SDF are termed silver-modified atraumatic restorations (SMART). Methods: Sixty carious extracted permanent teeth were randomly allocated to two SMART groups and two control groups (n equals 15 per group) for a total of four groups. After selective caries removal, test specimens were treated with 38 percent SDF and polyacrylic acid conditioner was applied and rinsed; teeth were restored with Fuji IX GP® glass ionomer (n equals 15) or with SMART Advantage™ glass ionomer (SAGI; n equals 15). For control groups, specimens were restored with their respective GI material after selective caries removal, both without SDF. Restored teeth were placed in Dulbecco's Phosphate-Buffered Saline solution at 37 degrees Celsius for 24 hours. Teeth were thermocycled between five and 55 degrees Celsius for 1,000 cycles, stained with two percent basic fuchsin, sectioned, and visually inspected for microleakage utilizing stereomicroscopy on a four-point scale. Data were statistically analyzed using Kruskal-Wallis one-way analysis of variance on ranks using Dunn's method (P<0.05). Results: Microleakage between the two SMART restoration groups was insignificant. SAGI alone demonstrated significantly more microleakage than all other groups. There was no statistical significance between the Fuji IX GP® control group and the two SMART restoration groups. Conclusions: This in vitro study indicated that silver diammine fluoride placed before glass ionomer restoration does not increase microleakage. Polyacrylic acid may be used after SDF placement without increasing microleakage.

The study aimed to examine the fluoride (F) release potential of arginine (Arg)-incorporated F varnishes. Four commercially available F varnishes were included in the study: Duraphat ® (5% NaF), Flúor Protector ® (0.9% SiH 2 F 2 ), Fluor Protector S ® (NH 4 F), and Fluorimax™ (2.5% NaF). L-arginine (2% w/v.) was incorporated in these varnishes to estimate F release at 1 h, 4 h, 6 h, 24 h, 3 days, and 7 days using an F-ion selective electrode. The media pH of eluded varnishes was estimated and primary inorganic F extraction was performed. The main effects pH, F release, and computed integrated mean/cumulative F release for experimental groups were significantly higher than the controls (p<0.01). The primary extracted F concentrations for the Arg-containing groups were significantly lower than the control groups (p<0.001) demonstrating a chemical interplay with Arg incorporation. To conclude, irrespective of the inorganic F content, incorporating Arg in F-containing varnishes increases their F release potential.

We aimed to determine whether adhesive components could increase the release time of effective fluoride concentration from an experimental fluoride varnish applied to bovine teeth. An experimental fluoride varnish containing 5% sodium fluoride (EX1) was prepared and combined with 35% hydroxyethyl methacrylate (HEMA) (EX2), 5% glutaraldehyde (EX3), or 35% HEMA/5% glutaraldehyde mixture (EX4). Two commercially available fluoride varnishes were used for comparison. Each group was applied to bovine incisors, and the fluoride release and pH were monitored for 30 days. Cell viability analysis, scanning electron microscopy, and energy-dispersive spectroscopy were performed. EX4 released the highest and most effective concentration of fluoride for the longest period and reached neutral pH at the earliest; the release was maintained for up to 30 days without cytotoxicity. In conclusion, EX4 is considered to be the most effective varnish to prevent dental caries.

In dentistry, fluoride compounds play a very important role in the development of teeth hard tissue. They have been modifying the development of the carious process for many years in accordance with the principles of minimally invasive therapy. Studies have confirmed their effectiveness in the prevention and treatment of carious lesions and erosion of deciduous and permanent teeth, as well as in the dentin hypersensitivity treatment. Typically, each varnish consists of 3 basic components, i.e., a resin usually in the form of mastic, shellac and/or rosin, an alcohol-based organic solvent (usually ethanol) and active agents. In the first-generation varnishes, the active agent is fluorine compounds, most often in the form of 5% NaF, while in second-generation varnishes, the composition is further enriched with calcium and phosphorus compounds in the form of CPP-ACP/CPP-ACPF, ACP, TCP, fTCP, CSPS, TMP, CXP, or CaGP. This influences the bioavailability of fluoride in the oral environment by increasing both its release from the product and its subsequent accumulation in enamel and plaque, promotes more efficient closure of dentinal tubules, and facilitates pH buffering in the oral cavity.

Objective: (1) to determine the effects of the silver diamine fluoride (SDF) and sodium fluoride (NaF) in demineralized dentin exposed to an acid challenge by pH-cycling, (2) to evaluate the remineralizing capacity of SDF/NaF products based on the physicochemical and mechanical properties of the treated dentin surfaces., Methodology: In total, 57 human molars were evaluated in different stages of the experimental period: sound dentin - negative control (Stage 1), demineralized dentin - positive control (Stage 2), and dentin treated with SDF/NaF products + pH-c (Stage 3). Several commercial products were used for the SDF treatment: Saforide, RivaStar, and Cariestop. The mineral composition and crystalline and morphological characteristics of the dentin samples from each experimental stage were evaluated by infrared spectroscopy (ATR-FTIR), X-ray diffraction, and electron microscopy (SEM-EDX) analytical techniques. Moreover, the mechanical response of the samples was analyzed by means of the three-point bending test. Statistics were estimated for ATR-FTIR variables by Wilcoxon test, while the mechanical data analyses were performed using Kruskal-Wallis and Mann Whitney U tests., Results: Regarding the chemical composition, we observed a higher mineral/organic content in the SDF/NaF treated dentin + pH-c groups (Stage 3) than in the positive control groups (Saforide p=0.03; Cariestop p=0.008; RivaStar p=0.013; NaF p=0.04). The XRD results showed that the crystallite size of hydroxyapatite increased in the SDF/NaF treated dentin + pH-c groups (between +63% in RivaStar to +108% in Saforide), regarding the positive control. SEM images showed that after application of the SDF/NaF products a crystalline precipitate formed on the dentin surface and partially filled the dentin tubules. The flexural strength (MPa) values were higher in the dentin treated with SDF/NaF + pH-c (Stage 3) compared to the positive control groups (Saforide p=0.002; Cariestop p=0.04; RivaStar p=0.04; NaF p=0.02)., Conclusions: The application of SDF/NaF affected the physicochemical and mechanical properties of demineralized dentin. According to the results, the use of SFD/NaF had a remineralizing effect on the dentin surface even under acid challenge.

This study aimed to evaluate the influence of the use of remineralizing agents on the tensile bond strength. The study sample consisted of 80 recently extracted molars, which were randomly divided into four experimental groups (n = 20): groups FG1 and FG30, in which fluoride varnish was used, and groups RG1 and RG30, in which Recaldent tooth mousse was used. The mesiobuccal surfaces served as experimental, and distobuccal as control (n = 80). Brackets were bonded to both surfaces and were submitted to a tension test at different time intervals (T1 and T30). Tensile bond strength (TBS) and the amount of adhesive remnant (ARI) were assessed. A statistically significantly lower mean of TBS compared to the control group was found only in the FG1 group (p < 0.001), and no significant difference was found between the other groups. The FG1 group showed significantly higher ARI scores (p < 0.001) compared to the control group. No significant difference was found between the other groups. In conclusion, bonding brackets one day after applying fluoride varnish significantly reduced the TBS, but after 30 days it was set back to an optimal value. The use of Recaldent before orthodontic treatment had no adverse effect., (© 2023. The Author(s).)

Background: Dental remineralization is the process of transporting minerals from the surrounding environment (i.e., saliva and biofilm) into partially demineralized tooth structures. Remineralization can be induced by professional therapies such as fluoride-based treatments that have the highest level of supporting evidence. High-intensity LASER and nonthermal atmospheric pressure plasma therapy have been known to increase the resistance of enamel to demineralization by surface modification., Aim: The aim of the study was to evaluate and compare the surface remineralization of enamel using ErCr:YSGG LASER and nonthermal atmospheric pressure plasma (NTP) activation with three different fluoride varnishes., Methodology: Sixty-eight extracted premolars were used which were sectioned mesiodistally to obtain 135 specimens and artificial caries were induced on the experimental surface. They were then randomly divided into three groups (n = 45): MI Varnish (GC Japan), Vanish Varnish (3M ESPE), and Embrace Varnish (Pulpdent). After varnish application, these groups were further divided into three subgroups based on the activation therapy used. Fifteen samples from each group were treated with ErCr:YSGG LASER, 15 samples with NTP, and 15 samples were the control that did not undergo activation. After 9 days of pH cycling, the mean ion concentration of the surface calcium and phosphate ions was recorded using FEG-SEM and EDX analysis. The data were statistically analyzed., Results: One-way ANOVA and post hoc Tukey test accepting P < 0.05 were performed for comparisons between all analyses groups. Vanish Varnish showed a higher Ca/P ratio in LASER, NTP, and control subgroups, followed by MI Varnish and Embrace Varnish. ErCr:YSGG LASER therapy showed an improved Ca/P ratio in all varnishes than NTP therapy and control., Conclusion: ErCr:YSGG LASER therapy showed positive effects toward improving the Ca/P, followed by NTP therapy as compared to control in all three varnishes indicating their role in enhancing the effects of remineralization. Vanish Varnish showed a higher Ca/P ratio indicating better remineralization post activation., Competing Interests: None

Among the available methods of enamel strengthening, fluoride varnish (FV) treatment has relatively better results. On the other hand, cold plasma technology has shown promising capacities in sterilizing the environment, surface modification, and improving adhesion. Accordingly, this study aimed to increase the adhesion of FV to the enamel surface to prolong the enamel interaction with FV with subsequently increased fluoride uptake by enamel. Emphasizing that the change in adhesion is evidence-based and has not been explicitly measured. For this purpose, we randomly divided twenty bovine teeth into two groups A (consisting of four teeth) and B (composed of four subgroups, each containing four teeth). Samples of group A and one specimen of each subset B investigated the effect of using Helium-DBD (He-DBDJ), Argon (ArJ), and Air-DBD jet on the enamel surface. Other B specimens are devoted to studying the release of FV fluoride ions from processed enamel. Two diagnostic techniques, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS), have been utilized to examine the samples' surface morphology and chemical analysis, respectively. Finally, the release of fluoride ions into distilled water was measured by an ion-selective electrode (ISE). SEM images showed that ArJ and Air-DBD significantly damaged enamel hexagonal structures, whereas, in the case of He-DBDJ, the hexagonal structures have only altered from convex to concave. EDX indicated an increase in calcium to phosphorus ratio and the amount of fluoride and sodium uptake on the enamel surface layer in the group processed with He-DBDJ plasma. The latter helps restore the damaged parts of the enamel. Analysis of fluoride released from the FV did not show a significant change owing to plasma processing (P ≤ 0.112). The combination of cold plasma and fluoride varnish treatment on the enamel surface might be considered as a more promising approach to increasing enamel resistance to tooth decay., (© 2022. The Author(s).)

Examine the effect of dental curing light and laser treatments applied after Silver Diamine Fluoride (SDF) on dentin hardness in carious primary molars. This in-vitro study consisted of 30 extracted primary molars with caries extending into dentin without pulpal involvement. The collected teeth were randomly divided into three groups: group 1: received SDF then Sub-ablative low-energy of Er,Cr:YSGG laser, group 2: received SDF followed by application of curing light for 40 s, group 3: had SDF treatment only. In all groups, 38% Ag (NH3)2F SDF was used. Vickers hardness test was performed on sound dentin below carious lesion. Kruskal-Wallis Test was used to determine the mean difference in dentin hardness of the groups at 5% Significance level using SPSS software. Surface hardness of sound dentin below the carious lesion was statistically significantly higher in the laser + SDF group (891.24 ± 37.33 kgf/mm 2 ) versus the two other groups (Light cure + SDF = 266.65 ± 90.81 kgf/mm 2 and SDF only = 117.91 ± 19.19 kgf/mm 2 ) with p-value ≤ 0.001. Although Photopolymerization of SDF increases the surface hardness of sound dentin below the carious lesion, applying laser after SDF has the highest surface hardness due to the laser's sub-ablation of dentin., (© 2021. The Author(s).)

Changes to the features of the enamel surface submitted to induced demineralisation and subsequent remineralisation were studied. The in vitro examination was conducted on polished slices of human molar teeth, divided in four groups: the untreated control ( n = 20), challenged by a demineralisation with orthophosphoric acid (H 3 PO 4 ) ( n = 20), and challenged by a demineralisation following remineralisation with fluoride (F) varnish containing casein phosphopeptides (CPP) and amorphous calcium phosphate (ACP) compounds ( n = 20). The specimens' enamel surfaces were subjected to analysis of structure, molecular arrangement, mechanical features, chemical composition, and crystalline organization of apatite crystals. Specimens treated with acid showed a significant decrease in crystallinity, calcium, and phosphorus levels as well as mechanical parameters, with an increase in enamel surface roughness and degree of carbonates when compared to the control group. Treatment with fluoride CPP-ACP varnish provided great improvements in enamel arrangement, as the destroyed hydroxyapatite structure was largely rebuilt and the resulting enamel surface was characterised by greater regularity, higher molecular and structural organisation, and a smoother surface compared to the demineralised one. In conclusion, this in vitro study showed that fluoride CPP-ACP varnish, by improving enamel hardness and initiating the deposition of a new crystal layer, can be an effective remineralising agent for the treatment of damaged enamel.

Objective: To investigate the remineralizing and staining effects of sodium fluoride (NaF) solution with polyethylene glycol-coated silver nanoparticles (PEG-AgNPs) on artificial dentine caries., Materials and Methods: Demineralized human dentine blocks were allocated to three groups. The blocks in group 1 underwent a topical application of a 12% silver diamine fluoride (SDF, 14,150 ppm fluoride) solution. The blocks in group 2 received a topical application of a 2.5% NaF (11,310 ppm fluoride) with PEG-AgNPs (400 ppm silver). The blocks in group 3 received deionized water. All blocks were subjected to pH cycling for 8 days. The surface morphology and cross-sectional features were investigated using scanning electron microscopy (SEM). The color parameters, crystal characteristics, lesion depth, and collagen degradation of the blocks were assessed using digital spectrophotometry, X-ray diffraction (XRD), micro-computed tomography, and spectrophotometry with a hydroxyproline assay, respectively., Results: The SEM showed that dentine collagen was exposed in group 3 but not in groups 1 and 2. The mean lesion depths in groups 1 to 3 were 118±7 µm, 121±14 µm, and 339±20 µm, respectively (groups1,2<3; p<0.001). The data indicated that fluoridated PEG-AgNPs introduced no significant color effect on dentine, but SDF caused distinct discoloration. The XRD indicated that silver chloride was formed in group 1, and fluorapatite was detected in groups 1 and 2. The concentration of hydroxyproline liberated from collagen was significantly less in groups 1 and 2 than in group 3., Conclusion: The use of NaF solution with PEG-AgNPs can remineralize artificial dentine caries and inhibit collagen degradation without causing significant tooth staining., Competing Interests: The authors declare that they have no conflicts of interest in this work., (© 2020 Zhao et al.)

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.

We assessed the effect of a new coating material based on resin-modified glass-ionomer with calcium (Ca) in inhibiting the demineralization of underlying and adjacent areas surrounding caries-like lesions in enamel. The measures used were surface hardness (SH) and cross-sectional hardness (CSH). Thirty-six bovine enamel specimens (3 × 6 × 2 mm) were randomly allocated into three groups (n = 12): No treatment (NT); resin-modified glass-ionomer with Ca (Clinpro XT Varnish, 3M ESPE) (CL), and fluoride varnish (Duraphat, Colgate) (DU). The specimens were subjected to alternated immersions in demineralizing (6 h) and remineralizing solutions (18 h) for 7 days. SH measurements were conducted at standard distances of 150, 300, and 450 µm from the treatment area. CSH evaluated the mean hardness profile over the depth of the enamel surface and at standard distances from the materials. The energy-dispersive X-ray spectroscopy analysis was conducted to evaluate the demineralization bands created on the sublayer by % of calcium (Ca), phosphorus (P), and fluoride (F). Ca/P weight ratio was also calculated. Based on SH and CSH measurements, there was no difference between groups at the distances 150 µm (p = 0.882), 300 µm (p = 0.995), and 450 µm (p = 0.998). Up to 50 µm depth (at 150 µm from the treatment area), CL showed better performance than DU ( p< 0.05). NT presented higher loss of Ca and P than CL and DU (p < 0.05). There was no significant difference in the % of F ion among the three groups. The new coating material was similar to F varnish in attenuating enamel demineralization.

The objective was to evaluate the effect of application of silver diamine fluoride (SDF) on discoloration of demineralized dentin over time. Dentin specimens were divided into four groups according to time of dentin demineralization. A 38% SDF solution was then applied to the dentin surfaces. Half of the specimens were placed in light-proof boxes while the remainder were exposed to light. Both groups were maintained at 37˚C. Color change was determined using a spectrophotometer at different time intervals. SEM/EDS analysis were also undertaken. The 13 h EDTA demineralized group showed the highest values for color change among different time intervals, with the control being the lowest. The light exposed groups showed more color change compared to the unexposed groups. We concluded that the degree of dentin demineralization leads to a significant increase of the rate of dentin color change after application of SDF.

We evaluated the efficacy of light-curable fluoride varnish (LCFV) that contains 2-methacryloyloxyethyl phosphorylcholine (MPC) in terms of anti-biofouling properties and prevention of tooth enamel demineralization. MPC was mixed with and incorporated into LCFV at 0 (control), 1.5, 3.0, 5.0, 10.0, 20.0, and 40.0 weight percentage (wt%). Addition of high wt% of MPC resulted in increased film thickness and decreased the degree of conversion, indicating loss of the advantageous properties of LCFV. Addition of 1.5, 3, or 5 wt% MPC significantly reduced the amount of bovine serum albumin adsorbed from a solution and proteins adsorbed from brain heart infusion medium compared to the control (P < 0.001). A similar pattern was observed for bacterial adhesion: significantly less Streptococcus mutans cells adhered on the surface of LCFV with 1.5, 3, or 5 wt% MPC (P < 0.001) than on the control, and similar results were obtained for Actinomyces naeslundii and Streptococcus sanguinis adherence to LCFV with 3 wt% MPC. Finally, bacterial adhesion, surface microhardness loss, and the depth of demineralization were substantially lower on bovine tooth enamel surface coated with LCFV containing 3 wt% of MPC than in the control treatment (0 wt% MPC). Therefore, this novel LCFV containing a low concentration of MPC (e.g., 3 wt%) would be effective in anti-biofouling while maintaining the important advantageous features of light-curable fluoride in preventing demineralization.

Objective: Radiation-related caries are one the most undesired reactions manifested during or after head and neck radiotherapy. Fluoride application is an important strategy to reduce demineralization and enhance remineralizaton. To evaluate the effect of the topical application of fluoride during irradiation on dental enamel demineralization., Material and Methods: Thirty molars were randomly divided into three groups: Non-irradiated (NI), Irradiated (I), Irradiated with fluoride (IF). Each group was subdivided according to the presence or absence of pH-cycling (n=5). In the irradiated groups, the teeth received 70 Gy. The enamel's chemical composition was measured using Fourier Transform Infrared Spectrometry (organic matrix/mineral ratio - M/M and relative carbonate content - RCC). Vickers microhardness (VHN) and elastic modulus (E) were evaluated at three depths (surface, middle and deep enamel). Scanning electron microscopy (SEM) was used to assess the enamel's morphology., Results: The FTIR analysis (M/M and RCC) showed significant differences for irradiation, pH-cycling and the interaction between factors (p<0.001). Without pH-cycling, IF had the lowest organic matrix/mineral ratio and relative carbonate content. With pH-cycling, the organic matrix/mineral ratio increased and the relative carbonate content decreased, except for IF. VHN was influenced only by pH-cycling (p<0.001), which generated higher VHN values. ANOVA detected significant differences in E for irradiation (p<0.001), pH-cycling (p<0.001) and for the interaction between irradiation and pH-cycling (p<0.001). Increased E was found for group I without pH-cycling. With pH-cycling, groups I and IF were similar, and showed higher values than NI. The SEM images showed no morphological changes without pH-cycling. With pH-cycling, fluoride helped to maintain the outer enamel's morphology., Conclusions: Fluoride reduced mineral loss and maintained the outer morphology of irradiated and cycled enamel. However, it was not as effective in preserving the mechanical properties of enamel. Radiotherapy altered the enamel's elastic modulus and its chemical composition.

Response surface methodology (RSM) combined with a Box-Behnken design (BBD) was used to optimize the hot-water extraction (HWE) conditions which were determined to be: liquid-solid ratio 29.25:1 mL/g, extraction time 1.66 h, extraction temperature 95 °C, the optimized yield of polysaccharides 0.47 ± 0.01% (n = 3). Hot-water extraction polysaccharides (HWEP) and Microwave-assisted extraction polysaccharides (MAEP) both consist of Rha:Xyl:Ara:Fru:Glu with the molar ratio of 1.05:1.21:3.86:1:3.61:4.5 and 1:1.95:1.72:1.78:4.36:6.18, respectively. Ultrasound-assisted extraction polysaccharides (UAEP) consists of Rha:Xyl:Ara:Fru:Man:Glu with the molar ratio of 1:2.31:5.23:1.05:3.17:4.17:7.89. The molecular weight distribution of HWEP, MAEP and UAEP ranged from 16 kDa to 1698 kDa, 15 kDa to 913 kDa, and 17 kDa to 1118 kDa, respectively. The absorption peaks in FT-IR confirmed the skeletal modes of the pyranose ring in polysaccharides. The second derivative of FT-IR proved difference of polysaccharides obtained from different extraction methods. The antioxidant activity investigations shown all three polysaccharides extracts possess high scavenging activity of DPPH radicals, hydroxyl radical and ABTS+ radical. Polysaccharides from Carex meyeriana Kunth (CMKP) might be potentially used for various practical applications such as medical and food industries, and this paper provides a theoretical basis and reference for further study of CMK., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To evaluate the remineralising effect of the adjunctive application of 38% silver diamine fluoride (SDF) solution and 5% sodium fluoride (NaF) varnish on artificial enamel caries lesions., Methods: Forty-eight demineralised enamel specimens were allocated into four groups. Group 1 received 38% SDF and 5% NaF; Group 2 received 38% SDF; Group 3 received 5% NaF; and Group 4 received deionized water. After pH cycling, the surface morphology and fluoride content of the specimens were studied via scanning electron microscopy (SEM)/energy dispersive spectroscopy (EDS). The lesion depth and crystal characteristics were assessed using micro-computed tomography and X-ray diffraction (XRD) respectively. The crystallization reaction was performed by incubating hydroxyapatite powder with NaF or SDF for 48h. The precipitates were studied via transmission electron microscopy (TEM) and X-ray photoelectron spectroscopy (XPS)., Results: SEM demonstrated the destruction of the enamel surface in Group 4. EDS revealed that the mean fluoride weight percentage of Groups 1-4 were 1.28±0.15, 1.33±0.19, 1.03±0.09 and 0.87±0.04 respectively. The mean lesion depths of Groups 1-4 were 129±14μm, 131±16μm, 153±10μm and 181±21μm respectively. The addition of NaF to SDF did not reduce the lesion depths (p=0.779). XRD revealed that silver chloride formed as a main product in Groups 1 and 2. Meanwhile, TEM analysis indicated that silver nanoparticles were incorporated into hydroxyapatite crystal in SDF-treated hydroxyapatite. XPS spectra suggested that the chemical state of the silver was metallic., Significance: The adjunctive application of SDF and NaF varnish had a similar remineralising effect to that of SDF on enamel caries., (Copyright © 2018 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.)

The purpose of this study was to evaluate the effect of fluoride mouthrinses on dentin bonding performance of a two-step selfetch adhesive; Clearfil SE Bond. Bovine root dentin surface was treated with either 450, 900, or 9,000 ppm F solutions for 30 s (immediate), and continually treated for one month (one month) before the bonding procedures. Microtensile bond strength (µTBS) test and scanning electron microscopic (SEM) observation of the acid-base resistance zone (ABRZ) were performed. Chemical state of fluorine on dentin surface was analyzed by X-ray absorption fine structure (XAFS). The 450 and 900 ppm F fluoride mouthrinses did not influence the µTBS to dentin, while the 9,000 ppm F fluoride solution adversely affected the µTBSs. The fluoride application to dentin significantly enhanced acid resistance at the adhesive/dentin interface including the ABRZ. The XAFS analysis indicated different concentrations of fluoride might create different chemical compounds on the dentin surface, influencing the µTBS results.

This study evaluated bonding of adhesives to dentin treated with silver diammine fluoride (SDF). Micro-shear bond strength (MSBS) to sound human dentin was investigated for 3 adhesive systems: Clearfil SE bond 2 (CSE), and Scotchbond Universal in self-etching (SBU) and phosphoric acid-etching (SBT) modes, following 4 different SDF application protocols (n=10); Control: treated with deionized water. P1: SDF applied for 10-s, no rinse. P2: SDF applied for 10-s, rinsed off after 1-min. P3: superficial dentin polished off after 24-h following P1. MSBS data were obtained after 24-h water storage at 37°C. SDF significantly affected MSBS to dentin depending on the SDF protocol and adhesive system. Rinsing SDF off improved bond strength but superficial refreshing of SDFtreated dentin prior to bonding showed the highest bond strength. The two-step self-etch adhesive (CSE) and the universal adhesive in acid-etching mode (SBT) showed better performance than universal adhesive (SBU) alone on SDF treated dentin.

Objectives:: The objective of this in vitro study was to quantify the amount of mineral change in demineralized dentin at pH 5.5 after the application of dental varnishes containing fluoride with casein phosphopeptide-amorphous calcium phosphate, fluoride and bioglass, or fluoride alone., Methods and Materials:: A total of 12 extracted human sound mandibular premolar root samples were coated with an acid-resistant varnish, leaving a 2 × 3 mm window at the outer root surface. These root specimens were then randomly divided into four groups and separately subjected to the demineralizing cycle at a pH of 4.8 for five days to create artificial caries-like lesions in dentin. Subsequently, each sample was imaged using quantitative x-ray microtomography (XMT) at a 15-μm voxel size. Each test group then received one of the following treatments: dental varnish containing casein phosphopeptide-amorphous calcium phosphate and fluoride (CPP-ACP, MI varnish, GC Europe), bioglass and fluoride (BGA, Experimental, Dentsply Sirona), or fluoride alone (NUPRO, Dentsply Sirona), as well as a control group, which received no treatment. These samples were kept in deionized water for 12 hours. The thin layer of varnish was then removed. All samples including the nonvarnish group were subjected to the second demineralizing cycle at pH 5.5 for five days. The final XMT imaging was then carried out following the second demineralizing cycle. XMT scan was also carried out to varnish samples at 25 μm voxel size. The change in mineral concentration in the demineralized teeth was assessed using both qualitative and quantitative image analysis., Results:: There was an increase in radiopacity in the subtracted images of all varnish groups; a significant increase in mineral content, 12% for the CPP-ACP and fluoride ( p≤0.05 and p≤0.001), 25% BGA ( p≤0.001), and 104% fluoride alone varnish ( p≤0.001). There was an increase in the size of radiolucency in the lesion area with a significant decrease in mineral content in the nonvarnish group, 10% ( p≤0.05 and p≤0.001)., Conclusions:: There was encouraging evidence of a remineralization effect following the application of dental varnish on dentin and also an observed resistance to demineralization during the acidic challenge in all cases. However, a dental varnish containing fluoride alone appeared to have a much greater effect on dentin remineralization when compared with CPP-ACP with fluoride and bioglass with fluoride.

Purpose: The study objectives were to investigate the effect of silver diamine fluoride (SDF) on the microtensile bond strength between glass ionomer cement and carious primary dentin and evaluate the mode of restoration failure. Methods: Forty carious primary molars were sectioned in half through the middle of the carious lesion and randomly allocated to test and control groups. The test specimens were treated with 38 percent SDF, and the control, deionized water. The samples were stored in artificial saliva for 14 days at 37 degrees Celsius, and the dentin surfaces were conditioned and restored with Fuji IX GP Extra. After 24 hours in artificial saliva, the specimens were prepared for microtensile bond strength testing and stressed in tension at one mm per minute until failure. Mean bond strengths were compared using the paired t test. The failure mode was assessed with a stereomicroscope under 40X magnification. Results: The mean microtensile strength for the test group was 7.4 MPa (SD=±5.1) and 6.3 (±4.6) for the control group (P>0.05). Most common failure mode was the mixed failure mode in both groups. Conclusion: Silver diamine fluoride does not adversely affect the bond strength between glass ionomer cement and carious primary dentin in vitro.

Objective: This in situ study evaluated the effect of the association of low-F (4500μg F/g) gel containing TMP and FT (1100μg F/g) on enamel demineralization., Methods: This crossover and double-blind study consisted of five phases of seven days each. Volunteers (n=12) wore palatal appliances containing four enamel blocks. The cariogenic challenge was performed with 30% sucrose solution (six times/day). Treatments were: placebo toothpaste (PT, no fluoride/TMP); 1100μg F/g toothpaste (FT); FT+4500μg F/g+5%TMP gel (FT+TMP gel); FT+9000μg F/g gel (FT+9000 gel) and FT+12,300μg F/g (FT+Acid gel). After topical application of treatments for one min, two blocks were removed for analysis of loosely bound fluoride (CaF 2 ), calcium (Ca), phosphorus (P) and firmly bound fluoride (FA) formed in enamel. After the seven-day experimental periods, the percentage of surface hardness loss (%SH), integrated subsurface hardness loss (ΔKHN), CaF 2 , Ca, P and FA retained were determined. Moreover, the biofilms formed on the blocks were analyzed for F, Ca, P and insoluble extracellular polysaccharide (EPS) concentrations., Results: FT+TMP gel promoted the lowest%SH and ΔKHN (p<0.001). The highest concentration of CaF 2 formed was observed for the FT+Acid gel (p<0.001), followed by FT+9000 gel > FT+TMP gel > FT > PT. CaF 2 retained on the blocks was reduced across all groups (p<0.001). Similar values were observed for the Ca/P/F and EPS in enamel and biofilm for all fluoride groups., Conclusion: The association of FT+TMP gel significantly reduced enamel demineralization in situ., Clinical Significance: The association of treatments may be an alternative for patients with high caries risk., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: To compare the effect of TiF 4 and NaF varnishes on demineralized bovine enamel under different cariogenic activities in situ., Methods: Twenty subjects participated of this in situ study with 3 crossover phases (14days each), in which they wore palatal appliances containing demineralized bovine enamel samples (8 samples/appliance for phase) treated with TiF 4 , NaF (all with 2.45% F) or placebo varnish. The samples were subjected to different cariogenic conditions (1. absence of biofilm accumulation and sucrose exposure; 2. presence of biofilm and absence of sucrose exposure; 3. presence of biofilm and 20% sucrose exposure 4×/day; 4. presence of biofilm and 20% sucrose exposure 8×/day). All were exposed to fluoride dentifrice (2×/day). The mineral content and lesion depth were evaluated using transverse microradiography (TMR) and the data were subjected to RM two-way ANOVA/Bonferroni tests (p<0.05)., Results: TiF 4 varnish significantly increased the remineralization of artificial carious lesions compared to placebo, regardless of the cariogenic activity. On the other hand, the remineralizing effect of NaF varnish was dependent on the cariogenic activity. For NaF, remineralization happened only in conditions 1 and 3 compared to placebo varnish (p<0.0001). NaF was unable to prevent further demineralization under biofilm accumulation and sucrose exposure 8×/day (condition 4). In the absence of fluoride treatment, demineralization happened in all conditions, except in the condition 1., Conclusion: Therefore, 4% TiF 4 varnish was the only treatment able to improve enamel remineralization regardless of the cariogenic activity, while NaF varnish failed in preventing further demineralization under high cariogenic activity in situ., Clinical Significance: 4% TiF 4 varnish showed better remineralizing effect compared to NaF varnish, which was seen regardless of the cariogenic activity. This is a promising finding to support the indication of TiF 4 in the clinic., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The aim of this in vitro study was to evaluate enamel microhardness following bleaching treatments using either high- or low-concentration hydrogen peroxide (HP) agents containing calcium and/or fluoride. Sixty enamel blocks were bleached with 1 of 6 different bleaching agents (n = 10). The high-concentration HP agents were Whiteness HP Maxx (35% HP), Whiteness HP Blue (35% HP, 2% calcium gluconate), Pola Office+ (37.5% HP, 5% potassium nitrate), and Opalescence Boost (38% HP, 1.1% fluoride ion, 3% potassium nitrate). The low-concentration HP agents evaluated were Pola Day (9.5% HP) and White Class (10% HP, potassium nitrate, calcium, fluoride). High-concentration agents were applied in 3 sessions, whereas low-concentration agents were applied for 14 days. Knoop microhardness measurements were taken on the surface of the enamel before bleaching, at various timepoints during bleaching, and 14 days after the final bleaching treatment. The 2-way analysis of variance test showed that microhardness values were significantly influenced by the bleaching agent (P < 0.001) and application time (P < 0.001). The Tukey test showed that enamel bleached with Whiteness HP Maxx or White Class presented lower microhardness values than did the enamel treated with the remaining products. There was a reduction in micro-hardness values up to the end of the treatment. The results showed that the composition, concentration, and application protocol for each bleaching agent influenced the enamel microhardness values in that the microhardness decreased over time, regardless of the agent used or the addition of calcium and/or fluoride., Competing Interests: Disclaimer: The authors have no financial, economic, commercial, or professional interests related to topics presented in the manuscript.

Objective: Most of the commercially available fluoride varnishes (FV) have not been evaluated for their cariostatic properties. Consequently, the aim of this in vivo study was to investigate intra-oral fluoride retention and clearance patterns from three different FV., Methods: Eighteen subjects (7-11 years) participated in a laboratory analyst-blinded, randomized, crossover study comparing the ability of 5% sodium fluoride varnishes (CavityShield-CS, Enamel Pro-EP, Vanish-V) to enhance fluoride concentrations in biofilm fluid, centrifuged and whole saliva over a period of 48h after a single FV application., Results: Similar fluoride concentration×time patterns were noted for all investigated FV and studied variables, with the highest fluoride concentrations observed for the first biological sample collected after FV application (30min). Mean±SE (area under fluoride clearance curve) values were (μg F/g or ml×min): biofilm fluid - CS (472±191), EP (423±75),V (1264±279); centrifuged saliva - CS (42±7), EP (19±3),V (41±8); whole saliva - CS (68±11), EP (64±10),V (60±7).V delivered more fluoride to biofilm fluid than CS (p=0.0116) and EP (p=0.0065), which did not differ (p=0.27). For centrifuged saliva, CS and V were not significantly different (p=0.86), but resulted in higher fluoride retention than EP (p<0.0008). No significant differences among FV were observed for whole saliva (p=0.79)., Conclusion: The present study has shown that FV vary in their ability to deliver fluoride intra-orally potentially related to formulation differences. To what extent the present findings relate to clinical efficacy remains, however, to be determined., Clinical Significance: Clinical research that investigates fluoride release patterns into saliva and biofilm fluid from different FV products is insufficient. More research is needed to investigate different FV formulations for their efficacy in order to help clinicians make better evidence based treatment choices., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Aim: The aim of the present study was to evaluate the effect of two fluoride varnishes on color stability of three resin-based restorative materials., Methods: Fifty-four discs (14.5 × 1.7 mm) were fabricated from A2 and A3 shades of a compomer (F2000), a flowable composite (Z350), and a hybrid composite (Z250), and incubated at 37°C for 48 h. Dura Shield (colored) and Fluor Protector (colorless) fluoride varnishes were applied onto the discs. The coating was cleaned using a low-speed handpiece and nylon bristle brush after 24 h of storage in distilled water. A second coating was then applied. A control group with no coating was immersed in distilled water and used. The CIE L*a*b* color scale was measured before the treatments and following each cleaning utilizing a spectrophotometer., Results: The colored fluoride varnish exhibited the highest overall color change (∆E) after the first and the second cleaning procedures in all the materials. Among these, the greatest color change was observed in the A3 shade of F2000, followed by the A3 shade of Z-250. The ∆E was less than 3.3 in all groups, and was therefore clinically acceptable., Conclusion: Color changes following the application of fluoride varnishes were found to be clinically acceptable in all groups., (© 2015 Wiley Publishing Asia Pty Ltd.)

Aims: The aim of the present study was to evaluate and compare the sealing ability of root canal obturation after the application of fluoride varnish (MI Varnish) containing 5% sodium fluoride and casein phosphopeptide-amorphous calcium phosphate, fluoride varnish, and AH Plus and AH-Plus as root canal sealer by bacterial penetration test., Materials and Methods: Root canals of 65 single-rooted and single-canalled teeth were prepared. They were divided into three experimental groups (n = 15) and two control groups (n = 10). The root canal walls in Group I were coated with AH Plus, Group II were coated with AH Plus and fluoride varnish, and Group III were coated with fluoride varnish. All the teeth were obturated with gutta-percha using the lateral condensation technique. Enterococcus faecalis were used as test bacteria to determine the leakage during 100 days., Statistical Analysis: The data were analyzed using log-rank test and Kaplan-Meier survival analysis., Results: Group III showed significantly less bacterial penetration as compared to Group I (P = 0.01) and Group II (P = 0.03). However, there was no statistical significance between Groups I and II (P = 0.672)., Conclusions: It can be concluded from the present study that fluoride varnish can be used as a root canal sealer. However, further in vitro and in vivo studies are required.

Soil water repellency (SWR) markers are defined as hydrophobic compounds in soil causing SWR and are mainly derived from plants. Previous studies have shown the types and abundance of SWR-markers in soils. However, how these SWR-markers are exactly related to SWR and their origin is poorly understood. This study aims to understand the relationship between SWR-markers, vegetation type and cover and SWR for a simple sandy soil ecosystem, consisting of oaks with sedge and six grass species. All the soil (at different depth) and vegetation samples were collected in the field along a 6m transect, starting from an oak tree. Further along the transect grasses and sedges became more abundant. Free and ester-bound lipids from soils and plant leaves/roots were obtained using a sequential extraction method and identified by gas chromatography-mass spectrometry. Significant linear correlations were found between the main soil characteristics, such as total organic carbon content, and SWR. Single long-chain (>C20) SWR-markers derived from both plant leaf waxes and roots positively related to SWR. Both ester-bound ω-hydroxy fatty acids and C22 and C24 α,ω-dicarboxylic acids were predominantly present in the grass roots, but to a lesser extent in the roots of oak and sedge. These suberin-derived ω-hydroxy fatty acids and α,ω-dicarboxylic acids characteristic of roots could well predict the SWR. Additionally, the SWR predictors abundantly present in the soils matched well with high concentrations of the corresponding biomarkers in the dominant vegetation species that covered the soils. Our analyses demonstrated that grass roots influenced SWR more due to their more substantial contribution of organic matter to the topsoils than oak roots. This led to a stronger SWR of the soils covered with grass than those covered with oak vegetation., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: The aim of this study was to evaluate the ability of calcium phosphate and fluoride containing varnishes to inhibit enamel demineralization., Methods: Six varnishes were selected for analysis: (1) Enamel Pro containing amorphous calcium phosphate; (2) Clinpro White containing functionalized tricalcium phosphate (fTCP); (3) MI Varnish containing casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP); (4) Duraphat (first no added calcium control); (5) Profluorid (second no added calcium control); and (6) placebo (no added calcium or fluoride control). Human enamel slabs (36) were each cut into half-slabs and covered with one of the six dental varnishes to create a window. The half-slabs were then individually immersed in a polyacrylate demineralization buffer pH 4.8 for four days at 37 °C with a change of solution each day. Mineral content was determined using transverse microradiography., Results: All fluoride-containing varnishes significantly inhibited enamel demineralization when compared with the placebo varnish. However, out of the calcium phosphate and fluoride containing varnishes only MI Varnish, containing fluoride and CPP-ACP was superior to the fluoride-alone varnishes. MI Varnish also released the highest levels of calcium, phosphate and fluoride ions., Conclusions: MI Varnish containing fluoride and CPP-ACP was superior to the other varnishes in protecting against enamel demineralization., (© 2015 Australian Dental Association.)

Objective: The aim of this study was to evaluate the efficacy of CPP-ACP containing fluoride varnish for remineralizing white spot lesions (WSLs) with four different quantitative methods., Material and Methods: Four windows (3x3 mm) were created on the enamel surfaces of bovine incisor teeth. A control window was covered with nail varnish, and WSLs were created on the other windows (after demineralization, first week and fourth week) in acidified gel system. The test material (MI Varnish) was applied on the demineralized areas, and the treated enamel samples were stored in artificial saliva. At the fourth week, the enamel surfaces were tested by surface microhardness (SMH), quantitative light-induced fluorescence-digital (QLF-D), energy-dispersive spectroscopy (EDS) and laser fluorescence (LF pen). The data were statistically analyzed (α=0.05)., Results: While the LF pen measurements showed significant differences at baseline, after demineralization, and after the one-week remineralization period (p<0.05), the difference between the 1- and 4-week was not significant (p>0.05). With regards to the SMH and QLF-D analyses, statistically significant differences were found among all the phases (p<0.05). After the 1- and 4-week treatment periods, the calcium (Ca) and phosphate (P) concentrations and Ca/P ratio were higher compared to those of the demineralization surfaces (p<0.05)., Conclusion: CPP-ACP containing fluoride varnish provides remineralization of WSLs after a single application and seems suitable for clinical use.

Aim: This in vitro study analyzed the antierosive potential of a high-fluoride dentifrice on enamel adjacent to restorations., Methods and Materials: Enamel blocks (6 × 6 × 3 mm) from bovine incisor teeth were restored with three different restorative materials (resin, conventional glass ionomer cement, and resin-modified glass ionomer cement) and treated with dentifrices containing 0, 1100, or 5000 ppm F. After restorative procedures, initial surface Vickers hardness of the blocks were obtained. The specimens were submitted to pH cycles (4 × 90 seconds in soft drink) and treatments for five days. Between the challenges and overnight, the blocks remained in artificial saliva. At the end of the experiment, the final hardness was assessed and the percentage of surface mineral loss (%SML) was calculated. A 3 × 3 factorial design was used to conduct statistical analysis. Data were analyzed by analysis of variance and t-test, with significance level fixed at 5%., Results: High-fluoride dentifrice decreased demineralization caused by erosive challenge regardless of the restorative material used (p<0.001). Likewise, the blocks restored with conventional glass ionomer cement showed lower values of SML irrespective of dentifrice used (p<0.001)., Conclusion: Use of a high-fluoride dentifrice on teeth restored with conventional glass ionomer cement offers additional protection against enamel erosion.

Calcium fluoride-like materials ("CaF2") formed on dental surfaces after professional fluoride application are unstable in the oral environment but can be retained longer with a daily NaF mouthrinse. We tested the effect of twice daily 0.05% NaF rinses on the retention of "CaF2" formed on enamel and dentine after applying acidulated phosphate fluoride (APF). "CaF2" formed on enamel/dentine by APF application significantly decreased after exposure to artificial saliva and the 0.05% NaF rinse was ineffective to avoid this reduction. These findings suggest that the combination of APF and 0.05% NaF is not clinically relevant, either for caries or dental hypersensitivity.

Objective: To compare the effects of different treatment methods used for the enamel damage, on the shear bond strength (SBS) and fracture mode of orthodontic brackets., Materials and Methods: Freshly-extracted 140 premolars were randomly allocated to seven groups: Group I was considered as the control of other groups. The remaining groups were exposed to demineralization. In group II, brackets were directly bonded to the demineralized enamel surface. CPP-ACP paste (GC Tooth Mousse), fluoride varnish (Bifluorid 12), microabrasion with a mixture prepared with 18% hydrochloric acid and fine pumice powder, microabrasion with an agent (Opalustre) and resin infiltrant (Icon®) were applied in Groups III, IV, V, VI and VII, respectively. The specimens were tested for SBS and bond failures were scored according to the Adhesive Remnant Index (ARI). Analysis of variance and Tukey tests were used to compare the SBS of the groups. ARI scores were compared with G-test. The statistical significance was set at p < 0.05 level., Results: Statistically significant differences were found among seven groups (F = 191.697; p < 0.001). The SBSs of groups I (mean = 18.8 ± 2.0 MPa) and VII (mean = 19.1 ± 1.4 MPa) were significantly higher than the other groups. No statistically significant difference was found between groups IV (mean = 11.5 ± 1.2 MPa) and V (mean = 12.6 ± 1.5 MPa). The differences in ARI scores of the groups were statistically significant (p < 0.01)., Conclusions: All demineralization treatment methods improve bonding to demineralized enamel. Resin infiltrant application after demineralization showed similar bond strength values as intact enamel.

Objective: This in vitro study assessed the anti-erosive effect of experimental mouthrinses containing TiF4 and NaF on dentin erosive loss., Material and Methods: Bovine dentin specimens were randomly allocated into the groups (n=15): (1) SnCl2/NaF/AmF (Erosion Protection/GABA, pH 4.5, positive control); (2) experimental solution with 0.0815% TiF4(pH 2.5); (3) 0.105% NaF (pH 4.5); 4) 0.042% NaF+0.049% TiF4 (pH 4.4); (5) 0.063% NaF+0.036% TiF4 (pH 4.5); (6) no treatment (negative control). Each specimen was cyclically demineralized (Sprite Zero, pH 2.6, 4x90 s/day) and exposed to artificial saliva between the erosive challenges for 7 days. The treatment with the fluoride solutions was done 2x60 s/day, immediately after the first and the last erosive challenges of the day. Dentin erosive loss was measured by profilometry (μm). The data were analyzed using Kruskal Wallis/Dunn tests (p<0.05)., Results: Mouthrinses containing TiF4or Sn/F were able to show some protective effect against dentin erosive loss compared to negative control. The best anti-erosive effect was found for experimental solution containing 0.0815% TiF4 (100% reduction in dentin loss), followed by 0.042% NaF+0.049% TiF4 (58.3%), SnCl2/NaF/AmF (52%) and 0.063% NaF+0.036% TiF4 (40%). NaF solution (13.3%) did not significantly differ from control., Conclusion: The daily application of experimental mouthrinse containing TiF4 and NaF has the ability to reduce dentin erosion, as well as Erosion Protection and TiF4 alone.

Objective: This study evaluated the effect of fluoride gels, supplemented or not with sodium hexametaphosphate (HMP), on enamel erosive wear in situ., Methods: Twelve healthy volunteers wore palatal appliances containing four bovine enamel discs. Subjects were randomly allocated into four experimental phases (double-blind, crossover protocol) according to the gels: Placebo (no fluoride or HMP), 1% NaF, 2% NaF, and 1% NaF+9% HMP. Enamel discs were selected after polishing and surface hardness analysis, and treated only once with the respective gels prior to each experimental phase. Erosion (ERO) was performed by extra-oral immersion of the appliance in 0.05M citric acid, pH 3.2 (four times/day, five minutes each, 5 days). Additional abrasion (ERO+ABR) was produced on only two discs by toothbrushing with fluoridated dentifrice after ERO (four times/day, 30s, 5 days). The specimens were submitted to profilometry and hardness analysis. The results were analyzed by two-way ANOVA and the Student-Newman-Keuls test (p<0.05)., Results: The 1% NaF+9% HMP gel promoted significantly lower enamel wear for ERO compared to the other groups, being statistically lower than 1% NaF and Placebo for ERO+ABR. Similarly, the lowest values of integrated lesion area were found for 1% NaF+9% HMP and 2% NaF, respectively, for ERO and ERO+ABR., Conclusion: The addition of HMP to the 1% NaF gel promoted greater protective effect against ERO and ERO+ABR compared to the 1% NaF gel, achieving similar protective levels to those seen for the 2% NaF gel., Clinical Significance: Gel containing 1% NaF+9% HMP showed a high anti-erosive potential, being a safer alternative when compared to a conventional 2% NaF gel., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objectives: Calcium glycerophosphate (CaGP) was added to fluoride varnishes to analyze their preventive effect on initial enamel erosion and fluoride uptake: potassium hydroxide (KOH)-soluble and KOH-insoluble fluoride bound to enamel., Materials and Methods: This study was carried out in two parts. Part 1: 108 enamel samples were randomly distributed into six varnish groups: base varnish (no active ingredients); Duraphat® (2.26%NaF); Duofluorid® (5.63%NaF/CaF2); experimental varnish 1 (1%CaGP/5.63 NaF/CaF2); experimental varnish 2 (5%CaGP/5.63%NaF/CaF2); and no varnish. Cyclic demineralization (90 s; citric acid, pH = 3.6) and remineralization (4 h) was made once a day, for 3 days. Change in surface microhardness (SMH) was measured. Part 2: 60 enamel samples were cut in half and received no varnish (control) or a layer of varnish: Duraphat®, Duofluorid®, experimental varnishes 1 and 2. Then, KOH-soluble and KOH-insoluble fluoride were analyzed using an electrode., Results: After cyclic demineralization, SMH decreased in all samples, but Duraphat® caused less hardness loss. No difference was observed between varnishes containing CaGP and the other varnishes. Similar amounts of KOH-soluble and insoluble fluoride was found in experimental varnish 1 and Duofluorid®, while lower values were found for experimental varnish 2 and Duraphat®., Conclusion: The addition of CaGP to fluoride varnishes did not increase fluoride bound to enamel and did not enhance their protection against initial enamel erosion., Clinical Relevance: We observe that the fluoride varnishes containing CaGP do not promote greater amounts of fluoride bound to enamel and that fluoride bound to enamel may not be closely related to erosion prevention.

Aim: The present study examined the effect of topical fluoride treatment on the shear bond strength (SBS) of orthodontic brackets using single-dose fluoride varnishes and assessed according to different post-application times and the pattern of debond., Methods: Of the 105 extracted human mandibular premolars used in the study, 70 were subjected to the SBS test and the remaining 35 to the Adhesive Remnant Index (ARI) test. The teeth were divided into a control group and six test groups: Kolorz ClearShield 5% NaFl varnish Day 1, 8, and 15; and Vanish 5% NaFl varnish Day 1, 8, and 15. The samples were coated with their respective varnish, following which, brackets were bonded. Each specimen was subjected to a shear force in a universal testing machine until failure. Data were analysed using the analysis of variance (ANOVA)., Results: At all time intervals, the mean SBS of the Vanish groups was not significantly different from the control group, and the shear strength in the ClearShield groups was significantly higher than the control and Vanish groups, except at Day 8 (no difference). For the same bonding material, there was no significant difference in mean SBS over different time intervals. ARI scores showed no significant difference between the groups., Conclusion: The application of single-dose fluoride varnish, irrespective of the length of time between the fluoride treatment and bonding procedure, does not negatively affect the shear bond strength of orthodontic brackets.

Dentin hypersensitivity is treated using materials that occlude the dentinal tubules or release potassium ions that induce nerve desensitization. In this study we formulated a novel varnish containing potassium chloride and fluoridated hydroxyapatite and evaluated its physical properties and cytotoxicity. Potassium ion release from the varnish was measured. Dentin permeability was evaluated by measuring the hydraulic conductance of etched dentin discs treated with the varnish. The direct contact test and MTT assay were performed to evaluate the varnish's cytotoxicity. We found that the varnish released potassium ions over 6 h, and demonstrated a statistically higher reduction in dentin permeability compared to commercial fluoride varnish or control. Dentin disc scanning electron microscopy images demonstrated occluded dentinal tubules in the novel varnish group after brushing. The cytotoxicity tests indicated the varnish was biocompatible with gingival and pulpal fibroblasts. We propose the novel varnish is a potential material for use in hypersensitivity management.

The aim of this study was to evaluate and compare the effects of resin infiltration and sealant type on enamel surface properties and Streptococcus mutans adhesion to artificial enamel lesions. Artificial enamel lesions were produced on the surfaces of 120 enamel specimens, which were divided into two groups: Group A and Group B (n=60 per group). Each group was further divided into four subgroups (n=15 per subgroup) according to sealant type: Group I-Demineralized enamel (control); Group II-Enamel Pro Varnish; Group III-ExciTE F; and Group IV-Icon. In Group A, hardness and surface roughness were evaluated; in Group B, bacterial adhesion was evaluated. Icon application resulted in significantly lower surface roughness and higher hardness than the other subgroups in Group A. In Group B, Enamel Pro Varnish resulted in lowest bacterial adhesion, followed by Icon. This study showed that resin infiltration of enamel lesions could arrest lesion progress.

The aims of this study were (1) to assess the amount of fluoride (F) released from varnishes containing calcium glycerophosphate (CaGP) and (2) to assess the effect of the experimental varnishes on in vitro demineralization. Six test groups using 5 varnishes: base varnish (no active ingredients); Duraphat® (2.26% NaF); Duofluorid® (5.63% NaF/CaF2); experimental varnish 1 (1% CaGP/5.63% NaF/CaF2); experimental varnish 2 (5% CaGP/5.63% NaF/CaF2); and no varnish were set up. In stage 1, 60 acrylic blocks were randomly distributed into 6 groups (n = 10). Then 300 µg of each varnish was applied to each block. The blocks were immersed in deionized water, which was changed after 1, 8, 12, 24, 48 and 72 hours. Fluoride concentration in the water was analyzed using a fluoride electrode. In stage 2, 60 bovine enamel samples were distributed into 6 groups (n = 10), and treated with 300 µg of the respective varnish. After 6 h the varnish was removed and the samples were subjected to a 7-day in vitro pH cycle (6 h demineralization/18 h remineralization per day). The demineralization was measured using surface hardness. The results showed that both experimental varnishes released more fluoride than Duofluorid® and Duraphat® (p < 0.05), but Duraphat® showed the best preventive effect by decreasing enamel hardness loss (p < 0.05). Therefore, we conclude that even though (1) the experimental varnishes containing CaGP released greater amounts of F, (2) they did not increase in the preventive effect against enamel demineralization.

The aim of this study was to analyze fluoride stability in dentifrices stored during nine months in schools from Careiro da Várzea, State of Amazonas, Brazil. Analysis of total fluoride concentration, total soluble fluoride, and ionic fluoride in the dentifrice samples was performed in four different time periods: at the time of purchase (baseline); after three months, after six months, and after nine months of storage. Fluoride concentration was determined using a specific electrode (Orion 96-09) connected to an ion analyzer (Orion A-720) and calibrated with fluoride standard solutions containing 2.0 to 32.0 ppm F. The results obtained during the measurements were analyzed by analysis of variance (one-way ANOVA), followed by Tukey's test for comparison of the means. After nine months of storage, total soluble fluoride, the active form of fluoride, decreased by 21.9%. As total soluble fluoride was below the minimum required for anticaries efficacy (1,000 ppm F) in the fourth analysis, it may be concluded that anticaries potential decreased with storage time.

Purpose: Fluoride uptake of enamel after application of fluoride varnishes was compared with fluoride release into artificial saliva. The hypothesis was that fluoride uptake is higher for products exhibiting faster fluoride release., Materials and Methods: Fluoride varnishes, i.e. Fluor Protector S, Duraphat, MI Varnish, Clinpro White Varnish, Profluorid Varnish and Enamel Pro Varnish were applied on bovine enamel specimens. Subsequently, specimens were incubated in artificial saliva. After removal of the varnishes, surface bound fluoride was extracted with potassium hydroxide and measured with an ion-selective electrode. Structurally bound fluoride was etched from the same specimens with perchloric acid. Fluoride release of varnish films into artificial saliva was measured for comparison., Results: After 4 h in artificial saliva, the highest total enamel fluoride uptake of 47.9 μg F·cm-² was found with Fluor Protector S, followed by Enamel Pro Varnish with 22.1 μg F·cm-². The other products ranged between 12-16 μg F·cm-². This was several times higher than the negative control. Fluoride uptake did not correlate with release into artificial saliva. During the first 4 h, Duraphat released the lowest and MI Varnish the highest amount of fluoride with 7.7 and 249 μg F·cm-², respectively. The fluoride uptake of these two products was not statistically different., Conclusion: Enamel fluoride uptake cannot be predicted from the fluoride release rate of a product. Hence, based on the results of this study, fluoride release into artificial saliva is no measure for the efficacy of a fluoride varnish.

Objective: The aim was to investigate the in vitro fluoride release from fluoride varnishes under acidic conditions., Study Design: Poly(methyl methacrylate) blocks (Perspex, n=3 per group) were painted with 80 ± 5 mg fluoride varnish (n=10) and placed into artificial saliva for 30 min. Then, blocks were placed into either 1% citric acid (pH 2.27) or 0.3% citric acid (pH 3.75) solutions (n=3 per solution and varnish) for 30 min with the solutions being replaced every 5 min. Saliva and acid solutions were analyzed for fluoride content. Data were analyzed using three-way ANOVA (varnish, solution, time)., Results: The three-way interaction was significant (p>0.0001). Fluoride release and release patterns varied considerably between varnishes. Fluoride release in saliva varied by a factor of more than 10 between varnishes. Some varnishes (CavityShield, Nupro, ProFluorid, Vanish) showed higher fluoride release in saliva than during the first 5 min of acid exposure, whereas other varnishes (Acclean, Enamel-Pro, MI Varnish, Vella) showed the opposite behavior. There was little difference between acidic solutions., Conclusions: Fluoride release from fluoride varnishes varies considerably and also depends on the dissolution medium. Bearing in mind the limitations of laboratory research, the consumption of acidic drinks after fluoride varnish application should be avoided to optimize the benefit/risk ratio.

Unlabelled: Fluoride varnishes play an important role in the prevention of dental caries, promoting the inhibition of demineralization and the increase of remineralization., Objective: This study aimed to analyze the amount of fluoride released into water and artificial saliva from experimental TiF4 and NaF varnishes, with different concentrations, for 12 h., Material and Methods: Fluoride varnishes were applied on acrylic blocks and then immersed in 10 ml of deionized water and artificial saliva in polystyrene bottles. The acrylic blocks were divided in seven groups (n=10): 1.55% TiF4 varnish (0.95% F, pH 1.0); 3.10% TiF4 varnish (1.90% F, pH 1.0); 3.10% and 4% TiF4 varnish (2.45% F, pH 1.0); 2.10% NaF varnish (0.95% F, pH 5.0); 4.20% NaF varnish (1.90% F, pH 5.0); 5.42% NaF varnish (2.45% F, pH 5.0) and control (no treatment, n=5). The fluoride release was analyzed after 1/2, 1, 3, 6, 9 and 12 h of exposure. The analysis was performed using an ion-specific electrode coupled to a potentiometer. Two-way ANOVA and Bonferroni's test were applied for the statistical analysis (p<0.05)., Results: TiF4 varnishes released larger amounts of fluoride than NaF varnishes during the first 1/2 h, regardless of their concentration; 4% TiF4 varnish released more fluoride than NaF varnishes for the first 6 h. The peak of fluoride release occurred at 3 h. There was a better dose-response relationship among the varnishes exposed to water than to artificial saliva., Conclusions: The 3.10% and 4% TiF4 -based varnishes have greater ability to release fluoride into water and artificial saliva compared to NaF varnish; however, more studies must be conducted to elucidate the mechanism of action of TiF4 varnish on tooth surface.

Aim: The aim of the study was to correlate the pH and fluoride ion uptake with surface hardness of composite resin based restorative materials after topical fluoride application., Methodology: Forty disks of each of test materials Composite (Filtek Z350XT, 3M ESPE, St Paul, MN, USA), Resin modified glass ionomer (Vitremer) and Compomer (Dyract AP) were made and ten disks of each material were placed in different test solutions - 1.23% APF gel, Sodium fluoride mouth rinse, 0.9% neutral fluoride and distilled water (Control group). After 36 hours of immersion, specimens were subjected to microhardness testing machine for evaluation of surface hardness., Results: The greater hardness deterioration for all materials resulted with 1.23% APF gel when compared to the control group. Composite (Filtek Z350XT, 3M ESPE, St Paul, MN, USA) showed 17.13 VHN (control group 59.11 VHN). Vitremer showed 9.71 VHN (control group 37.71 VHN). Compomer showed 19.22 VHN (control group 36.78 VHN)., Conclusion: 1.23% ApF gel significantly decreased hardness of composite, Vitremer and Compomer. Hardness deterioration associated with sodium fluoride mouth rinse and 0.9% neutral fluoride was less compared to 1.23% ApF gel.

Background: A range of dental varnishes have been commercialized recently that contain calcium and inorganic phosphate in addition to fluoride. The aim of this study was to analyse the fluoride, calcium and inorganic phosphate ion release from: (1) MI Varnish containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP); (2) Clinpro White containing functionalized tricalcium phosphate (fTCP); (3) Enamel Pro containing amorphous calcium phosphate; (4) Bifluorid 5 containing calcium fluoride; and (5) Duraphat (no added calcium control)., Methods: The varnishes were applied to a standardized surface area of polyvinyl chloride (n = 7 per group) and immersed in 25 g of distilled deionized water which was changed at 1, 4, 24, 72 and 168 hours. The ion release was determined by ion chromatography and expressed as μmol (cumulative) per gram of varnish., Results: All varnishes released measurable fluoride and calcium, however only MI Varnish and Enamel Pro released significant levels of inorganic phosphate. At 24 hours the order of cumulative fluoride release was: 1>3>4>2=5 with 1 significantly higher (p < 0.05) than the rest. At 72 and 168 hours, the cumulative calcium release was: 1>4>3>2=5 with 1 significantly higher (p < 0.05) than the rest., Conclusions: MI Varnish containing CPP-ACP had the highest release of calcium and fluoride ions., (© 2014 Australian Dental Association.)