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Objective: To investigate the effect of daily intake of fluoridated milk on enamel demineralization adjacent to fixed orthodontic brackets assessed with quantitative light-induced fluorescence (QLF)., Materials and Methods: Sixty-four healthy adolescents (13-18 years) undergoing orthodontic treatment with fixed appliances were enrolled and randomly allocated to a randomized controlled trial with two parallel groups. The intervention group was instructed to drink one glass of milk (≈ 200 ml) supplemented with fluoride (5 ppm) once daily and the subjects of the control group to drink the same amount of milk without fluoride. The intervention period was 12 weeks and the end-point was mineral gain or loss in enamel, assessed by QLF on two selected sites from each individual. The attrition rate was 12.5% and 112 sites were included in the final evaluation., Results: There was no statistically significant difference between the groups concerning fluorescence (ΔF) values and lesion area (A mm(2)) at baseline. After 12 weeks, a significant decrease (p < 0.05) in ΔF was registered in the fluoridated milk group and a significant increase in the non-fluoride control group (p < 0.05). The mean reduction in the test group was somewhat lower (14%) than the increase in the control group (18%), but individual variations were evident. Only minor alterations of lesion area were recorded over the 12-week period and no statistically significant differences compared with baseline were found in any of the groups., Conclusion: Daily intake of fluoridated milk may aid remineralization of white spot lesions adjacent to fixed orthodontic appliances.

Objective: The objectives were to bring light on fluoride to control dentin hypersensitivity (DHS) and prevent root caries., Materials and Methods: Search strategy included papers mainly published in PubMed, Medline from October 2000 to October 2011., Results: Fluoride toothpaste shows a fair effect on sensitive teeth when combined with dentin fluid-obstructing agents such as different metal ions, potassium, and oxalates. Fluoride in solution, gel, and varnish give an instant and long-term relief of dentin and bleaching hypersensitivity. Combined with laser technology, a limited additional positive effect is achieved. Prevention of root caries is favored by toothpaste with 5,000 ppm F and by fluoride rinsing with 0.025-0.1 % F solutions, as the application of fluoride gel or fluoride varnish three to four times a year. Fluoride measures with tablets, chewing gum, toothpick, and flossing may be questioned because of unfavorable cost effectiveness ratio., Conclusion: Most fluoride preparations in combination with dentin fluid obstruction agents are beneficial to reduce DHS. Prevention of root caries is favorable with higher fluoride concentrations in, e.g., toothpaste., Clinical Relevance: Fluoride is an effective agent to control DHS and to prevent root caries particularly when used in higher concentrations.

In this study we investigated the effect of fluoride on plaque acid tolerance. The test group consumed 200 ml of milk supplemented with 5 mg F/l as NaF once a day, the milk control group drank 200 ml of unsupplemented milk, and the no-milk control group did not consume milk in this manner. Plaque samples were taken at baseline and after 15 months. The proportion of acid-tolerant bacteria in plaque was estimated using LIVE/DEAD® BacLight™ staining after exposure to pH 3.5 for 2 h. The fluoride group showed a statistically significant decrease in plaque acid tolerance compared to baseline. This study shows that daily intake of fluoride in milk reduces plaque acid tolerance., (Copyright © 2012 S. Karger AG, Basel.)

Objective: To evaluate the effect of a new formula of a chlorhexidine-thymol varnish on mutans streptococci (MS) colonization and fissure caries development., Methods: The study group consisted of 58 healthy adolescents (12-17 years old) undergoing orthodontic treatment with fixed appliances. A double-blind split-mouth design was applied, and 116 pairs of molar teeth were randomly assigned to topical varnish applications with either the new Cervitec Plus or its predecessor Cervitec. Both varnishes contained 1% CHX and 1% thymol (CHX/T) as active ingredients, but differed with respect to adhesive properties. The varnishes were applied in the fissures at baseline, and then every sixth week throughout the 48-week study period. Endpoints were MS colonization (CRT test) and occlusal laser fluorescence (LF, DIAGNOdent) recordings carried out regularly during follow-up., Results: A significant reduction in the levels of MS in the fissures after the initial treatment was displayed with both varnishes (p < 0.05), and the levels remained consistently suppressed throughout the follow-up period. A non-significant but clear tendency was noted in favor of the new formula after six and 12 weeks, with fewer teeth harboring high counts (> or = 10(5) CFU) of MS (6w:12% vs. 24%, 12w:16% vs. 26%). No new lesions were registered in any subject, and the mean LF recordings did not change significantly over time in the groups., Conclusion: There were no statistically significant differences between the CHX/T varnishes in terms of bacterial growth and caries prevention. For MS suppression, a tendency towards an initially superior effect was displayed with the new formula.

Objective: From a dental care perspective, we analyze whether the prevention of approximal caries by fluoride varnish treatment (FVT) or by fluoride mouth rinsing (FMR) could contain costs in an extended period of follow-up after the end of school-based prevention programs., Material and Methods: It is assumed in a model that, after 3 years of prevention with either FVT or FMR according to published studies, the "natural course" of approximal caries progression would follow for 5 consecutive years, as described in a Swedish longitudinal study. The outcome and costs of FVT, FMR and controls were modelled from years 4 to 8., Results: The FVT program had a better outcome in reducing approximal caries than FMR, and costs were lower. The FVT was expected to result in cost containment compared to controls 3 years after the end of the preventive FVT program. The ratio benefits to costs were 1.8: 1 for FVT and 0.9: 1 for FMR., Conclusions: Prevention of approximal caries by FVT may result in cost containment, at a benefit cost ratio of 1.8: 1, given that the program can be administered at school.

Objectives: To assess levels of fluorosis and fluorosis of esthetic concern in children from a naturally fluoridated and a non-fluoridated area of Sweden, and to determine the relative contributions of fluoridated water, parental educational level, and infant oral health-related behaviors., Methods: A parental questionnaire collected information concerning child F-supplement and F-dentifrice usage histories, and socio-economic status. Photographic examination of 1336 subjects (F=791; N-F=545) was undertaken. Fluorosis was assessed (blind to F-exposure) in a random sample (n=250) of 35 mm slides by four dental and two lay "jurors" (with 10% random repeat-viewing for inter-observer and intra-observer agreement). Four outcomes were assessed on each slide: fluorosis at any level, fluorosis of esthetic concern, acceptability of appearance, and treatment needs. Ordinal logistic regression models were used to determine significant determinants., Results: For presence of fluorosis of esthetic concern, majority jury agreements (>3 of 6) were seen in only 2.3% (N-F) and 13.4% (F) pupils (p<0.001), albeit jurors unanimously scored only 13 F and 2 N-F exposed children as having esthetically unacceptable fluorosed teeth (p<0.001). The over-riding significant factor in terms of fluorosis of esthetic concern was exposure to water fluoridation in infancy in both unadjusted and adjusted models., Conclusions: The important factor in relation to fluorosis of esthetic concern was explained by exposure to fluoridated water in infancy, and was not explained by age, sex, level of parental education or early childhood oral health behaviors. However, prevalence of this condition was relatively low. These findings should inform policies on appropriate total fluoride exposure levels during infancy.

Purpose: To assess the clinical effect of daily use of a toothpaste and mouthrinse, both containing amine fluoride, on primary root caries lesions (PRCL) in an adult caries risk population., Methods: A clinical trial based on male and female subjects, 55-81 years of age, randomly assigned into two equal groups (Groups A and B). Fifty subjects allocated to Group A used a fluoride toothpaste twice a day, (Elmex sensitive toothpaste, 1400 ppm F) plus a mouthrinse twice a day with 10 ml of a fluoride solution (Elmex sensitive rinse containing 250 ppm F). The fluoride used was amine fluoride and potassium fluoride (AmF/KF, 1:1). Subjects in Group B used the same fluoride toothpaste plus a placebo mouth rinse solution without fluoride. At baseline, a total of 420 PRCL were clinically recorded as either soft (score 3) or leathery (score 2). Parallel and blind recordings measuring electric resistance of the selected PRCL were performed at baseline and after 3, 6, 9 and 12 months using an electrical caries monitor (ECM). Prevalence of tooth sensitivity and subject's satisfaction was also measured in the two groups., Results: The clinical results showed statistically significant higher numbers of reversals of soft (score 3) and leathery (score 2) PRCL in Group A compared to Group B. After 12 months, the number of soft PRCL (score 3) decreased in Group A from 74% at baseline to 11% compared with 73% to 46% in Group B. After 12 months, 67% of the PRCL became hard (score 1) in Group A compared to only 7% in Group B (P < 0.001). Statistically significant higher (P < 0.001) ECM mean (sd) log10 resistance values were recorded for the subjects in Group A, 2.67 (2.56) kOhm compared to 2.12 (1.88) kOhm in Group B. Tooth sensitivity was substantially reduced after 12 months, by 56% in Group A compared to 20% in Group B.

Purpose: To investigate and compare the effects of a dental cream containing complexes of casein phosphoprotein-amorphous calcium phosphate (CPP-ACP) and fluoride mouthwashes on the regression of white spot lesions (WSL)., Materials and Methods: The study group consisted of 26 healthy adolescents (mean age 14.6 years) exhibiting 60 teeth with 152 visible WSL sites on incisors and canines immediately after debonding of fixed orthodontic appliances. After bracket removal, professional tooth cleaning and drying, a visual scoring (0-4) and laser fluorescence (LF) readings were carried out. The patients were randomly assigned to two different treatment protocols with the aim of remineralising the lesions: A) daily topical applications of a dental cream containing CPP-ACP (Topacal) for 3 months followed by a 3-month period of daily toothbrushing with fluoridated dentifrice, or B) daily 0.05% sodium fluoride mouthwash combined with fluoridated dentifrice for 6 months. The registrations were repeated after 1, 3, 6 and 12 months and follow-up data were compared with baseline with aid of chi-square and paired t-tests., Results: A significant improvement of the clinical WSL-scores was found over time in both groups, but there was a statistically significant difference (p < 0.01) concerning the number of sites that totally disappeared after 12 months in favour of the CPP-ACP regime, 63% compared with 25% respectively. The clinical registrations were mirrored by a statistically significant decrease (p < 0.05) in the LF readings at the 6- and 12-month follow-ups compared with baseline. No significant differences were displayed between the groups., Conclusions: Clinical scoring and LF assessment suggested that both regimens could promote regression of WSL after debonding of fixed orthodontic appliances. The visual evaluation suggested an aesthetically more favourable outcome of the amorphous calcium phosphate treatments.

Purpose: The aim of the present investigation was to study the effect of daily use of fluoride dentifrices containing various antimicrobial agents on mutans streptococci (MS) in saliva and approximal dental plaque., Materials and Methods: Fifty-nine healthy adolescents, 12-14 years old, undergoing orthodontic treatment with fixed appliances and harbouring high levels of MS in saliva and preferably also in interdental plaque, were randomly distributed into four groups, using dentifrices with: 1) zinc lactate (n = 16), 2) amine fluoride-stannous fluoride (n = 13), 3) triclosan (n = 15), and 4) no antimicrobial agent (control; n = 15). Changes of MS scores versus baseline were determined after 1, 3 and 6 months, using the Dentocult SM Strip mutans test., Results: At the 6-month sampling occasion, the subjects using dentifrice with either amine fluoride-stannous fluoride or triclosan showed a tendency to lower MS scores in interdental plaque (p < 0.05). In saliva and in the 1- and 3-month plaque samples, no changes of MS were detected in any of the four groups., Conclusion: This 6-month clinical study showed that dentifrices with various antimicrobial agents only result in small or no changes of the MS scores in saliva and approximal dental plaque in orthodontic patients.

The aim of this study was to investigate the effect of fluoridated milk on enamel lesion formation as assessed by laser fluorescence (LF). The material consisted of 18 extracted premolar teeth that were cut in mesial-distal direction and pairwise assigned to either test or control samples in an experimental caries model. The teeth were exposed to a low-pH 5% cellulose gel for 4 h, 5 days per week immediately followed by a 4-h period in either fluoridated (5 ppm, test) or nonfluoridated milk (control). In the meantime, the specimens were stored in pooled human-stimulated whole saliva in room temperature. All teeth were examined by visual inspection with a magnifying glass and by LF readings (DIAGNOdent) at baseline and after 2 and 4 weeks. The baseline LF readings ranged from 3 to 7 with a mean value of 5.6+/-0.9. The mean values increased with time in both groups but the increase was more marked in the control teeth, 8.7+/-2.3 vs 12.8+/-3.3 after 4 weeks, this difference being statistically significant (p<0.01). The visual examination could not distinguish between the test or control samples after 2 and 4 weeks, respectively. The findings indicated that fluoride added to milk may to some extent counteract enamel lesion formation as assessed by LF in an experimental caries model.

The aim was to evaluate a 3-year randomised controlled trial of school-based fluoride mouth rinsing (FMR) on approximal caries development in 13- to 16-year-olds with low to moderate caries risk. The adolescents used F toothpaste at home and underwent prophylactic treatment at yearly check-ups at public dental clinics. Out of 788 randomly selected 13-year-olds, 622 completed the trial, carried out in 1999-2003. Supervised by a dental nurse, the subjects rinsed with a 0.2% NaF solution at different intervals. Group 1 rinsed their teeth on the first three schooldays every semester; group 2 on the first three and the last three schooldays every semester; group 3 on three consecutive days once a month during semesters; group 4 once every fortnight during semesters, and group 5 (control) did not rinse. Radiographic recording of approximal caries was performed. FMR on the three first and the three last schooldays every semester (group 2) had a prevented fraction of 59%, with approximal enamel lesions as a diagnostic threshold. Corresponding figures for groups 1, 3 and 4 were 30, 47 and 41%, respectively. The control group differed statistically from groups 2-4 for new enamel and dentin lesions and fillings (p < 0.01). Enamel lesions constituted more than 90% of the new caries lesions. Caries progression was low for all groups and no significant differences were found between groups. The main conclusion from this randomised controlled trial is that school-based FMR, as a supplement to the daily use of F toothpaste, reduces caries incidence on approximal surfaces in adolescents with low to moderate caries risk., (Copyright 2005 S. Karger AG, Basel.)

The aim was to evaluate, in a 3-year RCT study, school-based fluoride varnish programme on approximal caries incidence and approximal caries progression in 13- to 16-year-olds in high, medium and low caries risk areas on the Swedish west coast. Seven hundred and fifty-eight (89%) fulfilled the trial. Using a simple mobile unit, 2 dental nurses treated the adolescents with F varnish: (1) twice a year at 6-month intervals, (2) 3 times a year within 1 week, (3) 8 times per year during the semesters with 1-month intervals, and (4) no treatment (control). Radiographic caries recording was performed blindly by one of the authors. Concerning total approximal caries incidence, control groups in all areas developed more caries than F varnish groups, with the largest difference in the high risk area: 3.05 +/- 3.37 new approximal caries lesions (mean +/- SD) compared to 0.54 +/- 1.26 for group 3, 0.95 +/- 1.67 for group 1 and 1.40 +/- 1.89 for group 2 (p < 0.001). More than 90% of the new approximal lesions in all the groups and in all areas consisted of new enamel lesions. Regarding progression of enamel lesions, there were only significant differences between groups 1-3 and group 4 in the high caries risk area. Prevented fraction for fluoride varnish treatment twice a year at 6-month intervals was 69% in high, 66% in medium and 20% in low risk areas. To conclude, school-based F varnish treatment every 6 months in 13- to 16-year-olds is excellent to prevent approximal caries in medium and high caries risk areas., (Copyright 2005 S. Karger AG, Basel.)

Objectives: To determine the prevalence and severity of dental fluorosis in children aged 7-9 years from non-water-fluoridated Halmstad, Sweden, and to relate the results to their reported fluoride exposure history during infancy., Material and Methods: In Spring 2002, a questionnaire distributed to a cluster random sample of 1039 parents enquired into their child's early oral health behaviors and included a "photographic toothpaste menu". The permanent upper anterior teeth (13-23) were examined clinically (+10% repeats) using a modified Thylstrup-Fejerskov Index., Results: Complete data were available for 53% (n=548) of the sampled children. The prevalence offluorosis at any level was 49% (95% CI: 45-54%), and of fluorosis with esthetic concern (TF score > or =3) 4% (95% CI: 3-6%). Based on repeat observations, reliability was good (kappa = 0.82). There was no statistically significant increased risk of dental fluorosis prevalence associated with any of the fluoride exposure risk factors examined, including reported usage of (1000 ppm) fluoride toothpaste from time of first deciduous tooth eruption., Conclusions: While there were low levels of dental fluorosis of esthetic concern, half the children had some degree of dental fluorosis. The prevalence of dental fluorosis was not explained by the risk factors, including fluoride toothpaste usage as explored in this study.

Aims: To evaluate and compare remineralisation of root caries lesions after in vitro treatment with various fluoride (F) agents using an Electric Caries Monitor (ECM) and Transversal Micro-Radiography (TMR)., Materials: Permanent human teeth were extracted and root surface specimens were sectioned, prepared (n = 35), and randomly allocated into seven different experimental groups (groups 1-7)., Methods: Root surfaces were demineralised in an acidified gel (pH = 5.0) for 3 weeks followed by various F treatments and stored in a standardised remineralising solution at 37 degrees C for 6 weeks. The root surfaces were treated twice daily with different dentifrice slurries for 2 min, either with a neutral placebo dentifrice without F (group 5); or a neutral sodium fluoride (NaF) 1400 p.p.m. F dentifrice (group 1); or a neutral 1250 p.p.m. F dentifrice (group 6); or an acid dentifrice (pH 4.7) with 1400 p.p.m. F containing amine fluoride (AmF) (groups 3 and 4) or a 1250 p.p.m. (pH 4.7) AmF dentifrice (group 6). In groups 1, 2, 5, 6, and 7, the root surfaces were additionally rinsed for 2 min with a neutral non-F placebo solution. In groups 3 and 4, rinsing were performed for 2 min with an acid (pH 4.7) 250 p.p.m. F solution, containing 125 p.p.m. F as AmF and 125 p.p.m. F as potassium fluoride (KF), once or twice per day respectively. ECM was used to measure electrical resistance on root surfaces at baseline and after 3 and 6 weeks respectively. TMR technique was used to measure and compare root surface lesion depths and mineral loss., Results: Six weeks daily treatment with a dentifrice slurry containing AmF followed by rinsing with a combination of equal amounts of AmF and KF solution twice a day showed a statistical significant higher ECM values compared with the other groups. TMR data measuring lesion depths and mineral loss reduction supported the results of the ECM findings., Conclusions: Daily application of a dentifrice slurry containing 1400 p.p.m. F as AmF combined with twice daily rinsing with a 250 p.p.m. F solution containing equal amount of AmF and KF significantly remineralise primary root caries lesions in vitro. ECM and TMR are valuable complementary methods in order to analyse the remineralisation processes.

The aim of this systematic review was to evaluate the caries-preventive effect of combined caries-preventive methods, defined as two or more different interventions in combination, each expected to prevent dental caries. The Medline database was searched for articles published in the period January 1966 to June 2003. Twenty-four controlled studies met the inclusion criteria, and their value as evidence was assessed according to predetermined criteria. The level of evidence for the overall conclusion regarding each method was graded according to the protocol of the Swedish Council on Technology Assessment in Health Care. The scientific evidence for the combination of treatments involving fluoride that had a preventive effect on caries in children and adolescents was graded as moderate. However, for elderly patients the scientific evidence for the caries-preventive effect of different combinations of treatments was found to be incomplete. No conclusion could be drawn regarding the evidence for combinations of treatments being effective for groups at high caries risk, as the results from the identified clinical studies were conflicting.

The aim of this paper was systematically to evaluate the caries-preventive effect of professional fluoride varnish treatments. A search of the literature for articles published between 1966 and August 2003 was carried out in electronic databases, reference lists of articles, and selected textbooks in accordance with the strategy of the Swedish Council on Technology Assessment in Health Care. Out of 302 identified papers, 24 randomized and controlled clinical trials comparing fluoride varnish with placebo, no active treatment or other fluoride preventive regimens of at least 2 years' study duration were included. The trials that met the inclusion criteria were assessed independently and systematically by at least two reviewers and scored from A to C according to predetermined criteria for methodology and performance. The main outcome measure was the preventive fraction expressed as a percentage. The results displayed limited evidence (evidence level 3) for the caries preventive effect of topical applications of fluoride varnishes in permanent teeth. The average prevented fraction was 30% (0-69%) when compared with untreated controls. Inconclusive evidence (evidence level 4) was found for fluoride varnish treatment in the primary dentition and in adults. This systematic review reinforces the need for future dinical research of high quality, incorporating modern concepts of dinical performance and evaluation to assess dental caries control using professional fluoride varnish.

The aim was to evaluate the effect of habitual consumption of fluoridated milk on the composition of the salivary microflora. The study group comprised 20 healthy schoolchildren and young adults with a mean age of 13.6 years and the investigation had a randomized double-blind crossover design with a washout period of 1 month. After professional tooth-cleaning at baseline, the subjects were supplied with either fluoridated (250 mL, 5 ppm F) or non-fluoridated milk for one daily intake during a period of 4 weeks. Salivary samples were collected immediately before tooth-cleaning and after 1, 2, and 4 weeks, respectively. The samples were immediately cultivated for total viable counts, oral streptococci, mutans streptococci, lactobacilli, and actinomyces spp. Bacterial counts were logarithmically transformed before statistical evaluation using ANOVA. No significant alterations of the salivary microflora were found during any of the milk regimens compared with baseline. There was a slight reduction in the proportion of mutans streptococci after 2 and 4 weeks during consumption with fluoridated milk but the difference failed to reach statistical significance. In conclusion, this study was unable to disclose any significant alteration of the composition of the salivary microflora following daily intake of fluoridated milk.

Purpose: Milk can be used as vehicle for fluoride administration. The aim of this study was to investigate the lactic acid formation in dental plaque after daily intake of fluoridated milk., Materials and Methods: The study group consisted of 15 healthy schoolchildren, 6 - 15 years of age, in a double-blind crossover study design. After a one-week fluoride depletion period, 250 ml of fluoridated (5 ppm; total amount 1.25 mg F) standard milk or non-fluoridated control milk was consumed once daily together with an ordinary meal during 3 days of plaque accumulation with no oral hygiene. On the fourth day, plaque samples were collected immediately before a final milk intake and then after 30, 60 and 180 minutes. After a washout period of two weeks, the whole procedure was repeated with the corresponding fluoridated or non-fluoridated milk regimen. All samples were suspended and the sucrose-challenged lactic acid formation rate was determined enzymatically., Results: The results showed a statistically significant (p < 0.05) increase of the lactic acid levels 30 min after the intake of the standard (control) milk while no such elevation was evident after the fluoride-containing milk. No differences were found after 60 and 180 min compared with baseline for any of the milks., Conclusion: The findings suggest that fluoride added to milk may counteract the lactic acid formation that follows a non-fluoridated milk intake.

With a questionnaire addressed to general dental practitioners in Sweden, the Swedish Council on Technology Assessment in Health Care launched a project group in 1999 to systematically review and evaluate the existing literature on various caries preventive methods. The aim of this article was to report findings concerning the caries preventive effect of fluoride toothpastes in various age groups, with special emphasis on fluoride concentration and supervised versus non-supervised brushing. A systematic search in electronic databases for articles published between 1966 and April 2003 was conducted with the inclusion criteria of a randomized or controlled clinical trial, at least 2 years follow-up and caries increment in the permanent (deltaDMFS/T) or primary (deltadmfs/t) dentition as endpoint. Out of 905 articles originally identified, 54 met the inclusion criteria. These studies were assessed independently by at least two reviewers and scored A-C according to predetermined criteria for methodology and performance. The measure of effect was the prevented fraction (PF), expressed as percent. The results revealed strong evidence (level 1) (i) for the caries preventive effect of daily use of fluoride toothpaste compared to placebo in the young permanent dentition (PF 24.9%), (ii) that toothpastes with 1,500 ppm of fluoride had a superior preventive effect compared with standard dentifrices with 1,000 ppm F in the young permanent dentition (PF 9.7%), and (iii) that higher caries reductions were recorded in studies with supervised toothbrushing compared with non-supervised (PF 23.3%). However, incomplete evidence (level 4) was found regarding the effect of fluoride toothpaste in the primary dentition. In conclusion, this review reinforced the importance of daily toothbrushing with fluoridated toothpastes for preventing dental caries, although long-term studies in age groups other than children and adolescents are still lacking.

The objectives of this study were to evaluate systematically the evidence of the caries-preventive effect of fissure sealing of occlusal tooth surfaces and to examine factors potentially modifying the effect. The search strategies included electronic databases, reference lists of articles, and selected textbooks. Inclusion criteria were randomized or quasi-randomized clinical trials or controlled clinical trials comparing fissure sealing with no treatment or another preventive treatment in children up to 14 years of age at the start; the outcome measure was caries increment; the diagnostic criteria had been described; and the follow-up time was at least 2 years. Inclusion decisions were taken and grading of the studies was done independently by two of the authors. The main measure of effect was relative risk reduction. Thirteen studies using resin-based or glass ionomer sealant materials were included in the final analysis. The results showed that most studies were performed during the 1970s and a single application had been utilized. The relative caries risk reduction pooled estimate of resin-based sealants on permanent 1st molars was 33% (relative risk = 0.67; CI = 0.55-0.83). The effect depended on retention of the sealant. In conclusion, the review suggests limited evidence that fissure sealing of 1st permanent molars with resin-based materials has a caries-preventive effect. The evidence is incomplete for permanent 2nd molars, premolars and primary molars and for glass ionomer cements. Overall, there remains a need for further trials of high quality, particularly in child populations with a low and a high caries risk, respectively.

The aim of this study was, systematically, to evaluate the effect of dietary changes in the prevention of dental caries. A search and analysis strategy was followed, as suggested by the Swedish Council on Technology Assessment in Health Care (SBU). The search strategy for articles published in 1966-2003 was performed using electronic databases and reference lists of articles and selected textbooks. Out of 714 articles originally identified, 18 met the inclusion criteria for a randomized or controlled clinical trial--at least 2 years' follow-up and caries increment as a primary endpoint. This included the total or partial substitution of sucrose with sugar substitutes or the addition of protective foods to chewing gum. No study was found evaluating the effect of information designed to reduce sugar intake/frequency as a single preventive measure. It is suggested that the evidence for the use of sorbitol or xylitol in chewing gum, or for the use of invert sugar, is inconclusive. No caries-preventive effect was found from adding calcium phosphate or dicalcium phosphate dihydrate to chewing gums. The review dearly demonstrates the need for well-designed randomized clinical studies with adequate control groups and high compliance.

The aim of the present study was to perform a systematic review of economic evaluations of caries prevention. A search in Medline from 1966 until May 2003 and a manual search in a number of journals identified 154 references, 74 of which were included. There were 17 original studies including an economic evaluation, and these form the basis of the present article. The rest were reviews, model studies and reports concerning economic practice in dentistry. The results show that the reviewed original studies on economic evaluation of caries prevention do not provide support for the economic value of caries prevention. The scarcity of well-conducted studies, as well as contradictory evidence in the reviewed articles, makes it difficult to judge the health-economic effect of the studied caries-prevention methods.

The aim of this study was to evaluate the fluoride concentration in supragingival dental plaque after single and repeated intakes of fluoridated milk. The study group consisted of 22 schoolchildren, young adults and adults of both sexes, 8-41 years of age. After a 2-week fluoride depletion period and 3 days of plaque accumulation, 200 ml of fluoridated milk (1g F) was ingested along with a standardized lunch meal. Plaque samples were collected immediately before the intake and after 30, 120 and 240 min. From the adult participants (n = 9) additional samples were collected after 12 and 18 h. After a fluoride-free washout period of at least 2 weeks, the whole experimental procedure was repeated after 4 consecutive daily intakes of fluoridated milk. The fluoride concentration was determined after micro-diffusion with a fluoride selective electrode. The results showed a statistically significant 3-fold increase of the plaque fluoride levels up to 4 h after the intake. At 12 and 18 h after the intake, the recorded levels went gradually back to baseline. There was no significant difference between the fluoride concentrations in the supragingival plaque after the single intake compared with the repeated intakes. In conclusion, the findings support the suggestion that milk is a suitable vehicle for local fluoride administration into the oral cavity, also when consumed together with a meal.

This study determined fluoride (F) concentrations in whole saliva and dental plaque after intake of fluoridated milk using a randomised crossover experimental design. Eighteen healthy children (6-8 years) were subjected to each of four different 3-day drinking regimens: (a) 200 ml F-free tap water; (b) 200 ml tap water with 1.0 mg F; (c) 200 ml standard milk, and (d) 200 ml standard milk with 1.0 mg F. A washout period of 7 days was organised between the different drinking regimens. All children used F-free toothpaste prior to and during the trial and were instructed to avoid F-rich food and drinks. F concentration in unstimulated whole saliva was determined at baseline and after 15 and 120 min and in plaque samples at baseline and after 2 h. The mean baseline values ranged from 0.01 to 0.02 mg F/l in saliva and between 10.4 and 14.2 mg F/l in dental plaque. A statistically significant (p < 0.05) increase of F was disclosed in saliva 15 min after drinking F-containing milk and water (0.052 and 0.058 mg F/l, respectively). After 2 h, the salivary F(-) concentrations were back to baseline values. In the plaque, however, a statistically significant (p < 0.01) twofold increase was found at 2 h after the intake of fluoridated milk and water, respectively. The results indicate that consumption of fluoridated milk contributes to a F storing process with significantly elevated F concentrations in dental plaque up to 2 h after intake. Further studies are required to determine the 'therapeutic concentration' of F in dental plaque after intake of fluoridated milk., (Copyright 2002 S. Karger AG, Basel)

The aim of this study was to compare the effect of two different dental varnishes on approximal caries incidence in teenagers with proven caries susceptibility during a 3-year period. Two hundred 13- to 14-year-old subjects exhibiting at least two approximal enamel caries lesions were selected to take part in the study. One hundred and eighty subjects participated after informed consent and were randomly assigned to two equally sized groups. One group was treated with a fluoride varnish (FV, Fluor Protector) containing 0.1% F every 3rd month and the participants of the other group were treated in the same mode with a chlorhexidine varnish (CV, Cervitec((R))) containing 1% chlorhexidine and 1% thymol. In total, each subject was treated 12 times during the experimental period. Approximal caries including enamel lesions (DMFS(appr)) were recorded from four bitewing radiographs exposed at the start and end of the study. The mean (+/-SD) caries prevalence at baseline was 2.2+/-3.4 in the FV group and 2.5+/-4.0 in the CV group. After 3 years, the average approximal caries incidence was 2.7+/-3.1 and 3.1+/-3.5 in the FV and CV groups, respectively. The differences at baseline and after 3 years were not statistically significant. In conclusion, treatments every 3rd month with either a fluoride- or a chlorhexidine/thymol-containing varnish showed a promising effect with low approximal caries incidence and progression in teenagers with proven caries susceptibility.

The aim of this study was to evaluate interdental caries incidence and progression in relation to the effect of antibacterial varnish treatments in schoolchildren anticipated at caries risk. After a screening procedure, 110 healthy children (8-10 years) with moderate and high counts of salivary mutans streptococci (MS) were invited to join a 2-year longitudinal study. At baseline, MS were enumerated at all mesial interdental sites of the first permanent molars with a chair-side technique. The children were then treated 3 times within 2 weeks by interdental spot applications with a 1% chlorhexidine/thymol-containing varnish (Cervitec). Follow-up samples of saliva and plaque were collected 1, 3, 6, and 12 months after onset of treat. Caries prevalence, incidence and progression of the selected approximal surfaces were scored from bitewing radiographs exposed at baseline and after 2 years. Sixty-three children of the same age formed a non-varnish-treated reference group. Reduction of caries incidence and progression was dearly dependent on the outcome of the antibacterial treatment. A significantly (P< 0.01) higher progression score was found among children who exhibited a less marked suppression of interdental MS levels compared with those with high suppression and the children of the reference group. The results suggest that a suppression of MS in interdental plaque may be an important event to prevent and arrest approximal caries development in schoolchildren at risk. Monitoring the effect of antibacterial agents in a site-specific way could therefore be advocated.

Caries development on approximal surfaces was studied in 139 adolescents for a period of 3 yr. A test group was randomly sampled (n=69) and subjected to a new intensive mode of fluoride (F) mouthrinsings using 10 ml of 0.045% NaF neutral solution once a day for 3 d, twice a year in all, i.e., 6 rinses per year. A control group (n = 70) rinsed in a similar mode using fluoride-free tap water. The two groups received the same basic prophylactic program during the trial. Detection of approximal caries lesions and fillings was based on bitewing radiographs at baseline and after 3 yr. The test group developed an average of 2.75 + 4.76 (mean +/- SD) approximal DFS compared with 3.21 + 4.74 DFS in the control group (n.s.). However, among those teenagers who were caries free (DFS = 0) at baseline, the incidence of approximal carious and filled surfaces was 1.76+/-4.52 in the F-rinsing group (n = 26) compared with 2.76+/-5.01 DFS in the control group (n = 32), a 36% caries reduction which was statistically significant. The intensified mouthrinsing procedure seems to be a promising prophylactic mode for collective caries prevention.

Objective: The aim of this two-year community demonstration trial was to study the caries inhibitory effects of semiannual applications of a fluoride varnish in preschool children., Methods: Twenty-four public dental health clinics in the county of Halland, Sweden, with 5,137 preschool children, 4 and 5 years of age, were matched and equally allocated to a fluoride varnish group (n = 2,535) and a reference group (n = 2,602). The children in the fluoride varnish group were treated every six months with topical applications of a silane fluoride varnish, Fluor Protector (0.1% F), while no fluoride varnish was used in the reference group. Both groups received a basic preventive program at annual checkups consisting of dietary counseling and instructions to parents to brush their children's teeth at least once daily with fluoridated dentifrice. Caries data were collected by clinical examinations at baseline and after one and two years., Results: Caries prevalence at baseline did not differ significantly between the groups. After two years, the mean caries incidence was low and no statistical difference was found in the total number of carious and filled surfaces (dfs) between the two groups. However, the incidence of approximal lesions (dfsa) was significantly lower (P < .05) in the fluoride varnish group than the reference group. Children in the fluoride varnish group with dfs scores of 1-4 and > or = 5 at the start of the study exhibited a statistically significant (P < .05) reduction in approximal caries incidence of 19 percent and 25 percent, respectively, when compared with the reference group., Conclusion: Preschool children 4 and 5 years of age with clinical caries who receive semiannual applications of a silane fluoride varnish containing 0.1 percent F experience a reduced incidence of approximal caries over two years.

Development and progression of approximal caries is still difficult to prevent and control even in societies with declining caries prevalence. In this study, a test group of 115 12-yr old children were treated semi-annually with a mixture (1:1) of a varnish containing 0.1% F (Fluor Protector) and 1.0% chlorhexidine (Cervitec). A reference group of 104 children received fluoride varnish treatment (Fluor Protector) semi-annually. Approximal caries was recorded from bitewing radiographs at baseline and after 3 yr. At baseline, total decayed and filled surfaces (DFS) including enamel caries were 1.79+/-2.36 in the reference group and 2.0+/-2.77 in the test group. After 3 yr, the mean approximal caries incidence including enamel caries was 3.01+/-3.74 and 3.78+/-4.32, respectively. The differences at baseline as well as after 3 yr were not statistically significant. The results showed that both groups had a comparatively low incidence of approximal caries during the experimental period, and suggest that a mixture of fluoride and antibacterial varnish had no additional preventive effect on approximal caries incidence compared with fluoride varnish treatments alone.

The aim of this work was to study the fluoride (F) concentration in the approximal area after using toothpicks and other F-containing products. The exposure time was standardised to 2 min. 24 subjects participated, divided into 4 groups, with 6 individuals per group. In 3 of the groups, the following 4 products were compared: (1) a toothpick impregnated in 4% NaF; (2) a dentifrice containing 0.32% NaF; (3) a mouthrinse solution containing 0.025% NaF; (4) a tablet containing 0.55 mg NaF. In the 4th group, 3 commercial F toothpicks and 2 F dental flosses were compared. In all 4 groups, the F concentration was determined up to 60 min at 4 approximal sites. On each sampling occasion, 3 triangle-shaped paper points were used, absorbing 3 x 1 microl. In general, the toothpick gave similar or somewhat higher F concentrations in the approximal area than the dentifrice, mouthrinse solution and tablet. Comparing the various commercial toothpicks and dental flosses, 2 of the toothpicks gave higher approximal F concentrations than the other 3 products. When comparing the series in which the very first sample was collected from 2-20 min after the F treatment, it was found that the sampling procedure itself reduced the subsequent approximal F concentration. The main conclusion from this study is that an F-impregnated toothpick is a promising vehicle for delivery of fluoride to the approximal area.

The aim of the present study was to evaluate and compare the effects of three different chlorhexidine (CHX)-containing preparations on mutans streptococci (MS) levels in interdental plaque and whole saliva. Ninety-three healthy school-children (8-10 years old) with high scores of salivary MS were selected by a screening procedure and randomised into three equally sized groups. MS were enumerated at all mesial interdental sites of the first permanent molars with aid of a modified chairside technique. The patients were then treated three times within 2 weeks with either a 1% CHX/thymol-containing varnish (group A) or a 1% CHX gel (group B), or they were subjected to daily supervised toothbrushing with a 0.4% CHX dentifrice for 1 month (group C). Follow-up samples of saliva and plaque from the interdental sites were collected 1 and 3 months after termination of treatment. A statistically significant reduction of MS levels in saliva and interdental plaque was found in all groups after 1 month. The CHX-containing dentifrice (group C) was the most effective method in reducing MS levels in saliva, and a significantly stronger (p < 0.05) suppression was found after 1 and 3 months when compared with the gel and the varnish forms. The gel (group B) tended to be slightly more effective than the varnish (group A). In the interdental plaque, the reduction of MS was less marked than in the saliva, and the three groups exhibited MS reductions of similar magnitude (20%) and duration, persisting up to 3 months. However, a high proportion (approximately 50%) of all interdental sites were relatively unaffected by the treatments. In conclusion, our results suggest that the interdental MS colonisation was difficult to combat, irrespective of CHX preparation and method, while the salivary levels were more easily affected. Daily tooth-brushing with a CHX-containing dentifrice was more effective in reducing MS in saliva compared with the gel or varnish applications.

Fluoride concentration in whole saliva and in separate gland secretions was studied after a 7-day fluoridated milk regimen (1mg F per day) in 12 healthy schoolchildren aged 10-13 years. A 2-week fluoride-free run-in period preceded the tests in order to establish the endogenous baseline levels. Unstimulated and stimulated whole saliva and stimulated parotid and submandibular-sublingual saliva were collected at 1, 3, 6, 12 and 24h after F-milk ingestion, and fluoride concentrations were determined with an ion-selective electrode. Typical time-dependent excretion curves were obtained in all collected secretions. The fluoride levels were significantly elevated 1 and 3h in whole saliva and up to 6h in the gland secretions after intake of fluoridated milk when compared to baseline values. When acid-stimulated, the submandibular-sublingual glands were the major contributors of fluoride in the oral cavity. In conclusion, the results of this study demonstrate that fluoride ingested with milk is excreted through the salivary glands, indicating that the bioavailability of fluoride from milk equals that of other vehicles.

The aim of this investigation was to study the effect of the interproximal use of fluoride (F)-impregnated and non-impregnated birch toothpicks on the degree of de- and remineralization of enamel and dentine in situ. Ten volunteers with complete dentures in the upper jaw participated. Each subject had four specimens: (1) sound enamel, (2) demineralized enamel, (3) sound dentine and (4) demineralized dentine; placed pairwise at two approximal sites (15/16 and 25/26) of the maxillary prosthesis. The study involved three test periods (A, B and C), each lasting 4 weeks. In A, the subjects used F toothpicks (impregnated in 4% NaF) and, in B, nonimpregnated toothpicks 3 times daily. During period C, no toothpicks were used. Dentifrice or other F-containing products were not allowed during the 4-week periods. Transversal microradiography was used to determine lesion depth (ld) and mineral loss (DeltaZ). The results revealed that all the sound samples lost mineral during the three experimental periods; DeltaZ for both enamel and dentine was less for A and B compared with C (p<0.01) and less for A compared with B and C for dentine (p<0.05, p<0.01). The demineralized samples also lost mineral, apart from dentine, during periods A and B, i.e. when F-impregnated and non-impregnated toothpicks were used; ld for enamel and DeltaZ for dentine were less for A compared with C (p<0.05). Four weeks' use of toothpicks, especially F-impregnated toothpicks, thus reduces the demineralization of enamel and dentine at approximal sites in situ.

The aim of the present study was to evaluate and compare the effects of an intensive and a monthly mode of antibacterial varnish application on the levels of mutans streptococci (MS) in interdental plaque and whole saliva. Eighty-eight healthy schoolchildren (11-13 years) with high scores of salivary MS were selected by a screening procedure and randomised into two groups, MS were enumerated at all mesial interdental sites of the first permanent molars with the aid of a modified chair-side technique, disclosing a total of 161 sites with moderate or high colonisation levels. The subjects were treated with a 1% chlorhexidine-thymol-containing varnish (Cervitec) either in an intensive mode (IM) with 3 applications within a 2-week period or in a monthly mode (MM) during a 3-month period. The varnish was applied with a miniball burnisher after the teeth had been cleaned interdentally with dental floss and dried with air. Follow-up samples of saliva and plaque from the interdental areas were collected after 1, 3 and 6 months. Both groups exhibited a statistically significant (p > 0.05) reduction of interdental MS after 1 month when compared with baseline. An eliminated MS growth appeared more frequently following the IM compared with the MM. After 3 months, a significant reduction compared with baseline was still found in the IM group but not in the MM group. No reduction was found in either group after 6 months. MS levels in saliva were mainly unaffected at the follow-up samplings, with the exception of a slight reduction in the IM group after 1 month. In conclusion, the results suggest that an intensive mode of chlorhexidine-thymol varnish application is more effective against interdental MS than the monthly mode of application. Bacterial growth should be monitored in a site-specific way, since interdental reductions were not adequately reflected in whole saliva samples.

The levels of salivary mutans streptococci and caries experience were used as predictors for caries incidence in 3 groups of pre-school children from areas with different levels of natural and topical fluoride exposure. Altogether 1022 children, 4-5 years of age at baseline, were examined according to the WHO-criteria and followed for 2 years. The low fluoride group (n = 374) had a low fluoride level in the piped water and no topical fluoride applications; the F-varnish group (n = 442) had low water fluoride but semiannual topical applications of a fluoride varnish; the optimal fluoride group (n = 206) had an optimal level of fluoride in the drinking water and semiannual F-varnish applications. The number of salivary mutans streptococci was estimated and scored at baseline with the Strip mutans chair-side method. The sampling procedure was repeated in 337 children of the low fluoride group 3 weeks after baseline. In comparison with the low fluoride group, caries incidence was 30% and 60% lower in the F-varnish and the optimal fluoride group respectively. The caries predictive ability decreased with increasing fluoride exposure. The sum of sensitivity and specificity decreased from 151% (65% + 86%) in the low fluoride group to 131% (40% + 91%) in the optimal fluoride group. The positive predictive value was highest (62%) in the low fluoride group. Repeated salivary samplings at baseline did not improve the caries predictive power. The results suggest that the overall fluoride exposure should be taken into account when caries risk assessment strategies for preschool children are developed and implemented.

Caries incidence during a 2-year period was studied in 4- to 5-year-old children from three areas with contrasting levels of natural fluoride (F) in the drinking water and different regimens of topical fluoride varnish applications; group A (n = 448) was from an area with a low level of F (0.1 ppm) and semi-annual applications of fluoride varnish; group B (n = 374) was from a low F area (0.1 ppm) and no fluoride varnish treatments; group C (n = 206) was from an area with optimal F (1.2 ppm) and fluoride varnish treatments. All children were clinically assessed at baseline and after 2 years according to WHO criteria. The number of salivary mutans streptococci was estimated and scored at baseline and after 2 years with the Strip mutans method. The varnish containing 0.1% F was applied every 6 months on all accessible tooth surfaces after cleaning with a pumice paste. Basic preventive care was given to all children and restorative treatment on individual indications. Higher levels (p < 0.05) of salivary mutans streptococci were found in the low-fluoride areas compared to the optimal fluoride area at baseline and after 2 years. The caries incidence (mean dft +/- SD) in the different groups was A: 0.65 +/- 1.40; B: 1.09 +/- 1.85; C: 0.53 +/- 1.09. The difference between group B and groups A and C was statistically significant (p < 0.05). A positive relationship (p < 0.05-0.001) between salivary mutans streptococci scores at baseline and caries incidence was found in all three groups. This study confirms the close association between salivary mutans streptococci and caries incidence in preschool children and suggests a caries-reducing effect of topical applications of the fluoride silane varnish.

Birch and lime toothpicks were impregnated in a 4% sodium fluoride (NaF) solution for different periods of time, viz. 30 s, 30 min and 3 d. After impregnation for 30 min, an average of 4.1 mg NaF per birch toothpick was taken up. The corresponding value for lime toothpicks was 5.1 mg. About 60% of the fluoride (F) was released within 1 h in vitro when the toothpicks were kept in water. In vivo, the concentration of F was determined in whole saliva from five adults during 30 min after using birch toothpicks immersed in a 4% NaF solution. After 2 min, the mean salivary F concentration was 2.7 mM. Impregnation of birch toothpicks in 1, 2 or 3% NaF resulted in lower F concentrations both in vitro and in vivo, with a clear dose-response effect. When comparing the use of a 4% NaF impregnated birch toothpick, a mouthrinse with 10 ml of 0.025% NaF, sucking on a F tablet containing 0.55 mg NaF, and toothbrushing with 1 g of an 0.068% F (as NaF) dentifrice--all procedures carried out in the mouth during 2 min--the highest concentration of F in saliva was obtained after using the fluoridated toothpick. Thus, NaF impregnated birch and lime toothpicks show a quick release of F in vitro as well as in vivo and may be suitable as home care products for prevention of dental caries.

The aim was to study whether the use of a xylitol-containing dentifrice could affect the number of mutans streptococci and lactobacilli in preschool children with medium and high initial salivary counts. After screening 147 healthy preschool children, 3-6 years of age, 70 were selected and randomly assigned into two groups for 3-month's use of either a xylitol (9.7%) or a non-xylitol-containing fluoride dentifrice. The parents were trained to brush the teeth of their children twice daily in a standardized manner and the study was carried out double blind. Bacterial levels at screening and after 3 months were enumerated with aid of chair-side methods. No significant differences in mutans streptococci levels or lactobacilli counts after 3 months were obtained, either in comparison to baseline or between the groups. About 50% of all children exhibited unchanged bacterial scores at the end of the test period but more children in the xylitol group disclosed reduced scores of salivary mutans streptococci compared with the non-xylitol group (38% vs 16%). The results suggest that the dose level achieved by using this xylitol-containing dentifrice in preschool children, did not provide sufficient antibacterial action to suppress caries associated microorganisms in the saliva of those with high initial counts.

The effect of an antibacterial varnish (Cervitec) on the levels of mutans streptococci in plaque adjacent to bonded orthodontic brackets was evaluated in 18 children using a split-mouth technique with a placebo varnish control. The test varnish contained 1% chlorhexidine and 1% thymol as active ingredients. Both varnishes were applied on four occasions during a 3-month period, and plaque was subsequently collected between 1 week and 6 months after the onset of treatment. All teeth involved in the study were carefully examined and clinically assessed for enamel demineralization prior to onset of the fixed appliances and immediately after debonding. The results showed a more frequent growth of mutans streptococci in the dental plaque collected from placebo-treated quadrants as compared with the test quadrants on all sampling occasions. The proportion of mutans streptococci within the plaque microflora was significantly (p < 0.05-0.01) lower on the test sides than on the opposite sides at the 1-week and 1-month examinations. The incidence of incipient enamel lesions around the brackets and along the gingival margin was generally low, and no differences were found between the test and placebo varnish treated quandrants at the time of debonding. The results suggest that mutans streptococci in plaque from orthodontic patients can be suppressed effectively by topical applications of an antibacterial varnish.

The purpose of the study was to evaluate the effect of daily use of a low fluoride containing toothpaste (250 ppm F) on the uptake of fluoride and development of enamel lesions as well as the prevalence of lactobacilli and mutans streptococci in dental plaque compared to the use of placebo toothpaste. 16 children were selected with homologous premolar teeth. The teeth were cemented with orthodontic bands ad modum Ogaard for plaque accumulation and enamel lesion development. The plaque accumulated during 4 weeks was collected and analysed for lactobacilli and mutans streptococci. The teeth were further analysed by secondary ion mass spectrometry (SIMS), determining the concentration profiles of fluoride and other elements in the outermost enamel and in the lesion. The results show that although significant amounts of fluoride were taken up in the surface enamel from the fluoride toothpaste, the extent of the lesions was not influenced compared to teeth brushed with a non F-toothpaste. Neither were microbiological differences in the dental plaque found between the groups. An interesting observation was that early demineralization of enamel took place without detectable levels of mutans streptococci in the overlaying dental plaque. The conclusion is that fluoride taken up in enamel from F-toothpaste has no significant influence on enamel lesion development if a cariogenic dental plaque with high levels of acid producing microorganisms is continuously attached to the enamel surface.