An ex vivo investigation into the fluoride release and absorption profiles of three orthodontic adhesives.
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Prevention of peri-bracket decalcification is essentially mediated by effective oral hygiene, which is patient dependent. The potential to compensate for poor oral hygiene may be through the release of free fluoride ions from direct bonding agents. It is well established that glass ionomer cements (GICs) release free fluoride ions which may be replenished by exposure to fluoride containing solutions. The aim of this ex vivo study was to compare the fluoride release and absorption profiles of a recently developed low fusion, monophase GIC, Limerick glass, with two materials in common clinical use, namely, Fuji-Ortho L.C. and Concise. Ten test specimens of each material were fabricated and stored in deionized water at 37 degrees C. The concentration of fluoride release was measured daily for the first 7 days after immersion and then weekly for 5 weeks. On day 42 the test specimens were recharged in 2 per cent sodium fluoride solution and fluoride release was measured initially after 24 hours and then every 48 hours. The recharge regimen was repeated for 3 weeks. Both Limerick glass and Fuji-Ortho L.C. demonstrated the characteristic fluoride release pattern of GIC with a rapid elution of fluoride after the first 24 hours followed by a more gradual release profile over the following 2 weeks. Fuji-Ortho L.C. released the greatest quantity of fluoride but the release profile of Limerick glass was more sustained. Concise released negligible amounts of fluoride. Limerick glass and Fuji-Ortho L.C. showed an increase (P < 0.01) in fluoride release following exposure to 2 per cent sodium fluoride that decreased both with time and subsequent exposures to fluoride supplement. (+info)
Sugar consumption and caries risk: a systematic review.
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This systematic review addresses the question: In the modern age of extensive fluoride exposure, do individuals with a high level of sugar intake experience greater caries severity relative to those with a lower level of intake? The MEDLINE and EMBASE databases were searched for English-language papers published between 1980 and 2000 using a search expression developed in conjunction with an experienced librarian. There were 809 papers located in the initial search. A review of titles and abstracts to identify clearly irrelevant papers reduced this number to 134. Two readers each read one half of these papers, and application of predetermined inclusion/exclusion criteria reduced this number of papers to sixty-nine. Criteria were established for scoring the quality of each of these papers on evidence tables. The maximum score for each paper was 100; the sixty-nine papers rated scored between 12 and 79. Final judgment of results was limited to those thirty-six papers that scored 55 or higher on the evidence tables and that reported studies carried out in countries where there is moderate-to-extensive fluoride exposure. Results showed that only two papers found a strong relationship between sugar consumption and caries development, sixteen found a moderate relationship, and eighteen found weak-to-no relationship. It was concluded that the relationship between sugar consumption and caries is much weaker in the modern age of fluoride exposure than it used to be. Controlling the consumption of sugar remains a justifiable part of caries prevention, however, if not always the most important aspect. (+info)
Effectiveness of methods used by dental professionals for the primary prevention of dental caries.
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This paper summarizes and rates the evidence for the effectiveness of methods available to dental professionals for their use in the primary prevention of dental caries. It reviews operator-applied therapeutic agents or materials and patient counseling. Evidence of effectiveness is extracted from published systematic reviews. A search for articles since publication of these reviews was done to provide updates, and a systematic review of the caries-inhibiting effects of fluoride varnish in primary teeth is provided. Good evidence is available for the effectiveness of fluoride gel and varnish, chlorhexidine gel, and sealant when used to prevent caries in permanent teeth of children and adolescents. The evidence for effectiveness of fluoride varnish use in primary teeth, chlorhexidine varnish, and patient counseling is judged to be insufficient. Use of fluoride, chlorhexidine and sealant according to tested protocols and for the populations in which evidence of effect is available can be recommended. However, they may need to be used selectively. Estimates for the number of patients or tooth surfaces needed to treat to prevent a carious event suggest that the effects of these professional treatments are low in patients who are at reduced risk for dental caries. The literature on use of these preventive methods in individuals other than school-aged children needs expansion. (+info)
Methods of stopping or reversing early carious lesions fluoride: a European perspective.
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The purpose of this review was to discuss the findings of the systematic review of the management of the early carious lesion with fluoride from a European perspective. The review was checked, and the overall finding that the evidence was incomplete was confirmed. It was suggested that the reason that few data were available was that clinical trials had not been designed to answer this question and that the baseline of healthy teeth and surfaces with very early lesions were rarely quantified. The European perspective would want to identify a clinical method that could manage these lesions better than the home use of fluoride toothpaste. Future research was recommended in the form of several systematic reviews and re-analysis of existing data. Only then could further studies be recommended. In modern European dentistry, restoring these lesions is not an option. (+info)
The use of combinations of caries preventive procedures.
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There are now a number of different approaches to preventing dental caries available to the clinician. Caries preventive methods are frequently used in combination. This paper reviews the potential effectiveness of combinations of preventive methods. Three groups of studies are reviewed; combinations of fluoride procedures; fluoride and fissure sealants; chlorhexidine and other agents. The review indicates that there is considerable benefit to be derived from using more than one fluoride procedure. Further research is required in the effectiveness of combining chlorhexidine with other agents. The most promising combination programme currently appears to be the use of fluoride with fissure sealing. The relevance of combination therapy for adults needs to be investigated. (+info)
Emerging methods used in the prevention and repair of carious tissues.
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A systematic review was undertaken to investigate four emerging methodologies that might be used in the prevention of caries and/or repair of carious tissues. These included a partitioned dentifrice, laser technology, fluoride-releasing dental materials, and for deep carious lesions, bone morphogenic protein (BMP) therapy. The search strategy was to review articles written in English, indexed in MEDLINE and EMBASE databases and published since 1976. Over two hundred articles were read but because of the inclusion and exclusion criteria, only thirty-three were included in the evidence tables. The review of partitioned toothpaste showed either a greater remineralizing effect or a greater increase in the resistance to demineralization of both enamel and dentin, with the exception of its lack of effectiveness on coronal caries in the only clinical trial. Five of the six in vitro studies on enamel and the one study on dentin reported that lased tissue was less soluble than nonlased. Six clinical and four in situ studies were reviewed in answering the question as to whether fluoride-releasing restorative materials increase the remineralization or resistance to demineralization of human enamel and dentin. Eight of these reported positive findings. Six animal studies investigating BMP were reviewed, and all showed the ability of BMP to induce tubular dentin formation. Although the laboratory, animal, and limited clinical trials report encouraging results, independent, randomized, controlled clinical trials need to be carried out before these emerging technologies can be recommended for use in general practice. (+info)
Clinical decision-making for caries management in primary teeth.
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The aim of this review of clinical decision-making for caries management in primary teeth is to integrate current knowledge in the field of cariology into clinically usable concepts and procedures to aid in the diagnosis and therapy of dental caries in primary teeth. The evidence for this paper is derived from other manuscripts of this conference, computer and hand searches of scientific articles; and policy statements of councils or commissions of various health organizations. Current evidence regarding the carious process and caries risk assessment allows the practitioner to transcend traditional surgical management of dental caries in primary teeth. Therapy can focus on patient-specific approaches that include disease monitoring and preventive therapies supplemented by restorative therapies. The type and intensity of these therapies should be determined utilizing data from clinical and radiograph examinations as well as information regarding caries risk status; evidence of therapy outcomes; assessment and reassessment of disease activity; natural history of caries progression in primary teeth; and preferences and expectations of guardians and practitioners. Changes in the management of dental caries will require health organizations and dental schools to educate students, practitioners, and patients in evidence- and risk-based care. (+info)
Clinical decision-making for coronal caries management in the permanent dentition.
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Optimal conservative treatment decisions to prevent, arrest, and reverse tooth demineralization caused by caries require probability estimates on caries risk and treatment outcomes. This review is focused on the use of the best scientific evidence to recommend treatment strategies for management of coronal caries in permanent teeth as a function of caries risk. Evidence suggests that assigning therapeutic regimens to individuals according to their risk levels should yield a significantly greater probability of success and better cost effectiveness than applying identical treatments to all patients independent of risk. Depending on caries risk levels, treatment decisions based on risk can minimize unnecessary surgical intervention by incorporating the best evidence to prescribe treatment regimens for the use of fluoride-releasing agents, sealants, chlorhexidine, or combinations of these products. (+info)