The Use of Silver Diamine Fluoride in Pediatric Dentistry

This book chapter aims to discuss the main aspects related to the use of silver diamine fluoride (SDF) in Pediatric Dentistry. The composition and mechanism of action of the SDF are presented, as well as the application technique and indications. The effectiveness of SDF is reported based on contemporary scientific evidence from laboratory and clinical studies, focusing on its effect in enamel and dentin remineralization and caries arrestment. Parental and professional acceptance of tooth staining is presented, as well as the use of potassium iodide as a possible alternative to manage this side-effect. Taking all the discussed information together, it is possible to conclude that the SDF is a simple and effective treatment to halt the dental caries progress in children

Orthodontic bracket bonding techniques and adhesion failures : a systematic review and meta-analysis

This systematic review compared the bonding failures of orthodontic brackets bonded by indirect or direct techniques. Data sources: The searched databases were Cochrane Library, LILACS, BBO, PubMed, Scopus, Web of Science. A search for randomized clini

Use of Sealants in Permanent Molars by Brazilian Dentist: A Comparative Study of Public versus Private

Objective: To compare the use of sealants in permanent molars between public and private dentists in Brazil. Material and Methods: This was a cross-sectional and analytical web survey study. The convenience sample consisted of dentists in Brazil who answered a pre-tested online form released via social media between July and October 2021. Descriptive analysis was performed using absolute and relative frequencies (%) and associations using the Chi-square test (p0.05). Conclusion: The percentage of use of sealants among dentists in Brazil is high, especially among professionals in the public service, and the most used materials were resinous sealants and glass ionomer cement

Global Oral Health Policies and Guidelines: Using Silver Diamine Fluoride for Caries Control

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

Avaliação da clorexidina no controle do biofilme dental em crianças portadoras de necessidades especiais

As crianças portadoras de necessidades especiais apresentam dificuldades para o controle do biofilme dental e elevada prevalência de alterações periodontais. Neste grupo de pacientes, a associação de agentes químicos à escovação dentária encontra uma indicação precisa, sendo a clorexidina o antimicrobiano de primeira escolha. Desta forma, o objetivo do presente estudo foi avaliar dois veículos de aplicação caseira da clorexidina para controle do biofilme dental em crianças especiais, bem como a opinião dos pais ou responsáveis sobre os protocolos testados. A casuística foi composta por 29 pacientes com diagnóstico de deficiência mental e idades entre sete e doze anos, que usaram digluconato de clorexidina a 0,12%, sob a forma de gel (protocolo GCH) ou spray (protocolo SCH), em duas aplicações diárias, associadas à escovação dental com dentifrício placebo. Como controle, gel placebo (protocolo GP) e spray placebo (protocolo SP) foram empregados do mesmo modo que os veículos ativos. O estudo foi desenvolvido no modelo cruzado e duplo-cego, com quatro etapas experimentais (dez dias), separadas entre si por três períodos de washout (quinze dias). Os pacientes foram avaliados antes do início e logo após as etapas experimentais, por um examinador calibrado, através do índice de placa de Quigley e Hein e presença/ausência de sangramento gengival marginal à sondagem. Condições clínicas semelhantes estiveram presentes no início de todos os períodos experimentais para o índice de placa (p=0,133) e sangramento gengival (p=0,060). Após os protocolos GCH e SCH, observou-se redução nos índices de placa e sangramento (p<0,0001). Verificou-se diferenças estatísticas, para as condições clínicas avaliadas, na comparação dos índices pós-tratamento do protocolo GCH com os protocolos GP e SP e do protocolo SCH com os protocolos GP e SP. Ao término dos períodos experimentais, um questionário foi aplicado aos pais ou responsáveis, que relataram maior grau de dificuldade para aplicação do gel (p=0,007) e a preferência pela utilização do spray (p=0,035). Conclui-se que os índices de placa e a presença de sangramento gengival foram reduzidos pelo tratamento com clorexidina, independente do veículo utilizado, o gel apresentou maior grau de dificuldade de aplicação e o spray foi o veículo de eleição dos pais ou responsáveis para utilização rotineira deste agente químico. As crianças portadoras de necessidades especiais apresentam dificuldades para o controle do biofilme dental e elevada prevalência de alterações periodontais. Neste grupo de pacientes, a associação de agentes químicos à escovação dentária encontra uma indicação precisa, sendo a clorexidina o antimicrobiano de primeira escolha. Desta forma, o objetivo do presente estudo foi avaliar dois veículos de aplicação caseira da clorexidina para controle do biofilme dental em crianças especiais, bem como a opinião dos pais ou responsáveis sobre os protocolos testados. A casuística foi composta por 29 pacientes com diagnóstico de deficiência mental e idades entre sete e doze anos, que usaram digluconato de clorexidina a 0,12%, sob a forma de gel (protocolo GCH) ou spray (protocolo SCH), em duas aplicações diárias, associadas à escovação dental com dentifrício placebo. Como controle, gel placebo (protocolo GP) e spray placebo (protocolo SP) foram empregados do mesmo modo que os veículos ativos. O estudo foi desenvolvido no modelo cruzado e duplo-cego, com quatro etapas experimentais (dez dias), separadas entre si por três períodos de washout (quinze dias). Os pacientes foram avaliados antes do início e logo após as etapas experimentais, por um examinador calibrado, através do índice de placa de Quigley e Hein e presença/ausência de sangramento gengival marginal à sondagem. Condições clínicas semelhantes estiveram presentes no início de todos os períodos experimentais para o índice de placa (p=0,133) e sangramento gengival (p=0,060). Após os protocolos GCH e SCH, observou-se redução nos índices de placa e sangramento (p<0,0001). Verificou-se diferenças estatísticas, para as condições clínicas avaliadas, na comparação dos índices pós-tratamento do protocolo GCH com os protocolos GP e SP e do protocolo SCH com os protocolos GP e SP. Ao término dos períodos experimentais, um questionário foi aplicado aos pais ou responsáveis, que relataram maior grau de dificuldade para aplicação do gel (p=0,007) e a preferência pela utilização do spray (p=0,035). Conclui-se que os índices de placa e a presença de sangramento gengival foram reduzidos pelo tratamento com clorexidina, independente do veículo utilizado, o gel apresentou maior grau de dificuldade de aplicação e o spray foi o veículo de eleição dos pais ou responsáveis para utilização rotineira deste agente químico.Disabled children show difficulties to perform the mechanical control of dental plaque and show a high prevalence of periodontal disease. In this group of patients, the association between chemical agents and dental brushing runs into an exact indication of use and chlorhexidine is the best suited agent for this purpose. Therefore, this research main objective was to evaluate two chlorhexidine vehicles for plaque control in disabled children, as well as parents opinions about the home usage protocols tested. The sample consisted of 29 patients, with medical diagnosis of mental deficiency aging between seven and twelve years old. The protocols tested used chlorhexidine digluconate 0,12%, delivered as a gel (GCH protocol) and as a spray (SCH protocol). A placebo gel (GP protocol) and a placebo solution (SP protocol) were used as control. The tested agents were administered twice a day by the handicapped patients parents, who also brushed the childrens teeth with a placebo dentifrice. The study was designed as a double-blind, crossover research, with four experimental periods (ten days) apart from each other by three washout periods (fifteen days). The patients were evaluated at the beginning and at the end of each experimental period by one calibrated examiner, using the Quigley and Hein plaque index and the presence or abscence of gingival bleeding during probing. Similar clinical conditions were observed at the beginning of all tested protocols when the plaque index (p=0,133) and the gingival bleeding index (p=0,060) were considered. After GCH and SCH protocols, there was a significant reduction in plaque and gingival indices (p<0,0001). There were seen statistically significant differences when comparing post treatment indices from GCH protocol with GP and SP protocols or from SCH protocol with GP and SP protocols. When the four protocols were completed, the parents answered a questionaire. They reported a greater level of difficulty when applying gel in opposition to spray (p=0,007), which was their preferable vehicle for daily use (p=0,035). It is concluded that plaque indices and the presence of gingival bleeding were reduced by chlorhexidine treatment, regardless the employed vehicle; chlorhexidine delivered as a gel offered greater application difficulties and spray was the parents choice for daily use of this chemical agent

Avaliação microbiológica da efetividade de uma escova antibacteriana: um estudo in vivo

OBJETIVO: Este trabalho consistiu em um estudo in vivo para avaliar microbiologicamente a efetividade de uma escova antibacteriana comparada à de uma escova convencional. METODOLOGIA: Trinta crianças de dez a 12 anos utilizaram escovas dentais convencionais e antibacterianas por dois períodos experimentais de cinco dias, com duas escovações diárias supervisionadas, sem dentifrício. O desenho do estudo foi cruzado com wash-out de nove dias entre as diferentes escovas. Ao término de cada período, as escovas foram imediatamente imersas em solução salina estéril e agitadas; o caldo produzido foi semeado em ágar BHI, nas concentrações de 10-2 e 10-3. Após um período de incubação de 24 horas a 37 ºC em aerobiose, foi realizada a contagem das unidades formadoras de colônias (UFC/mL) por meio de um software específico. RESULTADO: No grupo de escovas convencionais, a mediana e intervalos interquartis foi de 105 (27-564,5); já para o grupo de escovas antibacterianas, foi de 53 (4,5-333,5). Após análise dos dados, observou-se ausência de diferenças estatísticas entre os grupos (p = 0,145). CONCLUSÃO: Concluiu-se que as escovas de dentes antibacterianas exibiram contaminação bacteriana semelhante à das escovas de dentes convencionais

The Use of Fluoride for Enamel Caries Management in Infants

The presence of one or more decayed surfaces (cavitated or non-cavitated), lost or restored (due to caries) in any primary tooth in a child under 6 years old is considered Early Childhood Caries (ECC). Therefore, as soon as an initial enamel caries lesion is detected in a primary tooth, adequate measures must be adopted to halt the progression of this lesion into a cavity. To achieve this objective, fluoridated products are the most common resource, being available worldwide. Considering the age group, the use of fluoridated toothpaste and fluoride varnishes are indicated as simple and effective preventive and therapeutic methods. This chapter will discuss the advantages of these methods based on contemporary scientific evidence, as well as their expected clinical results when properly indicated and used

The hardness and chemical changes in demineralized primary dentin treated by fluoride and glass ionomer cement

Abstract Background Fluoride plays an important role in the control of dental caries. Aim To evaluate the chemical exchange between restoration of glass ionomer cement of high viscosity (GIC) and primary dentin with application of sodium fluoride (NaF) 2% through changes in hardness from uptake of calcium, phosphate and fluoride. Material and method Class I cavities were prepared in 40 sound primary molars, and the sample was divided into two groups (n=20) according to dentin condition: sound (1) and demineralized (2). Sub-groups (n=10) were formed to investigate the isolated action of the GIC or the association with NaF (F). This in vitro study examined the chemical exchange under two conditions, sound and demineralized dentin (pH cycling), to simulate the occurrence of mineral loss for the caries lesion. G1 and G2 received GIC restoration only; groups G1F and G2F received NaF before GIC restoration. The specimens were prepared for Knoop hardness test and micro-Raman spectroscopy. A two-way ANOVA test (α = 0.05) was used for statistical analysis. Micro-Raman data were qualitatively described. Result Increased hardness was observed in all the sites of direct contact with GIC in sound and demineralized dentin for all groups (p0.05). In the evaluation of micro-Raman, direct contact between GIC and dentin for sound and demineralized dentin resulted in increased peaks of phosphate. Conclusion The exchange between GIC and demineralized dentin may induce changes of mechanical properties of the substrate, and uptake of mineral ions (phosphate) occurs without the influence of NaF

The influence of tooth brushing supervision on the dental plaque index and toothbrush wear in preschool children

OBJECTIVE: To evaluate the effectiveness of tooth brushing supervision in one or more sessions on dental plaque removal and toothbrush wear. MATERIAL AND METHOD: 3- to 5-year-old children received new toothbrushes and attended a puppet theater about oral health. Forty-nine children were randomly selected and divided into 3 groups (GI=20; GII=14; GIII=14). Fones' brushing method was demonstrated to the GI and GII groups to evaluate the following: the professional direct supervision and tooth brushing training in five sessions (GI), the professional direct supervision and a one-training session (GII) and the puppet theater influence only (GIII-control group). The dental plaque index (IPL) was recorded at baseline (T0), after 24 days (T1) and after 46 days (T2) and toothbrush wear (ID) was recorded on T1 and T2. The Kruskal-Wallis test and the Friedman test (IPL), as well as the one-way ANOVA and the paired Student's t-test (ID) (p<0.05) were employed to analyze the data. RESULT: GI showed a significant difference from the others groups in T1 and T2 (p<0.01).The index of toothbrush wear increased (p<0.0001) from 24 days (0.52±0.35mm) to 46 days (0.90±0.48mm), but there was no significant association between toothbrush wear and plaque index for T1 (r=0.230-p= 0.116) as well as for T2 (r=0.226-p=0.121). CONCLUSION: The multiple sessions of professional supervision were effective to reduce the dental plaque index, which was not influenced by toothbrush wear, showing continuous oral hygiene motivation needs